The Stretch – Gut Check: Innovations Transforming Digestive Health & Employee Wellbeing

Kevin Fyock:

Today, we're going to dive into digestive health. And as such, we have aptly named today's episode, “Gut Check. Innovations transforming digestive health and employee wellbeing.” This is a topic that's getting greater attention these days as the scientific community discovers more about the gut and its many connections to the rest of our health.

And as employers continue to grapple with how to best manage chronic conditions for their employees and how they face them, that connection is becoming increasingly important to understand, and maybe more importantly, to create a strategy on how employers could potentially address that. So joining us today to help us unpack this fascinating subject is Bill Snyder, and Bill is the CEO of Cylinder.

So welcome, Bill.

Bill Snyder
Kevin, thanks so much for having me on.

Kevin Fyock:
Why don't you introduce yourself? We'd love to hear about you, your background, sort of how you got to Cylinder.

Bill Snyder:
Yeah. So as you mentioned, I'm the founder and CEO of Cylinder, where our mission is to revolutionize digital health gut first. So we work with individuals who suffer from chronic digestive conditions, things like ulcerative colitis, Crohn's disease, irritable bowel syndrome, GERD, and host of other conditions.

I'm passionate about this problem because I saw loved ones that were impacted by chronic digestive conditions. And what I saw was the toll it took on them physically, mentally, emotionally. And the fact that with these conditions, there's often kind of a meandering journey through the healthcare system to try and find resolution, to try and find the underlying problem.

So that was really the reason that we built Cylinder. Prior to this experience, I had over a decade of experience in the healthcare system, generally. Various positions at Humana. And then I really started my entrepreneurial journey from there with other digital health solutions before founding Cylinder.

Kevin Fyock:
Awesome. And, you and I had a chance to connect a little bit before this, and I love sort of how you characterize that gut health is really having a moment, right? So it's been highlighted in documentaries; it's on TikTok. So I just love your perspective on sort of how this has trended in the past 2, 3, 3, 4, 5, 10 years, because this wasn't a topic that we discussed in society, let alone in the employer benefit decision making room. So from a historical perspective, would love to hear your perspective on how things have changed.

Bill Snyder:
Yeah, I think one of the big problems with digestive health, just as you mentioned, is it has historically been a bit taboo or difficult to talk about what's going on in the bathroom. It's just hard for us to talk about. And what we see with, again, with my loved ones and then also with the patients that we serve across the country today is because it's been difficult to talk about, often that leads to feeling sort of isolation and loneliness because patients don't really know where to go.

To your point, what we're seeing is that gut health is having a moment. And that's really exciting because it allows those who have been suffering in silence to vocalize what's going on with them and to find support groups and support solutions out there. And so I think what's really interesting is not only it's empowering patients, but there's also just an enhanced view of the importance of digestive health for overall health and wellbeing.

So you mentioned, you know, we're seeing a trend on TikTok. And I think that's incredible because it's just empowering the patients and it's really putting these conditions in the spotlight.

Kevin Fyock:
It is. And you know, I love your, your characterization of it being a bit taboo. It's so on point. And that gives me so much optimism for just this topic and other topics that we can now sort of bring into the employer lens.

And just like mental health had its time as being somewhat taboo, that's in many ways been broken down. And it's following other historically-sensitive healthcare areas. You think about women's health and fertility. And it's a good thing, right? And we know that one of the defining attributes of Gen Z is largely their openness in talking about so many aspects of their life.

So from pay, as I mentioned, to mental health, to just health care more broadly. So maybe that's a good way to start the first question I'd love to ask you, Bill, which is, as people get more willing to have an open dialogue, they're more honest, more curious about digestive health. What are sort of some things that employers need to understand?

Bill Snyder:
Kevin, I think you're absolutely right. It's great to see patients being empowered to speak about their health from a variety of different conditions. And so, for us, in terms of chronic digestive conditions, I think there's a few things that we always want employers to understand. First is the scope of the problem.

I mean, one in four Americans suffer from a chronic digestive condition. So, it's a huge problem in terms of just the populations that they represent. And the second is the cost associated with these conditions. On average, a person with chronic GI conditions costs about $17,000 per year in medical spend.

