How Personal Tragedy Spurred This Technologist on a Mission to Improve Care Navigation

Prithvi Narasimhan spent time building tools at Stripe, Robinhood and Airbnb. So what led him to leave these firms behind and co-found Rely Health, a health tech startup focused on improving the Care Navigation process? He joins host Lindsay Kriger on this episode of "For Startups, By Physicians" to talk about his personal journey, how technology can transform patient care (e.g., improve efficiency and lower costs), and why he believes ultimately software won't replace the care that navigators provide to patients.

Make sure you like and subscribe to "For Startups, By Physicians" wherever you get your podcasts. And keep up with us on LinkedIn, Twitter, and Medium at @InflectHealth, and on the web at InflectHealth.com.

Transcript

[00:00:00] Lindsay Kriger: Hey everyone. This is Lindsay Kriger, director at Inflect Health, the innovation hub of Vituity, where we strive to be a catalyst for better care. I'm thrilled to be hosting For Startups, By Physicians where we share insights and guidance to healthcare startups and technologists looking to create the future of health.

[00:00:18] Lindsay Kriger: As a physician-founded firm, we have connections with clinicians and intimate knowledge of what they need and how. We will be interviewing our executives, frontline providers, and industry leaders to help your business be effective and scale. Thanks for joining and let's get going.

[00:00:42] Lindsay Kriger: Prithvi, I am so excited to have you on the podcast today. I know that we're not gonna fool anyone with thinking that you are a physician, but you are an industry leader, a fantastic founder and someone that we have really grown to admire and trust over the [00:01:00] last few years, so I can't wait to tell your story and have you share what you've been working on over the last year and a half with Inflect Health.

[00:01:08] Lindsay Kriger: So let's just get right into it. Will you tell us about Rely and who this new company is? 

[00:01:16] Prithvi Narasimhan: Hi Lindsay. Thank you so much for having me on the podcast. Fundamentally, when looking at Rely, we are building Care Navigation as a service. That's a turnkey solution that allows hospital systems and payers to pick us up and leverage our platform and our solution to help navigate patients, whether it's when they leave the emergency room or whether they're going through substance use treatment, whether they have an alcohol addiction or addiction to opiates. Really what we've done is we've built this software platform to help our navigators who are on the ground at hospital systems do their job in a more efficient and streamlined way.

[00:01:49] Prithvi Narasimhan: Under the typical navigation system, you see a lot of care navigators or case managers spending this incredible amount of time on the phone talking to patients, leaving voicemails, calling up other providers to schedule [00:02:00] follow-ups, or just messaging the patient constantly trying to get them to their next appointment.

[00:02:03] Prithvi Narasimhan: That entire process — although extremely effective — is extremely inefficient, and hospitals just cannot hire enough people to actually reach all the patient caseloads that they want to see. 

[00:02:13] Prithvi Narasimhan: So that's where we come in: we built this entire software suite. It's hyper-focused on understanding what the navigator does every day and taking bits and pieces of that workflow and automating it.

[00:02:24] Prithvi Narasimhan: So rather than the navigator having to pick up their phone and call every patient a couple dozen times to actually reach them, navigators can now focus on those patients that are A, not responding, or B, are actually in need of more urgent detention. 

[00:02:38] Lindsay Kriger: When we take a step back, I think about care navigation, and I always think about the simplest solution, which is just someone to help you out. If you've been in an acute setting, you understand the chaos of a hospital, and if you haven't been and it's your first time, it's super overwhelming and we know that people [00:03:00] just need help, people just want a connection, they want someone to explain to them this complex environment that we all are trying to innovate inside of. 

[00:03:09] Lindsay Kriger: And just like you said, while case managers and navigators are very skilled at what they do and they're so passionate about what they do, it's a really labor intensive process and we all know healthcare costs are rising across the board, and I love that you guys are really focused on bringing a technology solution that's also patient-friendly, that's also navigator-friendly.

[00:03:30] Lindsay Kriger: I know that you are an alum of UCSD and I'm a patient at UCSD, but the amount of automated phone calls and text messages I get from them for one appointment is just very silly. And I know you guys are building a much smarter solution. Tell me a little bit about your background and how you got to Rely.

[00:03:47] Prithvi Narasimhan: I'm a software engineer at heart. That's what I love. I've been obsessed with writing code, for lack of a better word, for as long as I can remember. Probably in middle school, elementary school, I just picked up on these small little applications I can build [00:04:00] and I've always looked at software as a means to solve problems in my life.

[00:04:04] Prithvi Narasimhan: Back in the day, my parents wouldn't let me hang out with my friends, so I'd build a little chat client just to message them over the internet back in middle school. And I've always seen software in that lens. 

