#166: Adam Graybill (Journey Biosciences) — Shifting the Future of Diabetes & Care

Adam Graybill (Journey Biosciences) [00:00:00]:
By ultimately identifying, you know, and giving people and the clinicians a 12 year runway to take clinical action to ultimately address kind of this new risk or individualized risk that's in front of them. It gives us the opportunity to not only extend life but improve the quality of life. Because today the average patient is getting diagnosed with kidney disease at stage 3 or later, which is really at the doorstep of really heavy therapeutics of dialysis and ultimately, you know, potentially being kind of in that end stage kidney disease phase of their diagnosis.

Jeffrey Stern [00:00:44]:
Let's discover what people are building in the Greater Cleveland community. We are telling the stories of Northeast Ohio's entrepreneurs, builders, and those supporting them. Welcome to the Lay of the Land podcast where we are exploring what people are building in Cleveland and throughout Northeast Ohio. I am your host, Jeffrey Stern, and today, I had the real pleasure of speaking with Adam Grable, the co founder and CEO of Journey Biosciences. With a robust 20 year tenure in the diabetes market, Adam has been at the forefront of assembling purpose driven teams and forging impactful strategic partnerships across the healthcare landscape, having played an instrumental role in building the Cardinal Health at Home Business to a $1,000,000,000 plus entity, ultimately serving over 300,000 individuals with type 1 diabetes each year. With a deep understanding of the demands and burden that come from managing a chronic condition, like a diabetes diagnosis, Adam co founded Journey Biosciences to positively impact the over 20,000,000 diabetes patients in the US alone and approximately 37,000,000 Americans who suffer from chronic kidney disease. Journey Biosciences has launched the 1st predictive screening for people with diabetes that identifies patients at risk of chronic kidney disease prior to any clinical signs or symptoms, allowing clinicians to then take swift targeted action with intensive interventions resulting in life saving and cost saving benefits. Technically, NaviDKD is Journey Biosciences' clinically validated and CPT code certified screening for adult diabetes patients.

Jeffrey Stern [00:02:24]:
It utilizes a variety of measurements like AGEs, a one c, eGFR, and other personal information, providing insight into long term complications of diabetes, blood glucose levels over time, and overall kidney function to stratify individuals into 3 distinct risk categories. This was an awesome conversation. Adam is incredibly passionate about ameliorating the lives of individuals affected by chronic health conditions, and it was genuinely inspiring to hear how he's built Journey Biosciences to that end. We cover his motivations, doing the work you are meant to be doing, the journey of Journey Biosciences, and a whole lot more. So please enjoy my conversation with Adam Grable after a brief message from our sponsor. Lay of the Land is brought to you by John Carroll University's Buhler College of Business, widely recognized as one of the top business schools in the region. As we've heard time and time again from entrepreneurs here on Lay of the Land, many of whom are proud alumni of John Carroll University, success in this ever changing world of business requires a dynamic and innovative mindset, deep understanding of emerging technologies and systems, strong ethics, leadership prowess, acute technologies and systems, strong ethics, leadership prowess, acute business acumen, all qualities nurtured through the Boehler College of Business. With 4 different MBA programs of study spanning professional, online, hybrid, and 1 year flexible, the Bowler College of Business provides flexible timelines and various class structures for each MBA track, including online, in person, hybrid, and asynchronous all to offer the most effective options for you, including the ability to participate in an elective international study tour, providing unparalleled opportunities expand your global business knowledge by networking with local companies overseas and experiencing a new culture.

Jeffrey Stern [00:04:12]:
The career impact of a bowler MBA is formative and will help prepare you for this this future of business and get more out of your career. To learn more about John Carroll University's bowler MBA programs, please go to business.jcu.edu. The Buller College of Business is fully accredited by AACSB International, the highest accreditation a college of business can have. So I was I was thinking of where, a fun place to start might be. And I thought we could revisit actually one of the the things that we first chatted about, which realizing is almost kind of a meta topic because it's it's also in some ways why we're here doing the podcast right now. And it's something I know has been kind of crucial to key inflection points along your own personal journey. But it's the it's the power of of saying yes to conversations. So I'd love as, you know, just a starting point, if you could share your thoughts on this power.

