A Breath of Fresh Air: An Oral History of Propeller Health

Posted by | September 6, 2017

The path of a startup is rarely linear. The macro trends surrounding a technology can have a profound impact on its success or failure. In the mid-2000s, the seeds for Propeller Health were planted in the mind of David Van Sickle. It took a confluence of circumstances to reach the point where technology improves patient outcomes. In the first official “Oral History” of the company, we hear from Propeller’s biggest advocates through various stages of growth.

For digital therapeutics, the last ten years could be compared to an era in the 1960s when nations battled to reach new heights — the moon.

Then and now, substantial financial resources were and are being deployed during a time of curiosity, discovery, and delirious competitiveness.

“Who’s going to get there first” is a mantra that can apply to today’s ambitious cadre of entrepreneurs. Technology has proved to be the catalyst for a modern “Space Race”, and this was recognized early by Propeller Health Co-Founder and CEO, David Van Sickle.

Over a decade ago, the nexus of innovation and healthcare was beginning to unfold in the Midwest college town of Madison, Wisconsin.

David: I moved to UW-Madison in 2006 from the Centers for Disease Control (CDC) in Atlanta. UW-Madison has one of the strongest allergy and respiratory groups in the country. At the CDC, I had been working for the National Asthma Control Program, and doing outbreak investigations for the agency and was frustrated by how a lack of timely and objective data would limit our ability to target, evaluate, or apply public health interventions to asthma and COPD. The data were often too little, too late. While I was there, I started thinking about how to measure and understand asthma in the community from more of a bottom-up approach.

In 2006, I joined Safeguard Scientifics which, at the time, specialized in specialty pharmaceuticals and life sciences. Soon thereafter, the tech industry would embrace a seminal moment.

On June 29, 2007, the first Apple iPhone was released to the public. With the birth of the mobile app, entrepreneurs had an entirely new way to get in front of customers. Healthcare professionals had some of their own ideas as well.

First, one needs to look at the macro technology shifts that enabled a pivot to digital health, which began more than a decade ago: cloud computing and mobile technology (now ubiquitous). Propeller would be an early leader in this space.

David: With our first sensor, we struggled to figure out what to do for flip phones. The first Propeller — then Asthmapolis — sensor worked with flip phones through Bluetooth and it was a challenge to engineer. But we made it work, because we had a view that digital health should and could connect everyone to their physicians, regardless of what technology they had.

Of course, smartphones took off and our flip phone connectivity was hardly, if ever, used.

Propeller has always been mobilized by the mission to maximize symptom-free days for people with asthma and COPD. David shares a moment when the idea driving Propeller’s mission first crystallized.

David: I was flying to a conference from Madison and I had this vision: that people all over Madison were using inhalers and there was a spatial distribution to the disease that we just could not yet see. I recalled a famous report of an asthma outbreak in Barcelona, Spain where they had to interview everybody to see where their symptoms started; it took them years to solve the puzzle of those events. I realized all of that footwork could be short-circuited, fast-forwarded by technology, if we could connect the inhaler to the network and see asthma symptoms as they were happening. I wrote a one page project plan on the plane to the Robert Wood Johnson Foundation and gave it to them when I got back. They provided a $10,000 seed grant to study the first version of the sensor. It looked totally ridiculous — but it worked and demonstrated the concept.

Shortly after David took flight and envisioned a ground-up asthma solution, he met Greg Tracy, Co-Founder and CTO at Propeller. The two were an undoubtable pair for launching what became a pioneer in digital health; together they created the perfect balance between respiratory and technology leadership.

Greg: If you go way back when I first met David, I was a little less interested in the idea of Propeller and respiratory, but I was super interested in David. And the second thing, I am a geek and love building stuff. So, I was excited about marrying hardware with software to create a new experience. In 2010, it just wasn’t being done, at all. That got me really excited on a pure technical level.

David and Greg’s enthusiasm and mission to conquer respiratory disease kept them pushing forward as they experienced turbulence expected when creating an industry. Greg shares a few peaks and troughs from the early years.

