Episode #611: Outpatient Innovation-Dr. Munir Ghesani Discusses Theranostics, Expansion, and Clinical Trials

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

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bringing Dr. Munir. He's gonna talk about

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Theranostics. We're gonna talk about advanced patient

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access, clinic rollouts, raising debt versus

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equity, and the new frontier of healthcare.

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So Munir, welcome to the show. Thank you for the

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invitation and good morning. Good morning. Well, I'm wearing a New York Knicks

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shirt, so I just wanted to give a shout out to my favorite basketball

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team and for you

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to talk about how we are going to extend

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people's life and happiness and more

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championships. So give us your background and we'll go from there.

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Yeah, so I'm a diehard New Yorker as well. I

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have been in academic practice in New York for

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more than 30 years until 2 years ago when I

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joined an outpatient private

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theranostics group called United Theranostics. And

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just like you, I'm also a diehard New Yorker. In fact,

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I'm a diehard Knicks fan. I was at the final game in San

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Antonio with my son. Oh, good for you. All right, I got my—

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I'm going to bring out my Knicks jersey

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because I was in San Antonio also for games 1 and 2. So

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use this as a way to basically gloat about our

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deal and our championship. So, give us some of

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your background on your academic side

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and then what kind of pushed you to go in and actually

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start a company and why you thought that might be better than

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staying on the academic front. So, academic

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side, I was fortunate to have several mentors

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who who trained me into— there was

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different aspects of medical practice. You know,

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as you know, the medical practice has a very— 2 diverse

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ends of it. One is purely academic where,

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you know, people while practicing academic medicine do not

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really realize the patient

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access and other issues that occur.

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But then when you are in the private practice and

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accommodating patient access, don't realize

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that you're losing the academic touch, which is where

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I realized that I need to make that change. So I spent

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32 years in various

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universities in New York, and I was

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involved in the clinical trials. I was involved in the clinical

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care, making sure that the patients are not

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delayed in getting to their appointment, but also reading the

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scans in a timely manner to report them out. But then I realized

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that there are quite a few bottlenecks in the academic

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practice, and the patients are not in the

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front and center of it. And which is when

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I met the founders of United Theranostics, and I

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saw what they were building, and I could not resist

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the temptation to pivot and

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make that change in my life and join

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United Theranostics in the outpatient practice. But I have to tell you

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that You know, one of the things that really appealed to me is that

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while we are front and center focused on patient

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access, that we are not sacrificing our academic

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pursuits. In fact, if you look at my CV over the last 2

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years, I have been more academically productive than

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ever before.

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

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are cutting back on rewards.

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Can

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you just explain to everyone, because, you know, before I

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started researching for our podcast here,

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what theranostics actually is as a, you know, what is

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the definition of that term? Yeah, so let me

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explain. I think I've to explain it in the very simplest terms.

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I need to compare it to the other treatment

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modalities. And I will— while theranostics is not

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necessarily just for cancer, the cancer is a good analogy

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to provide and provide the simplest understanding.

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So if you, for example, have a patient who's getting

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chemotherapy or immunotherapy,

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you may do some tests on them, you may do some genetic assessments,

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but ultimately the moment you administer it,

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you have no control over how that patient is

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going to respond because each individual,

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one of us, is a unique single individual. And while

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you may apply the data to the general

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studies that may have been done, you have no control over personalizing this.

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Whereas theranostics is where— what the simplest way to put it

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is, we treat what we see. And we see

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what we treat. So in other words, if I have a patient who needs

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a theranostic service, the very first thing we do is

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we do a personalized scan. Kind of like,

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you know, if one of the other ways to give the analogy would be going

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to a very fancy New York City tailor

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for your clothing. You may get off-the-shelf clothing

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from Macy's or JCPenney. but it won't fit

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you the same way a personalized tailor who

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would prepare that just for you. That's exactly what

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theranostics is. And to close the loop, not only we

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personalize the treatment by doing the scan first,

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but unlike any other treatment modalities,

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once we administer that treatment, we actually

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track it and we confirm that the treatment went to where our

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targets were. So if a patient has 5 cancer sites and we

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selected those sites by doing the scan first, we

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don't stop there. We actually go and after administering the

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treatment, we confirm that administration to those

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target sites. I don't think any other

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modalities in the medical space,

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maybe with an exception of one or two, that are this

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personalized in terms of delivering the care to the

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patient. And how does a patient get into

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the Theranostics ecosystem? Are they

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referred by someone,

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another doctor that believes

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stronger in your treatment

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process or therapies? Yes. So they typically—

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there are 2 different ways. And one is we actually

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increase the awareness by letting the patients know that in case if this is not

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brought up by your doctors during your consultation,

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keep in mind that this is a very strong and

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preferred option for their treatment. But the

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majority of the referrals still come from either medical

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oncologists, urologists, radiation

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oncologists, and sometimes even primary care physicians who are

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aware of our service. We also get a large

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number of referrals by the hospitals. And the reason is

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that while major academic institutions are in the

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major metropolitan area, patients live

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far from there. You know, there are data that show that 80%

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of the cancer care is given in a community setting.

