Obesity plays an important role in the worlds of many struggling with conception, and in recent years the field of Obesity Medicine has grown substantially. Weight loss makes the fertility journey so much easier while increasing the quality of life for the patient.
Today’s episode features Evan Richardson, CEO and Founder of Form Health, a modern obesity practice that remotely connects their patients to dieticians. He speaks with Griffin Jones about a wide range of topics relating to obesity and fertility, from their complicated connection all the way to the future of subspecialties and medical health as a whole.
You can find the episode anywhere you stream podcasts or at our website.
Today’s Episode Focuses On:
The role Of BMI in fertility
The importance of medical subspecialties
The difficulties behind sustained weight loss
The future of subspecialty practices
The relationship between obesity medicine and fertility medicine
Social Links:
Evan’s Linkedin: https://www.linkedin.com/in/evrichardson/
Form Health Website: https://www.formhealth.co
FH Facebook: https://www.facebook.com/formhealthofficial
FH Instagram: https://www.facebook.com/formhealthofficial
To learn more about our Goal and Competitive Diagnostic, visit us at FertilityBridge.com
Transcript
[00:00:00] Evan Richardson: We're a fully virtual program. So everything happens through an app. Then those patients are talking with us almost every day.
We talked to on average, we talk to our patients every day, and that's just not a sustainable model for a traditional primary care practice.
[00:00:55] Griffin Jones: Today on Inside Reproductive Health. I hosted Evan Richardson, who is the CEO and founder of a new tech health startup called FormHealth. Before I get into my show with Evan today, my shoutout goes to doctors, Adam Griffin, and Mike Sullivan from Buffalo IVF, who are the reasons that I got into this field more than seven years ago now, starting from a small rural village in Bolivia for $500 a month, doing organic social media to now something that is unrecognizable to that venture. And so a shout out to those guys. I don't know if they listened to the show, but you have been telling people have been getting the shout outs because you've been texting them.
So if you call on those guys or if you're friends with them. Please text them, let them know that they were in this shout out today show with Evan. I know some people are going to be grumpy with me because they want to come on the show. I've got to be real protective of who I have on the show, because this is the media platform for REI and business people in the field and practice owners.
So I've got to be really careful most of the time, I don't let industry, side folks on, although sponsorship is a different option available, but I thought it was important to talk about the ways that tech can help us. If not triaged patients, at least help you treat the patients that you need to be treating, doing the things that you need and want to be doing.
And then letting more efficient solutions help with that, which you don't. So if I sound incredulous in this interview with Evan, just because I was trying to be a good steward of how you might be combing through their value proposition. I'm not a clinician. I did my best. So you can take a listen to this show with Evan.
He's been in the tech space for a while. The health tech space for awhile. He was an early employee at Castlight health. He's a member of the board of directors of bicycle health. He was part of the founding management team at grand rounds, which is also a telemedical concierge. And so he is now in this VC startup world very much.
And I hope you enjoy the show.
Mr. Richardson, Evan. Welcome to Inside Reproductive Health.
[00:03:25] Evan Richardson: Very happy to be here. Thanks for thanks for making time here.
[00:03:28] Griffin Jones: I've got to tell you that I'm a little bit not looking forward to when this episode comes out for a reason that we've gotten, I've gotten very protective of the audience of this show in the last couple years, because now we're sort of the only media outlet for the business side of fertility, which has a lot of people asking me like, hey, can I come on the show?
Can I pitch this, or can we talk about this topic? And now, like, I also want to get to the point where we're in sponsorship mode. Didn't think that was the realm that you were in, but I just know that people that have asked me to come on are going to be like, what the heck why'd you let that guy on you didn't let us, I do have an explanation, but I, and I want to go back into the I want to start backwards a little bit before.
We'd talk about what form health is, but if we could start. Why fertility, what is the relationship to fertility? Then I'll get my answer and then we'll work back and then forth again.
[00:04:29] Evan Richardson: That makes, that makes a lot of sense. So I feel like that, to answer that question, I can tell a little bit about form, which is that we are a concierge telemedical weight loss services.
So we work within the realm of medical support. We are we are a medical practice. We treat patients and we work with those individuals to meet their broader healthcare goals within the context of helping them to lose weight. And it turns out that weight loss can be really important for fertility for a number of reasons for a number of practices folks have a BMI cutoff and patients would come in above that cutoff can't receive certain services because risks because risks around sedation for other folks, there's a, you know, a real demand for surrogates. Sometimes the surrogates don't meet a BMI threshold that's required.
