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

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This is Pete Moore on Halo Talks nyc. I have the pleasure of

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bringing to our podcast Ashok

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Gupta, originally from Gold's Gym, India.

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Just kidding. Now at Theranow we're going to talk about

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the telehealth platform. We're going to talk about the old

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days of the fitness industry and how you got started and

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coming in from from Texas. Welcome to the show.

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Oh, it's my pleasure. Thanks for having me, Pete. Awesome. So give us

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a little background on, you know, how you started this

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new company and where you saw kind of the white space

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to move into. Oh, definitely. Yeah. This new company is

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a little bit old now. We've been on thera now for almost nine years

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and it started out of necessity. So

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I'm a background doctor of physical therapy and I was all across

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like different settings in the United States. I work for Veterans affairs hospitals

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system right in the middle heart of the Manhattan, New York and then

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also worked in the small towns out of the Sioux City,

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Iowa. So I got to see the healthcare inside out

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and then realized like the one of the biggest problem in the

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healthcare even then and now still it has not been

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solved is access to care. People are driving 30 minutes

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to hour to get to the care. And me and my wife, also

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doctor of physical therapy, my co founder, we were sitting on a couch and watching

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a commercial and we saw mentally health telehealth and like

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what is stopping us from providing care via telehealth

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for the patients for physical therapy? And then the first word physical

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itself came in and then we're like that's not possible. Then we

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started thinking a little bit more and 10 minutes later we're like yes,

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we can help a lot more people in a lot more different ways. And

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when we become an adjunct to an existing physical therapy clinics or

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hospital systems, we can really help a lot of people.

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And that was a day. And after many, many pivots

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we are here. We are helping thousands and thousands of patients on a daily basis

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today via the telehealth physical therapy. Awesome. So

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are you actually partnering with groups that have bricks and mortar and you

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are their telehealth affiliate or are you going direct?

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Yes, as a business model wise, we do work for hospital

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systems exclusively. We enable their telehealth divisions.

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So they already have physical therapy departments

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and then they have a very good presence like big name brands like Providence Health

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Systems, Arden Health System, University of Texas Healthcare.

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They already have existing physical therapy brick and

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mortar clinics but they're facing a lot of different

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restraints for this time. Like one the Building

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can only occupy so many people. They can only actually

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service a certain geographical region and then certain type of

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staffing. Staffing is one of the biggest issue in America today.

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So that's when we come in and play. We bring in technology. We have

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400 plus therapists that work under our network and we

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provide virtual care to the patients from all over the country.

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And all that's being done over, you know, a zoom or

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a private video channel or how's it being done?

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That's a very amazing question actually. This is where I always talk

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about like when people think of telehealth, they think of like what

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we are doing right now is like meeting on a video call or a zoom

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call and then that will suffice telehealth. And that's why the

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common notion is physical therapy, therapy can't be done via the telehealth.

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But then when you provide the right tools, this is totally a

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different story. So we had to build our

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own native platform ground up to be able to provide

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physical therapy thousands of miles away. Like you're sitting right now

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in New York and I'm here in Texas and still be able to provide you

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care. If I can see how much you can move, how well do you

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move, I can document that that movement is. And then over time

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also, not only in this one hour session that I'm providing you,

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but I can also see beyond my one hour session how can I engage with

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you. So that means your quality of home exercise program and things like

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that. So we had to build the entire suite

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of tools ground up because nothing existed back

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then. And until today the technology and

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development in this space is happening about how do we

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replace the therapist instead of like how do we augment their

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ability to provide care remotely. So that is the mission

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statement of there now is our core delivery of care

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is exactly the same what we have been having for decades. It's just

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augmented by technology and limiting the barriers of

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being so far away from each other.

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This is Pete Moore. I want to let you in on a little secret. There's

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this company called Promotion Vault and what they do is they give out rewards

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from retailers that allow you to incentivize your

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members without having to do zero down and one month free

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or giving away shakes or giving away T shirts. What you want to

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do is build a rewards program that lasts, that people

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value and that doesn't discount your own products and services.

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So here's the deal. There's something called Rewards Vault. The Rewards

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Vault is going to allow a member to set up their own profile.

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They are going to answer questions, you are going to get those answers, you're going

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to be able to target those members and you're going to reward them inside your

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club, inside your spa and outside of the club and outside

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of the spa to get them to become loyal, to get them to pay

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their monthly dues and to be rewarded properly for

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the actions. A lot of companies are cutting back on rewards. You shouldn't

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be promotion vaults your answer. Trust me, this is real.

