Glooko – Russ Johannesson, CEO

Speaker 1 (00:06):
Welcome to Cowen Insights, a space that brings leading thinkers together to share insights and ideas shaping the world around us. Join us as we converse with the top minds who are influencing our global sectors.
Ryan Booker (00:26):
Welcome to the Cowen Future Health podcast, a part of Cowen's fifth annual Future Health conference held virtually this year on June 24th and 25th of 2020. Over the past five years, the Cowen Future Health Conference has brought together thought leaders, innovators, and investors to discuss how the convergence of healthcare technology and consumerism is changing the way we look at healthcare and the healthcare system. My name is Ryan Booker, and I'm an analyst at Cowen covering diabetes devices, an industry with exciting long-term secular growth. In this episode of the podcast, here to discuss the future of digital diabetes care, I'm pleased to have the CEO of Glooko, Russ Johannesson. Welcome, Russ.
Russ Johannesson (01:05):
Thanks, Ryan. Appreciate you having me.
Ryan Booker (01:09):
Thank you for coming on. Maybe before we jump into the detailed questions, it would be great to start with your background. What was your history prior to joining Glooko and what brought you to join the company in 2018?
Russ Johannesson (01:24):
Sure. Well, I've really spent my career at the intersection of healthcare and consumer engagement. I started out in healthcare consulting, mostly strategy and operations consulting, and then over time moved into technology consulting and digital health roles. The last couple of roles before I came to Glooko included five years as chief operating officer of Sharecare, a digital health business based out of Atlanta. And prior to that, I spent five years as the chief client officer of Optum Health, which is part of UnitedHealth Group. And there I was running all sales, marketing, client-side operations for that Optum Health business.
(02:08):
I joined Glooko in early 2018 as I was really wanting to spend this next phase of my career working on some of the more important and more challenging issues in healthcare. I wanted a chance to leverage my skills and my experience in growing and scaling businesses. And it really was just was one of those in the right place at the right time opportunities. I see it and have seen it really as a chance to make a real difference in a huge and growing problem in the industry. Despite the fact that there's been a lot of money and technology and innovation being thrown at this problem in many ways, it continues to get worse globally by a number of measures. And so really excited to join Glooko a couple of years ago, and it has not let me down. It's been quite an exciting ride so far, and I think we've got a lot of great potential ahead of us.
Ryan Booker (03:09):
Excellent. Maybe picking up on one of your points on overall care, can you talk a bit about what Glooko brings to the table to improve diabetes care today both from a patient perspective as well as a physician perspective?
Russ Johannesson (03:25):
Sure. Yeah. Glooko really works to simplify a very complex disease state for patients and for physicians, and a little more recently, even for clinical researchers. There are hundreds of devices, multiple treatment options that range from insulin pumps and connected insulin pens to CGMs and blood glucose meters. From a therapy perspective, there's insulins, long and short acting, there's oral medications, and then there's other lifestyle type therapies where folks are managing diet and activity and exercise to try to manage the problem. So it's a complex condition. It's exacerbated by the fact that it is a chronic and progressive disease, and it really does impact every area of the life of a person with diabetes. And it is often difficult to manage. So we help physicians manage this complexity by being the single, universal, and interoperable solution that brings all of this data together from all of these devices into one single user interface.
(04:37):
And especially during this time of the COVID-19 pandemic, we're also able to support diabetes care and clinical research that can be done 100% remotely without patients having to come into a clinic setting in order to be treated or in order to participate in the clinical trial. And so this is having a lot of impact in the market right now. But overall, our solution has been in play for a number of years, and we're really the only global, universal, device-agnostic data management solution out there in the market today. And it's been widely accepted across 26 countries, 15 languages. It is deep in the workflow of these clinical practices and leveraging the connection between that clinical workflow solution and the mobile application that we offer for free to anyone, and we connect those two to leverage telehealth and remote patient monitoring and the sharing of data, again, outside of a clinic visit if need be.
Ryan Booker (05:43):
Got it. Maybe on that point about being global, the merger of Glooko and Diasend in 2016, I believe put Glooko ahead of any other digital diabetes tool by number of patients and physician offices, certainly at that time. There was a lot of other companies with high patient numbers, but you clearly have the most scale and penetration within physician offices in the industry. How do you think about your market opportunity? Is increasing penetration of physician offices the primary driver to future growth? And if so, how far along are you within this opportunity today?
