Reversing Type 2 Diabetes with Virta Health’s Sami Inkinen

Speaker 1:
Welcome to Cowan 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.
Charles Rhyee:
Hello, my name is Charles Rhyee, Cowan's Healthcare Technology analyst, and welcome to the Cowan Future Health podcast. Today's podcast is part of our monthly series that continues Cowan's efforts to bring together thought leaders, innovators, and investors, to discuss how the convergence of healthcare, technology, and consumerism is changing the way we look at health, healthcare, and the healthcare system.
And in this episode, we'll be discussing the future of chronic care management, and ability now to leverage technology, to aid in reversing disease. And to discuss the topic with me is Sami Inkinen, co-founder and CEO of Virta Health; an innovative digital health company that helps members safely and sustainably type 2 diabetes by addressing root causes of the disease without medication of surgery.
Virta works with the largest health plans, employers, and government organizations, and puts 100% of its fees at risk, based on clinical and financial outcomes. Thanks for joining us today, Sami.
Sami Inkinen:
Well, thank you so much for having me, Charles. Very happy to be here.
Charles Rhyee:
Yeah, likewise. So, why not just maybe start with diabetes, right? Obviously, we're dealing with a diabetes crisis in America and it's certainly one that many companies are trying to tackle. And, frankly, it's a topic that we've touched on in some of our earlier podcasts here at Cowan.
The approach of most is to really try to manage this diabetes. Ideally get someone to some level of glycemic control and to stop progression of the disease. And however, certainly the conversation now is start to shift towards disease reversal rather than management. And it seems like it's a concept that has been getting traction and acceptance in the industry.
I think the American Diabetes Association, along with other international bodies, jointly published a consensus statement on diabetes reversal remission just last year. And that seems like a big shift.
Maybe, Sami, you can just help us here understand a little bit. How has diabetes historically been treating treated? And why hasn't there been a greater focus on reversal before now?
Sami Inkinen:
Yeah. Well, let me just start by kind of stating the hopefully obvious. If there's obviously two different types of diabetes, there's type 1 diabetes, which is autoimmune disease and oftentimes called like diabetes that hits kids. That's sort of one to 5% of total diabetes.
And then we have type 2 diabetes, which is often called the adult onset diabetes. So usually when we talk about diabetes in America, it's a type 2, which is more than 95% of diabetes in America. And sometimes people also call it the lifestyle disease.
So let me just very, very briefly paint the sad, grim big picture. So we've been fighting this disease, primarily type 2 diabetes, for the last at least three or four decades. But currently in America alone, we have 133 million, 133 million, adults who either have type 2 diabetes or they're on their way to becoming type 2 diabetic.
In other words, they have pre-diabetes. So the ridiculously massive numbers, and sadly, these numbers going up and up and up. And so very [inaudible 00:03:43] however you look at it, whatever we've done over the last three or four decades, it's tough to make a case that it's working, that it's fundamentally working.
And so to your question, I think the fundamental issue is the type 2 diabetes has been seen by scientists, by practitioners, as a chronic progressive disease, where is only one way, it's a one way street. Once you have it, you get worse and worse and worse. And the best that we can do is to try to slow down the progression of this disease, usually by prescribing medications to lower your blood sugar.
And so now the big idea that we are promoting, and hopefully proving in a process, at Virta Health, is that, "Wait a second, this is a disease that can actually be reversed. Nutritionally reversed." Well, we actually would take someone with type 2 diabetes and pull them back to a healthy state. And we can talk about in a second, what is the evidence there and how people are slowly start come around and say, "Hey, wait a second. Maybe the only way to actually address this epidemic is that we actually reverse this disease," which I believe is the only way that we can actually make a real dent in the problem.
Charles Rhyee:
And what do you think might have changed, over all? So you've been working on this for a number of years now, but it seems like the medical community is starting to come around to this, too. Anything specific about what's changed now to maybe bring people around?
Sami Inkinen:
Yeah, it's a good question, but if there's one word, it's evidence. Evidence, anyone can shout from the rooftops and say, "Hey, type 2 diabetes is reversible disease." But if you don't have evidence, you aren't going to convince the clinicians and the scientists and the practitioners that it can be reversed.
