[00:00:00] Rishi Sikka, M.D.: Hi, I’m Rishi Sikka and it’s my honor to be hosting the Day Zero Podcast with my guest here today, Dr. Kian Raiszadeh. Kian is the CEO and co-founder of Spine Zone, and we’re gonna hear a little bit about his journey as both a co-founder and CEO over the past several years. Kian, it’s great to see you. We’ve known each other for a bit and have so much respect for your work and what you’ve done. So thanks so much for being.

[00:00:25] Kian Raiszadeh, M.D.: Yeah, thanks for inviting me and looking forward to the convers.

[00:00:28] Rishi Sikka, M.D.: So, Kian, you’ve got a couple interesting elements to your backstory, like as if you were an Avenger superhero or something. Your Backstory’s got two interesting parts. First off, you’re an orthopedic surgeon and. A lot of physicians start and found companies that are very successful, but you’re a little unusual in that you started a company that’s designed to put you out of business. Talk a little bit about, what was the inspiration for Spine Zone and what Spine Zone does in that regard.

[00:00:57] Kian Raiszadeh, M.D.: Yeah, good question. This. Idea came about from my years as an orthopedic surgeon. I was a Kaiser and thought with all these years of training, I had all the answers and we were perceived as the experts. And then year after year, there were so many patients that came in with bad problems that were suffering significantly that I didn’t really have a good solution for. And. Patients I operated on that I thought I should have a good outcome, but ended up not having a good outcome. And so I quickly learned there was such a huge gap in our education and such a huge need to Help these patients that were really suffering unnecessarily. And so really opened myself up to the whole person orthopedic care model, which really wasn’t in our formal training. And I’d seen patients that had done the right things around where they take responsibility for their pain and really taking control of their life and don’t really come with that mentality of, Oh, hey, fix me. Hey, can you guide me in the right direction to fix myself? And so really got excited about, let’s add this perspective, our orthopedic perspective, our medical knowledge into the rehab realm, and radically change people’s lives in the most. Patients really don’t need surgery. And I, over the last decade plus as an orthopod, I see this more and more in the literature, prove this out more and more. If you address all of the biopsy, psychosocial factors of pain, surgeons will always be critical. And my surgeon colleagues are changing people’s lives every day and they do a great job. But I just think. There we can really transform the space if we empower patients a bit more. So that was the impetus for the company. Create an environment to allow the patient to heal itself, and that’s been our journey.

[00:02:46] Rishi Sikka, M.D.: So, so no offense, I think when people think about surgeons stereotypically, they don’t think of them as sort of being versed in some of the bio psychosocial aspects that you mentioned. What are some of those aspects that you’ve kind of brought to bear in, in, in the model, and what have been some of the results you’ve seen too?

[00:03:04] Kian Raiszadeh, M.D.: Yeah, so it’s first of all, it’s born out in my own personal experience I found myself in the ER two to three times repeatedly, and I thought, doctors thought I had a dissecting aortic aneurysm. I was about to get an invasive procedure and I had to take a deep breath and pause and say, Okay, what’s going on in my life? What are my stress levels? How are my relationships? How am I sleeping? How am I eating? So I first. Hand lived this experience in which I was a get about to get really invasive precision, and I took a couple weeks off, took a breath and stopped every aspect of my life. And I look at how and looked at how I was feeling, and it was pretty bad. And so that biopsychosocial model looks at how we feel, how we eat, how we sleep, how we walk, how we talk, how we think, all those other factors that create a chemical environment. Body that is either sympathetically driven, which is cortisol nor epinephrine. Epinephrine that sensitized the nerves creates these neural pathways in our brain that lead to chronic pain. The good thing is that they’re reversible if you change the chemical environment. If you sleep better, you eat better, you’re not angry, you’re not depressed, you’re not anxious. You look at your core relationships in your life and you fix that, all these other aspects go away. And it’s really remarkable when I’ve seen patients that have bone on bone arthritis in my office and I’m actually seeing them for something else. I’m like, This must be killing you. It’s bone on bone. No, I hike I bike, I do everything. And you look at ’em, they’re really balance. These are balanced people. They sleep well, they eat well. They love their kids, they love their wives. They’re just good citizens living a good life and not a lot of stress. So there’s something really to that and that’s been born out in our data. We’ve invested significantly in this bio psychosocial approach. We have independent modules that engage people with their anxiety, their depression, their sleep, their opioid use all these areas their nutrition. And so we’ve been able to, About a 50 to 70% engagement with the patients coming into our system engaging in these Whole Person Care modules, and there’s significant reduction in opioid usage. And overall, our results have shown consistently across markets. We can reduce the surgical rate about 30 to 50%.

