BoneChat #37 - “Game changer startup Green Sun Medical - Treating early scoliosis with The Whisper”

So welcome to bone chat discussion 37. I'm thrilled to have Jamie Haggard here today. He's the CEO of Green Sun Medical. They're helping kids suffering from scoliosis with intelligent brace. This is one of my favorite startups because Greensun has no competition other than antiquated clamshell braces. They've created a new category. They have strong tailwinds from patient advocacy groups and there's no VAC committees to deal with. So it's like it checks a ton of boxes. So handing. Anyway, handing the mic over to Jamie. It's all yours.

Thank you, tiger. I appreciate it. And share my slides.

It throws my screen all around, so make sure I can see.

We can. We can see it.

You can see it. All right, so like you said, my name is Jamie haggard.

I'm the CEO and founder of GreenSun Medical. I spent 18 years in the spinal.

Implant world and I had my co.

Founder said, you know, I think we.

Can keep a lot of these kids out of surgery. And as soon as you start helping.

Kids, the hook gets set and you don't easily get away from it.

So let me kind of introduce you to my world. For those of you that aren't deep into spine.

When it comes to scoliosis, if a kid has over a 10 degree curve, they have what's considered a diagnosis of scoliosis. They're monitored until about 20 to 25 degrees, and then they receive a prescription for a brace. Plastic clamshell brace. If the curve, if they struggle and the curve progresses past 45, 50 degrees, then the next option is either tethering a fusion or a dynamic device on the posterior side. There's about 100,000 kids a year that have curves over 25 degrees. These hard plastic clamshell braces, the Boston brace was developed in the 70s. There's been some advancements in colors and some shapes, but they're still plastic clamshell braces. They're pretty uncomfortable, and it leads to low compliance. About a third of the kids are compliant, about a third are partially compliant, and a third are not compliant at all. This leads to about 18,000 surgeries, and it burns the healthcare system by about $3 billion a year. So for these kids that are wearing these plastic braces, the reason they have such a low compliance is that they impede their natural movement. They restrict airflow, can cause overheating, causes core muscle atrophy, it leads to low compliance, and then it also results in these strained parent child relationships. What our team came up with is we said, okay, if kids need to correct their teeth, they wouldn't just receive one invisalign. They would apply continuous pressure and receive a series of trays. If kids are born with club foot deformity, they receive progressive cast to correct the deformity. So we wanted to apply continuous pressure in a dynamic brace. This young lady had been wearing Boston braces for three years before she started with her whisper. And this was her first experience. Oh my gosh, you could go really far. How far can you bend forward? So with the whisper, we wanted to be able to provide them freedom and mobility, of mobility and motion. We wanted unrestricted eating and breathing. It was one of the biggest complaints that kids had.

The other thing they complained about in.

The summer with these clamshell braces was it was way too hot. So we had temperature control through an.

Open airflow design and then we wanted.

To apply continuous corrective pressure with our spring system on their spines.

It's leading to improved compliance, better outcomes.

And it also makes much better parent child relationships. These parents start to be our fans.

As far as driving in the pediatric.

Market, we're seeing it on social media. We just had a convention last weekend in Chicago with over 400 attendees. And we had a whole group of whisper kids there and their parents celebrating it. They're getting on Facebook groups, they're getting, they're posting TikTok videos and it's starting to be get a groundswell of attention for us.

The little girl that was wiggling and.

Giggling in the previous video is the young lady in the gray shirt.

She's going to these conventions and she.

Ends up being our sales rep of the year. But a very wise man told me, you know, that brace looks great, but if you can't measure it, it didn't happen. So we wanted to develop a compliance system that an app that these kids could actually measure how many hours a day they're wearing the brace. So we applied to the National Science foundation. We've had over 1.8 million in grants to develop intelligent brace monitoring. We have a 12 pad sensor system and we do compliance and corrective spinal pressure measurements with integrated force sensors. They're synced to a SAS platform via the patient's phone. The parents and the patients can actively track the wear time and the patient and the parents can encourage compliance and also help them receive rewards. If you hit your hours, we're going to do something special this weekend.

The physicians are going to be able.

To bill for remote patient monitoring or more therapeutic monitoring, and they can actually ensure that their patients are receiving the proper treatment. Within this pressure sensor, we are tracking pressure, temperature and position data. This, the blue line is an average.

Of the pressure throughout the day.

We're doing 1400.

Measure.

Oops, sorry. We're doing 1440 measurements, one measurement every minute. And then on these 12 sensors.

And then with the temperature and the.

Accelerometer, we're getting over 18,000 measurements per day. We're tracking their positions. So this girl was starting at noon, if you see on the screen, and.

She was taking a break on a Sunday.

She spent the afternoon wearing the brace, watching a movie. Down here is when she went to bed at night and then when she got ready for school in the morning, I know she put the brace on the floor and set it down horizontal.

And the temperature is the green line.

It went down, then she went to school and she was mostly vertical, standing, sitting or walking throughout her whole day. What we're able to show is we're maintaining the same pressure no matter what the activity. And we're also going to now add instantaneous measurements. So when they get an in brace X ray, we're going to have a baseline to start from and show them if they're wearing it correctly or not. All of this data is connected via the patient or parent's phone and it's hosted on an AWS HIPAA compliance server. We also received a hundred thousand dollar grant from AWS to use their AI models on our data. What we're really trying to do is if you look at Tesla, they build a really fancy car, but they measure every mile, every minute that those cars are being driven to improve their autopilot. We want to develop the autopilot for scoliosis bracing so that we can show the exact amount of therapeutic pressure you need to apply to the spine and how many hours a day you need to apply it. It's been great for the kids and we only advertise for the kids on our website, but we get an amazing amount of calls from adults who have degenerative scoliosis and they're in significant pain and they want to reduce that pain. It's a lot of this that we try to help. Is muscle pain around the curve or from a balance shift? Like this young lady from Southern California. These adults, they go through 1 million physician visits a year specifically for scoliosis, leads to 42,000 surgeries.

And if you guys know anything about.

Large spinal deformity surgery, you can have a two year recovery and marginal outcomes. We put together a just stellar team of industry veterans. Mark Bland is The general manager of Intuitive for North America. He just joined our board along with some other great leaders.

