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 Happy Tuesday Hospitalogists, Recently on my Claims Denied podcast, I spoke with Scott Hickle, co-founder of Throne Science. Throne Science has built a device that clips onto your toilet and passively tracks gut health, hydration, and prostate health every time you use the bathroom. We covered the mechanics, the 68% hydration-behavior-change stat that stopped me in my tracks, the AI coach roadmap, and the long game toward catching microscopic blood in stool years before it'd otherwise be detectable. Full breakdown below. Before we dive in, a quick note on upcoming events: 9/23 → Healthcare Happy Hour: Specifically for people in workforce transformation. I'm buying. 9/30 → Building the VBC Playbook for 2027 and Beyond: New regulation is about to make VBC's broken workflows a lot more expensive. Let's talk about our options (virtual). 11/2-3 → Hospitalogy AI Retreat: A no-cost AI retreat for senior healthcare leaders. Join CEOs, CFOs, and Chief Transformation Officers from Kaiser, Sutter, Baylor, and more. 11/15 → HLTH is descending upon Vegas in November. I'm getting a group of healthcare's finance leaders together for drinks. Join me? Was this email forwarded to you? Sponsored by Navina I talk a lot about value-based care's math problem: better outcomes require better data, and physicians don't have time to hunt for it. An independent study out of Phyx Primary Care's innovation lab puts real numbers behind the fix. Across 120 physicians and 19 practices, Navina's AI copilot drove a +0.153 RAF score increase and a 1.9-point bump in STAR quality measures by surfacing missed HCC codes right at the point of care. Chart review time on complex visits dropped 40%. Burnout fell 32%. And this wasn't a tool gathering dust: 90% of physicians used it weekly, 92% trusted its HCC suggestions, and 84% would recommend it to a colleague. That's the kind of adoption VBC technology rarely sees. Throne Science's Bet: Your Toilet Is the Most Underutilized Health Sensor in Your HomeThere are conversations on this podcast where I walk away thinking, "yeah, that was a solid episode," and then there are the ones where I'm genuinely reconsidering my own health monitoring stack by the time we wrap. My sit-down with Scott Hickle, co-founder of Throne Science, was firmly in the latter camp. We spent an hour talking about what is — let's just say it — poop monitoring, and it was one of the most compelling digital health conversations I've had this year. Here's the setup. Throne Science has built the world's first device to passively and continuously track gut health, hydration, prostate health, and bathroom habits. No buttons. No sample collection. No manual logging. You clip the device onto your toilet bowl, pair it via Bluetooth, and it does the rest. Every time you use the bathroom, you get a report card. And the data these guys are generating is already changing how people understand their own bodies. From nurse staffing to smart toilets (yes, really)The Throne origin story is one of those startup narratives that sounds ridiculous until you realize it's brilliant. Scott and his co-founder Tim were originally building a nurse staffing marketplace — the classic post-COVID play. They raised a million bucks, went to market, and within a month realized the window had closed. The pandemic-driven nursing shortage was easing, and the thesis was dead. So they went back to the drawing board. Throne wasn't even in the first 30 ideas they evaluated. It emerged from a conversation Scott had with his mom, a geriatrician in New Mexico, who told him something that I think captures the entire market opportunity in one sentence: she stopped giving her phone number to patients because they kept sending her photos of their poop. That's the definition of earned wisdom. You're not reading that in a blog post. But what it told Scott was that people intuitively understand there's health information in their waste. They just don't have a good way to capture or interpret it. The state of the art is literally collecting a stool sample and mailing it somewhere, which has predictably terrible compliance rates. Meanwhile, we've got rings tracking our sleep, watches tracking our heart rate, and CGMs tracking our glucose. Nobody was looking at the output side of the equation. How poop tracking worksI'll admit I had a lot of questions about the mechanics here, starting with the obvious one about privacy. Scott walked me through it pretty thoroughly. The device sits on the rim of the toilet bowl. A motion sensor detects when someone approaches and pings your phone's Bluetooth to identify you. If it's a guest without a Throne account, the device stays off entirely. When it does activate, the