Welcome back to another episode of MedCity FemFwd, a podcast dedicated to exploring the breakthroughs and challenges in women’s health. In this episode, we’re joined by Dr. Rani Aravamudhan, senior medical director of Artemis at Nomi Health.
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Here is an AI-generated transcript of the episode:
Marissa Plescia: Welcome back to MedCity FemFwd. I’m Marissa Plescia, reporter for MedCity News. In this episode, we’re joined by Dr. Rani Aravamudhan of Nomi Health to discuss the company’s recent research on endometriosis
Hi, Dr. Rani. Thank you so much for joining MedCity FemFwd.
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Dr. Rani Aravamudhan: Hi, Marissa. It is very, uh, nice to be here. Thank you for giving me this opportunity.
Marissa Plescia: Yeah, absolutely. Very happy to have you here. Um, maybe just to start, can you just tell me a little bit about yourself and Nomi Health?
Dr. Rani Aravamudhan: Sure. Um, I’m Rani Aravamudhan
I am the senior medical director here at Nomi Health. I’ve been with the company for almost two years. Um, for a background, I am a general physician or a primary care provider, and I have been on the, uh, data and analytics side of, uh, healthcare for a little over 15-plus years now. Uh, Nomi Health, um, is a small company based out of Salt Lake City, and we are truly in the business of rebuilding healthcare from the ground up to make it easier for everyone involved.
Um, that includes all of us members that consume healthcare, um, to the providers and the hospitals that are providing that care to us, and then of course, to the, uh, insurance companies and the employers and health plans that are actually in the business of, um, you know, paying for that care. Um, part of Nomi Health, um, or one of the business units of Nomi Health is Nomi Analytics, um, which has the product Artemis, um, th- where I, um, sit.
Like, that is a part of the business that I sit in. And, um, our, our mission is to really make sure that employers and health plans, um, are able to make very, um, intentional data-driven decisions when it comes to the healthcare that they provide for their consumers. So we have a, um, system where we are able to bring in data from all different sources, that’d be claims, um, from, you know, various, uh, point solution vendors, lab data, disability data, you name it, so that it can all be then tied in at the member level to get a really good picture of, um, how a s- a, a given population or an individual person is consuming healthcare and what do those trends really tell us.
How is that changing over time? And how does that affect the way decisions are really made when it comes to the healthcare of a given population? And, y- you know, how we could help stakeholders do that more effectively and efficiently, thereby trying to control the costs and make sure that there are, you know, better positive outcomes for their members.
Marissa Plescia: Yeah. Yeah, that’s really great. And going off of that, um, you recently re- released some research on endometriosis. Mm-hmm. Um, can you tell me a little bit about why you felt it was important to conduct this research?
Dr. Rani Aravamudhan: Sure. Um, endometriosis, for, uh, those who may not be aware, endometriosis is a women’s health condition where, um- The tissue that lines the innermost lining of our uterus, which is called the endometrium, that tissue actually grows outside of the uterus.
It can grow on the ovaries, it can grow in the fallopian tubes, on the cervix, even on the bladder or the rectum sometimes. So what that, what, what that does is really, um, give way to a, or create a lot of symptoms and, um, you know, conditions, uh, that can be pretty debilitating. By itself, endometriosis is not necessarily dangerous or life-threatening to a woman, but it can be, like I said, extremely debilitating with, um, really very, um, severe pain, uh, pelvic pain, back pain, abdominal pain, very heavy bleeding during menses, um, or even breakthrough bleeding sometimes, where it gets very hard for women to function.
It may be that they have to take time off of work, or they cannot really participate, um, in family activities or, uh, you know, similar things or, you know, have a social life sometimes. Um, sex can be very painful, um- And, uh, it is one of the main causes of, um, infertility among women. So, um, you know, given all of this, um, we also know that, um, the lead time to diagnosis of, uh, endometriosis is anywhere between four to 11 years.