We've gotten advice, quite a bit of.

Advice from Alan Olson who is the founder of Danic and also Nick Farrell who is the A resmed. And then we've had some of the world's thought leaders in scoliosis surgery join our team. Many of them are design team surgeons at other companies, yet they've joined us to help keep these kids out of surgery. Right now we're raising a $3 million safe round and it'll lead into a $10 million full commercialization round. We've received 13 million in previous rounds from angel investors. Private or angel groups?

Angel investor, sorry, angel groups, private investors. VC, the world's largest racing company, DJO.

Inovis led our A round and we've also received NSF grants of 1.8 million and another half a million in other non diluted funding. We raised two and a half million in venture debt to qualify for the NSF grants. And with all these funds that we're raising right now, we're going to have hire a chief marketing officer for direct to consumer and geotargeting healthcare providers. We need additional field clinical specialists for training the orthotist to do the patient fittings. We need more distributor support for our VPS sales and then we need to put instrument sets in each clinic which run about eight grand. We're going to do some scale up now and we need to do some optimization on the brace to lower cogs and go to full scale manufacturing. So we'll be hiring a veteran VP of R& D including new molds for cog reduction. We're also adding a cover for esthetics. We need to expand our inventory production. We're using working capital for that, hiring of assembly techs. We're also going to expand our IP.

Portfolio and then we're going to most.

Importantly expand on this intelligent bracing system sensor system. We're going to improve the platform itself. We're going to dial into the analytics with AI to try and figure out some treatment insights and help provide better protocols for these kids. And then we also want to increase battery life in the user interface. And so we know that we're going to become the new standard of care. And we imagine a world where these kids aren't stuck with an old brace, where they have significant pain reduction and they have dramatically improved outcomes. That's us.

Jamie, explain Kind of the typical patient like the degree of deformity and then what the degree of correction kind of is.

So I would say we get two kids, we get like the families calling with a 55 degree curve, hoping for a Hail Mary, you know, and mom's in tears and all of that. Now some of those kids, it's like.

Hey, the best outcome, a grand slam. As we delay surgery a year and you don't get any worse.

Right?

We're not.

This curve's gonna go once you get past 50.

They really like to tip and go.

But mostly we get these kids from 25 to 35 degree curves. They're like that little girl Emmy, who was wiggling and giggling and they'd been okay. And then they start to lose off on their hours.

And moms are desperate for something different.

They're desperate for a better outcome for their kids and they're desperate to not.

Be wear the black hat all the time.

You know, I don't want to be.

Just the voice of the brace and like hammer them all the time.

So you take a 30 and you can get it to maybe a 20 or something like that.

Yeah, I mean, we've had, we've had.

A bunch of kids where we've.

If so we've had correction on kids. We had our first commercial patient, turns.

Out, lives five miles from me.

So there was no pressure there. Can you imagine running into somebody at the store who's worn your device and.

It not do well?

But she had a 48 degree curve.

And I said, I told the mom, you know, this is the great outcome is going to be delaying surgery. But she, we had some decent correction on her. She's been able to get down to 35 degrees. But the secret to that was she was hyper compliant. So she was hitting 20, 22 hours a day. She had growth throughout that. That time. We made adjustments about every three months. So we went back in, added a little bit more pressure and was basically like the orthodontic model. And every three months we had pressure. And the first year she was able to get down to like just under 40. And then by the second year she was able to get to 35.

So having that, you know, and we.

Probably got lucky in there, to be honest, at some point too.

Right. Because there are kids that you could.

Put them in a vise and their spine is going to go. But the data shows there was a New England Journal of Medicine published study. It was funded by nih and they actually randomized kids bracing or not bracing. And they actually had to stop the study early for the kids who weren't getting a brace because they were progressing to surgery much faster. But what they did in this study, they came out and they said, okay, if you hit 17.9 hours a day, you actually have a 92% chance of not progressing to a surgical outcome.

So we know bracing works. It's getting the kids to wear.

It was the whole.

Yeah, yeah. Compliance.

Yeah.

And so.

And the continual pressure just rather than.

Yes.

Static pressure.

Yeah, Right.

Because if you're in a clamshell brace and if you guys have kids, you.

Know, they grow, so you're putting pressure.

On them, and then as this kid grows, you're, you know, a year later, even six months later, you're not necessarily.

Putting pressure in the same spot. With our brace, it actually grows with them a little bit. We have adjustments to lift these rings up and let them grow so that at 12 months, you're still putting pressure in the right place. Cool.

Hey, Asher's got the first comment.

Thanks, Jamie. It's super exciting to see.

Oh, shit, my computer froze.

It's super exciting to see all the progress you've had. I actually applied for your company like six, seven years ago when you guys were super early stage. So it's exciting to see all the growth. My, I had scoliosis as a kid and it's kind of why I work in the spine industry now. And I had to wear a brace. So, I mean, I completely relate to what you guys are doing. I had a sort of two part question with the mobile app you have, and this may be difficult with HIPAA compliance unless you like opted in. Have you ever looked into gamifying it where you can kind of see rankings of what other kids are doing to kind of incentivize them to almost compete with each other? And then is there a way, because you're marketing to kids on TikTok, where you can kind of customize your brace and get it like Marvel themed or, you know, like, you know, Elsa from Frozen themed or whatever, you know, whatever the kids are into nowadays.

Yes and yes. So we're looking at some custom modifications or custom things to do on the covers that we're doing for it. And then as far as on the app side, um, I'm not a big believer in phones for young kids. Right. Except if they have scoliosis, then I'm like, they should have their phones on them 24 hours a day monitoring their brace. Yes. We want to do almost like a.

Snapchat thing and that.

Like, if you look at Snapchat, part of the reason it's addictive is it's like how Many times a day. How many days in a row did you.

Yeah, that's exactly what I was thinking.

Yeah, I do.

All of that. We actually want to add.

We've just got quotes for all of this.

Add a platform if you're new to scoliosis.

Here's kind of an educational side on it. Here's some of these scoliosis support groups you can go to and other resources.

Here's some kids you can connect with. We help with.

It's a group called Higgy Bears. And then we just did this huge convention. They host Zooms. And we have kids on there that are, you know, supporting other kids and walking them through that. So we kind of pair with them on that patient support. But we want to do a lot of that through the app. And you don't even have to have our brace. You'll be able to download the app on Apple Store or Google Play without, you know, needing to have the brace yet. But we know.