camera and microphone are pointed straight down into the bowl. It cannot see human anatomy. Thank you for that distinction, Scott. The device captures four primary categories of health signals. First is functional gut health: stool morphology and timing on the Bristol stool scale. Frequency, consistency, color, volume, sink or float. The second category is hydration, measured primarily through urine color and cloudiness. Third is bathroom habits: time to first evacuation (a proxy for urgency or constipation), total session duration, and frequency patterns. Fourth, and this one genuinely surprised me, is men's health via urinary flow rate, which is a validated proxy for prostate health. The device literally measures the sound of your urine stream and maps it to instantaneous flow rate. As Scott put it, you intuitively know the difference between the sound of a weak stream and a strong stream. Turns out, that's grounded in real physiology. The prostate health angle is particularly compelling from a preventive care standpoint. If you catch an enlarged prostate early, you're looking at OTC supplements and pelvic floor exercises. Catch it late and you're looking at surgery or, in Scott's grandfather's case, a permanent catheter at 94. The data Throne generates could genuinely spare people that trajectory. How to achieve championship level hydrationHere's the stat that made me sit up: 68% of Throne users see material improvements in their hydration habits after just two weeks of using the device. That's a behavior change number that most digital health companies would frame as aspirational, and Throne is hitting it this early after launch. The mechanism is beautifully simple. You look in the toilet, see yellow urine, think nothing of it, and move on. Three minutes later, Throne sends you a push notification telling you your hydration score is in the 40s. That little nudge — that quantified feedback loop — is apparently enough to change behavior for two-thirds of users. Scott admitted he didn't expect hydration to be the killer engagement feature, but there's this natural daily cycle where you wake up dehydrated (your longest stretch without water), watch your score climb through the morning, and everyone loves seeing numbers go up and to the right. It's simple, it's sticky, and it works. I couldn't help but think of that semi-viral University of Texas football hydration chart that ranked players from "championship hydration" down to "you are a bad guy" based on urine color. Throne is essentially doing that with real data and real-time feedback, minus the locker room shame component. Throne’s AI coach trajectory and the dietary trigger thesisWhere Throne gets really interesting from a digital health strategy perspective is the AI layer they're building on top of the hardware data. The current experience is largely observational: here's your digestive pattern; here's your hydration trend. But the roadmap is toward what Scott calls an AI Gut Health Coach. The key insight is that Throne doesn't need you to log inputs when your gut health is fine. It only cares about the deviations. When the system detects an episode of bad gut health, it selectively asks what changed in the last 24 hours. Were you traveling? Stressed? Did you eat something unusual? This is fundamentally different from the existing gold standards for identifying dietary triggers, which are either elimination diets (brutal to maintain, nearly impossible in social settings) or manual food-and-stool journaling with a dietician (tedious, low compliance, and not particularly rigorous analysis even when the data is good). The V2 roadmap is the idea of running controlled personal experiments. Isolate one variable. Cut red meat for a week. Add a probiotic. Track what happens to your digestive patterns. After 10 of these experiments, you've probably identified two or three things that meaningfully help and two or three things to avoid. That's more actionable intelligence than most people get from years of trial and error. And then V3 gets into population-level insights. For people with a similar "gastro type" (similar inputs and outputs), what interventions actually worked? Scott used the phrase "similar digestive profile," and I think there's something really powerful there. It's the same logic that powers recommendation engines everywhere else, just applied to your gut. For people like you, psyllium husk helped within a week. Or shifting dinner three hours before bed. That level of granularity, personalized and data-backed, changes lives if they can pull it off. The cancer screening long gameThe 5-year vision is where Throne moves from interesting consumer wellness device to potentially transformative health technology. The goal is to