Health care CEOs raked in $3.2 billion as pandemic raged

Health care CEOs raked in $3.2 billion as pandemic raged

Enlarge (credit: Getty Images | Jonathan Kitchen)

As the COVID-19 pandemic ravaged the country last year, the chief executive officers of 178 US healthcare companies saw their already lofty pay soar to even higher heights.

Collectively, the 178 CEOs took home $3.2 billion in 2020, according to a new analysis by Axios. Their median pay rose to $9 million, up from about $7.7 million in 2018 and $8 million in 2019. The 2019 US median household income was $68,703, according to the US Census Bureau. The Department of Housing and Urban Development estimates that the 2020 national median income for families was $78,500.

Thirty health care CEOs made over $30 million each. That list includes the CEOs of Regeneron ($174 million), Eli Lilly ($68 million), Teladoc ($45 million), UnitedHealth Group ($42 million), and Quest Diagnostics ($34 million).

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#ceo, #compensation, #covid-19, #for-profit, #health-insurance, #healthcare, #hospitals, #policy, #science

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Google will let enterprises store their Google Workspace encryption keys

As ubiquitous as Google Docs has become in the last year alone, a major criticism often overlooked by the countless workplaces who use it is that it isn’t end-to-end encrypted, allowing Google — or any requesting government agency — access to a company’s files. But Google is finally addressing that key complaint with a round of updates that will let customers shield their data by storing their own encryption keys.

Google Workspace, the company’s enterprise offering that includes Google Docs, Slides and Sheets, is adding client-side encryption so that a company’s data will be indecipherable to Google.

Companies using Google Workspace can store their encryption keys with one of four partners for now: Flowcrypt, Futurex, Thales, or Virtru, which are compatible with Google’s specifications. The move is largely aimed at regulated industries — like finance, healthcare, and defense — where intellectual property and sensitive data are subject to intense privacy and compliance rules.

(Image: Google / supplied)

The real magic lands later in the year when Google will publish details of an API that will let enterprise customers build their own in-house key service, allowing workplaces to retain direct control of their encryption keys. That means if the government wants that company’s data, they have to knock on their front door — and not sneak around the back by serving the key holder with a legal demand.

Google published technical details of how the client-side encryption feature works, and will roll out as a beta in the coming weeks.

Tech companies giving their corporate customers control of their own encryption keys has been a growing trend in recent years. Slack and cloud vendor Egnyte bucked the trend by allowing their enterprise users to store their own encryption keys, effectively cutting themselves out of the surveillance loop. But Google has dragged its feet on encryption for so long that startups are working to build alternatives that bake in encryption from the ground up.

Google said it’s also pushing out new trust rules for how files are shared in Google Drive to give administrators more granularity on how different levels of sensitive files can be shared, and new data classification labels to mark documents with a level of sensitivity such as “secret” or “internal”.

The company said it’s improving its malware protection efforts by now blocking phishing and malware shared from within organizations. The aim is to help cut down on employees mistakenly sharing malicious documents.

#api, #cloud-storage, #computing, #cryptography, #data-protection, #data-security, #egnyte, #encryption, #end-to-end-encryption, #finance, #google, #google-workspace, #google-drive, #healthcare, #privacy, #security, #technology, #thales

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New South African partnership gets $3M, launches telehealth product

For the early detection and treatment of health conditions, easy access to primary healthcare is crucial. Primary healthcare is best delivered by teams of primary care clinicians coordinating care between them. However, ubiquitous access to such care is scant across Sub-Saharan Africa.

There is a real opportunity for digital healthcare platforms to scale access to team-based care across the region. They can reduce the cost of quality care while improving health outcomes, reach patients in remote areas and reduce the pressure on the traditional medical support systems.

The pandemic has seen such platforms scale globally, and Africa is not exempt. A new platform (without a name yet) is launching out of South Africa and it wants to provide accessible quality care for Africans with its telehealth service. Today, it has closed a $3 million pre-Series A round to that end.

Yes, you’re wondering why the platform doesn’t have a name (I am too), but what’s interesting is the fact that a VC firm (Webrock Ventures) and two health tech companies (Healthforce.io and Doktor.se) joined forces to launch this new venture

Here’s summarized information on the trio.

Webrock Ventures is a Sweden-based investment company that employs a venture-building model. So essentially, the firm partners with tech companies in Sweden and combines its cash with the company’s business models to create portfolio businesses. It does this while maintaining a sizeable stake in the company.

Healthforce is a South Africa-based health tech company that tries to improve healthcare through multidisciplinary clinical teams. So far, it has set up nurses in over 450 clinics across the country while conducting more than 1 million nurse consultations. Healthforce also has a telemedicine play with over 110,000 consultations since launching the service last year.

As a Sweden-based telehealth company, Doktor.se allows patients to contact healthcare professionals through their smartphones across the whole spectrum of primary care. Most of its customers are in Europe, as well as in Latin America.

So why form a partnership to launch a telehealth product in South Africa with a plan for further roll-out in other African countries down the line?

Globally, telehealth investments have skyrocketed and increased by more than 50% since the start of the pandemic. With many of the fastest-growing economies globally, investors and companies (in this case, Webrock and Doktor.se) are now turning to Africa as a major growth region for such high-demand services.

South African telehealth

Saul Kornik (CEO & Co-Founder of Healthforce and CEO of the new venture)

Now, Doktor.se has two models for commercialising its telemedicine application. The first is to use its technology to personally deliver healthcare services. The second model licenses the core technology to third parties in markets in which Doktor.se has no intention of expanding. Doktor.se achieved this with Brazilian health tech startup ViBe Saúde (via Webrock), and last year, the platform had over 1.2 million patient consultations. It plans to do the same by licensing its technology to deliver care through Healthforce across Africa.

By forming a new partnership, a completely new opportunity is set up. Healthforce can leverage its current position to take core tech from Doktor.se to a new direct-to-patient market. In the background is Webrock, a willing investment machine set up to scale the platform.

The new venture will focus on the uninsured, B2C segment through a freemium-type offering. The platform offers on-demand and scheduled consultations with nurses, general practitioners and mental health professionals. It also provides chronic care management and will be integrated with Healthforce’s broader primary care offering.

Saul Kornik, co-founder and CEO at Healthforce, will resume a new role at the newly formed company. According to him, the partnership gives Healthforce an additional product to add to its healthcare product stack. In addition, it gives Doktor.se the ability to generate license fee revenue from a new market, while Webrock has an opportunity to invest in yet another large developing market.

“Webrock and Healthforce partnered to bring funding and strategic/operational capacity to this new pan-African direct-to-patient play, respectively,” he said to TechCrunch. “All existing independent operations will continue. However, under the NewCo, Healthforce as a major shareholder will expand its primary care product stack and Doktor.se will generate revenue off license fees earned.”

Sub-Saharan Africa has a healthcare market of about $90 billion. But health insurance coverage is in single-digit (percentage-wise) across countries in Sub-Saharan Africa except for South Africa with 16% coverage. Kornik says the three parties want to tackle a large portion of this challenge and are aligned about how the healthcare system in Africa could look if it were functioning optimally.

“This is a pure-play provider-of-healthcare venture. Through this pan-African venture, we will deliver high-quality healthcare at low cost to 75 million people through telemedicine, literally putting healthcare in the palm of their hands,” he said.

Partner at Webrock Ventures Joshin Raghubar and co-founder and CEO of Doktor, Martin Lindman, are enthusiastic about the opportunity Africa presents due to its large population and increasing smartphone penetration.

This new venture, which should hopefully have a name soon, is one of the few health tech platforms based in South Africa that have raised seven-figure sums in a fintech-dominated year. In February, hearX Group, a company that specializes in making hearing healthcare technologies, raised $8.3 million Series A to expand into the U.S. April saw Quro Medical close a $1.1 million seed round to scale its service that manages ill patients in the comfort of their homes. Judging by the spacing between each fundraise, we should see more from the country before the year runs out.

#africa, #doktor-se, #health, #healthcare, #healthforce-io, #quro-medical, #recent-funding, #south-africa, #startups, #tc, #technology, #telehealth, #telemedicine, #webrock-ventures

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Health clouds are set to play a key role in healthcare innovation

The U.S. healthcare industry is amidst one of the biggest transformations any industry has seen since the dot-com boom of the late 1990s. This massive change is being stimulated by federal mandates, technological innovation, and the need to improve clinical outcomes and communication between providers, patients, and payers.

An aging population, increase in chronic diseases, lower reimbursement rates, and a shift to value-based payments—plus the COVID-19 pandemic—have added pressure and highlighted the need for new technology to enhance virtual and value-based care.