And then for the broad population you know, risks around risks around becoming pregnant and then carrying a child to term all go up as BMI goes up from from the sort of obesity level, which is a BMI of 30. We've worked with fertility practices now for for quite awhile to help them to bring patients into the realm of being treatable from a fertility perspective, BMI down below any sort of hard ceilings, they may have to increase. The number of surrogates that they have available. And then also just to improve sort of all of the outcomes related to fertility all by helping their patients reduce their body mass index. And it turns out that, you know, the relation between the relationship between fertility.
And BMI is fairly clear, right? All risks to becoming pregnant or to carrying a child would turn to come down as a patient brings their BMI back towards the sort of clinically normal threshold below a BMI of 30. And that's really where we help. That's where we work with fertility providers to help, to improve not all of their outcomes and broaden the base of patients and surrogates they can work
with.
[00:06:29] Griffin Jones: What other subspecialties of healthcare, if any, are you working with?
[00:06:34] Evan Richardson: Yeah, well, so that's a really great question. The answer is is all so, you know, we work with primary care providers. , we work with folks in the orthopedic space and then, you know, kind of everybody else, I would say those are the big the big four with fertility kind of leading the way for the sub-specialties that we work with today.
But we do have referring providers that come from, you know, the broad. Medical subspecialties, because there really is no area of care that at wherein outcomes and patient outcomes are not improved by helping those individuals with a BMI over 30, to bring that BMI down below the obesity.
[00:07:15] Griffin Jones: Well, I don't really give a crap about those other subspecialties, but what I am interested is a little bit more on how you partner with clinics, but the reason why I was okay with having you on the show is because there a tremendous bottleneck in fertility right now there's simply more patient demand than there are providers to be able to treat them.
And we need other means to help. I dunno if triaged is the right word, but to help with some of the treatment that doesn't need to be going on at a fertility specialist so that the fertility specialist can do what only the fertility specialists can do. And so talk a little bit, but I also brought John because it didn't seem like, you know, you were necessarily.
That you had like this really, oh, I don't know deep monetized partnership with fertility centers. Maybe I'm wrong. How do you partner with fertility center? Yeah.
[00:08:12] Evan Richardson: So great question. Yeah. And I think, look, you're right. The challenge for fertility centers in a lot of cases is how to be as efficient as possible at delivering the care that they deliver to as many patients possible.
When you have somebody coming in, who doesn't meet one of your sort of basic requirements around care. That's a challenge to you know, to sort of work with that person, especially over a period of time. If they continue to not sort of be within that BMI limited require. What we do in partnering with fertility centers is we try to work as closely as possible with them in support of the patient's goal of fertility.
That means that we try to make the burden. In terms of getting patients to us as light as possible for those referring fertility clinics. And then we try to make sure that when that patient is ready to come back we make that process of coming back to the fertility center as easy as possible. So I would broadly kind of group our partnership into two kinds of patients.
The first one is patients whose BMI precludes them from one kind of treatment or another. So we'll hear frequently that, you know, a center has a BMI cutoff of 35 or 40 or so around IVF as a broad category. And the reasons for that, I have a lot to do risks from sedation and risk of airway collapse.
It's certain a higher BMI and the threshold depends a lot on the facilities that are available and just the, the policies that practitioners are put in place for those patients who have who have a BMI that precludes them from receiving care. We partner with the facility.
Take that patient understand their fertility goals, understand the fertility path forward for them understand the weight target that they need to achieve in order to receive in order to receive fertility treatment and work with that patient over the course of weeks and months, independent from the fertility practice.
And about the only thing that happens during that process is we update the fertility center on a regular basis and that. Frequency depends really on the fertility centers preference for those updates. Usually it's about once a month, we give them an update on sort of the patients that we're working with for them.
And then when that patient hits that BMI threshold, we then with the right amount of notice, cause then in many cases, you know, it takes you know, four to six weeks to get an appointment with a treating provider. We'll say to those patients who were ready, Hey, you hit your threshold or you're about to hit that threshold.