Adam Graybill (Journey Biosciences) [00:05:08]:
Yeah. So I think one of the the fortunate things we as people have, right, is free will. And we have the ability to say yes and say no to a lot of things. I think I think where it came up in our past conversations was really being at a moment of where, you know, there's really no wrong thing to do. I think we kind of talked about initially of getting bored. And part of it is, hey, how do you learn? How do you say yes to conversations? And really be focused on being curious, intellectually honest, and being open from my standpoint. I think what that subsequently led to was really a lot of conversations about future and new opportunities. But it also led me to taking a call that ultimately I probably ordinarily wouldn't have, just based off of first and kind of gut instincts of reviewing a website, but ultimately led to me finding my partner and kind of co founder in Journey Biosciences and truly found my, a kindred spirit of sorts.

Adam Graybill (Journey Biosciences) [00:06:17]:
That sees really kind of, the important role that healthcare can play in helping people with diabetes, as well as just more broadly having an impact on the world.

Jeffrey Stern [00:06:27]:
Well, I'll layer on one other thing we were just chatting about here before we turned on on record, which is, you know, working towards doing the work that you are meant to do, ultimately. I feel like these 2 kind of converge in an interesting way. But how is it that that you've thought about that idea as an underlying theme?

Adam Graybill (Journey Biosciences) [00:06:46]:
Yeah. So I think it's a really introspective question. I think one of the things that I've realized in still my relatively young kind of career as well as life is really the important thing for me is what I've realized is what I work on needs to be significant. It needs to have an impact on the world and it needs to be fun, exciting. And the more I can use my natural talents and abilities, the better. Somebody introduced me to the concept of igigai, which is a Japanese philosophy. And it really centers around how do you have an impact on the world? How do you do the things that you love? And how do you make money doing it? And how do you maybe help other professionals along the way, and just really love that concept. So I think as as I go forward and as I think about kind of future opportunities in our business, it's, hey, how do we find that proverbial sweet spot of where we can help people have a meaningful impact on society while making a living.

Jeffrey Stern [00:07:56]:
So tell us about your journey to Journey Biosciences. You know, what what were some of the pivotal moments along the way that that shaped your path towards entrepreneurship and towards this whole problem space?

Adam Graybill (Journey Biosciences) [00:08:07]:
Yeah. So I think my journey begins really with, and our business is really centered around the diabetes community and marketplace. So that began really in earnest when I was a kid. So I think most people have some level of kind of connection to diabetes. For me, there were close personal friends that were diagnosed with type 1. This is way back when before, you know, it was cool to have a sensor on your arm. Insulin pumps, looked more like backpacks than they did, you know, kind of pagers or cell phones. So it became for me really about, hey, understanding that.

Adam Graybill (Journey Biosciences) [00:08:45]:
And as I got into the professional world, I had the fortunate pleasure of working in healthcare, I think it was my 3rd job out of out of university. And diabetes was one of many disease states within there. And so it naturally pulled at me just because of the personal connection and friends in the past that were impacted by it. And ultimately, was very early in a small company, so I spent 2 decades effectively building a $5,000,000 diabetes business into over $1,000,000,000 Through that process, we had 3 exits, ultimately being acquired by Cardinal Health. And from my perspective, I had the pleasure of sticking around a Fortune 20 company, learning how big companies operate, understanding the good things and the bad things. And ultimately, as I kind of took a step back and started to evaluate what was next with my life, that's where really kind of that reset, that hard reset, understanding that I need to go out and learn, talk to people, say yes to conversations, really led me to finding our partner, my partner, Doctor. Paul Beissinger, and really focusing in on what are some of the key problems and challenges that people with diabetes face. And ultimately, how do we package up science and research into products and build a business that can distribute it to over 500,000,000 people globally.

Jeffrey Stern [00:10:15]:
So so I imagine, you know, coming out of that experience, acquired 3 times over time at Cardinal Health, there there was the world was your oyster in terms of the the kinds of things that you you could choose to focus on and and opt to, you know, pursue the the rest of your professional endeavor on. What drew you back to this space and and kind of take us through how you navigated ultimately what to work on next.

Adam Graybill (Journey Biosciences) [00:10:39]:
I think from my standpoint, the time off and getting bored and really reflecting and evaluating a lot of different things, there are certain things that became clear to me very early on. One, I wasn't going to leave diabetes. And 2, I wanted to be further upstream where innovation happens. In the past, it was really, hey, how do we innovate relative to services and solutions for what's happening right now? But ultimately, to truly have the size of impact that I wanted to have, it needed to be further upstream, more innovative, and more challenging of the status quo. So from our perspective, one of those conversations was with Doctor. Bieswanger. In it, I identified and we talked about one of the findings that he had from a research perspective. So to set the stage here a little bit, so, doctor Beiswinger was a an endocrinologist, a professor of medicine, and ran a research lab at Dartmouth College up in New Hampshire for over 40 years.

