#6 – Laying the rails (Josh Clemente & Ben Grynol)

Josh Clemente: I call this guy and I say, “Hey, my name’s Josh, been trying to get in touch with you all, would love to meet ASAP, I’m in the area.” And he was like, “Great. Let’s do three o’clock.” I was like, “Oh, awesome.” So I hang up and Casey walks in the door and it was basically, “Hey, Casey, great to meet you in person, this is David, this is Andrew, do you want to come and join us at a meeting with Truepill? This is kind of an existential conversation for us. We were working on getting access to basically building out an above board access pathway for a CGM and this is a core piece.”

Ben Grynol: I’m Ben Grynol, part of the early startup team here at Levels. We’re building tech that helps people to understand their metabolic health and this is your front row seat to everything we do. This is A Whole New Level.

Ben Grynol: The early days of bringing any new technology to the world. There’s a lot of focus on building the ecosystem that surrounds it, laying the rails, developing the infrastructure that allows a new technology to exist. And that was very much the case with Josh when he started building Frontier Biometric. What eventually became Levels. Who’s this uphill battle trying to bring things to market and it wasn’t easy, but he kept going. He was focused on building this physician network and figuring out what infrastructure was actually needed to bring this tech to the world.

Ben Grynol: As he tried to get more meetings, as he tried to convince more doctors, more physicians, more policy makers, everybody that metabolic health and the crisis around metabolic health was a real thing, and that continuous glucose monitors could help people to get their own biometric data to better understand their metabolic health. It was basically a Sisyphean endeavor and the more he kept going, the more that he and Sam had started to connect with other people to bring on more co-founders. David Flinner, head of product, Andrew Connor, head of engineering, and Casey Means, the chief medical officer for Levels. The more this co-founding team started to come together, the more that things started to fall into place. And each one of them was instrumental in laying a piece of that infrastructure so that Levels could come to life.

Ben Grynol: Tell me, where we left off last time?

Josh Clemente: I wish I could remember.

Ben Grynol: I’ll tell you. Okay. So, in June you and Sam had this assemblage and that’s where a bunch of your friends and people you knew came together and one of the people that you ended up connecting with was Andrew. Andrew Connor is head of engineering and he came on board to lead engineering and he started really opening up some of the thoughts towards how do you actually solve this problem from a tech perspective. Things that were on the radar, but hadn’t come to light yet. So, fast forward, Andrew joins the team in the Fall and then around the end of December, December 19, January 20 is when Casey had come on board, and that’s where we had left off. Casey Means who is the chief medical officer and the fifth co-founder of Levels.

Josh Clemente: Yeah. So, things moved quickly with David, things moved quickly with Andrew, things moved quickly with Casey, but Casey started out because she had a full-time practice as a physician, she started out as a contractor, basically wanting to contribute to the vision of Levels. And one of the core philosophies that we have is that education is key to accomplishing our priority of solving the metabolic crisis because people need to know that this exists and right now most don’t. And so she started out very much focused on the content side and wrote some of the initial, foundational pieces on what optimal glucose levels should be based on a compendium of research that exists today. Looking at the background research on CGM use in the non-therapeutic case, and breaking out all of these exceptional topics for exploration to help get our first steps behind us and the content effort.

Josh Clemente: That was immediately such a beneficial addition to our team. She brought clinical experience. Obviously she brought awareness of outcomes, not just as a physician, but as a surgeon had having seen the very long-term effects of metabolic dysfunction and inflammation. Then she also as an editor of numerous journals and papers in her past had a killer sense for good writing. She quickly had some really exciting stuff ready for publishing. So we threw together a blog and started posting her stuff. She and I were working pretty closely together on some of the initial, fundamental articles. Initially I think she had wanted to stay fairly focused on her practice, but she was letting us know that part of why she was searching for something like Levels is that she actually wanted to build it herself.

Josh Clemente: She had had this idea to scale the benefits of a functional medicine practice beyond her own sort of individual contributor capability. One doctor can only achieve so much with their direct first degree patients. So that’s what she was looking for and we knew that she had that desire to make a meaningful impact to go well beyond just her practice. So, on the team, we were just so blown away by her execution and her as a person, we were like, we got to get her full-time. So we started those conversations as early as we could in the contract and by early 2020, she was ready to make that move. I think she had had enough time to explore Levels as an organization, the team, spend time with us and understand how we were looking at the space and build the confidence in the execution plan.