You're ready to go back. Let's get you set up with that care. We a ll work with the fertility, the referring fertility practice to make sure that person who previously was just not eligible for care and previously could not have received treatment. Now it gets back into their practice in a pretty seamless way.
And, and is able to get care. Typically we continue to work with those patients because now they're in the second category of care, which is patients who are eligible for fertility services, but who would but, and who are already sort of receiving those, but who would like to continue to lose weight.
And for those folks, typically we are treating alongside the referring provider. And again, you know, we make that pretty, pretty seamless to the referring provider. There is no change.
[00:11:25] Griffin Jones: Referring provider in this case, being the REI?
[00:11:28] Evan Richardson: That's correct. Right. Isn't the fertility is the fertility specialist. It's pretty seamless to their fertility specialists.
They don't have to do anything to change their path of treatment because is actively losing weight. We always are making sure that we're up to date on the path of treatment forward patient, and that we're practicing in line with those care needs. And the patient often, you know, continues to lose a meaningful amount of weight as they go through treatment.
We will stick with those patients oftentimes through pregnancy and then afterwards continue to help them to lose weight when it's appropriate to lose weight again, which of course it's not appropriate during break.
[00:11:58] Griffin Jones: So while we're on the topic of referring providers. When we say referring providers, we typically talk about OB GYN, sometimes PCPs.
And one thing that I've heard from REIs for as long as I've been in the field is there's often a trepidation of disrupting their referral patterns. They don't want to they don't wanna, they don't want OB-GYNs to perceive that they're taking their patients who have always send them. So that they'll keep getting referrals.
Some, there's probably some threads of this concern that are valid often. I think it's probably not valid. OB-GYNs are just as busy if not busier than REIs. And so our PCPs and very often we're talking about low margin insurance patients which is why I'm interested in exploring this telehealth idea, but I can hear a couple people, a couple REI's in the back of my head saying, well, why would we refer these patients out to a platform like this and piss off the, you know, the, when we could be sending them back to their PCP? Sure. That's a
[00:13:04] Evan Richardson: great question. Look, I think, you know, For some patients the PCP is a perfectly appropriate place to treat their obesity.
And in many cases, the PCP has already been a part of the discussion, right? So most patients that have obesity are counseled by their PCP, that they should be losing weight. They'll ask that BCP, hey, what should I do? And that BCP will have sort of, you know, taken them through their, their frontline treatment.
I think the reality is. In the vast majority of cases, those that mode of treatment doesn't work. And so just like we work with BCPS and, you know, different side of our business, we work with PCPs is the referring provider, as opposed to fertility as the referring provider. And we do that because the PCP say, all right, I understand that there is this new area of medicine called obesity medicine and that's our subspecialty. That's a specialty in which form health practices, our physicians, our obesity medicines board, they have they typically come from an endocrinology or primary care background, but they've all passed their ABOM. The American board obesity medicine boards.
And they just have a, just like, you know, , cardiologist has advanced experience within their area of specialty. Our physicians have advanced experience for these harder cases in the field of obesity. So while an REI might say, gee, why wouldn't I just send this back to the PCP?
Who by the way, sent me the patient the first place. I think the, the short answer is. Oftentimes those PCPs have already done the work that they're able to do and haven't gotten effective results. And in many cases, when it comes to actively treating these patients for for obesity many PCPs don't feel that they're sort of the right set of folks to deliver that care, which is why we work them as referrals as well.
[00:14:44] Griffin Jones: What evidence supports your idea that the treatment is very often unsuccessful. Obesity treatment is very often unsuccessful with the primary care.
[00:14:54] Evan Richardson: Well, so, I think the biggest piece of evidence would simply be the continued upward climb of the rates of obesity in the United States.
Even though everybody's PCP who has a BMI over 30, we'll sit them down. You really need to change?
[00:15:10] Griffin Jones: What are we talking? Numbers wise. And I know that you probably have this like memorize for VCs. So like numbers wise, what are we talking about obesity and that you're
[00:15:20] Evan Richardson: discussing today, the obesity rate for adults in the U S as close to 45%.
And it depends on what what statistic you want to look at. There's a few, they're not suggesting. The pandemic and the folks that being home there've been some pretty substantial increases in that number, but, you know, here, as recently as 1982, the rates in the us were 10%, right?
