#33: Charu Ramanathan, PhD (vitalxchange)

-- AI-Generated Transcript --

Charu Ramanathan, PhD (vitalxchange) [00:00:00]: What we wanna do is change the stigma around special needs. Lay? You will get stigma to sympathy is an easier transition, but we want stigma to sympathy to support, you know, to solutions. So I mean, that's The journey. Right?

Jeffrey Stern [00:00:15]: Let's discover the Cleveland entrepreneurial ecosystem. We are telling the stories of its entrepreneurs and those supporting them. Welcome to The Lay of the Land podcast where we are exploring what people are building in Cleveland. I am your host, Jeffrey Stern. And today, I have the pleasure of Speaking with doctor Charu Ramanathan, who is the CEO and cofounder of VitalXchange. Charu is also a serial entrepreneur, though. She co Founded Cardio Insight, a company specializing in noninvasive cardiac imaging systems, which she successfully led through its growth stages Land, ultimately, Its acquisition by Medtronic back in 2015, after which she also cofounded Locotiota Global, which is developing advanced credit scoring algorithms To foster financial inclusion in emerging economies. Most recently though, Charu is building Vital Exchange, Which is a person focused health network centered around patients, people, caregivers, and families.

Jeffrey Stern [00:01:18]: Vital Exchange is based here in Cleveland and has raised over 2,000,000 in capital in pursuit of positive impact and elevating human life. Trio's passion really comes through in full in this conversation, which I very much enjoyed, and I really hope that you all do as well. So you've been working on Vital Exchange now for a few years. But as I understand it, this is not your 1st stop on the entrepreneurial journey in terms of building something from scratch, Leading a startup bringing new technology to market to push the healthcare industry forward. So I'd love if you could just share a little bit about what Ultimately got you into entrepreneurship and the path that has led you to Cleveland and the work that you're pursuing today.

Charu Ramanathan, PhD (vitalxchange) [00:02:07]: Yeah. So I came to the United States to pursue a master's degree in biomedical engineering Land then ended up staying on to do a PhD for mostly primary reason was that I actually didn't have an idea of what I was gonna do after my at school after masters. Right? But I was very lucky in that the project that I worked on, which was a mapping system, which was basically to non invasively record the signals of the heart so that you could interpret from the outside what was going on with respect to any of of normalities on the heart. I had to take that technology with the help of my adviser at the time, doctor Yuram Cleveland a couple of colleagues from bench to bedside. So we really did animal models. We did computer models. We did we started to do clinical studies here at the University Hospitals of Cleveland Land started to see how it could benefit patients and How excited the cardiologists were to see the results. Like, they could map it not invasively.

Charu Ramanathan, PhD (vitalxchange) [00:03:13]: And then so I started to think, hey. We're writing NIH grants every year asking money from the government that this would be a clinical tool someday. And how is that gonna happen? Like, are we gonna do this through 1 publication at a time, or are we gonna do something about this? And I started to have those conversations with, you know, at that time, I'm, I had a mentor. I had a side job with A company in town called Athersys that had, moved into town from the Bay Jeffrey. Founder was Gil Van Bocklen that that had Started a company. It's a biopharmaceutical company. So I was talking to him about it, and he said, we gotta do a Stern up. And then I was like, Lay, well, how do I do that? Well, do you have patents on the technology? Yes.

Charu Ramanathan, PhD (vitalxchange) [00:03:58]: We'll go talk to the university about licensing that technology. And so that was a kind of the conversation with the with Case Western Reserve University to say, hey. We have all these patents. You know, obviously, I was a co inventor on them. I just thought, yeah. Go inventor. Let me license this and build a company. Oh, wow.

Charu Ramanathan, PhD (vitalxchange) [00:04:15]: That was a very unpleasant surprise because the university is like, well, wait a back. And you may not invented it, but we funded it Land then we own it. And, you have no experience. You're just a graduate student. How are you gonna start this company. And keep in mind The was 15 years ago where the culture was still very old school. Right? You had to have a business degree in years years years of sweet c suite experience before, you know, anybody could start anything. And clearly, many, many people from Marks of the world have proven them wrong.

Charu Ramanathan, PhD (vitalxchange) [00:04:48]: So life has really been different.

Jeffrey Stern [00:04:51]: Right. Right.

Charu Ramanathan, PhD (vitalxchange) [00:04:52]: So, basically, that's kind of where I got my my bug to be an entrepreneur. It just happened, and I enjoyed it. I enjoyed translating the the technology. I enjoyed kind of growing on the job. I'd say like growing, maturing, to be a leader, to take responsibility for things that I had never done, like, you know, growing a team, nurturing a team, raising funding, watching that funding disappear, And then redoing that without really losing my mind and, you know, doing all of that through the economic downturn of 2009 and, you know, and so on and so forth Land really making very strong allies, and friends along the way that were very similar thinkers, whether they were investors or advisers or collaborators or other physicians or other health care leaders. So, yeah, that was kind of my journey. And, the company got acquired in 2015 by Medtronic. And, I was with Medtronic for 2 years, learned a lot about how big corporations run, learned a lot about the things that would need to be done properly in order to be assimilated into a large company.

Charu Ramanathan, PhD (vitalxchange) [00:06:00]: And it doesn't happen organically. And when people say that it's not really cliched, it's true. Because when very large companies acquire small companies, They're under a lot of exposure, right, with the FDA liability, all that stuff. So they they want to take this little company that is producing The line of products into a system that they can Stern, that they that their brand can stand behind. So that that requires a lot of like, I hate this word remediation, but it's very process oriented. And I am not that's not what I'm passionate about. I'm passionate about solving problems and of. And, you know, it's it's quite difficult, you know, 4 layers down where to The decisions would have to write up and probably get lost somewhere in the 2nd of 3rd Lay.

