“Russia is a country of patient people who underestimate health problems”: Rim Safiullin, Kale

“Preventive medicine is very expensive, because the check-ups are marketers”

Why did you decide

create medical digital services?

— In 2017, my partner and I opened a clinicpreventive medicine. We focused on checks, inspections and other initiatives that help to identify risks at an early stage and work to ensure that they do not occur. The demand grew - more and more people were interested in health in the early stages. We soon saw the problem that customers face - preventive initiatives are very expensive, because the check-ups are made by marketers. They usually include everything that is in the price list of the clinic.

Rim Safiullin

In parallel with this, we got acquainted with the medicaldirector of Yandex, they then wanted to launch the Yandex.Health platform. I asked for an audience with this person, said that we were developing preventive medicine and would be happy to join their project. Surprisingly, after 3-4 weeks we became one of the first partners of the service - we began to help them with medical power. So we began to understand how the telemedicine market in Russia works.

In 2018, my partner and I first learned thatsuch startups, venture market, capitalization and fired up with this idea. They rolled out the first startup in which they made all the traditional mistakes - they didn’t show the product to anyone and worked on it for too long. By the middle of 2019, a check-program constructor was made - a robot that interviewed customers and, based on these surveys, formed an individual check-up program. We removed all unnecessary analyzes, so our checkups were about 40% cheaper than the market ones. Then the client went to partner clinics, and we received a commission. History did not fly - the economy did not grow together. We got a client for 10 thousand rubles, and received about 3,500 agency rubles from him.

— How did you solve this problem, how did you transform the product?

- We were told that adults have a headcrammed with a completely different one - how to change tires or arrange children in a university. And what should we think about children, because by starting a preventive approach from a young age, you can achieve very good results. We regrouped and did something between tamagotchi and child health management. It was an app downloaded by young mothers. There it was possible to create a child's account, and then, in accordance with WHO recommendations, we gave tasks on what should be done at a certain stage in the child's life. For example, Mashenka is eight months old - WHO recommends showing her to a pediatric neurologist.

But the parents deleted the application after 1-2 days - theyit was difficult to master a new IT solution. They did not want to delve into it, it was easier to continue to intuitively act on their own. And then we decided to cooperate with pediatricians from polyclinics and offer their services to clients by subscription. They were supposed to become family specialists with whom you can correspond on Telegram and learn about the necessary vaccinations. Clients liked this business model, in a month and a half we gained more than 200 users. Then we began to build a system around this in the form of an application where you can consolidate all medical documents. And inside there is a specialist who will give his recommendations on these documents.

- If this model has gone, why did you decide to change again and acquire an even larger shell around?

At the same time, we saw that manyClients ask us non-core questions. For example, about the health of her husband or a situational medical problem with her mother-in-law. We decided not to limit the user and called our doctors not subscription pediatricians, but family doctors. Then we changed the name - they began to be called CloudDocs (as we say - "doctor in the cloud"). And since medical activity is very overregulated, I wanted to move away from this and position myself as a preventive service. We just didn’t want to hear criticism like “How can you help a person on the Internet who has something sick?”.

But here, too, we have a new problem.Physical health tracking does not last long - a conditional 36-year-old man who works in an office will receive all our help in 2 months, the rest will be hyper-prophylaxis. Therefore, users left our service after 1-2 months, and no one would invest in such a startup due to the limitations of its model.

Therefore, we decided that we can talk to the clientnot only about tests or ultrasound, but also about nutrition, sleep, lifestyle. This is no coincidence - according to WHO, 50% of good health is a lifestyle, not medicine. We bought courses, books, organized the retraining of our specialists. But we faced the fact that a traditional doctor from a university, as a rule, does not have the best communication skills in order to build long-term relationships with a client. He is more focused on finding a problem and solving it, but here there is no problem - we are proactive. Therefore, we went in such a direction as health-coaching - in Russian it is a healthy lifestyle specialist. He talks to a person about a lifestyle and what can be changed in it.

It was 2021, we began to grow smoothly, but this is notthere was a multiple growth - the hockey stick was not drawn on the chart. We again decided to change something - we showed this story to corporate clients, offered ourselves as an additional social package for employees. We have an office in Innopolis, so we went to the neighboring guys. We were not immediately accepted, as we were later told, in general, few people look at the product, but more at cases, but we didn’t have that. Therefore, everyone said that it was cool, but they did not go to paid versions.

- At what point did you come up with the idea that all this should be in the shell of a virtual assistant?

- That's when the product began to be called Kale -if someone does not know, this is kale, which has a huge amount of vitamins. At the same time, free pilots were invented for corporate clients - they can use our product for free for a month and see how it works, how employees react. This format has worked — since the beginning of 2022, we have been actively working in this direction.

These clients have been involved in shaping ourproduct - they asked to return the service of doctors and psychologists. Now the core of our product is mental, because this issue is the most pressing. Companies want to avoid the undesirable conditions of employees - burnout, stress, painful thoughts that affect work. During the period of competition for personnel, one cannot lose an expensive specialist who finds himself in such a state. In large companies, it is difficult to keep track of each employee, it is almost impossible to constantly find out how everyone is doing, and this is what we help our clients with.

Kale Service

“Now it’s easy to run into what they call themselves experts using controversial practices.”

— How do you differ from standard VHI, why do companies choose you?