This is a this is a health challenge that up until January of 2020, along with opioids was, you know, one of the two major problems at the US phase. And I think, you know, we haven't seen sort of any change there that is despite a lot of healthcare focus in the area and a lot of counseling from BCPS.
I think the challenges that for for many doctors you know, that there is a there's a sense of, Hey, know, what to deliver the right care for obesity medicine to deliver, you know, the right kind of accurate around weight loss. We need to have a very active set of interactions with a patient.
Perform health, for example, meets with our patients once a month with their physician twice a month with a dietician so they're seeing somebody from form health almost every week, and then we're a fully virtual program. So everything happens through an app. Then those patients are talking with us almost every day.
We talked to on average, we talk to our patients every day, and that's just not a sustainable model for a traditional primary care practice. In addition to that for some patients, and then there's an asterisk here because for patients who are maybe pregnant or working to get pregnant, many of the medications in the space, aren't always appropriate.
But for many physicians there's a world of medications that are helpful to. And they're not comfortable in prescribing those for a variety of reasons that have to do with training and history and all this stuff. And so, that's why you know, a lot of physicians today are excited to refer out to specialty focused obesity medicine.
[00:17:13] Griffin Jones: What kind of results are you seeing now? And if you're still in forecast mode, how will you be measuring the results?
[00:17:19] Evan Richardson: Yeah, that's a great question. So, so, you know, we've seen results that are best in class for obesity clinics. You know, we have our specialty, as I mentioned is obesity medicine.
And so there's a fair amount of research that looks at. The rate at which folks are able to lose weight, you know, for us patients that are doing great can lose up to 25% of their body weight over the course of six months those are the results that we have seen. So very very substantial weight loss.
Typically a patient is losing about a pound a week and, you know, for some patients they'll stop and they'll say, hold on a pound a week. You know, I shouldn't, I be able to lose it faster with a medically engaged program. And the answer is. No, and you're losing weight much faster than that then it's not sustainable weight loss, and you're much more likely to stop.
And you're much more likely to see rebound after that. And so lots of studies today show that you know, about a pound a week is sort of the upper threshold for how fast somebody it's a little, it's a little faster than that when you start weight models. But the sustain rate is about a pound a week and we see that.
And I think the thing that's really important for our field is how long does somebody stay in. This kind of program. So for a lot of more traditional weight loss either self guided or guided through a program, like a weight Watchers, et cetera, people retain on those programs for a very short period of time.
Right? We're talking 20 days, right? 22, 23 days, and sort of average retention there. And if anybody's tried it themselves, you've probably had a similar experience. The first two weeks you're really motivated. Third week you started adding up. I want to keep doing this. By the end of the third, we get a couple of reasons not doing he.
Didn't what we see is that about 75% of our patients are still with us at 6, 7, 8 months. That's a lot. Right. And when somebody sticks around with you for that time, you're really able to help them make material changes in their life, lifestyle, and health. And you're really able to see those folks go from you know, from a very high BMI down to something that's more you know, more clinically help them.
[00:19:10] Griffin Jones: Have you done any abstracts yet?
[00:19:11] Evan Richardson: We've done a couple of posters. We did a poster at the at the obesity society here last year. And we did one at ASPM, American Society of Pediatric Surgeons here this year.
[00:19:22] Griffin Jones: Summarize a couple of those findings for us.
[00:19:25] Evan Richardson: Yeah. I think, you know, in line with what we just talked through.
So, you know, typically patients are losing about a pound, right? and that we see that retention that is, you know, very substantial during the forecast period, I think, you know, the results that we're the most proud of you know, are actually coming out of some of our work with fertility centers where, you know, we had just this month two patients who became pregnant who had been having, you know, real challenges or.
Eligible to be getting fertility services because of their weight. And after working with form, went back to their REI and are now working on building a family. So that's the kind of thing that we get really charged up about.
[00:20:02] Griffin Jones: That's what the audience gets charged up about too. A pound a week and a longer enrollment in the program for the intervention.
What compared to baseline, I guess, what is the average intervention yield?
[00:20:22] Evan Richardson: The average intervention, self-guided intervention doesn't yield anything. And so I think that's a really important thing to think about. So, you know, the alternative to referring to obesity medicine provider is the tele patient, hey, you know, you should maybe join a weight watchers. You should you know, you should work on this yourself self guided interventions because they don't last long. Don't tend to show great results, you know, weight watchers and others have some good clinical studies where they will show that their population is able to lose weight.