Charu Ramanathan, PhD (vitalxchange) [00:06:52]: And it was a little bit frustrating. I matured. I learned a lot. Yeah. But it also confirmed for me that what I needed to do was to come back into the startup world because that's where I did my best. And the funniest thing is one of the cardiologists that was a mentor that we worked with that was also an advisor for Medtronic told them like, let her go. Tiggers need to do what Tiggers do best. They need to bounce around Land her bounce is gone.

Charu Ramanathan, PhD (vitalxchange) [00:07:22]: So what I did was by that time, I had Khetil Patel, who was our head of product development at, at at Cardio Insight, the The company that I just my first company that I founded, he and I had become really good friends. And we started to brainstorm towards the end of that 2 year journey. What are we gonna do? Right? We gotta do something that solves a bigger problem. And both of us are of Indian origin. We are he's a he's a 2nd generation immigrant. I'm a 1st generation immigrant to the United States. And we he had prior to Cardio Insight worked on a cancer treatment system called View Rate. And before that other systems as well.

Charu Ramanathan, PhD (vitalxchange) [00:08:03]: And combined, we realized that we had worked on medical products that was affordable in the Stern world where, you know, there's insurance and, you know, people can pay. You know? What we also realized, the price point of what we had built. Like, take cardio inside for instance. It was 1 disposable vest was about averaged around 2 to $3,000. I mean, that is like, you know, higher than the average annual income of a lot of people in India. So we wanted to create something that had universal appeal access and solve a global problem. And around that time, both of us being part of a sandwich generation, getting kind of up in age, had had some chronic issues of our own. And we also had kids that were, you know, starting to, you know, have some issues at school.

Charu Ramanathan, PhD (vitalxchange) [00:08:57]: And then parents that were aging that, you know, we were caregiving for. We were googling all the time, you know, Googling, you know, breast cancer, Googling, asthma, Googling colitis, you know, you're Googling, Googling, Googling, and then you realize, well, as a healthcare entrepreneur that knows so many physicians, you know, people reach us, reach to us for referrals. Say, what do I do? I've been asked to do this. Can you help me? And then we're Googling or trying to dissect the information and push it back in a very understandable way back to our parents or whoever it is that was asking that information. And so we we we in 2017, we kind of mentally created The concept except of vital exchange. We said, hey. It has to be it's it's it's a vital exchange of a piece of information that's gonna allow a patient to move forward, whatever that next vital step is. And then we, we Land of brainstormed that.

Charu Ramanathan, PhD (vitalxchange) [00:09:54]: So meanwhile, we took a little detour. So we were really ripe to do something disruptive, something that had impact. We wanted to have meaning in our lives coming out of the big corporate environment. And one of my friends said, hey. I have this fantastic idea. It's really prime for it. It's it's actually, you know, he had worked 15 years in the microfinance lending, global lending in Africa, India. And he said, there's no scoring algorithm.

Charu Ramanathan, PhD (vitalxchange) [00:10:22]: Like, there's no credit scoring algorithm to lend money to people that have no credit history. And I have this fantastic AI, like, machine learning algorithm that can do it. Can you just help me build The software? I'll bring in the domain knowledge. You guys help me build the software. You guys have done The startup before. So the 3 of us cofounded a microfinance machine learning based credit scoring company called Loketa. We got funding here, funded it through its seed stages, And it was actually based here in Cleveland. And then my cofounder, you know, kinda quit his he had some commitments.

Charu Ramanathan, PhD (vitalxchange) [00:10:59]: He quit his job with, World Bank. And then he came over and took over as Lokey as CEO full time, and we're both on the board of the company. So this happened in 2017 and 18. And then we said, okay. Well, we're ready to pick back up. Okay. Where where do we leave off with Vital Exchange. And then in 2019, we actually incorporated the company.

Charu Ramanathan, PhD (vitalxchange) [00:11:22]: And it it had been a very fantastic Right? Because in March, I, flew over to San Francisco for some other reason, actually personal. And I just made a stop over, you know with one of our advisors Adam Kaufman here who is a Cleveland who is also a partner at OvoFund And I had listened to Eric Chen's podcast that he had done, and I also met him while he was here. Eric Chenza is The founder of the oval fund, which is a very early stage seed fund. And I went over to San Francisco, and I said, We're gonna do this vital exchange thing. This is the concept. This is very broad vision, and we're gonna just go down the path and look at multiple different conditions Land then pick 1 where we can create the maximum impact. Next today, Eric called Adam and Adam called us and said, hey, who would like to invest in your company? So we had like we were in a situation where Or we had no plan, nothing, but we really were able to articulate. Like, we were we we knew we would do something really big no matter how complicated it was.

Charu Ramanathan, PhD (vitalxchange) [00:12:34]: And we wanted to create impact, not just try to be another limp along technology. So that's what we did. So we we got it and then jump start, you know, put in one of their early, you know, jump Stern participated. I had The we invested money as well as we had, couple of angels, One from San Francisco, another one from, Phoenix, Scottsdale, Arizona actually, invest. And we've raised about $2,000,000 so far, and we profiled 21 different conditions, interviewed hundreds of patients. So meanwhile, we were really starting to see some issues with the schools, some issues with our kids. Really started to kind of back end into this concept of neurodiversity Land autism. And It was like an epiphany because I come up from a family of several types of neurodiversities like dyslexia, attention deficit, and autism.

Charu Ramanathan, PhD (vitalxchange) [00:13:33]: And I'd never thought and when we connected the dots in April of 2, like like Yeah. During the pandemic year early. It was like, wow. What are we doing? Anything else? Let's just do this because if we can if we can really solve the problems of these parents that wanna do the best for their kids. We're doing something impactful here. That's even with all the infrastructure, many problems in the US. Just imagine if you The countries where there's no strong public school infrastructure or public health infrastructure. So that's my long winded answer to your question.

