Sean Salmon on Medtronic's Announcement on Companion Medical Acquisition

[00:00:00] Rob Howe: What's up everybody, Rob Howe here. If you are in tune with the goings on in the diabetes community, which you are because you listen to this podcast, you probably heard about a big acquisition last week. Medtronic Diabetes announced that they are acquiring Companion Medical, makers of the InPen, the only FDA cleared smart insulin pen. Medtronic asked me to get questions from you, the T1D community, to ask Sean Salmon, EVP and president of Medtronic Diabetes, so he can answer your questions. questions on this pod. Now, a few things to note. First, I'm a paid consultant and ambassador for Medtronic. This podcast was made possible by Medtronic Diabetes, but my thoughts and opinions are my own. Second, this podcast was recorded on August 18th, 2020. So the acquisition has not yet closed. So we're not able to answer all the questions until it does close. So we're going to do a second episode on the acquisition once it closes. So be sure to tune in for our second episode where we'll continue to chat with Medtronic and get to all the questions that we can't answer today. Okay, enough preamble. Let's go behind the scenes with Sean Salmon to learn more about Medtronic's acquisition of Companion Medical. Enjoy. Hello and welcome back to another episode of Diabetics Doing Things. We are telling the amazing stories of people with diabetes from all over the world. My very special guest, not his first time on the pod, but here was some big news from the diabetes community. Mr. Sean Salmon, welcome to the show, sir.

[00:01:31] Sean Salmon: Thanks, Rob. Appreciate the opportunity.

[00:01:34] Rob Howe: Of course, and it's always a pleasure to have you back. You know, it seems like it's been a long time since we last chatted, but then again, what is time? We're here in this quarantine. We're all in the same place back at home. We were all joking before we got on the call about haircuts and how we plan to look as presentable as possible over Zoom. So thanks for the tips. So we're here for we're here for some big news. Medtronic Diabetes, as we announced, or you guys announced last week, the time of publishing today is August 18th, 2020. Medtronic Diabetes is in the process of acquiring Companion Medical, makers of the InPen, the only FDA-approved smart insulin pen. So what can you tell us about the deal and what makes you so excited about it?

[00:02:19] Sean Salmon: Yeah, well, Rob, you know, when I came into this new leadership role for the diabetes group, I really took the first few months to just really listen and learn as much as I could. And what was really striking to me was just how personal this disease really is and how different it is for everybody that is on a journey with their condition. And, you know, I think those preferences really need to be honored. And particularly how do people want to manage their disease with more or less control, with more or less discretion? and you know the choices that people make we thought were really important so i had this opportunity you know when we looked at the companion medical in pen to think through that's a choice that a lot of people are making i think something like the majority depending on the country you're in but uh you know more than two-thirds of the people in this country choose injections as their preferred route of insulin administration for those who um inject daily. And, you know, digging into that and trying to understand what that's about, some of it is, as you'd expect, there's some economic drivers for that, and some are just straight up preferences. And I think when we took a look at Companion and what we're excited about with the acquisition is that once it closes, we think we can bring better and better outcomes to patients that choose this route of insulin administration. And really in the same way that we're trying to endeavor to do with pumps just continuously reduce the burden and challenges of having to think about this disease that's with you all the time. So our vision here with, together with Companion Medical, once we do close this deal, is to offer an affordable, discreet pen solution that can really expand our ability to help serve people in their journey in a way that's really meeting their personal preferences. So, you know, it's exciting all the way around for patients for us. And it really does also move us out of our own paradigms of being sort of a tethered pump company only. And I'm excited about that expansion. Yeah, I am as well. And I think,

[00:04:24] Rob Howe: you know, you talked a lot about preferences. And I think something that I've heard you say, both in Medtronic ambassador calls, as well as publicly is meeting people where they are meeting patients where they are in their diabetes journey. And as you mentioned, with almost two thirds of diabetes patients in the U.S. choosing multiple daily injections, this is a big step for Medtronic.

