The MATTER Health Podcast

Tales from the Trenches™ with Lihi Segal, Founder and CEO of DayTwo

August 05, 2021 MATTER Season 1 Episode 9
The MATTER Health Podcast
Tales from the Trenches™ with Lihi Segal, Founder and CEO of DayTwo
Show Notes Transcript

Lihi Segal joined us for a conversation moderated by VillageMD Chief Marketing Officer Ellen Donahue-Dalton to discuss her experiences leading both startups and large public enterprises, the inspiration and motivation behind founding DayTwo and advice for fellow entrepreneurs.

Lihi founded DayTwo in 2015 to bring personalized health solutions based on the gut microbiome into the mainstream consumer market. Since then, the company has become a leader in precision nutrition with the world's largest and highest resolution microbiome discovery platform, offering a sustainable path to remission for metabolic disease.

DayTwo's results set a new national benchmark for diabetes and metabolic disease care, with significant sustained clinical results in reducing A1C, improving Time in Range and reducing or eliminating prescription medications. Their scientific research is cited by the NIH as a foundational element in its 10 year, $150 million strategic plan for precision nutrition.

The Tales from the Trenches series invites seasoned healthcare entrepreneurs to the MATTER stage to share their journeys — from how they got started to what they’re trying to accomplish and what they’ve learned along the way. Tales from the Trenches is sponsored by VillageMD.

Register for the more MATTER events here.

For more information, visit and follow us on social:

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Speaker 1: (00:11)
Hello, everyone. Welcome to tales from the trenches. This is a series that matter produces together with village MD. Uh, my name's Stephen Collins, I'm the CEO of matter. We are a healthcare technology incubator and innovation hub built on a belief that collaboration between entrepreneurs and industry leaders is the best way to develop healthcare solutions. Today's program is part of our tails from the trenches series, which features accomplished healthcare entrepreneurs, sharing their learnings and stories and key takeaways from their journeys. We have a great collaboration with village MD to produce this series. Uh, village MD is Chicago based. They're a company that's innovating in value based care. And I think one of the most interesting companies in value-based care, they now operate in 13 markets around the us, working with physician practices to implement true value-based care models. Um, our guest today Ishe Siegel uhhe is a serial healthcare technology entrepreneur.

Speaker 1: (01:16)
Uh, her current company is day two, which she started in 2015 and it brings personalized health solutions based on the gut microbiome into the mainstream market. Umhe has really made waves in the precision nutrition space, setting new benchmarks for diabetes and metabolic disease care. The science behind day two comes from the Wesman Institute in Israel, and their research has been cited as a key component of the NIHS 10 years strategic plan for precision nutrition companies raised about 85 million employees, about 120 people split between Israel and the us. Um, our moderator today is Ellen Donahue, Dalton, who is the chief marketing officer of village MD. Uh, she recently joined the team, uh, after about 10 years at med decision and has about 25 years of experience, uh, leading marketing and, uh, customer experience for various companies. Thanks to both of you for joining us today, Ellen. Uh, I will turn it over to you.

Speaker 2: (02:22)
Excellent. Thank you, Steven. Appreciate it. And, uh, Hey everybody hope you're all having a good afternoon thrilled to be here. So I'm Matt Lee Siegel a couple of years ago before the world changed. Uh, we were at a women in healthcare conference together, um, at a luncheon listening to a really impactful speaker and she told me what she did and what her company did. And of course, I looked down at my, at my lunch and thought uhoh, you know, I, I wonder if I'm eating the right thing here. Um, but Lee, so it's nice to see you a again and it's impressive to see how much, uh, the company has advanced and, and how much, um, funds you've you've raised, et cetera. Um, I thought we would just start with a really simple, basic question, uh, which is that, um, you know, some people think entrepreneurs are, um, are born not made, right. That you kind of have to be an entrepreneur your whole career. Um, and I was wondering what you think about that. Have you always been the kind of person that was destined to follow your own path? How do, how do you think of that?

Speaker 3: (03:33)
Yeah, well, um, I'm very excited to be here first. Thank you so much, uh, for hosting. Um, and it was great to meet you at that luncheon and you were probably eating the right the wrong things. You probably should have eaten them a little bit differently, but that's a different thing. Uh, so, uh, to your question, um, I, you know, uh, an entre entrepreneur to me is really someone who, who has the courage right far and foremost, the courage to take risk, to disrupt an industry that maybe is going one way and think about it in a very different way and unlocking value in that industry. Um, someone who wants to define and lead a category and think very big about it. Um, so you have to be able to do all these things. Um, first of all, you know, to build a winning team, it's never, it's never just one person.

Speaker 3: (04:33)
And I think the, the ability to really realize that realize where you're not, uh, you, where you're missing elements have a team that really compliments you, um, is something that's, that's, uh, crucial in order to be successful. Uh, you have to make quick decisions, bold courage, again, um, you have to learn from past failures, you have to constantly test, right? And so when you're looking at all these things, that to me is what makes the entrepreneur really, you know, successful and you're thinking, is this something that you're born with or, you know, has it always been on my path or is this something, uh, that you can grow into? Um, I think, well, I, I, you know, I think I agree and I disagree. I think that some of the qualities are qualities that you have from the start. And they're very hard to learn.