And this is not a statistic that, uh, I’m quoting off of our data, Artemis data or something. This is national data that has been published by the, uh, American College of Obstetrics and Gynecology and the American Medical Association. So four to 11 years, think about that. That’s a long time for someone to be going from, you know, “I am in severe pain all the time, and, uh, I have no idea what’s going on.”
And they go to their providers, they go to their doctors, and they’re being treated for one symptom or another. And it is really hard, um, for women to sometimes get the attention that they need. Because many times, and, uh, I’m pretty sure that all of us know somebody in our lives that has endometriosis, will tell you, people will tell you, women will tell you that they’ve been told, “Well, that’s just how their body is.
Some women just have heavier periods, and it is just something that you need to learn to live with.” Um, so this is, you know, something that is going on in our culture. And more importantly, um, recently there have been some, um, you know, uh, some, uh, news that has come through where the, um, American College of, um, Obstetrics and Gynecology and some of the European, um, you know, organizations are really talking about, uh, shortening that time to diagnosis so women can get the right care, um, quickly and easily.
Our, um, you know, our intent was to try and see what exactly does that mean from an employer or from a health plan standpoint. If there is this much lead time, what does that mean from a cost standpoint, from a, uh, productivity standpoint in the workforce and that type of thing? So because we do have access to a very large, um, you know, dataset from, you know, we call it our book of business dataset, um, which has the data from all of our customers.
We have over 3,000 employer customers. Um, we felt that it might be a good exercise to see, are we seeing that in our data? Are we seeing this lead time to diagnosis, and what exactly is that costing an employer or a health plan? How is that truly affecting the lives of the women that are, you know, um- that, that do, are, that are afflicted with this condition.
Uh, another, um, area that, um, interests me in particular is also, um, you know, I did talk about the severe pain, um, of endometriosis already. That is probably one of the more common symptoms. But endometriosis is known to have a very wide-ranging area of symptoms. Everything from back pain to joint pain to migraines, um, to feeling very cold or feeling very h- warm, you know, all kinds of things.
Um, which because of that, it, you know, they s- you know, women sometimes have to go through a very Different, uh, process to get to that diagnosis. That is also part of the reason that it takes a long time. Um, and today at least, as of, as of today, I should say, the definitive diagnosis is based off of surgery, um, typically laparoscopic surgery and some biopsy.
So you can imagine, um, providers will tend to try and rule out all other conditions where some of these symptoms might overlap before they even think about, um, you know, connecting a lot of the dots that, um, you know, uh, w- women are talking about and have seen over the past one, two, four or six years to then say, “Oh, uh, this could be endometriosis.”
And then, um, uh, you know, then investigate them for that. On the other side of this spectrum is women that may have no symptoms at all, or have very minimal symptoms, but then it comes to a head when they are trying to have a family, they’re trying to get pregnant and have a baby and they are dealing with, um, you know, infertility, which is, uh, you know, not, um, easily solved for with hormone treatments or something else.
And then when they do a laparoscopic, um, investigation, they find that, yes, this person does in fact have, um, endometriosis. So there is a lot of, um, you know… I- it has a lot of impact. As of, uh, today, the, um, American Medical Associat- A- Association estimates that one in 10 women of reproductive age, so, um, those who are between, let’s just say, 15 to, let’s say about 45 or 50, one in 10 women has endometriosis.
It is obviously very under-recognized and therefore under-treated. So, um, we feel that, you know, um, that needs to change. And if we can do something to bring, uh, or to, to shine a light on this, especially with some hard data, I think that could go a long way. So I should say that that’s my long-winded way of saying, um, there’s a lot of interest in it because of how it affects women.
Marissa Plescia: Yeah. Yeah, very well said. Um, really important stats that you just mentioned. Um, going off of that, what, um, was your methodology for this research, and what are some of the findings that really stuck out to you?
Dr. Rani Aravamudhan: Yeah. Um, so as I said, you know, we do have a very large data set that we are privileged to work with.