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So in the, in the health club space there were

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several groups out there.

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Fizz Moto, I want to say Dave Ganlon was one

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as well as TRX maps. So basically you were

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able to stand and do, you know, like maybe like three squats or something. It

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would like track different muscular skeletal

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points, data points. Is that part of your assessment or

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evaluation or how are you actually, what, what native

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tools did you build if you're allowed to tell

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me? Oh, absolutely. We love to. Thanks. Yeah.

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So I think before I even specifically talk about the

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tools, I need to talk to you about the journey of a patient or a

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journey of a disorder. So one is, is like you and me right now, we

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are not in a pain. We are healthy living and then our goal is to

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be more healthier than what we. That's called as fitness and

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wellness. The approach at that time is totally different. You are

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analyzing athletes, you're in a golf simulator and you are

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actually like analyzing a very high functional movements. That's

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the one part of it. And the second is like you got hurt a little

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bit, but you're not at that point where you really need doctor's help. And

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that's where the early intervention and that's where you see a lot of products out

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there where you stick a sensor on top of your body and then actually exercise

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with the app. And then all you are doing is like some recommended

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programs or protocols and they work great in that particular.

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But when you actually are at the level where you need to meet the doctor

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and then the doctor writes you all these different prescriptions, they want to

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do a surgery or prescribe you a higher level of care. But

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before that they want to actually perform a real physical therapy on you, that's

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when either the clinic or us come into play and we start doing

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assessments. So when we talk about assessments is like is the

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physical therapy evaluation. It's a combination of active motion,

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passive movements. Obviously when we are in telehealth,

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we replace the passive movements with functional movements. And when you

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talk about technology in it we bring in computer vision. So you may

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have seen some forms of computer vision, but

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their application of computer vision is very different. So like if you go

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walk into a grocery store, they use computer vision to see if

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you're shoplifting or not versus a wellness person

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would probably use it to count the reps versus

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our computer vision is about like how well your functional motion

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is and then every single joint in that

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compounding movement, how much is that specific joint moving?

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Is it in the right order or in the sequence? And that's what is provided

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to a physical therapist in real time when you're. I'm actually working with you

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so I'm able to provide you a right guidance and then actually work with your

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rehabilitation. Let me just ask a couple quick questions. So I

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understand this is the sensor that you're referring

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to. Is that something that the patient needs to have on their

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computer or is it able to be done through your system?

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So there are two different approaches. One sensor is like a hardware. We don't

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use that approach. I love those sensors too, but again

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they're amazing and they're bulky and sometimes even they're a patch. Small

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patch. But again it's 100% patient driven self

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care. That is great for early interventions. We

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specifically work with the prescribed patients

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that are for physical therapy. The tool that we use is

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computer vision. So you don't need any specific sensors. Like right now,

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how we are doing a video telehealth. Computer vision AI is able to

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analyze where the body parts are and how much are they moving, in what order

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they're moving. So you literally. Other than your phone or your computer with the

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Internet and a camera, there's nothing special equipment you need in your

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home to perform our sessions. Got it. I just want to speak. That

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was the best approach of dissing somebody

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else's hardware in the nicest way possible that you just did

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and say, okay, this is how we do it. That was awesome. Very, very eloquent.

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Very eloquent. I like that. I like that.

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That was just so good, man. Because I was like, what do you love this

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technology? Like no, no, no. He's going to throw it under the bus. Okay, Just

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took a little while. Thank you. There's nothing wrong or the

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other. It's just one. It's just how you. It's just how

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you approach the question. The answer there was just like

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priceless. For Halo talks NYC Gupta

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style. Let's call that. Oh, here you go. I love it.

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So. So you're not disintermediate district

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intermediating any of the physical therapists, right? They

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work with you, Are they working with you through

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the hospital? Are they actually employee or

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1099? And then the other question is how much volume do

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they get that it's like makes sense for them to work with you on a

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remote basis versus, you know, in like an ATI or

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Sprints and more. Oh, so you know the space very well.

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Yeah, no, it's a great question actually. Like the

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way a normal day for our most of our clinicians is

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100% on themselves. We have a lot of

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therapists and some state require us to have therapists on

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W2. That means like a literally full time employees. They're

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like California is one of them. So you have to have them. But

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there are other, other states where a lot of therapists are moonlighters. And then to

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work with us on a 1099. So from the patient perspective

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literally depends on the need in which state the therapist is

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in. And then how many clients do we have. But so far we

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are always hiring. So with this, I want to

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talk to you about the piece of tech. We are a tech forward service company.

