#143 Vital Audio

I’m Josh Muccio, this is The Pitch, where startup founders raise millions and listeners can invest. The pitch for Vital Audio is coming up right after this.

When I first met Nyamitse-Calvin, he told me that he’d developed a novel technology that would save lives.

Sounds pretty cool! But there’s a problem. Historically, a lot of this life saving innovation ends up being crazy expensive, so then not everyone gets access. Kinda dampens the whole life saving thing.

But THEN Nyamitse-Calvin told me that his technology uses something so simple, so unassuming, that everyone can access it. You don’t need to buy a device, download an app, or even go to the doctor to use it.

All you need to do is pick up the phone.

Nyamitse: Hello. 

Charles: Good afternoon. 

Today, Nyamitse-Calvin is pitching Cyan Banister

Cyan: Hi. Cyan.

Nyamitse: Nyamitse-Calvin.

Charles Hudson

Charles: Hey, I'm Charles.

Nyamitse: Nyamitse-Calvin.

Charles: Nice to meet you.

Mac Conwell

Mac: Mac. 

Nyamitse: Nyamitse-Calvin. Nice to meet you. 

Jesse Middleton

Jesse: Jesse. 

Nyamitse: Nice to meet you. 

And Lee Jacobs, with Long Journey Ventures

Lee: Lee

Nyamitse: Nyamitse-Calvin. Nice to meet you. 

Nyamitse: So what if I tell you that we could take eight seconds of your voice and share your cardiac status with you. 

Cyan: Let's do it. 

Jesse: Yeah. I'm in. Let's do it.

Nyamitse: So as I mentioned, my name is Nyamitse Calvin, and at Vital Audio, we did just that. Our story actually begins with a tragedy. I moved to the US in 2014. My mom had joined us to the US, and in less than a year, she lost her life due to complexities of navigating care. So the death of my mother and the lives that I've actually had the privilege to not only touch but also provide care as a clinician, motivated me to actually build Vital Audio. In under two years, we've developed the technology that takes in human voice, isolates cardiopulmonary frequencies, and reports heart rate, heart rate variability, lung capacity, and respiratory rate. We've submitted two patents. Moved a step farther to actually secure our FDA exemption. And our technology is ready to go live with our five first partners, covering six states and over four million lives across the US alone. I'm here today raising three million to transform the 4 billion calls that are requesting care around the world, and to establish Vital Audio as a global leader in digital vocal biomarkers I'm happy to do a demo. 

Cyan: I would love to see a demo. 

Nyamitse: So that you can also see the technology. Josh here has volunteered to be -

Jesse: Hi, Josh

Josh: Hey guys!

Nyamitse: - our guinea pig. 

Cyan: All right. 

Jesse: I know that Josh didn't sleep as well as he should have last night.

Mac: HRV.

Josh: My recovery score is at 3%. 

Nyamitse: Right. That's good. So, he's going to receive a phone call. I'm going to turn the screen towards you. He's going to use a monotone, like an eight second vowel sound of ahhh, and then once the call ends, we'll have his measurement right here. So, I will go ahead, place the call. 

Josh: I’m so nervous

Jesse: Your heart’s probably pumping fast

Phone: Hold the tone “ahh” until you hear the next beep

Josh: AHHHHHHHHHHHHHHHHHH

Phone: You have successfully recorded your audio. 

Josh: That actually was pretty nerve wracking. 

Charles: We're watching the screen. 

Jesse: We're watching this heart rate monitor. 

Charles: It's like a little waveform. 

Nyamitse: I hope you're not dead.

[laughter] 

Charles: Oh, we got a patient diagnostics. 

Josh: What does it say? 

Charles: It's got a report. 

Nyamitse: I'll pass it around. 

Josh: So my heart rate is 128. Systolic pressure unobtained. Lung capacity unobtained. Respiratory rate unobtained. 

Mac: Is that due to how far the phone was from him? 

Nyamitse: So no. The first iteration of the product development. We just focused on the heart rate and micro variability. We're focusing on targeting atrial fibrillation and congestive heart failure patients. And then the second patent, that's what it actually covers, all the additional biomarkers, which account for lung capacity, respiratory rate. And we're actually working on a single-lead ECG derived from like the hidden frequencies in the voice. 