Russ Johannesson (06:18):
Yeah. We really see three strategic growth pillars for us going forward. Certainly, one of them, and maybe the most fundamental to support the rest of our strategies, is this continued focus on aggressively growing and expanding the clinical footprint you just described. Like I said before, we're currently in 26 countries. We'll be in more than 30 by the end of the year. But there is still a lot of room for growth. Our footprint today is concentrated in North America and Europe, a little bit in the Middle East, Australia, New Zealand, a little bit in South Africa, but there are very large global regions with a very high prevalence of diabetes where we have not yet entered. Think all of Latin America, India, China, Japan, major markets with a high prevalence of diabetes where we think we can have a big impact. And those will be part of our growth trajectory over the next couple of years. We're currently exploring a couple of those markets with partners to enter into those.
(07:19):
So that first pillar around the continued expansion of our clinical footprint also includes deeper penetration within the existing countries that we serve today. Today, we are penetrated in the US to the extent that we're in about 65% of the specialty endocrinology clinics in the US. In a couple of countries in Europe, in particular in the UK and Sweden and Norway, we're in nearly 100% of the specialty clinics in those markets and expanding pretty aggressively into primary care clinics in those markets as well. So we continue to expand that footprint because it really gives us the ability to leverage the value for the rest of what we do. The second of our growth pillars is really around enabling telehealth. We've been offering remote patient monitoring and telehealth solutions for a number of years as is true pretty much globally. The adoption of those solutions has been slower than I think anyone would have liked.
(08:23):
With COVID-19 coming on, actually, the adoption has accelerated so rapidly literally over the last couple of months. And we do believe that that is more of a paradigm shift that will continue to stay at higher levels going forward. It won't stay at that level it's been at these last several weeks, but it will come down to a new normal level, which I think will be much higher than it has been historically. So given the nature of our platform and the fact that we've continued to invest in these additional capabilities, it's put us in a really strong position to enable telehealth and remote monitoring from a diabetes perspective globally. In many countries, including the US, UK, France, Germany, they've really leaned into creating new reimbursement channels for these types of capabilities, which has made it a much different value proposition for providers and health systems. And now, we're able to be viewed by the market as a way to expand the business side of these health systems and clinics.
(09:28):
We actually have now the conversation has shifted to our ability to support reimbursement and new revenue streams versus being an expense item for what historically might've been viewed more as a data management or workflow efficiency solution. So that enablement of telehealth has really helped boost our business and give us some tailwinds through this.
(09:49):
The third piece of our third growth pillar is really around enabling clinical research. We've got over 13,000 clinical locations around the world, and we have this ready, connected ecosystem of clinics and patients that can help researchers conduct prospective and retrospective clinical research. We've seen a big uptick in the interest by CROs and study sponsors, especially since the beginning of the pandemic, as they're able to run, or in some cases actually rescue trials in a virtual and remote fashion.
(10:29):
We've done clinical research for a number of years. Last year, we started to see a lot more interest, and we spent the time and focus and money to invest in our platform and make it CFR Part 11 compliant so we can do more research. And then with the shift to the need to support research from a virtual perspective happening so quickly between mid-March and today, the demand for those services has really gone through the roof. So those are really the three key pillars for our growth and our expansion over the next couple of years. It's expansion of that clinical footprint, it's the enablement to telehealth, and the enablement of the clinical research side.
Ryan Booker (11:15):
Interesting. Yeah. That's an interesting point you mentioned on tele-health and the incremental potential revenue streams that could open up over time for the company. Can you talk a bit about how you monetize across those three pillars today both currently, and how you think about the long-term opportunity?
Russ Johannesson (11:36):
Sure. Historically, we have leveraged a SaaS subscription-based model to our core solution for clinics and health systems. And then a big part of our business has been really a number of different business models, but leveraging strategic partnerships with pharmaceutical companies, medical device companies, et cetera. So we do have several different revenue streams, including what we're really leaning into now in support of these types of telehealth solutions is really a per participant per month charge to health systems and clinics and license fees for using our clinical research platform to conduct trials or real-world data studies. The strategic partnerships that we have, in some cases, we private label parts of our solution for pharmaceutical and device companies as well. So it's a mixed bag. The piece that has really shifted more recently for us is over the past two years since I've been on board, we've taken a more enterprise approach to selling at the health system level versus clinic by clinic, and we wrap other services around that, including EHR integrations and digital therapeutics and more advanced analytics and the remote patient monitoring solutions.
