11 Health & Technologies | Bernhard Gilbey, CEO

(Transcription)

Bernhard Gilbey  0:03  

Thank you very much Muhammad as Good morning, everybody. As Muhammad said, I'm Bernhard Gilbey. Everybody just calls me Burn. There's too many syllables, frankly 11 Health is here really to help patients meet some chronic unmet needs that I'll talk a little bit more about, we talk about ourselves as eliminating the complications of major digestive surgery through personalized data driven care. So let me talk a little bit about the clinical problem. I'll talk a bit about our solution, how well we've done and then I'll talk about the marketplace, having an ostomy, which is where the bowel is diverted out through the stomach wall to protect the bowel, sometimes permanent, but sometimes temporary, but often permanent, is really the end stage of a series of problems for patients, many of them, if they've had IBD Crohn's or colitis, it'll be the end of a long term program for those patients, as they learn to live with an ostomy. For some patients, it's less serious motility disorders. Often things like colon cancer will lead to the creation of an ostomy. And then sometimes trauma to this kind of procedure. This stage of life where people end up with their bowel being diverted out through the stomach wall effect over a million people in the US alone, at any given time, probably somewhere between 1.2 and 1.4 million individuals. Their patient journey really falls into two phases. Once they've had the procedure, the first 90 days are really the highest risk period. And you get some sense of how that risk translates into complications and problems. When you look at the sort of statistics for the number of patients who end up with a rehospitalization event within those 90 days, something approaching 40% of patients will find themselves either being readmitted or with an ER visit in those early stages, and those complications are largely split almost three quarters into dehydration related issues or wound wound related or skin issues that lead to those rehospitalization events. But really, the problems don't end there. As they get only into that chronic care phase of their journey. You see ongoing significant quality of life challenges for these individuals, an extrordinary 25% of these patients will end up with kidney failure within two years of surgery, and over 75% of patients will live a lifetime of skin related issues. So what is the answer? The answer is to put technology into the ostomy wearables themselves. For years, this has been a technology freezone. And we have incorporated technology into the typical ostomy wearables that these patients have to wear anyway. So what you can see is the wafer, which is in the top left hand corner, with sensor technology in there that will detect things like leakage and skin related complications, we call that a peristomal skin monitor. And then the remote output monitor, which within the marketplace is a bag or a pouch. And again, that incorporates technology that detects the activity of the stoma, the drainage of the bag, and we can convert that then into an understanding of the patient's hydration level, and send that information over to the patient. Naturally enough that's supported by an app and I'll show you a little bit more about what the patient out looks like. This is really a patient first solution. It's providing the patient with the information that their body is already telling them about what's happening and they can then convert that into some behavioral change and do something about it before it becomes a rehospitalization event. There is a clinical dashboard and for the physicians, the medical team, typically the surgeons to start with and then the wound ostomy. Nurses can look at the status of their patients, they can do that either on a cohort basis or on an individual patient level. Just some idea of what the user interface looks like. There's a sort of typical landing page when you open up with helpful information down to things like where is the nearest restroom and I talked about quality of life earlier. These individuals can find themselves in a very awkward place and need some help very quickly. So actually knowing where the nearest restroom is, is remarkably important to these individuals. There's a page that shows them where their health is broadly up to. And then you begin to get more detailed data around, for example, where the patient's hydration level is, they can begin to see that trends and see if they're going too high, which would be indicative of a potential dehydration problem looming, or indeed too low, which might suggest that there is a blockage, or their skin related issues and the way in which the data is presented will show the patient if they have a leak, or if they're showing signs of inflammation, and roughly where, where that is on the clock face. Now importantly, the thing that then happens is if those indications suggest that there is a problem, there'll be an alert sent to the patient, and they will then be taken through to the sorts of material and information that will help them know what to do about it. If you're headed towards dehydration, you may not be surprised to hear actually, just drinking water is not really the answer. You might need an isotonic drink and something to replace more than just the water involved. does the system work? Well, I think the answer to that, if you look at the data we've collected must be yes. So what you can see in each of these three graphs on the left hand side is the typical rates of complications that you see, in each of the periods for 3060 90 days. These are readmissions statistics. And they show these extraordinary levels of readmissions for patients that are that are typical. What you then see on the right hand side of each of the graphs are the different cohorts and our improved patient outcomes that are reflected in those much lower rates of readmissions. So the graph further is on the left. The initial blue line shows the 30 day, initial cohorts of patients and the outcome of that was published in the diseases of colon and rectum last year, and then you can see the Cleveland Clinic study, which is the pale blue one, showing improvements all the way through to 90 days. And then we have our own cohorts of patients in a multicenter site. And again, you can see the significant reductions that that larger cohort cohort of patients have demonstrated. Just moving tack across to the marketplace itself, this is actually a very significant market. By 2025, we can expect a billion of these units to be sold across the world. That's what we call the remote output monitors what the marketplace will call a bag, or the peristomal skin monitors what the marketplace will call the wafers. Now if you convert that into dollar value, it is something like $3 billion worth of value. And as you can see, although it's a considerable marketplace, 11 Health really does stand out on on its own in terms of providing a different kind of care model and data that's available. The economic benefits of this are remarkable, partly because we reduce the complication so significantly, so we go from an average cost of care about eight and a half thousand dollars to something like five and a half $1,000 a $2,000 per patient per month, saving from having the right system available. It's of interest to providers who would otherwise end up picking up the costs of those readmissions, together with opportunities for revenue for providers using the remote monitoring codes that are available all the telehealth codes, it's being reimbursed under the a 4421 code at the moment. 11 Health is piedad registered and we have contracts with payers that we are utilizing at the moment. A broad picture of patient growth and revenue. One of the things to remember about the majority of these patients is that once they're on a system, they'll stay on a system. The average life of an ostomy patients is 10 to 12 years. So there is an annuity element to 11 Health's revenue stream. And we are raising a $9 million a two round predominantly to do three things really drive the commercial activity in q4 of this year, and run some of the pilot programs that we have available to us. We want to run randomized control trials in the each of the different wearable scenarios. And we have a continued r&d activity both to improve our manufacturing technique and the nature of our sensors as well as the other use cases we can move to. We are blessed with a strong board of directors with experience from the finance world of the payer world and we have some experienced investors on board too many of whom come from this world I will be delighted to tell you more about 11 Health and answer your questions in the breakout room next door Thank you very much