0:03 Eugene Borukhovich
Welcome to Digital Therapeutics Edition of Digital Health Today, and I’m your host Eugene Borukhovich. In the last episode, I reconnected after many years with Peter Hames, CEO and founder of Big Health. With dozens upon dozens of peer-reviewed publications and at least 13 RCTs, Big Health is at the top of the list of the most studied digital health companies to date. Make sure to check out that episode to learn more.
In this episode, I’m delighted to speak with Melinda Decker, chief commercial officer (CCO) of Mymee. Since we’re recording the episode, Mymee, which started out via a crowdfunding campaign, has recently closed an $8.7 million round– congrats to the team. But before we dive in, I have heard a lot about Melinda Decker, but only just recently connected with her on the Shot of Digital Health Therapy podcast that Jim Joyce and I record every single Wednesday. Melinda did not disappoint. An engineer at heart, she has an amazing commercial background, deep knowledge of science, and is just a super sharp professional with a sense of humor. And now we jump to my conversation with Melinda.
I’m here with Melinda Decker, chief commercial officer at Mymee. And before I hand it to you to introduce your journey to Mymee (and before), a funny thing– when you came on the Shot of Digital Health with Jim Joyce and I, I got questions like, “you’ve never met Melinda?” And I said, “well, I’ve heard of her, but we never met actually.” So thanks to the Shot of Digital Health for us meeting and here you are again. So please, I’ll hand it off to you now.
1:44 Melinda Decker
Certainly. Great to be here. And I’m excited about all the different avenues we’re taking in podcasts and with different teams. It’s wonderful to see. So I’m Melinda Decker. I know probably many of you– some of you I don’t know– I am an engineer by training. I always mention that so that people know I’m a biochemical engineer; it’s the way I think and it’s one of the things that sums me up very well. I started my career in research, which is not uncommon from many other people, but I think my personality is not a typical researcher. So people are sometimes surprised by that. The couple interesting tidbits that I don’t think we got to cover on Shot of Digital Health is that I went to school at UC Davis, which is one of the premier winemaking, viticulture and enology schools, and I actually did most of my research in undergrad and grad school in that space. I shifted a bit to biopharmaceuticals later, but actually focused a lot in agriculture and viticulture enology, so lots of good winemaking stuff before I got into healthcare.
2:36 Eugene Borukhovich
Close enough. I know you spent time in life sciences, and you’re now in DTx. So what was your journey to the DTx industry? Maybe tell our listeners about that.
2:48 Melinda Decker
I spent about two decades in pharmaceutical companies– at Pfizer and AstraZeneca primarily. About 10 years ago, I had the opportunity (as digital marketing was ramping up in social media and other places) to get heavily embedded in digital, which then led to digital health and digital therapeutics. I joined a team within AstraZeneca that was focused on using digital health in R&D and commercial to improve patient outcomes. So that was 2011 that I officially made the switch to focusing just on digital. But I was a marketer and in R&D and manufacturing before that.
3:21 Eugene Borukhovich
So coming out of the pharma industry after two decades, I’m sure you had your options to join different companies, I’m sure including other pharma. What’s the background story of you joining Mymee? What attracted you to the company and to the leadership team?
3:37 Melinda Decker
So first off, I had worked in autoimmune disease for quite a while. I actually worked on Enbrel for five years at Wyeth, which is now part of Pfizer, so I already knew that space really well. I’d also been leading oncology at AstraZeneca, which has a lot of immunology, which lays over in this space. But a few years ago, serendipitously, I ended up meeting the founder and CEO, Mette [Dyhrberg], at one of the digital therapeutics meetings– actually, the inaugural meeting that GreyGreen put on out in San Jose several years ago. She and I hit it off there, ended up seeing each other at conferences after that, and along the way, she asked me to join as an advisor to Mymee. That was actually the first step. I was advising other companies, doing consulting, and trying to figure out if I wanted to go back to big pharma or join a startup, when the opportunity presented itself about a year ago to join Mymee as the chief commercial officer.
4:28 Eugene Borukhovich
I’m curious, what got Mette started on Mymee? Is there a story? What was the market opportunity? I mean, there’s got to be some background. I always say that, especially in health care, entrepreneurs start these companies for a reason.