Um, so, um, I worked with our analysts to try and define, you know, how do we do this? Because so much of this is nebulous, right? Um, the symptoms vary. It can be, like, no symptoms to, like, very, um, you know, um, w- women with all kinds of symptoms that are very disparate. Um, and then it can also s- go from, uh, somebody who’s been complaining for the last three months to someone who’s been trying to find an answer for the last eight or 10 years.
So it, it’s a lot of, um, you know, lot of variables, lots of unknowns. So the way we decided to do this was, um, let’s try and just try to quantify, um, the costs that have been incurred in those who ultimately were diagnosed with endometriosis. Um, let’s try and quantify the costs for the 12 months before they were diagnosed.
Let’s just start there, one year. So let’s just look at one year of their, uh, medical, um- Uh, claims or, uh, the, you know, um, what, what is the term I’m looking for? The, the, the care that they got, their experience, their medical experience, medical and pharmacy, of course. So any me- um, any, uh, care that they got for just 12 months before they ultimately had a diagnosis.
So we obviously then, you know, went about looking for women that had been enrolled in a medical plan for at least 24 months so that, you know, we are kind of looking at those who’ve been on, uh, you know, w- uh, who- who’ve been in our data set for a long time so we can go back and look at their, uh, historical data.
So we looked at anybody, uh, that already has a diagnosis of endometriosis within a certain age range. They were all excluded. So we’re not, you know, looking at them. We’re only looking at those who ultimately did get a diagnosis. And we formed some cohorts. So a cohort of women who were diagnosed for the first time, as we say, first observed diagnosis of endometriosis in 2023, 2024, 2025, and created some cohorts of women, and then went back 12 months from that data diagnosis, um, to look at all of their claims.
Now, the minute we started to do that, then there was a lot of overlap because obviously, again, like I said, you know, it is most often confused for, um, things like inflammatory bowel disease, urinary tract issues, or, um, back pain and sciatica, um, migraines, um, all kinds of things other than endometriosis. So then the question becomes, you know, how many– for all of the women that, for instance, have migraines, how many of these were actually migraines?
And how many of those were ac- you know, like probably not appropriately diagnosed? I wouldn’t say wrongly diagnosed, but appropriately diagnosed, um, as endometriosis. So for that, we went back to peer-reviewed studies and looked at the 15 to 20 most common conditions that we see in women who ultimately are diagnosed with endometriosis and just took those conditions.
And that included, of course, pelvic pain, pelvic inflammatory disease, um, sciatica, chronic back pain, um, chronic fatigue, iron deficiency anemia, very heavy bleeding, all those types of things. So, um, I’d be happy to provide a list of those, um, if that would be helpful. Um, and then we looked at just the cost of care for those 15 or 20 conditions that are seen most often in women who are ultimately diagnosed with, um, endometriosis.
So again, it is not… The, the intent was not to find every single person, every single dollar, every single service that was rendered, but more to try and scratch the surface a little bit to see if we just went back 12 months, what do we find? Which tells me that, okay, um, if we then extrapolate that to two years or five years, what does that really mean, right?
So that was our general methodology. What we found was the number of women that were being diagnosed each year for the first time was fairly consistent. Um, you know, it, it was probably about, I think in our dataset, we saw it was about 21 or 23,000 or something like that, um, across the country, all over the place, of course.
Um, so that was fairly, um, stable. And then we saw that for these women over a two-year period, um, when we looked at all of their costs for just the 12 months and for just these 15 or 20 conditions, that came to almost $37 million a year Now, in the grand scheme of things, as, uh, expensive as healthcare is, one might say 37 million, hmm, not, not a whole lot, you know?
But when you think about that is just for one year and for one condition where people are still trying to find an answer. This is not the actual care for the condition itself. This is not like, okay, now I know what I’m dealing with, and there is a standard care protocol for this, and that is what I’m following, and that is costing me this much.
We’re not at that point yet. We’re simply looking at just the amount of, um, time, energy, and money that was spent in trying to arrive at that diagnosis. So those were some of our findings. We saw that, you know, women were so on a, um, average, it was about $1,800 per 1820 or something like that, $1,800 per person per year being spent on, um, the care that they were getting.