[00:04:15] Prithvi Narasimhan: And actually in high school I had a close family member get diagnosed with diabetes. It's a fairly common diseases course, but it's also a chronic disease that requires a lot of ongoing treatment and management. And I remember I was like, I wanna try to do something with software to solve that problem. And I ended up interning at this company — this is way back in high school — and they were working on — and this was before RPM even was a thing — they were working on RPM solutions for diabetes. They had this little wearable tracker device to track blood sugar, and they had an entire application around that device to help follow the patients and keep track of how they're doing.

[00:04:49] Prithvi Narasimhan: And this was in 2013, I think, they were working on this problem and interning there and getting to understand and empathize with A, like how a lot of patients are not necessarily as [00:05:00] technically adept as I was at the time, and B, the complexities of healthcare, being able to navigate all the way that doctors and nurses and everyone else within the system functions together to make this really complicated system work so well.

[00:05:12] Prithvi Narasimhan: And so that was really my first experience with healthcare. After that went to UCSD to study computer science and I had the opportunity to work at some really cool tech companies such as Yelp, Robinhood, Stripe, Airbnb, where I got to work on just framing the modern consumer experience and understanding how these multi-billion dollar businesses could grow.

[00:05:33] Prithvi Narasimhan: In fact, I was at some of these companies when they were pretty early on. This was years ago, so a lot of them were much earlier stages, and I had the chance to work really hands-on with large portions of the team to really understand how everything worked at debt. 

[00:05:45] Prithvi Narasimhan: During that time. I actually had a family member that unfortunately passed away with breast cancer. And that was really a wake up call for me where I had this mindset that, oh yeah, technology can solve this, technology can solve, that software, can do anything. Clearly not . [00:06:00] There are some things in life that just give you that wake-up call. And at that point I think I, I just finished this internship and it was a great internship, got a lot of experience working on cool products that impact millions but it couldn't do anything for my family member who passed away. 

[00:06:13] Prithvi Narasimhan: So I remember Soham, my co-founder — he was a pre-med major at UCSD, and he was super passionate about the conjunction of technology and healthcare. He was working at a couple of research labs at the time and really understood how frustrating technology is within the context of a hospital, how it comes in the way, rather than producing a positive impact. And we were just talking, and I just, I was bugging him honestly. I was like, "what can I do?" I need to do something to like help tackle this problem so that maybe someone else in the future doesn't have to deal with the same issues that my aunt had to.

[00:06:46] Prithvi Narasimhan: And we came across this research paper in ASCO. It was this paper that talked about how metastatic breast cancer patients who were able to communicate their symptoms to a group of nurses on a weekly basis lived 50% longer. So these [00:07:00] are stage four breast cancer patients. It went from 12 months to 18 months.

[00:07:03] Prithvi Narasimhan: That's a dramatic impact for an intervention that doesn't actually require, like anything medical, it's just being able to communicate to the nurse and having a way to automatically triage that. Now this was done at one of those large teaching hospitals with a lot of funding and a lot of extra money to dedicate to a project like that.

[00:07:19] Prithvi Narasimhan: But the fact is most hospitals, even today, still don't have the money or capacity to be able to afford to do something like that. So we set out to build this symptom-tracking application for lung cancer patients within UCSD. We spent a couple of years really diving deep on that, and we realized that this is a problem space where yes, software can have an impact where we can, by following up with patients and by understanding what they're going through and helping nurses do their jobs, have an impact on patient outcomes. So after college we both decided to, or Soham actually dropped out, but we decided to work on this.

[00:07:51] Lindsay Kriger: Don't tell his mom. Don't tell his mom. . . 

[00:07:52] Prithvi Narasimhan: But yeah, that's a bit about my background and how we got started with Rely. 

[00:07:56] Lindsay Kriger: The thing I love about everything you just said [00:08:00] is that it's so rooted in stories and stories that are deeply personal to you, and that's actually exactly why inflect was so passionate about incubating the care navigation programs that we did because we all have personal stories, right? Whether it's your aunt or your family member or as physicians, they see hundreds of patients that all are individuals and that all have a story, and the power of storytelling and the power of relating your own experiences to something that drives you is what makes, we believe, the best founders. And it's one of the reasons that we believe so much in, in Rely because you guys are grounded in the thing that really matters, which is, of course we wanna use technology, but it's really about the story and the person and the impact that we can make.

[00:08:56] Lindsay Kriger: So I just, I love that about your background and thank you for [00:09:00] sharing. And of course, some of the sharing is hard because it involves loss and we all, unfortunately, are grappling with those challenges in the healthcare space every day, so thank you for being so honest about that. 

[00:09:12] Lindsay Kriger: When we came across Sympto, it was so obvious that you all solved a technology problem, and while we were building and scaling this navigation program, it was also very apparent that we needed each other. And so we are just thrilled about this merger and we're also thrilled about the leadership you all bring in this storytelling journey because there's so many stories that need to be told. 

