The human element of research is vividly brought to life in the realm of healthcare and patient data.

In this episode of the Greenbook Podcast, host Lenny Murphy engages in an inspiring conversation with Maria Muccioli, one of the honorees on the 2024 Greenbook Future List. Maria shares her captivating journey from her early days in Russia to her recent endeavors in the field of healthcare research. Delving into her academic background in biochemistry and molecular biology, Maria reflects on her transition from traditional academia to making significant contributions in healthcare through research. The discussion covers the challenges of healthcare market research, the impact of the COVID-19 pandemic on patients, and the exciting potential of AI in analyzing patient data. Emphasizing the importance of diversity in research and her personal dedication to improving patient care, Maria's story showcases resilience, innovation, and a profound commitment to enhancing the healthcare landscape.

You can reach out to Maria on LinkedIn.

Many thanks to Maria for being our guest. Thanks also to our producer, Natalie Pusch; and our editor, Big Bad Audio.

Hello, everybody. This is Lenny Murphy, and welcome to another edition of the Greenbook Podcast. Sure am happy that you are here to spend time with me and my guest. And today I am joined by Maria Muccioli, the research lady from Thrivable. So, Maria, welcome.

Thank you so much, Lenny. I appreciate you having me.

We’re glad to have you. You know, our audience hears me say this all the time that it’s always a special delight when I chat with somebody for the first time, and this is our first conversation. So I’m looking forward to learning, just as our audience is, about you. So we’ll keep it fun.

Awesome. Awesesome. I’m looking forward to it.

All right. All right. We’ll see if you think when we’re done.

[laugh].

But so far, every-, no one has said, “Oh, my God. I wish I had never talked to you.” So…

[laugh].

We’re going to try and keep that track recording going. So [laugh] why don’t you tell us a little bit about yourself and a little bit about Thrivable.

Yeah. Absolutely. So I actually grew up in Russia. I immigrated to the United States when I was about seven and a half years old. My background is in traditional academia. I got a bachelors in biochemistry from Suffolk University, and then a PhD in molecular and cell biology from Ohio University just about almost ten years ago. I went the traditional route, did a couple of postdocs looking at cancer research, embryology research. Really had a passion for improving lives of people living with different health conditions, and dabbled in a couple of different areas in that regard but at the test tube level, so I was looking at different molecular mechanisms to help make small influences on the bigger picture of actual patient treatment. So I really wanted to make a difference that felt more tangible to me. And while I really enjoyed working in the lab, I also found out when I started doing survey-based research work as part of my science writing contract job at Diabetes Daily—which was actually owned by the same folks who founded Thrivable in 2019. We stared doing some data-driven journalism, and I just had this eye-opening moment of feeling like, “Oh… there’s a whole different world of research outside of the test tube that’s really capturing important information at a more human, more translational level.” And Thrivable is the little startup that could and continues. We went from inception in 2019 to now being a leading patient experience data provider. We’re really helping all the major healthcare organizations working in the diabetes space to deeply understand patient behavior in the market.

Wow. That’s so, so much that’s cool about all that, Maria. A quick antidote. Obviously, I’ve always been in the traditional research space and in the last few years have had the opportunity to work with clinicians on research and kind of their—so pro bono work that I’ve done with a few nonprofits, and who—they have the academic background, so their approach is what you’ve described your early career. And it’s like, “Wait… the survey can be really interesting—a great tool to understand some of these dimensions as well.” So I have a sense of what that transition was like for you because I’ve been experiencing some of that in reverse order of yeah, you know, sometimes we can just do a survey and [laugh], you know, and get good data that can help inform more of the structured approaches that are, you know, common in that world. So, anyway, that’s just neat how you came from the other direction. So you also are one of our 2024 Future List Honorees. And how’s that for you? What’s that feel like?

Yeah. It’s definitely an honor. It wasn’t something that I was necessarily expecting, but our marketing director, Adam Zandman, recommended it to me, and he nominated me. And so I was thrilled to apply. I thought it was a great program, and thank you so much. Yeah. It’s been really an honor.

