How AI Is Enhancing Nevro's Therapies for Chronic Pain

Earlier this year,  Nevro said it has now initiated the U.S. full market launch of its HFX iQ spinal cord stimulation (SCS) system, following the completion of a limited market release.The Redwood City, CA-based company touted theHFX iQ as the first and only SCS system that uses artificial intelligence to optimize and maintain pain relief using each patient's response.

Claire Smith, VP of global strategic marketing for Nevro, discussed the technology and how it was making an impact in patient's lives during Episode 14, Season 2 of Let's Talk Medtech. Smith also spoke her career as a medtech salesperson in this compelling and can't miss-episode. 

Transcript of the Episode

Omar: Well, Claire, welcome to let's talk medtech. How are you?

Claire: I'm great, thanks. Thanks for having me.

Omar: Yeah, thanks for joining us. So I want to talk all about what Nevro is doing right now in the field of chronic pain. But first I want to dig deep into your sales background. I'm fascinated by sales. I kind of work closely with the sales team for MD+DI and they're just some amazing people. Shout out to Paul Whitehouse and to Jon Paomi and Nicole Welter. They're just awesome people. But I want to first dig deep into your sales background. Now you started about twelve years ago, correct?

Claire: It started at Nevero around twelve years ago, but I actually started my career around 19-years-ago with GlaxoSmithKline in a sauce capacity. So SaaS is definitely near and dear to my heart.

Omar: Talk about sales when you first started vs. how different it is now and what advice would you give to someone who wants to jump into sales for medtech or healthcare for that matter?

Claire: Sure. So it really is almost a different world today than when I started. I believe when I started selling, we were definitely adding value to our healthcare providers by bringing them new data. However, it felt like one way traffic. Whereas today, I think not only is the innovations taken huge step forwards, the way we partner with healthcare providers in a true partnership really allows us to serve their needs and patients'needs better. So rather than just bringing information, it really is a partnership, one that I really enjoy watching and be a part of.

Omar: And I would ask now if we could shift our conversation a bit to talk about Nevro's HFX IQ. Talk a little bit about this. This is the first and only AI-based spinal cord stimulator. How does it work and what makes it stand out?

Claire: Absolutely. I could talk for days around. So if we take a step back before we jump into the product, specifically spinal cord stimulation is there to help patients with chronic pain. It really tries to block the pain signals by quieting down the nerves in the spinal cord. Now, nevro HFX is unique to our competitors out there in the market. By using our proprietary waveform of ten khz therapy, we are the only Ses approved to use ten khz therapy. And what that does is allows us to be completely different to other spinal cord stimulation systems. So the other systems create pain relief by masking pain, creating a small pins and needles like effect over the area of pain. Whereas Nevro's HFX is totally paresthesia-independent.

So patients are not feeling anything, any tingling, really just pain relief. Now, this is really important when it comes to our PDN patients, our painful diabetic neuropathy, which we've recently had approval for in the US. Market, these patients are already suffering with different sensations. Burning, tingling, and having a therapy that does not add to that is certainly an advantage. Now, if I think back to my time when I started at Nevro twelve years ago, carrying the bag, I knew that collecting data was incredibly important. Data has been part of our DNA since the day we started the company. And so we have collected data on every interaction with our patient and recorded not only what we've programmed and what we've done, but the outcome to that.

Now, that data generation was with a vision of creating an algorithm that allows patients to quickly gain pain relief and maintain that over time. And that's exactly what we've done with Hfxiq. We took the 20 million data points from 80,000 patients and used AI to enable an algorithm that now we've put really in the palm of patients hand. So instead of coming into clinic and being reprogrammed and having multiple phone calls with not only nevro but also their HCPs and the providers that they're working with, patients can now answer four very simple questions around their pain relief, medication and function, and receive recommendations direct to the IPG to make changes as and when needed. It's really giving personalized therapy to patients when they need it the most.

Omar: It's very interesting. And the fact that you're combining AI with this artificial intelligence, I mean, I can look in the news today and see AI being used across a broad array or broad swath of applications. But just the fact that AI is being incorporated in this, it shows that the field is growing right, that AI is encompassing everything. I don't know whether to be scared about that or excited or maybe feel a little bit of both. I feel like now most companies are going in this route using AI, and it's very transformative.

Claire: Absolutely. I think AI has this ability to allow us to become more efficient, make us make decisions more quickly, get patients care. However, I think it's not everything for everybody. It should never replace that human touch in healthcare. It really is just allowing us to make better decisions for patients and be able to really understand the data that we have in our hands to be able to move forward. I couldn't even imagine looking at the data that we have today without using an AI algorithm and moving forward the data that we'll collect. It's certainly going to be part of our pipeline for the foreseeable future.

Omar: And it takes the AI application, it takes HFX to a different level, would you agree? I mean, let's go back 10 or 15 years ago and look at some of the applications, the ses applications or the chronic pain treatment applications, without that learning, that machine learning model. Well, I don't know how I would describe it. It's kind of like, I don't know, how would you say not a needle in a haystack, but just adjusting based on feeling as opposed to having real true data that says this is what we need to do and win.