Improving medical outcomes now requires processing massive amounts of healthcare data, and the cloud plays a pivotal role in meeting the current needs of healthcare organizations.

Challenges in healthcare

Most of today’s healthcare challenges fall into two broad categories: rapidly rising costs, and an increased burden on resources. Rising costs — and the resulting inadequacy of healthcare resources — can stem from:

An aging population: As people age and live longer, healthcare gets more expensive. As medicine improves, people aged 65 and above are expected to account for 20% of the U.S. population by 2030, per the U.S. Census Bureau. And as older people spend more on healthcare, an aging population is expected to contribute to increasing healthcare costs over time.

Prevalence of chronic illnesses: According to a National Center for Biotechnology Information report, chronic disease treatment makes up 85% of healthcare costs, and more than half of all Americans have a chronic illness (diabetes, high blood pressure, depression, lower back and neck pain, etc.)

Higher ambulatory costs: The cost of ambulatory care, including outpatient hospital services and emergency room care, increased the most of all treatment categories covered in a 2017 study in the Journal of the American Medical Association.

Rising healthcare premiums, out-of-pocket costs, and Medicare and Medicaid: Healthcare premiums rose by an estimated 54% between 2009 and 2019. The COVID-19 pandemic has spurred enrollment into government programs like Medicaid and Medicare, which has increased the overall demand for medical services, contributing to rising costs. A 2021 IRS report highlighted that a shift to high-deductible health plans — with out-of-pocket costs of up to $14,000 per family — has also increased the cost of healthcare.

Delayed care and surgeries due to COVID-19: A poll by the Kaiser Family Foundation (KFF) in May 2020 indicated that up to 48% people have avoided or postponed medical care due to concerns about the COVID-19 pandemic. About 11% of those people reported that their medical condition worsened after skipping or postponing care. Non-emergency surgeries were frequently postponed, as resources were set aside for COVID-19 patients. These delays make treatable conditions more costly and increase overall costs.

A lack of pricing transparency: Without transparency, it’s difficult to know the actual cost of healthcare. The fragmented data landscape fails to capture complete details and complex medical bills, and does not give patients a complete view of payments.

The need to modernize

To mitigate the impact of increased costs and inadequate resources, healthcare organizations need to replace legacy IT programs and adopt modern systems designed to support rapid innovation for site-agnostic, collaborative, whole-person care — all while being affordable and accessible.

#articles, #chronic-disease, #cloud, #column, #digital-services, #ec-column, #ec-healthtech, #health, #healthcare, #healthcare-data, #healthcare-industry, #saas, #united-states

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Amazon and Walmart try—again—to upend prescription drug prices

Amazon and Walmart try—again—to upend prescription drug prices

Enlarge (credit: Getty | George Frey)

Amazon and Walmart are ramping up their efforts to grab market share in the $360 billion prescription drug market in the US.

Today, Amazon announced that Prime members can receive a six-month supply of several widely prescribed drugs, starting at $6. Many drugs are pricier but are still discounted relative to typical cash prices. And yesterday, Walmart said it would be adding new discounts of up to 85 percent on prescription drugs purchased through its Walmart+ RX service, with an average savings of about 65 percent.

The new announcements come as the retail behemoths have largely failed to disrupt the traditional pharmacy industry. Big names still dominate, with CVS and Walgreens topping the rankings by revenue. Walmart, which has a significant physical footprint for its pharmacies, comes in fifth. 

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#amazon, #healthcare, #pharmacy, #policy, #prescription-drugs, #walmart

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Indonesian healthcare startup Prixa raises $3M led by MDI and TPTF

Indonesian healthcare startup Prixa has raised $3 million led by MDI Ventures and the Trans-Pacific Technology Fund (TPTF), with participation from returning investors including Siloam Hospitals Group.

This brings Prixa’s total raised to $4.5 million since it launched in 2019. Co-founder and chief executive officer James Roring M.D., told TechCrunch in an email that the new funding will enable Prixa to scale its platform and customer base. Prixa uses a B2B model, partnering with healthcare payers like insurance providers and corporations. Through its B2B customers, it currently serves about 10 million patients.

Prixa currently works with four major insurers and has six additional insurers in its short-term pipeline. It also works with Indonesia’s largest third-party administrators, Roring said, allowing it to reach more policyholders.

Prixa’s platform includes a digital health assistant to answer patients’ questions, telemedicine consultations, pharmacy deliveries and on-demand lab diagnostics. Usage increased during the COVID-19 pandemic as more patients sought online consultations for primary care.

Other telehealth startups in Indonesia include Halodoc and Alodokter (which is also backed by MDI). Both connect patients directly with healthcare and insurance providers. Roring said Prixa differentiates by focusing on greater cost control for healthcare payers and positioning itself as a digital primary care platform.

“By symptomatically managing patients outside of tertiary care facilities and caring for chronic non-communicable diseases online, Prixa is able to effectively reduce the amount of outpatient claims and downstream inpatient cost incurred by healthcare payers,” Roring said. “Additionally, the combination of a growing and robust medical database, as well as proven clinical guidelines, contribute to cost efficiency and service optimization through the standardization of treatment by our healthcare providers.”

In press statement about the funding, Aditia Henri Narendra, MDI Ventures’ general manager of legal and corporate communication, said, “MDI co-led this financing because Prixa has demonstrated its ability to support insurance companies and hospitals in making medical services more accessible and affordable through its AI telemedicine platform.”

#asia, #fundings-exits, #healthcare, #healthtech, #indonesia, #prixa, #prixa-ai, #southeast-asia, #startups, #tc, #telemedicine

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Ada Health closes $90M Series B led by Leaps by Bayer

The digital health space continues cooking on gas: Berlin-based Ada Health has closed a $90M Series B round of funding led by Leaps by Bayer, the impact investment arm of the German multinational pharma giant, Bayer AG. Other investors in the round include Samsung Catalyst Fund, Vitruvian Partners, Inteligo Bank, F4 and Mutschler Ventures.

The startup last raised around four years’ ago, reporting a $47M Series A round in 2017. But don’t be fooled by the low lettering of these rounds: Ada Health has been working on its symptom assessment tech for around a decade at this point — relying, in the first several years of its mission, on private funding from high net worth individuals in Germany and elsewhere in Europe.

Initially it was also focused on building a decision support tool for doctors before pivoting to directly addressing patients via an AI-driven symptom assessment app.

It’s not alone in offering this type of tool. Others in the space include Babylon, Buoy, K Health, Mediktor, Symptomate, WebMD and Your.MD — but Ada claims its app is the most used and highest rated by users. It can also point to a peer reviewed study it led, which was published in the BMJ, and compared the condition coverage, accuracy and safety of eight competitors. The study found its app led the pack on all fronts.

One reason for that edge is that Ada Health’s medical knowledge base covers around 30,000 ICD-10 codes (aka the alphanumeric codes used by doctors to represent different diagnoses) at this point — which co-founder and CEO, Daniel Nathrath, tells us is “by far the largest coverage of any of the systems in this space”.

The Ada Health app, which launched in late 2016 — and remains free to use — has been downloaded by more than 11 million people across 150 countries so far. Users have completed some 23M assessments using the tool which he likens to having “24/7 access to your trusted family doctor”.

Currently, the app has support for 10 languages. But the goal with the funding is to push for truly massive scale.

“The idea is to help as many people as possible get better access to healthcare around the world,” Nathrath tells TechCrunch. “Our ambition is, in a few years, that a billion people instead of 11M people will be using out technology. In order to get there we think that working with the right investors can help us accelerate that growth path and give more people the benefit of our technology faster.”

“With 11M app downloads I believe we are the most used AI symptom assessment technology that I know of in the world,” he goes on. “We are also the most rated and reviewed app in the medical category of the App Store and Google Play Store ever — after, what, just four years. With about 300,000 ratings and reviews, most of them five-star. So… we have gained some users but we think it’s just the beginning.

“Digital health — with all the things you see going on — is at an inflection point where it’s being realized not only by the users who have already been using our technology but also by health systems, governments, and payers, insurers, and life sciences companies — I think everyone has realized digital health is here to stay.”

As well as putting its symptom assessment app directly in the hands of patients, Ada Health offers a suite of enterprise solutions where partners pay it to be able to embed and deeply integrate its triage technology into their websites and digital services. That means they can use it to offer an entry point for their users — to help direct them to the correct service and provide administrative support by arming clinicians with health information provided by patient via the Ada interface (and the AI’s own assessment) ahead of the appointment.

