For the Record with Nestor Jaramillo, President and CEO, Nuwellis

March 18  

Nestor Jaramillo, Jr. has been a key player in medical device commercialization for more than 20 years and has led commercial organizations in both startup and multinational companies.

Prior to joining CHF Solutions (now Nuwellis), Mr. Jaramillo was president and CEO of Innerspace Neuro Solutions, Inc., a Tustin, Calif.-based commercial-stage medical technology company that developed, manufactured, and distributed an intracranial pressure monitoring system. He also worked in a variety of capacities at startup Transoma Medical, St. Jude Medical, and Medtronic.

In addition, Mr. Jaramillo also spent seven years as a managing director of healthcare investment banking at both Cherry Tree & Associates and Craig-Hallum Capital, both in Minneapolis.

Mr. Jaramillo holds an electrical engineering degree from the University of North Dakota and a Master of Business Administration from the University of St. Thomas in Minneapolis.

Give us Nuwellis’s elevator pitch

Maintaining fluid balance is a key aspect of treating heart failure and critical illnesses. From the NICU (neonatal intensive care unit) to the ICU (intensive care unit), no two patients are the same and no two patients will respond the same way to therapy, which is why Nuwellis is dedicated to researching, developing, manufacturing and commercializing personalized, simple, flexible and predictable methods of removing excess fluid from patients suffering from fluid overload. Our portable Aquadex SmartFlow® system is indicated for temporary (up to 8 hours) or extended (longer than 8 hours in patients who require hospitalization) use in adults and pediatric patients weighing 20 kg or more whose fluid overload is unresponsive to medical management, including diuretics. Treatment is administered by a health care provider, and can be delivered bedside within an outpatient or inpatient clinical setting.

Our mission is to transform the lives of people suffering from fluid overload.  It may sound cliché, but when I travel and speak with healthcare providers, our field team, and patients, I’ve found that we are truly transforming the lives of patients and their families. Seeing those transformations motivates me to continue working toward our mission. And the entire organization is passionate about what we do.

What is the one thing the Medical Alley community might be unaware of about Nuwellis that you think would be good to know? 

The company has been around since 2002. You may have previously known us as CHF Solutions, which stands for “Congestive Heart Failure Solutions.” Since 2019, we’ve evolved to serve beyond the heart failure patient population and rebranded to Nuwellis in 2021 to signify the “new well” we bring to pediatric, critical care and heart failure patients. Our new name reflects what our purpose has always been – saving the lives of pediatric patients, improving mortality and morbidity in patients in the ICU, and making significant savings for health systems and patients with acute decompensated heart failure. 

What are the biggest milestones to come in the next few years for Nuwellis?

At a high level, we’re working to make our Aquadex therapy the standard of care for treating diuretic-resistant patients suffering from fluid overload. Diuretics are the current standard for fluid overload patients, but they’re only effective for about 60 percent of patients – and a quarter of the other 40 percent are readmitted to the hospital within 30 days of initiating intravenous (IV) diuretic therapy with a significant cost burden to the healthcare system.

In order for Aquadex to become the standard, we’re working to expand our body of clinical evidence and improve reimbursement. On the clinical evidence side, we recently initiated a randomized controlled trial  (REVERSE-HF) to evaluate the economic and clinical benefits of our Aquadex therapy in comparison to IV diuretics for heart failure patients recalcitrant to diuretics.

Another key element in the standardization of a therapy is reimbursement.  A newly released dedicated Category III CPT code for therapeutic ultrafiltration became effective at the beginning of this year. These two initiatives will have a meaningful contribution in making the Aquadex System the standard of care. 

We’re also working on a dedicated pediatric ultrafiltration device. Last year, with funding from an NIH grant, we began developing a fully integrated pediatric continuous renal replacement therapy (CRRT) device designed to provide care for babies and small children under 20 kgs. The new device will differ significantly from our existing Aquadex technology but will be designed to reduce the clinical risks associated with using adult devices in pediatric patients, enhance the functionality of traditional CRRT devices, and incorporate technologies needed to better address issues relevant to small children. 

What does leadership look like for you?