4:42 Melinda Decker
Yeah, and her reason was very personal. For a couple decades, she had struggled with autoimmune disease herself and wasn’t finding answers. The science is evolving over time and obviously there’s been advancements in pharmaceutical treatments, but there were also advancements in understanding the food and environmental triggers that are going on in people’s lives. The Stanford School of Medicine actually came out with something recently that showed about three-fourths of what controls your autoimmune disease is actually environmental. That came at a time as Mette was going through her own challenges and she said, “there’s got to be something to this.” I think she started with a spreadsheet and was tracking all of her symptoms, her food, and what she was eating in a very complicated way to say, “can I figure out what it is?” Along the way, she hacked her own health– we call her a little Sherlock Holmes– and figured out that for her, a healthy food (chicken, of all things) was a trigger that ended up being part of the reason that her symptoms would flare and present themselves.
5:45 Eugene Borukhovich
Amazing. Every individual is unique, right? That’s a little bit of the hypothesis there. You joined about a year ago, and prior to that you were advising and helping. I know Mymee’s history started somewhere around 2017, and while you may not have been in that startup room, I’m sure you have had discussions with Mette about it. So can you tell us any early stories or hypotheses that she had at the time about the business? Going through some accelerators– a bunch of them, right? I think you take away certain things [from that experience].
6:20 Melinda Decker
Yep. So I think what’s really interesting is that although she’s an economist by background, Mette actually didn’t have a healthcare background, so those accelerators were actually extremely valuable, as well as some team members she brought on to understand what kind of clinical evidence we’d need, what types of reimbursement models, who you would go after, etc. This was not her world at all. Some of the things that I take for granted because I’ve been in the industry for 20 years, is very, very different. She was doing it just as a patient advocate, trying to help others like she had helped herself and make it available. So going through some of those accelerators really helped her understand what kind of randomized clinical trials she should do and the types of payment models; how much is this valued at? Do you go direct to consumer? I think over time we’ve continued to evolve because the market evolved too. That conference that I said we met at a few years ago, David Klein and Ed Cox were the co-chairs that day, and boy have things changed for both Click and Dthera in that time. Omada was presenting too– I’m trying to think of all the folks in the room– but at the time we were trying to figure out do you go DTC? Do you go for prescription digital therapeutics? Do you go after self-insured employers? Looking back now, it’s probably comical if we found any of the early documents on what the business plan was, because everything has evolved so much.
7:36 Eugene Borukhovich
I’m almost afraid by the time this limited series of podcasts is over, we’re gonna have to do another one, because so many things are changing. You mentioned DTC prescription employers. Maybe you can talk a little bit about Mymee’s journey through that path, and to the extent you can– I know you guys are privately held– even some of the initial experiments on pricing and channels.
7:58 Melinda Decker
Absolutely. So I can’t talk about most contracts, but the first contract with a B2B client was with Oscar Health. It was a fully risk-based contract. This happens quite frequently when you’re early on, before you have all the established evidence. It was looking at actual value-based contracting, based on medication savings; if we could show improvements in outcomes that results in medication savings, we could get paid. That’s risky for investors, right? It can be a lot of money, but it’s a delayed cash flow to run, get the analysis, and then finally get paid. We’ve now expanded and we have partnerships with employers and payers, and we also sell directly to consumers. The price right now on the website for direct to consumer is $250 a month. You can pay less if you pay in advance, or if you pay for a year there’s a discounted price as well. But that’s the price point. The price point for payers tends to be higher than that and risk-based contracts tend to pay more.
You know, one of the things when you look at savings models is that, unfortunately, the cost to treat autoimmune disease can be very expensive. So if you’re talking about payers or self-insured employers, as an example, oftentimes the clients, or the members, can pay $100,000, $150,000, or $200,000 for rheumatoid arthritis, lupus, etc., based on some of the treatments as well as hospitalizations and surgeries. Like Crohn’s disease– if you get admitted for the week to the hospital and get blood transfusions, that can be quite expensive. And so some of those things that you do to keep people healthy, what is it worth to them?
9:30 Eugene Borukhovich You mentioned the different disease subcategories. Just for our listeners– because I’m hoping that it’s not only our “crew” that’s listening, but some of the masses learning about digital therapeutics– can you describe the autoimmune market?