Jeffrey Stern [00:14:11]: No. It's an incredible journey to to get here today. I love if you can just kind of expand on the the problem a little bit in terms of, you know, ultimately, who When, you know, when when you're doing that Googling to find, you know, the right information, how is it that you're going about the curation of, You know, the the right direction that you wanna, you know, guide people who are who are seeking answers to the kinds of questions that may have been difficult to Right. Find before.

Charu Ramanathan, PhD (vitalxchange) [00:14:40]: Here is the little journey within the implementation of Vital Exchange. Initially, our premise was that we would match to patients The other patients or families to other families that had similar circumstances. And then we would have an experience differentials so that the experienced family could help the less experienced family or the family at the beginning of the journey. And we quickly realized that so we we build a community platform essentially. So we beta did in April. We we brought a couple of partners on board, that were like special needs, schools and practices. And we onboarded the families that were their customers. And then we we really started to look, and then obviously Facebook groups and other like, we started Northeast other communities.

Charu Ramanathan, PhD (vitalxchange) [00:15:29]: And what we found was, unfortunately, there is a lot of noise and it's very hard to electronically moderate that. So for example, take the there's a there's a specific kind of therapy called applied behavioral therapy in the The health space. So it's basically a kind of regimented therapy, which is put which the children go through so that they would behave inside a constrained environment. The are for every parent that believed that ABA saved their kids' life and made it much more helpful for them to function. There will be a parent that basically says ABA is abuse. Okay? So when you look at the moderator's problem, you can't take sides. Right? Like but if you look at it, it's, ABA is evidence based and, you know, it's It's this. It's a that.

Charu Ramanathan, PhD (vitalxchange) [00:16:26]: So then we really started to veer towards the concept of matching families to qualified resources so that they would kind of drive and connect the dots on their own. But the sources of information was vetted. So we were, like, thinking, hey. We need to have providers on the platform, but we actually did not like how providers and patients exchange information. You know, half the time before I even decide I wanna go see a doctor to get the scheduling done. I gotta drive. I gotta fill out all this paperwork. And oftentimes, especially in this type of, you know, in in behavioral health or in pediatric therapies or whatever.

Charu Ramanathan, PhD (vitalxchange) [00:17:05]: Half the time you don't like the provider because they're not the exact fit for you. Right? But I'll I'll keep on limping along because I've done all this overhead work. So we were not to interested in the traditional information delivery because that was after the fact. We wanted to say, how can we take all of this wisdom that was trapped and and held behind the walls of a very bureaucratic health care system and really open the door so that wisdom would reach patients. Right? We had heard unequivocally from all the providers that they hated it when when parents came in and said, I Google this. Okay. Look at this printout. This is what it says.

Charu Ramanathan, PhD (vitalxchange) [00:17:43]: And, like, Well, I went to medical school, you know, doctor Google's not gonna solve your problems, you know? But the reality is Googling is easy to do. Right? So what is the recourse for the for the patient? Are you gonna talk to the patient every time in the middle of the night this child is having a seizure or They need to ask a question. Are you gonna be there? No. So we were like in this around the summertime during the Pandemic year, we just launched. We were like, what do we do here? Right? And then something like a really silver lining happened in the pandemic cloud. And that was the like, people started adopting telehealth technologies, remote service delivery. Like, a lot could be done through a camera and through, like, you know, like and so really that was the foray of remote service delivery into the health care system that really entered main street. Like before it was, what, 6 to 9% something penetration Land really during the COVID year, most places reached 96 plus percent of utilization.

Charu Ramanathan, PhD (vitalxchange) [00:18:47]: And what happened was this entire pediatric special needs therapy space that had a significant amount of burnout because it's really hard to care for the children. There's a lot of emotional, You know, what we call empathy fatigue with with the providers and a lot a lot of burnout. And now telehealth and remote service Delivery was really offering providers a nice new way to practice help families without, you know, and but but at the same time balancing their time without really sitting and filling the paperwork, showing on-site driving to different places. So we decided, in late fall to create a new paradigm. You know, we and I think, you know, one of The themes that I wanna talk about, which I think you alluded to as well is why isn't consumerism in health care? Right? You're talking to a generation of parents, especially younger parents The are just getting their children diagnosed with any type of neurodiversity. They're Ubering, they're Venmoing, they're DoorDashing. And when it comes to healthcare, they're filling out paperwork. Right? So then, then we really we really started to say, okay, what if we created based on combining the gig economy and the creator economy, a new model that would put the therapist or the expert loosely speaking in the role of the creator.

Charu Ramanathan, PhD (vitalxchange) [00:20:10]: What if they created classes? What if they created chats? What if they created Webinars, courses, recipes, so many Lay. Right? So we that's what we did. And so we created a Shopify for health. So we have the community piece, which is really the I'd say it's foundational. It's not the front and centerpiece, but then we have the Shopify Northeast. It's kind of a two sided marketplace. We did launch in February Land and we have everything, the payment processing, the scheduling, social sharing, everything. It's it's it's it's literally a contest in a box.

Charu Ramanathan, PhD (vitalxchange) [00:20:45]: And but but not an not a traditional telehealth practice. It's actually a way for for the therapists to share their wisdom in multiple different ways. So we we Stern the shelf. It was it was like the most It was such a crazy uptake we had. So we went to, like, 2 or 3 different bloggers in the space and said, Lay. We would like for you to promote Vital change and say, Lay. See if any of your therapists are interested. I am not exaggerating.