Speaker 3: (05:25)
I, I don't think that maybe, and again, maybe I'm wrong and there's a lot of people in the audience that are different, but, um, it's hard to be, it's hard to learn, to be courageous where if you don't have that in you or the ability to change, to jump, I, uh, people can always grow into things. I do think that as well, but I think some of the things are, are better off if you have them and you don't have to learn them. Um, I think when you look at children, the ability to lead is something that you see. So, so you see these things in, in children already, but I do also think that many, many times, and I think to some extent that happened to me as well, uh, people grow into their moment. Okay. So even if you were, you know, on the shy side or you had to, you know, get more, um, um, I'm losing the word, a confidence, right.

Speaker 3: (06:22)
To that is something that comes with your lifetime experience with getting, you know, the valuable experiences that build your character. Um, so, you know, I personally, I spent years as number two, to your point, was I an interpret entrepreneur forever? Not at all. This was my fir this is my first, um, uh, COO position. I spent years as CFO as COO. Right. And so I was part of a team. I was happy as part of the team. Um, but then, you know, I jumped on the move to be a co position as the moment presented. And so it is a combination of those elements in me that once, you know, that was an possibility, I was like in a second, I chose that. And so, but, but I do believe even for our audience, I'm saying this, that, uh, a lot of the things you really have to grow into being in your element, it doesn't always happen immediately.

Speaker 2: (07:19)
So, so you and I, um, met each other at this, at this conference, which again was for women and healthcare leadership. And I know we share some common colleagues, um, who are also female, um, healthcare professionals, very entrepreneurial in orientation. Um, I, I know one of them is on your board and, and I was just wondering if you could comment on sort of the power of that net, that network, right? Like, um, like even as you grow into the role that you were describing, even as you gather confidence and maybe kind of up your courage, um, you get a lot of power from that network too, right?

Speaker 3: (08:00)
Oh, uh, definitely. Um, I have to say I have, my mom was an entrepreneur in a PLA, you know, years ago in a very male dominated industry. Um, and I, and I used to watch her, uh, you know, do all these amazing things and, and she was always constantly on a fight constantly to prove that prove as a woman, not just her abilities, that the business was solid, it worked right. She didn't have to work at that, but just to be able to, to really sit at that table and, and be seen and known. And, um, but I saw it, I saw it as I was growing up. So this was my environment. It was always with a powerful woman as my, um, I would say mentor, um, as I grew into the business and I'm getting this question a lot of the times, did I feel like it was, uh, you know, the fact that I was a woman was, uh, inhibiting anything or was there a glass ceiling?

Speaker 3: (08:58)
And I have, um, I have, I had really the, the, uh, fortune, I wanna say to always work with people who, who did not have that aspect at all now that it's not by choice because, you know, whoever promoted me to positions was of course, someone who did not see that as a, as something to, to even consider. And then at some point in my career, um, probably the previous job. And of course this one I got into the, all those women forums and I'm also helping, you know, other women in their journeys as well. And I think that that is the so, so powerful as I told you on that day, right? This is a conference and the first day is women only, I wonder what would've happened by the way, there was a men's only day, right? That that's the question. But, uh, there was a woman only day, and that was the best day of the conference because there is something in the power of the women around us, the fact that others are successful, the fact that, you know, we've talked in all those sessions about the differences in leadership styles and what maybe, you know, women bring to the table qualities, but sometimes are less evident in men.

Speaker 3: (10:10)
I'm not saying this as a, you know, of course there's cross on, on both genders. Um, but there's something about a layer. I think that we tap into better and it's, uh, it's really, uh, encouraging and empowering to see how others have done this as well. And it gives you the ability to see this in yourself and to say, Hey, you know, I have that too. And how can I bring it into the boardroom? How can I bring it into my leadership style? Um, yeah, that's very powerful

Speaker 2: (10:39)
Le Lehe. We had a, a question come in, uh, from the audience while you were speaking. And it actually connects to a question that I was gonna ask you many people who come into healthcare come in from a specific personal story or experience that happened. Right. And, um, and the question that came in from the audience mapped the, the idea of a calling to what you mentioned earlier about courage. And I was wondering if you could just talk about this connection between you and day two and this particular medical, uh, tech, uh, innovation that you are, you know, advancing in the market and, and talk about like, what was that a calling? Did that come from a, a personal place? Or how, how, how do you think about that?

Speaker 3: (11:28)
Yeah, I, um, I, when I interview people, it's a funny story, but when I interview, um, you know, people on my management team or, you know, in the earlier stages, every person in the company, I was, I would interview healing engineers. And I always said to people who did not come from the healthcare industry, that they have to know that once, once you touch healthcare, it's very hard to go back, uh, because there's something very empowering in that, but I actually did not. It did not work that way for me. Um, I, I was a CFO, as I said, uh, in many industries in, in, uh, semiconductors, in, in mobile and then telecommunications. Um, and I was very fortunate to find a, a CFO position at a company called, uh, DB motion. Um, and DB motion did interoperability, um, and really taking a look at one clinical record integrating disparate systems, um, and bringing that to the clinicians at the point of care.