Adam Graybill (Journey Biosciences) [00:11:49]:
He was at the forefront of a lot of really innovative research ideas and was one of a handful of people globally who were focused on specific biochemistry products. And so what we discussed was really that he had found 3 biomarkers or 3 products that are biomarkers for people with diabetes that predict whether someone is going to develop diabetes related kidney disease. And so the perspective here is in the US, there's 37,000,000 people with diabetes. About 12,000,000 of those have kidney disease at present. You drive through small communities, large communities, inner city, rural, typically you're going to see dialysis clinics popping up basically across the street from Starbucks, from McDonald's. There's just too many of them. And part of this is kidney disease is an asymptomatic silent complication of diabetes as well as a broader disease affecting other people for other reasons. But what these biomarkers allow us to do is to basically predict whether a person is going to develop diabetes related kidney disease up to 12 years prior to any clinical signs or symptoms.

Adam Graybill (Journey Biosciences) [00:13:08]:
And for me, kind of as we think about that moment of, alright, what kind of business could this be to look at it and say, hey. There's 25,000,000 people with diagnosed diabetes that are walking around stressed or fearful that if they don't do the right thing all day every day, that they could develop this complication. And what we've effectively identified is that it's not by chance, it's genetic. And that these biomarkers allow us to identify who's at risk and who's not. So by ultimately identifying, you know, and giving people and the clinicians a 12 year runway to take clinical action to ultimately address kind of this new risk or individualized risk that's in front of them, it gives us the opportunity to not only extend life but improve the quality of life because today the average patient is getting diagnosed with kidney disease at stage 3 or later, which is really at the doorstep of really heavy therapeutics of dialysis and ultimately, you know, potentially being kind of in that end stage kidney disease phase of their diagnosis. Wow.

Jeffrey Stern [00:14:29]:
So from having understood the implications of what doctor Paul's, you know, research could mean. How do you begin to, you know, explore what it takes to traverse from this academic world of research to kind of like applied, you know, in the real world?

Adam Graybill (Journey Biosciences) [00:14:46]:
Yeah. So honestly, my first response was I wonder how many other innovations and other great research got basically closed up with an office as a professor or a researcher retired and it went into a box. But I think from my perspective, and I think this is where us being matched together through a a family a family connection with type 1, It allowed kind of the connection of, hey. How do you build a business that supports products, solutions, services, innovation, along with kind of that scientific and clinician viewpoint. So from my standpoint, and this is where I become a little bit methodical of how I operate and how we as a company operate, is it became, okay. Let's figure out the steps involved with this. So we have this product. Step number 1 is let's make sure that we protect the intellectual property behind this.

Adam Graybill (Journey Biosciences) [00:15:46]:
Not necessarily to stifle future innovation, but effectively to cement what we have and protect the future business that we're going to create. The second thing is really going through the regulatory requirements and understanding how we need to operate and how we're going to measure these products in a commercial laboratory setting with really a viewpoint of how will we do this initially, but then how will it scale and how will it grow. So it becomes, hey. We're doing this not necessarily for the now, but as we look at extending this out 5, 10, 15, 25 years into the future, as we build a big business that's helping millions of people globally across the world, how do we wanna do this? And really going through those kind of checks and balances. And then the 3rd part, I think, as we look at this is as that infrastructure is built, how do we wanna distribute it? And what are the key selling points? And how do we make sure that this matters to physicians, to patients, as well as to other stakeholders like health insurance plans and making sure that it's covered for the patients and they're not having to pay out of pocket or they're unintentionally excluded from being able to access it because it's too costly. So really going through all of those different phases of what we refer to a lot as right? So initially, let's build. 2nd, let's grow. And 3rd, let's scale.

Adam Graybill (Journey Biosciences) [00:17:19]:
So as we go through, there's really kind of a checklist of items that we have kind of documented that we're going to deliver against both in the past as well as through the future. So we're at that cusp right now of closing out our build phase and shifting into that grow phase.

Jeffrey Stern [00:17:36]:
How has the journey been thus far?