But the live reality of somebody on Weight Watchers is very different from a lot of those studies. And the reality is most patients don't stick around on those studies for very long. And so, I would suggest to folks that are listening to think about their patient population and think about those people who they've said, Hey, you know, if you want to have better outcomes on agent lose and weight and think about sort of what percentage of those folks were actually able to achieve that weight loss in our experience and, you know, sort of more broadly looking at the broader population data, it's very unusual for someone to be able to under sort of self-guidance or under.
A purely behavioral program to lose a significant amount of weight. We're not talking about 10 pounds, you know, but lose 30 plus pounds. And keep that off that's fairly rare.
[00:21:32] Griffin Jones: Yeah. Well that was going to ask how do you stratify that a little bit more? Because I imagine some people will say, well, these programs work excellently?
And so to say like self intervention doesn't work, it could be, right, but how do you, what are some of the parameters that, show us that's true?
[00:21:53] Evan Richardson: Yeah. So I think, you know, one of the biggest one is just the overall gain in BMI, across population. And again, that's been, you know, that the rate of obesity has been taking up you know, very substantially over the course of the last decades was really no pause right there, there is not a year in the last in the last 20 where the obesity rate in the country in the U S has gone down and that's generally the case globally. And so, you know, I think that again, if a person is not able to stay on a plan for more than a handful of weeks, they will not be able to achieve results. You know, you can think about a weight gain, typically takes a while. So for many patients, they're, you know, gaining a, you know, a couple of pounds a year on.
And they may have a year or two when they gained a substantial amount of weight. But if you asked them kind of, what was the trajectory of your weight gain over time? Typically it's, you know, it's a couple of pounds a year and just like weight gain can take a while. You know, that weight loss often can take awhile, even when it's medically assisted, right?
The fastest that you can go is about an hour a week. And so, for a lot of patients, what they find is, you know, gosh, if you're staying on that program for 14 days or 20 days, that might be fine. If you want to lose five pounds to go to the beach or for an event or something like. But when you're talking about sustained weight loss, most patients, the vast majority of patients benefit from that intervention.
[00:25:38] Griffin Jones: How does the formhealth get paid? Is there a partnership from the fertility? Is there a referring fee?
[00:25:46] Evan Richardson: It's a great question. And the answer is no. So no cost to the referring provider and, you know, we look at this partnership as working to help the we're gonna help the individuals, our mutual patient to achieve their broader health goals in the context of fertility, the number one goal at the top of the list is I want to have a baby. And that's the goal that we are working towards together, but just like the fertility, especially just like the REI is not is not paying and is not able to pay. their referring provider. Fee to the provider who refers patients to form.
And you know, we think of this in terms of, you know, what value can we provide to that provider? So that's why we are keeping them updated in an effective and pretty efficient way for their time in terms of how these patients are working. That's why we're making sure that we're treating inline with that provider sort of needs for that patient when we work with them.
And really at the end of the day, this is just about us helping these patients. Together to achieve that fertility goal.
[00:26:42] Griffin Jones: So is it a monthly subscription from
[00:26:46] Evan Richardson: the great question? How do we get paid for? So, so, so there's two parts to how how our economics work. We are a we are a reimbursed.
Service. So when a patient sees their physician that service is submitted to their insurance, just like any other physician interaction would be. And then and then that sort of adjudicated through their insurance coverage, et cetera any cost to the patient for labs, any costs, the patients for medication all of that sort of runs through the insurance just like it would for any other medical interaction. And then in addition to that, we have a monthly fee that's $99. And that really covers the cost of the dieticians that patient works with. So there's two parts to that team. One is the physician two is the dietician. And so those dietetic services are covered by the $99 a month fee, which is paid for by the patient.
[00:27:34] Griffin Jones: I want to talk a little bit about the insurance and telemedicine, and that will make this tangent make sense because in February, 2020, I was at a small fertility conference. Very cool. Intimate fertility conference in Colorado. And we were starting to talk about this novel virus that was developing in the east, but.
[00:27:56] Evan Richardson: I haven't heard of it.
