Surgical Innovations goes further to connect patients, surgeons with medtech and digital tools

October 27, 2021

Following the company-wide reorganization, Surgical Innovation emerged as Medtronic’s large operating unit. In this episode, Matt Perry, president of the group, explains where the business will find future growth. At least some of that will come through digital effort like the GoFurther app, which connects bariatric surgeons with their patients. Dr. Marina Kurian joins the interview to explain how the app is streamlining the process patients must go through undergo the life-changing procedure.

 

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Tom Salemi (00:00):

Hey, everyone, this is Tom Salemi of DeviceTalks. Welcome to our newest member of the DeviceTalks podcast family, it's called MedtronicTalks. Our constant search to find new ways to bring new insights in the med tech industry led us to the fine fine folks at Medtronic. They've agreed to make their senior leaders available to us, and to you. In each episode, we'll discuss the opportunities and challenges facing one of med tech's clear leaders, so you'll have an inside view on what makes Medtronic go. We'll ask the questions, Medtronic will provide the answers, and our great network of sponsors makes it all possible. So sit back, hop on a treadmill, take the dog for a walk, whatever you do when you listen to a great podcast and let's listen to how Medtronic is getting the job done. Let's go.

Tom Salemi (00:43):

Hey, everyone. This is Tom Salemi of DeviceTalks. Welcome to this episode of MedtronicTalks. Great to have you here. We're going to talk about the Surgical Innovations business today. We're going to focus in on one particular part, the work that it's doing in the bariatric space, including a app called Go Further. We're going to speak with Matt Perry, the president of the group, and Dr. Marina Kurian. She is a bariatric surgeon who will explain to us how Go Further is helping her practice and helping her patients. We'll also talk with Matt about other work being done in the Surgical Innovations business.

Tom Salemi (01:22):

But before we begin this episode, I'd like to introduce our sponsor, CPC. I'm here with Blair Plackner, the Director of the Core and Customs Business at CPC. Blair, tell us about CPC.

Blair Plackner (01:36):

CPC is the leading provider of quick disconnect couplings and fittings for low pressure fluid handling applications and medical bioprocessing, thermal management, and specialty industrial markets. At CPC we pride ourselves on innovation, having largely pioneered the low pressure fluid handling connection space over 40 years ago. And now we offer a portfolio of over 10,000 standard optic shelf and custom engineered connection products today, in volumes ranging anywhere from hundreds to millions of pieces per year.

Blair Plackner (02:05):

We're headquartered in Roseville, Minnesota, which is in the Twin Cities metro area, but are able to work with development teams globally with regional engineering and sales throughout the world. We're an ISO 9001 and 13485 certified company and have world class manufacturing facilities, including multiple state-of-the-art class seven cleaner reduction environments.

Blair Plackner (02:25):

Our vision is to inspire confidence at every point of connection. It's a little bit of play on words, given our product, our connectors, but we're really seeking to inspire that confidence at every point of connection, both with our customers and starting internally with every interaction that the CPC team has, and every touchpoint that we have with our customers. Of course, it's also largely inspired by the validation and testing challenges that our customers face, and confidence in performance that our products must deliver.

Tom Salemi (02:53):

Thanks, Blair, we'll hear a little more about CPC a little later in the podcast. For more information right now, you can go to cpcworldwide.com. Now let's begin our interview with Matt Perry and Dr. Marina Kurian. Well, Matthew Perry and Dr. Marina Kurian, welcome to the podcast.

Dr. Marina Kurian (03:12):

Thank you.

Matt Perry (03:13):

Thanks, Tom.

Tom Salemi (03:13):

Well, thank you both for coming here to tell us a bit about Surgical Innovations. It's the largest group in Medtronic, so I want to make sure we give it it's due. But you're focused on an interesting area, which is bariatric surgery that I want to delve deeper into, and perhaps we'll certainly get into some other therapeutic areas as well.

Tom Salemi (03:31):

Matt, I typically start these podcasts asking about your background. I know you came over in the Covidien acquisition. I'm going to throw you a curve ball, so I hope you're ready. I actually just, through serendipity, interacted with someone who works in your business this morning and mentioned I was going to talk to you, and the reply I got was that, "Matt is an amazing leader. His memory is incredible. He'll meet someone once and remember specific details. Truly a good human." So this is even a softer than a softball question. I thought that was really nice commentary on you and the fact that you remember specific details about the folks who work for you, and I'm sure others in the industry as well.

Tom Salemi (04:07):

Is that something you've trained yourself to do or does it come naturally? Because I'm frankly losing that ability by the day it seems.