Speaker 3: (12:28)
And, uh, so that was my first healthcare company. And it was a healthcare it company, not at today. We touch customers and members, you know, I touch the people in a very direct way. I, I, I get stories back testimonials all the time of all the people we saved in deep motion. It was, it was a little bit, you know, separated because we sold into health systems, but we still had those stories. Um, and after we sold deep motion, uh, to Allscripts, uh, we, um, I was looking for another position and, uh, I work in Israel. So that was, uh, you know, there's not a lot of relevant positions at the time that you're actually looking for a position. And I found a, um, a company called se sense. Who's now a unicorn in, in business intelligence. And I went to work as CFO and COO, and I spent, you know, a few months there its a great company, great COO uh, great team.

Speaker 3: (13:27)
And my previous CEO yal  came to take, took me to breakfast one morning and said, Hey, great, you found a new job. How's it going? And I was like, yeah, it's great. It's fine. You know, great CEO, great team, great management team, uh, great, uh, you know, product. And he said, but Lehi, you're losing, I don't see the spark in your eyes, like what's wrong. And I said, well, you know, they're doing something that the world doesn't really need. And that statement that just came from the, my, you know, from the bottom of my soul was like, it's, you know, it's just, it's, it's, it's not impactful. And he said, well, if this is your answer, um, I'll allow myself to disrupt your world and please go meet, uh, these two scientists at the Whitesman Institute. And so I went and met them. Um, and I, uh, was blown away like as I keep saying, they had me at hello and they really had me at for two reasons.

Speaker 3: (14:27)
Uh, they, they were all about the gut microbiome research. And this is right before we even started negotiating with a tech, uh, office in Whitemans. It is like seven years ago, the gut microbiome. Now everybody knows what it was, what it is, was unknown to most of the people, including to me, they, you know, gave me the, the, the whole pitch about the gut microbiome. And of course they added all these, uh, things about, you know, breastfeeding and C-sections. So the mother and me will be immediately connected in a, in the way. Um, and I got very excited about the fact that this is a new frontier in medicine and that I could be part of bringing that really into the mainstream. Um, but on the other hand, I don't have the patience, you know, I'm much or the temper for, uh, this long seven, 10 year drug development.

Speaker 3: (15:23)
Like a lot of the microbiome companies are doing, and that, that was really not appealing, but they found a way to harness the data. They turned it into data plate, they used machine learning and AI in the technology that we licensed. And we are now doing the same. We have an algorithm that's built on the data that we have, including the gut microbiome to personalize, you know, what you should be eating and what is good for your blood sugar. And the fact that I knew that I could take this and immediately in a very short period of time, I think within one year we were out with a, you know, the better product. Um, we could immediately make a very big impact on people's health. And this is, you know, the span of the people that can really, um, this can be beneficial for is, is very wide.

Speaker 3: (16:12)
And so that was, that was really something important to make an impact on people's lives as soon as I can. Um, and that was really the driver. And while we do, we're doing that, we did build a program. So it was a dual strategy of, you know, having something very actionable. But on the other hand, not lose sight of the gut microbiome research. And we have an enormous database today with full shot and sequencing. So a very deep knowledge about the gut microbiome. And we're now, you know, at looking at how to partner and monetize around this gut microbiome research for our second product, third product in, you know, various directions. So, so it's been very fulfilling in that sense to know that I'm part of that.

Speaker 2: (16:56)
Yeah. So, so it sounds like in your case, the seed or the kernel of your product set or your service set was, you know, kind of well established, um, can you talk a little bit about maybe some ups and downs of the journey that, that you've had with day two? Like sounds like that was a, a, a great thing. Like what else maybe wasn't there, or what was maybe harder to, to bring, you know, as, as you had to bring the product to market, um, and start to commercialize what, like didn't work so easily.

Speaker 3: (17:33)
Yeah. Um, I think, you know, you always hear people talk about the maniacal focus that you need to be when you're growing a company, you always have limited capital limited time. You have to pick something, one thing that you can do well and do it, um, versus just like, you know, getting spread all over and with the limited resources that sets you back in each of those initiatives. Um, so I think very early on, we understood that we have, uh, a challenge there. And the reason we had a challenge is, um, because day two was so groundbreaking, right? We had technology that we licensed and the, the, uh, two scientists were just on every stage. It was published as we went out in around 2015, the cell paper, uh, they had hundreds, hundreds of, uh, citing in articles all over the world, including Iran who didn't mention it was in Israeli, but, but could not help even report on the, you know, groundbreaking science.

Speaker 3: (18:42)
And so since it was so no across the world, and, um, the fact that day two licensed, it was also known and we were starting to, you know, to come out as well. Uh, we just got approached all the time, all the time. Like every day we would get inbound business development, like business development was not something that was ever hard to do all the time. And now you're looking at a core technology, right? We did not license a product. We licensed the ability to look at a person, identify their biomarkers, including gut and personalize through the AI, their nutrition. And when we had to look at where that could be beneficial, the list is endless. And this was challenge number one. Um,  Glen Tillman is writing. Um, funny. Um, hi Glen. Uh, so the, the idea of, you know, this could fit healthy people, worried well conscious, you know, all those healthy, conscious, we want to, uh, limit our risk for disease because blood sugar, as everybody knows, is connected into all those disease, including cancer and overall mortality.

