Andrew: Hey there, freedom fighters. My name is Andrew Warner. I’m the founder of Mixergy where I do interviews with entrepreneurs about how they build their businesses, and I record it explicitly for an audience of real entrepreneurs who are, chances are, building their business right now while they’re listening to me record . . . or while they’re while listening to this recording of this interview.
So get this, I’m really good at researching and preparing for my guests. I’m good at reading details about then, and still, whenever I go to a doctor’s office and they hand me a piece of paper telling me what to do, I get confused. And the truth is what they do is they give me this piece of paper that’s copied of a copy of a copy of a copy of a copy, so it’s just blurry and hard to read in the first place and it makes no sense. It wasn’t written by a real copy writer or anyone who has any concern for my understanding, and they just kind of throw it at me, and they say, “Here, take it. Don’t worry about it. I don’t need to explain to you. I have to rush my next patient. Here’s a piece of paper that will explain what you need to do. Go take care of it.”
And for years when that happened I kind of blamed myself. I said, “You know, there’s just . . . It’s me. I don’t understand it. Maybe there’s something wrong with me. I didn’t spend enough time reading it. Maybe it’s something wrong with me. I don’t care enough about my health.”
Well, today’s guest said it’s actually not the patient’s fault. We’re just not arming them enough information to figure out what to do with the medication that we send them home with. It’s not the patient’s fault. It’s the system’s fault. And he said, “I’m going to come up with a company that will actually solve this,” and he did.
His name is Dr. Rami Cohen. He is the founder of Telesofia. They’re making medical information clear. So instead of going home with this copy of a copy of a copy, you go home with some really clear instructions on video often telling you what to do. We’re going to find out how he built up this business, how well it’s going, and how it’s getting the medical community on board. They’re not the easiest clients to get, but he’s getting them.
We’re going to do it all thanks to two great sponsors. The first will host your website right. It’s called hostgator.com/mixergy, and the second will help you hire your next phenomenal developer. It’s called toptal.com/mixergy. Rami, welcome.
Dr. Cohen: Welcome. Thank you, Andrew. Happy to be here.
Andrew: You know what? Why don’t we start off with an example . . . actually you know, I’m going to start off with the toughest question, the one that I think we should just get out of the way that you don’t love to answer but I think is important, revenue. What’s the annual revenue of the business right now? Give us a sense of the size.
Dr. Cohen: I mean, we can say that we passed the million-dollar mark, but I can’t share too much about revenues and, you know, it’s a private company, but happy to talk about everything else.
Andrew: You won’t even say the names of the clients that you have even though in confidential terms you told me before we started. Give me a sense of who’s buying the service.
Dr. Cohen: So eventually in healthcare it’s [inaudible 00:02:43] to find an alignment between those who benefit from something, to those who actually pay for it, to those who actually have the access to deliver whatever you are making, and that’s hard. You know, the hard stuff to make some kind of revenues in healthcare. But we are working with the big pharmaceutical companies and their providers and also talking with health systems and we find a way to now allow some of them to pay revenues for us that allow others to provide the service and all sorts of other ways to do that, but eventually revenues are coming mainly from pharmaceutical companies, and . . .
Andrew: So the people making the medication are actually paying for it?
Dr. Cohen: Yes. Eventually they want you to take your medications correctly. I mean, the scenario that you just described in the beginning as . . . you know, it’s a lose-lose situation. Nobody wins from that, right? The patient goes home and doesn’t know what to do. The physician is frustrated from you not following your instructions, and the pharmaceutical companies are losing over $600 billion a year because of it.
Andrew: Wait, why? Why are they losing that money?
Dr. Cohen: So if let’s say you need to take a medication once daily and you take it once weekly, they lost that, or you start taking the medication but you don’t do it right and you stop taking it after a while, not taking the full advantage of it, then you don’t get well and they stop getting paid because you’re not buying the medication anymore. So it’s a lose-lose situation, and we tried to make it a win for everybody.
Andrew: Because a lot of the medication that I saw on your website is for things that people have to take over and over, right? Like, injectables, and so if . . . the user has to have a long-term relationship with the product.
Dr. Cohen: Yes, and a lot of the times, you know, it’s very different if you have a headache and you take a pill for the headache rather than if you have some kind of a disease that you are not really aware of any symptoms. So let’s say if we take cholesterol for example, nobody really feels it every day and one day you really feel the damages but you won’t feel it on a day-to-day, and just in the minute that you take the pill, that’s the only time of the day where you really feel like a patient.
So nobody likes that moment of taking the pill and this is where you need to educate the patient to make it a little bit more vivid, to show them what is cholesterol and what are the benefits and etc. and get them engaged and get them to actually change their behavior and take their pill. A lot of the non-adherence and a lot of the forgetfulness that we see with people is intentional. I mean, it’s not that people want to do damage to themselves, but they kind of choose to ignore the instructions.
That’s one part of and it’s a behavioral thing that we need to engage them and make them part of the treatment, and the second part is the part of really not understanding how to take those complex medication like, you know, the injectable, the inhalers, even pills, but sometimes pills you don’t need to swallow them. You need to chew them or you need to, you know, to . . .
Andrew: Oh, you’re saying, “Look, there’s all this inner resistance for people who take pills. First of all they don’t want to feel like patients, and second, they don’t know what to do, and nobody wants to feel confused, so they just blow off taking the pills. If they blow off taking the pills, the people who make it, who sell it, whose business depends on them paying for those pills lose out.” And that’s how you convince them to pay for something that ultimately is in the user’s best interest. By the way, when I was on your website what I saw was it was videos. You guys don’t just do videos? It’s not just video show me how to inject myself with whatever new medication the doctor gave me?
Dr. Cohen: I mean, how-to videos [inaudible 00:06:40] long time maybe even before Telesofia, and it’s great. And we know that how-to videos work very well. They reduce the [cumulative 00:06:47] effort, and they’re really . . . The easiest way to learn something new is from a video. However, in healthcare, there are a lot of small changes that are there. So if you’re . . . you know, it’s an injectable, maybe there’s a different dosage, maybe there’s a different device, different days to inject, different order of stuff, whatever. So all these small changes requires you to create a lot, a lot, a lot of versions. And what we’ve developed is a platform that allows us to send not just a video but it is a personalized video down to the level that is saying, “Hi, Andrew. This is what you need to do today, and on Wednesday you need to take this syringe. Put it under here.” All the smallest details.