[00:05:30] Rishi Sikka, M.D.: Wow, that’s impressive. So you are in the process of putting yourself out of business and, I didn’t realize some of that personal aspect to your story. One of the aspects of your personal story that you and I have talked about in the past is about your family and where you come from and your growing up. I’d love if you wouldn’t mind sharing a little bit about your heritage and your growing up and how that kind. Born in your decision around spine zone and founding the company and being a ceo.

[00:05:57] Kian Raiszadeh, M.D.: Yeah. Thanks for that question. I think I’m very grateful to the environment, speaking of the idealizing or optimizing the environment for success. My parents. Created an environment that was around sports, around fun, around kind of. Academics and athletics were everything. But if we were to take a step back, where did that come from? Both my parents came from Iran. They came, after the revolution. I was born here, went back for a couple years. The revolution started. We came back. They were entrepreneurs. My dad was a PhD chemist, my mom, a pathologist. I have two older brothers. We were all exposed to medicine. We. Ended up going down the orthopedic surgery route. So it’s a little odd and everyone says you must have been pressured. It was actually quite the opposite. We all loved medicine. We were exposed to it. Again, they had a, There were a small, tiny lab in a tiny town by the name of Oakdale on your way to Yosemite in Central Valley, California. And they fought with the against and competed against the big labs. And they did that for many decades. And we really saw first. What it meant to build something, what it meant to have an idea, what it meant to constantly improve upon that idea. And I think, how we grew up in this tiny, small town and how we each, as brothers grew up into our own lives. It’s been really mostly about this idea that, we. A lot of, We came from, and to be very clear, we came from a fortunate background. We had, everything given to us to really allow us to pursue academic and athletic interests. But all, I think the best gift they gave us, which imparted into my leadership mentality, was this idea that. You need to be constantly and never ending, improving your life. And there’s this growth mindset. That’s what’s really rewarding. And it really wasn’t about, you have to become a doctor. That traditionally Iranian mindset, either you’re a doctor or a lawyer or you’re a total failure. It really wasn’t that. It was that what do you enjoy and what’s your growth path? And so I think that mentality, Just constantly improving your environment. And my dad built us a tennis court because we said, Okay, we had this beautiful backyard, we had four acres, We had all these almond trees that were beautiful, all of this garden, these little rivers. And it was beautiful. My dad one day said, Hey why don’t we build the next thing? My dad built everything from scratch and it was just constantly in, in always improving. What he was doing and his passion was garden. And I think that mentality though, really came to bear as a ceo, which is, Hey, it’s not, no matter what we’re doing, are we learning? Are we constantly improving? I think that is really one of the gifts from my upbringing that I can, attest to my parents.

[00:08:37] Rishi Sikka, M.D.: I thanks for sharing that piece and then how you brought that into your leadership. know another aspect that you’ve had to bring into your leadership or that was a little bit a challenge and a transition was, for many years you were bootstrapping. The organization and then you made a decision to get funding. Tell us a little bit about that time when you were bootstrapping versus the time that you were getting funding and then the decision started to get funding.