Greg: In the beginning we were very much geeky. We thought that all asthma and COPD patients needed was a piece of technology; if they had this technology then they would be interested in it because it’s tech. We felt like consumers would have to invest a little bit as they do with anything else in their world that’s tech related. And if they did, then they would get all of these insights from Propeller — what was causing their triggers and other benefits. I could say that we miscalculated, but it’s probably more accurate to say that we weren’t even thinking about patients correctly at the time.

One thing that was clear from the initial days was the core design philosophy — keep it simple.

Greg: Patients already have this horrible chronic disease and have the burden of managing it every day, so you can’t give them a new burden. We can’t simply inject technology into their lives, we have to strive to make something that is passive, and only try to make their lives better. That’s the overriding design principle, and it’s true on both the hardware and software side.

As Propeller sensors reached patient inhalers, new data rushed in. With this data came big learnings, Propeller began to understand patient behavior from a new angle and adapted the product to make magical user experiences that help people with asthma and COPD breathe easier.

Greg: Once you’ve instrumented medications and you know when and where the medications have been used, you can augment this information with open data sets to better understand triggers. You can find environmental data such as pollen, pollutants, humidity, and temperature. As you are collecting this information and users are adding their own, you have a really rich dataset that is not just a big dataset for asthma but it’s a very personal dataset. No two Propeller users are coming into an experience that is the same, that’s all due to the wealth of the data. I think it’s the personal insights that make it sticky and meaningful for consumers to use the solution. It drives great health outcomes.

Together with Safeguard’s Chief Technology and Information Officer, Scott A. Snyder, Ph.D., we recognize Propeller’s data as rocket fuel.

From Propeller’s founding, it was not simply about creating a neat app. It was about connecting a mobile device that can detect when and where a patient is having a change in their disease, immediately trying to understand why and trying to intervene.

Snyder: I had actually been following Propeller well before I joined Safeguard. I was always intrigued with the notion of digital therapeutics and they were one of the few that had actually “cracked the code” of getting patients to engage by integrating sensors into an existing patient experience instead of forcing patients to learn a new behavior. As a result, they have been able to not only capture unique data on medication use/adherence, but they can use this data to deliver more personalized interactions to help patients better manage their condition.

Understanding patient behavior and how to influence it is a data problem. The more we know what works, what doesn’t, and the factors that lead to better outcomes, the more effective the results patients will achieve using the Propeller Health solution.

Snyder: Propeller has built out a world-class data science group to leverage the data they are capturing. They have found a way to engage different patient segments and help pharmaceutical companies recognize how their product is being used, better optimizing drug delivery along the way. At Safeguard, we use a Technology Maturity Model to help gage where our companies are on different elements of technology progress relative to the leading edge in the market. Propeller has developed a very flexible, scalable platform and has created a very strong data/analytics capability on top of this as a major differentiator in addition to the sensorized inhaler itself.

Propeller Health has carved out strategic relationships with big pharma companies like GlaxoSmithKline, Boehringer Ingelheim, and Novartis stocking their arsenal with an innovative technology that is ahead of where their own internal development efforts are.

Recently, GlaxoSmithKline and Propeller announced an expansion of their digital health collaboration. Commercialization and internationalization of Propeller’s sensor for GSK’s ELLIPTA inhaler will be a focal point of the continued relationship.

For many reasons, pharma has shifted from an emphasis developing drugs for disease that affect large populations (e.g., diabetes, hypertension, cardiovascular disease, respiratory disease, psychiatric disease). The risk-reward is not there. This is where digital tools may have a significant and near term effect.

Greg: Asthma and COPD medications are quite effective if they are used correctly, but once a patient picks up a prescription at the pharmacy, they are really off on their own. The most interesting part of aligning with pharma is bringing together the medicine with digital to make the medicine more effective in treating asthma and COPD.

By the time 2014 rolled around, Propeller Health had raced out to a clear lead in the space. Though, this wasn’t meant to be a vintage Usain Bolt 100-meter sprint. The leadership team had it’s sights set on the horizon, in other words, a marathon. That meant a strategy of raising capital and growing into a much larger business model.