Charu Ramanathan, PhD (vitalxchange) [00:21:13]: We have done a 100 interviews in the last 2 months alone for therapists. And we've onboarded we have about a pretty good balance of 50 therapists now on the platform with all different kinds of storefronts. We call them storefronts and offers on the storefront. Anything from 4.99, hey. Have a tea with me to talk about your kid to here's a toolbox that you can buy that with dollar store items to help your child with sensory issues at home. So like super exciting. So now we just as of last week, we because the pandemic also created a shift. We were a mobile app before, And now we're we are a web app also because kind of the world shifted to using computers more often because they won't call more.

Charu Ramanathan, PhD (vitalxchange) [00:21:59]: And so we just launched our web app version. And now going back to your original question, we're now using, search algorithms Land, you know, we're trying to divert the traffic, so to speak, that's looking at different parts of the journey, really working with different types of organizations, nonprofits, to be able to say, hey, your parents are looking for help, you know, come here. If the parents are googling for help, let's show you what we got. Don't have to read an article and get overwhelmed. Talk to somebody. And we we call our experts' vital guides. So they actually are your navigators.

Jeffrey Stern [00:22:36]: Now it's there are a lot of Threads there that I'd of to pull on and and go a little deeper. But I to start taking a Stern back and and more of the macro pitch picture, Why do you think we aren't seeing the consumer quality of life enhancements that we've seen across literally every other industry like you were mentioning except in health care? Right. This you know, with the proliferation of the telehealth, industry over the last year, you know, we've greatly increased everyone's You know, willingness and and comfort with with doing it. But do you feel like it's a there's a staying power to that catalyst or is it a one time event? How do you think about That space and why we haven't seen the just the technological adoption in the space that we've seen elsewhere.

Charu Ramanathan, PhD (vitalxchange) [00:23:19]: Yeah. No. I think that's a great question. And I I think it's slower. I wouldn't say we're not seeing it. It's definitely slower, But there's various factors for that. Right? Because, you know, I think The catalyst I would say is really a lot of tools that, enable patients to make informed decisions. Right? So for example, take GoodRx, which gives, you know, pharmacy discounts.

Charu Ramanathan, PhD (vitalxchange) [00:23:43]: It explains to you how how these drugs work and everything. It actually tells the patient what it's about and where they can buy it for cheap. Such an important decision, right, or what an alternative may be. So that information was before not available. So that's now consumerized, for example. The other aspect of it, the newer models, right, like direct primary care, like for a monthly subscription, you could access a primary care doctor front of the line without being worried about them trying to refer you to high costs, you know, like surgical procedures or whatnot at the back end because They belong to an affiliated larger hospital system that get that makes money not from the primary care doctor, but the procedure that you've referred them to. Right? The other aspect is value based health care and reimbursement shifting from the fee for service model to more outcomes based. That's kind of to me, it's, lovely.

Charu Ramanathan, PhD (vitalxchange) [00:24:39]: It sounds really great, but you gotta change so many people's habits to do that. I'll give you a trite example from a page from Amazon's hit, you know, 20 what is it? 22 year history is that, You know, when Amazon first started, if you if you read the original articles, there was a lot of dialogue about why it won't take off because, You know, no retailer wants to see consumer reviews. Right? Ratings about products. What guess what? Consumers wanna see them. Right? And so it took off. So similar to that, I like the fact that digital health is giving consumers a voice. It's giving consumers front row access to choices that they can make. And I think the newer models, and we believe vital exchange is one of those models which would help starting in the special needs world.

Charu Ramanathan, PhD (vitalxchange) [00:25:26]: We we have we we wanna replicate this playbook elsewhere is to say if I'm having access to the quality information and I'm starting to engage with the provider on my terms, then I will start now investing on my own terms and not my own health. And then slowly we start become becoming wellness focused rather than let's get let's get sick Land then, you know, somebody else in the back end fixes it. The stakeholders, I mean, I would say that the medical This, is really great for, you know, where you have a, like, a cancer or surgery, and it's really great for that. It's really not great for chronic illnesses that needs to be managed across the board, nutrition, sleep, fitness, stress management. It doesn't happen. There's no hammer and nail approach at the back end where they can give you a pill or, you know, cut you open and fix it. Right? That that's not gonna happen. So a lot of power, you know, lies in the 8,000 hours that I'm spending on my own The I'm not in front of a doctor.

Charu Ramanathan, PhD (vitalxchange) [00:26:24]: So Right. Right. I'm I'm up to I'm gonna be on in my own vices if I, up to my own vices if I you'll leave me alone. So what if I created a paradigm where you could actually, you know, give me access to my innermost concerns 20 fourseven and monetize it. Let the expert get paid for it. But one mentality change to go back to your sustainability question is it certainly works in the pediatric therapy space. I do have my doubts whether traditional MDs at this stage would would be like, well, My hour is $200 an hour or $300 an hour. You know? And because that mentality is permeated.

Charu Ramanathan, PhD (vitalxchange) [00:27:02]: Right? It's from the medical schools onwards, you know, that the doctor's time is more valuable than the patient time. Land that is a huge, huge barrier. If you do not Think that your patients are your customers. Consumerism's not gonna happen, but what's gonna happen is what happened with Amazon is when consumers are empowered and the supply side doesn't step up, it gets commoditized because there will be a whole faction that wants to step up and a whole faction that won't Land then the free market will fight it out. So Are we ready for that? I don't think so. Gonna make a lot of people really Land a lot of large health systems quite nervous, but it has to happen.

Jeffrey Stern [00:27:45]: In the shift Northeast in the direction of of that paradigm change where you think about where Vital Exchange sits Land and I'd love to kind of go deeper on The Shopify analogy and and Vital exchanges, you know, health practice in a box kind of of, but just, you know, a Simple question. How is it that Vital Exchange is making money, in in this ecosystem?