Andrew: And I get to see . . . but just to get concrete about it, it’s a text message that I get on my phone and a video that I get to see on my phone or a computer, right?
Dr. Cohen: Yes, text message or an email or a QR code, whatever you want to pass that link. Once you click that link, you don’t need to download any apps, anything and just click a link and watch video that speaks to you. You can see that your provider in the video. You know that it’s trusted and it’s coming from him. It says, “Hi, Andrew, this is what you need to do today,” shows you. Like, my patient used to tell me, “Can you show me what to do?” It’s actually showing you exactly what to do down to the level of where the plunger needs to be on the syringe and how to mix the . . . you know, anything that you need to do, or even demonstrate to you how to do it. Not only that, we are also doing the demonstration using models with matching demographics so you see somebody that you can relate to.
Andrew: So if I’m a man, I get to see a man. If I’m an American, I get to see an American.
Dr. Cohen: Yeah.
Andrew: Okay, all right. Now, that I understand the product let’s figure out how you built and got it here and how you’re actually selling to big pharmaceutical companies, who are not the easiest people in the world to sell to. They’re not just going on a Google search buying whatever they see and making impulse decisions. But going back a little bit, what was interesting to me is you’re in the Israeli army. That’s where you got interested in medicine. That’s how you started studying medicine. You became a real doctor. You don’t just have doctor in your name. I should’ve introduced you as Dr. Rami Cohen. I think that would’ve added a lot of credibility. I meant to.
But what was interesting to me was while you were in school, you paid for school by working for ICQ. ICQ was one of the original big chat apps that was an incredible hit that ended up selling for $400 plus million AOL. I remember that. What did you learn by working for that mega-successful company?
Dr. Cohen: So first I started when we were a very small startup and, you know, it was I think one of the first startups in Israel, maybe the first startup in Israel, that in a very short term got into this kind of big exit. And that was a big success story, and you learn because, you know, we were a small company, and you learn how to do everything. So this is how I learned how to code. I learned how to . . .
Andrew: You learned how to code there?
Dr. Cohen: Basically I started as a webmaster and knowing very little, and when I left, I was still a webmaster, but I knew much more because we were, you know, [inaudible 00:10:08] 20 million daily active users or something. It was huge, and we had to do almost everything ourselves because it was a very small team. So you learn how to work in team work, you will understand the way of how to manage a project, how to do that, and then while we got into AOL, we learned the corporate world, and this is actually very helpful when I’m dealing with pharma companies and . . .
Andrew: Give me an example. What did you learn about working at the big companies?
Dr. Cohen: Well, unlike startups where, you know, almost anybody in the company can make a decision very quickly and if he needs to have some kind . . . need some kind of an approval chain, it’s two people and you get it approved and typically most of their decisions are made very, very quickly. In a big corporate there is a process, and everything has a process.
Andrew: You know what? Forgive me but that seems kind of obvious. I feel like we should all know that. No? Where did it surprise you that a big company needs more decision making time and people?
Dr. Cohen: But, you know, it’s about respecting that process, understanding the process, understanding what would be the different motivations for those, and when you’re selling to big organizations you have to take this into account. So for example, you can’t expect the fact that the CEO of the company said, “This is great. I want it.” It doesn’t really mean that tomorrow you can do something with it. Will take another, you know, six months of time for that to run. So you have to take this into account and this is really helpful, and when you understand kind of the big corporate culture and the corporate world, it just really helps to navigate in those big systems.
Andrew: Let me ask you something about ICQ. One of the things that fascinated me about ICQ was after it was sold it was Yossi Vardi who built a reputation. He started then becoming an angel investor, shepherding Israeli entrepreneurs to the U.S. They would come a lot to Los Angeles to events. He was the guy who everyone associated with ICQ, but he was the father of one of the guys who worked there. How involved was he day to day?
Dr. Cohen: I mean, Yossi was involved I mean every day. He was not just the father of . . .
Andrew: Every day? Doing what?
Dr. Cohen: He had a huge impact on ICQ [inaudible 00:12:29]
Andrew: But I felt at the time that it was these like . . . I don’t even know how to pronounce their name. It was Amnon, Arik, and Yair, and it was those guys I thought at the time who were . . . oh, and Sefi, excuse me, who were the guys who were leading it, and then Yossi Vardi at the time felt like he was the father of one of the guys, and then after it was sold I never heard anything about the other guys. All I heard about was Yossi Vardi, Yossi Vardi. What did he do? What was his role day to day?
Dr. Cohen: I mean, I don’t want to get too much into that. That you need to ask Yossi, but I can tell you from my experience he had a lot of contribution. We were with him on the phone on almost a daily basis getting instructions on what to do and where to do, you know, and he was . . . de facto he was leading a lot of the business side of things. And I don’t think . . .
Andrew:[inaudible 00:13:27] side of things?
Dr. Cohen: . . . doing justice to say that he was just the father of . . . he had a huge role in the company, but, you know . . .
Andrew: But he’s more of the guider. He wasn’t the person who was coding up the website. He was more the person who would say . . .
Dr. Cohen: He didn’t code. He didn’t code.
Andrew: Nothing?
Dr. Cohen: He didn’t code the website, no.
Andrew: Okay, but he was the person who was just guiding them, who said, “Look, I’ve got experience here. I can help you figure out what to do next and . . . ”
Dr. Cohen: I think it’s more than guidance. Personally, I don’t want to talk about it. I can say that personally I learned a lot from Yossi Vardi, and I think he has a lot of great contribution, not just in ICQ, but in also in the Israeli entrepreneurship and scene and with a lot of other companies and other stuff that he’s doing for philanthropy work and others, but, you know, that’s . . . I’ll let you interview Yossi and . . .
Andrew: I should interview him. I feel like he’s a fascinating person and there’s . . .
Dr. Cohen: I’ll help you to connect with him.
Andrew: I feel like you’re a little intimidated by him, and I’m going to say I definitely am, and I don’t know why. I’ve never met him. I’ve emailed him a few times, but that’s it. He seems like a very serious guy. Am I right?