9:47 Melinda Decker
Absolutely. So autoimmune diseases– there are over 80 of them. There are some that are more common because you’ve seen television ads for psoriasis or lupus or psoriatic arthritis. Phil Mickelson, for example, has an Enbrel TV ad. CONSENTYX right now has Cyndi Lauper, so there are different commercials that you could see in that space. It also includes multiple sclerosis, uveitis, Hashimoto’s, etc. There’s a lot of different things. I would say if you’re curious, we have great information on our website, as does AARDA, the patient advocacy group. Autoimmune disease is when your body is attacking itself and it doesn’t realize it. Oncology is when your body isn’t getting things, and autoimmune is the opposite, when it starts attacking. It’s common to have fatigue, brain fog, swelling in your joints; there’s a lot of different symptoms we see in people. But again, it includes quite a few different diseases.
10:44 Eugene Borukhovich
Thank you for that overview. You mentioned earlier going at-risk and doing the studies and in October, specifically for lupus, you guys published an RCT. And I’d love for you to describe a little bit– let’s not get into the details, I know you’re an engineer at heart– the RCT setup. You have a combination of digital coaching, content, etc., so maybe you can talk a little bit about the RCT published and what you achieved there?
11:13 Melinda Decker
Yeah, absolutely. We had two publications last year, which is actually very exciting for a small company, and the second one was in JMIR in the fall. It was focused on lupus patients, which is where we actually started our research. Lupus in particular is underserved. For example, among women of color, there’s a large population that is on government health insurance. There’s a really, really unmet need, and that’s where it started. This predates me. I think it was through some of the accelerator work that got Mette connected up in Louisiana and New York, and did some of the early work in lupus that led to what we have now.
In general, setting up the RCT is making sure you’re testing the Mymee program– which as you said, is a combination of an app, data analytics and health coaches– and we can get into more details about the value of that later, versus standard of care alone. Do we see improvements versus what people are on? People are generally on medications for autoimmune disorders, so we’re not replacing that. It’s just an addition, which is actually critical to test if they can get better. In lupus, it’s very common to have high steroid use– for example, prednisone– and everyone knows the long-term effects of prednisone or other steroids are not great. [We want to get] people to have a lower dose or come off of steroids altogether. A lot of people end up using steroids, high-dose steroids, for months, every year, who have diseases like lupus. That’s actually some of where it started.
12:37 Eugene Borukhovich
You mentioned earlier that you have a direct-to-consumer offering and you’re talking to employers and other channels, but at the end of the day, it comes down to that individual. Back to my comment earlier, I’m hoping that outside of our Digital Health community people are listening. Can you walk us through what happens as an individual if I sign up for Mymee? What is my experience? What does that look like?
12:59 Melinda Decker
You come to our website and you enroll, and you answer a couple questions. You schedule time to meet with a Mymee team member who gathers additional information, and walks you through an app. We are all about outcomes. We are very focused on the fact that this is a true digital health program that’s trying to change outcomes, so we actually take baseline, patient-reported outcomes. So we ask you about things like how you’re sleeping, fatigue, etc., because we want to capture that and see how you’re doing in four months, or eight months, or a year. That’s also important data for us to have as real-world evidence. You answer some of those questions.
You then log into the app and do three days of baseline tracking– just an idea of what food you’re eating, do you eat lots of little meals, do you eat a few meals a day, things like bowel movements, how regular you are– we just want to track that. Then you meet weekly with a health coach. Many people do it for four months or so, where they meet weekly with a health coach.
The [plan is] tailored over time; with tracking, we’re trying to identify what triggers [a user has], food and environmental triggers. We all know behavior change is hard, so we want to make sure that you’re motivated along the way to keep participating and can see the changes that come from that. You meet with your coach, and the initial meeting is around 45 minutes, but after that it’s 30 minutes a week. They customize the app to what you’re looking for. For example, if you’re trying to figure out if chicken or corn is your trigger, those are the only couple things you’re tracking that whole week. You track them and you track any symptoms: bowel movements, water intake, those kinds of things. Then you meet with your coach again, and by the end, we find that at eight weeks, over three-fourths of people have seen an improvement in their symptoms.
We’re all focused on doing it in your own words with your own goals. If your goal is to take your dog on a walk, or to get out of bed with less morning stiffness, those are the goals that we help you work on.
14:58 Eugene Borukhovich
It’s interesting because what you’re describing goes into my next question. Are you considering yourself a DTx? And where does it fall in line between the prescription DTx versus disease management 2.0? The new breed of companies? I’m curious, since you’ve been around the block, in your two cents on it.