Adam Graybill (Journey Biosciences) [00:17:39]:
I think great in several respects. I think challenging, in other respects. I think, as you know, as a founder or co founder in several businesses, nothing seemingly goes as easily or as fast or as, I guess, affordable as you plan or that you want. So I think as we look at it, our process so we've been at this now for a little over 2 years. I think the accomplishments that we have are extensive and in the perspective of health care and regulatory and government, we've accomplished many, many great things. I think from our perspective, where we look at the world today and say, okay, how do we take this next step forward? It really comes down to, what do we need to do to grow this thing, screen patients at scale, as well as really drive and create a new market for this new category in diabetes that we're creating. From our perspective, the challenge right in front of us is, hey, from a clinician and from a physician standpoint, how do we educate about this new technology and this new innovation while also gaining greater awareness with the patient community, both the type 1 and the type 2 patients, as well as working through insurance coverage with the commercial payers, the Medicaid system, as well as the Medicare, which we've had 2 really important milestones over the last 12 months on.

Jeffrey Stern [00:19:19]:
I'm curious how that education process looks and feels, you know, in practice as you bring to market this kind of novel approach to predictive and kind of in advance of someone actually experiencing the disease that later they'll they'll get to treat? What has the reception been? And how do the clinicians and practitioners think about kinda, like, the second order consequences of what this means for what they will have to do?

Adam Graybill (Journey Biosciences) [00:19:48]:
The way that we think about this on a routine basis is the information that we're providing is potentially scary to the individual that's receiving it. So while people are stressing about this, the unknown today, on a weekly basis, I think recent surveys, we've seen 93% of people with diabetes worry about complications every week. Take away from the fact that it's a 20 fourseven, 365 diagnosis where everything that they eat, every time they exercise, they have to think about what is it going to do to my glucose levels. Yeah. That's a lot of burden to be on a person and then to have this outstanding risk. So we feel like bringing forward this innovation helps provide peace of mind of, am I at risk or not for this one thing. But we're also present present enough to know that what we're delivering can be intimidating and can be scary. What is important to us is to is when we take a step back and say, what are we truly trying to accomplish and what are we trying to connect? Is we're not just giving people bad information or tough information.

Adam Graybill (Journey Biosciences) [00:21:06]:
We're giving them something that can be clinically actioned by their physician, by them as an individual with technologies, with therapeutics, and with services that already exist, that are approved by the FDA, and that are already covered by insurance. And I think for us, along with the clinicians and the hospitals and the health systems that we've begun with are able to draw that direct line with, hey, this information is coming to me much earlier than I'm reacting to today. So it really becomes, hey, how do I shift that care from basically diagnose and react to now predict and prevent? And so what we're really ushering in, I think, as we think about our our business model and our go to market strategy is we are providing those insights that allow prevention to happen. And how do we kind of work with the physicians, the clinical teams, as well as the therapeutics of GLP ones, of SGLT twos, of continuous glucose monitors to really give the tools as well as the technologies that are gonna help that patient delay and hopefully prevent diagnosis altogether of kidney disease.

Jeffrey Stern [00:22:32]:
Yeah. I think you you got it there. Something I wanted to ask about, which is ultimately the this relationship between predicting and preventing. And, you know, so like if all this goes well, right, and Journey Biosciences is realized to the degree that you see it becoming in the future, what are ultimately the implications to the healthcare industry, to individuals, to practitioners? What does this afford in that future?

Adam Graybill (Journey Biosciences) [00:22:58]:
I'll speak about the maybe break it down into different segments. So if we think about the economics of what kidney disease costs the US healthcare system so today about $70,000,000,000 is being spent a year on treating diagnosed kidney disease. So as I mentioned in an earlier question is today, it's being diagnosed after stage 3. Effectively, there's 5 stages of kidney disease, so it's on the back end of it. And at that point of where it's being diagnosed, it's really at the doorstep of dialysis and more expensive treatments. So we start to kind of from an economic standpoint, from a patient perspective and from a we're identifying at that stage 1 or kind of pre any staging of kidney disease, of this individual has that risk. And rather than going right to the expensive therapeutics and treatments, it allows the patient as well as the clinical teams to use more cost effective solutions that really focus on the underlying kind of elements that are going to delay any progression to kind of subsequent stages of it. It also makes the patient aware of what are the clinical signs and symptoms.