Speaker 3: (19:53)
So anybody who wants to live healthy needs to balance blood sugar. So we could go into the healthy market B to C, we could do athletes, right? We've done athletes actually, right. We, we tried that for a while. So there's, um, an uptake in performance when athletes and professional athletes are eating the right food before they go into training before they go into a game. Um, and so we could, you know, that was a target market, potential target market. And then of course you have all those people with prediabetes and diabetes and fatty liver and all those other things that came. And so the target audience was very wide. The territories we could plan the markets we could plan were endless, and here are the approaches we got approach from China, from south, literally every country, our, uh, commercial, um, our chief commercial officer once drew a map of the world and mapped out all the approaches we got in order to do business with the people.

Speaker 3: (20:55)
And, you know, India has a, a tremendous diabetes problem. And in China, 50% of the adults have pred. And of course the us, which was always our target market. Yeah. So being able to choose the right market based on the data that we had and say no was difficult. Um, I think we did it relatively. Oh well, but we still could have done better. So I think if I have one message is really try for, for example, the Israeli market, we opened the Israeli market to collect data in order to make the algorithm better. And then it blew up as a market in its own. And to be able to say no to that market was very hard. I, I don't think we should have said no, but in retrospect it did, uh, provide a lot of information on the data on the product. We learned a lot, but it also slowed the penetration into the us, which is now booming, but probably could have been, you know, earlier.

Speaker 2: (21:57)
So one, one of our audience members, um, said, so what's next? What, what are your, what, what challenges do you see kinda looming in front of you that either you think will be really difficult to tackle or the ones that you think, okay, we got this

Speaker 3: (22:13)
Right. So a little bit goes back to the previous cases as well. Um, as an Israeli company going into the us market, I think, and, and this is probably true for every, for every company as well, but especially for people who are outside of the main territory they're playing in, uh, you have to be very careful in the way you spend your resources, which are again, always limited and really do it only when you have product market fit and, uh, you know, really meeting, which means you're you found your audience, the right target market, and you're selling the right product. And that took us a while to, to reach that point. And until we reach that point, it was, uh, if you start, you know, investing too much, you're building a sales team, you're building a, a full, you know, team on the ground in the us.

Speaker 3: (23:03)
If you do it too early, uh, then you won't get the results you need for your next round and your money will run out before you prove it. And so there's always this balance. You can't be too back. You can't be too ahead. Very, it can be too. I've had very difficult to find that point. Yeah. We found it last year in the midst of COVID. Um, and we're now selling, uh, to just metabolic disease. We're not doing anything on BTC. We're not doing anything on healthy and wellness. Uh, it's purely a solution to help people with metabolic disease, which is type two clinical BCD, fatty liver, um, uh, go into remission. Okay. And so we are selling to employers in pairs, again, it's a pure B2B to C, um, and that was, um, a strategy that we had to go through and, uh, you know, do, uh, a lot of data collection, a lot of, uh, you know, free pilots in order to really, to reach that point, that we have that product market fit. Now that we have it, the challenge becomes right as you go through the stages of building the company, uh, we're at the brink of the growth. So in the next year and a half, we'll be all about growing our customer base, uh, proving out the earlier proof points that we have really, uh, going into that growth period and then the scale. So now that's the period that we are in.

Speaker 2: (24:26)
So, so let me, so before we move to the, to the scale time, um, you, you build this great team, right? Everybody's super passionate. You're trying to figure out that product market fit. So you have your hands in a lot of pots around, right? Because you're, you're, you're, you're in that assessment mode, data collection mode, um, everybody's probably learning at the same rate and you're all probably learning really quickly. So you need to make fast decisions. You need to stop doing some things that people are really passionate about doing, like, maybe rolling this out in Israel. How do you, how do you keep that the mojo of the team together while you're making these really fast decisions, some of which are unpopular.

Speaker 3: (25:14)
Right. So first of all, I, I, um, yeah, I wanted, I wanted to say, you know, I don't make the decisions on my own. I have a management team, right. And so these decisions are things that we bring back into the room and we sit in that room and we make those hard decisions together. Um, but as I was thinking and saying this, it it's, of course always the decision there's one person making decisions, uh, in the room. Um, but I think the engagement of the team, no matter how hard the decisions are, is crucial in order to get the engagement. And sometimes we're making moves that affect team members directly. So for example, we stopped, um, at the end of 2020, we phased out of BTC altogether in Israel. Yeah. Until that point we did both BTC and B2B. We're selling through the largest HMO elite, uh, since 2019.

Speaker 3: (26:10)
And we're about to large to launch with a second HMO Maccabi, but we were still, uh, doing BTC. We had a, you know, a top line that's fueled from this BTC sales and we decided to stop doing it. And the reason is because of what I said before, the focus, uh, just allowing all the team to be hands on, on the us, nevermind where they are. Uh, but it, you know, there's team members on my management team that had to, you know, lay off people on the B to C team and that's very difficult, but the only way to successfully do it is really to get everybody engaged and understanding that that is the right decision to make for the company. And it's not easy to do.