Charu Ramanathan, PhD (vitalxchange) [00:28:08]: The model that we're test driving now is a model where the provider that's setting up a storefront pays us a subscription fee for data and you know, all access to the storefront services. And then they and then we also have a a technology access fee as a a percentage of The, money made on the platform because some of them are low value, high velocity services. Some of them are large value services. We are also looking at other verticals like employer verticals where the employer would provide vital exchange as a disability benefit to their employees. And we might, you know, move into a more of the B2C consumer model that could be subsidized or freemium access for the employer. You know, one of the angles that's very, very I'm very passionate about is that a majority of our therapists on the platform that really serve the special needs space are women. Land the parents that are parent mentors that we've interviewed and hired on the platform that have really off ramped from their entire careers to be able to take care of their special needs children. They're like superheroes.

Charu Ramanathan, PhD (vitalxchange) [00:29:21]: They're all mothers, and we are able to create opportunities for them to make money by helping other people. So And that's the other philosophy, right? Money is always more powerful than charity, and it makes everybody's time worthwhile. But we are really, really passionate about the social impact on women, and that's an angle we'll definitely explore. I mean, 1 in 3 women through the pandemic have considered leaving their jobs because the infrastructure was weak and the COVID and the lack of, you know, infrastructure in terms of caregiving responsibilities, childcare responsibilities, etcetera, really fell apart, right? A lot of women, you know, 45% of women, either off ramped or went part time. So it's something that we feel is it should be a key part of our monetization, our messaging, and value is is really how do we empower women through vital exchange

Jeffrey Stern [00:30:18]: yeah when I when I think about empowerment particularly in the context Of the of the Shopify analogy where, you know, you have against the the Amazons of the world being the, you know, the health the larger health care institutions in in this in this case, you know, people that were wanting to set up shops Land they just didn't have the right tools to pull, know, the payment infrastructure together, the distribution to the consumers. I'm just curious from, like, the technology perspective, how is it that you've pieced Of of these items together to create a, you know, a platform to empower the the practitioners to help, you know, offer these services to the To the consumers. And then on the consumer front, also kind of playing into the the Shopify analogy, you know, there's a there's quite a large consumer community that Exists within Shopify's world that I don't think quite exists within Amazon's world where people really connect with, You know, the specific stores that they have access to, and The the the relationships that they're actually able to develop with With the source of the information. And so I'm curious Land of the the parallel there.

Charu Ramanathan, PhD (vitalxchange) [00:31:25]: Exactly. So I think I think you hit the nail on the head is We don't call ourselves the Amazon of healthcare because that doesn't have the emotional component. You know, what Shopify does differently is in Shopify, The shop owners take accountability for the quality of services that they're offering through the shop. That's how they build that relationship with their customer, which is very important in vital exchanges case, right? The vital exchange is really happening between the provider and or or the or the vital guide. Let's call them vital guides Yeah. Up here on mentors, etcetera, as well as the the the person in need. So it's really important that they own it. They own that relationship.

Charu Ramanathan, PhD (vitalxchange) [00:32:03]: So our vetting process so going back to your question, like, there's a lot of parts pieces. So we we have a huge value chain diagram where we've really charted or from every piece to credit card processing, all the way to leading into reimbursement, the employer vertical aspect of it to even, you know, HIPAA compliance, electronic record integration. I mean, everything that you would need to put within the playbook of what a healthcare provider would need to start set up shop, but at the same time, scale into basically provide scalability. And we've probably implemented, like, 25% of it. So what we did is we basically implemented the piece, which is out of pocket payments, supplementary care, And our, honestly, our pitch to the therapist is quite simple. Like, they get in 10 minutes, they enter a few things. We have a web, a separate product. We call it BX Max.

Charu Ramanathan, PhD (vitalxchange) [00:32:57]: It's a web portal. Mhmm. They enter a bunch of things into it, and they get outcomes, a little storefront on the app, and a web page. No technology, no coding, nothing. So that's of of how it seems because a lot of The interesting part is because of the burnout, because of COVID, because of the nature of the job, pretty much a 100% of people that knock our doors have considered going on their own, but been very, very intimidated. I mean, we all know, right, as a cofounder, you know, starting your own business. It's it's hard. You gotta do it.

Charu Ramanathan, PhD (vitalxchange) [00:33:33]: You know, incorporate funding, you know, marketing, you know, technology. You gotta set up your own website. Now Google SEO algorithms are changing every day. So that's Land of what we do. So we have really 4 pieces to our platform. Number 1 is a mobile app so that, you know, everything has to be in the palm of your hands. We also wanna make sure that even if The family doesn't have high speed Internet computers at home. We want they have mobile phone.

Charu Ramanathan, PhD (vitalxchange) [00:33:59]: Right? Mobile penetration is so much higher than, you know, desktop computers. So number 1. Number 2 is a web application, which is of of where they would do most of their transactions, find us on Google, things like that. 3rd 1 is the VX Max portal, which is really the Shopify piece. And the 4th 1 is our learning engine. We call it VERA, like Veritas truth. It's got multiple components. There's a matching engine which is learning now.

Charu Ramanathan, PhD (vitalxchange) [00:34:25]: It's not yet deployed. We have a conversational interface that's coming out next actually in 2 weeks. So basically, really leading the asking questions, leading, leading the family to the right type of offering. And then obviously we're we have a huge data collection. You can imagine like every question that's being answered can end up, you know, being a database of different types of quality answers as well. So, I mean, there's, there's, that's The technology bucket right The. And ultimately, we want to create a lot of free resources that would be available for families Land then create that and use that to drive tools and create through a limited marketplace launch, create a very strong single player mode for the parents that they may come in Land we want we wanna monetize that single player mode as well.

Jeffrey Stern [00:35:16]: Yeah. For for those who have engaged within the the platform in the community already, what is the reception been? What has been the kind of impact that You've been able to see from people working with the the vital guides and and actually starting those relationships and and having access to this This platform and and all this information.