Capital always helps. You can’t get there without it. I think our experience with many aspects of their business helps us understand what needs to be built from a technology standpoint. From a business standpoint, the model for growing a successful digital therapeutic platform is being written. Given things we’ve seen before, including our experience in pharma and medtech, gives us perspective to help guide the team. That’s what has been so rewarding about the last several years. Being a partner with them has helped us learn and grow. We are judged by the company we keep.

David: The support and encouragement Safeguard has shown Propeller through the ups and downs has been remarkable. Gary has first hand experience operating companies and has become a prolific and successful digital health investor. He’s been able to bridge the traditional health life science perspective with digital health, while keeping an eye on where healthcare is heading more generally. Safeguard has been a great investor; we are really lucky across the board to have investors who are good people to work for and understand what we are trying to accomplish and what the opportunity looks like.

Propeller’s partners also extend to encompass municipalities like the City of Louisville. This spring marked the end of AIR Louisville, the only collaborative public health study of its kind. In 2015, Louisville municipal leaders engaged Propeller to help uncover soaring respiratory disease rates in the region. Together with the Institute for Healthy Air, Water and Soil, the Department of Civic Innovation at Louisville Metro, and the Robert Wood Johnson Foundation, Propeller created a plan to help Louisville residents take deeper breaths and live healthier lives. Meredith Barrett, Propeller’s VP of Science and Research steered AIR Louisville.

Meredith: At its core, AIR Louisville was a citizen effort — it was the largest citizen-science driven, sensor-enabled respiratory disease study ever conducted, collecting over 6.5 million data points and bringing together 1,147 local residents, who wanted to improve their asthma as well as contribute their data to improve respiratory disease in their community. It also brought together partners that don’t typically work together to tackle tough challenges like air quality and respiratory disease.

Based on the data collected in AIR Louisville, Louisville Metro government and local partners are taking a number of steps to make the City better for people with respiratory disease. They have committed money to enhance green infrastructure by targeting tree planting in high risk asthma areas. They are using the data to recommend alternative truck routes that would route trucks away from high risk neighborhoods, thereby reducing diesel emissions in these areas. They are developing a Smart Louisville Asthma Forecast notification system, powered by Propeller data, to warn all citizens about poor air quality and weather conditions. And they are considering changes to city-wide zoning policies to build in buffers around schools and residential areas to minimize the health impacts of highways and industrial emissions.

AIR Louisville was a creative way to uncover persistent social problems and inform solutions on a municipal scale, and the impacts have the potential to spread beyond. Project results demonstrated national air quality standards are not strict enough, so, AIR Louisville data will be submitted to the Environmental Protection Agency (EPA) for its next assessment of air quality standards.

When Propeller first set out to explore digital health, it was an unknown universe. And while the uncertainty remains vast, Propeller has many ideas to further help patients, organizations, and communities soar to new heights.

Greg: I think we’re on a path now where fully connected devices are inevitable. I think you’ll see this play out in all inhaled medications, biologics, and injectables. Add-ons will be gone, and when you get to that world, the user will take a prescription to a pharmacist they will pick up a device that not only gives a medication but is connected right out of the box.

David: We’ve come a long way but I feel like Propeller can continue to take more of digital health experience beyond the phone. I don’t feel it always has to be about an electronic interface. We continue to learn how to better support and interact with people in ways that become more and more compelling. I don’t exactly know what that means from a product perspective but I would hate to see it forever locked up in a phone, when we could make something a lot more magical happen around you.


Author’s note: Many thanks to my colleague, Anthony Stipa, and Propeller Health’s, Kristin Boyd, for all their hard work and support to help pull together the details and digital assets for this post. And of course, many thanks to David, Greg and Meredith for taking the time to partake in this walk down memory lane and for continuing to raise the bar in reducing the cost of care while delivering better quality of life for individuals with chronic respiratory disease.

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