One publicly disclosed customer for Ada’s enterprise offering is Sutter Health, in the Bay Area.

“They have integrated Ada into their own homepage and into their app so people can use it as a digital front door to the entire service of Sutter,” says Nathrath, explaining that the difference vs the version of the app that patients can download is “people don’t just get generic advice”. “It’s fully integrated. So if it says — for instance — you need to go to the emergency room… then you can go straight into appointment booking.

“And not only that; when you book the appointment the outcome of the Ada pre-assessment can then be shared with the health professional who will then look at you so the doctor doesn’t start from a blank sheet of paper but is already pre-briefed and gets decision support in terms of ‘this is constellation of symptoms the patient is reporting’ and ‘based on that these could be the most likely diagnosis and these should be the tests, examinations or investigations I should consider next to get to the confirmed diagnosis’.”

The added advantage for Ada’s enterprise partners is that patient data arrives with the doctor that sees them already structured so — after a few confirmations — they can easily import it into their documentation, saying precious minutes per patient, per Nathrath. “[If] you save a few minutes with each patient that means you have more time for the patients who really need you and not the patients who maybe has a cold and shows up in the emergency room, which unfortunately is a reality,” he adds.

With this enterprise strand of its business Ada is continuing to provide support for doctors. Nathrath suggests its patient-facing app is also being used for some informal decision support for doctors too.

More and more doctors are using the app “together with their patients”, he tells us, or else recommending it to their patients —  asking them “so what did Ada say?”.

The role of AI in healthcare will be a core one, Nathrath predicts — given that demand for healthcare professionals is always going to outstrip supply.

He argues that’s true even with rising use of telehealth platforms which can certainly make more efficient use of doctors’ time.

Ada did, at one point, offer a telehealth service itself — before deciding to fully focus its efforts on AI — so its approach now is to partner and integrate with other healthcare and health data providers throughout the care ecosystem.

“We think there’s a place for telehealth, obviously. It adds convenience. During the pandemic I guess it had a special role where for many it was almost the only way to interact with a doctor,” he says. “So we do see a place for telehealth but we also see an issue with telehealth in that it doesn’t address the structural issue in healthcare — that simply there aren’t enough doctors to serve the entire population of the world.”

“We’re building Ada as a multi-sided platform,” he adds. “We’ll be computing different sources of input data — which is sensor data, wearables data, lab data, genetic testing data — that’s on the input side — and then on the more downstream, on the next step after Ada, we can partner with any telehealth company in the world. And we’re seeing enormous interest from literally all corners of the world where telehealth companies approach us. And insurance companies and governments — where they say yes there is a use-case for telehealth but we basically need something before that, that filters people to the right next step.”

Whatever that right next step is in a patient’s care journey, “Ada is like the gatekeeper at the beginning of the journey that then sends you on your way,” is how Nathrath puts it.

The overarching vision is that Ada becomes not just an app in your pocket but an omnipresent “personal health companion” — or what it describes as “a personal operating system for health” — which is powerful enough to deliver preventative healthcare by being able to aggregate all sorts of data and spot health issues sooner so as to enable earlier and less costly interventions.

“What we’re building is really much more than a symptom assessment technology,” he tells TechCrunch. “Where you would also take into account lab results which can now be done much more direct to consumer than was previously possible, sensors and wearables data — and you probably say that Samsung is one of our investors but we’re obviously talking to all the large players in the space about this; how we can integrate that data best — and all the way to genetic testing and even the full genome sequence.

“When you take all these different sources of health information and compute them against each other on a continuous basis you’ll have something like an early warning system for your health — which, again, from a population health and system level perspective should be desirable for anyone who’s in charge of providing healthcare or paying for healthcare because you can catch the problem when it’s still a £100 problem and not yet a £100,000 a year problem.”

Given that ambition it’s interesting that big pharma is investing in Ada. (And its PR notes that it’s also in talks with Bayer on a potential strategic partnership.) But Nathrath suggests that the industry is well aware of the shifts being driven by digital health — and keen to avoid its own ‘Kodak moment’, i.e. by not adapting to the coming changes in a timely enough manner.

If AI-powered health interventions end up being so successful that they can shrink drug bills through earlier intervention and more preventative care then it makes good business sense for big pharma to be plugged into the cutting edge of digital health.

At the same time this type of tech might end up driving demand for medicines — exactly because of its scalability and because it can present a higher dimension view of more people’s health — meaning there’s more opportunity for increased prescription. So there’s not really a downside for pharma to get involved here.

“We’re really excited about the possibilities we can find by working together [with pharmaceutical companies] to really deliver a better healthcare experience to patients,” says Nathrath. “If you look at Bayer they have a consumer health business, they also have a pharmaceutical business and if you look at the cases within Ada if you look at the top ten most common ones it’s very comparable to what a GP would see all the time and a lot of those basically can end up in the recommendation towards healthcare where oftentimes an over the counter drug will be enough to address the issue. One area where Bayer has a lot of offerings, of course. But then their spectrum goes all the way towards rare diseases — where we’re also particularly strong. Where they have some drugs that help patients with very rare conditions.”

There are also potentially major research riches to be derived from the health data generated via Ada’s app which could also be interesting to pharma companies doing drug discovery.

Although Nathrath emphasizes that app users’ data is never used for research purpose without explicit consent from the individual (as is required under Europe’s General Data Protection Act).

But he also notes that Ada is able to do some interesting studies based on aggregated user data, too — giving an example of how it looked at kids mental health during COVID-19 lockdowns, comparing areas where schools had been shut vs those where they had remained open. “You could really compare what happened in different countries,” he says, noting that rates of depression in kids in Germany where schools and pre-schools were closed went up by over 100%, whereas in Switzerland where schools remained opened throughout there was no rise and even a slight improvement in children’s mental health.

In another example, involving aggregated data from usage of the app in US, he says it was able to show that it could have spotted a measles epidemic via the cases in the app slightly sooner than the CDC’s official announcement of an epidemic.

“If you think about the potential of that, in terms of spotting outbreaks earlier, that can be quite significant,” he suggests.

“We think there’s really a long list of ways we can work together [with researchers, policymakers and pharma companies] for the benefit of patients,” he adds. “The mission of all the people I spoke to at Bayer was really similar to ours — which is to help people, basically… That’s why we’re really happy to work with them.”

Commenting on the funding in a statement, Dr. Jürgen Eckhardt, head of Leaps by Bayer, added: “Investing in breakthrough technologies that drive digital change in healthcare is one of the strategic imperatives for Leaps by Bayer and for the entire field of healthcare. Ada’s truly transformative technology, combining powerful artificial intelligence with an emphasis on medical rigor and high levels of clinical accuracy will lead the way in helping more patients and consumers in achieving better health outcomes sooner by intervening earlier in their healthcare journey.”

#ada-health, #artificial-intelligence, #berlin, #digital-health, #europe, #germany, #health, #healthcare, #leaps-by-bayer, #pharmaceutical, #samsung-catalyst-fund, #science-and-technology, #sutter-health, #tc, #vitruvian-partners

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IMF says $50 billion is needed to end Covid pandemic in 2022

A vial with the Pfizer Biontech vaccine.

Enlarge / A vial with the Pfizer Biontech vaccine. (credit: Thomas Lohnes | Getty Images)

The world could “end the pandemic” in mid-2022 by vaccinating 60 percent of the population at a cost of $50 billion, the IMF has said, as rich countries and vaccine manufacturers pledged to address the inequality undermining the global response to coronavirus.

Countries with sufficient vaccine supplies could afford to donate 1 billion doses in 2021, even while continuing to prioritise the immunisation of their own populations against Covid-19, the IMF said in its report released at a virtual G20 Health Summit on Friday.

Combined with upfront financing, the vaccine donations would bring a faster end to the pandemic, saving millions of lives and yielding economic benefits of about $9tn to global gross domestic product by 2025, it estimated.

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#covid-19, #healthcare, #imf, #mrna, #pandemic, #policy, #science, #vaccination

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Mental health app Wysa raises $5.5M for ’emotionally intelligent’ AI

It’s hard enough to talk about your feelings to a person; Jo Aggarwal, the founder and CEO of Wysa, is hoping you’ll find it easier to confide in a robot. Or, put more specifically, “emotionally intelligent” artificial intelligence.

Wysa is an A.I powered mental health app designed by Touchkin eServices, Aggarwal’s company that currently maintains headquarters in Bangalore, Boston and London. Wysa is something like a chatbot that can respond with words of affirmation, or guide a user through one of 150 different therapeutic techniques.