- There is a big problem in this area - recyclingservices. For example, the industry standard for the disposal of VHI is about 10%. This means that if you buy VHI for 100 employees, spending a lot of money on it, only 10% of them will use it. The company simply throws away the rest of the money, because the insured event does not occur. Therefore, we came up with a virtual assistant, Cale, who can help a person in many life situations.

They began to teach her on the records of copyright content,videos, podcasts and conversations, scenario funnels. But if you directly ask a person about painful thoughts, he most likely will not join the question and will not answer as it really is. Therefore, it is necessary to ask leading questions - was there a situation when you could not rejoice in a circle of friends and you had thoughts that constantly distracted you? And what did you do with it? How satisfied are you with your response? And how does this affect your life?

Next, Cale pushes the person to turn toto the specialists that we have on board - go to chat or take a video consultation, do homework - write an essay, keep a diary. Interacting with customers constantly, we get high utilization, about 40-50%. Therefore, we tell companies that there is no need to pay upfront - you can first introduce the service into the team, and pay only for actual calls to specialists and completed cases. And employees will not accumulate small problems in their heads, which then will critically affect the quality of life and the level of work.

— Who are your clients, other than companies? Who are these people who come to you?

We currently have a minority of such clients.And then these are the people who remain after corporate programs - for example, a person has exhausted the limit of consultations and decided to buy them on their own. There is no promotion format where we are trying to sell services to individuals. They appear with us, but this is not the result of our marketing activities.

— And how do you check the competence of specialists? Recently, there has been a boom in psychologists who are not professionals.

— Yes, now it's easy to run into how theycall themselves specialists using controversial practices. Therefore, we have input testing from a fairly large pool of questions. The goal is to immediately identify those who tend to use unproven techniques. We communicate with the rest in video format, where, among other things, consultations are being analyzed. If we like everything, we study documents, ask formal questions about experience, check education. Next is a trial period, where we observe the specialist, at the same time the user rating system works. Their feedback can also be a hint or confirmation for us that the problem exists.

— Have you encountered negative feedback from the medical community? Not everyone makes such innovative decisions in their field so easily.

- We definitely did not meet negative ones.Conventional medicine deals with urgent matters - situations where help is needed right now. We do not do this, but we try to help the patient even before he needs urgent help. So we are rather helping traditional medicine and advocating that people want to manage and monitor their health.

But isn't this competition? If you work well, people will go to the hospital and ask for help less.

— But it is also important to note that we send peopleto doctors in situations where they need it, but they do not go. Russia is a country of very patient people who tend to underestimate health problems. If a resident of another country would have turned to a specialist long ago, a Russian person will say: “It hurts and hurts, it will pass.” So we send people to medical facilities who would never go there.

“We send those who would never go there to medical institutions”

Will your and similar systems improve the public health system? Can they help doctors?

— Success in the public health systemmeasured by how many urgent situations managed to be solved. In other words, the merit of medicine is not how many people do not get sick, but how many people it cures. Our approach is different - all our interest in working with clients lies before the clinical stage. I heard a phrase somewhere that modern medicine begins with a doctor, and the medicine of the future will end with a doctor.

This communication with the patient before he hasproblems arose, a very important stage for us. And this goes in unison with the tasks of the MHI, where they want to solve the high workload on doctors, therapists, first-line specialists, who receive a large flow of even non-core requests.

— What will telemedicine change for doctors?

— In parallel with the medical market, thea huge market of gadgets that allow you to take basic metrics from a person. This is not done by a doctor, but by a simple algorithm, and then, if it detects inconsistencies, the attending physician is notified about this. Therefore, you can go to him less often and just work for health according to the methods and understand the general trends that relate to health. Today, there are gadgets that measure glucose 24 hours a day and transmit it to the doctor - it is more convenient to base the treatment strategy not on notepad entries, but on permanent data.

“Everyone needs a virtual friend who knows everything about medicine”

- What will you come to? What is your end goal?

— We see a great response from ourusers to the appearance of a virtual friend who is endowed with high knowledge in the field of medicine. We would like to continue working in this direction - to make sure that next to everyone there is a know-it-all friend who will definitely not tell you anything bad. There is a saying: "We are the arithmetic mean of our environment." And we believe that if you have Cale in your environment, then you will definitely become better. She already knows how to conduct simple dialogues, but will soon learn more professional dialogues. In the future, we want to make it possible not only to correspond with her, but also to call her by video.

Your service is easy to scale. Are you planning to develop abroad? Or are there regulatory issues?

— We already have several clients from the CIS.By the end of the year, we are planning the first pilots in Asian countries. From what we see from market research, there are no strong restrictions that will prevent us from scaling quickly. Rather, the question is personalization - what do those customers who live in other countries need? For example, some talk about sleep problems, others about nutrition or anxiety. Such personal stories may differ from country to country, and they also need to be spoken about in different ways.

— How do you want to develop the service? Will you train the assistant further?

— Yes, we want to train him using machine learning.education. We need to make a more complex mechanism that understands much more conversational scenarios. So that we understand what the person who communicates with us is really talking about. Therefore, we are faced with the task of writing a huge number of datasets. But when we teach a robot to talk, we need to filter out incorrect recommendations that the device can give.

But that's not what we think about in the office whole.days. We are more focused on making the service as clear as possible and we can hear our users. We believe in them - they tell us how the service should look like and what we need to talk about with them.

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