Episode #594: Transforming Rehabilitation-Ashok Gupta on Building Theranow's Tech-Driven Platform

0:01 This is Pete Moore on Halo Talks nyc. I have the pleasure of bringing to our podcast Ashok Gupta, originally from Gold's Gym, India. Just kidding. Now at Theranow we're going to talk about the telehealth platform. We're going to talk about the old days of the fitness industry and how you got started and coming in from from Texas. Welcome to the show. Oh, it's my pleasure. Thanks for having me, Pete. Awesome. So give us a little background on, you know, how you started this new company and where you saw kind of the white space to move into. Oh, definitely. Yeah. This new company is a little bit old now. We've been on thera now for almost nine years and it started out of necessity. So I'm a background doctor of physical therapy and I was all across like different settings in the United States. I work for Veterans affairs hospitals system right in the middle heart of the Manhattan, New York and then also worked in the small towns out of the Sioux City, Iowa. So I got to see the healthcare inside out and then realized like the one of the biggest problem in the healthcare even then and now still it has not been solved is access to care. People are driving 30 minutes to hour to get to the care. And me and my wife, also doctor of physical therapy, my co founder, we were sitting on a couch and watching a commercial and we saw mentally health telehealth and like

1:32 what is stopping us from providing care via telehealth for the patients for physical therapy? And then the first word physical itself came in and then we're like that's not possible. Then we started thinking a little bit more and 10 minutes later we're like yes, we can help a lot more people in a lot more different ways. And when we become an adjunct to an existing physical therapy clinics or hospital systems, we can really help a lot of people. And that was a day. And after many, many pivots we are here. We are helping thousands and thousands of patients on a daily basis today via the telehealth physical therapy. Awesome. So are you actually partnering with groups that have bricks and mortar and you are their telehealth affiliate or are you going direct?

2:18 Yes, as a business model wise, we do work for hospital systems exclusively. We enable their telehealth divisions. So they already have physical therapy departments and then they have a very good presence like big name brands like Providence Health Systems, Arden Health System, University of Texas Healthcare. They already have existing physical therapy brick and mortar clinics but they're facing a lot of different restraints for this time. Like one the Building can only occupy so many people. They can only actually service a certain geographical region and then certain type of staffing. Staffing is one of the biggest issue in America today.

2:58 So that's when we come in and play. We bring in technology. We have 400 plus therapists that work under our network and we provide virtual care to the patients from all over the country. And all that's being done over, you know, a zoom or a private video channel or how's it being done? That's a very amazing question actually. This is where I always talk about like when people think of telehealth, they think of like what we are doing right now is like meeting on a video call or a zoom call and then that will suffice telehealth. And that's why the common notion is physical therapy, therapy can't be done via the telehealth. But then when you provide the right tools, this is totally a different story. So we had to build our own native platform ground up to be able to provide physical therapy thousands of miles away. Like you're sitting right now in New York and I'm here in Texas and still be able to provide you care. If I can see how much you can move, how well do you move, I can document that that movement is. And then over time also, not only in this one hour session that I'm providing you, but I can also see beyond my one hour session how can I engage with you. So that means your quality of home exercise program and things like that. So we had to build the entire suite of tools ground up because nothing existed back then. And until today the technology and development in this space is happening about how do we replace the therapist instead of like how do we augment their

4:32 ability to provide care remotely. So that is the mission statement of there now is our core delivery of care is exactly the same what we have been having for decades. It's just augmented by technology and limiting the barriers of being so far away from each other. This is Pete Moore. I want to let you in on a little secret. There's this company called Promotion Vault and what they do is they give out rewards from retailers that allow you to incentivize your members without having to do zero down and one month free or giving away shakes or giving away T shirts. What you want to do is build a rewards program that lasts, that people value and that doesn't discount your own products and services.

5:19 So here's the deal. There's something called Rewards Vault. The Rewards Vault is going to allow a member to set up their own profile. They are going to answer questions, you are going to get those answers, you're going to be able to target those members and you're going to reward them inside your club, inside your spa and outside of the club and outside of the spa to get them to become loyal, to get them to pay their monthly dues and to be rewarded properly for the actions. A lot of companies are cutting back on rewards. You shouldn't be promotion vaults your answer. Trust me, this is real. So in the, in the health club space there were several groups out there.

