Courtney Williams.mp3: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
John Shufeldt:
Hello everybody, and welcome to another edition of entrepreneur, where we help health care professionals own their future. Hey everybody, and welcome to another episode of entrepreneurs. I'm your host, John Shufeldt. Today I'm excited to have Courtney Williams on the show. Courtney received a bachelor's degree from University of Arizona's Eller College of Management and an MBA from Arizona State University's Thunderbird School of Global Management. She's also reclosing the local startup community, including U of a center for innovation startup Tucson's former thrive program, Bio Industries Organization of Southern Arizona, and the Venture Ready program with the Arizona Commerce Authority. Courtney comes at health care, entrepreneurism, and a little bit of a tangential way. She was not into health care throughout her education and came into it because of her sister's high risk pregnancy. Courtney, welcome to the podcast. I'm excited to have you.
Courtney Williams:
Thank you so much for having me, John.
John Shufeldt:
So where are you located right now?
Courtney Williams:
Right now I am in Tucson, Arizona.
John Shufeldt:
Is it raining down there? Because it's raining and cold up in Phoenix.
Courtney Williams:
We got a lot of rain last night and this morning, but it's cleared out now. It's short lived. Always.
John Shufeldt:
You know, I'm laughing. Say, it's kind of cold and it's 64 degrees. So everybody in the Midwest and Northeast are like, yeah, whatever, dude.
Courtney Williams:
Definitely. Well, it's cold compared to 110 for 31 consecutive days and nights. So yeah.
John Shufeldt:
Exactly, exactly. Well, I'm excited to have you on because you've got a really cool background and past. So let's start with your background. Give us a sense of how you got to where you are, and then we'll talk about where you are.
Courtney Williams:
Sure. Yeah. So I'm originally from Arizona. I went to undergrad at U of A, I got my bachelor's from, from Eller College of Management, had a minor in French. As soon as I graduated from U of A, I actually did an internship in Ghana. So I went to West Africa right after graduation and learned about entrepreneurship. I actually served as a business trainer for a group of entrepreneurs in a Google sponsored program for entrepreneurship all across the country of Ghana, and that taught me so much. Then took a hard turn and moved to California and worked for a fortune 500 for a few years there. And I was like, well, I want to learn more. So I got my MBA from Thunderbird School of Global Management. Really big in international business. And so that was Thunderbird originally was an independent business school. Now it's part of ASU. And I got a chance to work on business projects all over the globe. During that time, I learned Spanish as well, which I didn't know before, which is kind of rare in Arizona, actually, and that was a really pivotal experience. I ended up going into the corporate world after that and did a lot of projects in finance, and customer analytics was really my area of concentration.
Courtney Williams:
Fast forward a few years. I was working in customer analytics and helping set some corporate metrics for Energy Company, actually, and my sister had a difficult pregnancy. That was the first time that I had actually been close to sort of maternal health, or had experienced it through the eyes of somebody else, and she had a super high risk pregnancy where she was on bed rest for months. And there were questions throughout the way as to whether she was going to be okay or not. That whole experience opened my eyes to the fact that pregnancy is not necessarily safe, and that us can be a really dangerous place, despite all of our medical advances. It can be very dangerous to actually have a pregnancy here. So that plus working on the board of a of a nonprofit in Guatemala that really focused a lot on maternal health and maternal health education for the people that it served in Antigua and the area there. That opened my eyes to the fact that there is a lot of room for innovation in maternal health. It bothered me and started keeping me up at night. Of how many women struggle to get safe health care during their pregnancies, and I decided to do something about it.
John Shufeldt:
Wow. Okay, so what was your undergrad degree in? At LR?
Courtney Williams:
It was in marketing, actually, I did marketing, and then at that time they had an international business certificate. So those were my areas of focus.
John Shufeldt:
And so you didn't really have any health care background at all?
Courtney Williams:
No. In fact, the only health care experience I had obviously was as a patient or seeing my family members go through the medical system.
John Shufeldt:
You know, it's funny, I was at Mayo the other day and we were talking about the second year pitching ideas I had, and part of it was they weren't yet ensconced enough in the nuances of taking care of patients because they were second year. But the flip side is they had this brand new fresh eye experience. And it's funny how you can become ensconced and not see things that are in plain sight, because that's just the way they are. So it's really cool. You come in from the outside with a fresh set of eyes.
