Imperative Care CEO Fred Khosravi’s dream for medtech — and how to get there
30 Nov 2023
Medtech leader Fred Khosravi is betting on an innovative — and risky — approach to patient care.
Imperative Care co-founder, Chair and CEO Fred Khosravi, a refugee of the Iranian Revolution who became an engineer and serial entrepreneur in the U.S., wants medtech to shift its focus from treating diseases to treating patients.
He’s taking that approach at Imperative Care, the parent company of Imperative Care Stroke, Imperative Care Vascular, Kandu Health and Telos Health. The group is focused on innovating care for stroke patients and other vascular diseases, not only with interventional devices, but also with new technologies for disease detection and recovery.
In a keynote interview at DeviceTalks West 2023, Khosravi shared his vision for the future of stroke care and medtech more broadly and discussed lessons he’s learned in his long career. Below are some highlights from the conversation, which have been edited for space and clarity.
Innovation in stroke care
Khosravi sees too much “hammer-and-nail” focus on treating diseases in medtech versus a focus on treating patients through their entire journey.
“Stroke is one of those diseases that really requires that continuum-of-care-type of energy and connected care innovations,” he said. “Otherwise, the patients are going from silo to silo, and they’re confused at every silo, from home to ambulance to getting treated and then going to a rehab center.”
That’s why there are so many readmissions of stroke patients, Khosravi said, and most are for hip fractures and urinary tract infections.
“A stroke patient who gets readmitted to the hospital has a 60% higher chance of actually getting another stroke and dying from it. Low-hanging fruit: UTIs and hip fractures. If you prevent those, you’re going to save a lot of lives. And this is why we have Kandu Health,” he said.
Kandu Health’s platform follows stroke survivors, helping them avoid feelings of isolation and common causes of readmission. Approximately 80% of cases who go through Kandu’s program improve their Modified Rankin Scores from a range of 2-3 (slight to moderate disability) to 0-1 (no disability or nonsignificant disability), he said.
Imperative Care is also trying to give stroke patients the best chance of survival and recovery with innovative thrombectomy technology to quickly access and remove the blood clots that starve the brain of oxygen.
“We have the Zoom system, where today more than 60% of the procedures are TICI 3 — full revascularisation — under 10 minutes,” Khosravi said. “We can make it better. We’re going to continue making the technology better, but making the catheters better is not going to make it available to more patients.”
Technology for the future of stroke care
Making those innovative interventional therapies available to more patients calls for digital health, automation and robotics, Khosravi said.
Wearable detection systems could accelerate diagnosis and make sure a stroke patient gets to an appropriate facility for treatment.
“There are 900 cath labs in the U.S. that actually perform these procedures. There are 6,000 cath labs in the U.S., so if you end up in the wrong hospital, you’re screwed,” he said. “And if you’re in a rural hospital, you’re also relatively screwed, because you’ve got to get put on a helicopter and taken to the hospital, or the physician has to basically drive to you.”
Imperative Care’s Telos Health is working on robotics to allow a stroke specialist to remotely perform a thrombectomy on a patient who might be hundreds or thousands of miles away. Remote intervention for stroke treatment appears to his team to be the best use case for medical robotics, Khosravi said.
“Interventional robotics is not surgical robotics,” he said. “It’s not just cutting things and sewing things and what have you. It’s about linear coaxial motion, it’s about fluidics. It’s about catheters of the future — you can’t really use catheters of today for a technology that’s going to be in the marketplace in 2028.”
“You have to bring all of those three pillars to the table,” he continued. “And I think we are the only company in the world that can actually do that.”
Medtech 3.0
The company’s five-headed structure and approach might raise eyebrows from conventional medtech executives as startups typically focus on a single device or platform.
“If people are not laughing at you a little bit, you’re probably not trying hard enough,” Khosravi said. “What we’re doing is different. … If you’re taking five boulders up the hill, the probability of failure goes up by quite a bit. If you’re taking one boulder up the hill, the focus really makes you achieve what you’re doing with a higher probability. And we’re taking five boulders up the hill.”
He calls the approach Medtech 3.0.
“We’re essentially creating a hyper-growth revenue company in stroke and vascular, but we’re also making significant investments into the back half of the decade and the next decade, so there is durability and continuity of that growth,” he said.
More proportional gender representation is one of the biggest changes needed for medtech to improve patient care.
“For medicine to shift into treating the patient as opposed to treating the disease, we need more women in medicine,” he said. “We need more women in leadership in companies that are creating technologies for medicine.”
Leadership lessons
Khosravi learned an important lesson through the near-failure of one of his companies.
“Everybody can start a company,” he said. “But we all need to surround ourselves with people who are better than us in things that we’re not good at, as opposed to trying to both conduct an orchestra and play every instrument.”
As an engineer, he always thought leadership was about being involved in every aspect of the business, but he learned that as a leader he needs to spend more time working on the business.
“The fundamental thing that was wrong was that I actually thought it was about me. I learned that it can’t be about the person who’s doing it or running it. If it ends up being about the person who’s doing it and running it, the probability of failure goes up because you’re listening to a lot of people. You’re trying to please your investors, your family, your employees, your management and the doctors, instead of being focused on doing the right thing and having a North Star that you can follow. … You’ve got to have people that you trust and let them do what they need to do and make sure there’s an accountability process. But the CEO needs to be on the business more than in the business.”
‘This is what I want to do for the rest of my life’
Khosravi shared the moment when he knew he wanted to spend his life helping patients. While he was working in an intraocular lens company in one of his first medtech jobs, he found himself on a flight seated next to a woman who told him she just had surgery to restore her vision and could now fly by herself to see her grandchildren.
He realized her restored vision was thanks to the technology he had been working on. It was his first interaction with a patient.
“I sat there, and I said, ‘This is what I want to do for the rest of my life.’ And that’s what I’ve been doing for the rest of my life,” he said.
He traced it all back to his education in mechanical engineering at Tennessee Technological University after immigrating to the U.S. from Iran in 1978.
“Education is a place where there’s freedom to learn what you want to learn, as opposed to a central government pushing the education that they want to push into you,” he said. “For me, it was transformative. I basically got all of the elixir out of the opportunity to have an education. My other option would have been to go back home and be part of a million people who died in a war between Iran and Iraq. It was a tremendous opportunity for me to be here. And I actually really understood what freedom is like: freedom to think, freedom to decide to do what you want to do, as opposed to it being prescribed for you.”
That appreciation “has never diminished,” he said. “Never.”
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