I think that's a very good question. It's quite challenging, you know, to bring people onto apps. It's very easy for people to scroll through Instagram reels and spend days locked into that app, saying, 'Okay, I don't want to spend more than one hour on social media.' But when it comes to spending just 10 minutes on a health app, people often respond with 'I'll do it later' or 'It's okay.' Of course, people are willing to pay to get things done and be on a program to take charge of their health. However, engagement does become a challenge over time. Initially, there's a lot of motivation. You might see an ad, speak to program advisors, and think, 'Wow, I'm going to join this program!' The early weeks show high motivation and engagement. Eventually, as the novelty wears off, there's a dip in engagement. People start thinking, 'I'll do it later,' or 'I'll do it some other day.'

This is where our expert coaching comes into play. We have expert coaches from various domains – nutrition, physiotherapy, psychology – who know how to motivate people. Our program principle is strongly rooted in behavior change. Rather than asking for drastic changes, we focus on correcting small daily habits. These small changes build healthy, sustainable habits that help achieve and maintain goals.

This is where our expert coaching comes into play. We have expert coaches from various domains – nutrition, physiotherapy, psychology – who know how to motivate people. Our program principle is strongly rooted in behavior change. Rather than asking for drastic changes, we focus on correcting small daily habits. These small changes build healthy, sustainable habits that help achieve and maintain goals.

Another strategy we employ is continuous app enhancement. We introduce gamification elements, making the app more engaging and fun. Additionally, we foster a sense of community. We create communities for like-minded individuals. For instance, for diabetes, we have a 'Rise by Fitter Fly' community. Similar to what you're doing with MedBound, where like-minded doctors come together to discuss challenges, we bring together people facing similar chronic conditions. These conditions often lack clear symptoms and societal support. Unlike acute illnesses where families rally around, lifelong disorders like these don't always garner the same support.

Our community support is crucial in maintaining engagement. Members share recipes, daily activities, and success stories. Coaches and experts facilitate connections, sharing advice that resonates more when it comes from those who've experienced it. When I, as a doctor, advise someone, it's appreciated, but advice from a fellow patient who has seen real results carries a different level of motivation. Day-to-day life doesn't usually provide these examples. People offer a hundred different ways to manage a condition, but rarely do they provide the right motivation to take charge. That's what we aim to do – engage members by letting them connect with people like them who have found success. They can discuss what works and share their struggles. For instance, during festivals, we get many questions about whether sweets are allowed. People feel dejected when they're simply told 'No, you can't have sweets on Diwali.' But within our community, someone might say, 'Hey, I made these healthy laddoos. Give them a try!' And with a nutritionist on hand to provide guidance, it's more motivating. This is how people stay engaged and motivated within a like-minded community.

There are different outcome measures, and I don't believe there's too much secrecy around them. Many aspects are in the public domain where we discuss the outcomes we've assessed. Overall, our objectives involve laboratory parameters and clinical measurements that people use to gauge improvement. For instance, in diabetes management, the objective is to reduce parameters like HbA1c, which reflects the average glucose levels over three months, along with fasting and post-lunch glucose levels. Weight reduction is also a primary goal, whether in a weight loss program or for managing other chronic conditions.

In the context of metabolic conditions, weight isn't considered in isolation. Waist and hip circumference are also evaluated, as these measurements often involve stubborn weight that's challenging to reduce. Anyone who has attempted weight loss knows how difficult it can be to shed inches. Another outcome we examine is the quality of life and the adoption of healthy habits. Baseline assessments cover fitness levels, stress levels, sleep quality, and nutritional values, including calorie intake, carb-to-protein ratio, and micronutrient intake.

At the program's conclusion, we assess whether these habits have changed. Did participants transition from a high carb intake to a lower one, increase protein and fiber consumption, and achieve a more balanced diet? Did they improve flexibility and core strength, resulting in higher fitness scores? We also evaluate stress levels and sleep quality using standardized scales to determine if there's been improvement. Another parameter we analyze is changes in medication. Have participants been able to reduce or discontinue medications? Have they achieved remission?