Speaker 2: (26:54)
Yeah. Yeah. I hear you. So, um, so I wanted to ask you about, about, um, mistakes, right. You know, you mentioned a unicorn earlier day, two's had amazing success and a, and a relatively short period of time here, it can appear that things were flawless. Right. And that, uh, and that, you know, all execution mapped, uh, mapped together. Tell the, tell the audience about some of the mistakes that maybe aren't obvious. Um, and then I kind of have an interesting follow up question from someone in the audience.

Speaker 3: (27:29)
Okay. So, um, I think I actually mentioned the earlier, um, the focus, right? So as we were, you know, trying to focus, we did a lot of things that we probably should not have done, right. Athletes is one of them. Um, it's very, it was very hard because we all got so excited. We had, I don't want, I can't say the names, but one of the, one of the best NBA teams, you know, so we all flew over and, and these things take attention. Um, and I think the number one mistake is thinking things are small and you can test them and try them. But at the end of the day, the team is so small, the resources are so limited that every time you try to do something like that, it costs you focus. And, and that's, that's a small example were others as well, but, but it always goes back to focus. Um, and I think, um, especially in the beginning, um, there were several mistake, you know, decisions that I made based on the fact that the product would be available at the time that it was supposed to. Um, and the understanding that things don't always happen the way they're planned, even with the buffer that you're taking, you need to allow much more flexibility in the business plan, uh, to allow for, um, you know, things that will not necessarily go the right way on the R and D side.

Speaker 2: (29:02)
Yeah. Yeah. And, and, you know, that happens in companies of every size, right. Where

Speaker 3: (29:07)
Yeah, yeah.

Speaker 2: (29:08)
The best laid plans. Right. And really what you need is the best laid contingency plan. Um, right. And, and a lot of times we don't have the best laid contingency plan. So, um, so as a follow up to that, um, there was a question from the audience about luck, right. You know, there's this idea that, um, some entrepreneurs or some entrepreneurial efforts are just luckier than others, right. They're in the right place. They're in the right time, they met the right person in the elevator. Um, whatever it is, how, how do you think of luck compared to hard work, persistence, focus, et cetera, or in addition to hard work, persistence, focus, et cetera,

Speaker 3: (29:49)
Right. Each, so you always have to have, you know, persistence and focus and hard work. That's, that's basic. I don't think anybody's successful just because they found somebody in the elevator at the right time, but there's definitely an element of meeting the right person and timing and luck, uh, that can be very helpful. It could make a lot of the things much easier if you do have that element baked in. And I'm sure we ha I can't even think of, um, examples now, but I'm sure that over the years there were things that happened on the right timing and, uh, you know, things that didn't, but I don't, I really, I mean, you know, there's some, there's some examples of people who were at the right time at the, you know, in the right place at the right time or found the right partners. Right. We have several examples like that, of people very wealthy and with successful exits that maybe on their own are not the best talent or, you know, in other places maybe would not have shined as much. So definitely for these people being in the right place at the right time and the right company with the right support definitely made the difference, but they still worked hard and were, you know, putting the effort in, or they would not have been kept at those companies. Right. So it's a combination to me.

Speaker 2: (31:08)
Yeah. There there's, um, there's, there's some energy around here in, in the chat chain around what

Speaker 3: (31:15)
Not looking at the chat, so

Speaker 2: (31:17)

Speaker 3: (31:18)
We could talk and, uh, started

Speaker 2: (31:20)
Doing, you know, like, like

Speaker 3: (31:22)

Speaker 2: (31:23)
Like, is it really lucky? Or, you know, do you make your own luck and would it have happened if you weren't working hard, cetera, et cetera. Um, so, well,

Speaker 3: (31:32)
You know, there is, um, there's definitely a concept of, of, uh, you know, kind of, as I call it the universe, like being very tuned in positive energy, right. Uh, I'm trying to translate, um, I think you make your own future with how positive you are or envisioning an outcome will bring that outcome. Um, this is, uh, that that's a very, this is I think, a total different topic that we can dive into for another flowers. Okay. I definitely think though that there's, uh, a lot to say about positive thinking and positive energy, and it's funny, there's a, a great Ted talk that somebody sent me about, you know, striking the pose, the body pose before you go into interviews or speaking events, and it was mind blowing, right? The fact that you just, just by your, the body is even affecting how you are presenting yourself. And then I would always go and sit like this or do like this before I go into, you know, interviews. And, and so there's a lot of, a lot I have to say about, uh, about that. It's probably gonna, you know, go into what I do every day and I meditate every day and that's part of, of this as well, but,

Speaker 2: (32:47)
Okay. So go ahead. Go, go, go.

Speaker 3: (32:49)
It's uh, so, um, I, I, you know, this, the position of being, uh, of leading a company or, or, you know, people who are in really positions where a lot of responsibility is based on them. Um, as I, as I transitioned into this CEO position, um, I had a, a good recommendation actually from a physician, just from a, a regular physician. You said, you must meditate. You just, you have to meditate like that. That's gonna be your solution, nothing else. And I started, I learned, uh, transcendental, I think it's called in meditation in, in English. Uh, and I started meditating every day. And I think it is an amazing tool if I could have everybody adopt us. I think now with the, you know, the world is, has progressed into all this mental wellbeing. Yeah. Just doing that keeps so focused and so calm. And, you know, people ask me, so do you sleep at night? And I've not lost any sleep over for years, I've slept through the night, no matter how hard everything got. And, and it was because of this, it manages the stress levels, um, gets you focused with your energy. Sometimes I would just do it in the middle of the day. I would be so, you know, up and everything was so I would just zone out, sit for 20 minutes, come back, like totally new.