(12:54):
And now, with the shift in the opening up of reimbursement in the US and frankly globally, we're really being viewed much more, as I said before, as an ability to generate new revenue streams through the reimbursement for CPT codes related to remote data management as well as telehealth visits. And so we're seeing that per person per month business model really helping to drive that piece, which is overall a better win-win for our alignment with clinics and health systems anyway.
Ryan Booker (13:28):
Interesting. Yes. It's fascinating to me how much the product offering has evolved over the past five years. Five years ago, I would've thought of Glooko as a company on a mission to liberate the data and remove the friction from all these devices and the friction from downloading that data during patient and physician interactions. Increasingly, you're moving into other value-added solutions like analytics for providers, the intuitive new insulin dosing tool that you've launched over the, I believe the past year or two. Can you talk a little bit more about the evolution of the product offering and where you see the most opportunity across those different verticals over the next three to five years? What's the next major area of product innovation from Glooko?
Russ Johannesson (14:19):
Yeah. I think it really does come back to sort of those three pillars we were just talking about. You're right. Historically, we were viewed as a workflow efficiency data management solution, and there's nothing wrong with that. And we were building a great SaaS model business going after that and creating that value. I think what we've come to realize, and really where the focus has been, is that that's a great value and a great benefit, but from a scale perspective, leveraging that large clinic footprint, leveraging the data and the data rights related to that, coming out of that and putting it to higher value uses is really where the real value is going to be driven over the next few years. So as we look out the next couple of years, we're going to continue to invest in the platform and in clinical decision support and digital therapeutics, you had mentioned our insulin dosing tool.
(15:19):
We did create an FDA Class II cleared digital therapeutic called MIDS. Stands for Mobile Insulin Dosing System. And it's really an algorithm to support clinicians in onboarding Type 2 patients to basal insulin. Very effective way. Again, leveraging really remote patient monitoring and telehealth solutions, looking at the data in between visits to help get them titrated on their basal insulin as they onboard very quickly. It keeps them in range, gets them in range very quickly, avoids hyper and hypo events. It's just a much more effective and better health outcome using that.
(15:56):
We've also used our platform, continue to use it, to allow other digital therapeutics and algorithms to essentially ride on the chassis of our platform into the clinical footprint so that we can create this treatment hub and allow clinicians and care teams to select the best options for their patient population in terms of digital therapeutics and algorithms. We're not going to create them all. We've got a partnership with a company called [Driamed 00:16:21] who's got a Type 1 algorithm for insulin pump setting adjustments in between visits as well. Also leveraging that same remote patient monitoring technology.
(16:32):
In addition, we're going to continue to invest in our capabilities around enabling telehealth and remote patient monitoring. We aren't looking to create a unique standalone tele-health solution where we cover everything from end to end, including the support for a video conference between a patient and a provider. We really want to enable all of the telehealth platforms and all of the remote care platforms that are out there regardless of what the mode of communications you're using. We are the data management solution underneath that that allows that data to be shared remotely by a patient from their insulin pump, their CGM, or BGM their activity data, everything else shared with a physician either asynchronously, or they can share it remotely from home, or they can share it as part of a real-time visit that's happening.
(17:28):
In addition, we will continue to invest in our ability to support clinical research similar to our tele-health approach. We're not looking to be a competitive CRO. We're actually the data acquisition, in some cases, patient recruitment mechanism to get patients for really all kinds of metabolic studies, engaged remotely if need be, but also in-clinic, because we do have the solution from a clinical footprint in a wide number of countries and the amount of patients running through the platform. So that's really where we're going to continue to innovate and drive the solution going forward. And in many ways, it's about the connectivity between patients and providers, and it's about the data that gets generated through those to be able to leverage those for decision support, for population health analytics, for business intelligence purposes as well.
Ryan Booker (18:20):
On that point for decision support, you talked about internationally moving beyond specialty endocrinologist clinics and moving into primary care. Is that an opportunity in the United States over time as well? And along those lines, do you see an opportunity to provide medication recommendations for the broader Type 2 patient population prior to initiating long-acting insulin?
Russ Johannesson (18:52):
Sure. We do. And today we have a good portion of our patient population is Type 2. It's not just a Type 1 population. And as you know, more and more, the growth is really heavy in the Type 2 population. If you think about the spectrum of diabetes, our value proposition definitely resonates the most and is strongest at the most intensive end of that spectrum, which would be certainly the Type 1 patient. And a lot of data generated there leveraging myriad of devices there, but also on the insulin-dependent end of the Type 2 spectrum. Clearly, that's another one that we see a lot of usage of our solution and our product. Much of that care at that end of the spectrum is happening in primary care clinics. And we think, for example, in the US, we're in roughly 30% of the primary care clinics, especially the big ones that treat a lot of people with diabetes.