Dr. Cohen: He’s a serious guy. He’s a busy guy, and as I said, you know, I can try and connect you to him.
Andrew: All right, I’ll take you up on that. All right, so 2004 you were a student. You were doing the rounds in family medicine, and you started noticing that patients didn’t understand what they were being told to do. And unlike me who said, “Hey, it’s the patient’s fault. It’s my fault.” You said, “Maybe there’s something else going on here.” Before this interview started I asked you for an example and you told me about the guy who was sent home with an instruction to use a suppository. What happened?
Dr. Cohen: So this guy, you know, he didn’t really understand the instructions, and those suppositories comes with kind of aluminum foil on them, and he was using them. They weren’t effective. The reason was that he never took them off the . . . never took down the aluminum foil, and he was using them with the package.
Andrew: So wait. So he put the suppository in his bottom, let’s say, with the aluminum foil in it, which means that it can’t melt. It can’t go into his system, and he just had this thing bothering him in his . . .
Dr. Cohen: And it’s also painful because those . . . there’s like sharp edges, so it’s not the most convenient thing to do. And he needed them because he had a issue there. So it was really, really painful and that was, you know . . . and it says so in the leaflet. It’s what’s written in the leaflet but, you know, who reads those?
Andrew: I get it. It’s easy to skip it because it just feels like I got to just get past this as fast as possible. So what I was thinking of when I saw that is how does Telesofia then resolve that. You guys can’t show video showing people how to use it, right? Can you?
Dr. Cohen: We can. We can, and we show them the specific instructions. So for example somebody needs to self-inject and he’s using . . .
Andrew: No, let’s talk about a suppository. That’s the kind of thing where you’re showing . . . you’re talking about a body part that you don’t usually want to show on video. Are you showing it with a . . .
Dr. Cohen: Oh, can show with some kind of an animation. There are ways to work around it, but you at least show that you need to take it off the aluminum foil. We just need, you know . . . take even a simpler example. Taking a pill out of a package of the aluminum foil, some people are using it on the medial and breaking the pills. In some pills this is really important that you need to just push on the side. We even show that on the video. So we can go and show you the specific details because the video is already very concise, very relevant just for you. A man doesn’t get the pregnancy warnings if they’re not relevant for him, then why do you need 30 seconds of them? Let’s focus on how to take the pill off the box. This is more important.
Andrew: So the suppository is kind of a shocking example of how people misunderstand how to take medication. Give me another one that’s a little more typical that you would see as you were making the rounds.
Dr. Cohen: So a lot of times people are not aware that, you know, even with the simple pills, everybody think that all pills needs to be swallowed, but that’s not the use case. Sometimes you need to chew them otherwise they won’t be effective. Sometimes you need to put them under your tongue and wait for, you know, five minutes for them to dissolve because otherwise they won’t be effective, and people would just always swallow them. A lot of times people are not aware of the small warnings that there are.
Andrew: How would you know that? If I didn’t put a pill under my tongue and just swallowed it and came in the next day to see you, how would you know that I didn’t do it right?
Dr. Cohen: I won’t but I will see that there are no effects. So this is a lose-lose situation where I’ll say sometimes in some medications you only get the side effects but you won’t get any benefits. And then we say, “Oh, the medication doesn’t work.” We need to stop the medication. We maybe need to go to, you know, a more expensive medication or potentially maybe dangerous medication and it was just because somebody was misusing them.
I’ve a great example of this. We did work with hepatitis C where you had two vials one with powder and one with just saline, like water, right? Sterile water. And you had to mix the two. Apparently some patients were afraid from the powder, so they were just injecting the saline water. Now, this is a medication that costs $7,500 per week. They were throwing it to the garbage and injecting water, right? That’s the most expensive water in the world right now, and they were losing because if after four weeks you don’t show any good results, nobody will pay for your treatment and therefore they stop the treatment. So they lose completely just because of misuse. So the pharmaceutical company lost, the insurer lost, and the patient of course lost because he lost his chance to get him treated because they said, “Oh, it’s not working for you. Maybe your body doesn’t react to that medication.” [inaudible 00:19:40] throwing it away.
Andrew: So Doctor, at what point did you say I’m not going to go down the path of being a doctor and explaining things and teaching people and helping them this way and instead I’m going to start a business? At what point did you make that decision?
Dr. Cohen: So I was in vascular surgery, and I was working there, you know, getting patients, preparing them to surgery, sending them with instructions to how to prepare to surgery, and most of the time they didn’t follow those instructions, and they didn’t really understand what am I going to do with them with the surgery or catherization, whatever.
And I was sitting there and, you know, sketching stuff on a piece of paper saying, “Oh, you know what? This is what we’re going to do. We’re going to . . . This is what the vessels look like, and . . . ” In the surgical ward this is sometimes considered a waste of time unfortunately. You know, talking with patients, we don’t have enough time as physicians to really sit and educate the patient and make sure they understand because you’re working in a hectic environment, and you have to run and be in the OR and not in the room talking with a patient. And then I said, “Why wouldn’t I just do it in a video format?” So we started thinking about the concept of creating videos to explain patient all the instructions [inaudible 00:20:57]
Andrew: That’s for your patients or as a business?
Dr. Cohen: Initially I thought about my patients, and I thought this is not just my problem. It’s a global problem. Let’s make it a business and let me combine, you know, my passion to technology, passion to medicine, both of them and getting combined together so I thought it would be great [inaudible 00:21:17]
Andrew: Okay, let me pause right there. We’re going to talk about the first version and what that looked like because this is not an easy thing to create a first version for and continue with the story. But first I’ve got to tell you about my first sponsor, a company called HostGator, and in fact I’m going to tell you about a guy who uses HostGator, a guy named Syed Balkhi. You know how some people go on Facebook and they post pictures of their dinner that looks beautiful or some will show off by posting pictures of their cars? Have you ever seen that?
You’ve seen it, right? People they post a car, “Hey, look how beautiful my car is, how impressive.” This guy posted a picture of the Wells Fargo bank and he goes, “I just bought this building. I’m now the landlord of this.” That’s what he does. He buys real estate. And so I got together with him one time and I said, “How are you buying all this real estate?” And he says, “I got a website. It’s called WPBeginner.” And I knew about it because I interviewed him about and I said, “It’s that big?” He says, “Yeah, yeah.”