Josh Clemente: And I think that kind of set her mind to joining. So that became a very easy transition. It’s funny, thinking back to when we were first talking to Casey, I had had a few calls with her, and then, this is really funny. There was a time when David had wrapped up his Google work and he was getting ready to move cross country to New York. And this was, I think, early July, maybe late July. And we had started talking to Casey. She was very new to the group and very new to Levels. And I flew out to San Francisco to hang out with David and try to get a conversation with Truepill, which is an organization mail order pharmacy and kind of a telehealth company now. And Andrew also, who is in Sunnyvale.

Josh Clemente: He he came up to meet us as well. So I was talking to Casey, I was thinking maybe she can come and meet David Andrew and I in person and this will be great. And ended up the Sam joined us. So we kind of had this impromptu meeting in San Francisco and Casey decided to fly down from Oregon and join us. And the way this played out is that we’re at David’s, completely empty, house in NSF and Casey who none of us have met yet. I’ve just had a few calls with her, is coming there to just hang out. And we were like, I guess we’ll just talk and just hang out here and kick it while David finishes up some house tasks. Like an hour before Casey shows up, I’m still working all angles to try to get a meeting with Truepill.

Josh Clemente: We’re a company that barely exists. It’s kind of hard to track down a way to get in front of the executive team there. And I just ended up calling the pharmacy line of Truepill and asking for a specific name and the person at the pharmacy was like, sure. And she just gave me the cell phone number. And so I call this guy and I say, Hey, you know, my name’s Josh, I’ve been trying to get in touch. You all would love to meet ASAP, like I’m in the area. And he was like, great, let’s do three o’clock. And so I was like, oh, awesome. So I hang up and Casey walks in the door and it was basically, Hey, Casey, great to meet you in person. This is David’s. Is Andrew, do you want to come and join us at a meeting with Truepill?

Josh Clemente: This is kind of an existential conversation for us. We were working on getting access to basically building out an above board access pathway for a CGM. And this is a core piece. And she was like, sure. So we jumped in an Uber, like 20 minutes later go to this meeting. Casey is literally, this is, I don’t know her third conversation with me or anyone at the team. And we’re in this meeting essentially pitching troop hill on our vision. And she just jumped straight in, I mean, understood based on our conversations, what we were trying to accomplish. She was like a few times was able to offer some really significant pieces of just vetted perspective as a physician about why this is important and interesting. And so, literally on an hour and a half after meeting us in person she’s in there rubber hitting the road and we left that meeting and it was extremely positive.

Josh Clemente: We had a contact,, an account manager, who is basically verbally committed to our account and ready to just start moving on the logistics and sourcing of these devices, the primary product that we need to build the levels program. And that was, that experience was so awesome. We went to dinner later, Sam joined us and it was just really fun. And I think that is kind of an example of Casey just jumped straight into the fire with us. No questions asked, was happy to do it saw the inner workings saw like startup world works and, and the fact that this meeting did not exist until it did. And we were in the room an hour later. And I think she just really enjoyed that. And we obviously appreciated her willingness to be so flexible and so versatile. It was awesome.

Ben Grynol: And So you said that she was instrumental in getting the first few orders out the door.

Josh Clemente: Yeah. I mean that conversation, that meeting, that was the beginning of our, finding an edge to fulfill orders. That was crucial. So her first in-person meeting or conversation with the team was essentially that meeting and was fundamental to us being able to get the first customer orders filled.

Ben Grynol: Let’s break it down. Right. So Levels is the tech platform. There’s the performance cover, which goes over the CGM. There’s a box that as of today, which is March 31st, 2021, there’s a nice Levels branded box. And there’s two CGMs that come in the package with the performance covers in the insert card. But it didn’t start out that way, rewind to January of 2020, or even like December, December of 19. Walk me through what you were thinking when you’re sitting. There’s one photo, it’s the notorious photo of you and Mike Didonato, who is technically the first full-time employee of Levels outside of the co-founding group. You’re sitting on a carpet you’re cutting out performance covers. What did that look like? As soon as you had that Truepill meeting. And as soon as you had that locked in, it was now like, okay, we actually have to get these items to people.

Josh Clemente: The process of getting the sensors out, being able to fulfill these prescription devices was multiple months in the making. That conversation with true pill was a piece of the puzzle, but there was also a lot of regulatory and legal considerations to make, to know how to structure that arrangement and who we needed to talk to and how it needed to happen. So getting that Truepill piece in place was crucial. And by, I think about October, October of 19, we had the fulfillment side ready to go, and so we fired off a few initial orders, like towards the end of it was like October timeframe. And the way those orders were fulfilled is you get a brown box and there’s a prescription process on the background and all of that is done to secure the necessary, the regulatory concerns.