Much has been written about leadership and how to be a good leader, but I don’t think there’s a one-size-fits-all approach and I don’t have a magic formula I follow. However, I do believe that good leaders build a great team and let them get the work done – all while keeping the company’s broader legacy in mind. Take my predecessor, John Erb, for example. As he moved out of his role as CEO, he did everything he could to ensure my transition into the role was as smooth as possible and set me up for success. I’m glad I had the opportunity to learn from his example.

As a leader, I work to create the vision of where we want to take our company and what it will look like when we get there. We then work to attract, hire and retain the best talent possible and unite to create an environment where our team can be empowered to meet the needs of our patients and customers.

What is the best advice you have received in your career? What is the worst?

Throughout my career, I have been fortunate to work under the guidance of many great leaders. Early on, an organization I was working in was under significant changes out of my control and my manager suggested that I stay focused on those tasks that I had control of – he said, “keep your head down, and follow through.” I’ve come back to those words throughout the last two years of the pandemic as we faced obstacles out of our control and I needed to keep us focused on our vision and strategy.

As for bad advice, I’ve heard people say “fake it till you make it” when dealing with uncertain or unfamiliar circumstances. It’s easy to lean into advice like this, especially when the path forward isn’t clear. While the spirit of that advice isn’t necessarily bad, the idea of faking it when the stakes are so high is unsettling. Rather than faking it, I believe it’s important to show confidence, even when facing uncertainty. Have humility and be comfortable knowing you can’t always be the expert. I believe a good leader knows, and embraces, when they aren’t the smartest person in the room – it means they know their limitations and have surrounded themselves with people who complement their strengths. Good leaders seek advice and are ok saying “I don’t know.” Being vulnerable is not a bad thing. 

What have been the most rewarding moments in your career?

A career in healthcare means that you can have an impact and create memorable moments every day, especially when changing, transforming or prolonging lives of people suffering from illness that your products can address. Working for a small healthcare company means I get to see firsthand the impacts we make on patients’ lives – from our offices, to the manufacturing floor, all the way to the patient’s bedside. I’m grateful to have experienced more rewarding moments than I can count over the course of my career.

One recent moment that comes to mind is a concept review meeting I was a part of for our pediatric device in development, which I mentioned above. Vitaliy Epshteyn, our SVP of Engineering and Operations, and his talented, cross-functional team presented an extraordinary functional concept for our next generation pediatric device. I was blown away by how passionate, committed and tenacious our team is about developing this device. Watching this team come together around the common purpose of saving the lives of babies born with significant medical needs has been truly moving and rewarding.

What is one personal goal for the upcoming year?

My goal for the upcoming year is to be a better servant leader for the organization that will bring the Aquadex therapy to be the standard of care. Our clinical, education and marketing teams have been tasked with developing the clinical evidence and reimbursement path to appear in the medical societies’ medical guidelines as the standard of care for diuretic refractory people suffering from fluid overload. We are lucky to have a passionate and talented team, and I hope to provide any support they may need as they take on this audacious goal.

How do you relax/decompress?

Spending time with family, wife, children, and grandchildren.  I have three beautiful grandchildren and when I’m in their presence, it’s truly a different world. I don’t think about anything other than what’s happening in their little worlds when we’re together. They are a reminder to slow down and enjoy the moment. The other way I slow down is when I’m playing golf. Coincidentally, the advice to “keep your head down, and follow through” is also my golden rule of the game, although sometimes that is easier said than done!

That said, I truly enjoy what I do. I’m blessed to work with amazing people, in an organization with a strong, healthy culture, and with a great therapeutic product. We have customers that are very happy and appreciative of the work Nuwellis is doing for their patients. Despite my busy schedule, I find time to exercise, sleep well, morning spiritual reflection, and vacation in my homeland of Panama.

What do you enjoy most about the Medical Alley community?

When the average person thinks of innovation, Silicon Valley might be one of the first places to come to mind, but the reality is that health and medical technology innovation is happening every day in our backyards, right here in Minnesota! Medical Alley’s work to elevate our great state as the epicenter of innovation and the opportunities the community provides to connect with other leaders, entrepreneurs and innovators are invaluable. I’m grateful that Medical Alley’s organization has provided our team the opportunity to learn from other local companies making a difference in patients’ lives.

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