Wysa is Aggarwal’s second venture. The first was an elder care company that failed to find market fit, she says. Aggarwal found herself falling into a deep depression, from which, she says, the idea of Wysa was born in 2016. 

In March, Wysa became one of 17 apps in the Google Assistant Investment Program, and in May, closed a Series A funding round of $5.5 million led by Boston’s W Health Ventures, the Google Assistant Investment Program, pi Ventures and Kae Capital. 

Wysa has raised a total of $9 million in funding, says Aggarwal, and the company has 60 full-time employees and about three million users. 

The ultimate goal, she says, is not to diagnose mental health conditions. Wysa is largely aimed at people who just want to vent. Most Wysa users are there to improve their sleep, anxiety or relationships, she says. 

“Out of the 3 million people that use Wysa, we find that only about 10% actually need a medical diagnosis,” says Aggarwal. If a user’s conversations with Wysa equate with high scores on traditional depression questionnaires like the PHQ-9 or the anxiety disorder questionnaire GAD-7 Wysa will suggest talking to a human therapist. 

Naturally, you don’t need to have a clinical mental health diagnosis to benefit from therapy. 

Wysa isn’t intended to be a replacement, says Aggarwal  (whether users view it as a replacement remains to be seen) but an additional tool that a user can interact with on a daily basis. 

“60 percent of the people who come and talk to Wysa need to feel heard and validated, but if they’re given techniques of self help, they can actually work on it themselves and feel better,” Aggarwal continues. 

Wysa’s approach has been refined through conversations with users and through input from therapists, says Aggarwal. 

For instance, while having a conversation with a user, Wysa will first categorize their statements and then assign a type of therapy, like cognitive behavioral therapy or acceptance and commitment therapy, based on those responses. It would then select a line of questioning or therapeutic technique written ahead of time by a therapist and begin to converse with the user. 

Wysa, says Aggarwal, has been gleaning its own insights from over 100 million conversations that have unfolded this way. 

“Take for instance a situation where you’re angry at somebody else. Originally our therapists would come up with a technique called the empty chair technique where you’re trying to look at it from the other person’s perspective. We found that when a person felt powerless or there were trust issues, like teens and parents, the techniques the therapists were giving weren’t actually working,” she says. 

“There are 10,000 people facing trust issues who are actually refusing to do the empty chair exercise. So we have to find another way of helping them. These insights have built Wysa.”

Although Wysa has been refined in the field, research institutions have played a role in Wysa’s ongoing development. Pediatricians at the University of Cincinnati helped develop a module specifically targeted towards COVID-19 anxiety. There are also ongoing studies of Wysa’s ability to help people cope with mental health consequences from chronic pain, arthritis, and diabetes at The Washington University in St. Louis, and The University of New Brunswick. 

Still, Wysa has had several tests in the real world. In 2020, the government of Singapore licensed Wysa, and provided the service for free to help cope with the emotional fallout of the coronavirus pandemic. Wysa is also offered through the health insurance company Aetna as a supplement to Aetna’s Employee Assistance Program. 

The biggest concern about mental health apps, naturally, is that they might accidentally trigger an incident, or mistake signs of self harm. To address this, the UK’s National Health Service (NHS) offers specific compliance standards. Wysa is compliant with the NHS’  DCB0129 standard for clinical safety, the first AI-based mental health app to earn the distinction. 

To meet those guidelines, Wysa appointed a clinical safety officer, and was required to create “escalation paths” for people who show signs of self harm.

Wysa, says Aggarwal, is also designed to flag responses to self-harm, abuse, suicidal thoughts or trauma. If a user’s responses fall into those categories Wysa will prompt the user to call a crisis line.

In the US, the Wysa app that anyone can download, says Aggarwal, fits the FDA’s definition of a general wellness app or a “low risk device.” That’s relevant because, during the pandemic, the FDA has created guidance to accelerate distribution of these apps. 

Still, Wysa may not perfectly categorize each person’s response. A 2018 BBC investigation, for instance, noted that the app didn’t appear to appreciate the severity of a proposed underage sexual encounter. Wysa responded by updating the app to handle more instances of coercive sex. 

Aggarwal also notes that Wysa contains a manual list of sentences, often containing slang, that they know the AI won’t catch or accurately categorize as harmful on its own. Those are manually updated to ensure that Wysa responds appropriately. “Our rule is that [the response] can be 80%, appropriate, but 0% triggering,” she says. 

In the immediate future, Aggarwal says the goal is to become a full-stack service. Rather than having to refer patients who do receive a diagnosis to Employee Assistant Programs (as the Aetna partnership might) or outside therapists, Wysa aims to build out its own network of mental health suppliers. 

On the tech side they’re planning expansion into Spanish, and will start investigating a voice-based system based on guidance from the Google Assistant Investment Fund. 

 

#ai, #apps, #artificial-intelligence, #funding, #health, #healthcare, #mental-health, #startup, #tc, #wellness

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Telemedicine startups are positioning themselves for a post-pandemic world

Telemedicine, in its original form of the phone call, has been around for decades. For people in remote or rural areas without easy access to in-person care, consulting a doctor over the phone has often been the go-to approach. But for a large swath of the world used to taking half a day off work just for a 15-30 minute doctor’s appointment, it may seem like telemedicine was invented only last year. That’s mostly because it wasn’t until 2020 that telemedicine, in its myriad forms, debuted into the mainstream consciousness.

It’s impossible to predict how healthcare institutions will operate post-pandemic, but with so many people now accustomed to telemedicine, startups that provide services around virtual care continue to be poised for success.

Telemedicine has faced an uphill battle to become more relevant in the U.S., with challenges such as meeting HIPPA compliance requirements and insurance companies unwilling to pay for virtual visits. But when COVID-19 began raging across the globe and people had to stay home, both the insurance and healthcare industries were forced to adapt.

“It’s been said that there are decades where nothing happens, and then there are weeks when decades happen,” said StartUp Health co-founders Steven Krein and Unity Stoakes in the company’s 2020 year-end report. That statement couldn’t be truer for telemedicine: Around $3.1 billion in funding flowed into the sector in 2020 — about three times what we saw in 2019, according to the report. A health tech fund and insights company, StartUp Health counts Alphabet, Sequoia and Andreessen Horowitz as some of its co-investors.

Now that people see the benefits and conveniences of “dialing a doc” from the kitchen table, healthcare has changed forever. It’s impossible to predict how healthcare institutions will operate post-pandemic, but with so many people now accustomed to telemedicine, startups that provide services around virtual care continue to be poised for success.

The state of telemedicine

Major players in the field now look at the state of healthcare as, “before COVID and after COVID,” Stoakes told Extra Crunch. “In the post-pandemic world, there’s a significant transformation that’s occurred,” he said. “It’s all accelerated; the customers have shown up. There’s more capital than ever and consumers and physicians have adapted quickly,” he added.

In the U.S., healthcare is first and foremost a business, so while there are treatment approaches that have long been proven to improve patient outcomes, if they didn’t make sense financially, they weren’t instituted at scale. Telemedicine is a great example of this.

A 2017 study by the American Journal of Accountable Care showed that telemedicine can be quite useful for managing healthcare. “The use of telemedicine has been shown to allow for better long-term care management and patient satisfaction; it also offers a new means to locate health information and communicate with practitioners (e.g., via e-mail and interactive chats or video conferences), thereby increasing convenience for the patient and reducing the amount of potential travel required for both physician and patient,” the study reads.

But as we’ve seen, it took a global healthcare emergency to drive widespread adoption of virtual healthcare in the U.S. Now that investors recognize the potential, they are increasingly pouring money into startups that promise to take telemedicine to the next level. Some of the investors backing these newer companies include StartUp Health, Andreessen Horowitz, Sequoia, Alphabet, Kaiser Permanente Ventures, U.S. Venture Partners, Maveron, First Round Capital, DreamIt Ventures, Human Ventures and Tusk Venture Partners.

#ec-enterprise-health, #ec-healthtech, #ec-market-map, #health, #healthcare, #insurance, #startups, #tc, #telemedicine, #video-conferencing

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Esper raises $30M Series B for its IoT DevOps platform

There may be billions of IoT devices in use today, but the tooling around building (and updating) the software for them still leaves a lot to be desired. Esper, which today announced that it has raised a $30 million Series B round, builds the tools to enable developers and engineers to deploy and manage fleets of Android-based edge devices. The round was led by Scale Venture Partners, with participation from Madrona Venture Group, Root Ventures, Ubiquity Ventures and Haystack.

