How moving to the US completely changed the business model of NuvoAir Medical? An interview with Lorenzo Consoli, Founder and CEO

_Chronic respiratory diseases affect approximately 500 million individuals worldwide and are often linked with heart failure. In the United States, COPD and Chronic Heart Failure (CHF) alone account for a combined annual cost exceeding $100 billion. In light of this significant impact, how does NuvoAir Medical redefine chronic heart and lung disease management with their value-based specialty care platform?

Chronic heart and lung diseases affect millions worldwide, posing significant challenges to both individuals and healthcare systems. Limited access to specialized care aggravates patient burdens and drives up healthcare costs. Conventional care approaches frequently lack continuous monitoring and prompt interventions, resulting in suboptimal outcomes and unnecessary hospitalizations.

Proactive monitoring solutions, utilizing user-friendly devices like spirometers, blood pressure cuffs, and activity trackers, produce personalized data that enables early diagnosis and real-time management of patient health changes. Integrated within in-person and virtual care options, these innovations ensure timely and complete clinical care, leading to improved outcomes, cost reduction, and effective condition management.

Moreover, leveraging advanced technology for continuous remote monitoring and implementing personalized care plans represents significant progress in managing chronic heart and lung diseases. Providing continuous access to health data not only empowers clinical teams and primary care providers but also fosters a practical approach to wellness management, enabling individuals to take control of their health and improve the quality of their moments at home._

In a candid conversation with Lorenzo Consoli, Founder and CEO of NuvoAir Medical, we explored the company’s transition to the U.S. market, highlighting its shift to a value-based specialty care platform for managing cardiopulmonary conditions like COPD and CHF, while emphasizing strategic partnerships, lessons learned, and company’s plans for the future.

Research2Guidance: NuvoAir Medical has established itself as a prominent brand in Europe since 2017, pioneering the collection of respiratory endpoints in the home. What is your current business model?

Lorenzo Consoli: In early 2022, we moved our business from Europe to the U.S., pivoting to a model that sharply contrasts with our European operations.

We collaborate with cardiologists and pulmonologists who value their autonomy, want to continue practising in the community and remain independent. Our partnerships offer them substantial benefits, such as enhancing patient care, offloading administrative tasks, increasing revenue by expanding their patient base and leveraging new CPT codes, and transitioning them towards value-based care. We are facing dramatic reductions in access to cardiology and pulmonology care in many of our communities, and we aim to maintain as much access for patients as possible, in a way that gives doctors the freedom to practice medicine.

Additionally, we work with entities like Health Plans and ACOs that face challenges in engaging and managing high-risk cardiopulmonary patients. We help by reducing medical spending and increasing quality scores with a wrap-around team-based care model that includes cardiologists, pulmonologists, respiratory therapists, LCSWs, and health coaches. A comprehensive approach to cardiopulmonary care, melding in-person and virtual access, across disciplines, has not been done before, but is sorely needed by patients suffering from these debilitating chronic diseases.

Research2Guidance: How do you do that?

Lorenzo Consoli: Our platform and care model, developed over two years since our move to the U.S., breaks down the traditional silos in healthcare, enabling seamless coordination among all parties involved in managing complex patient care. It allows cardiologists and pulmonologists to focus on patient care rather than administrative tasks by efficiently handling back-office functions, including Revenue Cycle Management (RCM) and payer relations and contracting to name a few. Furthermore, our proprietary population health tool is integrated within the electronic medical record, enhancing patient coordination, and streamlining workflows. Additionally, we offer a comprehensive virtual care service that enhances patient outcomes and extends their practices into the home, where patients need it most.

This approach is appreciated by specialists who want their patients to have access to constant care, quick appointments and in-home programs like virtual pulmonary and cardiac rehabilitation.

Unlike others, we unify heart and lung care, as these systems often impact each other. This integrated approach delivers more holistic and thorough care for patients with these interconnected needs.

Research2Guidance: Given this patient population tends to be older, do people engage with a virtual care model, or is additional encouragement necessary?

Lorenzo Consoli: Certainly, that’s a good point. However, let’s not forget that our virtual care is designed to augment, not replace, the care from specialists, making it inherently hybrid. Engagement levels indeed vary – some patients are more ready to engage with a virtual care team, while others might need a bit more prompting.

We’ve built our platform with this in mind, ensuring it offers the right amount of encouragement. It supports patients in carrying out essential tasks like sticking to medication schedules and following their care plans, without feeling intrusive. We use a mix of communication methods—texts, automated calls, emails—and have coaches dedicated to each patient to help build trust and a sense of connection, keeping them active in managing their health.

Research2Guidance: Over the years, you’ve partnered with various healthcare stakeholders. Could you introduce some of your recent partnerships?

Lorenzo Consoli: In September 2023, we unveiled a significant partnership with Security Health Plan of Wisconsin, an affiliate of Marshfield Clinic Health System. Through the PROMISE study, we aim to evaluate the effectiveness of our virtual care model compared to standard practices in reducing exacerbations, ER visits, hospitalizations, readmissions, and overall costs of care for COPD patients. This decentralized 12-month study involves up to 1,500 participants, highlighting its extensive scope and significance.