Adam Graybill (Journey Biosciences) [00:24:26]:
So that ultimately, if they are experiencing those, they're talking to their clinical team and things can be treated in a much more intensive way, which again are cost cost effective versus transplant or dialysis. But I think maybe the more important side outside of just the economics of, Hey, how do we save $8,000,000,000 a year by delaying progression by 20% is when we think about a patient and people with diabetes are are people, the opportunity for them to, you know, as opposed to their last 5, 7 years being in dialysis clinics, the quality of life not necessarily being as great as it is, the way we think about that same 20%, 25% delay in progression that saves $8,000,000,000 we look at it and say, hey, if each stage is just delayed 3 years, not only are we potentially giving somebody 12, 15 more years of life, the quality of those years can be significantly enhanced and optimized just because they're healthier going from stage to stage, and there's the knowledge and awareness of of what's in front of them. And that might be the difference between somebody getting to see grandchildren, you know, weddings, those types of things and experiences that we all kind of take for granted. That's ultimately kind of the driver behind our mission is, hey, you know, let's in addition to predicting and preventing, let's also understand the human element of we're giving people more good years of their life that they can spend living as opposed to worrying about when's my next appointment and how am I going to get to the appointment or what how am I going to feel afterwards is they can just live.

Jeffrey Stern [00:26:28]:
Yeah. The health span amelioration is quite, you know, powerful as an underlying mission and and something to work towards. When when you have that, you know, kind of underneath and and in front of you as well, how have you, in the more methodical approach, you know, laid out what is between, you know, you being able to, with the team, achieve those kinds of goals and the path in front of you?

Adam Graybill (Journey Biosciences) [00:26:52]:
Yeah. So I think as we looked at it, so we recently announced kind of 2 significant milestones relative to reimbursement and coverage for NaviDKD, which is really the biomarker test that we've been talking about. Over the last 12 months, we received our CPT code, which is a billing code that hospitals or providers will use to get reimbursement. And then we also just, received our fee schedule publication for that code on January 1, 2024. So I guess a month ago at this point. I think in basically 12 months, we do what typically companies, it takes 3, 5 years to do. But our team has an extensive background in reimbursement and diabetes and really just put everything into making sure the foundation for coverage and reimbursement was in place. So how we think about from this point forward now that we have this is we're actively out working with health insurance companies to finalize, get contracts in place.

Adam Graybill (Journey Biosciences) [00:28:01]:
So that as access is opened up, we can simply go to health systems and say, hey, this insurance is now covered. Let's identify your population of diabetes patients that could benefit from a screening, and let's get started. So the reimbursement is kind of a fun path. It's an important path. And from our standpoint, we've been very focused on making sure that Medicaid and lower income populations and parts of the US so as we think about inner city and rural, we wanna make sure that those folks have, if not first access, early access and coverage into it because those are the communities that are hardest hit with kidney disease and other complications of diabetes. And then on the flip side of reimbursement, we're also actively out working with health systems, hospitals throughout Ohio initially, but also kind of focused on, hey, where are opportunities in key centers of excellence that we can introduce this into to other states and other geographies across the country.

Jeffrey Stern [00:29:14]:
Lay of the Land is brought to you by Impact Architects and by 90. As we share the stories of entrepreneurs building incredible organizations in Cleveland and throughout Northeast Ohio, Impact Architects has helped 100 of those leaders, many of whom we have heard from as guests on this very podcast, realize their own visions and build these great organizations. I believe in Impact Architects and the people behind it so much that I have actually joined them personally in their mission to help leaders gain focus, align together, and thrive by doing what they love. If you 2 are trying to build great, Impact Architects is offering to sit down with you for a free consultation business, please go to ia.layoftheland your own business, please go to ia.layoftheland.fm. The link will also be in our show notes. From the perspective of a patient or, you know, even just for for myself, as someone not informed of the how to of of biomarkers and and what that actually entails, What does this look like from the perspective of getting the actual screen?

Adam Graybill (Journey Biosciences) [00:30:30]:
Yeah. So how NaviDK works. So first, it's for adults with diabetes, so type 1, type 2. We're drawing a 3 ml sample of blood. So for people with diabetes, labs are pretty common. It's the same blood sample size that's used for an a one c, which is one of the more common labs that, people with diabetes are getting on a routine basis. The difference is that that blood sample for our test is being sent directly to our laboratory here in the Cleveland area. And with that, we're running a patented method of how to measure the specific biomarkers in our lab, and we are sending that back to the clinician as well as to the patient, what we refer to as our our COMPASS report, which outlines what an individual's risk is for developing diabetes related kidney disease, as well as a summary or the ability to access a summary of standards that can be deployed if a person is at risk for kidney disease.