(19:53):
Our mobile solution actually does have value for anyone with diabetes, even if they're not on insulin therapy. The ability to just track and manage your blood glucose levels, look at the data and insights that we push around the intersection of the data points that come in through the combination of your carb intake, your activity tracking, your medication adherence, even if it's oral medication and not insulin therapies, the ability to look at that data, to look at it retrospectively, look at trends in those different data sets is really valuable to anyone who's managing their blood glucose levels on a somewhat regular basis. So we do see that piece of it.
(20:30):
And again, our value proposition resonates the most at that more intensive end, and frankly more expensive from a medical expense end of the spectrum, but there is value that gets [inaudible 00:20:42] in the earlier stages. We're working today in creating some educational components to our platform. We're working on something with the NHS in the UK right now, starting first with education of healthcare providers. And the second phase of that will be education of patients. So once that educational content component starts to get in there as well, that will also be something that helps us span and bridge into earlier stages of Type 2 diagnosis for diabetes as well.
Ryan Booker (21:15):
Interesting. Yeah. Maybe along those lines, just thinking about continuous glucose monitoring, CGM use today and where that's going over time, specifically within non-intensive Type 2 patients, do you believe that over the next five to 10 years, the vast majority of those patients are going to be using CGM in some form or fashion, and does having that incremental CGM data maybe provide more of an opportunity for you to add value on the decision support side for physicians?
Russ Johannesson (21:49):
Yeah, absolutely. And I do think that the increase in CGM usage will continue to happen. I think it will continue to proliferate in the Type 2 population as well. Likely not Type 2 patients wearing a CGM full-time, but maybe more periodically for a couple of weeks at a time to get some consistent data for review by their physician, but not necessarily wearing them all the time. But I think that will continue to happen, especially as the price point and the feature function set around CGMs, the price point comes down, I think we'll continue to see that proliferating. And it does have an impact for us. In one very tangible way, the volume of data that gets generated and created when you shift from traditional leverage of a blood glucose meter to measure a few times a day to getting readings every five minutes has really driven just the size of our real-world evidence database exponentially.
(23:02):
I mean, we're at 20 billion data points and growing all the time because there was so much data coming through. And it does create a different view and the ability for clinicians to have a much, I think, sharper view of what they can do to manage this complex condition. And it does allow you to start to look at data that can measure what's happening in your everyday life, and then align that with what is happening in your episodic delivery of care world as well and marrying that episodic and every day so that you can find out what's really driving the condition. It's a complex condition. In many ways, it works differently for different people. And really, the more data that you have, and you can align that with everyday activity data, et cetera, you can really get a good sense of what it takes to manage for any individual patient going forward. So we do think that's going to happen. We think it will continue to proliferate. And we think creating more value and I think more precision around managing outcomes for patients.
Ryan Booker (24:10):
Fascinating. Maybe moving to competition. How do you think about competition long-term? In our conversations with investors, I think people frequently compare you to other chronic disease management vendors, although I think of you a bit differently as a lot of those companies, like the Livongos, Omadas, Onduos of the world are often outside of the traditional care infrastructure, while Glooko is directly integrated with physicians. Who do you think of as your primary competitors? And would you include the device vendors who are also on your platform, but also are increasingly investing in their own software offerings over time, such as Dexcom with its CLARITY software?
Russ Johannesson (24:55):
Yeah. I think it's a great question. It's one that we get all the time, and I think you've hit it on the head that it's a space that is frequently misunderstood. Because of our deep integration into the workflow of the physician practices and in the patient's day-to-day management of their disease, we do have a different position in the whole cardio-metabolic digital health space. We view those other companies that you had mentioned, the Livongos, the Omadas, the Onduos, we're very supportive. This is a big problem, a big complex problem, and I think none of us individually are going to be able to solve it. We view our solution, frankly, as quite complementary to what those solutions are delivering. They're very focused on helping equip patients to do better self-management. To your point, not really connected back into the clinical delivery system.
(25:56):
We think it's very important to be able to do both of those things. And the more interoperability, the more connectivity, the more sharing of data between those two types of solutions, whether you're managing employees or health plan members versus patients in the clinical system, those are the same people. They're at work and they're managing their diabetes, in many cases with the help of coaches who are giving them the appropriate feedback and nudges around lifestyle behavior change, those types of things. But they are seeing a clinician, and the ability to share that data back and forth we think is really important. And again, our differentiation, our value proposition is really in managing that patient-to-provider connection. So we think that's really important.