15:22 Melinda Decker
So we have historically been a digital therapeutic, but as you note, we are going direct to consumer, over the counter. How do people want to look at that? We are available. We do not need to be FDA-regulated because we’re treating symptoms of disease, not disease itself. Or trying to improve the symptoms, I should say, not treating them. Because of that, are we a digital care program? Are we a digital health program? I would probably lean more towards that.
Obviously, all of us, Mette and I, have been super active in the digital therapeutics community. The question long-term, about do you want to be reimbursed as a prescription digital therapeutic, I think is a question many folks are asking. Some of the folks who’ve had the most success, some of the companies and products, have actually gone the over-the-counter, self-insured employer route. I think we are all eager to see companies like Pear and Akili have success with prescription digital therapeutics and try to make sure everyone understands the value that they bring and have it reimbursed in that way. But right now, we are living in some of that grey space and seeing where that goes.
For example, David from Click Therapeutics made a comment about the price that they’re reimbursed at as a combination of the value that they bring and the cost that they save. I think that’s some of the question too: will people pay differently for different types of programs? If you could, for example, reduce hospitalizations and healthcare utilization by $25,000 and improve outcomes, could you see reimbursement at that level? I think people are very curious. And would prescription digital therapeutics versus digital care programs make a difference?
16:59 Eugene Borukhovich
Part of the journey as an individual is the digital platform, but there are also health coaches. You guys are going direct to consumer; you don’t need a prescription for your service (or through the self-insured employers). I’m not negating the need for doctors and nurses, but just for a second, I’m putting them to the side, because you are going direct to consumer. Can you talk a little bit about the health coaches? Selfishly, with YourCoach.Health, we have 1000+ coaches on the platform, so I think we believe in the same thing. Can you talk about the benefit of health coaching on top of the digital tracking?
17:36 Melinda Decker
Absolutely. So we find that we have tremendously better outcomes when we have humans involved. These are humans who understand your experience and can help motivate you along the journey.
There’s two things when looking at a program like Mymee: one is in identifying the triggers, and the second is sustaining behavior change. As all of us who’ve worked in diabetes in the past know, the behavior change is the bigger issue. We all know that we should drink less and eat less sugar and fewer carbs and those types of things. But it’s hard to actually make that change.
The same is true in changes to your diet in autoimmune disease, for example, or in your lifestyle: environment, stress, or other things you’re doing. What we have found with the coaches is that we get much better results. People stay committed to the program, they get encouraged along the way, and they get supported in the behavioral change that they need to make in order to maintain the lifestyle. For example, cutting out chicken from your diet or reducing dairy or some other things that people see as triggers.
18:32 Eugene Borukhovich
I’m going to jump back to your history of two decades in pharma. I’ve been asking all the guests, does DTx swallow the pill inside? Or does a pharma company swallow a digital therapeutic or novel service? You can argue that if you have a molecular asset for one of those 80 diseases, what you guys are doing is a patient support program on steroids that shows outcomes. So I’m curious about where your head is on the hypothetical future of the pharma and DTx relationship (and specifically for Mymee).
19:12 Melinda Decker
I think it depends on the product and where they’re headed. To me, some of the places where it may logically start some of the partnerships between [pharma and DTx] is when there’s a product that needs to differentiate or demonstrate additional value.
Imagine that you’re forced to enter in a market of IBD products, for example, and you have similar efficacy or similar value. If you partner with someone like Mymee, and in combination show even better results like better improvements in outcomes, even better health care reductions in health care savings, and those types of things, that’s where it’s ideal.
The other piece is in managing adverse events. So if I use the example of Mymee, we know that a lot of the immuno oncology agents work by activating your immune system. Unfortunately, sometimes a side effect is that they over-activate your immune system and end up having autoimmune disease-like characteristics. Of course, we know that we want to kick cancer’s butt, and we want to keep people on the therapy. If we could manage those ADs, it would not only keep people adherent to those medications but also reduce the cost. They wouldn’t have hospitalizations due to, for example, a Crohn’s flare or a Crohn’s-like flare that was induced, or something like that– an IBD-related side effect. Those types of things are where there’s tremendous partnership.