The company argues that there are thousands of device manufacturers who are building these kinds of devices on Android alone, but that scaling and managing these deployments comes with a lot of challenges. The core idea here is that Esper brings to device development the DevOps experience that software developers now expect. The company argues that its tools allow companies to forgo building their own internal DevOps teams and instead use its tooling to scale their Android-based IoT fleets for use cases that range from digital signage and kiosks to custom solutions in healthcare, retail, logistics and more.

“The pandemic has transformed industries like connected fitness, digital health, hospitality, and food delivery, further accelerating the adoption of intelligent edge devices. But with each new use case, better software automation is required,” said Yadhu Gopalan, CEO and co-founder at Esper. “Esper’s mature cloud infrastructure incorporates the functionality cloud developers have come to expect, re-imagined for devices.”

Image Credits: Esper

Mobile device management (MDM) isn’t exactly a new thing, but the Esper team argues that these tools weren’t created for this kind of use case. “MDMs are the solution now in the market. They are made for devices being brought into an environment,” Gopalan said. “The DNA of these solutions is rooted in protecting the enterprise and to deploy applications to them in the network. Our customers are sending devices out into the wild. It’s an entirely different use case and model.”

To address these challenges, Esper offers a range of tools and services that includes a full development stack for developers, cloud-based services for device management and hardware emulators to get started with building custom devices.

“Esper helped us launch our Fusion-connected fitness offering on three different types of hardware in less than six months,” said Chris Merli, founder at Inspire Fitness. “Their full stack connected fitness Android platform helped us test our application on different hardware platforms, configure all our devices over the cloud, and manage our fleet exactly to our specifications. They gave us speed, Android expertise, and trust that our application would provide a delightful experience for our customers.”

The company also offers solutions for running Android on older x86 Windows devices to extend the life of this hardware, too.

“We spent about a year and a half on building out the infrastructure,” said Gopalan. “Definitely. That’s the hard part and that’s really creating a reliable, robust mechanism where customers can trust that the bits will flow to the devices. And you can also roll back if you need to.”

Esper is working with hardware partners to launch devices that come with built-in Esper-support from the get-go.

Esper says it saw 70x revenue growth in the last year, an 8x growth in paying customers and a 15x growth in devices running Esper. Since we don’t know the baseline, those numbers are meaningless, but the investors clearly believe that Esper is on to something. Current customers include the likes of CloudKitchens, Spire Health, Intelity, Ordermark, Inspire Fitness, RomTech and Uber.

#ambient-intelligence, #android, #cloud, #cloud-computing, #developer, #device-management, #enterprise, #esper, #hardware, #healthcare, #internet-of-things, #iot, #madrona-venture-group, #microsoft-windows, #mobile-device-management, #operating-systems, #recent-funding, #retail, #root-ventures, #scale-venture-partners, #smartphones, #software-automation, #software-developers, #startups, #tc, #technology, #uber, #ubiquity-ventures

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Click-and-mortar is a better model for healthcare

Until COVID-19, healthcare was either all in-person or all virtual. Patients had to choose. Some patients chose both — an in-person health system for most things and perhaps Livongo for diabetes care or Hinge Health for back pain care.

The problem with this approach is that in-person all the time is inconvenient and a waste of time when all a clinician is doing is looking at a wound or responding to lab results. But all-virtual is not great when things are uncertain or patients need to be examined. While there are few silver linings to the horrendous COVID-19 pandemic, one is that nearly all providers and most patients have experienced virtual care and most have found it useful. This widespread adoption of virtual care, we believe, will lead to hybrid models that we call “click-and-mortar,” which combine the best elements of in-person and virtual care to deliver better outcomes more reliably and efficiently.

The uptake of virtual care in 2020 is stunning: 97% of primary care doctors provided some kind of telehealth care in 2020. Moreover, nearly 44% of Medicare beneficiaries’ primary care visits were provided by telemedicine in 2020, compared with a mere 0.1% the year before.

The notion of virtual care has become so common that Google searches for “doctor online” result in a specialized tool displaying widely available virtual care platforms, such as Teladoc, Amwell, Doctor On Demand and MDLive. Moreover, telemedicine providers like Doctor on Demand, MDLive, Galileo and Firefly have all launched “virtual primary care” services designed to deliver non-urgent longitudinal primary care virtually. While these services may meet the needs of healthier patients, the absence of a physical location for physical examinations, diagnostic tests and procedures may limit their utility.

This widespread adoption of virtual care, we believe, will lead to hybrid models that combine the best elements of in-person and virtual care to deliver better outcomes more reliably and efficiently.

Nonetheless, there are several potential advantages of virtual primary care. The ability to see patients in their homes can contribute new information about safety, social support and social determinants. In cases like behavioral health, they can decrease the stigma associated with accessing care. Virtual care platforms can more easily incorporate remote monitoring data, and virtual visits can occur as groups with teams of caregivers or other specialists simultaneously.

Furthermore, virtual visits may allow for more frequent “microvisits” to monitor how patients are progressing. They also facilitate more rapid treatment adjustments because they eliminate the need to travel to a doctor’s office. Virtual visits also have lower cost for physicians, avoiding brick-and-mortar overhead costs, and for some services offer 24/7 access, which may reduce the need to seek urgent care or emergency department care. Finally, patients may be able to gain expanded access to clinicians who match preferences based on things like ethnicity, LGBTQ orientation and gender, particularly in rural areas where options are limited.

For pure-play virtual care models to work, they need to rely on connected devices and patient cooperation. Using connected blood pressure cuffs, stethoscopes, oximeters, thermometers and scales, it is possible to replicate much of the physical exam. Just like for in-person care, a virtual provider can order lab tests, although it is impossible to do a quick urinalysis or strep test virtually without the supplies on hand.

Virtual providers who work closely with health plans may have more data on cost and quality to inform referrals but perhaps less local knowledge. A possible consequence is that virtual providers may have more transactional relationships with specialists and traditional local brick-and-mortar providers.

Data have shown virtual care delivers better clinical outcomes in certain cases. Virtual care has been shown to reduce emergency department visits and antibiotic overprescribing. Chronic conditions like Type 2 diabetes are examples where virtual care has outperformed in-person care. Virtual physical therapy has generated cost savings and resulted in fewer back surgeries.

Despite these benefits of purely virtual care, we believe that ultimately the most efficacious model of primary care is a hybrid one combining virtual and in-person interaction. We think that the mix of in-person and virtual is probably 80% virtual. We also think that most visits will be triggered by clinicians reaching out to patients in response to a change in remotely monitored data, perhaps a new fever, change in sleep patterns or weight change for a patient with heart failure.

The implications of visits being mostly virtual and largely triggered by changes in data are profound. It means that offices become places for problem-solving and procedures. It means clinicians spend their days responding to signals from patients and probably have their schedules largely unfilled until the night before. It means that patients will need to adopt passively collected and remotely monitored data.

We think this model ultimately will result in more frequent, shorter, virtual interactions that happen nearly continuously over text and be supplemented by email, phone and video. We also think this approach will deliver much better clinical outcomes and more rapid improvement since both the patient and clinician have much more data on how diseases are progressing.

There are risks with this model. It requires patients with mobile phones and devices to engage and respond to clinicians and ensure their remote monitoring devices stay online. Most importantly, patients need to follow the advice of virtual providers and prompts to get in-person labs, diagnostics or care when needed. Further, clinicians will need to be trained to conduct virtual clinical examinations and to incorporate as well as respond to remote monitoring data.

The COVID-19-fueled adoption of virtual care will hopefully create the demand on the part of patients and desire on the part of clinicians to embrace our “click-and-mortar” vision for care. These models have the potential to deliver more proactive, more engaging and, we think, far better care.

#column, #doctor-on-demand, #health, #healthcare, #opinion, #tc, #telehealth, #telemedicine

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Healios raises $10M to scale its mental health platform for children scarred by the COVID-19 pandemic

Heaven knows what will happen to the mental health of children who’ve gone through this past year but if there’s one thing we need right now it’s mental health provision for young people that can scale. And as much as some of us can’t bear the thought of another video call, a UK startup reckons it’s come up with the magic formula for online therapy for children.

Now, Healios has raised a £7 million ($10M) Series A round to expand its platform across the UK. If the roll-out is successful, the startup is looking at expanding internationally. The round was led by InHealth Ventures with participation from existing investors AlbionVC.

Healios will use the funding to expand its AI, machine learning, and data science expertise, as well as add to the team. Healios says its platform digitises the clinical pathway, enabling children, adults, and their family members to use clinical services at home.