Jesse: So he obviously doesn't have a heart rate monitor on him that he's wearing right now, but what does your data say? How accurate, how close is it? 

Nyamitse: So we conducted two studies in partnerships with NYU Langone, cardiology department, and Zipcare Clinic. Reached more than 500 participants across the New York metropolitan area. The technology actually performs at 96 percent accuracy compared to gold standard ECG. 

Jesse: Got it. And the future diagnostics that are covered under the new patent, will you expect them to be roughly as accurate? 

Nyamitse: Yes. 

Mac: You mentioned your FDA exemption. Can you talk to us about that? What is the exemption? How did you get it? Did you get a contractor? 

Nyamitse: Yeah. So the FDA process, I actually did it myself. Like, took three months to actually sit down, did my homework. Once I completed that, I did my first FDA presubmission, We received a non-significant risk designation from the FDA. And we wanted to actually put the technology forward to the general population because the technology, the more data it's actually processing, the better it actually becomes. So we submitted the data that we already had. At that point, we're actually around 90 to 94 percent accuracy. And FDA, upon reviewing, that's when we were actually given the exemption, that we were able to do a large scale deployment for data acquisition, as a data acquisition platform. In the future, we're actually looking to branch into the diagnostic, but that's going to be accounting for all the data that we're collecting this year to get us into the diagnostic space.

Mac: And what do you think is the time horizon for you to get that 510K? [inaudible] you can do with the diagnostics? 

Nyamitse: The FDA has actually shared that it's the first technology that they have encountered that takes in vocal frequencies or signals. So that, we are anticipating maybe a period of 6 to 8 months to actually complete that. 

Mac: To be able to file that exemption in three months and do that all on your own, it's really impressive. 

Nyamitse: Thank you. 

Mac: Not something you see every day.

Nyamitse: Thank you. 

Mac: So talk to us, like, what's your background? Who are you? 

Nyamitse: Yeah. So very first job moving to the US, I was the guy that you didn't want to see in the hospital. I was the guy who would knock on your door and say like, Hey, Mac, I'm actually here to collect your liability, or your deductible. I was that guy. But that actually allowed me to see a lot of, like, the flaws in the healthcare system. I transitioned from that, went into clinical, so I actually worked as a non traditional first responder. In the ER, I was supporting a paraplegic physician. So he was the brains. I was the hands and so forth. Later on, I actually navigated and transitioned into clinical research. My first clinical research was focused on leveraging 3D technology in trauma and orthopedic intervention. And then I dove into the biomedical engineering space. So my training or my specialty in the biomedical space is interactive medical robotics with subspecialty of digital signal processing. 

Lee: Talk to us a little about the market opportunity. Obviously the technology is really cool. We saw it happen. What's the first set of customers? Like, what's the status quo right now? Cause clearly they're getting the data, but what does voice unlock? 

Nyamitse: So, with the five partners that were going live, all together, we've built a pipeline of 1.5 today, with about 800 in contract revenue closed 

Lee: 1.5 million? 

Nyamitse: Yeah. 1.5 million. The first stage which we're focusing is the cardiac space. We're focusing on congestive heart failure. We're going to be expanding into pulmonary space, focusing on lung transplant patients, COPD patients. And then the next phase is going to be the medication adherence. If you're taking your medication, is it working? Are you tolerant to your medication? How do we adjust that? 

Lee: And is the hospital system the payer? Or - for the first market?

Nyamitse: Yes. We have one path that the payer, the primary payer, is like a hospital system, a call center. And then the other path would be like your average payer partners. So Medicare, Medicaid being able to like bill for those codes. 

Lee: What's the status quo right now? And like, what's the incremental lift voice can achieve? Is it like, don't have to send someone to the person? Is there a labor cost short - like question? Like, what's the -

Nyamitse: Yes. So as you saw, Josh didn't have 

Lee: Anything on his body. 