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So if the patients live 50, 60 miles

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from their academic center where they went for an

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expert opinion, but then they tell their

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primary, their hospital systems, their oncologists

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that, look, you know, this requires several visits and it takes me

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3 hours each way. Can you find a nearby place

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for me where I can get these treatments? And we have

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strong connections with the hospitals in major

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metropolitan areas. So they realize that it is

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easier for their patients to come to us and their

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patients are living 10, 15, 20 minutes from where we are.

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Makes it much more convenient for them. So you mentioned something before

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about if, if there's a doctor that, that

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knows you and it's worked with you or you're not with United

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Theranostics, you know, that, that becomes a, a lead generator,

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but also, you know, potentially having the patient

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know or learn about you. So how do you think

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about United Theranostics? Is it a

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are you serving the doctor? Are you also trying to create almost like a consumer

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brand or brand awareness as part of your— as

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part of the strategy, if you will? Yeah. So actually, and,

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you know, this is a fundamental rule that I've— I

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actually, I was also a program director of training in

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radiology, and I always emphasize that point

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to our trainees that As a radiologist,

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we have different constituents to address to.

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One is, of course, patient is front and center.

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But the second one is our referring physicians who

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we need to keep them in the loop. We need to make them aware

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of what we are doing in providing the service to the patients

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and try to reduce their burden so that they are

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willingly partnering in the patient care with us. They're willingly

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referring the patients to us because we are not throwing

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every single management step back to them. For example, if

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the patients have side effects, then we

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get involved and treat. Not only it should be our

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fundamental responsibility, but we know the side

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effects of these treatments better than the referring

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physicians. And as a result, it makes

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sense for us to take the charge. And once we do that,

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the physicians realize that it is— their time is very

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valuable and we are not simply a referral

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service. We are partnering with them in the care of

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patients. Gotcha. You know, just to

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kind of clarify, you know, the hospital used to

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obviously just be the hub. for everything. And then

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there's been a big trend of outpatient clinics.

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When you use the term outpatient, is there an idea at

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some point where the outpatient 4 walls that you control

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could be a partition of the hospital from

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a square footage standpoint, or are you trying to get into the suburban

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strip centers or medical centers? Are the hospitals

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basically all losing this hub and

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spoke model to groups like yours, or is there

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a way that sometimes you say, hey, why don't we just be in the hospital

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but basically control our own environment?

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That's a great question. In fact, I have to say that what

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really differentiates that hub and spoke model, and that has worked in many

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areas, right? For example, surgery centers, right? You know, you

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have, you have a major academic hospital

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or university that has 10 or 15 different

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satellite sites. What they do is that, for example,

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a surgery patient, if it is a simple surgery, they

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do it in the spoke model. If the patient requires a

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major surgery, then they come to the hub. In this

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instance, because it requires so much

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infrastructure it's heavily regulated and it

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requires specialized staff, the

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hub-and-spoke model for major academic institutions is not

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really working out well. So what they do is that

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they tell the patients, look, if you need an

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oncologist, we will provide you at our spoke

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model where they can come see you. We can even offer you

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a virtual visit so it minimizes your your number of

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visits to the major metropolitan area. But

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if you need a theranostic service, unfortunately, we do not have the bandwidth

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to create 10 different theranostic centers for a single

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institution. We do that all in our hub

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model. And that's where the patients start to complain

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because they say, well, if you're providing me the virtual visit,

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if you're giving me the convenience of going to your nearby

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satellite center for everything else, why not theranostic service?