[00:04:47] Sean Salmon: Yeah, that's truly where they are. And, you know, the second part of that phrase, we talk about taking people where they want to go. And, you know, I think meeting someone where they are means where are they in their journey? Are they brand new? Newly diagnosed? Have they been dealing with their disease for a long time? Are they frustrated with what they're doing so far. So again, all those choices, they're not static choices. People kind of move around with their choices. And for us to be a partner, we really have to have variety and opportunities to really meet those preferences along the way. So taking people where they want to go to us, that means how can we continue to get better and better outcomes and avoid complications of this disease without adding anything to an already burdensome condition, just continually making life easier and you know in pens are really interesting the pen itself you can't tell it looks like a normal durable pen but it's very very smart the way it talks to an application and that application gives you information that tells you how much insulin do you need to take and at what time getting a lot of guesswork out which we think is great and i think the combination of that technology with our own capabilities we can take that paradigm

[00:06:01] Rob Howe: on even further. Yeah, I'm glad you actually talked a little bit about the product itself, because Companion Medical, while somebody like me who's very plugged into the diabetes community, especially online, was fairly familiar with the product, many listeners may not be. And I've seen some comments from the community of, you know, this was their first time learning about the InPen. So I think let's spend some time digging into and explaining to the listeners what a smart insulin pen is and how it's different than sort of what we've come to know as the standard available on the market today, as well as, you know, partnering with the Medtronic smart CGM system with the InPen, which will also be new and why you're excited about that.

[00:06:45] Sean Salmon: Yeah. So at its fundamental level, you know, smart pen is an insulin logger. That's what all of them endeavor to do. But I think really that's just the first start. So you know exactly what time you took your insulin, how much you took. So knowing your insulin board is, you know, is a big part of the calculus that you need to go through to know when you're bolusing, how much you need to go bolus. Other factors like insulin sensitivity, carb ratio, all these kind of what we refer to as sort of settings that kind of drive pumps are really important because they get pulled in along with real time. Eventually once we get things integrated, CGM data, I think it gives you this really more precision on predicting where blood sugar is going to go, how you respond to food. And really, when we talk about a smart system, there's a couple other assets we brought into Medtronic that are really relevant here. One called Nutrino and one called Klue. And what Nutrino does is this is the world's largest food database, and it allows to know really the content of what's in food. And there's some predictive, really smart AI stuff that kind of knows that you're likely to be eating at some point in time. This other technology called Klue works on like a Fitbit or a smartwatch of some sort. And it can tell by gestures that you are in the act of eating or highly likely to be in the act of eating. So in combination with a pen that knows how much insulin you've already taken, detecting that there may be a meal, getting a more accurate carb count into that equation, you can imagine how this just simplifies things and gives the opportunity to really get outcomes to be improved because you're really personalizing the dose to the situation that somebody's in over time and at the moment. Fewer missed doses, that kind of stuff, which can only drive better outcomes. I think on average, If you miss your meal bolus just two times a week, that can bump your A1C up by about a half a point. And, you know, that's pretty significant over the long term. So avoiding missed boluses and getting the right amount of insulin when you need it is the vision for what we think we can do together once we bring this technology together with what we already have in-house.

[00:09:03] Rob Howe: Yeah, I think that's something that as a person who wears a pump and chooses to wear a pump, one of the benefits of wearing a pump is that you could see your bolus history and you don't have to wonder how much insulin is on board. And I think that's one of the things that I've seen people who use the InPen talk about, you know, a benefit of just being able to say, hey, now I don't have to wonder if I remembered to bolus for my meal. and then hearing as well like that half a point of a1c just missing two meals of or two boluses on meals per week can have a huge impact on your a1c because i know many people are very concerned about keeping that in a in a relative range so uh yeah like you said driving better outcomes there it is right there a super measurable way to do that in a way that you really don't have

[00:09:49] Sean Salmon: to think about it too right i think it's that idea that you can get better health and greater freedom And that's one of the things we talk about as a real goal for our overtime endeavor to do. And that's been pretty well delivered on in the tethered pump world. But to do that now in a form factor that others prefer, more discretion and more freedom without trading off outcomes, I think is really incredible promise that we hope to fulfill.

