A new approach to managing incontinence (transcript)

This is a transcript of my recent podcast interview with Steve Goelman, CEO of Unique Wellness.

David Williams: This is David E. Williams, co-founder of MedPharma Partners and author of the Health Business Blog.  I’m speak today with Steve Goelman.  He is CEO of Unique Wellness, which makes super-absorbent adult briefs.

Steve, how widespread is the problem of urinary incontinence?

Steve Goelman: The numbers that we currently have is up to 25 million Americans experience some form of incontinence from moderate to heavy incontinence. It is a growing problem, especially as baby boomers age. Those affected range from pregnant women to war veterans to the mentally disabled.  (They’re not physically incontinent but unfortunately they’re not able to go to the bathroom properly when they need to.) You also have active people such as lawyers and doctors that have undergone some form of prostate surgery.

Williams: What sort of approaches do people use to manage incontinence?

Goelman: I’m glad you said it that way. The words “managing incontinence” is exactly what our business is about, not treating incontinence.  Obviously the first step is to try to treat incontinence. You go to your local urologist, take medications such as Flomax, try Kegel exercises, and so forth. However treatment doesn’t work for everybody and we’re left with the issue of managing incontinence.

Managing incontinence is a very difficult scenario.  We start with those that are bedridden, such as those that are in nursing homes.  They are left with bedsores and there is discomfort for both the nurses and the patients themselves who have to constantly change or get changed.  There is also a huge financial burden involved with that because in order to just achieve the level that you need in order for the patient to stay dry and not susceptible to any medicine, you would have to change an average of ten times a day.

That is the way incontinence is currently managed.  Every time you change someone you need to use latex gloves, creams, cleansing wipes and so forth.  That’s all associated with incontinence. There is also an environmental impact with all of this waste because of the way incontinence is being managed.

We came up with a new way of managing incontinence because for about 50 years, nothing has changed in the way incontinence is managed.  We said we have to come up with a gold standard to help people who suffer from incontinence. We focus on: A) cost effectiveness, B) a more humane and easier way to handle and manage incontinence, C) the environmental impact.

We emphasize the three C’s: comfort, control and the confidence.  Confidence is a very big issue, especially for those who are active.

We came up with the three-a-day way to manage incontinence. All you have to do is change them three times a day with our product.  How could we even conceive this idea?  We said to ourselves: wait a minute, we do know that NASA astronauts go up in space and they have an eight hour space walk to service the Hubble space telescope or the International Space Station. They wear these absorbent undergarments called MAG’s, maximum absorbency garments.  So we do know that they have to be wearing something to keep them dry and confident with whatever they’re working on, because if they have an issue then they can’t work properly for at least eight hours at a time.  That’s A.

B) We do know that astronauts who go up into space are susceptible to various forms of infection and NASA has to take the appropriate measures to prevent that in every possible way.  So we could apply the exact same concept to the typical person suffering from incontinence.

We created the Unique Wellness brief, which has what we call Incon tek technology.  It’s based on the same principles as the maximum absorbency garments worn by NASA. We’ve developed a system where one who wears these briefs only needs to change them three times a day on schedule.

So they know if they are going out to a movie at lets say 6:00 pm and the regular change would be at 11:00 pm at night, 7:00 am in the morning and then again at noon time.  So they know where they stand exactly.  So that’s where control, confidence and comfort come in.

Then you have the cost effectiveness issue that I mentioned earlier. Your typical Depends cost about $0.90 each.  Ours retail between $1.39 and $1.49 each. However if you do the math you realize you only need three a day of ours as opposed to nine or ten of the Depends.

It’s not just the amount.  One of ours is equivalent to nearly five of Depends.  Using the three a day of ours you’re setting a new standard; it would be like  changing someone about 15 times a day.  The way people manage incontinence today is that they wait until you run out of capacity.  By the time someone has their adult briefs changed they already have gotten wet.  They already have gotten susceptible to a form of infection.  They’ve already gotten to that point of discomfort.  That’s what even prompts people to change.