So maybe Virta Health has been part of that. So as you mentioned, we've been at this for now six or seven years. We have a prospective clinical trial, five years into, so we have good longitude data. We've published about dozen peer reviewed papers to show that indeed you can reverse or put type 2 diabetes into remission.
So I think the first one is evidence, and very credible evidence, that indeed you can take someone whose late state start to diabetic on insulin. You get their blood sugar under control and get this person completely off of insulin.
So I'd say evidence is one. And then another way to look at the and to answer your question is like, well, what changed? How is possible, because we've been battling with this disease three or four decades? From our perspective, and as we think of what we do, it's really two things.
One is nutrition science, understanding that what is the role of nutrition in developing and reversing the disease. And it's not just about how much you eat, but it's what you eat. And so that's one that the nutrition science has advanced a lot. The understanding how you can actually address insulin assistance nutritionally.
And then the second thing is you can have the best nutrition protocol in the world, but if people don't follow it, it's worth nothing, right? And so what has changed over the last, I'd say five, seven, eight years is, with the adopting of smartphones and changing of telemedicine laws, now you can provide this 24/7 support, medical supervision digitally, which drives adherence and safety.
So when you combine the nutrition science advancements, and the ability to deliver kind of 24/7 support, literally through your smartphone, I think that has allowed us to deliver those outcomes. And then consequently generate the evidence to convince people that, "Hey, this is real."
Charles Rhyee:
Yeah. And I'm sure we're going to touch on some of that more in a little bit, but maybe just, to touch on it, your background wasn't actually healthcare to begin with. And so what led you to this journey to start Virta then?
Sami Inkinen:
Yeah, so absolutely right. So my background is in science to some extent. So I have a physics degree and started my career in a nuclear power plant, which completely does not qualify me to be in healthcare, obviously. So I do have sort of the scientific background, but then spent my whole career in technology and software prior to founding Virta Health.
So, how did I stumble on Virta and this very briefly, it turns out that I became pre-diabetic myself and I was on my way to becoming type 2 diabetic, which obviously, not a unique situation if there's 133 million Americans in that.
But what was unique to me was that I was a world champion endurance athlete. So world champion in triathlon, in my age group, and usually, at least in my mind, type 2 diabetes is seen as a lifestyle disease, that you eat bad food and you don't exercise.
And so I shockingly discovered that now I was one of them, the people that I was not supposed to be. And so in my frustration, I started reading a lot, meeting with scientist, [inaudible 00:09:03], asking "What the heck what's going on here? Like, how is this possible?"
I'm lean, I exercise 10 hours a week, what is happening to me? And so I kind of accidentally stumbled into these scientists who had been researching this area for many, many years. And they said, "Hey, yeah, the evidence is clear. It's not about how much you eat. You can be very lean. You can be an athlete, whatnot. It's about what you eat. And there's a nutritionally way to address this disease in a way that's kind of been forgotten for three or four decades.
And, I was like, obviously rolling my eyes first and saying, "Well, that's impossible, because this is a 400 billion dollars a year problem. If you really knew how to address this, you would have done it."
But eventually I became convinced and teamed up with this scientist and said," Hey, let's go. I think we have something here. We can actually go and address this massive, massive problem in a very, very novel way." And, here we are seven years later.
Charles Rhyee:
Yeah. And, so maybe just a good segue here. Can you give us a quick overview of the Virta treatment and how it addresses sort of root causes diabetes, type 2 diabetes.
Sami Inkinen:
Yeah, well, yeah. So the high level, so what is Virta Health? So we are a provider led virtual clinic that delivers a nutrition based treatment through behavior change to reverse type 2 diabetes. So if you kind of go under the hood, the company's one of two things.
One is nutrition protocols to reverse the underlying drivers of type 2 diabetes, 100% through behavior change. So we don't ship food, sell food, it's all through behavior change. And highly individualized the N equals one patient. And again, everything's customized, but it's sort of the science centers around individualized carbohydrate restrictions. So that's one part. So nutritionally through behavior change, we can reverse your internal assistance.
But then the second part is, again, what I mentioned earlier, if you don't follow the protocol nutritionally that you're supposed to, nothing comes out of it. So the second part that we have to kind of reinvent is how do we deliver care and how do we support our patients?