Um, we also found that, um, women were seeing multiple specialties, obviously, in addition to their OBGYNs or internal medicine doctors. They were seeing rheumatologists. They were seeing, um, orthopedic, uh, folks, GI, uh, doctors. So lots of different types of specialties were also being seen. So when we looked at that, it was, you know, in a year, it- an average of four different specialties had been, um, seen by m- many women to try and get to this diagnosis, to try and figure out what’s going on with them or try and get care for all of the things that they were experiencing.
We also saw that once they were diagnosed, you know, for people that were ultimately diagnosed, then the, the cost of that treatment for endometriosis did go up. It went up to something like, uh, 5,000 or 5 to $6,000 a year minimum, medical, pharmacy, everything included. So oh, um, the other thing of that we also found is there obviously was a lot of mental health comorbidity among these women because think about the stress and the anxiety that probably comes with, um, you know, trying to, um, get through their work and day and life and care for children and all of that with something that could be, um, fairly, um- Tiresome, you know.
Uh, pain and, you know, chronic pain is never good for anyone, so, um, there was definitely that angle. Um, and also most of the women had at least three m- or more of the 15 or 20 most common conditions that we had considered. So there was definitely a pattern that we saw. Um, and we felt that it was significant and, uh, wanted to bring that forward, um, to our customers to say, um, “Are you aware of this?”
You know, to kind of try and make sure that you understand that this could be affecting, um, the wellbeing of, um, your populations, especially, um, when it comes to, like, their work, their productivity, their… the amount of t- the amount of sick time or, you know, time away from work that they might be taking, how it’s affecting childcare, all of that plays into this.
So those were some of our findings.
Marissa Plescia: Yeah. Yeah, those are some really interesting findings. Thank you so much for sharing those. Was there anything, um, from those findings that really surprised you that you weren’t expecting to see?
Dr. Rani Aravamudhan: I wouldn’t say as much of a surprise. I think it was more of, um, the data that was affirming a lot of what, um, I had known as a clinician for a long time and what I had been, uh, reading and, um, you know, researching from the peer-reviewed studies and AMA and all these different sources.
So we were seeing that this is definitely playing out in our dataset too. Part of the reason that we wanted to do this in our dataset is we are, uh, you know, our data is all from commercially insured, um, you know, populations. When we talk about AMA or CDC and such, which is all across the country, that takes into account, um, you know, Medicare, Medicaid, commercially insured, all different populations, so sometimes those patterns are different.
Um, and so I was really interested in seeing whether our, um, or, you know, exclusively commercially, uh, especially self-insured employer population dataset kind of, um, shows similar patterns as what is being reported nationally, and we did. I think what did… You know, if you wanna call it a surprise, I think when I saw that most of the women in the cohorts had three or more of those 15 or 20 conditions that were most commonly seen, when, when I saw that, I was like, “Oh, okay.”
So there is that pattern which if the, um, you know, if data was seamlessly available to all the providers, they may have all seen that quickly. So I mean, what I mean by that is, um, you know, if I go to my primary care provider, I talk to them and say, “This is what is going on,” and they say, “Okay, um, yeah, you might need a referral to go see a gynecologist,” or, um, you know, “You, you should probably go see a gynecologist and an orthopedic person because you’re complaining of these two or three different things,” um, that seem to be, quote-unquote, unrelated at first glance.
Now, um, I go to the gynecologist. Um, they probably have a little note from what, uh, they got from my PCP, but nothing more than that. Then I go and see the orthopedic person, who again has a little something from the PCP, but nothing more. The p- the orthopedic surgeon and the GYN have not exchanged notes.
If they did that sooner We might be getting to diagnoses faster. So that was something that, you know, came to mind. And, um, so you could call that a little bit of a, “Oh, wow, okay, um, this is truly, um, playing out in our data sets too.” So there are women in our, uh, client base who are going through this process that is being so widely written about, you know?