Matt Perry (04:13):

Well, first off, I need to find out who made that comment and thank them, and also, benefit and give them a little bonus for Christmas. It was awfully nice of them. If you talk to my family, my boys would tell you that I can't remember the name of our next door neighbor, so the fact that somebody says that I meet somebody once and I can remember their name is an awfully gracious compliment.

Matt Perry (04:32):

I'm blessed to have worked with so many good people over my tenure here, almost 30 years, as a matter of fact, I've been with the organization. It will be 30 years at the end of this year. And had so many great experiences, Tom, it's just been a joy. And I will tell you that I look back on the last 30 years, it's been not only an interesting ride, like you mentioned, we were acquired by Medtronic, we were acquired over the course of my career by a couple of other companies. But the opportunities that the organization has presented me over that time has just been fantastic.

Matt Perry (05:00):

I've had the opportunity to come up through so many roles, but also not just within the US, I got a chance to spend a fair amount of time over in Western Europe and got a chance to directly manage parts of our Western European organization, then really closely worked with and managed part of our emerging markets organization. So spent a lot of time in Central and Eastern Europe, Middle East, Africa, and Latin America before moving back to the States and taking on a general management role. So it's been an absolute joy to be here over the years. And again, I got to find out who that person was and thank them face to face. Hopefully when I see them, I'll remember their name.

Tom Salemi (05:34):

I will not reveal my sources, but I know this person listens to the podcast so your thanks will reach them. So before we get into surgical innovation, I do want to delve into the business itself, but Dr. Kurian, you're kind enough to join us. Please give us a moment, just how did you find your way into medicine and tell us a bit about your practice and your many other activities. This is not your first media appearance.

Dr. Marina Kurian (05:58):

Right, well, so, you asked why I went into medicine. I always tell everybody I'm like Hawkeye Pierce minus the philandering. I wanted to be a surgeon from the moment I decided I wanted to go into medicine, and I'm telling you, MASH was definitely part of that whole business.

Tom Salemi (06:15):

I trust you don't have a still in your living room.

Dr. Marina Kurian (06:18):

Funny, at one point I said I should make my own gin, but I never did it. And then I got into bariatric surgery just because when I started my practice, which was in 2000, there were very few people in the country able to do it laparoscopically, and laparoscopic or minimally invasive surgery is such a boon for patients in terms of their recovery and even long term, because when we used to do things with these big open incisions, there was a high risk of hernia in the severely obese population, so the fact that I was able to do it and mobilize the patients so much faster was really helpful and helped start my career because of that.

Tom Salemi (06:59):

Excellent. And you appear on ABC News Radio, you've been CBS Evening News. Is this the topic that you're speaking on all these channels and shows about?

Dr. Marina Kurian (07:09):

I've been in different media exposures and yeah, we've generally talked about bariatric surgery and talking about really some of the aspects of postoperative care as well. So yeah, that's been a lot of it. I'm also a host on Dr. Radio on Sirius XM and there I'm actually the Primary Care Medicine Show, and when I realized that I said to my executive producer, I'm like, "You know I'm a surgeon, right?" He's like, "Yeah, but you could talk about anything." So I'm the Primary Care Medicine Show. Along with a wonderful co-host, we take care of that.

Tom Salemi (07:46):

Matt, why don't we take this opportunity before we get into talking about bariatric surgery, to tell us a bit about SI. I know the names Surgical Innovations can mean a lot to a lot of different people. What are the businesses and the products that fall under the SI group?

Matt Perry (07:58):

Sure. Thanks, Tom. And if those of you that aren't familiar with Medtronic, we're set up, there are 20 operating units that make up Medtronic, Surgical Innovations being one of them. And as you said, Tom, we are actually the largest operating unit within Medtronic, and we're the largest because we cover such a wide variety of surgical procedures.

Matt Perry (08:17):

If you look across the portfolio of Medtronic, there's a lot of operating units that focus in a specific disease state or even a specific procedure. Yet, I would say the Surgical Innovations, we have products that you could use in almost every surgical procedure across the globe. While we have so many opportunities from a portfolio perspective, we really concentrate in six procedural areas in terms of where we focus, and that's bariatrics, thoracic, colorectal, gynecology, hernia, and general surgery. Those are the areas where most of our innovation and most of our time and effort is spent.

Matt Perry (08:52):

And then if you think about it, we've got not just so much a broad portfolio in terms of the number of procedures, but if you think about the specialties that I just called out, and you think about the stages of a surgical procedure, just at a very high level. You think about access, we've got to get access into a patient. We've got to then do the dissection to get to the target tissue. We've got to do the resection to take out the target tissue, oftentimes a tumor. And then we have to close the patient back up.