We call it continuous remote care, which in a sense it's 24/7 support by providers and other care team members, fully remotely through your smartphone. And then we track your biomarkers, mostly blood based, multiple times a day. So we have this objective picture in what's happening in your body. So we know how to help you. We know how to guide you.
And we also know how to de-prescribe your medications, because if your blood sugar starts coming down, naturally, if you on drugs like insulin, we actually have to de-prescribe you very, very quickly. So when you combine those two things, the right nutritional science and protocols and the 24/7 support virtually, you can actually get the kinds of results that we've seen now, thousands and thousands of patients both in clinical trial and commercially.
Charles Rhyee:
Yeah. And if we think about nutritional science, I think you just touched on a little earlier, right? I mean, some of it's not necessarily new, or at least some of these ideas aren't necessarily new. It sounds like you're saying nutritional science itself though has advanced.
But obviously if people don't follow the protocols, it doesn't really work, right? Maybe touch a little bit more, you talked about this kind of care support, continuous remote monitoring or engagement. Can you talk about how you're engaging the patients, and how does that in itself kind of affect sort of this long lasting behavior change that you're seeing?
Sami Inkinen:
Yeah. Well, first you mentioned the word engagement and it's all always important to remember the sort of two meanings to that. One is just to get people into the door. And, in our case, it's about just sharing the outcome and end goal, which is that, "Hey, you've had this lifelong disease, progressive chronic disease called type 2 diabetes. It's actually reversible." And surprise, surprise, that's a very, very strong and well resonating message to most people.
Nobody really wants to live with type 2 diabetes or injecting insulin or whatever drugs they might be on, so that's kind of the first part of engagement. And that's working very well simply by the virtue of explaining that this is a reversible of disease.
But then the second part of engagement is, okay, you get someone into the door, they become outpatient. And we start the treatment. How do you actually keep people engaged? And I'm going to tell you a secret. This is one of the reasons why traditional diabetes management doesn't really work very well. And here's the secret.
The number one driver of engagement is outcomes, it's outcomes. So when the use of perceived benefits are so strong that people are feeling fantastic, they're getting off of their, again, let's just say insulin drugs, they're sleeping better. They're losing weight. They're just literally feeling energetic, that is the number one driver engagement. It is not a trick to send five times more messages or have a wonky user interface in the app that gets people addicted. It's literally outcomes.
And, that's a result again of the nutrition science and then the ability to provide 24/7 support. So outcomes is the number one driver of engagement. But then, of course, just the fact that our patients can feel that their care team, a licensed medical provider, MD usually, and then our other care team members, are right then and there to support them, whether that's a practical problem or symptom or health issue, whatever they have; that we are right then and there to help them gives them the, I guess, the user center and empathy that is always needed in a treatment like this.
Charles Rhyee:
I mean, is that sort of the feedback that you get from your members, these patients. They've obviously been living with disease, they've probably been sort of shamed, maybe, to a certain extent that it's their fault, right? It's that they're living with something that's progressive and they can't reverse. Is that just the number one reason why we haven't seen much progress, right? A doctor prescribes a medication, the doctor's not really convincing them that they can really get better in the long run.
Sami Inkinen:
Yeah. Well, it's interesting. The reaction of many of our patients, let's say month into the treatment, is rage. They're outraged, they're angry, but they're not angry at Virta. They're angry about the fact, and this is not every time, but this pretty, pretty common, that they've been living with type 2 diabetes for a decade, maybe two. And maybe they've lost a toe. Maybe they don't really feel their hands, their eyesight's going down. They on this massively expensive and inconvenient drug [inaudible 00:16:23]. It's just feeling like crap.
And I'm not exaggerating here in 30 or 45 days, they reverse the decade or two of damage. And so patients saw [inaudible 00:16:35] to say, "Wait a second. How is this possible? Why didn't I hear about this a decade ago?" And I'll just give you an example here, which this is my favorite thing to share.
We now have multiple Virta patients, who've reversed their type 2 diabetes and are after that, on their own, spontaneously, they've gone and tattooed the Virta company logo on their body permanently. Permanently. And so why would you do that? Now, even I sometimes think that's kind of a little out there, and I obviously, I don't know the reasons, but it goes to show me that the experience of getting rid of what's kind of like the death sentence effectively, in a matter of months, is life transforming. Literally life transforming. And, obviously, as a CEO of a company, it feels like the MPS 100 moment, when your paying patients decide to tattoo the logo of the company.