So sure enough I go and I look it up. According to SimilarWeb, he’s got eight million monthly visitors. It’s huge. He says, “So from that and then I have some software that’s built on top of that where people who are, like, in the WordPress world will read my blog and that does well from advertising and then some of them will end up trying some of the software that I built.
We’re talking. We’re talking. I say, “You know what, Syed? Let’s go have lunch and just continue the conversation.” So we walk out. We get to this lunch spot. I sit down. He sits down and then he goes, “Oh, look at this.” I go, “What did you find?” He pulls up a coin. I think it was a penny. Dude, I’m not kidding. I think it was a penny. He holds it up and he goes, “I found a penny.” I was just like, “Who’s this guy?” But that’s part of his personality. He’s super cheap about things, super cheap about things so he can pump money out of his business and go buy real estate and that’s what he wants to do. And I think he even buys this real estate for cash. He doesn’t even want to buy a mortgage. That’s his passion in life.
So the reason that I’m saying that when it comes to HostGator is because I want to see who he’s using for his hosting company and it turns out he uses HostGator. And the reason that I bring this up is he’s a guy who’s got eight million monthly visitors, more than most people who are listening to me are going to have and he’s still hosting a site on HostGator. Why? Because HostGator will scale up with your business as it gets bigger. They’ve got the reliability that a business like his and mine need, and it’s super inexpensive, so a guy like him who cares about every penny because he wants to save it up to buy another Wells Fargo bank building can save up his pennies and not blow it on hosting packages.
So if you’re out there listening to me and you don’t like your hosting company or you want to save some money on your business by shifting over to a new company or you want to start off right. Start off the way that I just started my new chat bot business, the way that he’s hosting his company by going to HostGator, and in fact, if you want to save even a few extra pennies go to the special URL where they’re going to give you up to 62% off their already low prices. Go to hostgator.com/mixergy, hostgator.com/mixergy. You’ll get up to 62% off unmetered disk space, unmetered bandwidth, unlimited email addresses, tons of free templates to make your site look good, and they will even give you a $100 AdWords offer to help you promote your business. Go sign up right now hostgator.com/mixergy.
One of the things that I’ve committed to doing is telling better stories in my ads so I’m working on it. This was one story I spent like 20 minutes before the interview started with you saying, “All right. I got how Telesofia works. Let’s see if I can spend some time understanding this . . . like getting a good story for the sponsor.” Wait. He’s a user. Great, we got the story.
All right, so I understand how you thought about solving this problem with video. I understand where you were going with it. I’m curious about what the first version looked like.
Dr. Cohen: So the first version we said, “Let’s start with something simple. Let’s go with, you know, medications.” We started with statins, a medication for lowering cholesterol, and I said, “You know, I need to show like two versions, and I wanted to see how people would react to that.” So we created completely manually. I mean, no technology was there. Just as they call minimal viable product. We created like two boxes with QR code in them with two videos that we filmed in my home, you know, with instead of a green screen it was like a green blanket and there wasn’t good lighting and it was . . . you know, if you look at these videos today, I mean it’s [inaudible 00:25:50]
Andrew: It was you go on camera with this blanket behind you saying, “Here’s how to open up the pill package?”
Dr. Cohen: Yeah. Like, it was a [inaudible 00:25:58] but she’s like one off right, and then we put a QR code on a box and I went to visit some friends that I had in New York and they were working in advertising . . . and by the way, you asked about the AOL connection. So we all met and we all know each other from the AOL days, and I said, like, I want to get their opinion, what do they think about it, and I showed it to them, and I showed it to others, people in the video industry to get to see what were they thinking, and people in the medical . . . I just was going with a piece of paper that . . . and printed on it a box with two QR codes that led to some, you know, static video. It was hosted on Vimeo or some, like, free . . . free video.
And when you scanned the QR code, you get a video, but just this notion of, you know, seeing a box with pills and I had a leaflet with me. So when I demoed it I said this is the leaflet. This is the box. Scan this. They scan it . . . boom. There was a video explaining about it and people reacted very positively about it. So I said, there’s something here. Initially everybody thought it was crazy because of the number of variations for just two simple medications. Initially, we had 14,400 different videos. Different versions for just two simple medications.
Andrew: Why?
Dr. Cohen: Just because, you know, the statins come in different pills, different shapes, different colors, different imprints.
Andrew: So you recorded 14 different hundred videos?
Dr. Cohen: So we created initially . . . it wasn’t technology, but we created 14,000 different videos and everybody said, “This is completely unscalable. This is just two medication. We have 14,000 videos. How can you scale up?” And then we evolved a system and a technology so now everything is dynamic and we are generating the videos in real time.
Andrew: You know, before we get into that I want to understand a little bit more why did you pick statins? I did a Google search for what a statin is to understand, and I see things like Lipitor. I look at a picture of what people would have to take. It just looks like pills in a pill pack. Why did you pick that? It seems kind of obvious for people how to take a statin, no?
Dr. Cohen: Yeah, it seems kind of obvious but the real life is that people are making a lot of mistakes with it. They’re not taking them as often as they should. They don’t really understand why they need to take them. They take them because somebody told them but that’s not a good incentive for you to do it [inaudible 00:28:30]
Andrew: Also the video wasn’t just about take it out of the pill pack . . .
Dr. Cohen: No, it was also explaining what is a statin, why do you need to take it and how to take it properly and, you know . . .
Andrew: Complete with the cartoon or something?
Dr. Cohen: [inaudible 00:28:41] grape juice. You’re not supposed to drink any grape juice with it and most people aren’t even aware of it. You don’t suppose if you are feeling some muscle aches, it might be because of it. You should be aware of it. So we started with this and they were kind of common, and they were the most simple ones that we wanted to start with something simple. Later on we moved to things like surgeries and . . .
Andrew: Okay. Let me just stick with this. I get now why you would go with this. You’re saying it’s easy to explain, and people don’t understand why they need to take it and that’s leading to lack of compliance and that’s leading to issues. All right. When you showed it to people, you showed it to doctors, you showed it to pharmacists, and they then were supposed to send it to their patients. When the patients saw it, what did you learn about those first videos that you recorded?