Courtney Williams:
Yeah, I definitely have taken the patient perspective as I've developed my company and developed our innovations, just because that's the perspective that I bring. Frankly. The first product that we developed was our FDA cleared handheld ultrasound. It's called Vista Scan. And initially that was intended for low resource settings. And when we're talking low resource settings, I'm talking about some of the places that I've lived and worked places like Argentina, Guatemala, places in Africa. So like 50% of the world doesn't have access to radiology. And so that was initially kind of where we were thinking. But then time went on and we realized, wait, there are a ton of communities here in our own home country, our home community in some senses, that don't have access. So having the outsider's perspective, I think, has been helpful in seeing those realities.
John Shufeldt:
Wow. So use the butterfly. And a lot of people in emergency medicine use butterfly. Is that basically the similar thing?
Courtney Williams:
It's similar yet different. How is.
John Shufeldt:
It different?
Courtney Williams:
So similar in the fact that you're using your cell phone, plugging in an ultrasound probe, and being able to image anytime, anywhere at the bedside, in transit, at home, anywhere in between. The difference is sort of our approach. So butterfly is an amazing innovation. They are mostly focused on generating AI from the images that they are creating. We are taking a different approach. We're literally just focused on getting imaging to where it doesn't exist yet. So we're not taking the AI approach with the images themselves.
John Shufeldt:
Okay, let's talk about the company. So your sister had a high risk pregnancy. What did she struggle with that gave you that light bulb moment?
Courtney Williams:
The fact that she was bed bound. She's told you're on bed rest. You're at home. But then. Oh, you got to go to these doctor's appointments all the time. And how scared that she felt during that process. It felt dangerous to actually go to the doctor. And the fact that the medical imaging equipment is really, really great at the medical facility. Yet we have awesome internet connections for the most part in our community. We all have cell phones. They're more cell phones than humans on the planet right now, so why couldn't we leverage that in order to make her feel safer and get the same information to her physicians in the same amount of time, faster? That was the impetus for thinking, wow, this is something everybody should have access to.
John Shufeldt:
Okay, so we came up with this idea. Then what did you do?
Courtney Williams:
So then we got it FDA cleared. We did feasibility testing. We worked with different types of medical specialists. We worked with folks in emergency medicine. We worked with folks in the maternal health area. We worked with folks in cardiology and kidney specialties. But it was so broad. The problem with ultrasound, and also the benefit is that there's so many different things that you can do with it, whereas other companies, I think are more focused on the cardiology space and kidney care and some of the bigger markets. We kept being told, if you focus on maternal health, that's really a niche and it's not big enough and there's not enough money in it. We decided to double down on maternal health, especially as we got our FDA clearance right as Covid happened. And it was just kind of a no brainer because the awareness for maternal health crisis became much more broad across our country, and the disparities in maternal health and the need to really double down and serve this particular population became very apparent to us.
John Shufeldt:
Looked on your website, are you a B2C or a B2B?
Courtney Williams:
Yes, both. So yeah, that kind of brings us to like what? How our company has evolved. So we started off as B2B, where we created an imaging tool that was specifically for clinicians in low resource settings. Yet fast forward to the middle of the pandemic. I had a high risk pregnancy myself, and I got preeclampsia in the postpartum period, and I had no idea that this was going to happen to me, and b, I had no idea how to communicate my information to my provider. Instead, I was having to go to the doctor's office multiple times a week just for blood pressure readings. And, you know, obviously I'm putting myself in danger at that point because it was the height of the pandemic. I was putting my family and also, to be honest, my providers, just by being in there. And I was like, why can't we communicate this information in a digital way? And also like, how do I know how high my blood pressure should be? There's never any follow up about that. So hence we develop our app which is our patient facing app. And this brings us to the B2C component. And now we have a B2C area of our business where we're dealing with customers, providing them with a maternal health app where they can track and log their maternal health, their vitals, their symptoms, their mood, and any questions they have for their doctor. They can do that digitally. Then they can also communicate that with their doctor. Remote patient monitoring platform that we have.