According to UK government statistics, one in eight (12.8%) five to 19-year-olds in the UK have a mental health disorder but two-thirds are unable to access NHS care because of soaring demands. And the Covid-19 pandemic has made things worse.

Launched in 2013, Healios says it has now worked with 65% of NHS Mental Health Trusts, with 70,000 specialized clinical sessions delivered, which is a high success rate for a startup, considering how hard it is to get NHS approval.

The online, family-focused therapy program for young people zeros in on psychosis and schizophrenia. Healios says that studies have shown involving family members from the start can reduce suicide by as much as 90%. It also covers anxiety, low mood, autism and ADHD, as well as support to their families.

Unlike some startups in the area of mental health, Healios is not a marketplace of advisers but is an end-to-end provider of these services.

InHealth Ventures and InHealth Group Chair, Richard Bradford, will be joining the Healios board, alongside Cat McDonald of AlbionVC.

Rich Andrews, Founder, and CEO of Healios, said: “This funding will help us reach more families in need and enable us to develop further sector-leading interventions and therapies. By bringing together clinical experts and giving them the tools to reach their patients regardless of where they are, we are closing the access gap which has plagued mental health provision for far too long.”

Andrews also told me: “A young person will have an initial mental health assessment with us. If needed, we’ll make a diagnosis and then they’ll move on to other interventions with us, so this is a seamless experience.”

Dr Ben Evans, Managing Director of InHealth Ventures, said: “Healios is a standard-bearer for healthcare innovation. They bring together clinical excellence with digital expertise, working in partnership with the NHS to address a critical, but complex area of care delivery. Healios’ work to date speaks for itself; their holistic approach to diagnosis and treatment has had a substantive impact on clinical outcomes and patient experience.”

Cat McDonald, Investor at AlbionVC, added: “Covid has engendered a pace of innovation previously unseen in healthcare. In particular, we have seen that remote care not only works, but often works much better than traditional alternatives. The option to receive care remotely, at home and in a family-centric setting is the strong preference of most kids suffering from poor mental health.”

#artificial-intelligence, #autism, #ceo, #chair, #europe, #health, #health-care, #healthcare, #machine-learning, #mental-health, #national-health-service, #nhs, #online-therapy, #schizophrenia, #services, #tc, #uk-government, #united-kingdom

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Unmind raises $47M for a platform to provide mental health support in your workplace

Mental health has been put into the spotlight in a big way in recent times. For many of us, our lives and lifestyles have changed massively in the last year, and alongside that, we’re collectively facing pandemic-fueled mortality on a global scale in a way that hasn’t existed for generations, a perfect storm of sorts that has inevitably had an impact on our state of mind and our moods.

Today a startup that has built a platform to help people think about and respond to this situation is announcing a big round of growth funding, specifically to help address all of this and how it plays out in one of the more stress-inducing aspects of our life — our workplaces.

Unmind — a London startup that has built a mental health app for the workplace — has raised $47 million, a Series B that it will be using to continue investing in its research and development and also to expand its business reach. The funding is being led by EQT Ventures –- a very active investor at the moment in UK growth rounds — with participation also from Sapphire Ventures and previous backers Project A, Felix Capital, and True.

The core of Unmind’s service is an app built around a set of questions to help employees explore their own states of mental health, which could include depression, anxiety, insomnia, and a host of other manifestations. It provides advice and content to begin addressing the results of that — exercises, advice, podcasts, links for further reading, and links to seeing further help from professionals (not more machine interfaces, but humans). It also provides a service to the employers, sharing anonymized data from the app with them so that they, too, can consider how better to respond to their employees’ needs.

The app has seen some notable traction especially in the last year, a time when the conversation about mental health has become much more commonplace and critical, given the environment we’ve been living in.

Unmind does not disclose user numbers, nor how they have grown, but it tells me that uptake and adoption of its app ranges from 15% to over 60% of an organization’s workforce (this varies by size, and the emphasis that the organization itself puts on using the app, among other things). It said that of those employees who are using Unmind, 88% have said they experience an improvement in mental wellbeing, work, or relationships, while 92% report higher confidence, awareness, and understanding of mental health.

The company also said that revenues grew by more than 3x in the last 12 months. Meanwhile, its customers include major retailers like John Lewis and M&S, high street bank TSB, Uber, Samsung, Virgin Media, British Airways and Asos — a list of companies that have strong degrees of customer service around them, have been greatly impacted by the lockdowns, and you can imagine must have a lot of people working in them pretty stressed out as a result of being on the front lines of interfacing with a stressed-out wider population of consumers.

The company was co-founded by Dr Nick Taylor, who previously had been a clinical psychologist and worked for years in mental health care (and before that was a classically-trained singer), who said he came up with the idea after feeling like he was seeing too many people only for the first time at a stage when their issues were already very advanced.

“I kept encountering the same frustration time and again: I wish I’d met this person six months ago,” Taylor said in an interview.

As with all kinds of preventative healthcare, it’s always better to identify and work on issues before they grow big and more urgent, and so he set out to think about how one might approach the concept of a preventative check-up and check-in for mental health.

The workplace is not a bad place to base that effort. Not only is it often a source of stress for people, but it’s a regular place for them to be every day so creating a way of assessing mental health through that implicitly creates a kind of routine to the effort. It also potentially means a closer connection to the employer to work on issues more collectively when and if they emerge, in a way that the employer might not do (or ever discover) through other means.

The connection between work and mental health is a longstanding one but has perhaps been proven out more than ever before in the last year.

“I didn’t know what would happen with mental health during Covid,” Taylor recalled. “I actually wondered if it would be demoted,” given all of the other conflicting priorities. “But the prevalence of mental illness has escalated. It’s out of control. And in the workplace, it’s a leading cause of absenteeism and turnover.” And given how full-on everything has become, including likely more hours spent working since now it all has merged with our home lives, we all know (and may well be among) many people who are feeling incredibly burned out right now.

Taylor said that in fact quite the opposite has happened to his early skepticism: mental health has become front of mind, “and the shackles of stigma are falling away.”

This is part of what has really caught the eye of investors: technology that is not just effective, but very relevant to right now. “It is now universally recognized that our Mental Health is as important if not more important than our physical health – but has long been neglected. That is now changing rapidly,” said Alastair Mitchell, a partner at EQT Ventures. “As a result there has been a massive rise in the popularity of consumer mental health apps which is now being matched by surging demand from employers and employees for the same in the workplace. Unmind is the leading mental health app for the enterprise and we are so excited to work with Dr Nick and the team to support their scaling globally.” EQT is also a strategic investor, not just a financial one: it’s rolling out Unmind across its own workplace and its many portfolio companies.

Unmind, it should be noted, is not the only company that has identified this “opportunity,” if you could call it that. They include other startups like SF-based Ginger — which has also built a platform that partners with employers, but also healthcare providers and other stakeholders, to help people identify and manage their state of mind. Ginger has been well-capitalised over the years. Others in the same space include Welbot in New York, Spill also out of London and a host of others providing different aspects of mental wellness like Calm and Headspace, the meditation apps.

I’m inclined to think that, given the size of the problem and that mental health should not be a bunfight but something that takes a village to address, the key will be in how each company approaches its remit, and how people respond to it, and whether what people do ultimately use results in better bridges for employees to getting the help and peace they need, whether it’s from the app or a professional.

“We have a responsibility to connect with our mental health in the same way that we do when it comes to healthcare,” Taylor said, likening the effort to how it takes a number of skill sets sometimes to work on the complexities of a health issue. “Great healthcare integrates across a number of systems.”

#europe, #funding, #health, #healthcare, #mental-health, #therapy, #unmind, #wellness, #workplace

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Quix raises $3.2M from Project A and others for its ‘Stream centric’ approach to data

Quix, a platform for Python developers working on streaming data, has secured a £2.3 Million ($3.2M)Seed funding round led by Project A Ventures in Germany, with participation from London’s Passion Capital and angel investors. The Quix Portal is also providing developers with a free subscription to a real-time data engineering platform.

Quix attracted angel investors including Frank Sagnier (CEO, Codemasters), Ian Hogarth (Co-author, State of AI Report), Chris Schagen (CMO, Contentful), and Michael Schrezenmaier (COO, Pipedrive).

Quix wants to change the way data is handled and processed from a database-centric approach to a ‘stream-centric’ approach, connecting machine learning models to real-time data streams. This is arguably the next paradigm in computing.

Use cases for Quix, it says, include developing electric vehicles, and fraud prevention in financial services. Some of its early customers are the NHS, Deloitte and McLaren.