Charles Rhyee:
Yeah. I obviously that's a strong endorsement. If we think about the way you support patients, maybe talk a little bit about how you leverage technology, and obviously your background from technology, I'm sure plays a big part of it. Can you talk about how that background kind of shaped the way you design the platform and the services to patients to support them?
Sami Inkinen:
Yeah, well, it's interesting. I grew up on a farm, but got a computer when I was like, I don't know, seven or eight years old, and I was a software developer until like 2000 or so. And then my whole professional career has been in technology and software companies as a founder, so I know the power of software.
But perhaps here's the interesting thing, I think, for me as a leader, which is our patients, our Virta patients, could not care less how cool the software is, or how much we use AI. And I think that's been an important realization for me, what they care is the outcomes and the care and their experience.
And so what we try to do is to hide the complex and cool technology and give patients, of course, deliver the outcomes, but the feeling that we have real people delivering care, caring about our patients, and individualizing, whatever needs to be individualized. And always be there, kind of delivering the empathy, even though everything's delivered digitally.
So we try to hide all the AI and software. And what I like to say, externally and internally, is that we use a lot of the AI to give our care team members, which is our providers and coaches, super powers. So the patient still feels like, "Oh, there's a human helping me," even if a lot of the actions and productivity, and even the decision support tools are based in software and AI, so that's the fundamental approach.
Charles Rhyee:
And maybe also touch on them, right? Because obviously, I'm sure a lot of these patients have their own primary care physician or specialist that they see. Can you talk about how you integrate care, then, back into sort of their ongoing medical care?
Sami Inkinen:
Yeah. So Virta is not a primary care provider. So we are sort of a specialist. We are diabetes specialist for these patients and we are not trying to replace the PCP or the primary care. I guess there's a couple of things to mention. So one, as a provider led organization, again, we have our own providers delivering care. Providers are used to provide provider communication, so that's actually pretty smooth. And whether that happens through fax or email or even individual consultations and calls.
So we are not one tech company that throws an app at a patient and then a PCP is like, "What the heck's going on here." So that's sort of the one thing that's very important that providers like to talk to providers and just a mutual respect, so that's sort of a one thing.
The second thing is we always try to over communicate. So when a patient enrolls in the Virta, we immediately send communication to their PCP saying, "Hey, here's the company. Here's what we do. Here's links and information about our published and peer reviewed results is how it works. You have any issues, call us."
And then the third thing I would say, most PCPs are ridiculously busy. They are having very, very hard time with people living with type 2 diabetes. And so the kind of high point, high experience for the PCP that usually happens, is their patient comes back for the every three or six month visit, and they go, "Wait a second, wait a second. What happened? How is your blood sugar A1C down from 10 to, I don't know, 6.5 or seven and you off of insulin?" And they literally, and again, I'm not exaggerating, but we hear these stories that the PCP goes and hugs these their patients, says, "I've rarely or ever seen this in my career, but your diabetes is not there anymore."
And so that's kind of the high point. And then often the PCP goes, "What are you doing?" And then we get a message saying, "Hey, can you tell me more about this? And is there any way to get more of my patients into, into the treatments?"
Charles Rhyee:
Yeah.
Sami Inkinen:
So those are some of the sort of practical experiences, but also the truth, is it's always hard. PCPs are busy, they don't have time to read extra stuff. They certainly don't want to get a data dump and say, make something out of that. So we try to do the work with them and for them, as it relates to type 2 diabetes.
Charles Rhyee:
That's really interesting. And you mentioned a little earlier, and maybe you can just jump into that then, about you have now a lot of longitudinal data on your patients, right? Going on five years. I think you have maybe three and a half years published so far, but you have five year data. Maybe talk a little bit about some of the clinical and financial impact that you've seen so far in the patients you've treated.
Sami Inkinen:
Yeah. So you are absolutely right. Our prospective clinical trial is now completed past five years. So the five year data is in peer review. And why is that so important? Well, reversing type 2 diabetes for month makes no difference. Six months, pretty interesting. Year is starting to be a game changer. If you do it two years or more, it's really transformative, both economically because health plans and employers really care about sort of "Show me the money in two years or I don't care."