Well, I think the honor is ours when we have, you know, great folks doing good work. And it sounds like that you do an awful lot of really impactful work. I have profound respect for anybody who focuses on healthcare specifically within research. I mean, we all—I think we’re all the heroes in our own stories. Right? But it’s kind of hard to escape the focus that we want to make people’s lives better and addressing some of those issues. So let’s talk about that just a little bit. So, thinking about your work at Thrivable, and it sounds like you focus on diabetes. Is that one of the primary areas?

That’s right. That is our primary focus. So, as I mentioned, Thrivable was actually born as a result of an organization named Diabetes Daily that was owned by the same CEO, David Edelman. So that was a forum for patients, where we had a very large community, and we also published educational materials: whether that was very text specific, educating what kind of insulin pumps, what kind of continuous glucose monitors are available, whether it was just resources about lifestyle medications, different medications, standards of care, or even more personal stories from people living with diabetes. At the time, we had med-tech companies that were advertising on the site, and they came to us asking, “Wow… you have a really large community. We would love to get their opinions to help shape our product development, and they are really difficult to connect with because of a lot of the HIPPA restraints of gathering patient information.” And so that’s kind of how Thrivable was born. We started running some experiments, doing some data-driven research gauging the interest of these—this community of becoming research participants, and it really took off. So now, 3, 4 years later, we’re at the stage of over 50,000 people living with diabetes, also caretakers of children living with diabetes. We have a really nice geographical representation and a lot of diversity and a lot of different recruitment channels, so no longer just constrained to the Diabetes Daily community but really widespread on a national level. So that’s been very rewarding and particularly for myself as a person who lives with type 1 diabetes, it was really, really exciting to be able to connect that personal element of my life with my background and kind of start new to make a difference in this community.

Yeah. That’s really the sweet spot, isn’t it, when we can translate personal passion and interest into impactful action for other people. So very cool. Very cool. Well, let’s step back for a minute because you mentioned immigrating to the US. So what was that like to come from Russia to the US? And then go from there.

Yeah. Yeah. For sure. So, yeah, I was seven and a half. We used to live in the Southern Siberian Plain and also spend summers on the Volga River. It’s kind of close to the middle of the country, where Europe and Asia are kind of divided. My parents—we actually came over. My parents were both academics, so we came over as a result of job opportunity for them. And so science and math was always very highly valued in the household growing up. I had a lot of help form my parents in those departments. I also had a very impactful biology teacher in high school who really was able to engage my interest in—specifically in genetics and cellular functions, and so that kind of shaped my desire to pursue biology and molecular biology. So, during my postdoc, I was, again, trying to figure out how to hone on that niche to study, and then I had a thought that maybe there was an opportunity to do something different. And so my initial thought was it might be science writing for me. I’ve always loved writing. I felt it was a strength of mine, and I also appreciate the possibility of it allowing me to potentially work remotely, especially as we started a family and had our kids. Just having that flexibility seemed like a really, really interesting and useful thing to have those back in the day of commuting, right? So I started working multiple jobs as a contractor to try to get my foot in the door in science writing, and that’s when I came across David Edelman at Diabetes Daily. And we kind of already talked about how that evolved and how we started running those experiments, using some of those of those forum members to conduct surveys, and how evolved into Thrivable. So that’s kind of how we landed.

So I have to ask—again, more selfishly—so I have mitochondrial disease. And you mentioned doing, you know, work in cellular. So is there any interesting insights that you’ve had around, you know, cellular function and health that has—even if you have type 1 diabetes, things that you’ve learned, you know, interesting insights for any of the audience that may be dealing cellular stuff?

Yeah. I don’t much specific to mitochondria. I think my proudest moment was in my first postdoc, where I actually figured out how molecular mechanism works. This was in the embryology field, and we were working in neural tube defects, and so we were studying cellular processes that drive tissue bending. And this was specifically having to do with folic acid and folate and those receptors and trying to understand why folic acid/folate is so important during pregnancy to drive tissue bending. But the mechanism of how on a cellular level that drives that mechanism was really not well understood, and so that’s something new that I actually contributed to science that I feel extremely proud of. Because I think originally when I threw the theory out there of how it might work, I think everybody thought I was maybe a little crazy [laugh].