Matt Perry (09:20):

We have products that address each and every stage from access to dissection to resection to closure, so it's not just that we cover such a wide variety of procedures, but we have such a broad portfolio that really can be used throughout the procedure. So that's really what makes SI such a large part of Medtronic's business.

Tom Salemi (09:38):

I've asked other business heads this question, how has the reorganization helped you? I keep trying to look for someone who gives a complaint about it, but no one's taking the bait.

Matt Perry (09:48):

You are not going to get me to take the bait either, Tom. Actually it's a great question though, because we've been in the new operating model since last February, and what I like about it is it really has brought us closer as an organization.

Matt Perry (10:03):

Before we used to have the commercial organizations that sat in a different part of the organization, so now we sit together as an organization. We've got not just the R&D teams, the general managers, but we have the commercial leaders from all around the globe that sit at the same table and are making the same decisions around some of the critical decisions around resource allocation, around focus, and so forth. So I really think it's brought us close in organization.

Matt Perry (10:27):

And again, Jeff's going to think I'm just saying this because he might listen to the podcast, but it really has made us closer to the customer, because when you bring those commercial leaders to the table and you're sitting with the R&D leaders, and you're sitting with the general managers, you've got the closest voice to a customer sitting at the same table, and that has been really powerful for us.

Tom Salemi (10:48):

Let's talk about the bariatric area. It's clearly why we have Dr. Kurian here and it must represent one of the opportunities where you see a huge opportunity for growth. Dr. Kurian, just talk a bit about the disease itself. I mean, we're all aware of how it's impacting many Americans and many people across the world, but can you provide some sort of context as to how serious a situation we're facing?

Tom Salemi (11:15):

Let's take a quick break from this conversation to hear once again from our sponsor, CPC. I'm here with Blair Plackner of CPC. Blair, what role does CPC play in the med tech space?

Blair Plackner (11:27):

Well, we engage directly with med device design engineers to solve their most challenging fluidic handling and connection needs. CPC's expertise in fluidic connections and customer collaboration model allow med tech design engineers to focus more on their core competency by offloading the design and sourcing needs of the connection point to CPC.

Blair Plackner (11:46):

We have a comprehensive portfolio of standard connections and fitting solutions that can meet the needs of many of the most demanding med tech applications. You can find CPC products in use throughout the healthcare environment, in the OR, in surgical equipment, often connecting consumable tools to durable equipment, in patient positioning devices, patient monitoring applications, and life supporting technologies, like ECMO or oxygenation.

Blair Plackner (12:12):

Outside of the OR, you can find CPC and recovery in support surfaces, compression and thermal therapies, wound drainage, really virtually anywhere a low pressure connection point is needed.

Tom Salemi (12:25):

Finally, Blair, explain to me, why are your connectors essential products in surgical procedures?

Blair Plackner (12:31):

Connections between the surgical tool and device are often a key point of interaction between a surgical tech or surgeon and your device. CPC focuses on the user experience in our product innovation process to ensure connections can be made safely and intuitively, whether during setup or in procedure. CPC products provide an intuitive connect/disconnect method that allows the user to connect the fluid pathway with a simple one handed linear actuation that doesn't require any level of orientation. An audible and tactical click will confirm a secure leak free connection has been achieved.

Blair Plackner (13:03):

Multiline products offer the convenience of connecting multiple lines in a single connection interface, preventing misconnections and improving the overall design look and integrity of the device. Enhanced connections involving integrated RFID help ensure that the proper connection has been made, that single use devices are not reprocessed or reused, and can help even configure the device automatically by recognizing the tool connected.

Blair Plackner (13:27):

Finally, electro fluidic hybrid connections can combine your data, power, and fluid connections into one easy to use interface that aligns with the look and usability of your brand.

Blair Plackner (13:38):

Whatever your challenge, CPC is your partner for fluidic connection solutions in the medical device space.

Tom Salemi (13:44):

All right, thanks, Blair Plackner for all the information and thank you to CPC for sponsoring this episode of MedtronicTalks. Once again, for more information, you can go to cpcworldwide.com. Now let's get back into our conversation.

Tom Salemi (14:02):

Can you provide some sort of context as to how serious a situation we're facing?

Dr. Marina Kurian (14:07):

So many things to say here. Did you know that there are 108 million people in the US alone who try to lose weight every year, and during the course of the year, there's four to five attempts by those individuals? And while we are talking about losing weight, we also have to look at different categories of being overweight to the different stages of obesity. And in this country at this time, about 36% of the population is obese, meaning that their body mass index is over 30 and there's almost 67, and in some ethnic populations 70%, that are considered overweight.