Marissa Plescia: Yeah. Yeah, really interesting. Thank you for calling that out. Um, well, I just have one last, uh, question for you. Um, you know, based on the findings of this report, what do you want, um, healthcare stakeholders, whether it’s employers, payers, um, providers, to really take away from these findings?
Dr. Rani Aravamudhan: Great question.
Um, because at the end of the day, you know, um, for me personally and, and, and for Nomi Health as a company, um, we want our data to bring about change. Um, even if it means that it is small, it, it is in small steps, it’s incremental, that’s fine, but we do want that change to come. So, um, one of the things that, like I said, I mentioned it a little bit before, that is changing is the recommendation, um, on the diagnosis protocols.
That is coming up, and that probably will be available, uh, a little bit more, um, you know, in, in the next few months. But, um, for… O- oh, and what that will do is, um, it shor- uh, will attempt to shorten the time to diagnosis. So as I was saying, right now the, um, the, the definitive diagnosis is based on laparoscopic surgery and biopsy.
Um, the ACOG, um, AMA, and some of the European organizations are recommending that, um, you know, uh, providers do not wait for something like that. They estimate that, um, something like 50% of women that present with infertility, um, will ultimately have endometriosis, and 70% of women that, uh, complain of chronic pelvic pain will be diagnosed with endometriosis.
So let’s start there and, you know, base our, um, treatment, our diagnosis and treatment more on the history, the clinical findings, and the imagery, and let’s not wait for that, um, for, for the surgery unless it’s a very complex case. So that is a recommendation that is coming up, and that’ll probably, you know, will be a very good change.
From our part, um, from the data that we’ve unearthed, what I would like people to take away is let’s start with the people who are most affected, the women, the members. I would like women to really educate themselves, um, about this condition. If, uh, they feel like there’s something not quite right, um, that doesn’t, you know, neatly fit into boxes of, “Oh, I just have joint pain You know, something like that, then they should talk to their doctors.
They should, you know, research endometriosis, um, ask. It- e- endometriosis is also, um, ver- uh, you know, hereditary. It is known to, uh, you know, if, if your mom or your aunt, uh, sisters have it, chances that you have it are … go up. So educate yourself about your family history, talk to your doctor about that, and advocate for yourself for sure.
You know, that is, uh, definitely it. Um, for the, uh, providers, I would say please take your patients seriously. When they tell you that this does not feel normal, um, they say that, you know, “I bleed so much and I am so tired and I am … You know, the amount of pain I feel is way … It’s way more than what I’ve seen my friends or my sister or my cousins or my mom go through,” take them seriously at that.
It is not just, “Oh, your body is different than anybody else.” It’s more than that. And for the, um, the, um, insurers, the, the health plans, and the employers, I would really say that please treat this. This is women’s health. Women’s health is more than just maternity. Women’s health starts way before women are, um, ready to have children and will continue a long, uh, time after they’ve had children and gone through maternity.
So, um, it’s important to understand that there are these, um, conditions that can be, um, very detrimental to women’s wellbeing and have to be treated seriously. Um, so if they are looking for, uh, you know, vendors, women’s health vendors that they would like to bring in as part of their wellbeing programs, talk to them about what other than, um, maternity do they bring to the table.
Are … Do they have clinicians and, um, services that will support conditions like endometriosis or other conditions too? Lots of other ones. So understanding that and being, uh, at the forefront of it to say that we do support women in all stages of their lives and, um, do what we can to, um, make sure that they are well cared for is in their best interest too, because that will bring down the amount of sick time that women take, the amount of time that they are away from work and, and that is a huge, um, cost savings for the employers too.
So I would really want them to take that, um, to heart.
Marissa Plescia: Yeah. So well said. That is a great call to action to end on. Um, thank you so much, Dr. Rani, for joining. This has been such an interesting conversation. Really happy to have you on Fem Forward.
Dr. Rani Aravamudhan: Thank you so much, Marissa, for giving me this opportunity. I really appreciate talking to you.
It was, it was fun.