And are you guys targeting. So I guess beyond marketing to the kids and families, are you targeting them when they get to the pediatric orthopedic surgeon stage, or are you targeting at the PCP level before they even get referred out?

Yeah, right now it's, it's either through social media, they're. They're finding it, or through the, the spine surgeon. We just got the paperwork and, and.

We may be going to aap American Academy of Pediatricians in October.

Okay, that makes sense.

Yeah.

If you look at High Ridge now, you know, they, they have a huge.

Booth on tethering right to the right.

That's what I was thinking.

Yeah.

And it, the, with that, it's, it's not like you have to fully educate the pediatricians, but tethering is much more complicated with kids embracing.

It's like, it's a pretty obvious indication. Once you get over a certain degrees and you were lowest surgical range, you get a brace. Here's a different option for you.

Yeah, we get them to get the.

Information that it's going to be helping us quite a bit.

Yeah.

And I'm assuming because it's an accessory, you can almost, you know, kind of almost. I don't want to say skip, but you know, really reduce the dependency on marketing to the healthcare professionals and just have kids sort of market it themselves to the appropriate demographic and then, then it sort of catches fire and it becomes like a trend amongst, you know, the sub 18 crowd.

Yeah.

Just after this weekend, just this scoliosis.

Convention and what they're posting, we're getting.

A ton of leads on it where we've had success. It's like in accounts where, you know, we knew the surgeon or met him and kind of showed them.

And then also, a parent comes in.

And says, okay, you know, I want to try it. And then it's like, no risk for the doctor. They're like, okay, I do know a little bit about it, but, okay, we'll.

Give it a shot on your child.

One of the places is Riley Children's.

In Indianapolis, was just there on Tuesday.

Our very first patient. We got very lucky. The mom had contacted us and was a patient of this doctor we already knew. And she said, okay, I'm gonna have.

Insurance pay for the whisper brace. I'm gonna have.

I'm gonna pay for a Boston out of pocket.

I want to compare them both and.

Do X rays on both. I just. I don't want to take any chances.

That's fine. You know, whatever you want.

And so she did it, and she was driving home, and she had to pull over for 20 minutes after the.

Girl was wearing the Boston.

She's like, I got to take this thing off. And she did put her whisper on. And three weeks later, the mom called me and said, I can't believe you let me talk her into buying the. Or let me buy a Boston brace for her. You should have talked me out of it. I said, I can't get in the.

Way of your decision.

But they didn't even take an X.

Ray on the Boston.

The doctor was like, okay, I think this thing's working pretty good.

And that's led to, you know, know, more prescriptions. Yeah, it's super exciting.

Best of luck with everything. It's really exciting to see all the growth.

Yeah, it's.

It's been a long process in a crazy world.

I'm gonna let we. Sam go first, because he's got to drop off. Yeah, you probably.

Thank you guys so much for the invite.

This.

This looks pretty slick, honestly. When you measure heat, are you measuring, like, body heat or. Or skin temperature or.

It's on the. It's somewhere in the pad.

It's.

It's not skin temperature because it's embedded.

Inside the pad, so. But it's.

They have. Right now, you'll see a lot of places have what's called an I button.

And all it is is a food.

Heat sensor that they. They embed into one of the pads.

And if you get over a certain temperature, it shows compliance.

The problem with that, you leave it in your car while you're in gymnastics, it hits the Right temperature, it shows compliance. You get creative and put it in your, on your dog, it can show compliance. Leave it in the window. In the right, right conditions, it shows compliance. Like, I've heard everything about how these kids are lying on their, their hours. Yeah.

The one thing that just kind of hit me, like, does it matter when, when the kids wear it? Like, does it like, do they sweat? Does it matter their body temperature goes up or down or.

Yeah, I'm not as concerned of that. It's kind of like the last backup validation besides accelerometer and pressure, where I think we can go down the line.

With adults is if they get pressure sores, if they're in rigid braces, they tend to pressure sores. And that has to do with humidity. And we're looking at adding that and temperature.

So it's like temperature, humidity, pressure.

If someday we could try and figure out, hey, they're at risk for a pressure ulcer because of things happening, we could be preventative and definitely improve outcomes compared to what is out there.

Have you thought of implementing maybe like some sort of a gyroscope into your app or the body temperature itself?

For the body temperature? No, but we're still, yeah, maybe the app.

It might not be a bad idea, honestly, like if somebody has like an Apple watch or whatever, like a guy might be interesting to know kind of their mobility, etc. I don't know.

I, I, that's why we put that accelerometer, so we could show, you know.

They'Re vertical or laying down and that.

At the conference I had Noel Larson.

If anybody knows her from Mayo, came in and spoke and one of the studies she had done was she had.

Kids tracked on just a step sensor and they were, they had scoliosis and they averaged 12,000 steps a day.

And as soon as they got their brace, it dropped to 3,000 steps a day, which is like, what Chronic, chronic illnesses.

And so she's like, I think we.

Can use your technology and like go back to that. And I want to see the difference in, in kids with your brace versus what I collected for.

Awesome.

Cool.

Thank you. Yeah, absolutely.

Thanks, Kyle.

Questions? Do you have a lower age limit?

We don't have a lower age limit. We have an lower size limit. So, you know, we, we kind of did this going out for 10 to.

18 year olds basically.

And so around 10 is around the age. It's more, the rings can get down.

To about 22 degrees on their way.

Or 22 inches on their waist. So that's, that's our lower kind of size limit. They have to be just tall enough.

And then have a big enough waist. It crushes me. We were at this conference and we had a line of these eight and.

Nine year old little tiny peanuts, you know that, that were just too big for. But they're like, all right, we're on the list, you know and they've got the measurements and they're going to be watching their waist and seeing when they.

Can get big enough to get it.

So we've got a couple of big.

Doctors in the a juvenile scoliosis world that want to work with us. We're going to go after NSF for another grant to do a juvenile version of the brace.

Second question is, is discomfort the only reason for non compliance or there's some other sort of restriction like if they got to use the toilet, they, they have to take it off and then they leave it off or things like that?

Absolutely.