[00:27:57] Griffin Jones: When people didn't really know what was going to happen yet so this is like the first week of February. And at that conference separately. We were also talking about the future of telemedicine, but also kind of how it was a pain in the neck because if you practiced it, if you hadn't, let's say you're in oh, Erie, Pennsylvania, and you're seeing patients.
Just across the border in New York state that you would have to have a law in some states. I don't know if this is true for Pennsylvania, New York, but at least in some states you'd have to have a license to practice in multiple states and.
[00:28:28] Evan Richardson: That's the case in the majority of states.
[00:28:30] Griffin Jones: Okay. And so, and then all of a sudden a month later, a lot of these regulations were put on hold and health and human services and office of civil rights I believe is, are the two agencies that that enforce HIPAA. And so they said, you know, you can use zoom, you can use FaceTime, you can use Skype. And so how did that affect or not affect you all at that time?
[00:28:54] Evan Richardson: Really good question. You know, we have been a purely telemedical business since we got started and so we have been working within the sort of fairly complicated telemedical regulatory regime that exists. And so for us, in some ways, you know, we were already really prepared for everybody to get pretty excited about telemedicine. We didn't change the way that we work with patients.
We already had tools that were HIPAA compliant that were in place. I think some of the benefit to some providers was that, you know, some of the interstate licensing requirements or were waived or otherwise loosened for a period of time. I think, you know, for us that didn't have a big impact either because our providers, you know, were already sort of licensed in these states where they practice, you know, for us as a growing business, our perspective was we never know how long these waivers are going to last.
And they are really important for some of the emergency or near emergency medical treatment that had to happen around around COVID. But we didn't want to build our business on some of those sands that could shift pretty quickly. And so by and large, you know, everything that we did was highly compliant with the pre waiver world of telemedicine.
[00:30:09] Griffin Jones: Your explanation of how you get paid from patients and from insurance companies and not from centers is part of the reason why I had you on the show. People sell to centers, then they're going to be more likely in that sponsorship category. I know that some other people are still going to say to me, oh, that's me too.
Why can't I come on show? Listen, sometimes I'm in a good mood, keep trying me. And but I am really interested in the idea that we just have to be doing, we have to be getting people to other solutions that are found in tech and do you think that we need to be propagating that for the triage aspect?
One concern that I've seen is, we've seen people come in and there's been a couple of them that thought, oh yeah, they're going to be great. They're going to stick around. And then it's like what? They burnt through that money pretty quickly. I didn't know you could burn through $60 million that quickly, but apparently you can and VC is a cutthroat world.
[00:31:07] Evan Richardson: Great parties.
[00:31:08] Griffin Jones: So what challenges are you on the lookout for?
[00:31:13] Evan Richardson: Yeah, look, I think, you know, we think that not surprising the world of obesity medicine, the specialty of treating treating folks in BMI north of 30 or in some cases be north of 27 with certain comorbidities. We think that is a big growth area in healthcare broadly today only about 1% of individuals with a BMI north of 30 are receiving medical treatment for their weight.
If you look at any other major medical condition type two diabetes, high blood pressure depression. Typically treatment rates settle out for reimburse services at about two thirds. And and I think, you know, we are entering a world with AMA recognizing here about seven years ago, that obesity was a medical condition with the creation of the American board of obesity medicine in a world where treatment of obesity will be more the norm. It is the exception today. It's absolutely the exception and, and I think, that's part of why, fertility, for example, has been a big growth area for us because patients weight so directly impacts their ability to to, to conceive and to carry a child.
And so I think, you know, we are headed over the next 10 years towards a world where treatment is more than normal, where we start to see treatment rates north of 50. For individuals with a BMI of 30. And that doesn't mean that all those people go to obesity sessions, right? Primary care will start to treat this more frequently, et cetera, et cetera.
But you know, in that world, what we are really looking at over the next 10 years is an incredible period of growth. And I think, you know, for us as a result, some of the biggest areas of concern are really just, you know, how do we grow effectively? How do we support that? In a way that matches with our very high level of standards for the care that our patients receive.
And how do we continue to do that as we scale out larger and across more states. So I think, you know, the the question for folks in our space is you know, as awareness grows, as referrals grow, as practitioners start to say, well, I'd refer out. If I saw high sugars, I'd refer, you know, for treatment, for what looks like it might be, know, a case diabetes.