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And that's when the patients start to either insist on it or they

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explore and they find, oh, there is a United Theranostics

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sites in the suburban area. So majority of our sites

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will be in the suburban area just because of

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that reason. And for the reason I mentioned that 80% of the

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cancer care is being given in the community

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setting, in the suburban areas and rural areas. So,

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you know, as part of reading up on the growth

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plans for United Theranostics is to have

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50 clinics in every

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state within the next 7 years. Given

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your role as the, you know, chief medical

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director and officer, as well as, you know, head of training and

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quality control and, you know, efficacy of service

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offerings. How does— how do you feel about that? How does that

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work from a staffing standpoint? How does that work from a

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recruiting, you know, for somebody to work

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under that brand and umbrella? What does that

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take? And are you pulling people laterally

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from hospitals or— Are you acquiring

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radiology or oncology groups that are basically saying, hey, I like your business model

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better, build me a clinic and I'll come work for you? That's a

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great question again. So no, we do not acquire the

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existing models because it is such a unique

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infrastructure-driven enterprise that it's not

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so easy to acquire,

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retrofit, and then train the staff that may not

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they may not even have a regulatory clearance to

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deliver these treatments. So the way we work

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is, this is where our academic side comes in as well. So every

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single society organization meeting, we

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are heavily presenting our

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data. We have a very unique way of following the

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patients that not many academic institutions are

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able to. And that spreads the word

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that people are recognizing how unique and quality work we

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do. And so that brings us to

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the ability to attract the trainees who are

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about to graduate, also young professionals who are,

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you know, in a similar mindset as ours, saying that, you know,

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In order for the theranostics service to grow, it has to be

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in an independent outpatient model. So that's where

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the majority of our recruitment comes in, by

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spreading the word about United Theranostics' unique model

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and attracting the trainees and young professionals from

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academic institutions.

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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 HigherDOSE,

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higherdose.com. They are the leader in

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end up saturating your market, having your members walk outta the club

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and going into one of their locations for $200 per

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And hey, let's get people happy, healthy, and sweating,

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and the recovery should be just as good as the workout.

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So what are some of the things that you've been

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pleasantly surprised by or

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have scratched your head as you move

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from academia to running a commercial,

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high-growth capitalist business?

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Yeah. So one of the areas we have realized is that we thought that

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this could primarily be for delivery of

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clinical care, but because our model is so robust and we

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also provide a very unique expertise

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and infrastructure for everything that is needed for

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clinical trials. So Currently in our

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enterprise, there are 22 clinical trials and

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the patients are increasingly

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becoming savvy in finding the trials and finding

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our location as a result of it. We are also finding that

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some of our own competition

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is not able to manage very complicated cases.

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Since I have served in the academic institutions and all of our physicians have come

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from academic institution. So

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we are very comfortable in handling

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complicated, complex cases, and that's not the

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expertise that exists across the board. So one of the pleasant

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surprises is that because of the clinical trials, the referrals to

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us have increased because these patients want to stay even for their

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clinical trials within where they live. And

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our ability to provide that access rather than having to

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force them to go to New York or

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Philadelphia, in our case, in Princeton office, makes it

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very convenient for them to join. And that has

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become a significant motivating factor. It also

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allows us to provide these cutting-edge, newly

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introduced treatments that are not widely available. So we have

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patients who are traveling not just within the local

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neighborhood, but when they find that there are only 2 or 3 sites in

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the country that are offering these trials. Patients are traveling from

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everywhere in the US to come to us. And just

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to clarify, clinical trials are

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non-FDA-approved

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prescriptions or medications or

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procedures that are being tested in order to get to

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FDA approval? Yes. So they are not FDA approved,

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but on the other end, FDA still reviews these

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before they're administered to humans. So there is an

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FDA clearance for us to

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participate and offer these trials to the patients. But you're right,

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they are not approved for widespread use in

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humans yet. So they're being tested first to see

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if they're effective. And then does the

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treatment— I'm not that familiar with this, but educate

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us. If I want to get into a clinical trial,

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I would apply for it based on the fit with what

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the symptoms I have or the issues that I'm dealing with. Is that

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covered by insurance or is this out-of-pocket that they're

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paying, or is the drug company paying for the clinical trial because

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they're— want the results. Right. So for the insurance

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companies, the typical benchmark is

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Medicare and Medicaid. And if Medicare and Medicaid have

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approved it, then the other insurance companies cover. And one of the

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requirements for Medicare and Medicaid is that they have to be

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FDA approved. So that brings us to a point where if

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we are going through the trials, none of the insurance

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companies— I should say maybe 99.99%

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of the insurance companies would not cover So they'd be— they'd pay out?

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So they're covered by the drug companies. By the drug companies. Gotcha. Gotcha. Yeah.