Dr. Cohen: So the first version you couldn’t even send it because it was personalized to one person that didn’t exist, but the second version with the 14,000, then we learned at first that they were too long. We were doing it completely wrong. We were trying to put everything in them and people . . . I mean, everything was there but they didn’t retain anything because when you are [inaudible 00:29:57] these are the 70 side effects that would happen, nobody can learn anything. So we learned that we need to keep these to be more concise, more clear, more to the point, and there are other stuff that we learned like how to better engage the patients, you know, show [inaudible 00:30:16], and we still learn even today. We are always improving the videos [inaudible 00:30:20]
Andrew: How did you know that? How are you able to see that people didn’t want a long video? Were you just looking at the stats?
Dr. Cohen: So initially, we showed it to several people and then we interviewed them and get their, like, what do you think? Can they give us . . .
Andrew: You showed it to a patient and then the patient would sit down with you and tell you what they thought?
Dr. Cohen: Yes, yes. And we send it to them and maybe call them, you know, three days later and say what did you think? Give me some . . . and we did that with a few. And then when we look on the stats, we can see exactly by 10% progress when did people stop watching the video, and our goal is to get you to the end of the video, and we get much better engagement rate than any of the standard engagement rate that we [inaudible 00:31:12]
Andrew: Okay, but in the beginning you were looking and engagement rate wasn’t great. When you talked to people, they admitted they didn’t watch all the way through. All right, I kept saying 1400. It’s 14,000. How did you create 14,000 different videos?
Dr. Cohen: Initially, it was, you know, it was a lot of rendering of a computer, and then we add some . . . there was some automation to it. It wasn’t completely done manually. There was some automation work, but it wasn’t scalable just because of uploading the videos and then if you want to change something, you need to . . .
Andrew: But who did it? Did you hire someone to do it? Did you do it yourself?
Dr. Cohen: Yeah, well, at that stage, we already had a company and we raised some funds, you know. We could do that [inaudible 00:31:48]
Andrew: Oh, okay. So once you got doctors and pharmacists to say, “Yeah, this has legs. We could understand it.” Then you went to raise money, or did you get a commitment from them?
Dr. Cohen: No, no, once I showed it around and got the initial feedback that there is a need for it everybody said that, you know, technologically-wise that’s not feasible and you will never be able to hand the real complexity and, you know, it’s just two medications brings you to 14,000 different videos, then what would you do if you need to do . . . And by the way, today on that system that’s completely automated, we are supporting 11,000 medications, so we have an infinite number of videos.
Andrew: So what kind of proof did you have or what kind of traction or evidence did you have that people would use this before you raise money?
Dr. Cohen: Just the initial feedback of the [inaudible 00:32:40] and we had . . . Yeah, it was a very small round, but that helped us, you know, start the company, build the company and start working on the first version of the technology, the second version of technology, and then we raised additional funds once we got, you know, interest by big organizations.
Andrew: So you know what? So I went to Crunchbase to see where you raise money. I could see that you raised a seed round but it’s not saying from who? Where did the funding come from?
Dr. Cohen: So yeah, I don’t think those websites are always updated. Our funding is coming from a VC that is specific for digital health, a VC called LionBird set in Chicago and Tel Aviv, but we have a strategic investor, which is the hospital chain from Germany called [Rhön-Klinikum 00:33:31], and we have some private investors that are invested that, you know, want to remain private.
Andrew: Okay, all right. So you started raising money then you hired people to put together these videos. They created 14,000 videos. Did you personally call up the people who use those videos, or did someone else?
Dr. Cohen: I did some of them, and we had someone else who did . . . so it wasn’t just me but I did some of them myself, and I think it’s really important when you are getting the feedback for the founders or the entrepreneurs to do it themselves because you would be able to find things maybe that are said in between the lines. Maybe you are not asking the right questions, right? And I think it’s really important to understand what your users are thinking, and you need to be close to your users.
If you’re putting too much distance and you just hire, you know, a company to do it for you or hire somebody to do it for you, you give them a set of questions. A lot of the tacit knowledge will stay there and not get back to you. You need to be closer to the bucket, closer to your users, especially in the beginning when you are trying to kind of find what is right with you.
Andrew: I was wondering how you got your first customers and then I saw the notes from our producer who said your first customers came free because you were part of a Microsoft accelerator, right?
Dr. Cohen: Yes.
Andrew: How did that work? Microsoft introduced you to whom?
Dr. Cohen: So we were part of Microsoft accelerator, and then there was some part of the accelerator where we were in Atlanta, Georgia, and we were part of another accelerator that was partnered with Microsoft and over there they introduced us to a pharmacist in Atlanta that was the first user of the system and actually we got from him some feedback and he was using the systems in a way that we would never imagine people to use it.
Andrew: How?
Dr. Cohen: He was actually instead of sending the videos to patients, he would show them to them on a mini iPad and give them to watch the video while he’s filling the medication in the box. So he was using that gap time and then after that if they had any questions, he would answer them, which was really smart. If you have a mini iPad, you’re going to use that kind of dead time where he goes and put the pills in the box, he will let you watch a minute and a half video. And then if you don’t have any questions, great, you saved him time. If you have any questions he’s there to answer. And we never thought about it. We were sort of like, “Oh, let people take this and watch it at home.” And he said, “No, I want them to watch it in the pharmacy.”
Andrew: Oh, that is clever because people are kind of frustrated that it’s taking so long but if it’s used properly, got it. Okay, it makes sense. And then did you get other clients that way?
Dr. Cohen: Other clients then we moved . . . as I said, we would walk into big pharma. With pharma it’s a little bit different. With pharma it’s a very long sales cycle. I mean, the average of the industry is about 18 months, something for those who are [inaudible 00:36:49]
Andrew: Eighteen? Yeah.
Dr. Cohen: Eighteen months average. It could be longer. This is the average. So it’s a long process. Also you need to take into account it’s an expensive process. A lot of lawyer time and, you know, due diligence that pharma would do to you to security and safety and all that and that you need to go through. So that’s something that people need to keep in mind if they want to . . . if anybody out there is aiming at these kind of companies, they need to know it’s something that you need to be prepared . . .