Adam Graybill (Journey Biosciences) [00:31:42]:
So that could be technologies, therapeutics, or everyday behaviors to help empower the person to start taking a first step.

Jeffrey Stern [00:31:52]:
So having unlocked the the billing part of this equation, what are you most excited about looking forward, you know, in terms of what comes next? Doctor.

Adam Graybill (Journey Biosciences) [00:32:02]:
So for us, what we're most excited for is really the most important thing, and that's screening patients in advance and really getting this out into the wild and starting to kind of that growth cycle of how do we identify the patients and the people with diabetes that can be screened? And ultimately initiating this process and getting to the point of where we're screening 100 of thousands, millions of people on an annual basis. From a business perspective, what that equates to is, you know, screening a 100,000 people on an annual basis equates to about a $100,000,000 of revenue. And so as we think about kind of the growth of our business and really the more good that we do for the diabetes community, the larger our business becomes and the more health care dollars we save as a result of delaying and or preventing kidney disease down the road. So just the growth cycle is something that we're all really, really excited about. We've built $1,000,000,000 diabetes businesses in the past, that have served 100 of thousands of people. So we're excited to really get this out and to scale it and have an impact on the world.

Jeffrey Stern [00:33:23]:
How has that prior experience shaped your thinking coming into Journey Biosciences? And what have you learned along the way this time that that is, you know, differed from, you know, the model you had in in place in in your own mind about how you thought this might work going into it?

Adam Graybill (Journey Biosciences) [00:33:39]:
So there's certain elements, I think, that you learn or certain things that we learn in the process, in addition to things being a little bit slower and more expensive than we planned. One of the most important lessons has been, hey, how do we build a mission aligned team? As we evaluate partnerships, making sure that they share the same values and alignment to what we're trying to accomplish. And even how we engage with initial key opinion leaders, initial customers, making sure that they understand the important role that they have. And in terms of, you know, being beta users, sharing feedback is ultimately the more we do upfront and the more feedback that we get and learn from mistakes, failures, it makes us stronger and helps us, I would say, scale the impact of what we're trying to do more effectively. So, you know, we've been really, really lucky and fortunate to have great team or build a great team, kind of initial team along with doctor Beiswinger and I. But really, it becomes about, hey, how do we carry those same characteristics across really all of the stakeholders that we're engaging with on a daily basis is the most critical element.

Jeffrey Stern [00:35:03]:
Have you changed your mind about anything? Initial assumptions or or theses that you've had that just have had panned out differently than you would have expected?

Adam Graybill (Journey Biosciences) [00:35:13]:
Probably the most important pivot that we had thus far has been we did some initial AB testing on the way that we want to go to market. So initially, I and we believe that a similar commercial structure that companies in continuous glucose monitoring or insulin pumps, we felt that we could leverage a similar type of model and be able to reach the patients and the health systems in a scalable and thoughtful way in what we learned versus an enterprise model, which was going top down from a health system perspective. And we were blown away with the initial results of, one, how fast an enterprise can move. We were surprised that that sales cycle was 3 to 6 months, Whereas even getting into an individual's doctor's office, selling the benefits of what we're doing and getting to a yes, we were looking at 6 months or greater. So that just blew us away in terms of the sales cycle as well as the overall kind of impact we can have in terms of large number of patients being screened to where we did a a hard pivot towards that enterprise model while also supporting kind of the patients and the clinicians from more of a marketing led approach of, hey. How do we make sure that people are aware? How do we make sure people are supported? But really using that marketing engine versus the highly intensive sales model of lots of feet on the street calling on doctors' offices really became apparent within 90 days of our proof of concept.

Jeffrey Stern [00:37:04]:
If the the underlying efficacy is ultimately there and and the the go to market mechanism is is kind of already in motion, I'm curious if you were to just apply, you know, an an adversarial lens to to this whole exercise. What would be the reasons that, you know, in retrospect, if Journey Biosciences doesn't break through in the way that, that you want it to? What, what are some of the things that kinda keep you up at night at this point in the journey?

