A medical system that could innovate at warp speed immunizations against deadly viruses still directs us to sit in doctors’ waiting rooms and fill in personal information forms on a clipboard. It’s a curious system that asks us to make an annual physical appointment with a physician, who often will suggest another drive to a diagnostic laboratory. Then, our journey will continue either to the physician who ordered the test to discuss the results or, if all is fine, we receive a reassuring telephone call from the doctor’s office. Efficient? No!
If the consumer-doctor connection is the window to early prevention, diagnostic testing is the early biological warning system for some easily treatable illnesses. But discovering fixable problems often happens after the doctor’s visit. That’s “closing the barn door after the horse has escaped.”
The process assumes that everyone is committed – or worried enough – about their health to follow through quickly and follow their physician’s request to obtain needed diagnostic information. It doesn’t always happen that way! Almost 70% of medical decisions use lab test results. The problem is that 40% of physician diagnostic prescriptions are never filled.
Could a change in how consumers access diagnostic data impact the tragic trend that more than 70% of US deaths (41 million annually) are related to often treatable non-communicable diseases? In this Medika Life exclusive, we talk with health-tech innovator Pouria Sanae of ixlayer about why he is working to shake up the current “sick care” system by empowering consumers and the health system through affordable, reliable, reliable and accessible home-based testing.
Gil Bashe: Tell me about the genesis of ixlayer and your vision to make it easier for physicians and patients to work together around the convenience of diagnostic testing. What problem did you set out to solve?
Pouria Sanae: Two stories explain how ixlayer got started. Several years before I launched ixlayer, my mother was selected to participate in a clinical trial. The clinical site’s onboarding process included diagnostics that revealed abnormal blood levels. The follow-up testing found a malignant tumor in her neck. She was operated on a month later and is alive and healthy today. This was a time-sensitive discovery; had she missed the tumor – until even six months later – it would have been too late. After that experience, I knew I needed to do something in the health sector that could help other people and families. Survival cannot be left to serendipity.
Our co-founder, Dr. Poorya Sabounchi, lost his father to a medical condition that could have been prevented if detected earlier. His professional passion became genomics and genetic testing, and he first joined Illumina to pursue that mission. When we met, we immediately connected on this idea that so many people are ‘hosts’ to a disease without knowing it – many people need screening but don’t get it. How many lives are lost because the information isn’t available? That is core to why we advocate for consumer engagement in diagnostic medicine. Ixlayer is more than a company. It is a catalyst for long-awaited change that will benefit providers, payers, and, most importantly, patients and their families.
Bashe: Unfortunately, you’re right – the stories you shared happen too often. Your and Dr. Sabounchi’s experiences – harnessing diagnostic information within us as a preventive strategy – should be the standard of care. How did you transform life-changing family experiences into ixlayer? What were the operational steps?
Sanae: I made the change very quickly – I left my job in the tech sector and moved to the health sector. First, I joined Helix, a promising sequencing lab providing the same concept for genomics. There, I realized that the hurdle to better, frequent diagnostic testing is the difficulty in operationalizing or shifting the process itself. This is a very fragmented market.
I was involved in launching the lab testing platform for Geisinger, Mt. Sinai, Invitae, and National Geographic. On top of Helix – they were all spending millions of dollars and 18 months on development. They were inventing the same wheel over and over! We saw what was missing: infrastructure and patient experience layer on top of the lab work. The observation and need were the basis for ‘ixlayer.’ I for infrastructure and X for the experience. Suppose we could equip the industry with this missing piece. In that case, we could increase lab testing volume and offer preventative options, affordability, patient experience, and in-home convenience.
Bashe: When we look across the lab testing sector, even as some assays or technologies evolved, the patient experience for diagnostic testing has remained unchanged. Would you say that’s true?
Sanae: Yes. There are three issues when it comes to the consumer experience of diagnostic testing. One is convenience, the second is affordability, and the third is the ease of use.
For example, if I want to go and get my thyroid checked, I first need to go to a doctor and discuss the need for the test. I need to get a requisition or “req” form. Then go to drive to a lab like LabCorp or Quest. Then, return to the doctor to discuss the results. Once the test is ordered, this clinical journey requires at least two physician visits and a lab visit. Let’s also add in the scheduling and drive time.
Another issue is affordability. Based on my current insurance, I pay $60 for this, out of pocket – two $20 copays for the doctor visits and another $20 for the lab. It adds up.
On top of it all, consider time constraints. I don’t have the time to see a doctor. Most people don’t have the time. This system assumes you have complete power over your schedule – put the employer aside. Get someone else to handle childcare.
So those are the three things that need to change within the system. It’s not the doctors’ or labs’ fault. No one is to blame. The system is the system, and it is failing us.
Bashe: You mentioned a thyroid test as an example. How does a consumer access a consumer-oriented diagnostic test like this?
Sanae: The beauty of partnering with a national retail pharmacy is that we provide something the end consumer can pick up off the shelf. CVS calls this “symptom to treatment in a box.” Once you pick up a test, scan a QR code and begin a digital experience. A telehealth physician oversees the process on the back end. You get instructions on how to collect your sample. You ship it back to the lab, which processes the test, and you get a result. If your results are abnormal, a physician calls you and explains the result and next steps. And in this case, CVS owns the process; if your results are abnormal, you’re sent back to Cvs Minute Clinic for continuity of care.
Bashe: Tell me a little bit more about the tests themselves. What types of samples are used in your tests?