And so, for those individuals suffering, it's really expensive. Now they're going to see a lot of different doctor visits. They're oftentimes ending up in the emergency room and also oftentimes being prescribed high-cost biologics. So in addition to the big scope, it's really, really costly.

And then the third is similar to what we opened the conversation talking about. These individuals are suffering not only from a physical perspective, but these conditions have an outsized impact on their mental health, on their emotional health, on that feeling of isolation. And so, we see that show up in terms of problems with absenteeism and presenteeism, inability to feel secure in the workplace.

And so it's massive problem, really high cost for the patients that are suffering from these conditions and ultimately impacting their emotional and mental wellbeing as well.

Kevin Fyock:
Wow. I mean, picking up on something you said though, one in four, that number, that's huge. And I think being at Aon, that's a bit in contrast to the fact that some of our latest surveys suggest that less than 5 percent of employers offer a digital-first digestive health solution focused on gut health.

So if we can go a bit deeper into this one in four and sort of sizing the problem. I understand that Cylinder recently published your State of The Gut Health In The Workplace, which is a great name for a survey report, by the way. Could you highlight some other sort of sizing of the problem? Help us better define the issue that employers are facing here.

Bill Snyder:
Yeah. So we did that survey in partnership with the Harris Poll. So it was really insightful for us because it gave us a better idea of not only the size and the spend associated with these conditions, but also how does it impact employees ability to show up at the workplace and be productive. And it found a lot of interesting things.

71 percent of all employees surveyed said that they had some type of GI distress. 71 percent. Massive percentage. Of those, 72% said that they had either missed a day of work, had to leave early, or show up late because of these symptoms. So, when you think about that size of the problem, it's not just those that have a specific condition.

At some point in our lives, we're all suffering from some type of GI distress. It happens to almost everyone. And so, for us to understand that that impact is so large in terms of scale and then that these individuals have said, “Hey, it did impact my ability to come into work, or to show up on time, or to stay the full day,” was really insightful for us and for the employers that we've worked with.

So, I think it's just putting that kind of understanding and data towards here's the specific percentage of individuals impacted, here's how it shows up in terms of their ability to come into work and be present every single day.

Kevin Fyock:
Yeah. I mean, that productivity element is coming up in sort of every facet of the employee benefits discussion. So I appreciate you touching on that. And maybe to our listeners, you can download a copy of that report. And it is a fascinating read. So I'd encourage folks to take a read.

So maybe back to this topic of sizing the problem. Maybe we can touch on sort of the trend, sort of how this has evolved and maybe just a couple questions that I'm wondering that are related. Has there been an increase in digestive health problems? And I think tied to that, I'm sort of thinking, has this issue been hiding in the shadows or has there been more going on? And my mind goes to things like modern lifestyle habits. There's so much research around connectivity, so many chronic conditions in one's lifestyle, heightened levels of stress, anxiety. So why don't you walk us through that, Bill?

Kevin Fyock:
Yeah, it's a good question, Kevin. It's a combination of both. So it's a combination of the fact that we haven't been able to see it specifically in the claims data previously because we haven't been looking at it the right way. Coupled with the fact that these conditions are on the rise for reasons that you just cited in terms of our modern lifestyle and our modern food.

To kind of address the first piece, when you think about the way that we've all reviewed claims in the past, we've leveraged CPT subgroupers and we've thought about kind of umbrella CPD subgroupers that say, Hey, here's the overall spend associated with kind of an umbrella chronic conditions. There was never any digestive health CPD subgroup.

It was always broken out by specific condition area. So ulcerative colitis, Crohn's, Irritable Bowel Syndrome, those were all broken out into separate pockets of spend. When you pool all that together and when you look at secondary codes for reasons that people are going into the emergency room or having multiple doctor visits, what you see is the spend is massive.

And so, we've seen that change. We've seen partners like Aon starting to go through their claims process and say, oh, this is a really high percentage of spend for these employers. So that's really exciting.