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I do not disguise as a tech company when at the end of the day

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what we offer is a service which is our physical therapists, our

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clinicians, speech therapists, occup therapists are providing care to the

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patient and that is what we are actually billing and getting them paid for.

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So what we started to see the demand and supply was a problem. We had

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a lot of clients and then clients had like millions of lives that they were

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serving. So the patient volume was rising very fast

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between identifying the therapist, credentialing the

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therapist, training the therapist and bringing them on a platform. It was taking on

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an average 14 days for us. So early this year

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we decided we need to solve this problem to be able to sc.

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And you would be surprised. Last week we started this process and

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finished this entire process in 12 hours. From

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job application, onboard a new physical therapist to your system,

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onboarding, credentialing and training every single thing

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in 12 hours. How did we do it? We created this entire

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interview process as an asynchronous software platform. So you could

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actually go on theranaut.com, go to the job section, apply for it,

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and then it automatically screens you in or out and then you can apply

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via asynchronous video. And then those interviews are getting assessed in

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real time and then actually like you finish entire onboarding right

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there itself. So that was like how we always talk

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about technology is great. It's just like when you can put this in the right

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workflow for augmenting your problem solution.

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So let me just stop here for a second. As you develop these

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types of tools for yourself, when do you stop

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and say, wow, like, we just created this onboarding recruiting tool that might

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be like another path to like spin off into another company.

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Does your brain work like that? Sometimes be like, let me just do what I'm

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doing. But. But like, this could probably be its own. On its own.

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You're really getting into my brain right now. That happens every single day.

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Yeah. Okay, good. Yeah. All right. That's good, man.

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Bro, you like Golden Ship Media, man. Like, we're like tight already. It is so

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hard. My wife has to bring me back. Always is like, focus. This is, this

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is what you do. This is your problem statement is. And then

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you got to get back to the reality that like, we're not an ATS provide,

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but the ATSs out there are not built for our problem

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statement. So then you have to build something for yourself.

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So a couple more questions. So we work with this company called

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Zeel Z L and they are a tech

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enabled medical massage, but they actually send

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people to the homes. They've got relationships with

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hospitals and the va, but they're actually physically

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sending people into the home to do or into the workplace

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to do. Do you get that kind of demand also? Are you saying,

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like, look, I got a gate around my, you know, my

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therapist that they're not, they're not leaving the virtual

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kind of, you know, domain? How do you think about that?

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I love that model. There's definitely a need for

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that specific model where you take the clinician and send it

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to the patient's home. But it's a logistical nightmare.

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You can't service entire America

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with 400 clinical therapists. You would need this to do the same

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amount of volume what we do today. We'll probably need 5 to 10,000

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therapists on our network.

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And then from the financial perspective, if you look at it, it's almost the

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same in the reimbursements or when the revenue side

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if you look at the business. So

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technology first is our motto all the time.

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And telehealth is like one of the best. Got it. And then a

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couple of just quick questions related to that because I'm super interested in how

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this model kind of evolves over time. Does the

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hospital say to you, hey,

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look, this is a telehealth session, so I'm not paying you the same

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amount as an in person or are you Able to say hey look,

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I'm actually delivering the same amount quality of care. So

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it's not really negotiation on like

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the hourly pay rate or comp.

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That's a good perspective. But when you come into

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healthcare, things are. I'll give you a

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great example of like how physical therapy is evaluated and paid for.

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So if I'm having you a session with you, I'm paid

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on a base of 8 minute rule. Every 8 minute I'm able to bill a

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1 unit and it goes up to

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22 minutes, 8 to 22, 1 unit and then 22 to

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37 and then things like that. And the amount

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of a time, whether I'm meeting you virtually or I'm meeting you in a

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clinic or I'm meeting you in your house is exactly the same. So the

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delivery, the cogs or cost of goods sold here is the labor

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and the labor is exactly the same which the CMS and

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every regulatory body understands. And on the side

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is like okay, someone can say okay, so your cost is same, so our

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reimbursement should be same. But on the flip side of it is

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your quality subpar. So to that answer is

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you would not have seen many studies so

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far. But I can talk to you specifically from our data itself

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is our mcid, minimally, clinically.