Adam Graybill (Journey Biosciences) [00:37:33]:
So certainly reimbursement is something that is it's a hard thing. Insurance companies by nature don't wanna pay for things that they don't see a cost benefit to. I think from a clinician perspective is we're present enough to know that we're introducing a new category into diabetes management and care, to know that it's not easy to do that. And so I guess if I were going to restate it more simply, reimbursements and demonstrating the actions, the clinical action a physician can take, that they truly are empowered with these new insights are the two areas that we have to knock it out of the park on to truly do what we wanna do. Once we have that traction on both of those fronts, sky's the limit, but we need to be relentless in our kind of pursuit of both of those growth initiatives.

Jeffrey Stern [00:38:38]:
How do you layer in Cleveland as a geography into all of this?

Adam Graybill (Journey Biosciences) [00:38:43]:
So Cleveland is home, but more more importantly and I think as we've evaluated different areas or geographies, I think, as we think about rolling out, doctor Paul was based out of Dartmouth, which is in New Hampshire, as we evaluated where to build a commercial lab, where we evaluated where do we want to launch first. Ohio is a highly populated state. We have tremendous health systems. We have tremendous doctors and innovators within that space. And we have really good insurance carriers. So as we think about Anthem, as we think about UnitedHealthcare, Buckeye, really all of the health plans are very progressive in supportive of innovation. So we see it as really kind of the the epicenter of what we're building as a place where we can learn, get feedback, and have really well respected experts, whether it be at the health insurance or at the health plan or at the health system level, really be kind of our pilot sites to help us carry the message as we go kind of out from Ohio, hitting the East Coast, West Coast, and the rest of the Midwest.

Jeffrey Stern [00:40:01]:
So when you think about the life cycle of a company, you know, you mentioned kind of the the build, grow, scale kind of framing. And I think we've covered, you know, at least the history, the the path forward. Are there parts of the work that you're doing that are particularly important that you don't think we've covered that are requisite to this whole equation?

Adam Graybill (Journey Biosciences) [00:40:23]:
Maybe the most important stakeholder for us, we talk about where we sell to. Mhmm. We talk about who needs to pay for it with health plans. But the patients and just a recognition of what people with diabetes go through. Yep. And ultimately their commitments and their advocacy for new technologies, for taking initiative, cannot be screamed from the mountain tops loud enough. So the more, again, kind of stated earlier in the conversation is we all are connected in some way with somebody, whether it's a family member, whether it's a friend, whether, you know, it's somebody we work with, is there's people impacted by diabetes everywhere. It's not an easy condition to live with.

Adam Graybill (Journey Biosciences) [00:41:15]:
As mentioned, it's a 20 fourseven, 365. So I think it really takes a community to really get the word out to share experiences, to share feedback. We're fortunate that we understand when good experiences happen in diabetes, people are very vocal, and they wanna share it. But there's also a stigma attached to complications, and just diabetes in general. So I think as we look at this is what we're playing a small role in relative to kind of the patients and that stigma that's attached to it is that, you know, what somebody eats or what decisions they make doesn't always have a direct impact on the complications that they get. Much like cancer or cardio conditions or diseases, the complications in diabetes in general is there's genetic dispositions that patients have and we're really shining a light on the specific one for kidney disease. And so part of this is how do we empower, how do we support people finding out and proactively going and getting screened just as they would for early cancer detection, for understanding risk of heart attack or heart failure. We're trying to do that same thing for diabetes, trying to fight through really that stigma that people, that have been diagnosed with diabetes diagnosis because there's things that can be done to ultimately, manage it in a much more thoughtful and engaged way and ultimately take steps to prevent conditions like kidney disease that we're proving more and more are preventable.

Jeffrey Stern [00:43:17]:
You know, and you mentioned just kind of yelling it from the the top of the mountain. How has the patient reception been, if you will, to the work that that you're doing and the work to come?

Adam Graybill (Journey Biosciences) [00:43:27]:
Yeah. So I think from our standpoint, so the we're fortunate. So I think as we think about the diabetes community, there are probably a higher percentage of early adopters and innovators within the community. So in addition to the initial patients that raise their hand to get screened, a lot of those are clinicians, and they've shared their experience, not only with us, but kind of out with the markets. We've also been we're fortunate to be selected as the first company in the StartUp Health type 1 diabetes moonshot, which was largely funded and and organized by the Helmsley Charitable Trust, which also has a type 1 diabetes focus. So we've been really surrounded with great people and stakeholders as well as interested parties in supporting our early days. But as we move forward and kind of branch more into the type 2 space as well as going deeper into the type 1 space, it's what's more and more important is for for people that are screened, whether they're at risk or at low risk, to share their experiences not only with us but with friends, family, colleagues. Just ultimately the importance of early screening so that ultimately progression can be prevented.