[00:09:01] Kian Raiszadeh, M.D.: Yeah. It was, an interesting time. We, I left medicine back in 2014 and it’s really, I would say the first thing that comes to mind when I hear that question, it’s, An amazing team we had that were each of ’em so incredibly mission driven. We had a team of about six to eight people that were so dead set on this is what the market needs. And bootstrapping it means you’re working, you’re burning the candle on both ends. You’re constantly putting out fires while you constantly grow the business. And it’s really. It’s a blessing to have the team that we did and to have such a mission driven passion behind what they were doing. I don’t think it would’ve lasted, quite honestly, We wouldn’t have been able to do without each of them not believing in the mission. Our mission is to, lessen the unnecessary suffering that is, is burdening all patients with muscle skeletal pain and they really believed in it and we really. All felt like we had an opportunity to transform the space. And I would say that life bootstrapping was stressful. It was hard. I was single, then I got married and I got kids. The impact on your personal life is significant. And I would say the impact for all of. My founding team on their life was significant. And I think the transition then to get venture capitalist funding really came when we realized, okay, there’s an opportunity to scale this and have more impact and have more support. I think we all want the additional support and getting professionals that. Taken this journey before and it also meant, shedding an old mentality of kind of, lot of my good mentors constantly reminded me that get what got us here won’t necessarily get us to the next point. And so, really bringing in a new mindset of saying, Okay, if we’re gonna scale what we did, we now need new experts that have different skill sets. We need to build the team and really build this for scale, for the primary goal to have more impact. We all wanted to just impact what we saw and in our little corner in Southern California, we wanted that to have a national. And so that was the whole impetus between behind deciding to get venture capitalist money. A lot of demand from our national partners as well, and we really got excited.

[00:11:14] Rishi Sikka, M.D.: That’s great. That’s great. Context and background. What is sort of changed? Either with respect to your leadership or management since you’ve taken formal funding and maybe talk a little bit about what the environment is like now, particularly in the past couple months, and that’s how that’s kind of affecting your your day to day management and some of your leadership as well, given

[00:11:35] Kian Raiszadeh, M.D.: I think.

[00:11:36] Rishi Sikka, M.D.: the macroeconomic environment.

[00:11:38] Kian Raiszadeh, M.D.: I think undoubtedly with the venture capitalist money, we were able to professionalize our board. We were able to. Season experts that have taken this journey before. And as a first time ceo, that’s really refreshing to have experts that have taken this path, gone down this journey. And so I think that’s been a great help. We’ve been able to get experts from other industries to lead, our product, our growth, our marketing. So we’re able to now attract talent like we haven’t been able to do before. And I think, so that’s the really exciting. But we’re also not immune to the ma macroeconomic forces that are at play. We specifically focus on our partnerships with providers and health plans and, we’ve all been reading the news. We know all health plans have been losing. Significantly over the last couple quarters. So that’s had an impact on the rate of growth within these partners and just overall in the market. I think the strain of the labor costs has been significant. Overall labor issues reimbursement’s still going down similar. Forces that have been going on healthcare, but now much worse, that’s impacted a lot of our partners. So I think it’s slowed down a lot of that growth trajectory. I think a lot of, 30% of venture back companies now are 30% off their budgeted for this year. So it’s we’re not, we haven’t been immune to that. We’ve, that has impacted us to some capacity, but I think it’s, we’ve been fortunate to have great partners around the table that ha have a long term mindset. That are really in this for the long term as well. So I think that’s been really important. We’re playing the long game. We’re not incrementing on what we’re doing. We’re going for the exponential transformational impact and feel really fortunate to have a team around us that is, has a similar mindset.

[00:13:25] Rishi Sikka, M.D.: Oh that’s great perspective. Let’s, I wanna build upon that a little bit. So you’ve obviously got short term action that you’re taking in response to the environment, but then you’re also very much. Planning and thinking, and also trying to take action that’s in accord with the long term. I wanna hear a little bit about what the long term does look like for you for the organization. Six months out. Six years out, and we’ll talk a little bit more about how you balance those two. But what’s coming up in the near term and long term future you.

