Interview with Jonathan Palley, Spire Health’s Co-Founder and CEO — How a novel patient-friendly technology is set to transform the continuous remote monitoring market for respiratory patients

Connected digital health apps, wearables and tracking sensors have started a new era of healthcare with user-generated data being the core of patient-centered business models. With over 500 million Asthma and COPD sufferers today, the global digital respiratory market offers a huge opportunity for Pharma, med-tech and start-ups to offer tailored innovative patient-friendly solutions to empower respiratory disease patients and transform the remote patient monitoring market.

Asthma and COPD are two primary respiratory conditions that affect nearly 8% of the global population. According to Research2Guidance’s “The Global Digital Respiratory Solutions Market 2009–2023” report, 210M chronic respiratory disease patients can be targeted with digital respiratory solutions already today. Although the size of the opportunity is huge and potentially even bigger than the digital diabetes care market, the digital respiratory market is still at an emerging stage with many digital offerings being at the stage of formation or yet to be commercially launched.

With chronic respiratory diseases representing an overwhelming burden for healthcare ecosystems, remote patient monitoring solutions are becoming key vehicles for significant cost savings, taking up the challenge for disease prevention and management. These solutions also play an invaluable role in assisting patients and in most cases help them manage more effectively their conditions every day.

A leader in delivering continuous clinical-grade health-sensing solutions for the remote patient monitoring market is Spire Health. We had a chance to talk to Jonathan Palley, Co-Founder and CEO of Spire Health about the company’s business model and their novel technology that is set to influence the respiratory patient monitoring B2B market and clinical care, as well as to learn his view on the reasons behind the low adoption rate of digital health respiratory solutions by Asthma and COPD patients.

Enjoy the interview.

Research2Guidance: As a short introduction to Spire Health, could you please share the story behind it and what Spire Health’s service offering is?

Jonathan Palley: Spire Health is a pioneer in continuous respiration sensing and high-adherence, patient-friendly ambulatory monitoring.

We work with partners across a range of health conditions, including COPD, congestive heart failure, asthma, etc. However, we are uniquely and strategically focused on respiratory related diseases and how to empower these patients effortlessly. Being a part of consumer wellness space with our first product, Spire Stone, a stress management and activity tracker, we saw that in many of today’s wearable devices there are a lot of limitations that stop patients from using the devices. Remembering to charge the device is just one example.

Over the last couple of years, we validated and scaled our novel respiratory sensing technology for continuously measuring breathing with no time commitment from the patient. At Spire Health, we have figured out how we can get very accurate respiratory signals in a very patient friendly and unobtrusive way.

We recently introduced our latest product, Health Tag, the smallest health-tracking consumer device that discreetly adheres to clothes while providing real-time, personalized patient data. With the opportunities in the United States, particularly the new remote patient monitoring reimbursement policy, we are very focused on deploying our technology to help chronic disease patients stay out of the hospitals. We provide a solution that is very patient friendly. The patient doesn’t have to do anything while Health Tag continuously captures and analyzes his/her respiratory detailed patterns, pulse rate, sleep, movement, etc. The data can be shared with physicians and healthcare staff in a very interpretive way so that they can understand when things are not going right for their patient and when it makes sense to have, for example, a follow up visit.

By deploying over 150,000 units of Spire Stone and Health Tag, we have been able to optimize our solutions, further train our machine learning models on billions of respiratory data points to better serve and really empower respiratory disease patients.

Research2Guidance: Can you please elaborate a bit more on the “patient friendly way” point?

Jonathan Palley: To better understand the “patient friendly way”, we first looked at the market challenges. Different market players have tried to address the remote patient monitoring space for quite a while in various forms. It is very hard to be successful because of the very low patient adherence.

When you ask a patient to do something, particularly every day at home, he/she is very unlikely to do that, especially for a long period of time. It is very challenging to motivate someone to charge a device, or to remember to switch it on, or to stick something on their body for monitoring their health. More often than not, that doesn’t work.

If a company really wants to successfully deploy a remote patient monitoring solution, it needs to collect accurate measurements of a variety of biosignals without requiring the patient to do anything.

How do we at Spire Health address this challenge?

We have spent many years developing our unique technology called Health Tag. The concept behind it is very simple: design a solution such that all a patient needs to do is just continue to wear the clothing he/she wears. Health Tag is a little tag that our customers can stick on the clothes they wear more often (available in 3-packs and 8-packs). For example, such clothes can be pajamas, or for women it is a bra, for men it is underwear. Once Health Tag is adhered to their clothes, the patient doesn’t have to do anything else. Our device lasts up to a year and is washer/dryer safe.