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I always get this One wrong is

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in a simpler word is objective

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measure of clinical impact of any

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modality. And when we compare our clinicians and our

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service to the clinic and when you go to the clinic it's exactly the

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same and in some events it's even higher. So

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it was a very easy case to make in front of the regulatory bodies and

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others. So till this date we get paid the same whether you come to me,

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I come to you, or we meet virtually. Good, I'm happy to hear

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that. One, because I like you and two, because it's fair there.

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So one other question related to this. If I have a physical therapist

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and I, you know, I had a accidents or

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worker, workers comp. And I'm building a relationship with a

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physical therapist, you know, locally are you, is the patient

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able to prioritize or like ask for certain

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therapists and like they become like part of their like client

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list or is it all just like hey, whoever you get, you know, on

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your repeat sessions. Right. We

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understand the stakes are high when you're treating patients telehealth, we

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can't touch them, they are not in the same room. So we 100% make sure

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that the patient starts with the one physician clinician and then finish

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the entire episode of care over the six to eight weeks or period

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with the same person. Oh, that's awesome. Yeah. We do not

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use assistance. So you would see this happen a lot as well.

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Is like you go into a rehabilitation setting and then the one

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clinician will start and then their assistants will actually come in

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and finish off the session or they will be the one seeing you for next

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seven sessions and then the clinician comes back again. So because

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again, as I say, the stakes are high. Telehealth has some limitations of

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its own. To make that fulfill, we only and

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only use Doctor of Physical Therapy or Masters of Physical Therapy and

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then higher from the education perspective.

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This is Pete Moore. Here's the last tip for you of the podcast.

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We are partnered up with a company called higher dose

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higherdose.com they are the leader in

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workout recovery products. Infrared technology,

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LED light masks, neck enhancers and

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other products such as PEMF mats and sauna

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blankets. If you have not gotten on the workout

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recovery train yet that your time and your stop

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is now. You got to get these products in there before these workout

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recovery and spas end up saturating your market.

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Having your members walk out of the club and going into one of their locations

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for 200 bucks per month where they're paying 39 to

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00:19:59,370 --> 00:20:03,210
you. Let's become an expert in workout recovery. If we

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00:20:03,210 --> 00:20:06,530
are already an authority in workouts, Higher dose,

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check it out. There's a wholesale code and we look

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forward to helping you augment your products and services

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to meet the demands of your members. And hey, let's get people

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happy, healthy and sweating and the recovery should be

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just as good as the workout.

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Last question related to you started the company nine years ago. Did you

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take on any private capital or do you self fund this?

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Not 100% bootstrap, but we kind of fit in the definition of

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bootstrap because we did family and friends round and

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nobody would pay us. We couldn't raise capital and

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we only had two options, do or die. So obviously die

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was not an option. So we bootstrapped ourselves 100% from that

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point on and today we are a profitable company and

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we are doing a significant amount of revenue and hundreds and thousands of

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patients every day on our roster. Sir, that's amazing. It's really

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good. And who, who do you. You. You founded

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the business originally. Did you have any other co founders

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or who'd you hire first? I

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was the first hire actually. My wife is a co founder and

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I was an operator and she was the brains and the

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CEO of the company and we started to grow as a,

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as a couple and now we have a four year old and a five year

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old daughters. So she, she had.

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So we defined our own ways of like handling Thera. Now,

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now I actually have. If you have seen my LinkedIn, I

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recently stepped up and then became a CEO of the company. So

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that's what my role is today. Excellent. Good stuff.

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And as the four and five year olds are they thinking about getting into

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physical therapy or are you grooming them for a succession plan?

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Usually people would say it's a little too early but actually fact is that

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yes. So outside of therap now

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my wife actually she's a doctor of physical therapy, my co founder but

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she runs senior care assisted

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livings in Texas so she owns and manages them. So our

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kids are entrepreneurial kids. So they do not hear

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normal conversations on a dinner table. They are always talking about

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here and listening about stuff that normal 4 and 5 year old

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would not be part of. It's

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refreshing to hear instead of like Fortnite or Call of Duty or something. Keep going,

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tell us the story. Oh, I was just going to tell you this one. I

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always bring it up because when we go to the hospital type of

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settings or assisted livings or nursing home, we usually are scouting or

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visiting the building trying to see if this is a good

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acquisition target or not. This is outside of a tech and theranow business.

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So obviously you don't get the childcare all the time.