Sanae: We cover everything when it comes to at-home testing. Depending on the type of test, our services support all samples for at-home tests, including saliva, blood – whether finger-prick and dried blood spot or tube – and we also do stool and urine. The first one we started with for the four Cvs tests is blood.
Bashe: There seems to be a major movement to make pharmacies more accessible in personal health management. I’m curious to get your take – with the rise of at-home testing and telehealth during the COVID-19 pandemic, do you see a behavioral shift in consumers wanting more accessible care?
Sanae: Yes. We entered the market before the pandemic, back in 2018. Initially, the feedback from the industry was that the end user – the consumer – wasn’t ready. The Covid era has changed the concept of in-home care, and people realize how easy it is to engage with their health on their terms. CVS, Walgreens, Walmart, and Amazon are entering the market and have financial models where they feel they can add value. On top of that, consumers – especially Gen Z, Millennials, and Gen X – seek improved home care.
Bashe: It sounds like you’re talking about sparking a movement of health-conscious consumers – those who say maybe I should check my thyroid function or my cholesterol proactively. Is that your hope?
Sanae: A future of at-home health testing is key to preventive care. It provides a snapshot of personal health information over time. The doctor already knows that 133 million Americans have chronic conditions that often require ongoing lab testing. But 60 million Americans have a chronic condition and don’t know it. What if we could help more of those people get diagnosed sooner – maybe even before their condition becomes a serious problem? Suppose we manage to test that individual more often. In that case, we can identify high-risk patients and hopefully, get them the treatment and support they need before their condition becomes a problem.
Through the CVS partnership and others, we can help more pharmacy and health system partners realize the significant value of empowering consumer health.
Bashe: Could you share with me a little bit about ixlayer technology itself? How does your technology differ from other systems?
Sanae: Oneof the challenges for the diagnostic space and in-home testing is that it is a very fragmented market, with different regulations for each state. We developed a technology layer, a cloud layer, that integrates into forty different services, and we keep adding services daily. This includes 27 different labs, a physician network in all 50 states, fulfillment services, picking and packaging, in-home mobile phlebotomy, insurance, Emr, and so forth. On top of that, we combined this into a very easy-to-use patient experience layer, transforming a complex, segmented ecosystem into a patient-friendly flow.
We can launch our customers within six to eight weeks. It might take years if a retail company or provider network wanted to do this themselves. We are making it possible to operationalize the shift from sick care to self-care and support the medical practice of preventive care.
Bashe: When you look at the future, share with me what you think might happen realistically a year from now.
Sanae: Consumer adoption of these tests will increase. The goal is to have lab testing be like a toothbrush. If toothbrushes were invented for the first time today, your dentist would tell you that you don’t need that thing. Come in when you have a cavity. That is what health care is today. We wait for people to have pain instead of giving them preventive tools to monitor and maintain their health. Our vision is that lab testing can and should be like that toothbrush – the preventive care in-between visits. You should test yourself every quarter, should monitor yourself, and then, when you come in for your checkup, you can show the results and discuss them with your doctor. That’s preventive engagement.
Bashe: What are your thoughts about how physicians understand this change as a fulfillment of their vision to be healers and address the needs of people who need healing? Will the fragmented health ecosystem realize that a smarter, educated, engaged consumer is the Holy Grail of wellness?
Sanae: I’m glad you brought that up because many disagree with this industry topic. Many primary care physicians are against patient-initiated testing, where an individual patient goes to a lab on their own. They are concerned that the patient won’t get the correct information or support without guidance from a physician. In reality, there is demand for that kind of access, and we all need to find the balance between what we do and what physicians do.
This type of service benefits providers, too. If we can work together to prevent healthy people from coming into the hospital, it may reduce physician fatigue. That means doctors will have more time and energy for patients with pressing needs. If physicians adopt in-home testing, which they are, it reduces the cost of a hospital bed and the cost of care. ixlayer adds value to preventive care, disease management, and the chronic condition diagnosis journey.
Bashe: You have a diagnostic business model, but it feels like you also have a public health model. When people are actively engaged in conditions that could be well-managed and engaged at the earliest stages, we can improve people’s survival outcomes.
Sanae: We are an ally to public health. The public health system needs to know that this is available to make lab testing more straightforward and accessible. For example, the Netherlands provided an in-home lab test for colon cancer for every household because they realized the significant benefit of pre-screening and early detection. This is a catalyst to have consumers recognize that they have the most at stake – healthy longevity.
We are a platform that powers consumer and public health. The provider network, retailer, payer, or government agency can tap into the ixlayer platform to set up their offering. They can utilize their health system lab because we’re lab agnostic. They own the data. They own the patient relationships. ixlayer is just the pathway.
Attempting to manage a person’s health without regular diagnostic data is like putting your ear on the car’s hood to understand if the engine is functioning correctly. Suppose we get more people to check more often. In that case, our system supports the medical community that seeks longer, healthier lives for everybody.
With chronic non-communicable illnesses on the rise, detecting health issues early enables health professionals to guide the course of treatment – to adjust diet, offer medication options and engage other medical specialties. Creating this “pre-patient” model of care empowers consumers to be better informed and engage in their health. Suppose we encourage frequent lab testing by reducing cost, access and convenience barriers. Can we also reduce obstacles to lowering system costs and shift emphasis from sick care to preventive care? Pouria Sanae and his ixlayer team are long-awaited catalysts for these changes.