Dr. Marina Kurian (14:47):

When we look at obesity, we break it up into class one, which is a body mass index... And just a little background, body mass index is how we measure and stratify people for their height and their weight, and then there's BMIs, or body mass index, that is considered problematic. So BMI over 30 is considered obese, which is stage one obesity. A BMI 35 to 39.9 is considered stage two obesity. And then stage three and above is severe obesity. And when we look at just the severely obese population, it's about 6% of our country.

Tom Salemi (15:27):

How much of a solution is surgery for this problem? It's seen largely as a worst case solution for those who are suffering, who are carrying the highest BMIs, who are suffering the most with obesity. Is surgery something that can help more people than is currently is? And what has changed over time to make it a procedure or an approach that can be perhaps more widely used?

Dr. Marina Kurian (15:55):

I think the use of minimally invasive techniques have made the surgery much more safe, with less complications. I've watched that evolution from my training before I started my practice from going from open surgery to minimally invasive, and now a lot of practices incorporate robotics as well. And the overall theme is that patients feel better after surgery, they're up moving quicker, they're home faster, and that the complications are less.

Dr. Marina Kurian (16:29):

In terms of why we are not actually doing surgeries on all 18 million, which is a percent of the population, and the reason there are a lot of barriers to care, there's also concerns, like you said, that it seems like an extreme option. It is an option that we as surgeons and with our teams, that we counsel the patients that this is not something to jump into lightly.

Dr. Marina Kurian (17:00):

All of my patients have been on multiple diets and tried to lose weight, and when they feel like their quality of life, their overall health, all of those things are impacted, then they come to seek help. And because we've made these surgeries, as I said, again, minimally invasive with small incisions, they can recover quicker and not suffer as much postoperatively. And because we've made it safer, it's a wonderful option.

Dr. Marina Kurian (17:30):

The other issues is really talking about access to care and whether insurances will cover it, and many insurances do cover surgery, and so it is available. And I think part of the concern and reasons that patients aren't coming forward for surgery is sometimes it's not discussed with them by their primary care or other doctors, or they're just worried about having surgery and what the long-term ramifications are.

Dr. Marina Kurian (18:01):

However, if all those patients who are on the fence came to anyone of myself or my colleagues' offices, they would meet so many happy patients that are post-bariatric surgery, who will always say they wish they had done it sooner.

Tom Salemi (18:17):

Well, that's an interesting statement. Matt, what does that say to you and to Medtronic about an opportunity in this space? And how has Medtronic contributed to treating obesity through the years?

Matt Perry (18:31):

I think Dr. Kurian nailed it in terms of the size of the problem in terms of what's really driven some of the change. And if you think about what Surgical Innovations has contributed to that growth in the lifecycle in terms of bariatrics, I would first start with where we do best, which is innovation, and Dr. Kurian talked about it. How do we make this procedure, these procedures, safer? Dr. Kurian talked about minimally invasive surgery, but Surgical Innovations was at the forefront of driving minimally invasive surgery. We launched the instrumentation. We did so much of the work to drive minimally invasive surgery, which has just been a game changer for bariatrics.

Matt Perry (19:09):

First and foremost, SI, or Surgical Innovations, if you think about the core of our Medtronic Mission, Tom, it's about alleviating pain, restoring health, and extending life, and using our biomedical engineering technology to deliver products that deliver meaningful improvements in patient outcomes.

Matt Perry (19:27):

So, first and foremost, we've done a great job historically, and we're going to continue to deliver innovation to make surgeons like Dr. Kurian even more comfortable in surgery and try and make those procedures even safer. So that's the first thing we do.

Matt Perry (19:40):

The second piece, and this goes back again, you think about how these procedures have come a long way in the last 10, 20 years, is surgeon and clinician education. So we believe it's not just providing the right technologies in the hands of the surgeons, but really providing the right education support. And if you think about some of the specific areas that we've tried to really invest from an education perspective, again, fundamentals of laparoscopic surgery, we have literally trained thousands of surgeons over the years in the fundamentals of laparoscopic surgery to make sure that these surgeons are trained in those techniques.

Matt Perry (20:14):

Secondarily, it's not just about delivering innovation, but delivering innovation and then training physicians in the safe and effective use of that technology. So it's on us to not just deliver nice technology, but if we don't train people appropriately, it's a big miss on our part. So we've done a lot of work in the education of safe and effective use.