Andrew: And you knew instantly they were going to be the clients. How? They weren’t the ones who had the pain.
Dr. Cohen: I didn’t know it instantly. I wish I knew instantly anything.
Andrew: Who do you think the original clients were going to be?
Dr. Cohen: What, sorry?
Andrew: Who do you think the customer was going to be?
Dr. Cohen: I thought initially that the providers would be the customers because they have a lot to benefit from it. Unfortunately, not always they have the resources to pay for stuff so . . .
Andrew: Did you try to talk to them and see if they would buy it and that’s how you discovered it in other resources?
Dr. Cohen: Yeah, I did. I did talk with a lot of players in the healthcare industry and the pharma were the ones who were, you know, I can’t say really low hanging fruit because it wasn’t that easy, but they are the one who has the funds and the ability to actually move things forward but much easier than, you know, a hospital system.
Andrew: How did you get in front of them to ask them that and to know that they would be willing to do it?
Dr. Cohen: A lot of conferences, a lot of footwork, a lot of, you know, “Let me show you a quick demo of what this could do,” and, you know, it’s a lot of work.
Andrew: At a conference? Who . . .
Dr. Cohen: Conferences, yeah, a lot of them.
Andrew: Who at the pharmaceutical companies seemed interesting? What’s the job title of the person who you were able to get to?
Dr. Cohen: Sure, so at the time there weren’t many, you know, innovation or that digital. There are some rules now that didn’t exist when we started, so we had to kind of find a way. So we would pick on anybody who just works at pharma and say, “Oh, what do you think?” I said, “Great. Can you introduce me to somebody?” And then you need to get in front of, like, you know 5 to 10 people in the organization before you can start anything meaningful.
Today I think it is easier because today there are in almost any major pharma company there is somebody who is in charge of innovation. There’s somebody who’s in charge of digital and somebody who is in charge of patient experience etc., so it’s much, much easier to kind of . . . they didn’t even have that role back in the day and that made it much, much harder. Today it’s much easier, and in fact, when you present in a conference that has people in the crowd that are relevant, those would come to you and that’s most of our . . . most of clients are inbound requests that, you know, saw a demo in a presentation, saw this, read it on Forbes or whatever, and then said, “Oh, we want to do something with that and can you show us?”
Andrew: But when it was . . . before you got into Forbes, before you got all the press, it was just you walking around I imagine with something like this tablet just saying, “Hey, can I show you something? Does this make sense? Would you want it?” That’s it?
Dr. Cohen: Yeah, that was . . .
Andrew: Essentially looking at their eyes to see . . . do you remember what excited them when you showed it to them? Because sometimes when you show people in person, you get to see where they get bored and where they get interested.
Dr. Cohen: I won’t name names, but I can tell you that at least in one case there was a C-level officer of a pharma company that I chased in many, many conferences every time showing there with an iPad, “Can I show you a demo?” She’s like, “No, no.” [inaudible 00:40:55] she was not interested. I showed her once, she said, “Nice. Well, I don’t know what to do with it? You know what? Maybe.” And then after a while I showed it again and she actually showed the demo, watched it, liked it, ended up being one of our best customers and advocates.
So, you know, you need to keep trying. You need to keep trying. You need to do it politely. I’m not saying that you need to be annoying, but you have to keep trying and if somebody tells you no or doesn’t [inaudible 00:41:30] not now. And I think also the market changes because of pharma was doing a lot of transformation in their business model understanding that they’re losing patents on many of these medications, losing revenues and thinking, like, what can we do in order to go beyond the pill and because we had these relations with them so many years even before they were thinking about it, it really helped it, and once they were ready, we were there with a ready product for them.
Andrew: All right. Let me take a moment to talk about my second sponsor who is Toptal for hiring developers, designers, finance people, and to do that I’m going to tell people about this guy Doug McKay. He is a first time entrepreneur who said, “You know what? It’s too hard to find the services that you need to run your business, to find the software that you need to run your business.” He said, “I know. It’s going to be my breakthrough idea.”
And he had the idea but he said, “You know, if I talk to people about it they’re not going to understand it. I need a visual.” In fact, he’s a guy who won I think a Daytime Emmy. So he had experience in visual. He had experience in showmanship but not in entrepreneurship.
So he went to Toptal and he said, “Can you get me someone who could design this, who could mock it up, who could create it?” And Toptal introduced him to someone named Anna Malysheva. And Anna’s a UI/UX designer, a lot of front-end development experience and she worked with Doug, she understood his concept, she took his idea, and within just three weeks, she gave him a design that he could use to show.
And he said, “All right, this is it. This actually is something that’s making sense. People want to use it. I want to raise some money.” So he went back to Toptal and he said, “You know, you guys also have a finance team.” They said, “Yeah.” He goes, “Here’s what I could use. I want someone to help me tell my story in the financial sense so I can raise money.” And so they introduced him to a guy named Jeffery Fidelman, who he hired. Jeffery is a guy who worked with HSBC bank, Morgan Stanley and helped create a venture capital fund, so the guy had a lot of experience, and so Doug hired him part-time to help him put together an understanding of what investors want, a pitch deck to explain to them and how to answer the questions that investors are likely to ask them.
That’s how Doug got prepared, and he went out there and he got . . . let me see. He got an interest from six VC funds, and I think he was able to raise money from . . . oh, I don’t know who but he did raise money in the process from doing it. Finally, he said, “All right, great. Now, I have my money. I have my design. I’ve got to go and get someone to build it. He went out and he hired an agency to do it, but it was taking too long. It was costing too much money and he said, “You know, screw that. Let’s just go back to Toptal. Toptal is going to cost a little bit more, but it’s worth it. I can’t deal with these headaches.”
He went to Toptal. He spent a little bit more but it turned out in the end by hiring developers from Toptal he spent less money to have his product built out than if he would’ve gone with the cheapo agency that was just taking too long. The reason I’m telling you guys this is because if you’re looking to hire and you want to hire fast and good people, really the best of the best, go to toptal.com/mixergy. You could do exactly what Doug did, hire designers, hire finance people, hire developers, and these are the best of the best, people who have experience for years. All you have to do is go to toptal.com/mixergy to get a special offer of 80 hours of Toptal developer credit when you pay for your first 80 hours in addition to a no-risk trial period of up to two weeks. If at the end of the period you are not a 100% satisfied, you will not be billed. Really, they want to make sure that you’re happy and they know that if they say yes, that they could deliver for you. So here’s the URL again, it’s toptal.com/mixergy. That’s top as in top of your head, tal as in talent, T-O-P-T-A-L.com/mixergy.
