Mural Health - giving power to the patients wanting to take part in clinical trials

The company is billed as a next-generation participant management platform offering its Mural Link tech platform giving trial participants the option to choose how they receive payments without predatory fees related to prepaid debit cards. It helps them get to sites without incurring a cash expense and opens dialogue between participants and site personnel.

OSP: Tell me about your stance on financial payments in trials, and I also wanted to ask you about the new FDA guidance on diversity. It seems like there are so many things to juggle.​

JD:​ Yes, it's tough. I'm sure from your previous interviews, you know that trial participants are wealthier and tend to be white and male. I see stats like half the US have less than $1,000 in savings and 20% only have no savings. So those people should they want to participate in trials, have to pay out of pocket.  So, how do you get them to participate? For Mural Health, getting people reimbursed quickly, or helping them not have to pay out of pocket at all is super important and what we strive for.

OSP:​ How does Mural Health work so that people are not out of pocket?​

JD:​ A lot of our travel solutions are paid directly and then we get reimbursed from the company. You know, so patients can book Ubers or can book hotels and whatever they need without them having to pay out of their own money for things.

OSP:​ Do you encourage the sponsors to deal with the finances from the off?​

JD: ​There's two parts to it. There's a reimbursement portion for services that patients need to get to the trial and then there's a piece where they get paid again for the time something like $40. A stipend is what we call it.

The first portion we try to reduce them being out of pocket for it, and the second portion, we try to get it into their hands as quickly as possible. So, something like 80% of patients get their money, usually, within at least two weeks, but certainly between two and 12 weeks. Through our digital methods, we usually get it to them instantaneously instead of through prepaid debit cards, which you can often lose, and there's a lot of fees associated with those. Our methods are free and safe.

OSP:​ Do you think this is still a big problem, obviously Mural is trying to tackle it but can you see it being handled differently in future across all trials in the future or is it companies taking small steps?​

JD:​ I think it's always been a big problem, but it hasn't been recognised as such. We've always talked about patient centricity, but I think with COVID, and with more decentralized trials, it's forced us to be more proactive in adopting new solutions. For example, a lot of the prepaid debit card solutions in COVID failed because they usually require you to go in to an office or the clinic to then get prepaid. That motivated us to launch something fully decentralized and fully decentralized friendly. Hopefully this will create a wave of recognition from all pharma companies quickly.

It is going to be trial by trial adoption, but I think we'll come to a point where we'll hit more than 50% where we switch from checks and cash to digital methods.

OSP: So how big is your team and how did you get into this area and come up with the ideas? ​

We're about 20-30 people now and we came out of another industry leader. One of our co-founders built that previous business. He was the co-founder of that business. We saw there were a lot of issues with market leading solutions. There was a lot of tech debt and we thought it's time to innovate that for the 2020s.

We wanted to give patients much more freedom as to how they wanted to be reimbursed, as well as fee-free methods that are easy for them to use and easy for sites to use. Before trial staff had to literally ship boxes of cards to the site and then someone had to dish them out but ours is a very site friendly way adopted for the 2020s.

You know, now sites are all digital using laptops and whatever. A study startup can be two weeks. The last one that we did was 13 days - record time. We have this rich experience from the past and we think that market leaders have stayed in that era. We're just trying to bring it forward for the 2020s That's how we got started.

OSP: Who are you mainly targeting, sponsors, patients, or both?​

JD:​ We use advertising for sponsors, but the solution is ultimately mostly used by the site and then the patient but our sales responses, so to speak is like, ‘hey, do this to help yourselves, because your biggest roadblock is keeping patients engaged'. The cold traffic is finding patients and then helping them to stay in clinical trials. So patient centricity and removing these barriers, is going to be great for you, both for your reputation as well as for the success of a trial, which ultimately results in a successful bottom line.

That is way way that we sell, but our entire brand and message is very patient centric.

I think some people think that prepaid debit cards is going to actually increase diversity, but we see it as like a as a big barrier because actually you are putting a lot of fees on the patients in the process. We've talked to some sites, and this was a quote from a site that we talked to in the very beginning, they said, ‘I can't believe that we've been telling patients that they get $40 when they actually get $30’. I can't look at patients in the eye and tell them that - I feel guilty about that. That's why we really needed something that's fee free and digital. So that really motivated us.

OSP:​ Have you thought about campaigns and how to build in the underrepresented groups as well as just those in general wanting to do trials because that would be a good next step in relation to the regulations from the FDA - getting into those communities that are underrepresented?​

JD:​ We try to talk to these underrepresented groups. We tried to make our solutions friendly for underrepresented groups. Our app is friendly for people with different abilities and it's available in different languages. Right now, a lot of people get taxed if you get up to $600 in your stipend - it's not a big tax benefit for the government, but it's going to a big barrier for patients. I think it is going to be disproportionately impacting low-income patients.

OSP: I hear over and over how the pharma industry, as a whole, is quite averse to fast change, do you agree?​

Yes, I think we're generally a slow-moving sector in the life sciences and with tech.  It makes sense, that we are risk averse, we should be. However, if that is going to delay the adoption of helpful technologies or solutions that are going to improve the life of patients, I think we need to reconsider why we're being risk averse.

It requires work on part of the sponsors and big players as well as the CROs to think through why we are being slow, and whether this is going to be best for the trial. Are we being slow here because that is the easiest thing to do? Trying to selectively find places where you take more risk and then adopt new solutions is going to make the experience of the patients much better.

OSP:​ Do you think the FDA guidance on diversity is going to change the whole landscape and that more companies will be looking at ways to be more inclusive and encourage a broader range of participants? Presumably there are a lot of people that want to take part in a trial, but can't even consider it, because they don't have any savings so it's not their priority. Do you think there'll be a big shift now that people must try to be inclusive?​

JD:​ We've seen a lot of pharma companies have that as an explicit requirement now, which we've been very pleasantly surprised by. It feels like a bit of an ambiguous ask though - increase diversity. And you know, I'm sure we've been talking about this for a while, but we've been really encouraged by how much pharma companies are pushing for it. So, I'm hopeful.