Jeffrey Stern [00:44:52]:
Yeah. No. It's it's a powerful message. It kinda makes a lot of sense. It's this is a strange question that comes to mind. But, is there ever any, you know, aversion to wanting to know? Like, is there a downside in knowing?

Adam Graybill (Journey Biosciences) [00:45:07]:
Perception wise? Absolutely. But a lot of what the downside from a perception standpoint can be is knowing what you're at risk for can be scary because kidney disease is not a it's not something to be taken lightly, and it has serious consequences if not treated aggressively and early. I think where we look at it, the benefits to what we're bringing forward of where people shouldn't be scared with the information is that it's actionable. So we're providing insights, again, up to 12 years before there's any clinical signs or symptoms. And there's clinical interventions that can be taken to intensify managements today that are already approved, that are covered from an insurance perspective, that will ultimately give patients better tools and resources to do their part in preventing or delaying kind of progression to kidney disease. The absolute key is that it's up to 12 years before there's any clinical signs and symptoms. Whereas today, they might be going in with pretty significant symptoms, many times getting diagnosed in an emergency room.

Jeffrey Stern [00:46:32]:
Yeah. I mean, it's real prescience, you know, kind of actualized.

Adam Graybill (Journey Biosciences) [00:46:37]:
Yes. And I think, again, kind of one of the things I go back to, and we just kind of look at other conditions as we think about cancer, we think about cardiology conditions is I imagine for anybody that's going and taking a preventative screening for cancer, it's a terrifying moment. But when you look at the the opposite side of not getting diagnosed early or understanding if there's underlying kind of markers or genetic carriers, If you wait for signs or symptoms, it can happen too late to when it can't be treated or the prognosis of it being treated at those later stages becomes much lower probability of a successful outcome.

Jeffrey Stern [00:47:30]:
Well, I think bringing it full circle, I I'm glad ultimately that I feel you've found the work that you're meant to do because it's it's very exciting and compelling. Like you mentioned, I think I would imagine everyone, you know, knows someone that that this can can positively impact in meaningful ways. So it's very cool to hear about the work you're doing.

Adam Graybill (Journey Biosciences) [00:47:50]:
Thank you, Jeffrey. This is a great, great opportunity and appreciate you taking, taking such an interest in Cleveland based startups and healthcare businesses.

Jeffrey Stern [00:48:02]:
Absolutely. My pleasure. We'll bookend it here with our traditional closing question, which ties back in into Cleveland, which is for a hidden gem in the area. Something that, you know, other folks may not know about, but but perhaps they should.

Adam Graybill (Journey Biosciences) [00:48:16]:
Yeah. So I'll I'll go a little bit outside of Cleveland. So I grew up a little bit west on the lake. I think most people are familiar with, like, the Cedar Points and, you know, the putting bays for different types of fun activities. Having grown up on the lake, Kelly's Island is certainly something that can meet all families and all types and all kinds of interests in different ways. So I encourage as the weather turns warmer as we head into spring, for people if they're just looking for a quick weekend getaway or during the week getaway, look up Kelly's Island and get to enjoy a little bit of water and relaxation.

Jeffrey Stern [00:48:55]:
An amazing hidden gem. Well, thank you again, Adam. I really appreciate it. If folks had anything they wanted to follow-up with you about, what would be the best way for them to do so?

Adam Graybill (Journey Biosciences) [00:49:04]:
Sure. So easiest way to kind of get in touch with us and be connected is go to our website, which is www.journeybio.lifeonline. It's got, some different forms for whether somebody is a clinician or a patient or, you know, potential investor or other. They can fill out the form and stay connected with what we're doing. And our team is actively in conversations with folks that, that fill out that form.

Jeffrey Stern [00:49:37]:
That's all for this week. Thank you for listening. We'd love to hear your thoughts on today's show, so if you have any feedback, please send over an email to jeffrey@layoftheland.fm, or find us on Twitter at podlayofthelandor@sternjefe, j e f e. If you or someone you know would make a good guest for our show, please reach out as well and let us know. And if you enjoy the podcast, please subscribe and leave a review on iTunes or on your preferred podcast player. Your support goes a long way to help us spread the word and continue to bring the Cleveland founders and builders we love having on the show. We'll be back here next week at the same time to map more of the land.