John Shufeldt:
So who pays for it? So you're an average income woman in any city. And you say, I want my first baby. I'm scared to death. I want it all. How do they sign up and who pays?
Courtney Williams:
Yeah, the app that we have is actually free, so it's free to anybody that has access to iOS or Google Play Store, frankly, can download and just use it as a tracker if you want pregnancy wellness coaching, if you want more hand-holding, then we provide that as well so the patient can pay for pregnancy wellness coaching, where they can meet with a nurse practitioner and discuss their specific questions and concerns that they don't have time to talk to their doctor about. Their doctor meets with them 10 to 14 times during pregnancy for 15 minutes. Providers also pay for the remote patient monitoring platform, where they can see their patient's data in real time as well. It's billable.
John Shufeldt:
Have you ever thought about having it where patients in a remote area gets an ultrasound probe to lease, and you use an AI model to say, move probe here, move probe here?
Courtney Williams:
Definitely. Yep.
John Shufeldt:
Is that coming down the pike?
Courtney Williams:
Potentially. Yeah. One of the things that makes us different is the fact that we are connected more to the patient. So compared to other handheld ultrasound companies that are around, they're all focused on the clinician. But we're focused on improving the connection between patient and clinician. So integrating our three platforms together gets us there. We've got the patient app. We've got remote patient monitoring platform. And we also have the ultrasound. So yes the answer to your question is yes.
John Shufeldt:
Having the patient have access to an ultrasound probe. And I can see the good and the bad of this. I can see some women who are so absolutely paranoid about being pregnant that they're on the thing 24 over seven, sending these images out. And then I also can see the benefit of it. So you don't have to go into your ob's office necessarily. You can literally dip your own urine for protein, check your blood pressure and do an ultrasound. What's your thought on that?
Courtney Williams:
My thought is that is definitely the way of the future, especially once we can get the world of billing and insurance wrapped around that idea. And everybody's supportive in the medical system and medical community. I think that is definitely the way of the future. I think in like 15, 20 years, that's going to be what happens.
John Shufeldt:
15 or 20 years. Wow. Well, that's kind of pessimistic. I don't disagree. It's kind of pessimistic, though.
Courtney Williams:
It is while we're in this huge maternal health crisis in our country. And like, this is the most dangerous and expensive place in the developed world to give birth. We also have systems that are set up in order to maximize revenue. We also have an OB crisis on top of this, where 49% of US counties do not have a practicing ob gyn. So there's like a confluence of factors that are coming together that make me think that realistically, that that model will take some time.
John Shufeldt:
You know, what's interesting is I could argue this both ways, but I think the challenge for OBS is there already an incredibly high risk group as far as medical legal challenges? I think if I were them, I would be like, I do not want this deluge of data coming in from patients that I'm going to be responsible for and all of a sudden say, well, I can't really see that image, so it can't be held responsible to make your call that I have horrible images on. I wonder how you get around that. I think it's.
Courtney Williams:
Twofold. Number one, on the ultrasound piece, like with the Alara principle and, you know, kind of like as low as reasonably acceptable amount of ultrasounds for patients. And then also at the same time, being able to limit the tools so that you as a physician could get the data that you need, but you don't get surplus information because surplus does nobody good. And then obviously building in AI and machine learning to help manage the data and filter it so that it is relevant and the most urgent things bubble up to the top for physicians. That's, I think, how we manage this in a long term, sustainable way.
John Shufeldt:
Yeah, I think you're right. I think there has to be a machine learning component with it, because otherwise it'll be a deluge of data that no one can get through. And you're right, there has to be able to be reimbursed for it. Or if they're on a fixed capitated plan, feel comfortable enough that they can divert some of it to this this process and not see the patients in their office. Definitely in what you've learned and studied and from your fresh eye perspective, why is it that US developed country has a relatively poor statistics for maternal fetal health?