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So we take the kids with us. So one day one of

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my younger one was actually like having a ear surgery. We go

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to the hospital for her ear surgery that day she's like are you here for

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a deal? I'm like no dear, we are

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here for your surgery. That's awesome. So that's the kind

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of kids actually are growing up in our house. Deal. All right, we'll

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catch them. We'll catch them. On the next ter now episode

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10 years from now we'll check in, see how the, how the internships are

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going. Boss. Awesome. Sounds like it might happen. Hey, so let me just

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ask you the last question here. We work primarily with health clubs,

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big box sports complexes,

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boutique fitness studios. Is there any like

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tuck ins or relationships that may be, you know, not as

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typical as you would see from just like a hospital standpoint

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from maybe like a workout recovery or you know,

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rehabbing certain, certain you know, athletic injuries that we should

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be thinking about you for.

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From the physical therapy and fitness always go hand in

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hand. There's like this is circle or like a

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journey of a patient life cycle. So from that

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perspective, absolutely. Anytime we would love to plug in our network in

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any other product that where we can enhance the patient outcomes.

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We love it from the product market fit. It took us

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like four years to really understand where our product works. And we

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realize our product is in the hospitals. So when it comes to

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money and our business and revenue models, like now, we

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have understood what works the best is a large hospital systems.

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They have a lot of patients and not enough therapists and not enough buildings

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to be able to put those patients in. And that's when they need our help

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to expand their access and their services.

395
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Yeah. All right. Sounds good, man. Well, thanks for coming on the show.

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00:24:55,720 --> 00:24:59,080
We're excited about what you're doing. We'll. We'll send you a couple of intros also

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to a couple of our clients that might make sense. And then Dave will get

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00:25:02,880 --> 00:25:06,360
the show notes up and would appreciate it. See if we can help you

399
00:25:06,600 --> 00:25:10,320
and let me know if in any way I could assist. We

400
00:25:10,320 --> 00:25:13,520
might. We might hit you up if we need any. Like, if I need to

401
00:25:13,520 --> 00:25:17,040
like, say something bad about somebody in like the nicest way, I'm gonna hit you

402
00:25:17,040 --> 00:25:20,680
up because that. That was awesome, bro. I like telling you I really enjoyed it.

403
00:25:20,680 --> 00:25:24,500
No, I appreciate it. I'm just getting is my new gig. So

404
00:25:24,580 --> 00:25:28,380
I'm the guy who's actually is building. I either treat patients or

405
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I build stuff. So this is my. Not a

406
00:25:31,940 --> 00:25:34,740
comfort zone. I'm out of my comfort zone right now and

407
00:25:35,460 --> 00:25:39,060
starting out to build a brand around my company now. Yeah.

408
00:25:39,060 --> 00:25:42,820
All right, well, I'm sure it'll work out. Just, you know, be patient. Know that

409
00:25:42,820 --> 00:25:46,540
the progress is happening. All right, man. Keep doing what you're doing. I'm glad we

410
00:25:46,540 --> 00:25:50,060
connected. Sounds good. Thank you. Appreciate it. But vehicle, let us see.

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This is Pete Moore on Halo Talks, your captain speaking. I am the

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00:26:00,620 --> 00:26:04,380
founder and managing partner at Integrity Square. We've been around now

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00:26:04,380 --> 00:26:07,900
for 15 and 1/2 years. We have been helping

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00:26:07,900 --> 00:26:11,340
people like yourselves get capital, do mergers and

415
00:26:11,340 --> 00:26:14,940
acquisitions, consulting, strategic advice in the health,

416
00:26:14,940 --> 00:26:18,700
active lifestyle and outdoor halo sector, trying to

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00:26:18,700 --> 00:26:22,020
help as many entrepreneurs as possible get to the next level,

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00:26:22,580 --> 00:26:26,020
take that inflection point and be the force behind your growth.

419
00:26:26,580 --> 00:26:30,220
We are helping companies that have at least $3 million of

420
00:26:30,220 --> 00:26:34,060
EBITDA, around $10 million of revenue. And we

421
00:26:34,060 --> 00:26:37,140
are positioned to help you get institutional growth capital

422
00:26:37,780 --> 00:26:41,590
or to negotiate deals with strategic partners. If

423
00:26:41,590 --> 00:26:45,390
you go to integritysq.com forward/isq,

424
00:26:45,390 --> 00:26:48,990
you can see our capabilities. Deck happy to set up a consultation at any

425
00:26:48,990 --> 00:26:52,510
time that is free of charge, and we look forward to

426
00:26:52,510 --> 00:26:56,270
helping solve obesity, loneliness and diabetes.

427
00:26:56,350 --> 00:26:56,990
Go ahead,

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00:27:06,600 --> 00:27:29,050
Sam.