Indeed, the founding team consists of former McLaren F1 engineers who are used to processing real-time data streams from the systems used by most Formula 1 teams.

Co-founder and CEO Michael Rosam said: “At Quix, we believe that it will soon be essential for every organization to automatically action data within milliseconds of it being created. Whether it’s personalizing digital experiences, developing electric vehicles, automating industrial machinery, deploying smart wearables in healthcare, or detecting financial fraud faster, the ability to run machine learning models on live data streams and immediately respond to rapidly changing environments is critical to delivering better experiences and outcomes to people.”

Over email he told me that Quix’s main advantage is that it allows developers to build streaming applications on Kafka without investing in cloud infrastructure first: “Uniquely, our API & SDK connects any Python code directly to the broker so that teams can run real-time machine learning models in-memory, reducing latency and cost compared to database-centric architectures.”

Quix is entering the data ecosystem alongside batch data processing platforms like Snowflake and Databricks, and event streaming platforms like Confluent, Materialize, and DBT. However, this ecosystem is very complementary with organizations usually combining multiple products into a production infrastructure based on the strengths of each proposition.

Sam Cash of Project A Ventures said: “Data streaming is the next paradigm in data architecture, given end-users accelerating demand for live, on-demand and personalized applications. The Quix team are leading the way in this market, by democratizing access to data streaming infrastructure, which until now has been the reserve of the largest companies.”

Malin Posern, Partner at Passion Capital commented: “The world today is generating unimaginable amounts of data from digital and physical activities. Businesses of all types and sizes will want to make use of their data in real-time in order to be competitive.”

#api, #ceo, #cloud-infrastructure, #codemasters, #computing, #coo, #data-stream, #databricks, #deloitte, #europe, #financial-services, #germany, #healthcare, #ian-hogarth, #kafka, #machine-learning, #mclaren, #nhs, #passion-capital, #pipedrive, #project-a-ventures, #python, #streaming-applications, #streaming-data, #streaming-media, #tc, #technology, #wireless-networking

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3 golden rules for health tech entrepreneurs

If the last 10 years practicing family medicine have taught me anything, it’s that there is a desperate need for innovation in healthcare. I don’t just mean in terms of medical treatments or protocols, but really in every aspect. As a physician, I’ve worked with my fair share of “the latest and greatest” innovations both in my outpatient practice and at hospitals.

As I shifted into my current position, I’ve come across some products that were distinguished winners, eventually going on to become not just highly successful but the new gold standard in the industry. Others, unfortunately, never even got off the ground. Often, in the back of my mind, I felt like I could always tell which ones had the staying power to transform healthcare the way it needed to be transformed.

When it comes to ensuring the success of your product, service or innovation, following these three golden rules will put you on the right track.

When it comes to ensuring the success of your product, service or innovation, following these three golden rules will put you on the right track. It’s no guarantee, but without getting these three things right, you’ve got no shot.

Design for outcomes first

Stephen Covey coined the phrase: “Begin with the end in mind.” It’s the second of his 7 Habits. But he could have also been writing about habits for health tech innovators. It’s not enough to develop a “new tool” to use in a health setting. Maybe it has a purpose, but does it meaningfully address a need, or solve a problem, in a way that measurably improves outcomes? In other words: Does it have value?

When the COVID-19 pandemic hit, pharmaceutical and research firms set out upon a global mission to develop safe and effective vaccines, to bring the virus under control and return life around the world to something approaching “normal” … and quickly. In less than a year, Pfizer and Moderna crossed the finish line first, bringing novel two-jab mRNA vaccines to market with extraordinary speed and with an outstanding efficacy rate.

Vaccine makers started with an outcome in mind and, in countries with plentiful vaccine access, are delivering on those outcomes. But not all outcomes need be so lofty to be effective. Maybe your innovation aims to:

  • Improve patient compliance with at-home treatment plans.
  • Reduce the burden of documentation on physicians and scribes.
  • Increase access to quality care among underserved, impoverished or marginalized communities.

For example, Alertive Healthcare, one of our portfolio companies, wanted to meaningfully improve round-the-clock care for when patients couldn’t get in to see their physicians and developed a platform for clinical-grade remote patient monitoring. Patients download an easy-to-use app that sends intelligent alerts to providers, reducing documentation and decreasing time to treatment. Patients enrolled in the app reduce their risk of heart attack and stroke by 50%. That’s compelling value and an example of designing for outcomes.

When designing for outcomes, it’s also important to know precisely how you’ll measure success. When you can point toward quantifiable metrics, you’re not only giving yourself goals in your product design and development, you’re also establishing the proof points that sell your product into the market. Make them as meaningful and measurable as possible, as soon as possible.

#column, #ec-column, #ec-healthtech, #health, #health-systems, #healthcare, #healthtech, #startups

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4 strategies for building a digital health unicorn

It’s an entrepreneur’s market in digital health today, with startups raising record-breaking funding at soaring valuations and debuting on public markets to eager investors.

According to CB Insights, as of March 3, 2021, there are 51 healthcare unicorns — “startups” — worth $1 billion or more around the world. Global venture capital funding, including private equity and corporate VC, into digital health was the highest ever in the first quarter 2021 at $7.2 billion, according to Mercom Capital Group.

The massive influx of capital to healthcare should not be surprising; the pandemic has made it starkly clear that digital health is the future of healthcare. To that end, we should anticipate additional healthcare exits worth more than $1 billion in the near term. Which again, is great for entrepreneurs — as long as they understand how hard it is to build a unicorn in healthcare. Today, becoming a unicorn requires founders who are long on vision and operational experience.

Today, becoming a unicorn requires founders who are long on vision and operational experience.

Company founders most often turn to veteran investors for help with grand-slam strategies to create the next healthcare unicorn. That’s why many of them seek counsel from the Merck Global Health Innovation Fund: Because we have the experience, resources, successful track record and networks to build real scale in digital health.

During the pandemic, lots of investors jumped in to invest in digital health for the first time. But we’ve been investing for more than a decade. Two of our portfolio companies, Preventice Solutions and Livongo, exited last year as unicorns, rounding out the $6.2 billion in digital health market value MGHIF has exited over the last two years. And we are expecting two more unicorn exits in 2021. But we’re not stopping there; we’ll be investing our $500 million fund in drone-supported supply chain technologies, telehealth, AI, digital pathology, remote clinical trials and Internet of Medical Things (IoMT).

Given our success, here are four instrumental strategies to building a unicorn in digital health that we know work.

Raise the “right amount” of capital to build the right company

We often ask entrepreneurs: Would you rather own 20% of a $50 million company or 5% of a $1 billion company? To most, the answer is obvious. In our experience, too many entrepreneurs worry about dilution and never raise the right amount of capital.

It’s well known that companies with rapidly growing revenues are valued at a premium — but it’s important to remember that this is hard to do in healthcare. Getting to scale takes time because healthcare is so complicated and involves so many stakeholders.

#column, #ec-column, #ec-consumer-health, #health, #healthcare, #private-equity, #startup-company, #startups, #unicorn, #venture-capital

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IAC’s NurseFly rebrands to Vivian Health as it expands its healthcare jobs marketplace

NurseFly, the healthcare jobs marketplace owned by IAC, has rebranded to Vivian Health as it expands its range of services. Originally launched for traveling nurses (or nurses willing to travel for short-term positions), Vivian Health now includes listings for permanent positions, per diem shifts and local openings. It also added employer reviews and a pay database that uses information gathered from the 1.7 million jobs that have come through its system.

Founded in 2017, NurseFly was acquired by IAC in August 2019. It is used by providers like AMN Healthcare, Cross Country Healthcare, Host Healthcare, Trinity Health, SSM Health and Honor Health. During the pandemic, Vivian Health quadrupled its employee headcount in order to meet demand, founder and chief executive officer Parth Bhakta told TechCrunch in an email.

“Over the past year, we’ve grown to fill nearly 10% of all travel nursing positions across the United States, oftentimes helping fill a crisis position in a matter of hours rather than weeks,” Bhakta said. During that time, the platform heard from major health systems “that their challenges around hiring for permanent roles were oftentimes even more dire than filling their travel positions,” he added. “Permanent roles at health systems were taking months to fill, costing tens of thousands of dollars to hire, and leading to short-staffed facilities in the meantime.”

As a result of these conversations, Vivian Health’s team spent three months rebuilding the platform to serve a wider range of healthcare providers and employers. Its rebranding and expansion comes at a time when many healthcare professionals are reporting burnout as a result of the pandemic.