Charu Ramanathan, PhD (vitalxchange) [00:35:36]: Right. So I think, you know, we're just at the beginning stages of that. So like I said, we opened the doors last week. We we have about a few 1,000 patients on the platform. I mean, families on the platform. That was part of our beta, so to speak. So we just started to now on onboard for All the value propositions that I just spoke about giving a child every opportunity they deserve, you know, providing a Sherpa, a vital guide to every family, every every mom and dad that wants to do what The, you know, understand what their child is going through and really find them every support that they Land, you know, that sort of thing. So the response so far in terms of, Like, I would say it's anecdotal.

Charu Ramanathan, PhD (vitalxchange) [00:36:17]: We're just starting to collect the metrics has been really overwhelmingly positive. You know, I just Just announced this on LinkedIn The other Lay. We had so many, professional. It was like a professional announcement, but I had so many comments from My professional colleagues that I didn't even know had children that had graduated Land they said, hey, I wish I had this, You know, when my child was in school, and this is great what you're doing. Let me know what support you need. And that's that's that's really the the unfortunate truth is what we wanna do is change the stigma around special needs. Lay, you will get stigma to sympathy is an easier transition, but we want stigma to sympathy, to support, you know, to solutions. So, I mean, that's the journey, right? So that's what we're trying to do.

Charu Ramanathan, PhD (vitalxchange) [00:37:05]: And, you know, we are we we we can't do this alone. So Scalability depends on the kind of very focused verticals that we can, unleash like the employers are a key part of it, right? As of, I think 2021, I think 50% of the landscape, which is even higher than health and human services employers are responsible for. Ultimately, they are the payers, right? They are the ones that are footing the bill for our health. So, it's really important that they are, I mean, I would boil it down to say that it's a key part of what an employer can do for particularly their parent employees, particularly their women employees. Because when you have a child and you're young, you don't. When you have a child that's in distress, it's not easy to focus on the job. Like, what does that mean to productivity? What does that mean to retention? What does that mean to loyalty? I mean, I would be very loyal to a company that actually took care of my entire family. Right? I would prefer that over chocolate bars, vegan food, and yoga classes.

Jeffrey Stern [00:38:03]: Right. Right. Yeah. That that matters ultimately. You mentioned in the earlier days of of Vital Exchange how Perhaps the initial thought was connecting families to families rather than to the guides necessarily. And and but as you build this community Over time of of the families on the platform, how are you thinking about unlocking the community potential, just within the family side of the platform and Just through, you know, those empathy and and the relationships and just the the shared experience that that that you could unlock just by connecting those people.

Charu Ramanathan, PhD (vitalxchange) [00:38:40]: True. So that's that's a great question, and I'll give you a partial answer to that because we put in 1 solution. And so we have Six free communities on the platform centered around different themes like autism, special needs, learning disability, you know, that sort of thing. And what we've done is we've actually created a commune that community is free for anybody that joins it. And and and, we we our The, based on what you enter during the onboarding process, will decide which community you fit them the most. Right? And those communities also have those appropriate providers as well. So it's not just the parents, but it's also the of, and we moderate that. And the idea here is to Cleveland we we can see this Land we actually studied several Facebook groups that are moderated by a parent or a patient, and then you have multiple patients kind of putting in their opinions versus groups where you have, you know, the professionals as part of it as well.

Charu Ramanathan, PhD (vitalxchange) [00:39:43]: So you're really trying to we're trying to create an environment where more like, Quora, for example, really good Quora threads are where where You speak only if you have, you are qualified to answer. So we are trying to create that culture versus a Reddit or Facebook kind of culture where everybody talks, and then you have 10% of the people that talk louder than everybody else. We're trying to create, like, when you give an answer, it's gonna be long. Is gonna be detailed, but but then it's gonna be authoritative that, hey, I am a parent. I've gone through this. This is what I mean, or I am a professional. I treat this. Come talk to me.

Charu Ramanathan, PhD (vitalxchange) [00:40:19]: Yeah. I mean, that's our, our first attempt at answering the question about how do we create not lose the community piece and make it more transactional. Also, every provider on our platform also gets a community. It's free for every anybody to join. And of I by services from you. I'll automatically get joined to your community, so we're trying to create that. But there's new habits to teach, right? Unlike creators on Patreon that are used to engaging with customers in this way. Doctors, clinicians are not used to writing long only the bloggers Do that.

Charu Ramanathan, PhD (vitalxchange) [00:40:55]: Right? Not everybody can blog. Not everybody can write. Not everybody can podcast. Right?

Jeffrey Stern [00:41:00]: Right.

Charu Ramanathan, PhD (vitalxchange) [00:41:01]: So it's something that they're learning on how to engage other than 1 on 1 consultations in the clinical consultation. So it it there's a learning curve there. We are we will be launching a seller services program as well. So really providing, bringing in invited speakers to do master classes, teaching people how to help themselves, how to set up, how to promote their businesses. So like I said, our value chain, like we've charted is overwhelmingly complicated. We are trying to think about

Jeffrey Stern [00:41:30]: it. I can imagine. So No. I was just gonna say The the the vision and the, you know, scope of impact that you hope to have is, like, incredibly ambitious. And I'm I'm just curious on the company building side, especially as a repeat, you know, founder and entrepreneur, how you kinda have harnessed the the bounce of of Tigger, as you mentioned. And and just like the The What are the things that you're doing differently this time around Land just on the company building side with with the the breadth of a vision that you have for the company? Just how you think about Reconciling the breath with focus in in the current moment Land just, a little bit more about how you've gone about actually The the company building side of it.