[00:09:40] Lindsay Kriger: I know you were just actually out at one of the hospitals. Do you have any stories from this week that you wanna share or any insights that you gained that would be relevant to our listeners?. 

[00:09:53] Prithvi Narasimhan: Yeah, absolutely Lindsay. So over the past week, me and our VP of Operations, Tarren, we actually went out to Chicago to meet with [00:10:00] one of our largest sites, Ascension Health. We are currently working in eight of their emergency rooms to help patients navigate their journey, post emergency room discharge.

[00:10:08] Prithvi Narasimhan: Yeah, I spend a lot of time really just working with our navigators, figuring out how we can build better software to guide them. I think that really speaks to two things. One is this idea that software is one thing and providing care is another thing. Those two areas I really believe are intertwined.

[00:10:24] Prithvi Narasimhan: You cannot just build software in a silo and expect it to magically work. Our navigators are amazing. They're really empathetic folks who make this active effort to reach out to patients, but without software, they wouldn't be able to reach out to very many patients at all. So really the marriage of the two is what enables our navigators to do as good of a job they that they do today at Ascension. They're able to reach out to this large amount of patients at scale while also having that individualized attention for each one as needed. 

[00:10:50] Lindsay Kriger: As a technologist, you can be honest, just tell me your first thoughts when you saw how manual the navigators were originally doing things. How bad did that [00:11:00] hurt you in the inside?

[00:11:01] Prithvi Narasimhan: The world runs on CSVs or Excel, I should say. I think that's part of it. There are just so many inefficient processes that we take for granted, for example, if someone's on the phone for five hours waiting on hold, that probably should be automated. Or if someone is copying and pasting information from one, like medical record system into another system, that could also probably be automated.

[00:11:23] Prithvi Narasimhan: Our navigators join these jobs because they love to focus on actually talking to patients, helping them get to the next place, actually providing with better outcomes. But instead of that, what I found initially was a lot of the time was just spent on administrative stuff, on copying and pasting data, on literally waiting on hold for 30 minutes to schedule an appointment for a patient, or calling a patient multiple times, leaving voicemails, recording those voicemails like manually. That easily, like half of their day, if not more, was spent on these very manual processes.

[00:11:54] Prithvi Narasimhan: And there is just so much low hanging food room for efficiency gains here, and that's really what we've been focused on. 

[00:11:59] Lindsay Kriger: [00:12:00] As the CTO of Rely what is your vision and how do you wanna bring technology forward, both for patient care navigation, but really as a transformative tool in the healthcare industry?

[00:12:12] Lindsay Kriger: How do you wanna do it and what challenges do you anticipate being able to overcome? 

[00:12:16] Prithvi Narasimhan: That's a great question. So on our team, Tarren and Melissa, they've done this amazing job of training these navigators, making sure that these navigators are as effective they can be, and have them trained to basically get patients from zero to one after they leave their appointments, whether it's in the emergency room or through substance use navigation.

[00:12:34] Prithvi Narasimhan: Now, we're at really technology coming in is what can we do to make these navigators not. The best in terms of the training and in terms of the workflows they follow, but the best in terms of their overall efficiency compared to everyone else out there. And that's where I see us coming in to build that software up.

[00:12:51] Prithvi Narasimhan: One of the key initiatives that we're focused on is just breaking down the navigator's day and understanding what each part of it is and seeing where technology can fit in. So over [00:13:00] the next year, really one of our biggest goals is to double, if not triple, the amount of patients these navigators can see through technology and through automation of some of that grunt work. 

[00:13:10] Prithvi Narasimhan: My goal is for navigators, rather than focusing on any administrative stuff, rather than focusing on these phone calls, I want them to be able to focus on what they love to do, empathizing with the patient. We work with a ton of patients, especially on the lower income scale, who might be on Medicaid or even uninsured. These patients are just struggling to navigate care as.

[00:13:28] Prithvi Narasimhan: So why are our navigators spending all this time copying and pasting things from Excel when they could instead be just talking to these patients, helping them out, and we handle the rest of the work with software? 

[00:13:40] Lindsay Kriger: Seems like such a no-brainer, but we know that health systems in general and payers for that matter, have been slower to adopt technology and automated processes, and we all can imagine especially with everything going on with GPT and AI right now, there's this fear. 

[00:13:57] Lindsay Kriger: How do you approach [00:14:00] technology to more traditional healthcare systems, and how do you feel like you can help overcome some of those hesitations and increase that adoption? 

[00:14:08] Prithvi Narasimhan: First of all, the hesitations are really understandable.

[00:14:10] Prithvi Narasimhan: If you recall, Watson had this big initiative to automate a lot of like decision making in the clinic, and we all know how that turned out. I'm sure they did a great job on the technology side, but integrating that with the healthcare system is not that straightforward. They're too many edge cases. This is, these are patient lives we're talking about here, right?