Nyamitse: Software. He didn't have anything in his phone. The idea behind was, I personally, from like my experience working in the healthcare, we get excited with new technologies a lot. That excitement leads to 10 devices that a patient has to operate. We tend to forget maximizing the opportunity with the existing device. If you look globally in almost everyone's pocket is a cell phone. Patient doesn't have to learn a new skill? The provider doesn't have to learn a new skill. We're just leveraging the existing patient provider communication channel of like, Hey, I need care. I'm reaching out to my doctor. In that call, my doctor, on the other hand, is actually receiving information as I'm actually speaking to him. 

Lee: How do you think of what the ROI is here? I either stop the patient from having a cardiac arrest, which theoretically leads to some cost savings. Like, how do your payers value these things? 

Nyamitse: Yeah. One, when it comes to healthcare, time is everything. Time is money. Time is a life saved. So on average, a provider spends $400 to track a patient with less than 10 percent yield of good data to actually use. So it's cutting the time and cost to access care and preventing those avoidable visits. And at the same time, if you're able to increase conversion rate from like in-person visits to like follow ups, which are actually happening remotely, you're creating room for new patients to actually come in, the patients that need the care. So you're actually increasing and expanding your revenue access. Yeah. 

Jesse: Doubling down on Lee's questions, so your first million and a half dollars in contracts, stretch this out for us two years, three years. Sort of, what is the opportunity with the first product in the US? W hat's each system willing to pay for? Is there a dollar per patient, do you think? Or is there a dollar per visit? It's just - how do you think about the larger opportunity? 

Nyamitse: As far as from all the numbers and engagement with the customers that we've actually had, from the payer partners, it's north of $3 from a general cut. uh Hospitals' call centers is north of $5 and we're actually looking at per rate, per phone call, rather than like a month. So we have a lot of levers to actually drive more utilization. 

Mac: How many phone calls does one of these centers get a month?

Nyamitse: A small practice can process anywhere from 3,000 to 10,000 phone calls monthly.

Mac: And you'll get $5 every phone call? 

Nyamitse: Yeah. And a call center from a large hospital system, annually they process about 250,000 phone calls. 

Mac: So I have to run. I have a situation that I need to go take care of 

After the break, a new investor enters the villa.

Mac: So I have to run. I have a situation that I need to go take care of, but this is really interesting. I know a bit about this market. I've made investments in this kind of space. I have some heartburn from the space, but -

Lee: Pun intended.

[laughter]

Mac: No pun intended. 

Mac: But being based in Baltimore, I actually know the CEO of CareFirst fairly well. With your blessing, I would love to bring this to him, see what he thinks. If something like that was to go well, then my heartburn might be alleviated for a different conversation. 

Nyamitse: Sounds good. Sounds good. 

Mac: It's been a pleasure. Love you all. 

Cyan: Mac's got to bounce. 

Cyan: Bye Mac.

Jesse: We'll turn it into an animated GIF for the -

Cyan: Do you want to reconfigure us, or? 

Josh: No, I think it's just a part of the episode now, and -

Jesse: Are you going to join us? 

Josh: I think I just have to take his spot. 

Cyan: Oh, nice! 

Jesse: After I suggested it, and you pooh poohed the idea, now you're going to take a spot. I get it. 

Josh: Yeah, it's now my idea, so it's a good idea.

Cyan: So I'm going to go ahead and go next. I want to put in 50k. I do need to know a little bit about your fundraising history. 

Nyamitse: Okay. 

Cyan: Like How much have you raised to date? If we could walk through that a little bit. 

Nyamitse: Yeah. So I love competing. It's like my sweet spot. When someone says free money, I'm like, I'm right there. So for pre-seed, we did a lot of non-dilutive totaling north of 150k, For this round, we have about 1.75 that is already committed, and we're actually just working the motion right now.

Cyan: Okay, great. 

Nyamitse: Yeah. 

Cyan: Well, I'm definitely in for 50k. And then one of the people I want to introduce you to is the head of cardiology at UCSF. He invested in Zio Patch. I don't know if that's too much of a conflict. 

Nyamitse: No, no, no. 

Cyan: But it's so different. 

Nyamitse: Yeah. 

Cyan: Yeah. And I don't know what this is, but it's a, it's a heart monitor for things like this, but you have to wear for two weeks.

Nyamitse: Yeah. You but it and then -

Cyan: And that's the state of the art right now, which is, it's this sticker. And you have to shower with it and you have to put plastic all over your chest. 