Josh Clemente: These are prescription devices. And so there’s a prescription process which we had built. And then once an individual is approved for a prescription, then this box arrives and it’s just a brown cardboard box with, a random, it doesn’t say Levels anywhere on it. It’s like it has a pharmacy sticker on it. And then inside are these two sensors and then just a bunch of pharmacy paperwork. And it’s actually, you can’t, you don’t even know where this came from, unless you remember what you ordered. And so that’s how the first I got to say like 60, 75, maybe a hundred orders went out. And so people got this sensor system and then we would send them an email. We would try to time this email so that we, we kind of knew when their order was going to leave the facility and so that it would jog their memory.

Josh Clemente: So they would know where this box came from. And then through the email, they would start the process of onboarding, which was very manual. And this is where Mike Didonato was, he joined us in November, but prior to that, it was David and I doing onboarding calls. And so they would grab a time on our calendar. We would walk through an onboarding call and we would get them sort of cued into how this process was going to go. And this was before we had a Levels product, right? There was no app. This was like, you’re going to use a CGM. And you’re going to text back and forth with us about what you’re finding, insights, questions, considerations. And then we would use that as feedback about what structure needs to fit here to fix this person’s experience. Like what is missing such that this experience would be by default insightful for this person, these questions would be answered on their own by the solution that has yet to exist.

Josh Clemente: And so that’s how this kind of prototype beta experience was going to go, that’s how it started off. And then we were like, all right, we have to solve this problem of like inanimate object showing up at your door with no source information, Levels as a brand and we’ve got to get ahead of this. So one of the key pieces was the sensors themselves don’t retain very effectively. It’s pretty easy, especially if you’re not familiar with using one to take your shirt off and peel the sensor off, or when you’re toweling off, you accidentally knock it off or walking through a doorway is a classic one. You never know how close you come to your door jams until you’re wearing a quarter inch sensor on your arm, on the back of your arm. And suddenly, it’s impossible to keep it attached because you come within a quarter inch of your door jam every time you walk through it.

Josh Clemente: That was happening consistently. We were like, all right, there’s an opportunity here to improve the product by improving retention of the sensor. And also add a brand, a branded component that kind of would sit over the Levels sensor and give it Levels brand, and also improve the adhesive footprint. And then we also obviously wanted to improve the packaging experience, which was a separate project, but that picture of Mike and I is, that is a very early prototype of the performance cover. The Levels performance cover that specific version was. And I think we will resurrect something like this in the future, but that was a flexible, 3D printed. I would describe it as silicone cover, which we were applying medical grade adhesive to the underside of. So we had basically, we had a large order of these soft 3D printed covers, which would conform to the arm and they had a larger footprint.

Josh Clemente: They had a branded sort of cut out shape that looked like the Level’s logo. And then the larger footprint, we would apply a multi-stage medical adhesive to the underside, which basically had the same adhesive properties of the CGM sensor itself. And that would sit over the sensor device and help to adhere it. Or that was the idea. So we had sheets and sheets of this, of this medical adhesive. We were punching giant holes in them with this huge, like hammer and hole punch, and then cutting, applying the two-stage adhesive to the underside of the printed cover and then trimming with scissors the profile. We did hundreds of these and it was just quiet backbreaking work. Cause you’re like sitting on the ground. I didn’t have any good workstations set up in my living room. And, I think in that specific instance, it looks like we’re working by candlelight.

Josh Clemente: It’s such a dumb picture, but that kind of tells yoU the situation there. And we just did. I mean, we did hundreds of them, my hands were completely callous from that, that project, which ultimately like the covers performed terribly. The material that is 3D printed has really bad thermal properties and water absorption problems. So it’s, we did it 3D printed because it was a fast turnaround to get a complex shape. Otherwise you have to do an injection molding iteration, which is quite expensive and takes time. So we did this 3D printed thing and that just completely undermined the adhesive because the adhesive wouldn’t stick to this material. And anyway, that project ultimately ended up in our fabric performance covers, which I think work very well. But I do still like kind of the tactility, the robustness of that rubberized cover, we should bring it back at some point.

Ben Grynol: That would not be MVP to go spend 20 grand on a bold, an MOQ of like a hundred thousand units or so

Josh Clemente: Exactly. Especially with the apply the adhesive manually.

Ben Grynol: And that would never be good, but that cover, the way that it looked, that looked very much like this, it looked like the epitome of the biohacker like, it was like this a little, when you look at it back in these photos, it looks like this, it looks very different than the cover does now. The cover now is maybe more fitness oriented or it’s maybe more generic where it, anyone can wear it across different segments and it feels like it’s accessible to them. Whereas the other one felt very much like a biohacker or very sporty, maybe it’s the way that it’s being perceived, but it was very cool, but it’s very different than what we have now. And when you were doing it, was it because there weren’t there weren’t performance covers on the market? Because it seems now, if you go on Amazon, there’s every brand you can imagine has some CGM cover.