6:05 Fizz Moto, I want to say Dave Ganlon was one as well as TRX maps. So basically you were able to stand and do, you know, like maybe like three squats or something. It would like track different muscular skeletal points, data points. Is that part of your assessment or evaluation or how are you actually, what, what native tools did you build if you're allowed to tell me? Oh, absolutely. We love to. Thanks. Yeah. So I think before I even specifically talk about the tools, I need to talk to you about the journey of a patient or a journey of a disorder. So one is, is like you and me right now, we are not in a pain. We are healthy living and then our goal is to be more healthier than what we. That's called as fitness and wellness. The approach at that time is totally different. You are analyzing athletes, you're in a golf simulator and you are actually like analyzing a very high functional movements. That's the one part of it. And the second is like you got hurt a little bit, but you're not at that point where you really need doctor's help. And that's where the early intervention and that's where you see a lot of products out there where you stick a sensor on top of your body and then actually exercise with the app. And then all you are doing is like some recommended programs or protocols and they work great in that particular.

7:27 But when you actually are at the level where you need to meet the doctor and then the doctor writes you all these different prescriptions, they want to do a surgery or prescribe you a higher level of care. But before that they want to actually perform a real physical therapy on you, that's when either the clinic or us come into play and we start doing assessments. So when we talk about assessments is like is the physical therapy evaluation. It's a combination of active motion, passive movements. Obviously when we are in telehealth, we replace the passive movements with functional movements. And when you talk about technology in it we bring in computer vision. So you may have seen some forms of computer vision, but their application of computer vision is very different. So like if you go walk into a grocery store, they use computer vision to see if you're shoplifting or not versus a wellness person would probably use it to count the reps versus our computer vision is about like how well your functional motion is and then every single joint in that compounding movement, how much is that specific joint moving?

8:34 Is it in the right order or in the sequence? And that's what is provided to a physical therapist in real time when you're. I'm actually working with you so I'm able to provide you a right guidance and then actually work with your rehabilitation. Let me just ask a couple quick questions. So I understand this is the sensor that you're referring to. Is that something that the patient needs to have on their computer or is it able to be done through your system? So there are two different approaches. One sensor is like a hardware. We don't use that approach. I love those sensors too, but again they're amazing and they're bulky and sometimes even they're a patch. Small patch. But again it's 100% patient driven self care. That is great for early interventions. We specifically work with the prescribed patients that are for physical therapy. The tool that we use is computer vision. So you don't need any specific sensors. Like right now, how we are doing a video telehealth. Computer vision AI is able to analyze where the body parts are and how much are they moving, in what order they're moving. So you literally. Other than your phone or your computer with the Internet and a camera, there's nothing special equipment you need in your home to perform our sessions. Got it. I just want to speak. That was the best approach of dissing somebody else's hardware in the nicest way possible that you just did and say, okay, this is how we do it. That was awesome. Very, very eloquent.

10:00 Very eloquent. I like that. I like that. That was just so good, man. Because I was like, what do you love this technology? Like no, no, no. He's going to throw it under the bus. Okay, Just took a little while. Thank you. There's nothing wrong or the other. It's just one. It's just how you. It's just how you approach the question. The answer there was just like priceless. For Halo talks NYC Gupta style. Let's call that. Oh, here you go. I love it. So. So you're not disintermediate district intermediating any of the physical therapists, right? They work with you, Are they working with you through the hospital? Are they actually employee or 1099? And then the other question is how much volume do they get that it's like makes sense for them to work with you on a remote basis versus, you know, in like an ATI or Sprints and more. Oh, so you know the space very well.

11:00 Yeah, no, it's a great question actually. Like the way a normal day for our most of our clinicians is 100% on themselves. We have a lot of therapists and some state require us to have therapists on W2. That means like a literally full time employees. They're like California is one of them. So you have to have them. But there are other, other states where a lot of therapists are moonlighters. And then to work with us on a 1099. So from the patient perspective literally depends on the need in which state the therapist is in. And then how many clients do we have. But so far we are always hiring. So with this, I want to talk to you about the piece of tech. We are a tech forward service company.

11:46 I do not disguise as a tech company when at the end of the day what we offer is a service which is our physical therapists, our clinicians, speech therapists, occup therapists are providing care to the patient and that is what we are actually billing and getting them paid for. So what we started to see the demand and supply was a problem. We had a lot of clients and then clients had like millions of lives that they were serving. So the patient volume was rising very fast between identifying the therapist, credentialing the therapist, training the therapist and bringing them on a platform. It was taking on an average 14 days for us. So early this year we decided we need to solve this problem to be able to sc.

12:27 And you would be surprised. Last week we started this process and finished this entire process in 12 hours. From job application, onboard a new physical therapist to your system, onboarding, credentialing and training every single thing in 12 hours. How did we do it? We created this entire interview process as an asynchronous software platform. So you could actually go on theranaut.com, go to the job section, apply for it, and then it automatically screens you in or out and then you can apply via asynchronous video. And then those interviews are getting assessed in real time and then actually like you finish entire onboarding right there itself. So that was like how we always talk about technology is great. It's just like when you can put this in the right workflow for augmenting your problem solution.