Josh: Oh, geez. 

Cyan: My child just had to go through this. And so if I could have had my child call every day or several times a day.

Jesse: How much would you child have loved to go, ahhhh, all the time in the phone.

Cyan: Right? But it would have been way better than - because what happened is they're - people are noncompliant with the sticker. 

Jesse: Yeah. 

Cyan: It starts to itch and whatever, it feels weird. And so they just take it off. So we didn't even get enough data. 

Nyamitse: It's funny because there's also one incident where I had like a cardiologist who said, I had one patient who was compliant for the first, 30, 45 days, and one morning she woke up, she was so frustrated because she gets woken up at like 6 am by the system, and she broke the machine. And she didn't want to do it. Yeah. 

Jesse: In the telehealth space I mean, if you think about the innovative players, right? The Roman*, the Hims & Hers, they all do these doctor - Hundreds of thousands, millions of subscribers and they all require -

Cyan: All require it.

Jesse: Heart rate, you know. And blood pressure really is the other one that they all look at. So I would also do 50k in this. So I totally see it in the healthcare system. I think consumer-led healthcare is going to continue to grow. It's a category that I've invested in personally. And so I want to talk to a few of those founders to get some more insight from them. But I think, you know, with some very short diligence, but like I would get in for 50k. And then I would also look at it as our firm. I mean, stepping up, but I think that's - that'd be my entry.

Nyamitse: Thank you very much. 

Charles: Yeah. I'd like to do 25k. I have one - we have a company that does in-home cardiac rehab. I'm like 90% sure it's complimentary, not competitive. I just need to double check with them. 

Nyamitse: Virtual cardiac rehabs are one of like -

Charles: Yeah. 

Nyamitse: - our sweet spot we love them. 

Jesse: Yeah, that would - 

Charles: You could, you could do - I have a feeling you could do a lot for them. 

Nyamitse: Yeah. 

Cyan: Lee, you wanna weigh in?

Lee: Yeah. Yeah. So I think it's super interesting. I'd love to learn a little bit more about the market opportunity. It sounds like some people here are a little bit farther along on understanding that, It sounds, it looks like magic, which is pretty awesome. But we would definitely evaluate it at Long Journey. And, yeah, we're excited. 

Cyan: We're partners. 

Nyamitse: All right.

Lee: Yeah. Sorry. 

Lee: Business partners. 

Cyan: Business partners. Sorry! We can't say that anymore. You can't say that any more.

Lee: We have to make that very clear. 

Cyan: We are business partners. 

Lee: Yeah. 

Josh: How much do you have left in your round? 

Nyamitse: About 1.25. 

Lee: And what valuation is that?

Nyamitse: 8.5. 

Lee: 8.5 post? 

Nyamitse: Yes. And we're in due diligence with like a few of the investors at the moment for that remaining portion.

Josh: Just to clarify, if Long Journey were to invest out of the fund, what would that check size typically be?

Lee: One and a half or 2 million? 

Cyan: Yeah.

Lee: So the rest of the amount. 

Hold the phone. We’ll be right back.

Josh: Just to clarify, if Long Journey were to invest out of the fund, what would that check size typically be?

Lee: One and a half or 2 million? 

Cyan: Yeah.

Lee: So the rest of the amount. 

Josh: Okay. Well, if you could carve out 50k for the Pitch fund, that'd be great. I don't have any portfolio companies to introduce you to. You're one of our first health tech investments ever. And it also means there aren't any conflicts. 

Nyamitse: I love that. I love that -

Cyan: That's 175k committed, I think. 

Josh: I think math says that. 

Cyan: Congrats. 

Nyamitse: Thank you very much. 

Charles: Thank you so much. 

Cyan: Thank you for working on something so incredible. 

Nyamitse: Thank you. Thank you. It was great meeting you all. Thank you very much.

Cyan: Good to meet you too. 

[outside applause] 

Lee: I can see why you guys like this. It's fun. 

Cyan: This, this part is addictive. 

Josh: This is fun. I'm also experiencing this for the first time. 

Cyan: Being - yeah. Sitting in that seat?

Josh: I mean, it kind of breaks the format a little bit. 