Josh Clemente: There weren’t that many, there’s an increasing supply now and the materials are improving. But really what we wanted was to, we wanted to give this thing a hyper futuristic look so that people would instantly have questions. Like, what is that thing? And part of that was transforming the visuals of the sensor itself, which can look, it looks very clinical, it looks very medical. And so there’s this opportunity to improve it while also again, improving the resilience, the adherence to the skin. And so the idea was that while this soft molded piece that changes the profile, but also has kind of a tapered edge and while still being soft and comfortable and in a fairly small footprint will be the best of all worlds. And it will be this interesting product that is, supplementary to feed the device.

Josh Clemente: And I think the current performance cover it does the job. It has retained many of my sensors that I’ve run into door, jams, myself, et cetera, and in pool swimming and such. But like you said, it has a much more, I think it has a much more mainstream visual feel than that previous sort of prototype version. And yeah. You know, it was certainly iterating through that process, helped us understand people’s perception of that shape and of that concept overall, having something that is, that is molded and shaped and looks like kind of a future cyborg component.

Ben Grynol: Things have, have come a long way. Like one of the things that’s interesting is back to what you’re saying about texting. So when things started out, people would text, they were paying for Levels, they were paying $399 for two CGMs. And the idea was that, in their mind, they weren’t buying CGMs, they were accessing levels. And so they had probably this expectation around some experience, which was text messaging at that time. So how did that happen where you, you evolved it from actual texting to the David chat-bot to the first iteration of the product, which was the app?

Josh Clemente: The very, very first part of this was just the team like Sam and David and Andrew and Casey, all getting their first sensors. And so it was like the Josh bought initially, cause I was the only one that had used CGM on, on the team, like until they kind of joined and interestingly many of them, although they were totally bought into the concept and they understood it and they had been reading about CGM. It was, there were plenty of magic moments for each of them. And so that’s where it started as, I was just texting them as they were going through their very first CGM experience. And that became the clear archetype for what a, an initial customer could experience because it was so enlightening, so much more enlightening, I think for them than just CGM on its own.

Josh Clemente: Otherwise you’re spending hours on Google trying to dig up in some dark forum something that is relevant to you that is not necessarily diabetes related, almost all of the information on the internet. Of course, because CGM is designed for diabetes management specifically is related to the management of diabetes with CGM. And so it doesn’t explain for the person without that condition, what they’re seeing. So just having that resource in me, I think was useful enough. And then me watching their experience, I was able to compare that to my own initial experience with CGM and was like, man, I really wish I had this. Just somebody to bounce these questions off because I realized how much I had kind of picked up through and through intuition and experience with using it for a long time. And so we were like, this is fine.

Josh Clemente: People can just like, we can answer a lot of the low-hanging fruit questions. And then those will be like easily compiled into feature requests. And so that process was handed off to the David bot. So as David got more familiar through his own experience with CGM, he very quickly grasped the key, the underlying major mechanisms. And so I was kind of pushing the logistics side of getting CGM’s accessibility through, through Truepill. I was pushing that project and we were finally able to get the first orders out. And those customers began their communications with David and David being had a product he really needed to understand the customer experience, which is exactly what he did. So managing, onboarding, managing just a huge number of daily SMS communications, he was able to just quickly get a feel for the problem space and start kind of architecting app number one.

Josh Clemente: That process actually went on for, for several months. And David had a huge amount of just product work and on his plate and not to mention a whole host of other things. And so, as you can imagine, synchronous onboardings, synchronous, midpoint calls, synchronous, SMS communications, it’s such a huge volume. And even with just a few people in pipeline, we were quickly overwhelmed by the requirements for this David bot. And so that’s when the Mike bot started. So we, we recruited Mike who was one of our early customers and a friend of mine, and just asked him to come aboard and help out with this onslaught of inbound and take over that sort of day-to-day communications associated with the experience. And that was huge. Being able to alleviate the others, myself, to focus on logistic stuff, packaging, et cetera, David, to focus on starting the real product process was crucial. And Mike was able to just like slot right in.

Ben Grynol: Have you started your, my mind is mushed, dude. I got to eat. Glucose experiment yet?

Josh Clemente: I have not. I will probably do that thinking Saturday.

Ben Grynol: Oh, I’m so scared to do it.