[laugh].

Because it seemed out there, but I’m happy to say that since—and this was back in 2015, 2016—I’m happy to say that since then other labs have independently proven the same thing, so I was really, really thrilled with that.

Very cool. All right. So you’re in the history books then.

[laugh].

So [laugh]…

Well, at least in a couple of scientific journals, you know.

Right. You’re cited. You’re cited in the journals.

That’s right.

So there you go. Okay. All right. Very cool. Now, when working with the ADA, you were looking at healthcare experiences of underserved communities. What’s that? Tell us about that and how that’s played into your overall, you know, current role, passion, et cetera, et cetera.

For sure. For sure. Yeah. So the FDA—we collaborated to design a lot of this research. And depending on what their advocacy efforts and priorities were, they specified actually, for us, the populations that they would like to target, and those might be people who are minority groups, people who are, you know, of a certain insurance plan, all different kinds of things. One of the most impactful things that came out of our research was actually during the COVID pandemic. A lot of people were actually getting laid off. Some people were becoming homeless. And our research staggeringly showed that people with type 2 diabetes were something like 40 times percent more likely than people without diabetes to have become temporarily or permanently homeless during the pandemic. And that was a pretty staggering statistic, but also thinking about the cost of medical care and people losing their insurance, having to pay out of pocket for their insulin at ridiculous prices, you know, I’m sure played into that. So I—that was something that was definitely very impactful and slightly surprising. But after unpacking it, maybe not as surprising as it seemed at first. So…

Yeah. Yeah. That’s lots of unfortunate things like that that we’ve learned from that experience. But it sounds like, through the work at Thrivable, that you’re trying to use that to help companies develop new products and services to maybe address some of those inequities or challenges.

For sure. For sure. I think it’s so important: the selection process for research participants. So having that diversity on the panel that’s as representative as possible and having a large enough patient population, where you’re able to actually have it be representative in the studies, is absolutely crucial.

All right. So let’s—now you mentioned the community. And obviously, you know, fraud has been a hot topic in the industry for a long time, and especially in research that can deliver a higher value incentive. You have clinic trials or ethnographies or qualitative. So did you ever have a issue of that of folks that were trying to kind of just bullshit their way into your panel just to get higher incentives, and how’d you deal with it?

For sure. For sure. Right? So it’s a common problem in online panels in general, and you might have some proportion of bots as well as those unauthentic participants who just provide incorrect information to participate in paid research. What we ended up putting in place is a multi-pronged approach. So step one is we use a well-established platform called SEON, S-E-O-N, to screen parameters like their IP addresses, social media profiles, other elements, to help determine the probability of them being fraudulent. And then second part of the approach is actually looking at their self-reported therapy combinations and other questions that they answered during our intake survey. So basically it screened for 10 to 15 different therapy combinations that are just very, very, very unlikely, like they might be dangerous for people to do that. And if somebody is selecting that they have every health condition in the world, you know, that might be a flag. So we’ve been working closely with other teams, with our data product team, to refine what the best flags are and how many points to assign for each flag. Because you also don’t want to overshoot it and be screening out a large proportion of authentic people. And so it’s been a lot of fine-tuning that balance of where is that threshold and how many flags or how many points do they get. But I feel really, really proud of the progress that we’ve made over the last two years. And as a result, we have a very, very low rate of fraudulent accounts.

Good. Hence why you said the company is really growing. And I would say that would be one of the foundational elements. Certainly not the tip of the spear, but it is an important piece of the equation. So is—I think we’re all learning with the advent of AI. Yeah. I mean, garbage in/garbage out absolutely still applies. Right?

Yeah [laugh].

So [laugh]…

Yes. For sure.