[00:13:57] Kian Raiszadeh, M.D.: Really excited that in the near term we are rebranding. So it’s taken us about a year. Our new brand is Lavara. We love the name. It’s about living your best. And that’s we’d love to impart that mentality with our patients. So in the near term, we are undergoing a rebrand. It also re represents an expansion in our services provided. We’ve stayed really focused on spine cuz there’s so much complexity and opportunity to optimize that environment. But we realized this same model applies to the rest. So, expanding to shoulder, hip, and knee in the, in other body parts. Those, the key other body parts that really comprise 90 plus percent of the orthopedic spend. So really excited to take that same foundational model to those other body parts and really also expanding in the short to near term our business model. So we’re able to take full risk as. So that’s been a multi-year journey to work on multiple aspects of the companies and make sure we’re ready for that next stage. And our evolution as a company been really excited to be in that position, which is we’re squarely in line with what’s best for the patient. Now we want to be managing that care journey and that those finances as well.

[00:15:02] Rishi Sikka, M.D.: Talk a little bit more about that full risk piece, if you don’t mind for folks who may not have the full background or understanding about what you’re talking about how you get paid and where you want to get.

[00:15:13] Kian Raiszadeh, M.D.: So currently we’re, for those people who are in the value-based care world, it’s not a binary world. It’s a multi-stage process. Progress into being a more value based provider. I think if you look at what’s the quintessential value based provider, that’s Kaiser Permanente. They take, the full premium and they deliver all the care. If you now sub segment that out, And say, Okay, there’s, I don’t know, a thousand, $1,500 premium per member per month, but then you look at the orthopedic spend of that. The full risk model in that is that you’re taking that segment of the premium that is for orthopedic spend, and now you’re delivering care and managing that process. So from PCP to imaging, to injection, to rehab, to surgery, outpatient, inpatient, post-op care, that entire episode, you are now managing and you’re taking risk for it, which means if you do a great job, Instead of spending X number of dollars, you’re now 30% below that, you get the savings. But if you’re above it, again, you’re taking full responsibility of that and you’re financially responsible. So that’s really exactly where we want to be positioned. And, taking the learnings from the eighties and nineties worth the HMO expansion in all of the. Learnings of not having a clinically focused model. It’s exciting to chase that premium dollar, but we’ve been really thoughtful and slow about the time you have wanted to do that, to make sure this is really a clinical first approach that radically changes that clinical experience and then wrapping around all those services. So it’s been an evolution and we’re excited to, to have that in our short term.

[00:16:54] Rishi Sikka, M.D.: Great. Thanks for expanding on that. Let’s zoom out from that just a little bit. So we’ve been talking a little bit about now your, the short term actions you’ve been taking. This true north around clinical and your long term vision in mind of taking a full risk or a portion of the risk for orthopedic spend, How do you maintain that balance within yourself of thinking about short term and then long term vision? How do you work through that in your own mind and maybe what are even some of the practices you use to keep that balance within?

[00:17:26] Kian Raiszadeh, M.D.: Good

[00:17:27] Rishi Sikka, M.D.: It’s gotta feel like you’re being, It’s gotta feel like you’re being pulled like

[00:17:30] Kian Raiszadeh, M.D.: Yeah.

[00:17:31] Rishi Sikka, M.D.: damn short.