Courtney Williams:
I think we have a number of different factors that are working against us. Sort of touched on the fact that we have this OB shortage. Half of our country is located in a place that doesn't have access to a practicing OB, and I think that is a huge part of the crisis. If you don't have access to trained specialists or you have to travel, in some cases two hours each way to get to your prenatal appointments, which is not rare, and especially in our research, then that's an issue. You know, getting timely help is an issue. I think also the fact that, you know, we have to be honest about the fact that there are huge disparities in our country, racial disparities as well as economic, socioeconomic disparities when it comes to maternal health and outcomes. And until we can be honest with ourselves as to why those disparities exist, I think that we are going to continue to have a maternal health crisis. And I think the third piece also is it's pretty difficult to be a doctor in the US these days, from what I understand, and from the folks that are on our team that work with us, so many doctors are overworked. The burnout rate is really high, especially in certain specialties like OB. You touched on the fact already about how liability just comes into play. In such a major way, especially with maternal health. You're carrying liability for like 21 years for two patients. Essentially, all of those factors make it a very burdensome proposition to be able to profitably, safely and effectively care for patients that are honestly increasingly sick.
John Shufeldt:
I don't know why anybody would want to be an OB, and I love delivering kids. When I was in medical school and a few times in residency. But you're right, it's total high risk and it's a challenging specialty to begin with. So you're absolutely right. And it'll be probably an increasing shortage in the years to come, I would suspect.
Courtney Williams:
I think so too, which all the more reason why we need to apply more technology to this particular specialty to be innovative in solving these issues that are coming up.
John Shufeldt:
Yeah. Totally agree. What has been the most interesting thing that you've learned during this process? Because you came into a whole new sector that was totally new to you.
Courtney Williams:
The most interesting thing that I've learned is through a number of National Science Foundation grants that we've been awarded with. Along the way, we've also done programs that are really specific to customer discovery. We did a program with National Science Foundation called I-corps, where we went and we did customer interviews. We did almost 150 of them in six weeks. We did that multiple times. We've done that process multiple times. And the thing that I learned the most recently in doing that is we specifically narrowed in on maternal health. The experience for the patients and the experience for the providers. And what we learned was everybody has a story. Pregnancy is a really stressful process for everybody, and nobody comes out of that unscathed, both patient and provider. And having the compassion to understand the anxieties that patients go into the process with. And then also just how much of a burden, how high stress the field is for the providers has helped us to understand how we can get these two groups to communicate better and also, frankly, how we can make it more efficient for providers and lower cost.
John Shufeldt:
Yeah, I wonder, I'd have to think about this. Just other offshoots you can have from this to one, lower the anxiety and stress for both of them, and also lower the chance of medical error. I mean, obviously the earlier you catch things, the better off everybody is.
Courtney Williams:
Definitely. Yeah, that's actually one of the reasons why we developed our patient app is that we can get people on board being very cognizant about their health early on in the process, and that can help lead to better outcomes. So if somebody is logging and tracking their pregnancy health, like their blood pressure, their blood glucose, from the moment they find out about their pregnancy, they are so much more efficient at advocating for themselves. They ask better questions to their provider. They use their providers time better. They're able to educate themselves better through the process. And so that has been an important learning that we found as well. Getting patients to be a part of the process is important.
John Shufeldt:
Right. I still see when I'm on the reservations. There is a ton of women who come in. It seems like 1 or 2 a day with zero prenatal care in labor, and part of that is access and resources. Clearly, part of that is just patient education and medical literacy. And then part of it is just the economic disparity they face there. And those are going to be hard things to tackle, even with the best of efforts 100%.
Courtney Williams:
Absolutely. Well. And also infrastructure on the reservation not having access to consistent cell phone or Wi-Fi. That is one of the biggest barriers to implementing telemedicine effectively. Or programs like ours like remote patient monitoring. And so this sort of touches on how one of the other reasons why we have this maternal health crisis. It's not just maternal health. We see it in maternal health, but it's really in general kind of like an economic and health care and health disparities crisis as a whole in our country right now.
John Shufeldt:
Do you think that the market you are trying to target will be the ones who ultimately use this? Because it seems to me that what you've described is a product for the affluent to give them peace of mind, as opposed to the lower SES, to offer them some degree of care.