Well, and we didn’t talk about this in advance, but, yeah, there’s a lot of conversation right now about synthetic sample, which is effectively creating models off of data that could be AI training sets. And I know that in one of my other businesses that we’re working with some healthcare companies, and they’re very interested in that idea for, you know, kind of early stage modeling, not to replace patient journey, but to try and understand some different components of it. Has that come up for you guys? Are you exploring that idea, or any of your clients looking at your [unintelligible 00:15:22]?

Yeah. So I know that there are some AI initiatives going on with our data product team, specifically. For instance, one such thing that I’m somewhat familiar with but not too familiar, is the predicted health conditions too.

Mm-hm.

So using AI to say “Hey… this person looks like this. Maybe we don’t want to have to put everybody through 50 different healthcare questions, but based on XYZ, we can deduce that they probably also have this health comorbidity,” for instance. So that’s something that, you know, we’ve started dabbling in. Actually, it’s one of the things that I really want to learn more about is all of the new AI-enabled tools for analytics. It’s something that I’m not as familiar with as I’d like to be. So, if I had to answer what content am I currently obsessed with or trying to learn more about, that would probably be it.

Okay. Well, I think that’s probably a good thing to be obsessed with right now. So [laugh]…

[laugh].

It’s—you know, that tool set is only going to grow.

For sure.

And, you know, there’s bumps in the road as we go through the process, but it’s still certainly going to be a major part of the process as we move forward. And I wonder, you know, with your background in, you know, molecular and cellular biology and academia, whether that science basis of your experience and background—if that gives you an edge in thinking about the future of market research and how these tools apply. What do you think?

Yeah. I really—I think it does. Well, first of all, I just really appreciate that I still have the opportunity to do analytics and scientific writing as well as just the research operations day in and day out at my current position. You know, I’m able to dig through interesting literature in the diabetes space and just apply my background in research design and data analysis and then telling the story in a report. Currently, we have a new product, for instance, we’re going to putting out regarding people’s personal therapy journeys in the GLP-1 receptor agonist space. So those are the drugs like Ozempic, Trulicity. You know, they’re becoming very, very much talked about and seem to be very effective for weight loss, for blood glucose management, for particularly people with type 2 diabetes. And we have a lot of people who have a history of using these medications and maybe switching. So we put together a large survey and a very comprehensive report based on several thousands of people, and especially focusing on what that journey looks like. What have they tried? What were their pain points? What were the barriers and things like that? So that was something that was super, super exciting, and I also felt was still connected to my background in molecular and cell biology because you have to have some understanding of the drug activity profiles and things like that. So that was super fun for me to build out that research and dig into it.

Yeah. Yeah. Yeah. Absolutely. Again, for my past couple years, I’ve delved into working with, you know, clinicians, and actually going to have a peer-reviewed journal paper published here any day now with my name on it. The first—I’m one of only—in a team. The point is, I know how intense that process is. And it’s a whole other world and rigorous and beneficial. So I imagine your reports are pretty kickass.

Well, thank you. I’m so excited for you. You’ll have to share that with me when it gets published. That sounds great. Congratulations.

Oh, well, thanks. It’s—I was a very small contributor, but I am listed as one of the authors. But I can’t say until it’s actually, you know, published.

Right. Right [laugh]. Fingers crossed.

Yeah. You know how it is. Yeah. Yeah. Yeah. So I think we’ve passed the final hurdle. So, anyway, [laugh] we’ll circle back around. All right. So we’ve talked about the quality issue on the panel and within your community. Obviously, folks come there because they’re looking for sharing information with folks who have the same issues, et cetera, et cetera. But that’s not all there is to engagement and reducing churn. So any other tips? What have you learned that really kind of drives participation and engagement across the panel?

Yeah. I think it’s—the key is understanding the audience you’re talking to. We all know diabetes well. We have several team members who have family members with diabetes or have diabetes themselves, so we’re able to connect on a more personal level with all of our panelists. And I would say it starts with messaging that really resonates with that community so they understand how Thrivable is helping share the future of diabetes care. And we’ve also found that strategic partnerships with community leaders has led to great success in reaching and engaging the community. And last but not least, we only take on research projects that directly impact the individuals who participate in them. That has really built a trust between us and our community, that we are there to support them and better their lives. And this trust increases engagement throughout the entire recruitment process and allows us to produce more impactful insights.