So, these are the outcome parameters we focus on. Some are concrete, influencing medication adjustments guided by doctors. Others are patient-reported, significantly affecting individuals' quality of life. As a medical professional, my focus in the clinic might be on hard lab parameters – seeing blood sugar drop from eight to six is satisfying. However, for patients, true satisfaction comes from feeling fitter and stronger.

It's about progressing from only being able to exercise for 20 minutes to engaging in walking and strength training. It's experiencing improved sleep quality after implementing sleep hygiene practices from the program. While these aspects are gaining recognition in the medical community due to evolving research, patients themselves recognize their value. Reduced weight, better sleep, improved mood, enhanced physical capabilities, and reduced dependency on others hold immense significance. Patients no longer wish to be defined solely by their condition; they want to lead enhanced lives.

These are the outcomes we strive for, ultimately focusing on improving the quality of life for our patients.

There are partnerships at different levels. We have laboratory partners and specific physician partners. We maintain a dedicated channel for collaborating with physician partners, and currently, we have over a thousand doctors who refer patients to our program. Building trust is crucial, and our scientific focus ensures that doctors have faith in our approach. This, in turn, leads to patient confidence when recommended by their physicians. We manage this partnership with utmost sensitivity, ensuring that doctors feel comfortable referring our programs.

Our presence is prominent at various conferences in this domain. We showcase our research at multiple international events, with close to 60 abstracts and research papers presented globally. These include conferences by renowned organizations like the American Diabetes Association, the International Diabetes Federation, AS, EASD, the European Society, RSSDI, the Indian Societies, and numerous other Indian conferences. The well-acclaimed research serves to validate our scientific and outcome-focused approach. While the scientific community receives detailed presentations, we summarize the outcomes in a more understandable manner for patients.

Our partnerships extend to the use of devices within the program. These devices include continuous glucose monitors, glucometers, blood pressure monitors, and weighing scales. They seamlessly integrate with our app, eliminating the need for members to manually input data. This automation enhances convenience and maintains data accuracy, reducing the likelihood of human errors during data entry.

Collaboration is a key tenet for us, as all stakeholders work towards the shared goal of improving patient lives. The healthcare ecosystem has expanded significantly. While the traditional view might have been limited to doctor-patient interactions within a hospital, today's ecosystem is extensive. Collaboration with multiple stakeholders is essential to achieve the desired outcomes for a healthier world. People on similar missions come together to make this vision a reality. The sensitivity of collaborations, data integrity, and other related aspects are all carefully managed and taken into account.

On a broad level, there are several challenges. Firstly, there's the novelty of digital therapeutics. It's a relatively recent concept, and many people find it difficult to grasp its precise definition. Some tend to equate it with teleconsultations, which gained prominence during the COVID pandemic. Others might think of wellness or tracker apps that focus on activity and step tracking. Describing the complex nature of a therapy that encompasses various elements leading to tangible changes in disease parameters can be challenging. This explanation is not only a hurdle in conveying the concept to patients but also in explaining it to medical professionals.

The second challenge pertains to our market being largely out-of-pocket. Affordability is a crucial concern. While we understand the value and how improved outcomes translate into cost savings, many individuals initially weigh the money spent against the perceived savings. Unlike in Western countries where digital therapies are approved by regulators and covered by insurance, we face this particular challenge in our daily operations.

The third challenge is differentiation within the realm of digital therapeutics. The market is saturated with various types of apps, some of which are not developed by medical professionals and may not focus on the right therapy. This becomes a hurdle in the effective implementation of digital therapeutics.

I often discuss how the health tech space is dominated by technology rather than healthcare expertise. Healthcare providers often hesitate to engage in this domain, preferring the comfort zone of patient care, prescription, and witnessing improvement. However, to bring about meaningful change, more healthcare providers should embrace health tech. While technology plays a significant role, it's crucial to understand both doctor and patient behaviors, which are best comprehended by those directly involved. Collaborating with tech experts is essential, but the optimal synergy occurs when cutting-edge technology merges with healthcare expertise and empathy.

To truly make a difference, the blend of superior technology, healthcare knowledge, and genuine empathy will shape the future of digital therapeutics.