Matt Perry (20:34):

Then I'd say the last area is really around surgical technique. And if you think about it, and Dr Kurian knows way more about this than I do, but the techniques to address bariatric surgery have evolved so much over the last 10 to 20 years. Part of our role as an industry leader is to provide that training for physicians as things move from open to laparoscopic, and even thinking about how we approach surgery today, whether it's minimally invasive or robotic, we've got to make sure we're providing the education for physicians so they're competent and confident regardless of the surgical technique or approach.

Matt Perry (21:07):

Those are the historical ways that we've partnered with physicians like Dr. Kurian, innovation and education. And I'd say the last area, because I love things in three years, Tom, if you don't know that, the last thing I'd say is technology. And I would tell you, this is an area that's new for us. So we're very good at making great technology, but this is focused on improving the patient and physician experience, and what's different about this is it's outside the surgical procedure.

Matt Perry (21:35):

Everything I talked about with innovation has been on devices used in the procedure, education and focus on the procedure. Now we're talking about how do we use technology to enhance the experience for both physician and patient outside the surgical procedure. And it's new for us, but the reason why it's so important is, and Dr. Kurian can probably comment a lot on this, so much of that difficulty from a patient experience is pre and postoperatively. So if we really think if we're going to attack this issue and really open up more access to care and get at some of the issues we have relative to making sure patients who get into the care pathway stay in the care pathway, we've got to make this easier for them to manage and maneuver that care pathway.

Matt Perry (22:19):

So we've launched a new app called Go Further, and the idea there is to provide better connectivity for both physicians and patients. So if you're a patient, think about this, you're going through this, this isn't like one day you woke up and you had cancer, you've been dealing with probably being overweight for several years and you've got to find a way to make this journey, because it is a journey, it's not an episode of care, this is a journey that takes a long time, and Dr. Kurian can probably speak to how long that journey takes to get through for a patient, but we've got to provide better maneuverability for patients.

Matt Perry (22:53):

So we came out with this app, and the whole idea is to provide some support for patients. So you think about a patient who's been dealing with this care pathway. How do I maneuver? How do I better manage my appointments? How do I have on-demand information relative to nutrition, clinical support, research on procedures? So there's a lot of information at their hands.

Matt Perry (23:13):

I think one of the other things that's really cool about this is you are not going through this alone anymore. This is a lonely and long pathway for a patient these days, and to get some support, a support network, that can help you maneuver through this, is really critical.

Matt Perry (23:28):

I think that technology addition, we're trying to improve the pre and postoperative care, is great. And it's not just for the patients, I think, Tom, because part of what we're trying to do is improve that connectivity for surgeons like Dr. Kurian. And again, Dr. Kurian please comment, but we see a lot of patients drop out of the care pathway pre-surgery, so from that first clinical visit to the time they get surgery, something like maybe 50% of patients, probably not in your practice, Dr. Kurian, because you're well known and your so good at what you do, but a lot of practices, we see that high dropout rate.

Matt Perry (24:04):

How do we ensure that that physician and that patient have better connectivity? How do we make sure that surgeons get signals when patients miss appointments or look like they might drop out of the care pathway? So trying to better manage that and give tools to both the patient and the physician is a new area for us. But again, just to go back, it's innovation, it's education, and it's new technology apps.

Dr. Marina Kurian (24:27):

All right.

Tom Salemi (24:30):

Preach.

Dr. Marina Kurian (24:30):

Steal my thunder why don't you, Matt Perry?

Matt Perry (24:35):

Your thunder will go much deeper than mine because you know things so much better. I just set you up.

Tom Salemi (24:40):

Let's dig a little deeper in that, in terms of talk to me about the patient experience, about what brings them to you initially seeking this procedure and how you work with patients to help them understand what's coming and to keep them in this pathway, if this is the pathway they feel is right for them.

Dr. Marina Kurian (25:02):

I think the biggest point of this is patient engagement with my practice. And you said connectivity, Matt, and I think it is connectivity, it's touchpoints, but it's also engagement. And what generally happens is a patient will think about surgery, they may run into an old friend or a colleague who will be like, "I had surgery and you should go see so and so." That's how a lot of our patients for surgery across the US that come in are usually self referred. Sometimes they go to the internet, and they come to see you.

Dr. Marina Kurian (25:40):

Then once they see you, we discuss the options. And generally, because we're using insurance, not always, sometimes patients pay for procedures, but generally when we're using insurance, each insurance has a different requirement, and so most of our practices have one or two or three specialists that are very savvy about which insurance requires what, and then we make a list for the patient and we send them after discussion. Generally I put them on a diet that visit, and then we bring them back the following month.