And then to your point, on the second piece, we're also seeing uptick in digestive symptoms across the board and diagnosis of these different digestive conditions. And again, you know, our food supply has changed dramatically. The way that we live our lives has changed dramatically and that is leading to a significant uptick in all of these conditions and symptoms. So it's, it's kind of both of those coming together where now employers are saying, Whoa, this is huge spend. This is an area we need to focus on. And fortunately, they have recognized that. So, it's great to see that awareness coming from those two areas.

Kevin Fyock:
That's so cool, Bill, because, you know, we've spent a lot of time today on talking about the intersection between affordability and things like social determinants of health. And when we talk about social determinants of health, one of the places we go is one's community grocery stores, clean grocery stores, right?

And so you talk about the food supply; that really resonates with me. And then the conversations that we're having and it's a really difficult nut to crack, right? And not to go too deep down sort of the diet conversation, but it's hard to talk to an employer about what levers they have to pull around diet, around grocery stores, because many employers are not in the business of building grocery stores.

And so, impacting one's community is, it's difficult. So I'm excited to sort of go a bit deeper because I feel like there's something to be said about what you're all doing and how you can sort of connect the SDOH aspect.

Bill Snyder:
Yeah, thank you. And you're absolutely right. I think that, you know, what the unlock is hyper personalization.

It's really getting granular. And fortunately, that's the outside role that technology can play. It's personalizing based on every patient's need, and then making sure that they have access to the right type of care at the right time for things like medical nutritional therapy and a coordinated care team that does focus on not only health care, but diet and lifestyle.

So, I think you're absolutely right. It's a difficult challenge, but it's getting increasingly easier because of that hyper personalization that you can leverage technology to do.

Kevin Fyock:
Yeah, that's great. Okay. So outside of this, outside sheer and scope of the problem. I feel like we could talk about sort of all the negativity, but maybe we can sort of think about like, what can we start to do as employers?

Why should employers be concerned about their employees’ digestive health?

Bill Snyder:
Yeah. So I think just as we had mentioned, you know, it is impacting huge percentage of their employees. It's costing them a considerable amount of money. So again, digestive health is associated oftentimes with the leading for the second leading cause of emergency room visits in the US, associated with abdominal pain.

And then we see again, the onset of high-cost biologics sometimes as a first line of defense before they've tried any type of intervention that's not as costly and not as difficult for the patient themselves. So, from an employer's perspective, it's impacting a huge number of your people. It's especially a lot of money for you on your healthcare spend, and then it's impacting their presenteeism, their ability to be productive at work every single day.

And I think that's the reason, at Cylinder, we've seen such high adoption across the country, both from employers and then also from health plans who have recognized that this is a major driver of spend within their populations as well.

Kevin Fyock:
Yeah, that's really, really helpful. And, you know, I think as we think about how employers can start to manage this, we've been so fortunate at Aon to have this venue, The Stretch, to, you know, talk to and interview different innovators and recently, we had a group on talking about the future of health care delivery, and part of that thesis was integrating virtual care and brick and mortar care to sort of think about seamless delivery of care, really helping to rise to the challenge of provider shortages and for consumers who honestly desire more modern health care and more modern health care experience.

Maybe can you touch on, Bill, how does the delivery of care relate to digestive health?

Bill Snyder:
Yeah, it's really, really important for us when we build Cylinder to be integrated into the existing care ecosystem. And so we were very out front about saying we're not replacing GI docs. That's not our goal. Our goal is to make sure that there's no siloed care being provided.

And we're doing as much as we can virtually and then partnering with the brick-and-mortar physicians to make sure that the patients are going in and seeing them at the right time. And this is specifically a unique area within digestive health. And so, unlike a lot of other chronic conditions, when you talk to physicians across the country, what we hear time and time again is this stuff is really hard.

There's no singular novel biomarker that you can take from a patient to tell how their digestive health is doing. That doesn't exist. And so oftentimes there's a diagnosis by elimination, which means the patients are coming, seeing multiple doctors, trying to figure out what's going on. And oftentimes those providers are stretched thin.

You know, they're doing the best they can to serve every patient they see, but sometimes they're limited in terms of how much time can they spend with that patient. And they're not seeing what's going on with the patient day in day out, hour by hour, day by day, week by week. Instead they're getting a snapshot of that patient.