detect microscopic blood in stool and urine — quantities that are 100,000 times below what the naked eye can see. This is the early warning signal for colorectal cancer, bladder cancer, and kidney cancer. Scott framed it with a stat: roughly 43,000 Americans die in car accidents annually. About 50,000 die of colorectal cancer. If Throne executes on its screening vision at scale, they'd have the opportunity to save more lives than making every car on the road self-driving. That's a bold claim, but the underlying logic is sound. By the time colorectal bleeding is visible to the naked eye, the cancer has often progressed to later stages. Catching increasing concentrations of microscopic blood over weeks and months is the early detection window that saves lives. The path to get there involves FDA clearance, which Throne is deliberately sequencing. They're following the Oura Ring and Apple Watch playbook: launch as general wellness, build clinical validation, accumulate longitudinal data, then pursue regulatory clearance for the specific diagnostic claims. They're already publishing their first abstract showing their AI model matches board-certified gastroenterologists at assessing stool form, and just before we recorded the podcast episode, they got IRB approval for a urinary flow validation study at Stanford. The research infrastructure is being built. Go-to-market: DTC today, payors tomorrow, and the sky is the limitThe current model is DTC at $400 for the device plus $6/month — basically the Oura Ring pricing model. HSA-eligible. Scott mentioned Cologuard as the canary in the coal mine for eventual payor reimbursement: it's reimbursed at $592 every three years for adults 45-85. Scott’s bet is that a $500 device that continuously monitors for the same conditions and more, every single day, starts to look like an obvious value proposition for a payor, especially when you stack the avoided costs of late-stage cancer treatment or prostate surgery. The near-term commercial expansion is a clinician dashboard that lets GI docs, urologists, functional medicine practitioners, and nursing facilities monitor patients' data with opt-in sharing. For a GI managing IBD patients, setting up alerts for sustained low urinary flow or multiple diarrhea episodes within 24 hours is immediately useful. For skilled nursing facilities, where they're already using crude door-stop sensors just to know if residents are using the bathroom, Throne replaces guesswork with actual clinical signal: constipation, UTI indicators, dehydration trends, the whole picture. The nursing home angle is one I pushed Scott on a bit, as it would make a compelling institutional use case. Falls are the number one cause of accidental death in adults over 65. Chronic dehydration is the third leading cause of falls, behind only pharmacological factors. If Throne can demonstrate that monitoring hydration in elderly populations reduces fall incidence, the reimbursement conversation writes itself. Patience - and a discount codeI appreciated Scott's candor about the growth timeline. He's not pretending this is going to be an overnight rocket ship. He pointed to Oura's trajectory: 2,400 units on Kickstarter in 2015, five years to reach 150,000 units, then an inflection to a million by 2022 and three million by 2025. (And, since our conversation, the filing for IPO.)That's the “overnight” success that took a decade, and Scott is clear-eyed that Throne is asking people to do something even more conceptually challenging than strapping a ring on their finger. You're putting a camera in your toilet. His framing of the adoption curve was sharp: when Uber launched, riding in a stranger's car was insane. When Airbnb launched, sleeping in a stranger's home was crazier. Both are now so normalized they barely register. Scott's bet is that in 10 years, it'll be crazy not to have a Throne. Scott offered on the spot to set up a special code for Hospitalogy readers, and this wasn’t even a sponsored episode. Use the code HOSPITOLOGY (note the misspelling is necessary) for 20% off here. The chance to finally figure out what my almond milk lattes are doing to my gut health. I'm in. Are you? Sponsored by Motivosity Hospitals already track patient experience. It's reported to Medicare and affects reimbursement. But that score reflects a survey sent weeks after the visit, not the moment a patient actually said thank you. Ensure your healthcare teams feel valued. Grab time with the Motivosity team for a demo. ICYMI: Hospitalogy in AugustHospitalogy Interviews:
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Thanks for the read! Let me know what you thought by replying back to this email. — Blake | |||||||
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