And then the past two years, it's starting to be absolutely life for the individual patients. So the longitudinal data, and preferably populous and peer reviewed, it's sort of absolutely essential in addressing a chronic disease. The short term data, it doesn't really mean much. So that's why we've invested very heavily into generating this kind of a longitudinal data set, and openly really published and showed it to customers and partners.
And then when it comes to economic savings, that is something we've done, or economic impact, that's something we've done separately with our self-insured employer customers by analyzing their claims, which is probably the best way to truly estimate what the saving is.
And the first 24 month savings, which usually start in the first 45 to 60 days, because patients get off of their medications so quickly; the first 24 month savings, it's about $425 per patient per month. So about 10,000, $10,000 of gross savings per patient.
And this is claims based, analyzed with self-insured employers nationwide. So they're pretty massive numbers when you really think about it. And about half of that is elimination of diabetes medications, which again, happen very, very rapidly.
Charles Rhyee:
Yeah. That's pretty impressive. Maybe talk a little bit more about the receptivity you're seeing then among employers and health plans. And I'm curious, when you have some of these employer customers, unless say they have a subset of their employees who are diagnosed with diabetes or are struggling with it; when it's presented to them, what type of activation, what kind of conversion are you getting, typically, with those members and you see that kind of increasing over time, maybe through word of mouth within the employer?
Sami Inkinen:
Yeah, absolutely. Like, I think you asked earlier, and I mentioned earlier, that when people talk about engagement, there's two types of engagement. One is like, how many people do you get to the door? And then how do you engage afterwards?
And both matter, because at the end of the day, when we work with an employer, like, Home Depot, for example. They want to see maximum impact. And so let me address both of those. For the latter type of engagement, at one year we have 83% patient retention, so 83%. And still at two years at 74%, when in many, or most, lifestyle treatments have touched nutrition, after six months, most of the people have left. And so we have very, very high retention, 83% and 74% still at two years. And I think, as a big part of it is the support. But again, I do think the number one driver is outcomes.
And then the formal kind of engagement is when we start working with an employer or health plan, like how many people can we activate and how many people join the treatment? And we typically get to, with good marketing access, we get to about one third of the population. So that's a really good activation rate, which we think is something that can still be improved.
And largely, we also see this in more mature populations, because you mentioned word mouth, but it's actually the awareness. We get a lot of this feedback that when people get an email or flyer, however, we might communicate, there's a little bit of a disbelief like, "Wait a second. Is this real? Are you telling you can really reverse type 2 diabetes?"
And so people usually like to wait and see and see, "Oh wow, my colleague signed up and I heard about this," and as the word gets around, then we kind of get over the credibility hurdle. But that's what we've seen.
Charles Rhyee:
And, certainly, you guys put your money where your mouth is, right? I mean, you put your fees at risk. I mean, obviously there's a strong incentive for you to demonstrate the outcomes and the confidence you have in achieving it.
We hear other companies increasingly talking about that. It seems like the market, to a certain extent, is shifting that way. Is this something that you find that employers are demanding? Or is this something, when they're already intrigued just on the offering itself? And, then when you tell them, "By the way, we also put our fees at risk," that's kind of a bonus for them? Or is this something that you're hearing more employers and health plans maybe even ask for?
Sami Inkinen:
I think the market is moving there, but honestly, just to tell you the truth, we kind of had to early because, five years, so I guess two or three years ago, when we made Virta commercially available, a couple of things were happening in the marketplace, particularly among self-insured employers. But to some extent also health plans.
One, there was like the point solution explosion, there were all kinds of diabetes, this and that. And a lot of employers that kind of burnt their fingers and said that, "Well, we deployed this, but not quite sure if diabetes is going to go away." Well, obviously it hasn't gone away. So there was that one thing was happening.
And then the second one was for us to come to the market, and basically, make what sounded like an outrageous promise that you can reverse type 2 diabetes. Like I said, when I met the scientist that I started Virta with, I was rolling my eyes. I was like, "You are so full of hot airs. If this was true, everybody would know about it." Right? Like, of course, everybody would know about this.
And so we had a lot of that kind of disbelief. So the truth is we kind of had to, and I said, "Well, wait a second." And I was asking the self insured employers, I said, "Well, if this works, isn't this the greatest thing ever for type 2 diabetes?" And the answer was, "Yes, if it works."