[00:10:17] Rob Howe: And I think it actually ladders up as well to what we discussed last time you were on the podcast. and you were talking about areas where you wanted to see Medtronic improve and areas where in the past maybe Medtronic has fallen short and you're working towards bringing those together. And I think CGM, you mentioned, was a key component for you and your team. And you've already mentioned some of the other software that you're integrating and the acquisitions that you guys have made on the diabetes control front. Is there more that you can share on the plans for CGM and maybe some of the questions that you've heard from patients?

[00:10:55] Sean Salmon: Yeah, absolutely. I mean, as I told you at the outset here, the thing I did for the first, I don't know, four or five months on my role here was just to really listen. And it didn't take that long to learn that the experience of our CGM today is not meeting patients' needs. So making sure that we get a CGM that meets needs of what the patients really want the most is what we've been making really good progress on. And we understand how important CGM experiences and we still have some work to do. We are making good progress on delivering enhancements that we know are critical to customers. We're getting closer to that user experience that people expect from their CGMs today. We're also working to accelerate additional enhancements that are pleased to be making good progress. We know that CGM is a key component for many people and I want the diabetes community to know that I know and that I'm listening and that I do hear you. And that's why we made customer experience in terms of innovation and support our top priorities at Medtronic Diabetes. It's important for us not only to listen, but also to act on these insights by executing on these enhancements that are meaningful to people. And with all of our technologies, we really want to simplify diabetes and not add additional burden through a suboptimal experience. We're working really hard to get this right, in our next generation platforms that we're really looking forward to providing more updates on as we move closer to the commercialization of those. The other thing I also learned, Rob, was that a lot of the CGM experience that we've had was really driven by the 670G device. And that was the first time that it sort of put control over to a device for the administration of insulin, right? Where the CGM would be telling the pump what to do and how to do that automatically. And as you imagine, there was a lot of concern, both on our side as well as on the side of the regulators around the world for patient safety, making sure that that was not having a problem. And the default mode is always if something looks funny, kick you out of auto mode so that the person can deal with it. And, you know, it turns out that that attribution of what's wrong was always given to the sensor. It needs a calibration, it needs something else. They didn't really need those things. So I think as we move on from not just our CGM platform, but our own automated and delivery system platforms, I think getting rid of some of those guardrails and safety concerns will really enhance that user experience as well. So we have improvements to be made everywhere, CGM, pump algorithm, everywhere. And we're working hard at it.

[00:13:42] Rob Howe: Well, I think I could speak for 670G wearers everywhere. with that specific example that you mentioned about kind of when things start to look fishy, getting kicked out of auto mode, we're all really excited for that new feature. And I'll just leave it at that. So one of the things that I think a lot of people have asked, especially patients on the side of companion, but customer service is always top of mind for many patients, as well as Medtronic. And I know that as you guys are adding even more customers to the Medtronic family, a lot of people are anxious about the level of support they may expect to receive. What are your thoughts on sort of their reaction and how are you committed and Medtronic committed