Dr. Marina Kurian (26:18):

Well, some of the insurances are three months, some are six months. Sometimes getting a list of things that you have to do before you can even have surgery when you come in all gung ho like, "Hey, I finally made the decision to make this change in my life. Let's go," and then I'm like, "It'll be six months. We have to wait a little bit." And it's usually because of other requirements and not me.

Dr. Marina Kurian (26:42):

But it is important for patients to understand what they're getting themselves into, so there is some time in between meeting the patient and going to surgery. We do have recommendations. They need to have dietary evaluations and psychological evaluations to make sure they understand what's going on.

Dr. Marina Kurian (27:04):

Once they see this list, as I said, they can get turned off, frightened, or they might have missed a month because they were sick. "Hello, it was COVID. I couldn't get in to see the doctor." There's a lot of things that can happen, and I think this pandemic really super highlighted all the things that can happen. But there are saving points in the pandemic, which I'm going to add in a second.

Dr. Marina Kurian (27:28):

But the patients really sometimes get frustrated that they miss an appointment, then they have to start over. Well, so, talking about patient engagement, I've had the opportunity to use Go Further in my practice, I have a fair amount of familiarity with it, and one of the things that I had mentioned was that patients sometimes miss an appointment because something happened, they had to go pick up their kid from school or they had to stay late at work, there's so many different things. Traffic, that happened to one of my patients yesterday. They couldn't come in because of traffic, so they came in today.

Dr. Marina Kurian (28:05):

When that happens when you have a telehealth opportunity, which is within the Go Further application, you can actually interact with the patient and the patient can talk to you through the app. And so you have a HIPAA-compliant platform where you can have your consults or your follow-up meetings, and so the patient doesn't end up missing. Patient engagement's much higher because they're able to... I've had people pull over and talk to me from their car. They pull over, we're going to have this conversation. Not necessarily the initial consult, but certainly I've done follow ups with the patient or if they're having concerns or problems, we have discussions. So I think if the word really is engagement, patients are engaged.

Dr. Marina Kurian (29:02):

Then the other benefits of the app are that all those litany of things that I said, they have to do a psych, they have to do nutrition, they got to get this letter from their doctor, all of those things are on the app, and they can see what they have to do and it's like a little reminder, and then it's like a little checklist, and then they get to check things off and they can actually submit some of the documentation there themselves.

Dr. Marina Kurian (29:23):

So many times I've had patients come them to see me with their letter from their doctor in their hand, and now they can just snap a picture of it and upload it. So that functionality of the app is really spectacular. That ability to have the patients know when their next appointment is, if they can't make it, how they can get a telehealth appointment, that ability to check off the psychological, the nutrition evaluations, and then they see their progress, they can see that they're actually moving much closer to their goals.

Dr. Marina Kurian (29:57):

The other benefit, quite frankly, is my coordinator, and other practices' coordinators, are going to be so thrilled because now we're not chasing the patient down. They're able to be a partner with us in getting all of this done, and that also is so helpful. It helps streamline the office. It takes a lot of the burden off of the activities of our coordinators and our staff trying to track down these letters and these evaluations. So it's really been fantastic and well embraced. I thought it was a fantastic idea, and I loved it, but my coordinator is over the moon about it.

Tom Salemi (30:38):

Is there a need for it to track health information about the patients, about their weights or diets or things like that to keep them in line, or is that kind of data not necessary? And if there is a need, does this app do that?

Dr. Marina Kurian (30:49):

Well, they can. There is the ability to document the weights and the visits. I think when we do a visit, that's being documented as well. The app has a lot of functionality. In addition, there are opportunities for the patients to meet with a dietitian online, through the app, as well as there's, exercise classes that are on there. And this has been something that we've utilized for our patients for a long time.

Matt Perry (31:21):

I was going at one thing, Tom, I think one of the... And thanks Dr. Kurian, because that's a great explanation. I think one of the other things that really makes this unique is the fact that it's not a cookie-cutter approach. It's a customizable app. So again, Dr. Kurian talked about tracking their progress and making sure they're achieving their goals. Dr. Kurian talked about the different categorizations for BMI patients. So it is a customizable app that we can talk about what works for you.

Matt Perry (31:49):

That's important, because we don't want something that just is generic because patients are different, the time they're going to be in the care pathway is different, their goals and their expectations are different. So I think that's a really unique feature of the app as well time well, Tom.