(26:46):
And in some ways, we've done the work and we have a unique position in the industry where we do have great partnerships with the device companies. They see the value in being a part of our universal platform. It creates a lot of value for the clinics and the clinicians, and then they're willing to sign a device integration agreement with us and data license agreements with us to be able to create that value for clinics and for patients.
(27:15):
And their proprietary solutions have a lot of value as well. Most of them, not all of them, choose to create that and offer that to clinics as well to support their device, but it does become somewhat unwieldy for a clinic to be able to manage all those different pieces of proprietary software, to be able to see the data from those devices, somewhat in a silo and not integrated with a bunch of other data that includes multiple device data if folks are using different devices from different manufacturers as well as activity, lifestyle type behavior that we can bring in. And then the data insights that we push to them as well based on the intersection of those data points.
(27:52):
So in a sense they're competitive, but we see in more cases, in pretty much all cases, that both coexist quite easily in the marketplace. And so we think that's valuable. I do think over time, it will make sense in terms of advancing the ability to really manage the condition for patients, to see more integration, more data interoperability, sharing between device companies, payers, data management platforms like ourselves, coaching programs that are helping patients self-manage in between office visits. The more [inaudible 00:28:34] patient you can have, all of those players pulling in the same direction sharing data, I think the better off we'll be for helping them manage their condition.
Ryan Booker (28:44):
Interesting. That makes a ton of sense. So on those large industry partners that you start deals with both as investors and for commercial collaborations, companies in the med tech space like Insulet and Medtronic, on the pharma side, Novo Nordisk. Can you talk a bit about how these partnerships have helped you scale and how do they help you work towards your long-term vision?
Russ Johannesson (29:11):
Sure. Yeah. No. We do enjoy great relationships with nearly all of the device companies and pharmaceutical companies that are key players in the diabetes space. And so as you've mentioned, several of those folks are investors in our business, and of course, that's helpful for us just to capitalize the business. But also, they drive really valuable commercial partnerships for us. They help us go-to-market and they help us get into global expansion that the countries we wouldn't necessarily have otherwise been in there, and they help promote the solution as they launch their devices, their solutions, their therapies into new markets, since we support that, and it brings our business into those different markets as well. So they're really an important part of our go-to-market strategy and they help us grow much more quickly.
(30:12):
If you think about, for example, our relationship with Insulet, their field sales force helps put the Glooko solution in many health systems and clinics around the globe, and that's certainly a much bigger field sales organization than we could field are on our own. We have a small direct sales force, but being able to leverage the Insulet team as well is very valuable for us and the expansion. It's helped us get to this large global clinical footprint that we have today.
(30:40):
So our partners, they're working with us to really think about how we can make progress on the treatment of the disease, and we work jointly on clinical research opportunities. And so it's really been very rewarding, not just financially, commercially, but also in terms of having an impact and driving value in the market to be able to work with these great partners.
Ryan Booker (31:05):
Got it. Maybe moving to a financial question. Can you talk a little bit about the capitalization of the company today? Anything you'd be willing to provide on the financial performance of the company over whatever timeframe you'd feel comfortable on and how you're thinking about funding needed and your path to cash flow breakeven over the next several years?
Russ Johannesson (31:30):
Sure, absolutely. So we are a business. I came in a little more than two years ago and with really the mandate to start to grow and scale this business. And we've put in place... We spent the first little chunk of time getting the product and platform ready to grow and scale at an enterprise level, getting the internal infrastructure and processes ready to scale, and maybe most importantly, getting the right leadership team on the field to help grow and scale this business. And we've started to see the benefit of that. We grew over 30% on the top line from last year to this year. Despite disruptions from COVID-19, we'll grow more than 30% on the top line again this year, and our expectation is we'll be growing at north of 50% in '21 and '22 as we go forward. So we're really starting to turn that growth curve as well.
(32:27):
At the same time, we've tried to be good stewards of the capital that we do have in the business. We are on a path to cashflow positive, and we should hit that on a run rate basis. End of Q3 of next year is the trajectory that we're on right now. We're in the middle of a capital raise right now that gives us the capital we need to get that runway. We closed... We broke it into two pieces on this extension round. We did an insider round that we closed back in July, and we're open right now with a round for new equity investors coming in, and we're trying to get closed up here over the next couple of months.