Claire: Absolutely. So I think previous to using AI and huge databases, you really were at the kind of mercy of the local representative or doctor and their knowledge, right, which they are treating a good number of patients. They've got wonderful experience and the excellent intention, but you're really focused on what do they know as an individual. What we've managed to do is to bring everybody's experience together and actually look at the entire population of these 80,000 patients and say patients like you that have turned up with back and leg pain or PDN or whatever it may be. And they are answering these questions in this way. And they've had these previous experiences with the therapy. This is what's worked best for them. So it's really allowing us to give patients the benefit of everyone's experience, not just your local healthcare provider and your local representative. So it really does bring the value to every patient, no matter where they're located in the country.

Omar: It's true personalized care, it really is.

Claire: It's extremely exciting and it allows us to learn so much more about patients and what's working well for them and maybe what's not working so well for them, and to pull that into future algorithms and continue to update as we learn more. So we do not envision that we will be sitting on just 20 million data points, 80,000 patients forever. This is growing by the minute. And we do plan to make algorithm updates as and when these changes are required and we've learned more to give patients better care and also to free up our providers to go and do what they do best, spend time with more patients who truly need their time and energy.

Omar: Now let's go beyond HFX for a second. Let's talk a little bit about Nevro. How is the company standing out right now in the field of chronic pain management?

Claire: Yeah, great question. So nebro has always been different. So ever since I started, we've always done things slightly different to the rest and I've always taken huge pride in that. So whether it be our large RTTS really proving what ten khz therapy can do to the way we've really thought about our business model differently, we've always taken a patient first approach. So when I mentioned about the business model previously in other spinal cord stimulation companies, the patient would be relying on the representative to be available. So our reps, as you mentioned, the sales team, they're such an incredibly busy team, right? They are not only speaking to current customers and new customers, they're helping in the operating room.

They are driving from clinic appointment to clinic appointment and man, it's really hard to get them on the phone when you need them the most, when the patient needs them the most. And we observed this really early in our journey at Nevro and we knew that patients deserved better. Patients deserve to have a team who were dedicated really to be able to help them. So we have a large team of HFX coaches who are part of their care team, work in partnership with their providers, their local field rep teams, and clinicals, and actually spend time with the patient when they need it. So not only are they available on the phone when the patient calls in, we actually make proactive touch points to our patients and check in to see how they're doing and continue to optimize.

We've never been okay with the known news is good news idea. We know that's not the same with pain patients. Often these patients have been through such an ordeal over their time, they become despondent. And if something's not going well, it's almost like another treatment that didn't work for me. Whereas we know if we work closely with them, we can get those large majority of patients back on track. Now, what IQ allows us to do, which is different with this, is obviously the data that's coming into our database. We can create proactive care triggers that actually says this patient isn't where they need to be or isn't responding how we would have expected. And our HFX coaches usually call them within one day of seeing that and actually give the patient the education, the support that they need to get on track. And this just allows us to continually step up in the market and actually treat our patients how we truly believe they deserve to be treated.

Omar: What ultimately can we look forward to. From Nevro in the future? Any projects, anything that you all are working on that you could tease if you can't just outright disclose, but anything you can tease, absolutely.

Claire: So one thing you can always expect from Nevro is we will not rest until we have met the needs of our patients and our providers. We are extremely patient focused. In fact, it's our top value in our organization of patient first and also our customers needs are incredibly important to us. So we are working on innovations that allow our patients to get better care, better access to therapy as well as giving our providers the tools they need to be able to treat more patients. So I mentioned updating the algorithm within Hfxiq. We are absolutely actively working on that. We are looking at the data we have today, we are looking at those learnings to see are there adjustments and sophistications we can make to our algorithm to help drive pain relief. And I am confident we are on an excellent path forward with that. I think it's also you can expect from nevro that we will continue to become a deeper partner within our pain practices. So right now we are a spinal cord stimulation company and we are very proud to be specialists in this area. I do think we have an opportunity to be able to serve our patients and our providers further with other products down the line. So definitely could expect some diversification from Nevro as we continue to move forward in our journey.

Omar: And Claire, I've got to go back to this, I've just got to go back to your time in sales and ask you this is there anything you miss about it? Is there anything that stands out or that is super exciting about sales that you could talk about? And also have you ever had any nightmare scenarios working in sales?

Claire: I think we've all had nightmare scenarios working in sales. If you've ever been a real salesperson you could probably list many of nightmare scenarios whether that was be turning up at the wrong or at the wrong time or not quite remembering the equipment you were or having a complete blank of what you were supposed to be doing that day. But I tell you what I miss about sales, and I feel incredibly grateful at Navro that I still get this exposure, but not as much as you did in the sales team is just really working with patients and providers and seeing that transformation in their lives when they actually experience pain relief for sometimes the first time in decades, and actually watching them get back to what I call the small things. But those small things that mean everything. So I remember a patient who could not was engaged and was so concerned about the wedding because had such bad pain in her hand, couldn't have her wear a weding ring and actually after some treatment did phenomenally well. Or another patient who hadn't been able to go to the movies for so long and how they managed to do that, they are the stories that keep me going and I'm lucky that my team knows that that's what feeds me. And so regularly most Friday mornings get myself a little feel good story to keep me motivated. However, being in the sales team, you see that every single day. And I feel that's such an honor and a privilege to be able to work. And there's nothing better than that adrenaline rush of a sales role and knowing that you've converted a customer and you've spent sometimes weeks, sometimes months trying to get through to a new user and actually seeing that light bulb moment of when they say, okay, I'll give it a try. I don't think there's many feelings that beat that in this industry, for sure.

Omar: Amazing. Well, Claire, thank you for being a guest on Let's Talk Med Tech.

Claire: You're welcome. Thanks for having me.