One of the challenges with pharma is also working with some of the smaller companies. Right now in pharma, unless it’s a multibillion dollar product or has scientific capacity, it probably won’t get prioritized. Unfortunately, right now, with most of the DTx companies (on their own), the products tend to be forecasted for hundreds of millions, not billions of dollars in peak year sales. As an add-on, or at a small to midsize pharma where a $400 million product would be a great product, that’s where some of the opportunity lies in the near term, in my opinion.
21:11 Eugene Borukhovich
Well, it’s time for a question from my journalistic partner on this podcast, Brian Dolan, who is the founder of Exits & Outcomes, and as I like to call him, the digital health detective. Let’s see what question Brian has for our guest today.
21:25 Brian Dolan
It’s still early days for digital therapeutics, and almost everyone seems to know each other still. As Mymee set out to commercialize its products, did you find that other digital therapeutics founders and executives were helpful as informal advisors?
21:41 Melinda Decker
Thanks for the question, Brian. That’s a great one. First off, I’ll just say absolutely. The digital health and digital therapeutics community is amazing. And clearly, we have some things where we’re competitive, and we also have some things where all ships rise. If you track some of the people, we have people who’ve worked at multiple digital health or digital therapeutics companies. They jump around, and we all know our paths may cross again in a couple years somewhere else. The community has been fantastic. We’ve learned a lot, and we share best practices. There are many of us who are advisors to other digital health companies. Some of the Mymee advisors we mentioned, Mike Payne, for example, is one of the Mymee advisors. He worked at Virta before and at Gilead, and is now at ZOOM+Care, and he provides fantastic advice on things they’re doing, insights from that community.
22:32 Eugene Borukhovich
I’m gonna chime in here. When Brian asked the question about the community, that’s actually my hope and goal for this podcast, that this goes beyond this fast-growing community to the masses. This is a limited series, but I’m honestly tempted to continue this because now I’m getting a bunch of inbound, amazing entrepreneurs around the world. So you know, stay tuned– maybe, maybe not. We started with you, Melinda: who are you, what brought you to the DTx industry and Mymee specifically. But I’d like to also end this podcast with you and what gets you up in the morning. What is your why?
23:14 Melinda Decker
So as an engineer, I could have gone into agriculture. I could have designed widgets or Styrofoam cups. There’s a lot of different things– winemaking! I mean, who doesn’t love wine, right? There’s so many things I could do, yet I chose healthcare, because what an amazing experience it is to improve patient outcomes. To actually result in positive things in people’s lives, and put patients first. I gave the example of talking about Enbrel earlier. I happened to be the head of consumer globally for that product. One of the things I loved was, I’d be over in Barcelona at a patient event with Jane Seymour doing some great PR, and I’d be the only person from the company there. The patients would come up to me to thank me and say how Enbrel had taken them from being bedridden to playing soccer with their kids again. Autoimmune disease tends to actually hit people young, in their 30s and 40s. This isn’t your grandma’s disease. That experience is just the amazing impact that you can make on things like patient burden, user experience, and everything else– to make not just the outcomes better, but producing the medications, or the treatments, or the digital care programs. So I’m passionate about it. I love what I do. I think most people who know me know that I have a tremendous amount of energy. When I wake up in the morning, I love to go to work and make these connections and try to help people be empowered to be the best they can be.
24:37 Eugene Borukhovich
That’s what I heard, your energy. I absolutely validated that on the Shot of Digital Health, and I revalidated that today. You’re more than welcome back here to Barcelona, once things settle down a little bit with Mymee. I’m sure there’s stuff to do here as well. So thank you very much, Melinda.
24:54 Melinda Decker
Thanks, Eugene and Brian.
24:57 Eugene Borukhovich
Thanks so much for tuning into Digital Therapeutics Edition: Digital Health Today, a production of Mission Based Media. Be sure to hit that subscribe button to this podcast on your favorite podcast player, so you’re then automatically notified when we post our upcoming episodes, where I speak with dozens of leaders and trailblazers who are forging the path for digital therapeutics. If you’d like to learn more about YourCoach.Health, or Brian Dolan’s Exits & Outcomes, you can always find the links to this and more in the show notes for this episode. You can connect with me personally on Twitter @HealthEugene, or follow my journey of writing my first book, Hard Pill to Swallow at hardpilltoswallow.substack.com.
I’m Eugene Borukhovich, and catch you next time.