Speaker 2: (34:24)
Wow. That's good. I'm I'm now I'm gonna have to change my afternoon calendar around to, uh, to add number one, research on meditation and then number two, actually time to do it. So, you know, one of the questions that I, I wanted to ask you was, what would you tell your younger self? So other than learn to meditate. Yeah. Other, other than that, what would you tell? A 25 year old?

Speaker 3: (34:50)
Yeah. A lot of things, but, um, so first of all, meditate every day.  I, I, it's something that happened to me just as I grew older. Um, I, I, you know, people keep saying, how do you stop your mind? I everything's working so hard. You just stop. And I, and it takes a lot of time to learn how to stop swimming, yoga. Everything's contributing to that. So first and foremost, I would say, try to meditate every day to my Leia 25. Um, but the second thing that I would say, um, is that it's never as good. It's never as bad as like in the Moto that I keep telling everyone that I meet or the people that I mentor. Um, it's never as good and it's never as bad because this is a roller coaster. Everybody's been, you know, in the position of managing startups and probably other companies as well knows this, you start the day, you think it's going this way.

Speaker 3: (35:47)
It goes the other way. And on the positive side, you can go into an amazing meeting. You can meet, you know, like Walmart or, or weight Watchers or all those, you know, companies we met in the beginning and think, oh, this is amazing. I had an amazing meeting or the, you know, the discussions are going so well, this is, this is for sure gonna happen. And then nothing happens. Nothing. Like they go cold on you. So being, you know, kind of having that perspective. And then on the flip side, which usually happens a lot more than unfortunately the good side, the world crashes on you on a constant basis, there's drama, there's things that are not happening. And in the beginning they were, you know, they were like, oh my God, this just happened. What are we gonna do? And everybody got stressed. Nothing could not, you know, everything was solved within 24 hours.

Speaker 3: (36:37)
Every single time you sit down calmly, you figure out the solution, there's always a solution. And then this whole drama is not, it's not nothing, but you worked around it. And so after that happened a few times, the roller coaster going up and down and up and down, I said, oh, I have to beat this. Like I have to start, you know, narrowing the, the wavelength of this up, down, up, down in order to do this successfully and stay on track. And so that's what I would tell, um, you know, my younger self and the audience, that's something to learn.

Speaker 2: (37:11)
Nothing's as good as you think nothing's as bad as you think everything changes.

Speaker 3: (37:15)
You always have a solution. You always

Speaker 2: (37:17)
Always have a solution. And if you meditate, the, the, the band will get a lot of thin. That is great advice. I, I love it. I love it. Um, we, we had, we've had a couple of questions from the audience about the specific business at day two. Um, one, I, I, I think is really interesting because this can be the, the kind of thing that goes on forever or that you can really, um, time box. Right. Um, and, and that is the question of how long did you take to figure out that product market fit? I mean, you probably never have as much data as you want to have to really, you know, understand it 100%. How, how long did it take for day two?

Speaker 3: (37:59)
Um, that's a good question because we started off, um, as I said in Israel and we took the science, we decided to focus on what the science, uh, we had at that time, the data that we had that was healthy and pred, we didn't feel confident yet in going into more than that, because we didn't have data. We're very data driven and of course, science driven first and foremost. And so we started in healthy and pred, um, still not in the us, in Israel. And then we got a lot more data and we had data coming in from people with full-fledged diabetes, and we saw a very big impact on them. The algorithm worked even well, even better, right. It just, it worked well and better on people with, uh, full-fledged type too. We started adding that into the algorithm and train it specifically. Uh, and then when we started to approach the us, uh, we did it in a few ways, right.

Speaker 3: (38:56)
It took us a few years because first and foremost, we wanted to do a clinical trial in the us, just like the cell paper, just like the Whitesman clinical trial. So we replicated the clinical trial with the Mayo clinic and we wanted, you know, the, the number one name that we could find. Um, and we found the Mayo clinic as a partner to do that. We replicated, and we showed the world, and this was published in 2019 in Jamma and in the American journal of clinical nutrition that the algorithm is not just this Israeli thing that works just on the middle east, right. Crazy Israelis. This is something that works on us microbiome with us nutrition. We collected more data in the us, and that was something very crucial for us to be able to stand behind the scientific, uh, basis of the product also in the us.