Very cool. Do you share results back with them when appropriate, when allowed, on…

Yes. When appropriate, for sure. For instance, in the ADA collaborations where, you know, kind of public goods reports as opposed to some proprietary work for customers, correct.

Okay. Do you delve into clinical trials at all, just out of curiosity?

That’s a good question. We don’t consider ourselves a clinical trial recruiter, but we have partnered on projects with some other agencies that do that. So we can take on projects where we can pre-screen potential patient populations, but the aspect of actually getting them signed up for a clinical trial is separate from what we do.

Got it. Got it. You’re the connection point.

We’re the connection point.

You know, top of the funnel, but…

[laugh].

Okay. All right. So before we started this, we were just getting to know each other a little bit and talking about family and living and you shared that you had fairly recently just moved to central Florida and bought a three-acre, you know, property. So talk about that. You’re here from New Hampshire to Florida. And so what’s that transformation been like for you?

Yeah. It’s been great. We drove in the beginning of March, so it felt like driving into spring over the course of several days, which was pretty, pretty cool.

[laugh].

You know, we went from 20-degree, windy weather to 75, bright and sunny, over the course of 3 days, and it was nice. It was a challenging trip. We were in a 12-passenger van with, at the time, 4 dogs, a cat, a baby, and a 4-year-old, so that was eventful. It was an eventful drive with lots of stops along the way, but we made it, and we love it here.

Any run-ins with alligators?

Yes, actually.

Yeah [laugh].

We went on a boat tour a couple of years back, and it just happened to be one of those really awesome alligator sighting days. So our driver took us up really close, and we saw probably 20 to 30 alligators over the course of two hours. And I learned that they hiss. Because until I was in close proximity with one, I actually didn’t know that.

Yeah.

So now I know.

All right. But none on the property? So…

No, no. Thankfully. We’re not very, very close to a body of water, so I haven’t seen one on the property, no.

Okay. You know, all of our listeners know I talk about that all the time of moving to Kentucky, right, and living out in the middle of nowhere. And no alligators, but we did see a bobcat on our property just recently, and coyotes all the time. We actually just call them ‘the boys’. You know, “Oh, the boys are partying over, you know, over there,” because we hear them. So, I think, in Florida of, like, what’s the equivalent of the coyotes or the bobcats is the gators. So I’m glad you haven’t had to have the personal run-in with one on your property.

We actually—our neighbor said that she saw a bear climb over our fence once. So [laugh] there’s that as well. We have that in New Hampshire and in Florida.

Yeah. We have them here too. There was a neighbor who took a picture of one just a couple weeks ago. I have not seen one on our property. We put up a trail cam, actually. Yeah, there’s one picture that we don’t know that the hell it is. Like, what is that?

[laugh].

You know, and even was half convinced that maybe it could be a cougar, but there’s not supposed to be cougars around here. Anyway. So [laugh]… the joy of rural life. So what made you do that, though?

Made us move to Florida?

Yeah.

Well, we were trying to get out of the cold. At the time, my—because I was working remotely, I could do it from anywhere, and my husband got a new position in Orlando. But since then, he’s actually gone remote as well. So now we’re both saving the commuting time, and we get to live in Florida.

Okay. Cool. And the kids are the—getting to the age where you can enjoy Orlando. So…

For sure. For sure. Yes. We’ve done the Universal and the Magic Kingdom once. It’s expensive, though. I feel like, at their age, you can get more wow factor going to a smaller amusement park where they can ride more stuff so… and save some money.

Yeah. I would agree with you. And once is enough for me [laugh].

[laugh].

Although, I do regret that I haven’t been back since they opened up the Star Wars area.

Oh. Mm-hm.

I do want to see that, but I don’t know if I want to see it enough to deal with everything else involved with that trip.

For sure. The crowds, yeah.