Charu Ramanathan, PhD (vitalxchange) [00:42:15]: Yeah. So obviously there's a lot of lessons learned. Right? So because I was in experience I was a first time founder when I started Cardio Insight. So there were a lot of mistakes made mostly in self doubt. You know, I wasn't sure, should I trust my intuition, somebody else's advice. And as I mentioned, the Cleveland area network is still really emerging, right? It's evolving as a, as a, as a entrepreneurial ecosystem, much better now than it was before, but it's still emerging. Challenges with The. You know, one of the things is, the the I am extremely, extremely picky about the people that I choose to work with because one of, the key things that we and my cofounder is exactly the same Lay.

Charu Ramanathan, PhD (vitalxchange) [00:43:02]: And the 2 of us are actually really good friends in in life as well, so in personal life as well. And the important thing is everybody should embody that vision, embody that mission, and that And it's not an easy thing. Right? Because we're trying to not find the 1st business model that'll give us a few revenues and then not really We are away from the problem to be solved. And I I felt like with my first company, there was we didn't really crystallize exactly play what our vision was gonna be. We were mostly so like, we have this technology. It would solve all the problems in cardiac. We didn't know exactly how broad, how deep, who was you know, do we go to surgeons? Do we go to electrophysiology? Do we go do The? It was just very confusing. It was always confusing.

Charu Ramanathan, PhD (vitalxchange) [00:43:42]: It was confusing till the last day. Right? So we now it's although it sounds it's been a harder journey with Vital Exchange, I'll admit, because we didn't start with a technology platform. We started with a broad, ambitious vision. And we've you know, we met a lot of investors and a lot of collaborators along the way that said, I don't think this is gonna work because you're gonna cannibalize my practice or, you know, I charge $750 an hour like I'm not interested in your I mean, like, there's this constant Land then obviously The investors were like, well, this is an audacious too audacious of for vision and it's gonna take you a long time. We are looking for an MVP that'll turn on a dime tomorrow. Right? Or else you had the other end which is like your Your vision is not audacious enough. Right? We want to have moonshots. I mean, it's it's all of these things.

Charu Ramanathan, PhD (vitalxchange) [00:44:32]: But then because we were so steadfast in what it is that we tried to do because I knew this from my previous experiences. We're like, no. We're not moving because the problem hasn't shifted. Your perception of the problem may be in a different space, but our problem hasn't shifted. And just to have the the audacity and the confidence to feel and Stern on course without getting blown away. I mean, COVID year was hard for us. Right? Business development was really challenging. Try selling anything on Zoom.

Charu Ramanathan, PhD (vitalxchange) [00:45:03]: Like, I'm even bored of hearing my own voice droning on. So it it was hard. But, again, we're gonna do this. We're gonna do this. And guess what? I mean, COVID really opened the Shopify by door for us. You know, we really were able to jump on it and just, like, hit the ground running. So, I mean, that I would say is my biggest thing is like believing in oneself really steadfast, really building that culture The each grain, each each each morsel of our company actions we do, the employees we do, how they do their work is really focused on the mission and the and building that culture is really I I'm taking time to do that. So that's definitely something that I learned along the journey.

Charu Ramanathan, PhD (vitalxchange) [00:45:43]: Bring bringing in advisors so I don't get too lonely or I'm I'm in an echo Echo, Caitlin, Stern an echo chamber talking to each other and convincing ourselves and drinking the Kool Aid, trying not to do a lot of that. And lastly, most important, and then and I don't wanna say this I don't wanna sound trite because, you know, everyone says this is really finding that balance, and really being deliberate about investing in your own mental and physical well-being and our employees as well. And culture has shifted here also. And obviously, COVID's really exposed a lot of of you know, a lot of pressures that didn't that weren't acknowledged before. It's 15 years ago For 10 years ago, you'd be a hero on the job. You would work nights and weekends and days and losing sleep Land you'd brag about it. Right? That's what I did. Now if somebody does that I'll say you're a fool.

Charu Ramanathan, PhD (vitalxchange) [00:46:33]: Why? I why do you have to, you know, that you should be working smart not working hard. So That's a lesson learned for me because that's a culture that I try to detach from because that's not okay. It's not okay to let everything pass you by because you're trying to, like a crazy person run on this mission Land the brain flow and the brain and yourself holistically, spiritually needs nourishment and really not taking a step back once in a while is a good thing. So I'm really deliberate about The, and and I'm super passionate about I'm hoping Vital Exchange will start moving in that direction at some point too.

Jeffrey Stern [00:47:07]: Yeah. Yeah. Did does that just from your own, you know, personal journey here, does that just require A level of intentionality because, you know, building a Stern up as much as you can work smart is sometimes you just have to work hard. Land, You know, that we're we're at the stages in our companies where we haven't quite you know, we don't have the luxury necessarily of

Charu Ramanathan, PhD (vitalxchange) [00:47:27]: Of course.

Jeffrey Stern [00:47:28]: So how do you personally kind of, You know, you you mentioned The deliberateness for it. So

Charu Ramanathan, PhD (vitalxchange) [00:47:34]: I'll I'll give you several examples. Number 1 is every Friday, we take some time off. To take a step back. So you're not, like, doing the task management. Right? Meeting to meeting, you know, your Slack messaging, like crushing inbox 0, all of that stuff. No. You just take a step back. The last 2 days, my partner, Khetal and I, we Stern time at a local, It's like a Vineyard Resort thing nearby here.

Charu Ramanathan, PhD (vitalxchange) [00:48:01]: We just went over The, and we just sat there. We had a list of things that I jotted down on my iPad, and we just talked about it. It was a very meandering broad level con conversation, and we made a lot of decisions at the end of it. Totally behind on emails, dropped the ball on a 100 different things, but it was worth it. Right? Because otherwise, you're, like, doing the task, doing the task, doing the task, and really losing the big picture. So but that helps you. That builds you up because We I love I'm doing this podcast because I love talking about vital exchange at this level because it energizes me to talk about it. And then I feel like, Lay.