13:17 So let me just stop here for a second. As you develop these types of tools for yourself, when do you stop and say, wow, like, we just created this onboarding recruiting tool that might be like another path to like spin off into another company. Does your brain work like that? Sometimes be like, let me just do what I'm doing. But. But like, this could probably be its own. On its own. You're really getting into my brain right now. That happens every single day. Yeah. Okay, good. Yeah. All right. That's good, man. Bro, you like Golden Ship Media, man. Like, we're like tight already. It is so hard. My wife has to bring me back. Always is like, focus. This is, this is what you do. This is your problem statement is. And then you got to get back to the reality that like, we're not an ATS provide, but the ATSs out there are not built for our problem statement. So then you have to build something for yourself.

14:10 So a couple more questions. So we work with this company called Zeel Z L and they are a tech enabled medical massage, but they actually send people to the homes. They've got relationships with hospitals and the va, but they're actually physically sending people into the home to do or into the workplace to do. Do you get that kind of demand also? Are you saying, like, look, I got a gate around my, you know, my therapist that they're not, they're not leaving the virtual kind of, you know, domain? How do you think about that? I love that model. There's definitely a need for that specific model where you take the clinician and send it to the patient's home. But it's a logistical nightmare.

15:00 You can't service entire America with 400 clinical therapists. You would need this to do the same amount of volume what we do today. We'll probably need 5 to 10,000 therapists on our network. And then from the financial perspective, if you look at it, it's almost the same in the reimbursements or when the revenue side if you look at the business. So technology first is our motto all the time. And telehealth is like one of the best. Got it. And then a couple of just quick questions related to that because I'm super interested in how this model kind of evolves over time. Does the hospital say to you, hey, look, this is a telehealth session, so I'm not paying you the same amount as an in person or are you Able to say hey look, I'm actually delivering the same amount quality of care. So it's not really negotiation on like the hourly pay rate or comp.

16:05 That's a good perspective. But when you come into healthcare, things are. I'll give you a great example of like how physical therapy is evaluated and paid for. So if I'm having you a session with you, I'm paid on a base of 8 minute rule. Every 8 minute I'm able to bill a 1 unit and it goes up to 22 minutes, 8 to 22, 1 unit and then 22 to 37 and then things like that. And the amount of a time, whether I'm meeting you virtually or I'm meeting you in a clinic or I'm meeting you in your house is exactly the same. So the delivery, the cogs or cost of goods sold here is the labor and the labor is exactly the same which the CMS and every regulatory body understands. And on the side is like okay, someone can say okay, so your cost is same, so our reimbursement should be same. But on the flip side of it is your quality subpar. So to that answer is you would not have seen many studies so far. But I can talk to you specifically from our data itself is our mcid, minimally, clinically.

17:15 I always get this One wrong is in a simpler word is objective measure of clinical impact of any modality. And when we compare our clinicians and our service to the clinic and when you go to the clinic it's exactly the same and in some events it's even higher. So it was a very easy case to make in front of the regulatory bodies and others. So till this date we get paid the same whether you come to me, I come to you, or we meet virtually. Good, I'm happy to hear that. One, because I like you and two, because it's fair there. So one other question related to this. If I have a physical therapist and I, you know, I had a accidents or worker, workers comp. And I'm building a relationship with a physical therapist, you know, locally are you, is the patient able to prioritize or like ask for certain therapists and like they become like part of their like client list or is it all just like hey, whoever you get, you know, on your repeat sessions. Right. We understand the stakes are high when you're treating patients telehealth, we can't touch them, they are not in the same room. So we 100% make sure that the patient starts with the one physician clinician and then finish the entire episode of care over the six to eight weeks or period with the same person. Oh, that's awesome. Yeah. We do not use assistance. So you would see this happen a lot as well.

18:45 Is like you go into a rehabilitation setting and then the one clinician will start and then their assistants will actually come in and finish off the session or they will be the one seeing you for next seven sessions and then the clinician comes back again. So because again, as I say, the stakes are high. Telehealth has some limitations of its own. To make that fulfill, we only and only use Doctor of Physical Therapy or Masters of Physical Therapy and then higher from the education perspective. This is Pete Moore. Here's the last tip for you of the podcast. We are partnered up with a company called higher dose higherdose.com they are the leader in workout recovery products. Infrared technology, LED light masks, neck enhancers and other products such as PEMF mats and sauna blankets. If you have not gotten on the workout recovery train yet that your time and your stop is now. You got to get these products in there before these workout recovery and spas end up saturating your market.

19:52 Having your members walk out of the club and going into one of their locations for 200 bucks per month where they're paying 39 to you. Let's become an expert in workout recovery. If we are already an authority in workouts, Higher dose, check it out. There's a wholesale code and we look forward to helping you augment your products and services to meet the demands of your members. And hey, let's get people happy, healthy and sweating and the recovery should be just as good as the workout. Last question related to you started the company nine years ago. Did you take on any private capital or do you self fund this?