[00:17:32] Kian Raiszadeh, M.D.: A really good advisor once told me if I’m not spending at least a day or two a week on what I think will be happening one to two years from now, I’m not adequately spending my time. So I felt that’s been really good advice. We have a great team that’s really executing on the short term strategy, but if I’m not really aware of what’s going on in the market, spending time to take that data and to form that strategy and have. People around me to help kick these long term strategic ideas around, I think I’m not best serving the company. So I think the allocation of time and being very clear like this is really what you’re responsible for. At the same time, on the short term, it’s really executing on the strategy and really making sure we have the right metrics, the right framework in place to objectively measure our forward progress in that. I think those are the legit logistics of how I think of short and long term. I think that struggle’s always there and I really, I try to go back to the idea that the product, the company is also a representation of how much I’m enjoying my work and how much the. Members or a team are enjoying their work and loving what they do. So I think a metric that I internally use that at some point maybe I share with a board and professionalize this, but it’s really how would you rate the enjoyment of. What we’re creating the enjoyment of working with one another. I think that’s also a true, important metric of how successful your company is and the longevity of your company. So that is more of an internal metric that I’m paying attention to amidst these other kind of logistical ways to manage short and long term.

[00:19:17] Rishi Sikka, M.D.: That’s great. I like both your structured approach to ensure that you’re spending time on the long term in addition to the short term. And I like this last piece about enjoyment and how that’s reflecting both the health of yourself and the company. That kind of, Blurring of professional and personal. Speaking of sort of that blurring of professional and personal as we kind of closed this out and you started this segment not just about professional and personal, but a piece of advice you were given. If you could go back in time, , say, say seven or eight years ago as you were kind of starting some parts of this journey for yourself, if you could go back in time. And talk to your younger self, maybe put an arm around your younger self shoulder and give some personal and professional advice. What would that be? Both both personally and professionally? What would you wish you could say to your younger self?

[00:20:05] Kian Raiszadeh, M.D.: Wow, that’s such a good

[00:20:06] Rishi Sikka, M.D.: And by the way, I’m always talking to my younger self all the time. I can’t wait till they invent that time machine to do that

[00:20:13] Kian Raiszadeh, M.D.: I think on that note, I think the more we have a relationship with our younger self, it’s always a healthy thing. So, that’s a really good question. I think I would go back to that, my younger self when I jumped out of healthcare um, and really there was an advisor that told me this, and so, I didn’t actually take this advice fully, but I would go back and reiterate that advice, which is the mere fact that you’ve made this decision. Regardless of the outcome, the impact on your life will be extremely positive. So extract yourself from the outcome, but you’ve made a decision a growth decision, a personal decision that will transform your life in ways that will. Be evident in the short term or the long term, but trust that. And I think if I really would’ve stayed in that, I think the stress, the anxiety of being a, entrepreneur and a startup would’ve been significantly less, and I would’ve enjoyed it more. I think there’s always times in life whether small decisions, big decisions, where it’s either kind of, I’m gonna choose the more, let’s say, fear ridden, safe decision or the growth decision. And I was fortunate enough to make that decision, which is all about, I’m gonna double down on myself, on, on growth and let go of the sense of stability and security. It always works out, and I think in every way it, I’ve, in my narrow experience, in my short life, it has worked out. And those people who I trust, who have great advice also, I think I think that is where I really want to stay, which is if you’re taking the growth path you can’t control. Anything, but let it all play itself out. It’s the right choice. Don’t sweat it. Don’t question it. Just put your head down and enjoy the process. You made that decision. So that’s probably what I would tell myself as March of 2014, when I made that leap in amidst of time where everyone was calling me saying, Hey, oh my gosh, you know what you’re doing? I’m like, Oh, I’m freaking out. But

[00:22:16] Rishi Sikka, M.D.: Wow. Kian, thank you so much for sharing that, that showed not just candor, but vulnerability and courage, which I think has been a hallmark of your leadership and actually also you’ve shown that candor in the course of our conversation today. Thank you so much for sharing your journey as founder and CEO on the Day Zero podcast.

[00:22:35] Kian Raiszadeh, M.D.: Rishi, this is great. Thanks so much for the opportunity. Really appreciate.

[00:22:39] Rishi Sikka, M.D.: Hey, we can’t wait to hear more things about how spine zone lava is transforming the orthopedic space.

[00:22:45] Kian Raiszadeh, M.D.: Thanks, Richie. Have a great day.

[00:22:47] Rishi Sikka, M.D.: You too.