So you know, number one is motion and all these. We did a lot of surveys like we had a basic design but it.

Was like we, you had to get in the mind of the kids and the parents. Why aren't they doing it? Motion was number one. Kind of tied for a second was heat breathing and eating.

You know, you couldn't eat full meals in these, you know, it's like a Victorian plastic corset. So you couldn't eat full meals. They had trouble breathing which leds leads to more anxiety. If you take away their full breathing.

Capacity it increases their anxiety, which they already have in a brace and then temperature. So if it's the air can't flow through, you know, in the summer right now I can tell you when a heat wave is going through certain areas because that's when you get pinged on our website.

So it's, that's kind of the main things. The Velcro is really big. So we have these magnetic buckles and.

They.

We thought they were really cool.

Because they just kind of snap on and then you can easily pop them off. And kids all said they loved them. And I finally said why? And they're quiet and I said okay, what, what does that matter? And they said okay. When I met in the bathroom and.

I shut the door and people hear the rip of the Velcro, everybody's like what's that? What are you doing? They're in gym and they hit the Velcro. Kids come around the corner and look at them. We put hinges on the brace.

It wasn't just to get it on.

And off easier, it was actually so it could fold and go in a vertical locker in the gym locker room. And so the girls liked it because.

They can have it under their shirt, pop off the magnets, open it up and slide it in the locker.

Brilliant.

Thank you.

And yeah, Jamie explained the name whisper, which is fascinating because girls can wear this underneath their clothes and their friends don't even know they have a brace on. And so they whisper to their friends, which is a brilliant name.

Yeah, I heard it in a, I read it in a Tom Clancy book. There was a line that said no amount of yelling in the White House.

Amounts to a presidential whisper. And it was because a whisper is so powerful from a president. That's.

I thought about that. I'm like, we want something really powerful.

But almost, I love it.

And because we got in the mind of a 12 year old girl, all the braces out there are called a Boston brace, a Providence brace, a rego brace. So they're named after old guys or cities. The 12 year old girl didn't care about that. So we tried to go in a.

Different direction and see exactly, you know, what would appeal to them.

Excellent. Anthony.

Yeah.

Jamie, great presentation.

Are you guys anywhere outside the U.S. not yet. We get a lot of requests from Japan to Canada to Europe. We've had families fly over from Europe.

And get a whisper. We haven't gone over there yet. I mean it's, I.

There's demand.

I know we could go there, but you got to stay focused on your key sites here and, and do what you can.

Kind of started to spread out geographically.

You know, we're trying to be.

If you can drive four or five.

Hours, you can get a whisper in most of the populated areas in the country. So.

Yeah. Mark.

Great presentation.

Thank you.

Early part of my career, all of the orthopedic residency directors were mostly pediatric orthopedic surgeons and they were the very best doctors that made the least amount of money. I had great respect for those doctors and scoliosis was their foundation. And so my question is your B2C program, how are you doing that? What is that? Is that for the future? You're doing that now and how's that work?

So we've got, we've started bringing on distributors to handle the physician side as.

Far as the direct to consumer.

All of our inbound leads have all been, you know, it's TikTok, Facebook and that. We're actually not posting. We're encouraging it. We're supporting the parents and everything and supporting, we do a lot of support for these big scoliosis meetings for these kids. But we're not actually, we haven't spent.

Any money on, on marketing for any of this stuff. It's all been word of mouth, parents sharing to other parents. So.

And then, you know, with the distributors.

We'Re working with distributors that are, you know, have relationships with these pediatricians, spine surgeons.

So it's kind of a double, double approach. You know, it's like you've got to, it's, it's one of the few medical.

Devices you can go direct to the consumer.

And it is amazing with these parents.

They look at this and they're like, they, they could care less about their surgeon. At the end of the day, they're like, if this guy's not going to do it, we're going to go somewhere else. And I don't ever try and pull anybody from their surgeon.

But if somebody's like, yeah, you know.

I just don't know anything on that. I'm not willing to do it. They have, the parents will leave in two seconds and go somewhere else. So we've been, you know, because their, their idea is like, hey, the surgeons, once we get to surgery, for now I want to do the best brace that I can for my child.

That's pretty cool. I did a LinkedIn Live event earlier today on remote patient monitoring and chronic care management because I run a platform for the medical association called indie practice. And we, we try to bring new ideas to independent practices and this is much, much probably too specialized for those guys. Although, I don't know, maybe not. It might make a really interesting LinkedIn Live event one day.

Yeah, I'd be happy to participate. And the, that remote monitoring side, they came out with new RTM codes. There was remote rpm, remote patient codes.

I think it was last year, whatever year before they came out with RTM codes. So it was pretty specific to musculoskeletal remote monitoring.

So you had to be providing a.

Therapeutic event, bone growth stimulator, therapeutic device, bone growth stimulators, things like that. And they had to be connected. And so we've, what we've seen with our advisors in that, that do that like we're going to be able, as we have the established, the physician dashboard, they're going to be able to bill for.

That would be really good. That would be a great LinkedIn Live and have a panel of different remote therapeutic monitoring products and experiences of which that would be one. So anyway, I really enjoyed your presentation.

Thank you very much.

Jamie, walk us through. So a patient sees a doctor and they, they Learn about Whisper. And they say, okay, you're a candidate, tell me, walk us through how the customization happens, how long it takes.

Yeah, so we kind of follow the same workflow. If they were just getting a regular brace, they, they get a prescription from the doctor. Some institutions have employed orthotists like Shriners in that most of them have an outside vendor that either rent space in.

The hospital or they have a clinic outside the hospital somewhere. Hanger clinic would be the biggest one. They have, you know, around a thousand clinics throughout the country. So they take a prescription, they get an appointment to go see the orthotist. The orthotist uses a 3D scanner. Actually have mine right here.

So they use a 3D structure scanner or something similar and they take a.

Scan of the patient. They stand there and they walk around them about three feet away and it gives them a three dimensional OBJ file of their torso. They take that the. We have a measurement form and they send that to us with their X rays. And so we pair the X rays and the patient's torso and we can, the brace is modular, so we can custom build each brace specifically for each kid. We have different angles on the pieces going around. And so we custom build a brace for a kid.