Speaker 3: (39:48)
So the product, uh, the launch in the us was, uh, more or less waiting for that point, which happened in the middle of 2019. And then as we started to, to do that, and we started to go into employers and payers on a type two, uh, it took us probably another year or so to come with those proof points. We had phase ones done with, you know, about 10 employers, uh, where we put them on the program, the day two program, which is, uh, you know, profiling the, uh, members, the employees providing that intervention, and then looking at those outcomes. Instead, once we comes instance, once we were able to do that and show it repeatedly, and then we had one year results, right. Coming in, and we showed amazing reduction in A1C improvements in time and range, which is the metric that comes out of the continuous glucose monitor and naturally measures the spice. Uh, we saw weight loss, amazing weight loss. We saw improvements in energy and sleep and hunger stress levels came down and most important medications come down, which is the basis for our ROI. So once we were able to show that data and show it repeatedly, especially the, the co the medication reduction, then we could come into a full blown product market fit offering. Right. Which is really putting members on the program, um, continuous program on a multi-year basis, uh, with, um, uh, employers and payers.

Speaker 2: (41:21)
Did you know, were, was it clear when you started out where you were gonna have to get in terms of the set of information about product market data, or did you know when you got there, like, okay. Based on sales calls and our engagement and our business development, this is enough, and now we're there.

Speaker 3: (41:40)
Um, so, uh, you know, both, uh, the core offering and the strategy to get there, um, was known from the time, I think way in 2018, when we started to think about the us and, you know, hired the first, uh, um, team in the us, uh, we had a strategy of showing those proof points, doing the Mayo clinic trial, getting the data out. We also waited for a randomized controlled trial that we have, uh, that came out of the Weisman Institute. So not just showing that we have an algorithm that works, but actually showing 200 people a hundred that got the algorithm died a hundred, that got the standard of care on people with pred and showing the differences where everything was controlled, the dietician support, right? So we could just show how the precision nutrition element is superior in the results. So we were waiting for those two things.

Speaker 3: (42:39)
We had a clear path, of course, that took longer than what we wanted. It always does. So, but once we had both things in 2019, then we could, you know, execute on the rest of the strategy of how to approach the market. Um, but the whole, um, we provide a full solution today. We provide the algorithm and through the mobile app, and, you know, people can walk into a, um, any restaurant today in the us pull up the app, get the scores, the prediction on what's good for you, and what's not, or you can walk into any, you know, Krogers or Walmart store and be able to scan the product and get a score. So the product was also maturing to a point where people could really use the app in a much easier way than what it was in the beginning, but then we also provide the full support. And this was the element that changed based on the feedback that we had, the fact that we wanted to have more support through health coaches and dieticians. And that was something that we did not anticipate if I looked two years back, that was something that evolved over time until we reached that point of a multi-year full support, uh, agreement.

Speaker 2: (43:50)
So if, if I'm tracking correctly, what you described was about four years, is, is that right?

Speaker 3: (43:56)
Uh, when we, no, we started in about, uh, mid 2018 to look at the us.

Speaker 2: (44:04)

Speaker 3: (44:04)
Or mostly in Israel until then. And Israel would explode up, you know, around us with the product on the market. So from 2018, we waited for the re we started, you know, Mayo clinic and all that waited for the results. Got it. In 2019, mid 2019, where we started to go out and market the

Speaker 2: (44:23)
Solution. Got it. So a year,

Speaker 3: (44:25)
Um, to where we are today, it's about three years already, right?

Speaker 2: (44:29)
A couple of years.

Speaker 3: (44:31)
Yeah. Couple.

Speaker 2: (44:31)
Okay. I, I lost 2020. It just, yeah. Everybody in my mind, somewhere

Speaker 3: (44:36)
The Olympics is called, um, you know, Tokyo 20, 20.

Speaker 2: (44:41)

Speaker 3: (44:42)
So everybody now is in 2020, because that's how we feel on the screen all days, 2020.

Speaker 2: (44:47)
So, so we got, we got a question from the audience about, um, why, uh, day two, didn't choose the maternal sort of market focus or, or maternal focus. Um, you know, as you were thinking about metabolic versus athletes, et cetera, how, how did you, how'd you look at that and how did that decision get made

Speaker 3: (45:09)
Maternal in a sense of,

Speaker 2: (45:12)
Uh, yes. Yes. I'm and I'm not sure exactly from

Speaker 3: (45:17)
Tracking. Um, so there's a, there's a huge market for, um, I'm losing the word, um, gestational diabetes.

Speaker 2: (45:27)
Yes. That's probably what the question

Speaker 3: (45:30)
Asking, uh, because nutrition is nutrition it's of course, for moms who are pregnant, we tend not to start with them just because of the, you know, risk side, but if they were on the program before they would just continue to eat as normal. But when we looked at gestational diabetes and we were looking at that for a while, because gestational diabetes is a risk factor. Once they end the pregnancy, then they're prone to pred, um, you know, in later life. And also during the, the, the pregnancy, uh, if you can catch that earlier and start right, giving them the right nutrition, we believed we could have a very big impact on that. Uh, we actually did kick off a clinical trial with the Whitesman on the gestational diabetes and, and J and J as well. Um, it was very hard to recruit for the trial.

Speaker 3: (46:23)
It was very hard to, to just find participants. Um, and then we matured into type two diabetes that took off, right? The pred trial started in parallel and the pred, the gestational just took a long time. And so when we're looking at focus and, you know, testing and trying and looking at several things, that type two diabetes just took off much faster. It's still, uh, I, I wanna say as we look forward at some point, this is still an area that we think we can bring a lot of value, but it was, it would not be the number one, especially when we're looking at our go to market employers and payers, we would look first at hypertension. Right. Of course, all the metabolic disease, not sure gestational diabetes is on the, you know, top five things that employers and payers worry about now.