Yeah. And the expense and the… yeah… anyway. So [laugh] somewhat like-minded. All right. So looking at the future, what does that hold for you? What are your goals? Where are you thinking this goes for you?

Looking forward to continuing to build this plane as we fly it. Being in a startup has been an experience. It’s been a good experience, a very good experience—just really want to see more growth. We’ve started doing a lot of more in-person studies, like for FDA approval of med-tech. That’s been especially rewarding because we’ve seen a lot of organic feedback actually coming back from the participants saying how much they appreciated being able to contribute, to be on-site, actually handle the prototypes or interact with the applications and development. So feeling that in a very tangible way, so I hope to do more of that. And I’m really just excited. I’m helping our technology team build out a new platform. We’re undergoing a massive restructuring of how we store data and all of the bells and whistles and interactions and functions that are going to be available to both the research team and our customers in the coming year. So I’ve been learning a lot about what goes into actual development, and it’s a lot that goes into it, and there’s a lot to think through. But I just really like working across departments and learning new stuff from them as well.

Is there one thing, as you look at the year ahead specifically, that, like, okay, this really gets me going; I’m really excited about this one specific thing?

Yeah. It’s definitely the platform development. I think it’s going to be great. I think once we have a really good tech-enabled component, it’s going to help us really be more effective in our research delivery and be able to glean a lot more information from all of the data that we already have.

And does that tie into your interest in AI?

For sure.

Yep. All right.

My husband actually works in machine learning, so he knows a lot more than I do. But just learning all of the possibilities from him and also from much smarter on our team who work in that kind of space has been just really, really cool to see.

All right. So I want to be conscious of your time as well as our listeners, so here is the question that we always kind of wrap with overall. What did I not ask that I should have or you wanted me to?

I think you did a great job.

Well, thank you. I wasn’t fishing for a complement.

[laugh].

But the [laugh]—but I appreciate it anyway.

Best advice that I’ve ever gotten from anyone… Okay. My PhD advisor, Dr. Benencia, on one of the first days of my graduate student career gave a presentation where he put up a slide that showed the percentage of grants that you need to apply for in order to get one, in his own personal history with it. And it was something that was pretty ridiculous, like 1 out of 40. So he said the most important thing is don’t be afraid to fail, and I always try to take that approach.

Absolutely. And ideally fail fast.

Fail fast [laugh] is right. Yeah.

Yes. Fail fast. Get it out of the way. Move fast and break things. Right? So I had similar advice from other people in my life as well. And it—yes. It is—it’s wisdom, isn’t it?

For sure. For sure.

All right. So anything else? Anything else that you want to share with our listeners or with me or…

No. I really appreciate the opportunity, coming and chatting with you guys. Yeah. It’s been really, really, really fun. So I appreciate you having me.

Glad, glad to have you. Congratulations on being a Future List Honoree. Congratulations on the success with Thrivable and for making a real impact in people’s lives. It’s always nice to talk to folks that there’s something so tangible in helping to benefit people’s lives. And congratulations on life in Florida.

Ah. Thank you so much, Lenny. Thank you. I appreciate it.

All right. Well, Maria, thank you for being here. I really appreciate it. Best of luck in everything that goes forward from here. And to our listeners, thank you for being here. I want to thank our editor, Natalie; our editor, Big Bad Audio. Also, a little plug. If you’re listening to the podcast, you know, we have another thing called The Exchange by Greenbook, which is a weekly webcast that myself and Karen Lynch do ever Friday at 12. It’s 30 minutes just kind of recapping the news and our views on things. So, if you enjoy this and my voice is not too annoying, then please go and check out that because we have a lot of fun. And we think that it’s cool, and hopefully you will too. So that’s it.

Awesome.

Yeah. Yeah. And, Maria, please, if you’re not listening to The Exchange, we talk about AI a lot so…

[laugh] Awesome. Yeah.

So, if that’s your thing… We didn’t plan for it to be that way, but it does often just kind of being the week in AI because there’s just so much happening there. But, anyway, that’s it for now. Thank you guys for joining us, and we’ll see you on another edition of the Greenbook Podcast soon. Bye-bye.