We like to say two weeks mainly because if the, if they're new, newer orthotists and not going solo yet, I've got clinical specialists that can go around.

And attend the fitting. And we like to, you know, especially they're fair nowadays, nowadays it's nice to book it out a couple of weeks.

So they go through that process usually.

Within two weeks to three weeks, depending on usually the patient and the orthotist schedule. We come in and fit them for a brace. What's nice about ours is like if.

You get a, if you get a.

Regular clamshell brace, you kind of get.

It, you break into it from one to six weeks, depending on the surgeon.

And then you come in and, and you get an embrace X ray.

If you had a 35 degree curve.

You know, they'll see how much correction you were able to get on it. Is it aligned properly?

We do the same thing with ours, except we let the kids, we don't.

Put full pressure on them to begin with. We let them get used to it for a couple of weeks.

Then they come in to see that.

Orthotist again and then we crank it.

Up a little bit more to fully.

Pressure and then send them in for the X ray.

And so when they do that, they.

Tend to do A little better because they've gotten used to it. And then they can. They can get a little bit more.

Push them a little bit. So the. The X rays are just plain films like sagittal corona.

I usually just do a PA X.

Ray, although just recently at the POSNA meeting, they were starting to show how important sagittal balances and embracing, not just in surgery. So we're starting to see a little bit of shift to that where they're doing an AP and a lateral.

No CAT scans or MRIs or anything crazy. Okay.

They just do the X ray.

And for us, and for any type.

Of brace, you have markers in there, and so you want to see that that brace is aligned and applying the pressure where it's supposed to. You know, scoliosis isn't super complicated. You have a curve.

You put pressure above it, below it.

And on the apex, and then you.

Try to derotate it.

So.

So you just want to make sure.

Your pads are lined up with the apex of their curves.

Got it. And what about pricing and reimbursement and all that?

Yeah. So depending on the braces, there's customized braces out there.

These.

You know, the kind of fancier clamshell ones.

Those I've seen for 5 to 12 or $13,000. Sometimes insurance reimburses them, sometimes they don't. Average Boston brace, we see anywhere from, like 2,500 to 4 grand cost to the patient. Ours is $6,000 cost to the patient.

So it bills insurance 12, but they.

Almost all of them are contracted about 50% for the braces. So. And for.

We haven't really had. We've had a couple get covered under.

Medicaid, but it's usually private insurers. We do really well on Blue Cross.

Blue Shield, and a couple of them.

United is the challenge on most things.

So we get probably a little more.

Than half of them covered by insurance.

It seems like you could charge more. I mean, people will do anything for their daughter's health. I mean, you know. You know, Taylor swift tickets are $5,000.

I need the Taylor Swift version of the brace.

Yeah. Oh, man. Yeah. Get her to talk about it. Go crazy. What can. What can we help you with? Where's your pain in the business right now?

You know, right now it's like, okay, we got to this point. You know, you're raising money in that, and it's like you got a hidden inflection point point. Like our. Our growth constraints are capital constraints.

Right now. I need some more people to get out there. I need the instrument sets. I need that because we get these.

Shops that are like, oh, we'd love to have it here.

And I'm like, okay, we can add you next quarter or whatever as we go along. You know, we can only build so much or, or cover so much.

So we really wanted to, you know.

Hit an inflection point, especially with this last convention, having all these kids wear it.

We were at the same convention a.

Year ago and we had one kid.

And so we were this novel, kind of unique idea like, of people kept.

Their eye on us. Now they saw eight kids walking around with this. And those kids were just hammered by other kids with questions. And then the parents of those kids were hammered by other parents. And it's. It was really a takeoff moment for us.

So how many, how many. What's your throughput? How many patients could you do per week? Per month?

Per month. We could do about 25 right now.

But one a day?

Yeah, one a day. But like adding another assembly tech it. We could start them on Monday and by Friday we could have them going.

And, and they could be building them.

One of the things we used in.

Our NSF grants that we're working on right now is it takes like three to four hours to design all the parts for the brace or put the thing together. We're going to reduce that probably by 80, 90% where we've got some software coming where we just put where we want the ring and it auto fills it and puts all the parts together for us.

So that's going to reduce our design.

Time, which will increase our throughput. We're also like our brace right now, like the bigger ring has, could have 20 to 30 parts in it. We've done analysis on our last couple hundred braces and we're going to be able to sit there and take it and go down to, you know, three to five parts per ring instead of all of those pieces because we see where, you know, there's a lot of similarities between them. And so we're going to be doing. Do more new molds with longer parts instead of just these little inches parts.

Got it. Any questions from the gang? It's. I, it's just a, you know, we, we talked in the. Jamie and I have been talking for years and I would love it if you guys didn't use the word brace.

You know what? I, I hate the word brace. I don't want to use brace. Try and go through insurance without using brace. Getting an L code and it's all of that. If we Were outside of medical, we.

We would just call it the whisper. I only call it the whisper. But like, you've got to, you got to stay within the coding system you have, or you won't get any of them covered.

Yeah, I got it.

So we're going to go after our own unique code. We had a clinical study going. We have four sites shut down because.

It kind of post Covid the great resignation.

We had, we had doctors that were chiefs at Children's Hospital Los Angeles. Been there like 25 years. Our primary investigator move that happened at.

Four different sites where we were studying this thing.

And so we kind of. And we had the whole clinical team at a Shriners leave. And so we said, okay, let's, let's shut this down.

Right now.

We're working on this sensor system. Once this comes out, we've got such.

A greater accurate measurement of compliance, we'll be able to have much better data and be able to show very accurately what we're doing. So we're going to get that started back up soon. We actually have a lot of independent sites that want to study it doing different things. Like I said, from step counting to motion to pressure.

What's. What was the regulatory path and what, what claims can you make?

We're class one device right now. We're providing clinical decision support. At some point, we'll gather enough data and once we switch over that as.

We study it, enough to go, okay, this is, this is what you need to do. Here's the minimum you got to maintain.

And all of that. Then we'll have to. To up regulate and do that, but we don't have to cross over that line yet.

That's awesome.

Yeah.

And this, you know, so everybody knows, like, Tiger was part of the magic rods, right? And I saw like the playbooks already. I've already read the book and he.

Wrote a chapter in it and it.

Was, hey, you've got this.