And so, this is a very unique area from a condition perspective where we can leverage technology to understand the patient on an ongoing basis, use the information we're collecting to assess the risk of the patient, and then also provide them an evidence based clinical pathway. And then when we identify what a patient needs to get into brick-and-mortar settings, we can really influence that patient and say, Hey, you know what? You really should be going in for that scope. You really should be going in to see a specialist. And so I think that's been really well received by the provider community, by the health plan community, and certainly by our patients as well.

Kevin Fyock:
Okay. So you're not replacing brick and mortar, I think is what I heard you say, which is great. It's really sort of adding to the care ecosystem, sort of amping up. The support that a patient already has to sort of meet them where they are. Is that a fair characterization?

Bill Snyder:
That's exactly right. And we're seeing a lot of access issues across the country, especially to get into see gastroenterologists.

You know, some people are saying, “Hey, we can get you in in six months.” And so what do they do for the next six months? And so we can work with those patients, decrease symptoms. And oftentimes what we find is, hey, the root cause might be a specific trigger food that's causing inflammation in the gut. So, we can avoid those costly, unnecessary scopes.

But what we're also finding is we're saying, hey, you have a family history of colorectal cancer and you have not gone in to have a proper colonoscopy completed. And let's say you're 55. We are finding those patients. And when we're talking to those patients, typically they're nervous about going in. And so what we can then do is prepare the patient, get them settled in terms of what the experience is going to be like and get them into those brick and mortar providers and get them in to have those tests completed when they should be getting them done.

And so, I think the provider community sees that as an incredible value add because we're not. trying to take their patients away by any means. We're trying to say let's break down any silos of care, let's exchange information with your providers you're working with today, and let's make sure you're getting in to see the right care at the right time.

Kevin Fyock:
Wow. Nervous for a colonoscopy. Who would have thought? I didn't realize people felt that way. So, okay, so you've been hinting at what Cylinder does, how you impact patients. Tell us more. So tell us about, you know, your team at Cylinder. How are you addressing it? This obviously is a very important topic. So tell us more about what you're all doing.

Bill Snyder:
Yeah, absolutely. So I'll start with the team because I think that's the most important thing that we've done well. We've created a world class team. And what we found is that everyone who joined Cylinder is really dedicated to our mission. This is oftentimes when people come to work with us, they themselves or a loved one have suffered from a digestive condition.

And they look at this and say, yeah, this needs to be fixed. There's a much better way that we can deliver this care. So that's how this attracts world class talent to build our organization as we scale.

From a product perspective, what we've built is dynamic platform that will do a quick clinical intake for the member. And we do two things with that information, assess the risk of the patient for their condition and or symptom. And then provide them an evidence based clinical pathway. And this is again where technology can play that outsized role. Because we can leverage pattern recognition to say, Hey, we have a really good idea of what's going to work well for this specific patient based on that condition and or symptom.

And then from there, our platform is dynamic. So, it doesn't take a snapshot of the patient and provide them their path. It's learning as we interact with the patient on an ongoing basis. And then we provide those patients what is necessary for that specific condition and or symptom.

So that might be things like cognitive behavioral therapy for patients with IBS. It might be medical nutritional therapy. It might be working with one of our physicians. So, we provide them a wrapped care team made up of health coaches, registered dietitians, gastroenterologists, and internal medicine specialists. And with that group of individuals, we're ensuring that the patient has a coordinated care team that's tracking them through their evidence based clinical pathway, intervening at the right time. And then again, leveraging those brick and mortar partners as well when we say, hey, you know what, this patient might need to go in for a specific test or to go back to see their primary care physician based on what we've learned about the patient.

And what this has led to is incredible outcomes at scale where we're identifying trigger foods, we're reducing symptoms, we're enhancing the care that's provided to the members. And we're not only decreasing those symptoms and getting the patients to feel better, we're also saving money for the patient and their planned sponsor. So, taking hard costs out of the system along the way.

Kevin Fyock:
That's great. I mean, this is such a fascinating topic to me, Bill, because as a non-clinician, as a lay person, I sort of incorrectly always assumed gut health was only diet related, right? And nothing that, you know, vitamins and some probiotics can't fix, but this focus on CBT is fascinating to me.