Charu Ramanathan, PhD (vitalxchange) [00:48:38]: My life has meaning. What I'm doing has meaning because I'm narrating it to you with passion. Right? So that's Land of that. The other part is the exercise. So definitely 1 hour in the Lay, whether it's in the middle of the day, whatever. It's always it happens. I never if I if something gets scheduled, I'll say, sorry, I gotta go exercise. Yeah.

Charu Ramanathan, PhD (vitalxchange) [00:49:00]: So I that's those are the key things that I, that I'm very, very, very particular about. And my team is as well. They're also quite, Yeah. And I I try to make sure that they are also taking care of themselves, which has been really hard with remote work.

Jeffrey Stern [00:49:14]: Everything you've said has resonated a lot.

Charu Ramanathan, PhD (vitalxchange) [00:49:17]: Yeah. I mean, I do. I mean, I do. I have to work about 12 hours a Lay, and, you know, There are days when my family is not very happy with me, but I got to take a pause and acknowledge, yes, I understand. Okay. Let's do something that that all of us can go. I just took a vacation for Lay Cation for a week, took a step back, made sure that I'm not like and even if I did, I said, Lay, I'm gonna just check emails 1 hour in the morning. And what'll what'll wait will wait Land it's okay.

Jeffrey Stern [00:49:45]: Yeah. It's okay.

Charu Ramanathan, PhD (vitalxchange) [00:49:47]: But sometimes I feel like always when I come back and reengage it, something big happens. Something nice happens. I always find that. So I feel like that's the high I'm looking for. Not the high of saying I crushed it, I crushed it, I Crush it. I feel like I'm my hamster in a wheel Land I'm spinning really fast. That's okay too, but you should try out the pause. Pause also helps.

Jeffrey Stern [00:50:08]: Yeah. It just sometimes affords perspective that you don't get just head down all day. You just need to sit up and take a look around and see what's out there.

Charu Ramanathan, PhD (vitalxchange) [00:50:17]: Right. Right?

Jeffrey Stern [00:50:18]: In in the spirit of, you know, fun and and relaxing things, you know, one of the things that we have everyone on the show, you know, help us Collectively painting here is a collage of not necessarily people's favorite things in Cleveland, but of hidden gems or things that other people May not necessarily know. So with that

Charu Ramanathan, PhD (vitalxchange) [00:50:38]: Yeah. So I don't know. I mean, it's not like a what I love about Cleveland, which I haven't really been able to enjoy as much in other cities as the metro parks here. So large outdoor spaces. Right? There are parks with waterfalls. Some of them are right in front of Lake Erie, so you get a lot of beach type of interactions, lots and lots of trails, Bicycles, tracks. Yeah. And just on Tuesday, I I was in a yoga class by Lake Erie.

Charu Ramanathan, PhD (vitalxchange) [00:51:10]: So watch those sunset yoga right on Lake Mary Metroparks in Euclid. So it's like there's no crowd The. You know, the the you always find parking. It's safe, and it's beautiful. And pretty much 8 months of the year, unless it snows too too much or whatever. And there's snowshoeing as well in the metro parks. I don't I'm not a big snow person, so but it's beautiful. I mean, I just I just I'll and it's it's all over.

Charu Ramanathan, PhD (vitalxchange) [00:51:38]: Right? You know? You can you can have so many of them. Like, I get I have, like, 12 of them within my reach. And what I also found last summer during COVID was people left little rocks. Have you seen those little rocks?

Jeffrey Stern [00:51:52]: Just like the engraved or, like, carved ones?

Charu Ramanathan, PhD (vitalxchange) [00:51:55]: Yeah. So they paint rocks. So they would leave a message on a rock Land you would hide it. And then it I think it's called Northeast Ohio Rocks. It's a Facebook group.

Jeffrey Stern [00:52:04]: Oh, wow.

Charu Ramanathan, PhD (vitalxchange) [00:52:05]: And then you basically take a picture of the rock and you put it. And then whoever put it there would say, oh, you found it. And then you you find it. You take a picture of it Land you hide it again. It's just this amazing little, you know, hidden gem. Right? Hidden rock. Land it's it's because why? I'll tell you. And I'm not I'm usually not a super sentimental person at all, but social isolation was just such a big negative impact in all our lives that connecting with strangers through messages on these rocks, I just found it incredibly amusing.

Charu Ramanathan, PhD (vitalxchange) [00:52:37]: Like, I would go to the metro parks just to find these hidden gems. And Land I would leave little messages as well. Like, somebody else could have a nice day if they found it. You know?

Jeffrey Stern [00:52:46]: Yeah. So that's awesome. I love it. Well, Acharya, I really appreciate you coming on and sharing your story and and what you're working on at Vital Exchange. It is it is very, very cool to to see what you're building. And I just love hearing from the the passion, and it's it's very clear. So I'm excited that That you were able to come on Land, hopefully The share your story to our many, many dozens of listeners here.

Charu Ramanathan, PhD (vitalxchange) [00:53:15]: Thank you for the opportunity.

Jeffrey Stern [00:53:17]: Absolutely. If people have anything that they wanna follow-up with you about or The just say hello, where is the the best place for them to to reach you?

Charu Ramanathan, PhD (vitalxchange) [00:53:26]: They can email me at charu@vitalxchange.com, of else you can find me on LinkedIn. Yeah.

Jeffrey Stern [00:53:39]: Of on today's show. So if you have any feedback, please send over an email to jeffrey at lay of the land dot f m, or find us on Twitter at podlay of the Land or at Stern, j e f e. If you or someone you know would make a good guest for our show, please reach out as well Land let No. 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 Land 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.