This is our patient friendly concept. Our solution can passively remotely monitor patients’ health and provide valuable real-time insights to their healthcare providers. There is no need for behavior changes and one still gets accurate continuous data and empowers the patient.

Research2Guidance: Does Health Tag have direct market competitors?

Jonathan Palley: Health Tag has no direct competitors. This is patented technology that we have spent the last 4 years developing. We are the only one in the market that is able to build active sensors that adhere seamlessly to someone’s own clothes and provide invaluable continuous patient health data (processed and raw) and guidance while passively monitoring a wide range of factors. We use Bluetooth to transmit data from Health Tag to a gateway device (smartphone), which then transfers it to the cloud, where it is accessible by healthcare providers and / or researchers. I am proud to say Spire Health is ahead of other market players.

From a broader market perspective, we do compete with remote patient monitoring solutions. However, I believe that Spire Health offers adherence, comfort, and convenience to patients that is simply incomparable; patients often have to replace competitor’s devices every week, whereas they do not have to do anything other than just wear their clothes and it lasts for a full year.

Spire Health has two unique technologies: one is Health Tag and the other is our respiratory sensor. Because of that, we can get a full wave of respiratory signals — it is like ECG for breathing. Both our technologies are patented.

Research2Guidance: Do you have a different market strategy for Health Tag and Spire Stone?

Jonathan Palley: Spire Stone was a consumer wellness product that was really designed to prove our respiratory sensor technology. At present, our core focus is the Health Tag solution. This is what the company offers to the patient remote monitoring B2B market. We partner with healthcare providers and insurers.

We have done extensive validation studies to ensure Spire Health’s continuous respiratory monitoring technologies are clinical-grade. We continue to collaborate with healthcare organizations on rigorous clinical studies using Health Tag in regards to COPD, asthma, anxiety, etc.

Research2Guidance: What is your business model?

Jonathan Palley: Spire Health has a B2B business model that consists of two parts: one is working with providers to deploy Health Tag devices and the second is providing clinical research solutions. Our clients are typically providers, payers, and researchers / research organizations.

Spire Health Tag is an intelligent health tracking solution that works with our free iOS companion app to continuously track patients’ progress 24/7. It remotely monitors patient health and provides actionable real-time insights and recommendations via professional dashboard to healthcare professionals. Health Tag accurately measures respiratory rate and respiratory rate variability, heart rate, sleep stages, etc. Healthcare teams can review the customized patient data and send notifications, as they get notified when the data indicates the physician has to look more closely at that patient. The data, for example, can detect deviations from personalized baselines and trigger alerts and also potentially identify respiratory distress.

We offer different Health Tag packs, starting with a 3-pack for $129 and an 8-pack for $299. We have a membership option that provides personalized reports and other benefits for $10/month. We do have special corporate / healthcare pricing available for larger purchases.

The second part of our business model is providing Clinical Research Solutions via our Spire Health Research Platform for clinical trials. We have an increasing number of researchers (pharmaceutical and institutional) that are researching different disease factors. These healthcare stakeholders want to have a high quality, comprehensive and continuous data from participants in their studies. It is on a participant per month basis that researchers can get devices for their participants in their studies as well as access to an API and research management dashboard with access to all the data (processed and raw) from Spire Health Tag.

Our business model and Health Tag solution align very closely with the new remote patient monitoring codes that have come out from the Centers for Medicare (CMS) in the United States. CMS is now reimbursing physicians for setting up remote monitoring equipment and for the device’s daily reports on patient health. There is a code for device data capture and there is a code for the physicians reviewing the data.

Research2Guidance: Do you have a user retention strategy and how you engage with users?

Jonathan Palley: We are working with healthcare providers and insurers. Our Health Tag solution provides them with valuable and accurate actionable long-term clinical-grade insights that help them monitor and care better for their patients/members.

If we look from the patient side, a company that offers a traditional wearable remote monitor solution must come up with different ways to motivate its patients to use the product to keep them engaged with it. For example, a way to remind them to charge their device, to wear it, etc.