Tom Salemi (32:05):

Is there still a stigma associated with this sort of procedure? Be it maybe due to lack of education or feelings from patients that maybe they want to get it done on their own without the surgery? Does having this app in place help them, put them on a program, make them, I guess, feel more confident about that surgical path?

Dr. Marina Kurian (32:27):

Well, I think Matt mentioned that the app has a lot of information on the procedures, and I think that for patients to see that there is a great deal of success with these operations and how that will then impact them, I think that is important. I think having not just, "Hey, here's a checklist, check it off," but having that educational component is also very important. So I do think that patients who are maybe on the fence, once they see that and then they gauge through the Go Further app, I think that that does change some of their perspective and it really encourages them to continue with their pursuit of having surgery.

Matt Perry (33:13):

I might just add there, Tom, I think Dr. Kurian is spot on, because one of the other benefits is you're part of a community now. This is a difficult path to maneuver and go through on your own, and so many people, because of the pandemic, are not spending as much time with other people, especially people who are morbidly obese, where they're at higher risk from COVID infection. So I think the opportunity to say we're part of a community, we've got people we can interact with, there's people we can text with to get questions answered, there's groups that we can join, there's nutritional programs. It's just you're not going it alone, which is, again, you think about so many of the home fitness, and it's not just home fitness now, you're part of the Peloton community, you're part of the Hydrow community. There's communities where people are tracking their performance against their peers and they're motivating each other. So I think this gives people an opportunity to be a little bit more part of a community and not try and go this alone.

Tom Salemi (34:10):

And just the final question about the app, how does it help post surgery, where some people, at least historically, I'm not sure if this has changed, but some folks have been said to have difficulty keeping the weight off or maintaining the program that they needed to maintain to ensure that the surgery does what it is intended to do. How does it help on the other side of the surgery?

Dr. Marina Kurian (34:30):

Well, so there's some great resources for the postoperative patients on the other side, as you said, and many of that has to do with different exercise classes, but also one-on-one nutritional counseling or recorded nutrition classes, so that if they're out wondering about, can I do this? There's usually a class that's already recorded that they can look at that.

Dr. Marina Kurian (34:54):

In addition, the patients postoperatively are supposed to be following up with the surgeons practice, and we, as a whole team, try to help the patient to stay on track, and part of that might be referring them to dietary services or having them review some of the classes that are there. But it's also just making sure that we see where they are on their weight loss trajectory and then helping them, encouraging them, to do more and to try and stem any weight gain that we see.

Matt Perry (35:31):

I totally agree. I think we talked a lot about the pre-op pathway, but postoperative pathway is just as critical. And I think the fallout rate there and the patient's willingness to stay in a rigorous program sometimes trails off after surgery. And again, you now have an app that you can track things. If Dr. Kurian's staff recognizes that the patient isn't following their postop protocol call, they can reach out because they're going to be alerted to the fact that they're missing appointments and they're not following up. So again, it's just an opportunity to stay engaged with that patient postoperatively, just like you would preoperatively.

Tom Salemi (36:09):

Matt, as head of Surgical Innovations, and again, this is Medtronic's largest business, I think it's one of those that's charged with generating the revenues that help the organization as a whole, including those that may have a higher growth area, that have more investments in new tech. Is this an area, bariatric surgery, the primary area that you see new growth coming from, or one of many areas? How are you going to be finding new growth and ensuring that your business within Medtronic is growing as quickly as it can, or as much as it can?

Matt Perry (36:39):

I totally agree.

Dr. Marina Kurian (36:40):

I don't know, Matt, I think Tom's wanting your job or something. He's like, what's your strategy?

Matt Perry (36:46):

I was thinking about Dr. Kurian, maybe you want my job. I don't think I could take your job, but you could probably run Surgical Innovations, you're doing a great job talking through our Go Further app.

Matt Perry (36:53):

But Tom, so first off, there are other organizations or other operating units within Medtronic that have great investment opportunities and great growth trajectories, there's no doubt about that. But we at Surgical Innovations, while we're the largest, we still have a very clear path to accelerate our growth and bariatrics is a key part of that.

Matt Perry (37:14):

Dr. Kurian said this at the very beginning, I think we're servicing something like 1% of the addressable population in the United States. So it's a large part of our business today, a key focus for us, but there's so much more we can do to open up access to patients.

Matt Perry (37:31):

I think about our growth trajectory, we've got a variety of vectors that are going to add growth to us, including, obviously, robotic surgery, which is part of the Medtronic organization, but bariatrics, we think, just because the size of the patient population that's unaddressed today, and we think we can really help physicians like Dr. Kurian really crack that, and maybe bring more patients in the care pathway.