You'll get parents supporting these things.

Because when they were selling the magic.

Rods, they went into hospitals of like.

If they didn't sign up, they were like, okay.

And they'd get calls back because the parents were like, I'm leaving.

If you guys don't do this, I'm.

Going to somewhere else.

So it's like he says, the parents.

Will quickly change facilities or physicians if they aren't getting what they think is the best treatment for their kids.

Yeah, we had, you know, we had patients writing inpatient families writing letters to the FDA for years. We didn't even know about it. And and then when. When kids got a magic rod, they. They wanted to come to the company and hug the engineers. And that was something we had to get used to. You know, our CEO would say, all right, we got a visitor today at 3. I have no idea. Are they going to be in a wheelchair? You know what. And they would come in and, you know, they wanted to hug the engineer that designed the magic rods. That was just incredible.

Yeah, it's.

There's a whole. I was in spine forever. I actually sold Harrington rods, if any of you guys know. Yeah, I'm that old.

Right. You know, you. There's such another level of responsibility with this, because I, you know, I'm getting.

Gotten to know a bunch of patients.

And families in that, and it's like they're looking at you like, man, you have to do everything you can to help my kid, you know, so it's. It's completely different than selling screws and cages and everything that I did before.

Yeah. Alessa is not on the call, but she did send me a note about the adult market.

It's huge.

So we all sit there and say, like, people will do anything for their kids. Let me tell you, adults in chronic.

Pain from scoliosis would sell a kid to get out of it.

I mean, they will call you up crying. They will. They are so desperate, not only in scoliosis. Like, I've got the president of the Sherman's Kyphosis Foundation.

It wants us to, you know, can.

You do modifications to help with that and just.

Just a little bit of dynamic pressure to help with pain relief.

So that market between that and adult.

Degenerative scoliosis, it's 10 times the. The adolescent market. So we're applying for another NIH grant for. Through National Institutes of Aging, specifically for adults.

Wow. And is that. That's class two again or class one again?

Yeah, it'll be a class.

Love it.

Yeah.

So. And, you know, I was like, are adult deformity surgeons going to, you know.

Want to prescribe this thing? These guys want it now. And their thing is, I've got this lady in my office.

She comes in every six months, takes up 45 minutes. She doesn't want surgery. I don't want to operate on her, and I can't get rid of her. And if I could give her this. If you lowered her pain 20%, she would be ecstatic. And that's what we saw. That lady that I showed in my.

My PowerPoint, she's like, I. I used.

To struggle getting in my mailbox and and back.

And she sent me a text this.

The first day she got it, she's.

Like, we just walked around the neighborhood. And I haven't done that in a couple of years. I can't thank you guys enough. And it was just because. Because she was so far out of balance. She had all this low left back pain. And if you get. It wasn't even about correcting her curves, it was about getting her balance over. And once we were able to do that, it significantly lowered their pain and she was able to get out and walk in ways that she hadn't been able to in a couple of years.

Fascinating. Eric or Dr. Shuroff, any.

Hey, Jamie, congratulations.

It's.

It's. It's always great to find that, that extremely rewarding, unmet need. So good for you. That's, that's, that's what keeps us going, isn't it? I had a question. Are you thinking about any other indications for, for this device? I mean, it's applying load, you know, upward load or in, in different directions. So there's, there's indications that, that could use some, some offloading of, of the spinal elements. I know you're probably laser focused right.

Now, but, yeah, laser foot. Like I said, there's Sherman's kyphosis. There's, you know, the whole adult market. You know, if you have a degenerative lumbar curve, right, and they've got a radiculopathy, you can go in and kind of decompress that, but then it can end up collapsing. So we have Dr. Like, hey, if we can go in and, and see if you can provide any relief or if you can, hey, they got to.

Wear their, their brace and stabilize it.

You know, after we do the, the foraminectomy. We think it could be very helpful because you're, you know, keeping that pressure off the nerve. And they'll know, like, hey, if you're pinching on that nerve, it's hurting again.

Put your whisper back on.

So we're looking at things like that.

But it's the same thing. It's resources and you gotta have laser focus.

It's really hard to deal with all the patients that we call, you know, we get. And, you know, the one thing that we've expanded into a little bit is some neuromuscular and degenerative neuromuscular scoliosis as.

A result of other diseases like Friedrich's ataxia.

And that if anybody has neuromuscular issues, you put them in a plastic clamshell. You want to talk about muscle Atrophy.

They already have major problems with muscle atrophy. And now you're, you're enhancing it.

They might be stable, but in a.

Regular brace, but you can't, you know, they're going to have a decline in muscle atrophy. So we're starting to help with some of those kids.

Yeah, so, so the one thing that I, I was, I was thinking of is, is maybe, maybe the, you know, biggest market that we have, that, that still is pretty much, you know, under underserved is, Is, you know, back pain secondary to degenerative disc disease.

Yes.

Where we're offloading there can, can, you know, you can get some healing or you can, you know, hold off some.

Surgery for five years.

There are a few things we're looking at and maybe talking about partnering with a company on.

So I, that is a huge market, too. And, you know, if I have a.

Partnership and the capacity to do it, yes, I'll do it right now. Like, I've got kids to help. I got to prove it in this space, get the money to complete that.

And then we'll work on other markets.

You know, I learned that quickly.

You try the shotgun, you're not going to help anybody.

Yeah, completely. Well, let me know. That's been my life for a long time.

I can, Yeah, I would, I would love to connect with you on that. I mean, I, I. And as someone whose wife had a huge disc herniation and discectomy and then eventual fusion, like, it's, I understand that.

Whole, that whole market all too well, so. Or at least have lived with it all too well. Well, great, Great.

I'll. I'll ping you then.

Yeah, absolutely.

Could it be used in a knee brace to, like, offload the medial compartment?

That's kind of what we're thinking on that.

Yeah.

Right now we're not doing any distraction. All we're doing is lateral pressure, lateral medial pressure, and then we're doing rotation.

But we could add distraction, too. So it's one of those things that's.

That'S on the, on the board for.

Things we'd like to do. So. But we haven't gone too.

You got to focus. You can file patents, but you got, but you got to run your business. Yeah.

Got to run the business. Right.

Yeah, we, we talk about that often. The number one killer for startups is lack of focus. It's not lack of money or lack.

