Rehab-as-a-Service: Non-invasive treatment neuroplasticity regeneration and digital therapy

As Jeff Bezos said, “There’ll always be serendipity in discovery,” it is probably an important factor in JOGO Health and how an engineer-turned-sales head discovered the science and is today turned it into a thriving business.

“I was rolling off a project that delivered e-payments capability to one of the leading telecom service providers at that time,” recalls Sanjai Murali, “only to find one of the largest banks acquire the technology and kill it.” The founders at his consulting firm who were telco experts, recognized that he was not only good in engineering but also had great sales and business development skills. They promptly tasked him with heading sales and growing the firm, and over the next few years, Sanjai helped set up their India offices, and delivered good growth. Eventually, even that came to a pass, and he was wondering what he could do next. While it was a good run, it left him unfulfilled.

The CEO of the firm had helped create early product prototypes for Dr. Joseph Brudny and Dr. Gordon Silverman – early pioneers at using neuroplasticity for stroke rehabilitation.  He set up a meeting between these doctors and Sanjai. While Sanjai took the meeting out of courtesy and curiosity, he didn’t envision that it would change his career in ways he couldn’t imagine. He spent the next six months talking to doctors, patients, healthcare experts, venture capitalists – just to understand the space and the use cases. “These doctors had built the modality and telemedicine concepts in the 90s – it was way ahead of their time. It hadn’t become mainstream and the treatment wasn’t easy to consume.” muses Sanjai.

“I spoke to a patient from Holmdel, New Jersey, who made weekly trips, for several years, to New York for this therapy. She was in her early forties when she had a stroke. She’d have saved money instead of spending all her life’s savings – if only she had the same service close to home or a home use device” recalls Sanjai. “That struck a chord – the need was crystal clear. This was not a product in search of a market, but a market in search of a product to solve a pain point.”

He committed the next four years to build out the product, and business models. Drew Denardo, one of Sanjai’s friends and a tech wiz helped create the blue print for the product over endless cups of coffee at Dunkin Donuts in New Hope, PA. “Dunkin served as our first office” recalls Sanjai. Dr. Gary Krasilovsky – who had worked with Dr. Brudny at NYU – brought his vast clinical experience to creating the product. Building medical grade product is not for the faint of heart. In many ways, the number of constraints are of an order of magnitude greater due to the very nature of the human body (one size doesn’t fit all), the regulatory and reimbursement factors, etc.

It took four years to build a minimum viable product – initial demonstrations quickly snowballed into multiple uses cases—starting with stroke rehabilitation, there were new uses cases for treating chronic pain, urinary incontinence, fecal incontinence, among other neuromuscular disorders. “The ease of use generated new use cases we hadn’t imagined before”, says Sanjai.

“Clinicians were clearly excited about using JOGO, but the two biggest challenges were how to deliver the service, and for JOGO, how to monetize” recalls Sanjai. “We began with selling the product with training attached to it. This didn’t take off. The service delivery lacked discipline and the product was not exploited to the fullest extent to deliver outcomes to patients.”

It was around this time that Sanjai met Siva Nadarajah. “Siva had just sold his start up (Semantelli) to IMS Health (now IQVIA), and was leading digital health initiatives at IQVIA. JOGO interested him very much. Siva was my first investor – he helped change the business model: from selling the device to selling the treatment delivered using JOGO” says Sanjai. “Siva helped put a strong layer of clinical evidence and protocols behind the product.”

Seeing the results of JOGO therapy for his friend’s daughter who has cerebral palsy, Siva quit a comfortable job at IQVIA, running a business unit tracking $500M ARR to come onboard as JOGO’s Co-Founder and President. This patient was thirteen years old, couldn’t stand on her feet or walk. Her father had to carry her everywhere -including bathroom visits. The father’s ask of JOGO was to somehow make his daughter walk and be independent. His anguish was compounded by futile treatments from numerous specialists over past 13 years that cost a lot of money with very little to show for it. “JOGO set up a therapy session and we shipped the device and trained a therapist in Nashik, Maharashtra. Within three months, the girl was able to walk with the aid of crutches and is now reasonably independent.”

JFK Hospital in Edison, NJ, gave JOGO their first couple of patients, and the results were amazing, and the data that they were generating was “blowing our minds.”

“Every time we gave the machine to the hospital, I had to forego demonstrations for a few weeks,” laughs Sanjai. “We had to follow up and ask for the machine back—since I had funds to build just one.”

Loaning the machine to hospitals – for free – paid off spectacularly. Johnson & Johnson Innovation’s JLABS selected JOGO from among 5000 therapeutic companies worldwide, based on data from hospitals. JLABS helps promising therapeutics reach global scale. This was a big validation for a small startup.

Just as the 1st wave of pandemic shut down much of the world, a door opened for JOGO to offer its therapeutic to patients in the US: FDA approved clinical use of JOGO for patients. Clinical studies and commercialization were now possible. Harvard Medical School was impressed with JOGO device and set up an 80 patient clinical study – treating chronic low back pain with JOGO. Study has shown promising results and is expected to conclude in 2nd half, 2021. This was a key win in the middle of a pandemic.

JOGO had discovered a universe in a grain of sand—from solely focused on stroke, today the company delivers therapy-as-a-service using its digital therapeutics for any chronic residual disability: Chronic Pain, Stress Urinary Incontinence, Voiding Dysfunction, Mixed Incontinence, Pelvic Organ Prolapse, Post Prostatectomy Incontinence, Erectile Dysfunction, Functional Constipation, Defecation Dyssynergia, Chronic Pelvic Pain, Chronic Constipation, Parkinsons – Dysphagia, Dyskinesia; Guillain Barre Syndrome, Cerebral Palsy, Multiple Sclerosis, among others.

Most recently, JOGO became a part of ‘Long COVID alliance’ – a patient advocacy group in Washington DC, tackling post COVID disorders such as chronic fatigue syndrome.

“The NIH has invited us to participate in a program to wean people off the substance addiction—we are literally rewiring the brain to reduce oversensitivity to pain so that people don’t have to depend on substances to reduce their pain,” says Sanjai. “We are now on track to offer a full-service therapy program, and working with insurance carriers to enable reimbursement for patients.” From the back of a napkin, JOGO has grown to a worldwide presence. A universe of possibilities lies hidden in the unlikeliest of places – most often, right in front of our eyes. Serendipity is perhaps an entrepreneur’s strongest ally in discovering it.

 

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