There’s no official system.  That’ why they get to that point.  Using our system and our product you never get to that point.  You never run out of capacity.  You never get to the point of discomfort of living with incontinence.  You’re never susceptible to any form of infection.  Your cost of managing incontinence is lower by about 50%.

Williams: I have a question for you about NASA.  That’s a very interesting observation that if the astronauts are able to do it, it should be able to be done here on earth.  I guess another difference is space is the issue of gravity and weightlessness. With all that absorbency, won’t the brief get too heavy on earth?

Goelman: Well actually our briefs absorb more than those that the NASA astronauts wear and we designed it for that.  We actually had a recent phone call from a urologist who basically was furious and said it’s ridiculous to have someone wear up to 87 ounces.  That means they would have to change them once every day or every two days.

We said this is a very big misconception.  We’re not trying to tell someone to wear our products until they can’t wear them anymore.  We’re trying to tell them that they are so absorbent that by the time you’re changing them it’s still as dry as when you put them on. With the average person, you’re looking at maybe 20 ounces.  So when you asked the question about gravity, you’re right.  The math is a little bit different because of gravity and we address that issue by the amount of absorbency that we could take in.  So regardless, within that scheduled changing time within those eight hours, you’re never going to have a problem with that issue.

Williams: Tell me about how these products are paid for.  Does it tend to be an out of pocket purchase or is there a reimbursement from insurance or other programs?

Goelman: Most insurance don’t cover any form of adult briefs.  Now certain States do cover adult briefs from the Medicaid program. Different Medicaid programs work differently.  Some programs give you a certain budget with which to work;  x amount of money per month to cover adult briefs.  It doesn’t matter what you buy or what kind of briefs to use.

I know for example here in New York State someone using Medicaid would have a very difficult time using our product because Medicaid pays one dollar per brief. Usually it’s supplied by a nursing agency; whether it’s Depends or something cheap out of China. They pay up to $220, which is approximately eight changes a day for a month.

However by using ours it would translate into about $90 a month times $1.39. That’s $134, which is a 40% savings for Medicaid. However this is not the way Medicaid works.  Medicaid pays per brief and not per managing incontinence.  Now for New York State this is something that wouldn’t work well because Medicaid would never pay more than $1.00 for a brief.

However I know that in States like Florida and New Jersey, their system doesn’t work on per brief, it’s per cost of managing incontinence.

Williams: What are you doing in terms of distribution?  Where are these products available or where do you hope to make them available.

Goelman: Right now they’re primarily through the Internet.  We have ourselves and other retailers that are selling them through the Internet for us, because we’ve realized that someone looking for a specialty product will find them through the Internet.  Stores such as your typical Rite Aid, CVS, unfortunately are not interested in carrying our products because it’s not as profitable for them.  They realize that they make more money selling more briefs than using our program.

We are working on a specialty medical supply stores, surgical supply stores for those who have been purchasing them through the Internet.

Williams: Do you expect that your product is going to be evolving over time or will you add other complementary products and services? Is this the product that you expect to be on the market as-is for a number of years?

Goelman: Well that’s a good question.  Actually for the last year our product has consistently been evolving, whether it’s been improving on the absorbency end, whether it’s been some issues with raw materials.  I think that we’ve been consistently improving and we are consistently committed to always making a better product.

Right now one of the things that we do have, which people appreciate, is the fact that we have different colors for different sizes, such as the medium is blue, the large is green and extra large is purple.  This helps people automatically realize which size they are holding in their hands, whether they need to change their patients or their self.  There is not confusion in that.

There is something else in the works that’s rather interesting.  We’ve realized there’s a very big stigma of incontinence, especially for active people. They feel very uncomfortable in what we call today adult briefs, but technically they’re adult diapers.  We are working on coming up with a designer series to make people feel that basically they’re not adult babies.

Williams: I’ve been speaking today with Steve Goelman, CEO of Unique Wellness.  Steve, thanks so much for your time.

Goelman: My pleasure.

March 4, 2010

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