[00:14:27] Prithvi Narasimhan: And when we talk about AI and machine learning and how that can integrate into health systems, I don't think of it as something that can ever replace the human being. Our navigators are always gonna be the ones responsible for talking to patients. Our navigators will always be the final decision makers on everything.

[00:14:41] Prithvi Narasimhan: There's nothing — even ChatGPT, it can't replicate the human brain. So the way I see it is that technology is a co-pilot to our navigators. We either A, take care of the things that they just do repeatedly again and again, like making those phone calls or waiting on hold or sending out reminder text messages to the patient.

[00:14:58] Prithvi Narasimhan: That's stuff that we can automate. [00:15:00] The rest of it when it comes to actually talking to the patient, empathizing with them, yeah, AI and machine learning can help, but as a co-pilot, not as an autopilot, and that's really the key here. We can make it easier for our navigators to do the job, and we can make a lot of them to do it more efficiently, but ultimately when it comes down to it, they're the only ones that can do it as well as they do today.

[00:15:19] Lindsay Kriger: That's so beautifully said. Thank you. And that is such a core belief at Inflect as well. No one is ever gonna replace that physician to patient relationship or that navigator to patient relationship. But there's so much noise in that relationship that technology can bring support to and I think that is really critical and a voice that we at inflect and Rely, obviously agree on this is not about replacing, I like how you call it, a co-pilot.

[00:15:47] Lindsay Kriger: I'm gonna go back to the stories concept and I wanna end with any story or any impact that you feel like the navigators are now able to make and what you hope technologists can learn [00:16:00] in partnership with someone like a navigator to transform and better the healthcare journey. 

[00:16:06] Prithvi Narasimhan: I was just in Chicago, as you mentioned earlier, working with some of the navigators on the ground and just seeing the impact each and every interaction they have has on the patient. It's incredible. 

[00:16:16] Prithvi Narasimhan: There was this one patient who is incredibly ill, unable to do anything basically, and I remember she came up to one of our navigators and said, "she was my hero." She was like, this patient was like, basically this navigator was able to take this patient who is struggling to go through care who's incredibly ill and actually help them get to their next appointment.

[00:16:37] Prithvi Narasimhan: A lot of it is for patients, it's just being heard, especially with patients that don't have access to the same resources or information to make those follow-up appointments, who might be uninsured, who might not speak English as well? Just our navigators, hearing them out, making sure that our navigators empathize with them. That's really key. And I think when it comes to healthcare in general, software can never, ever [00:17:00] solve everything on its own. Software has to be built in conjunction with that empathy piece. And as many smiley faces or emojis you wanna put on a piece of software, on an app, it's never gonna be as empathetic.

[00:17:09] Prithvi Narasimhan: It's hearing another human's voice, hearing it on the phone, having them actually care about you. And I think that's critical to make sure that software is built with not just empathy and the user experience in mind, but also empathy when it comes to how the patient's gonna interact with it at the end. 

[00:17:24] Lindsay Kriger: Especially coming from a technologist and a coding geek, as you said, I think that is so important, and I love that you've embraced that philosophy and are learning how to solve problems in this hybrid way. So you've come a long way, and I know that you guys are gonna continue to be just pivotal in the solutions that we wanna bring forward to patients and customers and the industry at large.

[00:17:49] Lindsay Kriger: Thank you for your time today. This was really informative and if people wanna reach out to Rely, how can they get in touch with you guys? 

[00:17:56] Prithvi Narasimhan: Yeah, we have our website, Relyhealth.care, and [00:18:00] Lindsay, as you mentioned, we're just getting started. We're not only trying to build out our navigator team. We have sites both in California, Illinois, all over the country, but we're also really trying to build out our core product and engineering team.

[00:18:10] Prithvi Narasimhan: We are tackling a incredibly large problems face here. We've already seen over a hundred thousand patients on our platforms. That's just the tip of the iceberg. And over the next couple years, we plan on scaling this company beyond anything, going into as many health systems as possible, and really making care navigation standard, allowing every low income patient, every Medicaid patient, every non-English speaking patient, to have access to that same quality of care navigation across the board.

[00:18:34] Lindsay Kriger: Reach out if you're interested and we can't wait to be on that journey together. So thank you Prithvi so much and look forward to partnering together. 

[00:18:41] Prithvi Narasimhan: Thank you, Lindsay. Appreciate you having me on. Great chatting. 

[00:18:45] Lindsay Kriger: Thanks for joining us. And again, I'm Lindsay Kriger, director at Inflect Health. Here at inflect, the future of medicine care and health delivery is not just right for disruption. It's increasingly personalized, accessible, and human. Make [00:19:00] sure you like and subscribe to "For Startups, By Physicians" wherever you get your podcasts. And keep up with us on LinkedIn, Twitter, and Medium at Inflect Health and on the web, at InflectHealth.com.