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And then in closing here, you know, as you look

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at being a medical director, trying to solve

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everyone's problems, you know, finding a cure for everything that

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you can find a cure for, how often do you have to say, no,

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we're not ready to do that, or that's too speculative,

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I'm not comfortable with this clinical trial? Because I think

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there's a lot of similarities to

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entrepreneurs in every industry that maybe try and bite

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off a little too much and maybe accelerate their growth

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and maybe can't control it? Yeah. So that's

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another good question. What we typically do is we have our own

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committee that reviews all these trial proposals

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and we look at several factors. First of all, as I mentioned,

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if anything, our academic pursuits have grown even more.

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So we are constantly reviewing these

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new treatment options that are not approved yet. And if we

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don't find the data supporting their effectiveness or

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data that show that there may be significant

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adverse effects, then we say no to those. The other part would

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be that if we already have an existing trial

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that we are focused on and we have seen good results, if another

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trial addressing the same disease and same patient

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population comes in, we feel

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hesitant in accepting that because we

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have commitment to our existing drug companies

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that we are going to enroll the patients and we don't want to create a

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situation where we don't come through in what we had committed

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before. So we meet on a regular basis, we discuss

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this routinely. and decide on whether there is a

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trial that is, first of all, not appealing, or

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secondly, competing with our other trials that are already in our system.

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Great. Well, this has been a great tutorial for me

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and for our listeners. Congrats on the, on the new position

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and your vision for where this company's going. And if you

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00:24:20,145 --> 00:24:23,918
want to help us wave the HALO flag— Health Active Lifestyle Outdoors— we're

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00:24:23,918 --> 00:24:27,387
trying to keep people healthy. and healthier. So by the time they get to you,

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00:24:28,158 --> 00:24:30,921
um, or maybe they never get to you and you can just wave to them

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00:24:31,050 --> 00:24:34,761
because they're so healthy. Yes, thank you. Yes, and, uh,

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00:24:34,906 --> 00:24:37,717
I should have— if I had known that you are a Knicks fan, I would

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00:24:37,717 --> 00:24:41,444
have brought my championship cap to wear.

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00:24:41,589 --> 00:24:44,882
You can just send it to me. Dave will send you the mailing address. Now,

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00:24:44,963 --> 00:24:48,642
just— it was great, great to meet you, and, uh,

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00:24:48,658 --> 00:24:52,208
we'll get this up online and, uh, hopefully we can wave the flag

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Uh, for what you guys are doing, and, uh, it sounds like it's giving people

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00:24:55,697 --> 00:24:59,285
a lot more options and, uh, convenience and, and

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00:24:59,365 --> 00:25:02,681
results. So thanks for doing what you do. Thank you for the

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00:25:02,681 --> 00:25:06,436
invitation to speak. I really enjoy our conversation, and

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00:25:06,774 --> 00:25:08,250
all the best. All right, go

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Knicks!

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00:25:14,176 --> 00:25:17,986
This is Pete

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00:25:17,986 --> 00:25:21,477
Moore on Halo Talks, your captain speaking. I am the founder and

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00:25:21,557 --> 00:25:25,040
managing partner at Integrity Square. We've been around now for

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00:25:25,072 --> 00:25:28,330
15 and a half years. We have been helping

402
00:25:28,442 --> 00:25:31,797
people like yourselves get capital, do mergers and

403
00:25:31,797 --> 00:25:35,504
acquisitions, consulting, strategic advice in the health,

404
00:25:35,584 --> 00:25:39,356
active lifestyle, and outdoor halo sector, trying to help

405
00:25:39,356 --> 00:25:42,550
as many entrepreneurs as possible get to the next level

406
00:25:43,112 --> 00:25:46,399
and take that inflection point to be the force behind your growth.

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00:25:47,239 --> 00:25:50,648
We are helping companies that have at least $3 million of

408
00:25:50,696 --> 00:25:54,535
EBITDA, around $10 million of revenue, and we

409
00:25:54,664 --> 00:25:57,707
are positioned to help you get institutional growth capital

410
00:25:58,432 --> 00:26:02,254
or to negotiate deals with strategic partners. If you go

411
00:26:02,254 --> 00:26:02,704
to integritysq.com/ISQ,

412
00:26:06,094 --> 00:26:09,682
you can see our capabilities deck. Happy to set up a consultation at any time.

413
00:26:10,182 --> 00:26:13,362
That is free of charge, and we look forward to helping

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00:26:13,715 --> 00:26:17,167
solve obesity, loneliness, and diabetes. Go

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00:26:17,231 --> 00:26:17,938
Halo!