You see, from what I've read, amazing outcomes from folks really being able to materially change, you know, how they've been feeling and, you know, going back to your comments around productivity at work, you can now show up to work because of what you've done, you know, from a CBT perspective.

Bill Snyder:
That's so right, Kevin.

There's a very real clinical connection called the gut brain axis, where your gut and your brain are closely connected. And so what we see is sometimes symptoms that start in your gut can impact your mental health. They can heighten stress, they can heighten anxiety, and then that heightened stress and anxiety can cause more symptoms in your gut.

So, it's this, you know, never ending circle where, you know, that heightened stress and anxiety worsens as the gut, worsens as the gut, heightened stress and anxiety. And so, things like cognitive behavioral therapy have been really well researched and are considered a first line of clinical defense for conditions like IBS.

So, it's great we can support those tools for patients on demand. You know, they don't have to go take time off work, they don't have to find a provider that is licensed to do CBT specifically for irritable bowel syndrome. Instead, they can have it right at their fingertips. Day one.

Kevin Fyock:
So, Bill, this is great. And sort of digging into the clinical aspect of gut health. I've heard the term gut biome a lot. Not to be confused with the great 90s movie, uh, Biodome with Pauly Shore. But tell us about the gut biome. Are people talking about it? What is it? I'd love to learn more.

Bill Snyder:
Yeah. There's definitely a lot of interest in our microbiome.

And so really understanding how it correlates to our digestive health and our overall health. And so you see a lot of companies that are focused on that. You see a lot of consumers that have a lot of interest in the microbiome. And so I think our view on the microbiome is it's, it's really exciting. And it's very interesting and again, it's an area that we're still learning a ton about.

And so where I think there is potential for the future of leveraging information about the gut microbiome is looking longitudinally at a patient's microbiome and then taking additional information such as claims data, symptom data, food tracking, medication, and really starting to understand can we leverage the gut microbiome to help understand different patterns, what's impacting our health from those different areas. So not just a snapshot alone of the microbiome itself, but how does it relate to overall health and wellbeing and longitudinal symptoms or condition progression. And so, for us, we're really excited to continue to learn, continue to be on the cutting edge of that science.

And then I do feel forward looking in the future, hopefully we can leverage that information for things like precision medicine.

Kevin Fyock:
That's fascinating. That's, that's really cool stuff, Bill. So when we have our guests on, I like to end with a very consistent question and I sort of call it my crystal ball question.

So maybe the final question for you is, you know, we've talked a lot about how this has trended, the importance of digestive health, how employers can focus and lean into this area on behalf of their employees. If you were to flash forward with your crystal ball five, 10 years from now, what will digestive health look like and how will employer be responding?

Bill Snyder:
I think digestive health will be the focus of healthcare moving forward. And I say that because we're just at the starting point. It's an area from a scientific and a clinical perspective we are still learning a ton about. And we know that there is a very high correlation between your digestive health and your overall health.

And so, as we think about root cause to help decrease symptoms associated with all chronic conditions and claims and costs, I believe that digestive health will be the focus going forward. And I think that there's a lot of applications in the future for things like precision medicine and overall impact, not only on physical health, but mental health and emotional wellbeing.

So I believe in 5 to 10 years, it's what everyone will be talking about, focusing on in terms of patient care.

Kevin Fyock:
Okay. You heard it here, Bill, we're going to call you in five years and we're going to gauge if it's. Defocus, but that makes a lot of sense, right? I mean, the connection again, back to employee health, taking a taboo comment and really impacting employees.

That's fantastic. So Bill, thanks for joining us. It's been a lot of fun. Your expertise sort of speaks for itself and, and I love learning about this and I'm sure our listeners did too.

And to our listeners, thank you so much for tuning in. We hope you enjoyed this episode of “The Stretch, Gut Check, Innovations Transforming Digestive Health and Employee Wellbeing.”

And as a reminder, this podcast is dedicated to the ideas that are revolutionizing the world of workplace health and benefits. If you've enjoyed this episode, we encourage you to subscribe to the podcast and follow us throughout the season. We hope you'll join us again soon. Thank you.