Speaker 2: (47:12)
Right. Yeah. Uh, earlier today, or earlier in this, in this webinar, uh, there was a point made about, um, maybe a perception that to do innovation in the healthcare space, you need to be focused or have personal experience with a disease or a chronic condition or whatever. And yet the point of this, uh, post was that really everybody thinks about some of the prevalent, uh, conditions in our country or in our world that we all need to, um, focus on solving. And I was just wondering, be because you started your entrepreneurial and professional career outside of healthcare, um, how you would give advice to people who may not have specific personal experience with clinical information or, you know, in a clinical setting, uh, coming in to be an entrepreneur here.

Speaker 3: (48:12)
Yeah. Um, so it's true that, you know, most, a lot of the entrepreneurs and founders are, uh, working on experience right. And what is problematic to them. And then they try to find a solution and they find it that way. There's many stories like that. Um, actually for me personally, this company was also what I got excited, as I said in the beginning was the gut microbiome, but I did lose a very dear friend to type two diabetes. And that person did everything that they can, right. To keep blood sugar intact, did the recommendations that he was told. It's just, it didn't work. And he ended up dying at a very much earlier age than what he should. Um, so everybody has these, you know, stories, I think that get them there. Uh, so if somebody's coming totally out of the clinical, uh, side or healthcare altogether, um, I would ask why they would find, found a company in that area to start with.

Speaker 3: (49:11)
Right. And are you just, something has to spark up this innovative, uh, drive in, and it usually happens into something either, you know, very well or many times in Israel, it's because you worked in the technology in the army and you're just dying to take it into the, you know, uh, civil world, uh, world. Um, I think it would be of the, it would be difficult to bridge that, um, need, but, uh, assuming somebody would, you know, look at the country's, uh, you know, in a very cold way. I, I, I struggle a little bit because it would, you would say, okay, you know, this is an area that I want to innovate in. You can do that. Right. You can just look and map it and say, this is an area where I think, you know, it's, the solution is not good enough. A lot of the times there's something that's connecting you from other areas or technologies that you know about that could be applicable.

Speaker 3: (50:04)
So I, I, I don't think there's a real barrier. I think you can learn everything. You need to be able to find the right people to advise you and coach you in day two, even specifically every industry you go into, you're not an expert in, right. We, we did one thing in Israel. We came to the us, we did something very different. You have to find those consultants as you know, that we know you mentioned, uh, uh, our, uh, the person we both know, uh, Jan Berger to this case, we can give her the credit, right. So she helped us a lot to, uh, came in and, uh, uh, as a consultant and really advised us and shared her experience. And it helped us with that go to market approach and finding the right product market fit said, bridge it with people. As we said before, it's not a one person show and you have to compliment where you're missing

Speaker 2: (50:54)
Soy. We just, so this has been a great conversation. We just have a few minutes left and, um, I wanted to ask you, you know, we're, we were maybe coming out of this pandemic and then, you know, maybe we're going into wave to who, you know, who, who knows. Um, but what, and, and you mentioned you had some success a actually during, during this pandemic time, what did you learn during this time? Um, as, uh, as a woman pro professional, I don't know how old your children are, you know, your, your family situation or whatever, everybody during this pandemic had a lot to manage, no matter how engaged they were professionally. Um, how, how did you, how did you do that? If we go back into another period of time here where we're all, you know, masked and at home, et cetera, what are your words of wisdom?

Speaker 3: (51:49)
Yeah. Well, first of all, on the business side, it was great for us, right? Diabetes was the number one, you know, preexisting condition and it's a fully remote program. So yeah, as others, we, we enjoyed that tremendously on the business side. Uh, personally it was very challenging, right? We are, uh, cross, uh, Israel in the us. We have a team in the us. We have a team in Israel. We were stuck at home, uh, managing engineers, um, who are all working at home was something that we could not even imagine before. Uh, not being able to get on a plane and fly to the team in the us was very challenging, was all on zoom. So that was personally for me, the challenge of just not being able to be there with a team. Um, actually the home situation was much better for me and my children are not babies.

Speaker 3: (52:37)
So it was, it was awesome. No homework, no nothing. We were just focusing on work all day and they were happy. Uh, so I, I believe that, um, we did come out very strong, understanding that again, whatever is thrown at us, there is a solution. We delivered an amazing product at the end of, at the end of COVID, right. Which we could not have imagined being on time because people were on one hand, much more effective, right. They stayed at home, they were effective and what they were doing. They didn't spend two and a half hours on the, you know, in traffic. So things got offset and people after the initial shock, really learned to work that way. Um, and I think we, um, we just found that we could be as a team, very successful together to get things done, no matter in which you know, forum, we have to do that

Speaker 2: (53:31)
Welly best of luck and hard work and persistence and success ahead. I've really enjoyed getting, uh, caught back up with you. And I look forward to when we're in person together at some point in the future.

Speaker 3: (53:45)
Great. Thank you so much.