In January 2024, we announced a collaboration with Cary Medical Management (CMM), a leader in transforming traditional primary care into high-performing value-based care clinics. This partnership aims to enhance the capabilities of primary care clinics under CMM management, enabling them to provide comprehensive care for patients with complex heart and lung conditions.

Research2Guidance: You founded the company in Europe and now your focus is on the USA market. Are there distinct strategies and business models in place?

Lorenzo Consoli: In the UK, for instance, our business model diverges significantly. With the NHS, our objective is to aid clinicians in optimizing patient management. We provide technology and extend clinical support through respiratory therapies and coaching, aiming to enhance their capabilities without directly assuming a clinical role.

Conversely, in the US, we undertake full responsibility for patient care, operating as specialists. Our enhanced capability in various respiratory conditions strengthens our clinical model, allowing us to measure different endpoints and improve patient care significantly. Operating on a hybrid care model, we aim to enhance outcomes and reduce healthcare costs by preventing exacerbations and slowing the progression of chronic cardiopulmonary diseases.

Our ability to provide care in-person with our affiliate practices and partners as well as virtually gives patients the options they want and deserve in managing their care. We can also better align our entire care team to our model in ways not possible in the UK, with full data sharing and collaboration across disciplines.

Research2Guidance: How large is the addressable market in the USA?

Lorenzo Consoli: To provide you with a perspective on the market size in the USA, consider Chronic obstructive pulmonary disease (COPD) and Chronic Heart Failure (CHF), their combined cost is over 100 billion dollars annually in care costs. When factoring in Asthma, these three conditions account for over 3 million hospitalizations each year.

In terms of population, we’re looking at roughly 25 million individuals in the US that could potentially benefit from our care model.

Research2Guidance: Congratulations on the FDA clearance for the in-home use of the Air Next spirometer. What does this mean to you from a commercial perspective?

Lorenzo Consoli: Thank you. It is a significant milestone for us.

Previously, our Air Next spirometer was cleared for in-clinic use, and we were fortunate to leverage the in-home use under the Covid exemption. However, with the recent formal 510(k) clearance for in-home use, we can bring an important component on pulmonary medicine right in the home where patients need it the most.

Just envision the convenience and peace of mind this offers to individuals grappling with conditions such as COPD, Asthma, or ALS.

The data generated by the Air Next spirometer isn’t just about lung function data. It enables our clinical team to intervene swiftly at the first sign of trouble, offering immediate care to prevent further decline and avoid unnecessary hospital visits. It also makes every visit they have with their doctors more useful now that patients have their own longitudinal lung health data.

Research2Guidance: At NuvoAir Medical you are leveraging AI technology. What are your reflections on the current hype surrounding AI?

Lorenzo Consoli: AI is certainly captivating, especially in the context of patient care. Each patient presents a complex, multi-layered profile, demanding personalized interventions to maintain engagement. While human efforts to match individuals with the right interventions have limits, AI shines in this very aspect.

At NuvoAir Medical, we’re crafting an AI framework to enhance engagement and tailor clinical interventions. The trend is clear: to stay ahead, companies must weave AI into their fabric. It’s not just about jumping on the bandwagon—it’s about thoughtful and sustainable implementation. AI’s integration into every sector is inevitable; we’re just on the cusp of realizing its full potential.

Research2Guidance: What lessons have you learned in moving your business from Europe to the USA?

Lorenzo Consoli: Reflecting on our transition from Europe to the U.S., the most striking lesson has been the sheer complexity of shifting a business across continents. I have initially underestimated the effort needed. We made a strategic move by tailoring our organization specifically for the U.S. market instead of transplanting our European model. That took a significant financial and intellectual effort.

Understanding the distinct dynamics of the U.S. healthcare market was another key takeaway. The local nuances are crucial—they shape how healthcare entities function. It’s essential for any healthcare entrepreneur to grasp these nuances and ensure they’re addressing a market that’s large enough to be worth the effort.

Cultural differences were also enlightening. I had to adapt my leadership style and learn the cultural subtleties that come with managing a team spread across various regions. This complexity added a new dimension to our operations.

Finally, the pandemic accelerated our growth and shifted us to a virtual team model, which brought unique challenges. Keeping the team motivated and fostering a unified culture remotely required more deliberate action than I realized. It’s been an enlightening journey, and these lessons continue to influence our path forward as we grow.

Research2Guidance: What lies ahead for NuvoAir Medical?

Lorenzo Consoli: We are rapidly expanding in the US market and aim to maintain this growth rate in the coming quarters. As previously mentioned, hundreds of thousands of patients could benefit from our care model, and we believe we are just beginning to scratch the surface. However, rapid growth carries the risk of compromising the quality of care. Therefore, our top priority is to ensure that our expansion does not undermine the quality of care we provide to our patients. Maintaining a high standard of care throughout our growth is of utmost importance.

From a product perspective, we are very excited about the future. We have a clear vision of how we can scale our care model, the necessary automations, and how to integrate AI throughout the patient journey to personalize and optimize the care for our members. There’s no better time to be part of NuvoAir than now.