Of right or technology.

It's lack of focus.

And so right now we're just on that, getting people trained and, and going it Takes us, you know, five to 10 patients, depending on how quickly they.

Come in to get an orthotist comfortable. So they're going solo. So, you know, I'm sending a team, making sure they're good.

But once they're going, it's just, we get an order, send a product and.

Nobody has to be there. It's great.

Excellent. Dr. Shoroff, you have a question?

I have a quick comment. It goes along what you just said, tiger, and you know, venturing potentially in the knee, but the knee business, you know, is very busy potentially also, you know, looking at extremities. So ankle bracing is, is, you know, quite a big market and that could potentially also be very attractive. Maybe easier to get in than into the knee.

Yeah, we've looked at clubfoot also, you know, and if we could integrate our pressure, pressure sensor system into it like it is. It is. They've been doing the same thing for a long time and it's great, but they don't really know how much pressure they're putting on. And they kind of have a, a standard they go with, but it's not dependent on each kid or how flexible.

Their limber, their, their ligaments are in that.

So if we could kind of figure some things out about how to, you.

Know, do it until the next brace, I know there's some opportunity there also. Yeah.

What are the, what are the follow up times for patients? I mean, you talked about two weeks. You sort of go in and tighten it up. But what are the other follow ups?

They come in for a follow up with the orthotist and an X ray.

To make sure it's, it's aligned.

And then it's usually three to six months to come in with the doctors.

They usually do an X ray out of brace every six months. Months and they go through skeletal maturity. So you know, 14, 15, 16. In girls, more 15, 16, 17. And boys got it.

And, and when, and once, when do you, when do they stop using the brace? Once they're skeletally mature.

And skeletally mature. And then, you know, there's starting to be more data where these kids in, in regular braces, like, okay, even if they've had some correction, they went from 35 down to 30, 30. And you can't just pull them out right away because the curve will bounce back.

Right.

Five or ten. So you got to wean them off slowly. Personally, if it was my daughter and you had a curve over 25 or 30 degrees, especially to begin with, got up into the 30s or 40s, I would try and get them into nighttime.

Bracing like a retainer through high school. There's.

It's not going to cause any harm and it could prevent a lot of.

Things, you know, where these kids if.

If they quit too early and they have another little, little bit of growth.

Left, you can see curves accelerate very quickly.

Yeah, it makes sense. What does your team look like in Denver?

So we just have a couple of us here in Fort Collins, and then my sensor team is down in Denver.

And then I've got engineering office and, and that in San Francisco. And then I got a VP of sales and clinical special specialists and we're kind of all spread out a little bit.

So. So all the building, all the customizations done in Colorado.

No, all the actual assembly and everything.

Is in San Rafael in California.

Oh, wow.

That's for the smart. That's where the smart people are.

Fascinating. Everybody, Everybody got it really quick. There's no other questions or comments or.

Somebody tell me I'm crazy.

I, I think you gotta run like crazy with social media. I. Rather than the patients doing it themselves. I think you've got to have, you know, you YouTube channels and Facebook groups and.

Yeah, we just. So we did all the recordings on this, on this conference. We've just set up a YouTube channel, Scoliosis Whisperer. And we're going to be offering all.

This content and then we're going to have.

I want an educational platform because all.

These parents are drinking from a fire.

Hose, you know, as their kid gets diagnosed. We have a lot of information on.

Our website, but if we can be the YouTube source to kind of walk them through like a scoliosis university, these parents will absorb it. Our average time on our website's over seven minutes. That's an eternity.

That's a long time because we have all this stuff, all these videos. I mean, the parents I talked to.

More parents are like, I've read.

I stayed up till two in the morning and I read every single page on your website. And then I went over to Facebook and we googled you or searched you on Facebook.

And they, you know, see all these different parents and we tell parents, hey.

Like, look us up on Facebook.

Reach out to any parent. We have a very open attitude for.

That because they will.

Parents will trust other parents more than physicians or anybody from the industry.

So we're in, we're in some very big and some private groups that I'm not allowed into.

It's only parents. And I hear back from parents, you know, different ones reporting things. But it's Amazing how they communicate and give each other confidence in them.

Go ahead.

So, Jimmy, you might take a look at a company called Simple Show. They make Simple Show. They make educational videos that are, they look very rudimentary, but they're potentially very valuable for the audience that you're looking for. For kids that want to communicate, understand something, parents that want to help their kids understand and easily shareable. They're an educational development company. You can make a couple minute video for a couple thousand dollars. But perhaps more cost efficient for you is they have an authoring tool where if you got a member of your team that likes being creative, you can write the script, you can put in the images you want, you can drop in different things and it'll chew it up and spit out a video that's put together and you can render it. And if you're, if you're using it a bunch, you might get videos for a couple hundred bucks a pop. It's, they're fun to work with and it's a neat tool.

Okay.

Yeah.

And it's, you know, one of the things we're doing. So I've got this. We're going to have all this content on our YouTube page. We're going to kind of have a scoliosis university. And here's everything you go through as a parent. We're going to have a scoliosis university for kids and it's going to be taught by other kids. Because these kids are very educated. They, they try to pick up as.

Much information as they can.

One of the things we do, this.

3D scan of them.

One of the biggest anxieties kids have.

Over bracing is the scan. I learned.

And because they get told some guy.

Is going to scan their body to, to make a brace, whether it's a.

Whisper or other ones make a custom fit brace, most of them assume they're gonna, some guy is gonna walk up.

And be touching their body and scanning it.

They don't understand that you're standing three feet away.

So we just filmed a video for that that we're gonna put on there. Like this is what your scan looks like.

And I know that's probably gonna be our most shared video on our YouTube series because the kids are so anxious about that. If you've never been embracing and you just told you're getting scanned for a brace, imagine if you're 11, 12 years.

Old and you're going to see some.

Guy to do that.

You, you have no idea what's coming.

If they've ever seen an MRI machine.

That'S what they're going to expect. Yeah, something terrible.

Yeah, something terrible and whatever. And it's like something that, when that young lady told me that, that was my biggest fear. And then I started asking other kids.

And it was like repeated among all of these. So it's like if you can tap.

Into that and be the resource for.

That, that's how you can explode, you know?