If I saw high blood pressure, I'd probably refer out for that for treatment as well. I'm seeing somebody coming in with a BMI of 30, that is a medical condition. Of course, I'm going to refer out for that. But then as that becomes more of a norm of thinking, you know, I think the real questions are, you know, how do we as a.
As a specialty of medicine, how do we make sure that we support that growth in a way that's going to be effective and high quality for all of our patients?
[00:33:47] Griffin Jones: So what are some of the obstacles look like? Like you as the visionary of this burgeoning company, when you are thinking that six months to a year, what are the things that you're saying, this is what we're getting over as a company in the next half a year so?
[00:34:01] Evan Richardson: Yeah, well, look, I think you know, I think supporting demand is always a big challenge as a growing company, right? So, you know what we have seen in working with and working with fertility providers and other physicians more broadly is the impact we've been able to have not really has been positive for their patients and as a result we, you know, we'll often with a as an example with a fertility provider and they'll say, great, I'm going to refer you. The folks that come in and their BMI is over 45. I can't do anything with them unless we bring that BMI down. And within a couple of months, we're seeing everybody with a BMI. 30. And they're actively treating those patients between 30 and 45, but they've seen such great results with the patients that have a very high BMI that may start to say to everybody else along the path, Hey, let me just toss these folks over to form because they know the support is there and they know the results are going to be there.
And this is something that the patients want to achieve along with their fertility. And so I think, you know, for us, we look to growth and we look to making sure that we continue to support those patients in the best darn way that we possibly can. I think, you know, the world of COVID is an interesting challenge for us as well.
Are, as I mentioned, purely tele medical patients never come into an office. That's really comfortable for patients because now they don't have to leave their home. And even as they go back to work, they don't have to leave the office. They can sit in a conference room like I am now and have that conversation with their with their practitioner receive treatment and go on about it per day.
But I think that, you know, we're going to see what changes in people's expectations, you know, w what we've seen across our business is a lot of folks have had some pretty material unplanned weight gain during COVID. And so I think that is you know, an opportunity and a challenge, because there's more folks that need help, but at the same time there's a lot more obstacles in their way that are causing the gateway to.
So I think, you know, there's some challenges from the medical side there's some challenges.
[00:35:51] Griffin Jones: I thought of two more questions that the audience will be grumpy with me. If I let you off the hook, then I've got it right. Then I've got a selfish question for myself that is of zero value to the audience.
And then lastly you can conclude with however you want. So, but I know that some people. There is sometimes a referral paranoia in this. And again I think most of it is unwarranted most of the time because of how busy we all are, but some people may see you've had luck, at least building the beginnings of relationships with a couple of groups.
They see another group on they're like, well, yeah, Person is two miles away from me. If I refer patients to form health, they're going to refer them back to this other group.
[00:36:35] Evan Richardson: That's interesting. So, so, you know, I think all of these are things that we work really hard to just make sure for our referring physicians, when we receive a referral from a from a physician, you know, we mark that down.
And we are working with that physician at the very least, keeping them updated on their patient's progress. And then sometimes if that patient's actively receiving treatment, then we'll kind of get the the note from the from the referring provider to make sure that our treatment path is still in line with their path of care for that same patient.
And when it comes time to send that person. We are already queued up with that. with that the referring physician, the one that sent us the patient in the first place, and we just sort of naturally send them right back and we keep we keep pretty good records on that internally, mostly. So that weekends stay in line with that physician's path of treatment.
But this isn't something where, you know somebody sends a patient. And we said, okay, well, who do we like in, you know, in the city of Boston to that referring provider? I do think, you know, we, we do have growing relationships with a number of providers nationwide and you know, we have been excited to support our relationship with those providers.
So, you know, we have a bunch of providers and say, great, know, we, help generate some content with you. We're always happy to, you know, lend or medical experts out to a little bit of content with them. We've got, you know, mutual, a webpage that we stand up. There's the opportunity to do you know, some, some joint work in building sort of practice volume.
And we're always supportive of that you know, I think we want to do whatever we can to help differentiate our practice partners, our referring partners, and help make it clear to patients that, you know, incoming to this specific REI. It's not just, Hey, you're here for one thing and one thing only, but it's a holistic solution that can include weight loss that can include all the things that patient needs to make sure that they can have the best chance possible of fertility
[00:38:26] Griffin Jones: Hopefully, that's the more superficial concern, the more sincere concern that they will not let me off for letting you off is what are you doing with the data and what are you going to do with the data?