Boy, my voice is going. I wonder what it is. The only thing I can think of is I did karaoke late into the night on Saturday night, but we’re recording this on a Wednesday. That should not be impacting me. All right, I should do a little less of the heavy lifting in this conversation, just let you talk instead of straining my voice even more, but I can’t stop talking sometimes.
Dr. Cohen: I’ll send you a video for it.
Andrew: Sorry?
Dr. Cohen: I’ll send you a video for it.
Andrew: Is there a video for this?
Dr. Cohen: We’ll make one for you.
Andrew: You know what? Once you’ve figured out we need to customize these videos. We’re going to come up with software that will automatically customize it I understand it, right? So a statin, they do the same thing. They deal with the same part of the body. So the part of the video that explains what the medication is helping I could understand how it would be unique . . . sorry, would be consistent. And the part that is about the specific medication would be different. What I’m curious about is how do you address me as Andrew in the video? How do you get it down to that level of personalization?
Dr. Cohen: So that’s the simple part of the personalization. The more complex one is all the clinical stuff because not just about [inaudible 00:46:26] the combination of medications and protocols. And I can say that for example we have videos for [these chart 00:46:32] of people with pneumonia. Well, you have a 106 quadrillion. That’s 15, 15 zeros after the 106 different versions for every nurse for every 30 days, right? So that’s the level of complexity that we are dealing with. So the name is . . . and about 60% to 80% of the Lego blocks that are building the videos are computer generated, and we’ve built a system that’s a very complex system, and the technology is patented and, you know, there is some technology, heavy technology behind it of how to produce the videos and how to generate the video in real time in such a short time. It’s like 400 milliseconds and we have a video file.
Andrew: All those videos pieced together to make up the final product that I end up watching.
Dr. Cohen: Yes. And then because it’s a real video file, you don’t need any specific player. You don’t need anything. You just watch it on any device that is connected to the internet. Smart TV or a phone or a tablet.
Andrew: I saw that. I like to hunt around to see what’s on people’s site. I could see that you use Vimeo, but I don’t think that your videos for patients are in Vimeo because I think you could just download them. The finished product is available in a standard straight up video file that I think I could just hit . . . I mean I could right click on my computer and save it.
Dr. Cohen: Yeah, completely yes. And it’s hosted on our servers because it’s generated on our servers and that’s why it takes 400 milliseconds. If we wait for static videos, we use Vimeo, but, you know, just because we want to separate those from our live system dynamic systems, but the dynamic videos are generated . . . when you click play, we just generate the video and show it to you, and then it’s always up-to-date, always with your, you know, the latest and greatest and you can change stuff easily because it’s dynamic. So if you wanted to change these 106 quadrillion whatever number of versions and add another logo, you just add the logo. You don’t need to change all this video. Just change that part. It will be built now with whatever new logo [inaudible 00:48:45]
Andrew: So then do you have a video with every single person’s name in it so that you can slide it in and say, “Hi, Andrew, or Barbra, or . . . ”
Dr. Cohen: In a way, in a way, yes. There are some tricks to it, but in a way. So some names if you give me some kind of an odd name that wasn’t approved, then the system will default and say, “Hi, there,” or you know, [inaudible 00:49:07]
Andrew: Got it, so you do create all those.
Dr. Cohen: Also, because we are working in medical, every piece of Lego that goes into the systems goes through an approval process. This is really important especially when you are working in medical institutions or with pharmaceutical companies to really respect their medical legal [inaudible 00:49:25] team requests. So I can just do a system even though technically I can do it. I just can’t do a system that whatever you put in, it will put out in the video. There needs to be some kind of limitation to what the video would say, and it needs to be predictable. And the beauty of that system is that everything is predictable. I know exactly what the video will say and medical legal regulatory team that needs to sign off on the system, knows that only things that were approved will be said in the video. So it’s not just whatever you . . .
Andrew: But they don’t approve . . . they don’t get to see and improve every variation, right?
Dr. Cohen: No, they . . . what we even visible, but they approve the Lego blocks. They approved . . .
Andrew: That’s [inaudible 00:50:12] pieces are, but then . . .
Dr. Cohen: Right.
Andrew: Okay. Do you remember the first sale that you closed? Do you remember when you first closed it?
Dr. Cohen: Yeah, the first sale. Yeah, I remember it. It was a really exciting day.
Andrew: How did you find out? Tell me about it.
Dr. Cohen: So that was the first time where a pharma company were like a really meaningful sale. We were working on that I think . . . maybe all together it was a couple of years, but working on the deal itself, just on the deal, from the time that everybody agreed on what we want to do and just signing the deal, it was almost a yearlong of process with lawyers and everything. And then the minute it was signed, it was really a happy moment, not just for us, but also for the client. They were also working on it for a year with their teams and their lawyers and [recruitment 00:51:04] and, you know, and doing all the security checks and all the different audits just to get it signed so that was really an exciting moment. That’s [inaudible 00:51:14]. This can really work. I mean, it takes a lot of time, needs a lot of endurance but in the end, it can also work.
Andrew: And you said that it’s very expensive. I understand the lawyers. What else . . . what other expenses go into it?
Dr. Cohen: Time. Time is expensive. If you are just a single entrepreneur, you know, working by yourself that maybe is easier, but once you start a company, you start having [crosstalk 00:51:39]
Andrew: [crosstalk 00:51:42]. So what do people do while you’re waiting for that first sale to close for the year?
Dr. Cohen: Yeah, so we were working them on . . . you work on multiple channels. You don’t just do one deal. You walk on others, other initiatives, other things to do. You’re working on demos. You’re working on . . . So everybody is working . . . .
Andrew: Is it constant fail?
Dr. Cohen: Sorry?
Andrew: Sorry everyone is working on what? I interrupted.