Tom Salemi (37:52):

Does Go Further apply to other specialties as well? Do you see yourself creating an app of the same name, or a different name, that works for other types of surgery?

Matt Perry (38:01):

That's a great question, Tom. Today we're investigating that. I think we started Go Further in bariatrics because the care pathway in bariatrics is so unique and the fallout rate is so unique. If you think about colorectal surgery or thoracic cancer surgery, it's a different pathway. But we think there's a lot we can learn about the Go Further app in the bariatric space that can be applied to some of our other focus areas, so I think there's absolutely opportunity for this type of technology.

Matt Perry (38:31):

Because again, we're talking innovation, we're talking about education. That's not specific to bariatrics, that's across all those surgical specialties I talked about. And if you think about the technology, maybe it looks and feels a little different and we customize it for that specific disease state or that particular surgical procedure. But we do think there's a lot of opportunities to extend our learning from the Go Further app and bariatrics into some those other spaces.

Dr. Marina Kurian (38:56):

I want to add that what I think the focus of the app is really very patient centric, and in that there is opportunities for our abdominal wall reconstruction patients to be on the app and be encouraged to lose weight and have a structure that is helping them lose some weight before their hernia surgery.

Dr. Marina Kurian (39:22):

Similarly, this is something that we've seen benefit in infertility patients who need to lose weight, and this is a great method to try and get them to do that in a structured follow up. So I do think that there's a lot of applicability to different areas of surgery, but also medicine. And our orthopods would love something like this, so they can track a patient's progress because patients have to lose weight frequently for multiple different areas of surgery.

Matt Perry (39:53):

It's pretty clear, Tom, that we need to invite Dr. Kurian to our next strategic meeting around Surgical Innovations and the expansion of this, because she's got some great ideas. I love the idea about the hernia space for sure.

Tom Salemi (40:03):

Right. And final question. The data that's put in this app, is it used in any other way to assess the performance of devices or is it strictly related to specific patients and there's no aggregation, I assume anonymous aggregation, of data used in product development?

Matt Perry (40:24):

Well, there's things that we can learn all along. Like we can track where are the fall out? Where do people tend to fall out? What nutritional programs? What lifestyle programs? So there's a lot of learnings, just like any other app, that we can take away and refine to make sure that we're always trying to improve the quality of the content on the app. But in terms of the surgical procedure itself, it doesn't do anything necessary to the surgical, the episode of care in the surgical suite, it's more about the pre and postoperative care.

Tom Salemi (40:52):

Excellent. All right, well, exciting stuff. And Dr. Kurian, last question to you. The patients are enjoying the app and they're using it and employing it well? I mean, are they taking to it quickly and are they sticking with it?

Dr. Marina Kurian (41:10):

They are. It is fairly easy to, once you download it, everybody has a smartphone, so it's right there and they just pop on when we're doing telehealth. They find it easy. They like having the dietary options as well as the exercise classes.

Dr. Marina Kurian (41:28):

It's the ease of use, which I think is so important. You can have a great app, but if it asks you for a 30 letter and number combo password, hello, like this meeting, for me to log in, I was like, what is this? Anyway, it's much easier for the patients and it's very seamless and their integration is really great. So all of that makes it an app that patients will use and that they enjoy using.

Tom Salemi (41:56):

Dr. Marina Kurian, thank you for joining us in the podcast. Matt Perry, thank you for joining us in the podcast. Great to have you both.

Dr. Marina Kurian (42:03):

Thank you.

Matt Perry (42:03):

Thanks Tom. Thanks Dr. Kurian. Great to see you again.

Tom Salemi (42:07):

Well, that is a wrap. Thanks so much for joining us on this episode of MedtronicTalks. If you could do use a few favors, please post a review or a rating of this podcast episode so we know how we're doing, and it helps other people find the podcast. If you haven't already, please subscribe to MedtronicTalks. It's on every major podcast application, Apple, Google, Spotify, Amazon, it's all out there. You can find it there, and on devicetalks.com. While on devicetalks.com you can check out our other podcasts and our events page, including our upcoming in person meetings in Boston, Minneapolis, and Santa Clara, California. Those are all happening in 2022.

Tom Salemi (42:48):

Finally, you can help us out by sharing this episode on social media. And if you do, please connect with me. I am on Twitter @MedTechTom. I am on LinkedIn, Tom Salemi, S-A-L-E-M-I. I would love to be part of your Medtronic conversation.

Tom Salemi (43:05):

That's a wrap. Thanks again for tuning in to this episode of MedtronicTalks. We'll have another great episode waiting for you next week, so stay tuned.