[00:38:38] Evan Richardson: Good question. What we do with the data now is make sure that we're treating our patients appropriately and effectively.
I don't think that we have any plans around you know, looking at referral patterns or selling that data to other to other, you know, sort of like larger data entities or anything like that. I think, you know, there are opportunities, the things that we are really interested in with that data is publishing and making sure that the ways in which we are working with patients and the centers that we are working with you know, are really able to show the difference between those patients that, you know, that they worked with and help bring the BMI down. Some success rates they had there versus those patients who, for whatever reason were appropriate to referral or what there asking.
So we are actively working on a couple of paths now to start to publish with some of these larger opportunity groups. And if any of your viewers out there want to be part of something like that, where we can really take a look at the impact of of weight management around fertility treatment, you know, that's something where we're looking to add additional practitioners in groups into some of that work that we're doing.
[00:39:38] Griffin Jones: Okay. I think I've poked you to the extent that most of them would I think most has been filled. This is totally just for me. My two favorite influencer docks outside of the fertility field everybody's this is outside of the fertility field. My two favorite influencer docs outside the field are Jason Fung and Peter Attia and for their research and work on longevity.
And specifically with fasting protocols. This is just me. This is just me really curious how much of your protocols involve fasting or is that in your purview at all?
[00:40:15] Evan Richardson: So not really. And I guess the first, the first thing that I'd put next to that, I think Fung and Attia are often working with folks that have very different health challenges than those people who are dealing with obesity.
Right. You know, to the extent that I've read some of their stuff. And I think they're pretty interesting, but they're really working on folks that are, you know, kind of already, you know, pretty far down the road of hitting all of the basics of helpfulness and are trying to kind of tweak and do a little bit of biohacking and really make sure that they're squeezing the most they can out of their know, out of their lives and their physical bodies.
And I think that's pretty interesting. We certainly do work with patients on multiple different protocols that help them to control calorie intake. And so, know, there's two big pieces of our care one is working with that physician. Two is working with a dietician intermittent fasting is absolutely one of the tools that our dieticians use, not so much for, you know, some of the outcomes that Attia and Fung might be you know, really focused on, but just because there's a lot of data around IF that suggests that for some people it's really helpful with controlling caloric intake. I think we're a little bit more skeptical on data suggesting that your body is burning more calories when you're doing intermittent fasting or that you have sort of increased metabolic activity when you're on IF.
But we absolutely see that it's super effective for a lot of people and helping them to control which helps them to control calorie intake. So given that, the reason I said that it's not really part of our program, this is not a required part. What we do is we try to work pretty pretty carefully with each patient to make sure that the dietetic approach we take with them is built for them.
And for some people IF just as ineffective for other folks. You know, they want to try, they want to try a different kind of restriction and I want to try, you know, meal replacement, or we may believe that's going to be highest impact for them. And so we work within those within those protocols, but there are a number of our patients that do IF and many of them find it to be pretty, pretty impactful, but they apply it and it is applied a little bit differently than what Attia and Fung are typically doing up.
[00:42:22] Griffin Jones: Well, we got to do is get you a show so that you can have those guys on your show and then they can see if they see it the same way. But that's just for me, this audience is mostly REI is mostly execs in the fertility field, a lot of practice owners. So how would you like to conclude with, to that audience Evan?
[00:42:41] Evan Richardson: Yeah, I think, you know, first it's been fun to have the opportunity just to chat with you. I think to those folks that are listening form is a practice that is really built to support your patient's outcome. And we work today with with dozens of practices across the country to help their patients to achieve better fertility outcomes, to achieve more pregnancies and carry more pregnancies to term.
And we strive to do that in a way that has as little friction to their practices as possible. What helps them to work with more patients and deliver better outcomes. And so I think, you know, to the extent that is something that folks are are excited about, and at least in our experience, a lot of practitioners are excited about working with more patients and improving outcomes for all their patients.
We're ready. And, and we'd love to hear from you and you can track us formhealth.co
[00:43:36] Griffin Jones: I mean, I think this is the trajectory that we need to. At the very least look a lot more into, in the field to help expand text's use of applying the rest of the health treatment that we might not do. And thank you very much for coming on Inside Reproductive Health.
Thank you.