Dr. Cohen: Everybody is working on other stuff, and you can’t just do it one sale at a time. You have to do multiple together, and then hopefully, they won’t all close on the same day because then you also would be overwhelmed, but then . . .
Andrew: And it’s just constant demo. You told our producer, “Look, one of the things that’s most frustrating about this business is I have to keep proving myself. I have to prove that the technology works. I have to prove that the business model makes sense. I have to prove that’s it’s scalable. It’s constant improving, improving, improving, and so does that mean that before the first client signed up that they wanted to make sure that you could produce some [inaudible 00:52:40]. What did they ask you to show? What are some of the things that you had to prove?
Dr. Cohen: So you had to show first, you know, some kind of example videos, right? So you have to prepare a system with similar complexity to what they expect and to show them that it’s working. You had to show them the technology. That the technology for sending, the technology for any system that will allow them to manage the patient and send them the videos and then we had to go through some ridiculous stuff, right? They asked us . . . again, it’s a pharma company, so they said, “Can you show me the insurance of the trucks?” And then like, “What trucks?” “We want to make sure that all your trucks are cooled and are insured,” and I don’t need trucks. This is stuff that goes online. We’re not using trucks. We’re not going to ship the product for you with the trucks. There’s going to be a link.
And you have to go through this as well. And again, sounds funny but, you know, it’s another hour or two for your lawyer to talk with their lawyer to explain, “Listen, there are no trucks involved, that we need to take this off the contract.” And that’s how you end up building, you know, a year-long process, again, because these companies are not used to work with startups.
Andrew: That’ll drive me so crazy that level of ignorance would drive me nuts, and the slowness would drive me nuts. I want to see results right away. Do you ever feel like, “You know what? Maybe this is not going to work.” Because you go for months over a year without a customer.
Dr. Cohen: We had one very big frustration. We had this huge pharmacy chain, and we were working there on a deal. We were talking with all the C-levels, you know . . . I’m talking about these very big pharmacy chain and talking with them, having a deal. Deal worth for us like $5 million a month, right? It’s huge for a startup without a scale, especially then it was like . . . until today, it’s going to be huge, huge deal.
We were creating a free demo, putting all the efforts of the company. I think maybe over a year all the company was focused on these . . . you know, we were doing other stuff as well, but this was like %90 of the company focus was on this deal. And then just before it was signed, they had a merger and they released, like, third of the management, all the C-levels that we talked to were gone, all the people that we talked to were gone. Change of management, you know, the deal got loss of attention for a few months [inaudible 00:55:28] have to talk with anybody, and then once the dust settle, you could see that nobody was still there from the people that we knew, and you had to start everything from scratch, and of course, that deal went away, and that was a huge frustration. That was something that I would’ve said it will never work. No matter how . . . and we had a successful POC that we did with them. We created two billion video combinations, a system for them. Everything was working great.
Andrew: Just for them?
Dr. Cohen: Just for them. Just to show them that it can work. The bigger system was much, much more complex, but just for showing the complexity that we can handle, we had two billion versions system showing them that and we did demos like all over the . . . and we met with all the C-levels and everybody were aligned, and we thought it was %99 sure thing, and then suddenly something happens that you don’t expect. And I think this is a lesson maybe to learn that sometimes, you know, the startup company always . . . it seems like the startup company is the unstable one and these big corporates are the stable one.
I think that we had quite a few big corporation that had merger acquisition. One had, kind of, they get overtaken without the free wheel by another corporate and started . . . they got separated to few different companies, and people get fired, and people move and . . . so they’re much more hectic than sometimes the startup company. And everybody thinks the startup company will not be there at the end of the contract. Maybe, but a lot of time the people that sign the contract are not there in the end of the contract, even if it’s a year-long contract or a two-year contract. So I think you know we need to take this into account that those big corporates are not as stable as you would think.
Andrew: You know what? I was going to try to figure out who it was and then I looked and I saw . . . there are tons of acquisitions in the pharmacy space right now. The top search result that came up for me was from “Pharmacy Times,” which who knew that was a thing? “Pharmacy Wars” is the headline, an era of acquisition, mergers, and losses. And then as you scroll down you start to see CVS acquires Red Cross Pharmacies. Amazon to acquire PillPack. Someone acquired Target’s pharmacy. It just goes on and on and on.
Dr. Cohen: A lot of [inaudible 00:58:03] many activity in this world and a lot of consolidation also in the healthcare. Also with health systems right away. Hospitals are doing it all the time also. A lot of mergers and acquisitions. Yeah, it’s working in unstable environment. The startups are not really the . . . at least we can move fast, right? So they are unstable and move slowly so that’s their risk that we need to take, and it’s a risk when we are working with such a big organization, and that’s why I said you need more resources if you are working because you have to work with few of them not just one of them like we did. That was a mistake. We got out of it eventually with the help of our investors and then . . .
Andrew: Let’s end on something more positive. What’s the best part of having achieved what you’ve done so far?
Dr. Cohen: I think you know, a few weeks ago we launched another product for multiple myeloma, which is some kind of a blood cancer, and they launched it, and they invited me to talk about it with them in a patient conference. Typically, we talked with the pharmaceutical, with the physician but not with the patient. And for me after many years being out of the clinic, seeing the patients, you know, coming and shaking hands and saying thank you for what you are doing and sharing their stories of how they got confused and how the video helped them, that was really a moment that you feel like, “Wow, we’re actually doing good.”
And thinking that we’re helping hundred of thousands of patients. Last year or so we helped over 300,000 patients or something of the sort. You know, that’s a big thing, and it’s not just yet another advertising optimization or something that we are doing, but it’s something that’s really . . . we feel they kind of do-good. That really helps.
Andrew: I can understand that. I’m looking at videos. They’re really nicely shot. Anyone who wants to go check out the site or the videos it is telesofia.com. and I want to thank my two sponsors who made this happen. The first will host your website right. It’s hostgator.com/mixergy, and the second will help you hire your next phenomenal developer or designer or finance person, who knows? They might have doctors at some point in the future. These guys are growing their business. Dr. Cohen, thanks so much for being on here.
Dr. Cohen: Thank you, Andrew. It was a pleasure. Thank you very much.
Andrew: Same here. Congrats. Bye, everyone.