And I said, "What's your worry?" And they said, "Well, I don't want to lose my job. I don't want to spend X amount of money and then see nothing." I said, "Oh right, let's do this. I am so confident. We are so confident about these results, that you're going to pay nothing, unless we deliver a type 2 diabetes reversal at scale."
So honestly, that's the truth, we were kind of forced to. But then once we started rolling with it, I said, "Well, wait a second. This is the greatest thing ever, because if anybody else comes to the market and says, Hey, we do the same. There's one way to test how confident you are what you're doing, is to say, are you going to put 100% of your fees at risk? Like tied into real results, not just the lots of [inaudible 00:30:39] and kind of making the marketing claim."
And so that's how we ended up with this model. And, honestly, you ask me, I think this is what healthcare should be. It should be about paying for results, not just paying for showing up.
Charles Rhyee:
Yeah. And I mean, in theory, right, this whole value based care movement, in theory, is we should be paying for outcomes. Obviously, you guys are way ahead of the curve there.
Maybe as we kind of wrap up here a little bit, obviously the ability to reverse diabetes, comes with some pretty, pretty big implications, right? Including how we think about using medications, as well as impact on other common comorbidities like hypertension. What do you think this means for how we treat what we're currently calling chronic conditions, as we move forward?
Sami Inkinen:
Well, I don't want to sound too kind of grandiose here, but I will say something that may sound like that. And here's this, we spent about four trillion a year in healthcare in America. About four trillion, depending on whose numbers, you kind of believe. Chronic disease and cardio metabolic issues cover one to three trillion. So let's just call it half.
Half of that four trillion goes to treating what you might call lifestyle disease, so let's say two trillion. Most of that money goes into either treating symptoms like high blood pressure or high blood sugar with medications. Or the end result of those diseases, which is heart attacks and deaths and amputations and dialysis. That's obviously not going to go those diseases go away.
So here's the big idea, the grandiose thing, what if most of those diseases can actually be reversed nutritionally? What would happen to individual patients, taxpayers, payers, society. I think that is the big idea that we are executing at Virta Health. And also, of course, always trying to back up our claims with populous and peer reviewed results. And I believe that statement is true. Most of these cardio metabolic diseases are reversible nutritionally, with the right support and the right nutrition science.
Charles Rhyee:
Yeah. And the amount of productivity that would go back into society and into the US just on that alone, if we think just about balancing the budget, there you go.
Sami Inkinen:
Yeah. And, there is no way we will solve the diabetes epidemic with more dialysis. There is no way we will solve the cardiovascular disease epidemic with more heart surgeries. No, that's just catching the end complications and trying to keep people alive. You have to do something earlier, and that's what we're doing at Virta.
Charles Rhyee:
Yeah. So, then maybe just to wrap up here, what's next for Virta here? What should investors be focused on? You talked about your five year studies and peer review, maybe when you think that might get published? Anything that we should look out for?
Sami Inkinen:
Yeah. Well, totally. Well, I think we have something like dozen abstracts or so coming out at the American Diabetes Association session this summer, and I think our five year results also get peer reviewed and published this year.
But for us as a business, honestly, we have a treatment that's working, fundamentally working. We have getting close to 300 direct customers from large employers to health plans to even the US Veterans Administration. We're growing about a hundred percent year by year. So as, perhaps, boring as it's sounds, we've got a hammer, and there's a lot of nails, and we are just executing as fast as we can.
And scaling a Virta like company is not easy, but I would say execution and scaling is taking 80% of my focus as a CEO, and probably 90% of the team's focus. And that's really what we are doing right now.
And at the end of the day, it's also going to translate into very good business, which makes patient better, saves our customers, our employer and health plan, and government customers, a lot of money, so that's what we are working on.
Charles Rhyee:
Yeah. Well, we look forward to the progress you guys make and Sami, really glad you could join us today. Really appreciate our discussion today.
Sami Inkinen:
Yeah. Thanks, Charles, for having me and great job doing this podcast.
Charles Rhyee:
Great. Thanks. And thanks everyone for tuning in and hope you'll all check out our future podcast, as they come out. Thanks everyone.
Speaker 1:
Thanks for joining us. Stay tuned for the next episode of Cowan Insights.

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