The beauty of our Health Tag solution is its intelligence and user-friendly passive experience. Once our Health Tag is on the patient’s clothing, the patient doesn’t have to do anything for a year. We provide replacements automatically. We charge per patient per month. As long as the patient is subscribed to our service, we will replace the device. Health Tag has not even been a year on the market, and it has already shown us that when you create a real value for the patient and the healthcare provider, they are motivated to continue using your product/service.

Research2Guidance: What countries are you concentrating on?

Jonathan Palley: When it comes to Health Tag and working with healthcare providers and insurers, our focus is the US market. However, on the research side, our Spire Health Research Platform can provide continuous, longitudinal health data including unlimited access to both processed and raw data globally. In fact, most of our clients are outside the United States.

Research2Guidance: Can you please share how many patients are using Health Tag?

Jonathan Palley: At present, there are over 10,000 Health Tag users.

Research2Guidance: What challenges are you facing?

Jonathan Palley: The market scene for remote patient monitoring is evolving very quickly. It is an exciting time allowing all market players to learn. On a broader level it is an interesting challenge of how this space will continue to evolve and how will Spire Health fit into it. Currently, with our unique technology combining clinical-grade data with unparalleled adherence, we are a market leader in the continuous remote patient monitoring market.

Research2Guidance: In our latest Digital Respiratory Solutions report we shared that today the addressable target group is enormous: Out of 500M asthma & COPD patients world-wide, 210M can be targeted with digital respiratory solutions already today, at the same time only 1% are using the solutions. In your opinion, what are the reasons behind the extremely low asthma/COPD sufferers’ adoption rate of digital health respiratory solutions?

Jonathan Palley: To answer this question, I think we have to look at what the value proposition of existing solutions to COPD and asthma patients and their healthcare team is, and then what is needed to address this market. The value for a COPD patient, for example, is preventing hospitalization. A player in this market has to offer a solution that has a real value proposition to both the patient and the provider, as the care in this case is very expensive. The question around COPD is how a solution can predict and prevent that hospitalization.

At Spire Health, we believe that the way to do that is by continuously monitoring that patient’s breathing outside the clinic in the most seamless way and use the data to figure out ahead of time when things are not going well and when a doctor needs to interfere to prevent the hospitalization. It is very hard to measure what you need to measure when the patient is at home. Spirometry, for example, is one of the COPD solutions offered in the market. In this case, the COPD patient must blow forcefully into this device, yet this can be a very difficult task when you have trouble breathing. It is extremely difficult for a patient to do this reliably and accurately outside of a clinical setting.

We saw this gap in the market and that is why we have developed our respiratory sensing technology. That is also why we focus so much on adherence. With our innovative technology, we have really solved the challenge of how to get highly accurate continuous respiratory data without the patient having to do anything. At present, we are deeply involved in some large clinical studies to prove that with our data, we can in fact predict those negative COPD events.

When it comes to asthma, there are a couple of different challenges. One is segmenting patients — those who have a controlled asthma and those who have uncontrolled asthma. A lot of asthma patients can manage their asthma effectively, but many are unable to do that. A potential reason for that might be because their medication is not working. The digital health asthma monitoring solutions available in the market today cannot tell how effective the medication is or what other factors are influencing asthma and the ability to control asthma.

Continuous respiratory monitoring has a very important role to play and will dramatically increase the importance of digital solutions. This will enable healthcare stakeholders to see how the patient is doing, whether the medicine is working or not. The real-time, accurate and continuous data will be shared with both the patient and the doctor, so the latter can decide what the best treatment is to keep asthma under control.

Research2Guidance: Which drivers do you think will further shape the actionable continuous respiratory monitoring market and adherence medicine?

Jonathan Palley: I believe there are 3 key things that are essential for the market. The first super critical aspect of the solution is for it to be passive. This means it does not require any action from the patient. Secondly, it is important to give accurate continuous data of a patient’s health condition. Thirdly, the data needs to be made actionable to the provider/to the physicians. Our solution and services have all three elements.

Research2Guidance: What is next for Spire Health? Where do you see the company in the near future?

Jonathan Palley: We recently launched the Health Tag and we just introduced our research platform for clinical trials a month ago (February 2019). Our technology is innovative and unique for the respiratory disease market, so our focus now is to scale our service offerings up. While the Spire Health Tag app is currently only available on iPhones, we plan to provide Health Tag compatibility for Android devices in the near future!

At present, we are conducting a number of big clinical studies and we think that we will be able to share some interesting results that the industry will be excited about.

Research2Guidance: Thank you for your time and for all the insights you have shared with us, Jonathan.