Cyan: That's okay. 

Josh: Breaks the -

Lee: That's okay. Sometimes you've got to try something new.

Charles: Go ahead. Try it out.

Josh: I just couldn't bear the seat sitting empty. 

Charles: If you want one of us to go sit over there - 

Jesse: Yeah, you want - yeah. 

Josh: So what's - I mean, we've had a lot of like deep tech, health tech companies over this season, but this one in particular, it seems like you're able to come to a decision here without needing to look much further into the technology. Is it just simply because there was a demo that showed that it worked? 

Cyan: It's more than the demo. It's him. He clearly knows this space very, very well. He is personally affected by it. The demo helped, but you know, obviously, getting the other patented capabilities that he has online are going to be very key. 

Josh: Sure. 

Cyan: The part for me is, one, this is so much cheaper than sending out a Zio Patch. So Zio Patches are like thousands of dollars. 

Josh: Wow.

Cyan: And so the insurance has to cover that. So if you think about this, this is going to cut down the cost of that, and you're getting - potentially they can even prescribe that you have to call in five, six times a day. 

Lee: You happen to have personal experience here. 

Cyan: I have a personal experience. That's part of why - I had to wear a Zio Patch myself, and my child had to wear a Zio Patch. And so, I know what this process is like and so that's why I'm so drawn to it. 

Jesse: Yeah, I had a similar reaction on him. I - it's interesting. So the company that I started was - specifically I designed it because my grandfather had early-onset Parkinson's all the way through until he passed away. And it was about his medication adherence and how it affected him, because as he got older, he just wasn't, you know, he'd kind of say he did it, but you weren't sure. And If he could just answer the phone, talk to his grandson or his child and, like, in that flow, have it - 

Cyan: Where you don't have to ask. Because it's annoying to ask. 

Jesse: Oh God, yes.

Cyan: It causes anxiety. 

Jesse: It's like my grandfather doesn't want me calling me and like, Hey, did you take that? And by the way, how's your tremor doing? You know, whatever it is. So I think for me, there was a personal part to that. I also just, frankly, a lot of healthcare investments require you to believe like a systemic change. Like they require a massive shift in -

Josh: In behavior.

Jesse: - in behavior and how - what payers pay for -

Charles: Infrastructure.

Jesse: And infrastructure. And this, I mean, if I think about it, hundreds of healthcare systems in the country, $5 a call, I think he said 250,000 calls a year. Like there is a business here in just that in what he's already capable of doing, what he's already selling into. And he's proven it with traction. So to me, there's a system that's already in place. We may not like the system; it may be broken. But these things have to happen and it's wildly accessible. 

Cyan: Yeah, exactly. That's the part - everyone knows how to make a phone call. 

Jesse: If you would have had to have called the number, I would have been slightly less impressed. And I know it's not a thing that's difficult but like the way that he's thinking about it is we're going to call you to check on you anyway. So we're going to call you, we're going to have the same conversation, and we're going to get wildly more valuable data, and we can say to you, you're not reacting well. Go to the hospital before you have to call an ambulance, wind up in emergency care. Or you can just take yourself over to your doctor and have them give you something slightly different, because we heard it's affecting you inappropriately. 

Cyan: It might be part of the 911 call flow too. I can imagine, if I call and I'm like my heart and they're like, okay, well sing. 

Jesse: Yeah. 

Cyan: You know, and they're like, yep, you're having a problem. We're sending somebody. 

Lee: How do you guys think about defensibility in something like this? 

Jesse: I believe the patent will hold up. And so that's part of my -

Lee: You do? You have to believe that.

Jesse: That's part of my, I mean, you have to believe that. Yeah. Often in healthcare, it does hold up for a long time. But We have patent attorneys we worked with, we'd say to them, what do you think of this ruling? 

Cyan: There was a lot about him that I liked, by the way. He's so calm and so Zen, but then when he got into the non dilutive capital, he's like, I love competitions. And you just like - you saw this fierceness come out that like, I think was kind of hiding. 

Jesse: Yeah.

Cyan: So I do think that he would defend his patent. 