[00:14:28] Sean Salmon: to maintaining that level of service? Yeah, look, I certainly understand that concern. It swayed just anybody's concern. I think the fact that we do have a far larger and more extensive of support capability than what Companion had. I think that's something we can build on. But since I came in this role, I've really been preaching the idea of customer experience, and that experience is everything. It's how the products behave, are they reliable, do they say they're supposed to do, any other kind of touchpoint, whether it's technical service, a transaction you may be doing for supply or resupply or any kind of training engagement that you'd have, that that experience has to be excellent all the way along. And it was interesting, coming into the business, there's a lot put into plans for product pipelines and manufacturing. And it really became clear to me that we had to scale our capabilities within our ability to service customers 24 hours a day, seven days a week, anywhere in the world. One was, this was just really timely to help right at the outbreak of COVID, where we pushed a lot of the call volume, which was people really calling up customer service to find out where is their stuff. And we had this online service tool called diabetes.shop that we launched that works on its browser base. You can work it from your phone or any kind of connected device where you can find out where things might be stuck. There could be something wrong, like an insurance document being gone. So you know what's wrong. You know when it's coming. And then you can set things up for like auto resupply or reordering and get real-time shipment information for tracking with those devices. And it's really made a big, big difference for people as they're on the phone. They're hearing about this, and they're able to go out there and do more self-service for those who like doing that. And we measure everything. And one of the things we like to measure is how satisfied are people. And I'm proud to say that during all of this challenge of moving people to remote work and all the other changes, our transactional net promoter score, that's the metric we use to say, are we doing a good job, yes or no, is at an all-time high for the business since our existence. So that's very promising, and it's really something that I think we're heading in the right direction on. We measure other parts of satisfaction, including products and things, and clearly we've got a lot coming out that should help address that as well. But I recognize that we have work to do to regain the trust and confidence of the community, and I can assure you that there's nothing more important to me than the customer experience. It's our number one priority. And for those who would be coming over from the InPen community, I think we hear you, we understand what your concern would be, and you'll have my personal commitment that we're going to bring our level of support and innovation to customer service that you deserve and expect.

[00:17:29] Rob Howe: I think it's important to hear that as a patient, kind of taking myself out of the, you know, patient ambassador role that I'm holding here in this podcast. It's important to hear that from the top, because I think, again, just looking at accountability and being able to sort of humanize, you know, a big brand like Medtronic and say, hey, you know, I do. I hear that I hear from the from the leader's mouth that this is a priority. and I'd also go on record and say that I you know as a patient you know it's been my best experience with diabetes.shop and it's been just a breath of fresh air reordering supplies on a regular basis because I'm sort of a I don't like to plan too far ahead supplies wise although I have organized my supply drawer that I've documented that that's been a big step for me personally but diabetes.shop is a huge step forward and just a much more pleasant experience so you can tell whoever is in charge of that. They've got Rob Howe's vote of confidence. Well, I'll definitely tell them

[00:18:26] Sean Salmon: that, Rob. I think you can make a lot of people happy. There's a lot of hard work and thought

[00:18:30] Rob Howe: that went into that. So I'm glad it's working for you. So back to the topic, as I usually kind of wind down these crazy rabbit trails. But for those who are out there who use and love the InPen and are wondering what this planned acquisition means for their therapy and what this means for them. What can you share now, today, pre-close about Medtronic's plans for the InPen itself, as well as the patients who currently use the InPen? Yeah, well, good question. First of all,

[00:18:59] Sean Salmon: today, nothing changes. So we're working through the appropriate regulatory bodies to finalize this acquisition. And we anticipate the closing of the deal would happen in the next two months. And during that time, you know, anyone who's using InPen today should continue to work with companion medical and get in touch with them for any service or product needs that they have. After the acquisition is completed, we'll be working very closely to ensure that all the pieces are in place to make a really seamless and smooth transition. So nothing will change, but we will make sure that we are clearly communicating with the InPen customers for anything that might change that would affect them. And you can imagine things like customer service at some point will have one phone number you call. You'll be able to use things like this diabetes.shop that we just talked about. But really making sure, as I said, that customer experience is central to the value we're trying to help create. And it really guides everything that we do to ensure that after this acquisition is complete, that the customer experience is as seamless as possible during the transition.

[00:20:04] Rob Howe: Okay. I do have to ask you a question because this one came up when we put the questions out to the community and we said, hey, ask us, ask Sean questions. He's coming on the podcast. Got quite a few that asked this following question, so I hope you're ready. Should people who are using the InPen today with the Dexcom integration be worried about what this

[00:20:23] Sean Salmon: means for them and that integration? Look, I know this is a big question for a lot of people. On our end, we have no plans to discontinue the ability to use InPen to communicate with Dexcom, cgm or Senseonics for that matter so our intention is once the acquisition is complete that we would add capabilities to the impen and the insights that we offer people things we've talked about um we'd be just adding to the value not taking away from it so we're we have no plans