So simple show also lets you control voiceover. So if you wanted to have a kid record voiceover for it, you would have no problem with it.

And I got a ton of volunteers. We now have whisper ambassadors that are taking it and talking to other kids and doing stuff.

So, yeah, you were joking around. Your salesforce is all these kids and parents and, oh, it's.

Yeah, it's insane.

And they. And they don't even know, you know, they're just like, oh, I can bend over and I can do this and. And whatever. Like that little girl wiggling and giggling and laughing that has been seen tens of thousands of times times. You know, more parents we talk to say, like, I watched that video and.

That I wanted my kid to laugh like that. She's so miserable. Boom. That's it. You know, so it's. It's very powerful.

You want real stories and I want.

Them to connect with. With parents and that. Go ask them what they think. How it was going before, how it's going now is does any kid want to wear a brace? No.

Like, they don't even have to love the whisper.

They have to not hate it. And we have a home run. Right.

Like, literally, they hate bracing.

So if they don't hate this and yeah, I'll do it, then it's a home run.

Yeah. I liked Kyle's comment about gamification. That wasn't me, but I was thinking that was Asher. That was Asher. Maybe. Yeah.

Yeah. I couldn't agree more with that. I. There is so much we could do with this. On that app side, I think the.

Gamification may be as powerful as the whole sensor system.

As far as, you know, we'll get the clinical adoption and studies in that with our pressure sensors, but being able to do it from.

With the gamification is going to be huge for these kids.

And we already have some in there. Like, we have it. All right.

You hit four hours and it does.

This badge and you hit eight hours.

In that and you did this many.

Days in a row.

And there's some random things it'll show up and do. A badge.

One of the things one of our parents has done while we've been working through this is she's like, her phone time, hours time are dependent on her brace time, right? So it's love that. Like, dang.

All right.

You hit more time, you know, getting to use your phone and things like that. And so the parents were like, that.

Was the ultimate reward for her.

So she got to be able to.

Use it, you know, depending on her brace compliance.

And if you missed a day, it's like, guess what?

We got to get our hours back back up. And. And so you can try your phone again.

And unless the whisper is clasped together, the WI fi doesn't work.

Yeah, yeah, yeah, exactly. That would be great. You know, something like that. It's, it's, you know, there is, there's.

A whole science to that on gamification of devices and that we've looked into and you can. You spend some serious money.

But it's, it's about, it's mainly about.

You know, seeing senior hours and doing that and kind of competing with other kids.

But the biggest thing in all of.

This is feeling is not feeling alone. Scoliosis is the loneliest disease for these kids because even if they have great parents, great friends, they get diagnosed, they're alone.

We do these teddy bears.

Did I bring here it is.

So kids get a teddy bear with.

A whisper and has the magnetic buckles on it.

So, you know, instantly. And that's what this convention we were at is called higgycon, but it was started with higgy bears. So giving kids, you know, a little bear to connect with. And somebody understands when they show up at these conventions. I would say 80 to 90% of.

The kids that were there for the first time had never met another kid with scoliosis. And so instantly, yeah, and so instantly.

They'Re sitting there going, oh, this one mom, like we were still setting up the first night mom came in and she's like, yeah, we're from, from Missoula. We go to Spokane, Shriners and that. She's like, my daughter's never met anybody with scoliosis.

And I knew these team, these 15.

Year olds that were right by us, and I'm like, sweater. This young lady's never met anybody with scoliosis in this whole group. Like, and, and we're on her. And it looked like Taylor Swift talking to a young 10 or 11 year old.

They're like, let us see your brace.

How's it going? Yeah, this is the one I got. And, and whatever. And showing them pictures on the beach. Like, I wear mine on the outside all the time. And this girl was just blown away. And the mom was just kind of tearing up behind her, like, holy cow.

And I can't believe this event.

And it's amazing. Like, at this event, the amount of kids that are new, the first day, at the first break, they go find their mom. If they're not wearing a brace, they're like, can we go back to the room and get my brace? Because I look like an outsider if.

I'm not wearing a brace.

Right? So it's like the one place in the country where these kids, you know, are, feel safe, look like an outsider if you got a straight spine. So. And by the end of the weekend, these kids are wearing their braces on the outside side, going through the airport and everything.

They're not hiding them anymore. So, you know, the more we can support groups like that, the better off we'll do.

So how does the family find a surgeon? So is there a surgeon locator?

We're putting that on our website right now.

We've kind of been expanding and doing it. So it ends up, you know, with a lot of it, it ends up to new leads with surgeons, too, because it starts with the parents, you know?

Right.

I, I, I was in implants for 18 years.

I've had doctors call me up on.

The phone, hey, I've got this patient requesting a whisper.

I just pulled up your website.

I know a couple of those docs in that. Can you tell me about this thing? And then like, yeah, this looks good. Let's do a prescription.

And, and I mean, I've never had that in implants. So we're actually getting new business.

Half our business out there doesn't even have distributors yet. I know we can do better in those areas. And so we're kind of, you know, evaluating distributors, but like, in Mayo, we're getting that business just because she found out about it from patients and, and, you know, the different groups.

And then I, I met her.

So it's the biggest thing that, the biggest advantage you can have is that push versus pull. You know, as soon as you got other people advocacy for you. And, man, you get a lot of tailwinds. You need to, you need to just run with that as far as you can. The communities.

Yeah, it's all of that. And it's so powerful. The, the head guy had rainbow babies. He's, he looked through it and everything, and he goes, all right, this is the way I look at it. You know, those other braces work 30.

40% of the time. You might work.

7, 60, 70, maybe 80, 90. I don't know.

We'll see.

But I'm pretty sure that if I don't offer that to a family, they're going to go to somebody who does.

And if they ever do need surgery, they're not coming back to me. And that's exactly the way it goes. And we've already seen that, you know, so.

All right, well, this has been great. Jamie, thanks. This is everybody, one of my favorite startups. And, yeah, they're killing it. And you guys can see why. It's a unique solution, solves a problem in a unique way. And it's a new category and huge tailwinds from. From patients and families. So congratulations.

Thank you.

Appreciate. Luckily, tiger.

See ya.

Thanks, everybody.

Guys, awesome.

Thanks, Jamie.

You bet.

Have a great day.