Courtney Williams:
Yes, about 53% of our folks that are on our platform today are actually Medicaid customers. And I'm just speaking about remote patient monitoring and our patient app, not ultrasound related. So yes, there are quite a few affluent folks that use this and do receive lots of peace of mind. But on the other side, there are a number of Medicaid folks that are still gaining benefit from. We provide patient education like research backed articles. We have a huge article repository and that hopefully help stem the tide of people going to tick tock for their medical information, which is what we see a lot right now, frankly, less so Instagram and Facebook, but definitely lots of like med TikTok by being able to have a forum for people to monitor their vitals for free, that at least is one less conversation that they need to have with their health care provider. And that's one more conversation. Their health care provider can talk with them about something else that limited time that they have together, right?
John Shufeldt:
I mean, if you're able to monitor that and blood sugars, you mentioned protein in urine and glucose and urine weight. Huge, huge impact.
Courtney Williams:
Yeah. What we have seen so far in early times, we've only launched our app to the public. It's only been out for about ten months for the general public to use. And it is a freemium model. So you're right. The. Are the higher level tier where you get the extra coaching et-cetera and you get the extra set of eyes on you through your postpartum recovery three months through. But when we've done surveys of our current customer base, over 40% of people say they actually feel safer in pregnancy just by having access to this kind of technology. That's the first step. And next we will be starting to measure outcomes and see really where and how this moves the needle.
John Shufeldt:
What's been the hardest part for you so far? What was your kind of aha moment? I would say my 3 a.m. ceiling fan talks. What's been your ceiling fan talk?
Courtney Williams:
There's so much that we can do with the technology, and there's so much we have on our roadmap that we want to accomplish. And yet maternal health continues to be, in many people's minds, a niche compared to other medical specialties. There's just now starting to be lots of lots more non-dilutive funding available. But traditionally this realm of. And I hate this term, but I'm going to use it anyways. Femtech does receive less attention. You know women, there are fewer research dollars going towards women's health, as we've seen through time. And there's a huge report that came out about that this past week. So one of the biggest challenges is making it known that this is a problem, that maternal health is a problem, and that there's economic opportunity in innovation in this space and communicating that economic opportunity to people that historically haven't been aware of it has been the biggest challenge so far.
John Shufeldt:
Interesting. Yeah. You would think that given the rate of birth in the US, investors and others would look at this as, oh hell yeah, this is a wide open market. And I've heard the term femtech before. The way you said it, it sounds like a pejorative, almost like, oh, femtech, but is it because you're in Femtech that made it more challenging for you? Do you think that's what I'm inferring it is?
Courtney Williams:
I think even just having to have the heading of femtech, having to even just have that term in the vernacular is a problem, frankly. I mean, women's health is health and women's health care is health care. So given how many fewer investment dollars are directed towards this realm of femtech compared to other areas, I think that may perpetuate problems for folks that are in the industry dealing with periods all the way through menopause and geriatrics.
John Shufeldt:
Well, I mean, it's kind of frankly stupid to even has a name. I mean, you don't hear of medtech.
Courtney Williams:
Exactly.
John Shufeldt:
Yeah, that's kind of ridiculous. I agree with you. Okay. That's been a challenge. What else? Fundraising because of the moniker has been a challenge.
Courtney Williams:
For some folks. It has been. But for us, we have taken the non-traditional route. We've definitely gone really hard with the Non-dilutive path. So we've gotten grants from Department of Health and Human Services, from the National Science Foundation, Flint Foundation, Roddenberry Foundation. And so there are lots of non-dilutive opportunities that we have very astutely taken advantage of, and that's really helped us move our business forward.
John Shufeldt:
Wow, that's very cool. What advice do you have? As I mentioned before we started, there'll be people listening to this and say, wow, I want to be her when I grow up, even if they're already grown up. What advice do you have for people who have an idea want to start down this path? Because, you know, most ideas die with the owner?
Courtney Williams:
Definitely. So twofold. First, we took the path that I don't recommend taking, which would be we went the hardest way first, which was an FDA 510 clearance medical and software device, right as our first product. And having previously hadn't gone through an FDA clearance process before, didn't have experience dealing with the quality system, things like that. And so I would definitely say if you're considering innovation, think of the innovation that is easier to get to market and sort of don't want to say least regulated, but don't put yourself through a horrendous regulatory path as your first path. It takes longer. There's a huge learning curve and it's a lot more expensive to do that.