(33:09):
And so as you'd referenced before, we've got a great group of investors, some really supportive and great venture capital investors in Canaan partners and Georgian partners, and a great group of strategic investors, many of which you've mentioned, Nova Nordisk, Medtronic, Insulet, Samsung, Mayo Clinic. Great investors both supportive of the business financially, and then some great commercial partnerships that help us drive growth in the business as well.
(33:40):
So we're feeling pretty good about where we are. The COVID-19 pandemic has disrupted a lot of things in the industry, but in many ways, some strong tailwinds for us going forward as well.
Ryan Booker (33:55):
Fantastic. Yeah, it's an impressive acceleration off of an already pretty fast to top line growth rate. Is that increasing adoption of telehealth the primary driver? And maybe to finish up, can you provide a little more detail on that transition you referenced earlier of moving, instead of being a cost center for these physician offices, providing incremental revenue opportunities?
Russ Johannesson (34:22):
Yeah. Certainly. And if you think about the long-term trajectory of a business like our... the good success and continue to have good success selling in a SaaS model into the provider side of the healthcare world, and that made up about 50% of our revenue stream. But over time, that is a very margin-sensitive and pressured part of the healthcare system. And maybe particularly now post-pandemic as the financial situation on many of those hospitals and health systems is not in a great spot, shut down for a while. So it'll take a little time to recover that. We much prefer to be in a spot to have aligned incentives around helping them grow and drive new revenue from new reimbursement opportunities that are out there. So we think that's a great opportunity both for them to create sustainable revenue streams and for us to share in that rather than to be an expense item. They win, we win in those situations. And while no one would've wished for something like a global pandemic, it has actually accelerated our growth in a number of ways.
(35:40):
When the pandemic broke, the first thing we did really was lean into the issue. And we deployed a free remote care version of our product globally. We allowed any health system, hospital, clinic around the globe to sign up and leverage our remote care solution, no charge. And the real idea around that was to be able to help continue to provide support for people with diabetes when they could not come in for a physician visit. All [inaudible 00:36:09] visits got shut down immediately then, and this is not a condition that can wait. This isn't elective medical care. This is something that has to be managed. And so we made that offer free. Immediately got a lot of great uptake on it. Continue to get uptake on it. Over 100 hospitals and health systems around the globe have taken us up, and they continue to come in.
(36:32):
And we think eventually, once the pandemic dies down, we'll be able to convert those folks to a paying version of our solution that has all the features in it, et cetera, but that's really not the primary objective. It was to be able to make sure that we could meet the need and demand in the market to keep these patients safe. Because while people with diabetes are more likely to catch COVID-19, if they do get it, the complications can be much worse. And so we wanted to make sure we could keep those folks safe. The way that solution works is that the patients are able to... We can sign up a new clinic in 10 minutes and they're able to invite their patients to download the Glooko app. They connect their account to the clinic. The patients then can sync their device with Glooko and share that data with the physician and leverage... The patient themselves can see the same data and analytics. And via telehealth, we can support those conversations directly with the patient in between.
(37:36):
We had a really good response, and we really are glad to be able to do our part on that. Our remote sinking across all our sites has really increased by over 1,000% since this pandemic hit. And with the temporary relaxation of global regulations, it has made it easier to give and to receive and have paid for remote care, telehealth, et cetera, and we think that's going to be more permanent, as I've mentioned earlier. And we continue to just track that legislation and the positive reimbursement dynamics around the world. And we think that'll be a great boost for the whole community of people with diabetes. And we think that also is going to be a strong benefit for us as those things continue to happen.
(38:27):
So it's accelerated us a lot. We think the acceleration around the adoption of telehealth in general has probably accelerated five to 10 years in the last 10 weeks. So in that way, we really do think that this has given us a lot of strong tailwinds. We had a really strong 2019. We were enjoying a really strong start to 2020 when the pandemic hit, and it did cause us to step back and really reassess the business and try to understand what was going to be the impact for our customers, for our markets. We took some very proactive measures to tighten our belts and make sure we could preserve capital in an uncertain environment, but we're actually seeing a lot of positive tailwinds as we get through this.
Ryan Booker (39:16):
Excellent. I think we're bumping up at the end of time here, but I want to thank you again for coming on. Russ, we really appreciate it.
Russ Johannesson (39:25):
Thanks, Ryan. Appreciate you having me.
Speaker 1 (39:32):
Thanks for joining us. Stay tuned for the next episode of Cowen Insights.

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