20:36 Not 100% bootstrap, but we kind of fit in the definition of bootstrap because we did family and friends round and nobody would pay us. We couldn't raise capital and we only had two options, do or die. So obviously die was not an option. So we bootstrapped ourselves 100% from that point on and today we are a profitable company and we are doing a significant amount of revenue and hundreds and thousands of patients every day on our roster. Sir, that's amazing. It's really good. And who, who do you. You. You founded the business originally. Did you have any other co founders or who'd you hire first? I was the first hire actually. My wife is a co founder and I was an operator and she was the brains and the CEO of the company and we started to grow as a, as a couple and now we have a four year old and a five year old daughters. So she, she had.

21:36 So we defined our own ways of like handling Thera. Now, now I actually have. If you have seen my LinkedIn, I recently stepped up and then became a CEO of the company. So that's what my role is today. Excellent. Good stuff. And as the four and five year olds are they thinking about getting into physical therapy or are you grooming them for a succession plan? Usually people would say it's a little too early but actually fact is that yes. So outside of therap now my wife actually she's a doctor of physical therapy, my co founder but she runs senior care assisted livings in Texas so she owns and manages them. So our kids are entrepreneurial kids. So they do not hear normal conversations on a dinner table. They are always talking about here and listening about stuff that normal 4 and 5 year old would not be part of. It's refreshing to hear instead of like Fortnite or Call of Duty or something. Keep going, tell us the story. Oh, I was just going to tell you this one. I always bring it up because when we go to the hospital type of settings or assisted livings or nursing home, we usually are scouting or visiting the building trying to see if this is a good acquisition target or not. This is outside of a tech and theranow business.

22:57 So obviously you don't get the childcare all the time. So we take the kids with us. So one day one of my younger one was actually like having a ear surgery. We go to the hospital for her ear surgery that day she's like are you here for a deal? I'm like no dear, we are here for your surgery. That's awesome. So that's the kind of kids actually are growing up in our house. Deal. All right, we'll catch them. We'll catch them. On the next ter now episode 10 years from now we'll check in, see how the, how the internships are going. Boss. Awesome. Sounds like it might happen. Hey, so let me just ask you the last question here. We work primarily with health clubs, big box sports complexes, boutique fitness studios. Is there any like tuck ins or relationships that may be, you know, not as typical as you would see from just like a hospital standpoint from maybe like a workout recovery or you know, rehabbing certain, certain you know, athletic injuries that we should be thinking about you for.

24:03 From the physical therapy and fitness always go hand in hand. There's like this is circle or like a journey of a patient life cycle. So from that perspective, absolutely. Anytime we would love to plug in our network in any other product that where we can enhance the patient outcomes. We love it from the product market fit. It took us like four years to really understand where our product works. And we realize our product is in the hospitals. So when it comes to money and our business and revenue models, like now, we have understood what works the best is a large hospital systems. They have a lot of patients and not enough therapists and not enough buildings to be able to put those patients in. And that's when they need our help to expand their access and their services.

24:52 Yeah. All right. Sounds good, man. Well, thanks for coming on the show. We're excited about what you're doing. We'll. We'll send you a couple of intros also to a couple of our clients that might make sense. And then Dave will get the show notes up and would appreciate it. See if we can help you and let me know if in any way I could assist. We might. We might hit you up if we need any. Like, if I need to like, say something bad about somebody in like the nicest way, I'm gonna hit you up because that. That was awesome, bro. I like telling you I really enjoyed it. No, I appreciate it. I'm just getting is my new gig. So I'm the guy who's actually is building. I either treat patients or I build stuff. So this is my. Not a comfort zone. I'm out of my comfort zone right now and starting out to build a brand around my company now. Yeah.

25:39 All right, well, I'm sure it'll work out. Just, you know, be patient. Know that the progress is happening. All right, man. Keep doing what you're doing. I'm glad we connected. Sounds good. Thank you. Appreciate it. But vehicle, let us see. This is Pete Moore on Halo Talks, your captain speaking. I am the founder and managing partner at Integrity Square. We've been around now for 15 and 1/2 years. We have been helping people like yourselves get capital, do mergers and acquisitions, consulting, strategic advice in the health, active lifestyle and outdoor halo sector, trying to help as many entrepreneurs as possible get to the next level, take that inflection point and be the force behind your growth.

26:26 We are helping companies that have at least $3 million of EBITDA, around $10 million of revenue. And we are positioned to help you get institutional growth capital or to negotiate deals with strategic partners. If you go to integritysq.com forward/isq, you can see our capabilities. Deck happy to set up a consultation at any time that is free of charge, and we look forward to helping solve obesity, loneliness and diabetes. Go ahead, Sam.