Josh: What do you think the end state of this business is? I ask because I would imagine him licensing this technology to Apple to incorporate in Apple Health so that everyone can like own their own data. And I know you get this from the Apple watch, but there are so many people that don't use Apple watches simply for style choices, even though they would love to have that data. 

Cyan: I think this is one of many integrations that he can do. I mean, obviously focus in a business is important. And a big customer obviously like Apple is fantastic. But you don't want to just become the Apple company for a variety of reasons. The fact that it's just a phone call means that it can integrate into every telemedicine, if he could develop an API where if anything that you do, you can just - 

Josh: Yeah. You could integrate it to podcasts, to see if the host is feeling anxious. 

Cyan: Yeah. Who knows? Who knows where it goes. 

Josh: You could go back into history and, like, see how - 

Jesse: That's fascinating, actually.

Josh: Right?

Jesse: Go back in history and go see, like, people - I think that's a fascinating concept. That's a whole different thing. But I was thinking about like, Who loses if you win is like one of the questions I ask founders. I have a really hard time figuring out who loses. Maybe it's this one monitoring company or whatever, but I -

Cyan: Zio Patch loses.

Jesse: Like, I guess so. But I'm like in the system. And like, for like humanity - like - it's better, faster, cheaper, right? It's accessible Like that's a unique position to be in. 

Cyan: Yeah. 

Josh: Charles, you haven't said much.

Charles: I think they covered it all. 

Josh: Okay.

Charles: All right.

Cyan: Thank you.

Lee: That was fun.

Cyan: Congratulations, Lee. 

Lee: Yeah, yeah. That was cool. 

Cyan: Did you have fun? 

Lee: Yeah, it's fun. It's fun. I can see why it's addicting. Yeah, yeah, yeah. 

Josh: Sure you don't want to cancel your afternoon? [fade out]

Nyamitse-Calvin walked out of the room with three commitments totalling $125k. And $50k from me via you, the listeners!

But before the checks hit the bank, it’s time for due diligAAAAAAAAAAAAAAAnce [beep]

Cyan: Do you have any peer reviewing of your results?

Jesse: How are you thinking about fundraising? 

Cyan: Do you have a false positive rate?

Jesse: Will you test them, not just technically, but as a business model as well?

Cyan: Can you remind me what my commitments were on the show. 

Nyamitse Calvin: The commitment was 50K. 

Cyan: Okay

Jesse: My hope would be that over the next few months, we spend some time, we make some intros, I support you in whatever way you, you want from me. And potentially we get to a place where we say we'd like to lean in and lead something in the near future. 

Will Nyamitse-Calvin find his lead investor on our show? Join us for the season finale watch party on December 11th to find out. You can register right now at pitch.show/party

No offer to invest in Vital Audio is being made to the listening audience on today’s show, but LPs in The Pitch Fund do have access. You can learn more about the fund at thepitch.fund

Fund I closes to the general public on December 15th.

Next week on The Pitch… 

Jorge: We build technology that makes any mobile app work without the internet 

Jorge: Imagine there's a hurricane. , now you're getting all this information from the Red Cross - 

Jesse: we're receiving images from Jorge on multiple devices that are all airplane mode, only Bluetooth, and they're coming in like real time. 

Jorge: We're going to start with three countries, then we're moving on to five countries in two months. And by the end of the year, we're going to launch it globally. 

Cyan: And are you agnostic to regions? is there any place you wouldn't sell into? Are you just into free speech?

Jorge: I am into free speech. 

Jesse: What are you thinking? 

Josh: I'm thinking, I don't understand why you guys aren't investing. 

That’s next week! Subscribe to The Pitch right now, and turn on notifications so you don’t miss it. 

Founder applications are now open for our next pitch event - this January in Miami. So if you’re raising money for your startup, you can apply to pitch at pitch.show/apply

–

This episode was made by me, Josh Muccio, Lisa Muccio, Anna Ladd, Enoch Kim, and Jackie Papanier. With deal sourcing by Peter Liu and John Alvarez.

Music in this episode is by The Muse Maker, Breakmaster Cylinder, FYRSTYX, Marlon Gibbons, Amico Mio, Phantom Sun, and Land of Legs.

The Pitch is made in partnership with the Vox Media Podcast Network.