[00:20:53] Rob Howe: to do that great because i had a lot of people who were you know really they were responding in all caps so i knew it was important so i had to make sure that to make sure we address that on the pod Um, something that I think is interesting for me, and this was a new concept that really, I would say companion medical, and I'll give them a lot of credit here introduced me to is what's called a pump break. And the idea that, you know, maybe taking a break from being on a pump, a tubeless, a tube pump or a tubeless pump, and just give your body a little bit of a break, but don't want to give up the support of the outcomes that we know insulin pumps deliver. um so what are your thoughts on the pump break and you know how would you talk to you know existing medtronic patients who are interested in this concept yeah well look i you know i think

[00:21:45] Sean Salmon: what i've heard a lot um is i've learned about people's personal experience with this disease is that it just gets so burdensome this idea that you just have this relentless disease that doesn't take any breaks and it can get really exhausting at times especially when things are just seem to for no reason, just going off the rails. And we understand that people need to kind of change things up in their routine so they don't feel sort of burnt out and give up. As you know, leaning into this and feeling positive and motivated is important. So the concept of pump break makes a lot of sense. But of course this has to be done in consultation with a healthcare professional. Just taking a break and not doing the things that are good for your health are not necessarily good either. I think once this acquisition is complete, I think the thing that we're excited about is that you can take a break without really kind of losing that history. You talked about your BOLS history, for example, not losing that that we think would be connected in the same CareLink system that we use today. So if you're a Medtronic customer, you go off your pump. You want to just have this continuity of information and data for your own user, for your health care provider. our vision is that that would be something that would be sustained even though you're taking a quote-unquote break and if everything else works out you know in time and we get all this smart personalization data working the right way not trading off outcomes for the duration of that break if it's you know a week-long vacation that's different than maybe taking a year of pen smart pen use away from the great outcomes you're getting from your pump but you know we got more to do there to make sure that this all works and that's seamless but we think the vision here is really to said before right meet people where they are take where they want to go even if

[00:23:32] Rob Howe: that's on vacation you know i think uh there are a lot of people in this country that could use a vacation right now from a lot of things yeah exactly and you know i really like this conversation has kind of boiled down to three things for me um the first being reducing the mental burden and understanding and knowing that Medtronic understands the mental burden that associated with diabetes, as well as, you know, continuity for both patients of the InPen as well as Medtronic patients and their customer service. And overall, just again, flexibility and meeting patients where they are and taking them where they want to go. As you kind of think about going forward. What's maybe a closing thought that you have for listeners today as we look forward to the close of the companion medical acquisition? Well, look, I just say one thing that maybe

[00:24:29] Sean Salmon: left off your list here, Rob, is just, you know, we very much appreciate people trust us on their journey. And we know that that trust is earned. And it's something that we have to earn every single day. So my goal is around this idea of just creating an experience that fits people's individualized needs and does our part to help deliver the independence from this incessant disease that really is problematic for so many to worry about a lot, to think about a lot. And if we can ease some of that burden, then hopefully we'll be the right partner for people to choose. And whether that's an in-pen customer or a legacy Medtronic customer, a new customer, are newly diagnosed, our goal really is to try to provide as much support on a difficult journey

[00:25:16] Rob Howe: to make it a little less difficult. I love that. And, you know, I think that's been one thing that's always been very obvious to me as I've met more people behind the scenes. It's just very clear that you guys care a lot about patients and honestly know a whole lot more about people with diabetes and myself with diabetes than I ever would have bargained for. So thanks to you and the entire Medtronic Diabetes team for your time today. And looking forward to part two of this interview after the companion medical acquisition is closed. Me as well. Thank you, Rob. I appreciate it. And good luck with your haircut. I'm going to take that as a slight. That's a yeah, I'm never turning my zoom camera on again, Sean, that's tough. Thank you, Sean, for your time. And thanks to Medtronic Diabetes for making this possible. Thanks so much for listening and be sure to tune in for our second part of this episode once the acquisition closes. And if you want to learn more about Sean and his background and what he's working on in Medtronic Diabetes, check out episode 147 on Diabetics Doing Things. Thanks again, and I'll see you next time.