John Shufeldt:
Yeah. Totally agree. Going through the FDA is never easy.
Courtney Williams:
Yeah, we learned a lot and that set us up for a good foundation so that now as we develop additional products and as FDA's guidance on AI and machine learning is changing so rapidly, we're able to keep up much better now because we have that experience. So in a way, it's helped us. But having developed a patient app first, I think would have been the preferred route if possible. Yeah.
John Shufeldt:
How long did the process take you to go through the FDA?
Courtney Williams:
So it took us quite a while. We did an FDA market survey, a regulatory review, before even doing this determined the predicates. Et cetera. You know, all the testing that's required, all that is sort of separate from the actual FDA 510 process in total. It probably took us with testing and everything. Minimum eight months.
John Shufeldt:
Wow. Actually, I thought you would say 18 months. That actually is pretty fast. It seems slow experience, of course. But yeah, I think from my experience I've heard a lot more horror stories where it goes back and back and back and back before it gets FDA approved. Yeah, I agree with you about that. May not have been the best way to enter a market, but you're right, it built a hell of a lot of resilience. And you also have the hardest part done first. So in some respects not a bad outcome. So you know, I look at back at what you've described, what I've read about you, you saw a problem. Your solution was a combination of patient facing app to embrace them and give them some source of information and counseling if they so choose, and then also a device that where they can increase access for providers in places without ultrasounds, for example.
Courtney Williams:
That's it. Exactly. Absolutely. Yep.
John Shufeldt:
What do you see your exit look like and when?
Courtney Williams:
Well, when could be any time. What we understand is when you have a phase two award that apparently increases your visibility towards potential acquisition. And we do have we are currently working on a phase two award right now with National Science Foundation. We're open any time to that possibility. Right. But we have a lot to build in terms of AI and machine learning on our platform, and I'd love to do that before our exit, obviously. So any time I would say maybe in the next 24 or 48 months is probably going to be when our exit is. And in terms of acquisition, there are so many folks looking towards purchasing, frankly, and not having to build in-house their machine learning algorithms and having that sort of at the ready as a package to be able to hand off to a much larger entity could be very attractive, especially in the telemedicine space, which is growing so fast. And there are so many opportunities there, especially for more quote unquote, niche products. Right.
John Shufeldt:
Is your AI product based upon reading ultrasound images or.
Courtney Williams:
It is not, but we can go into that in more detail in a future episode.
John Shufeldt:
Fair enough. Now I'm starting to think what it would be based upon. What's the timeline for that, do you think.
Courtney Williams:
In terms of acquisition or just in terms of like market.
John Shufeldt:
Completion of that project?
Courtney Williams:
Oh, well, hopefully in the next 18, 24 months for sure. That's where we're shooting. But anything could happen, hopefully, maybe even sooner.
John Shufeldt:
Very good. Well, where can people find out more about you and more about what you're doing?
Courtney Williams:
So if they want to learn more about maternal health crisis, etcetera, we always we're posting our new research, our white papers, etcetera on our blog which is on medium. We're imagined solutions tech. If people want to learn about what we're building and be a part of our journey with the journey pregnancy, our app, the Journey Clinic, our remote patient monitoring platform and Vista scanner, FDA cleared handheld ultrasound. They can go to imagine, imagine Ft.com, which is our website.
John Shufeldt:
Perfect, and we'll make sure we put all that in the notes. Courtney, this has been a blast. Thank you. Congratulations! You are blazing a new path, and that's so impressive that you came in from outside of health care to do it. So congratulations.
Courtney Williams:
Thank you so much, John. Thank you for having me. And thanks for your attention on maternal health. I really appreciate it. Oh my.
John Shufeldt:
Pleasure. This has been a blast. Thanks, everybody. Thanks for another episode of entrepreneurs. We will see you again soon. Courtney. Best of luck. Thank you. Thanks for listening to another great edition of entrepreneur to find out how to start a business and help secure your future, go to John Shufelt Webmd.com. Thanks for listening.
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