In a study of 1,300 respondents published earlier this month, Vivian Health found that 83% said their mental health had been affected by working in healthcare over the past year. About 43% said they had considered quitting the profession.

One of the main reasons for burnout is working overtime, with 86% of their respondents reporting that their facilities are short-staffed, even as demand for healthcare professionals accelerates. According to the Bureau of Labor Statistics (BLS), about 17.3 million people were employed in the heatlhcare sector in 2018, and that number is expected to increase 15% to 19.9 million by 2028, making it one of the fastest growing sectors.

“Crisis-level staffing shortages” are compounded by the amount of time, sometimes up to 120 days, it can take to hire a permanent employee. Shortening the amount of time it takes to fill positions has a ripple effect because clinicians need to work less overtime. Meanwhile, recruiters can focus on the right leads. Bhakta said employers have been able to use Vivian Health to fill permanent positions in as little as one week, and are typically able to do so within 30 days.

Vivian Heath built a proprietary dataset of healthcare industry information through the 1.7 million jobs that have come through its systems and asks all of its staffing agency partners to include pay rates in their listings. As a result, job seekers are able to see how a position’s compensation compares against the market, while employers can quickly adjust their rates to be more competitive.

Bhakta said Vivian Health added pay information because “our business is built on transparency, which we believe is a crucial element in solving the healthcare hiring crisis.”

#health, #healthcare, #iac, #nursefly, #nursing, #tc, #vivian-health

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Personalized nutrition startup Zoe closes out Series B at $53M

Personalized nutrition startup Zoe — named not for a person but after the Greek word for ‘life’ — has topped up its Series B round with $20M, bringing the total raised to $53M.

The latest close of the B round was led by Ahren Innovation Capital, which the startup notes counts two Nobel laureates as science partners. Also participating are two former American football players, Eli Manning and Ositadimma “Osi” Umenyiora; Boston, US-based seed fund Accomplice; healthcare-focused VC firm THVC and early stage European VC, Daphni.

The U.K.- and U.S.-based startup was founded back in 2017 but operated in stealth mode for three years, while it was conducting research into the microbiome — working with scientists from Massachusetts General Hospital, Stanford Medicine, Harvard T.H. Chan School of Public Health, and King’s College London.

One of the founders, professor Tim Spector of King’s College — who is also the author of a number of popular science books focused on food — became interested in the role of food (generally) and the microbiome (in particular) on overall health after spending decades researching twins to try to understand the role of genetics (nature) vs nurture (environmental and lifestyle factors) on human health.

Zoe used data from two large-scale microbiome studies to build its first algorithm which it began commercializing last September — launching its first product into the U.S. market: A home testing kit that enables program participants to learn how their body responds to different foods and get personalized nutrition advice.

The program costs around $360 (which Zoe takes in six instalments) and requires participants to (self) administer a number of tests so that it can analyze their biology, gleaning information about their metabolic and gut health by looking at changes in blood lipids, blood sugar levels and the types of bacteria in their gut.

Zoe uses big data and machine learning to come up with predictive insights on how people will respond to different foods so that it can offer individuals guided advice on what and how to eat, with the goal of improving gut health and reducing inflammatory responses caused by diet.

The combination of biological responses it analyzes sets it apart from other personalized nutrition startups with products focused on measuring one element (such as blood sugar) — is the claim.

But, to be clear, Zoe’s first product is not a regulated medical device — and its FAQ clearly states that it does not offer medical diagnosis or treatment for specific conditions. Instead it says only that it’s “a tool that is meant for general wellness purposes only”. So — for now — users have to take it on trust that the nutrition advice it dishes up is actually helpful for them.

The field of scientific research into the microbiome is undoubtedly early — Zoe’s co-founder states that very clearly when we talk — so there’s a strong component here, as is often the case when startups seek to use data and AI to generate valuable personalized predictions, whereby early adopters are helping to further Zoe’s research by contributing their data. Potentially ahead of the sought for individual efficacy, given so much is still unknown around how what we eat affects our health.

For those willing to take a punt (and pay up), they get an individual report detailing their biological responses to specific foods that compares them to thousands of others. The startup also provides them with individualized ‘Zoe’ scores for specific foods in order to support meal planning that’s touted as healthier for them.

“Reduce your dietary inflammation and improve gut health with a 4 week plan tailored to your unique biology and life,” runs the blurb on Zoe’s website. “Built around your food scores, our app will teach you how to make smart swaps, week by week.”

The marketing also claims no food is “off limits” — implying there’s a difference between Zoe’s custom food scores and (weight-loss focused) diets that perhaps require people to cut out a food group (or groups) entirely.

“Our aim is to empower you with the information and tools you need to make the best decisions for your body,” is Zoe’s smooth claim.

The underlying premise is that each person’s biology responds differently to different foods. Or, to put it another way, while we all most likely know at least one person who stays rake-thin and (seemingly) healthy regardless of what (or even how much) they eat, if we ate the same diet we’d probably expect much less pleasing results.

“What we’re able to start scientifically putting some evidence behind is something that people have talked about for a long time,” says co-founder George Hadjigeorgiou. “It’s early [for scientific research into the microbiome] but we have shown now to the world that even twins have different gut microbiomes, we can change our gut microbiomes through diet, lifestyle and how we live — and also that there are associations around particular [gut] bacteria and foods and a way to improve them which people can actually do through our product.”

Users of Zoe’s first product need to be willing (and able) to get pretty involved with their own biology — collecting stool samples, performing finger prick tests and wearing a blood glucose monitor to feed in data so it can analyze how their body responds to different foods and offer up personalized nutrition advice.

Another component of its study of biological responses to food has involved thousands of people eating “special scientific muffins”, which it makes to standardized recipes, so it can benchmark and compare nutritional responses to a particular blend of calories, carbohydrate, fat, and protein.

While eating muffins for science sounds pretty fine, the level of intervention required to make use of Zoe’s first at-home test kit product is unlikely to appeal to those with only a casual interest in improving their nutrition.

Hadjigeorgiou readily agrees the program, as it is now, is for those with a particular problem to solve that can be linked to diet/nutrition (whether obesity, high cholesterol or a disease like type 2 diabetes, and so on). But he says Zoe’s goal is to be able to open up access to personalized nutrition advice much more widely as it keeps gathering more data and insights.

“The idea is, as always, we start with a focused set of people with problems to solve who we believe will have a life-changing experience,” he tells TechCrunch. “At this point we are not trying to create a product for everyone — and we understand that that has limitations in terms of how much we scale in the beginning. Although even still within this focused group of people I can assure you there’s tonnes of people!

“But absolutely the whole idea is that after we get a first [set of users]… then with more data and with more experience we can simplify and start making this simpler and more accessible — both in terms of its simplicity and also it’s price. So more and more people. Because at the end of the day everyone has this right to be able to optimize and understand and be in control — and we want to make that available to everyone.

“Regardless of background and regardless of socio-economic status. And, in fact, many of the people who have the biggest problems around health etc are the ones who have maybe less means and ability to do that.”

Zoe isn’t disclosing how many early users it’s onboarded so far but Hadjigeorgiou says demand is high (it’s currently operating a wait-list for new sign ups).

He also touts promising early results from interim trial with its first users — saying participants experienced more energy (90%), felt less hunger (80%) and lost an average of 11 pounds after three months of following their AI-aided, personalized nutrition plan. Albeit, without data on how many people are involved in the trials it’s not possible to quantify the value of those metrics.

The extra Series B funding will be used to accelerate the rollout of availability of the program, with a U.K. launch planned for this year — and other geographies on the cards for 2022. Spending will also go on continued recruitment in engineering and science, it says.

Zoe already grabbed some eyeballs last year, as the coronavirus pandemic hit the West, when it launched a COVID-19 symptom self-reporting app. It has used that data to help scientists and policy makers understand how the virus affects people.

The Zoe COVID-19 app has had some 5M users over the last year, per Hadjigeorgiou — who points to that (not-for-profit) effort as an example of the kind of transformative intervention the company hopes to drive in the nutrition space down the line.

“Overnight we got millions and millions of people contributing to help uncover new insights around science around COVID-19,” he says, highlighting that it’s been able to publish a number of research papers based on data contributed by app users. “For example the lack of smell and taste… was something that we first [were able to prove] scientifically, and then it became — because of that — an official symptom in the list of the government in the U.K.

“So that was a great example how through the participation of people — in a very, very fast way, which we couldn’t predict when we launched it — we managed to have a big impact.”

Returning to diet, aren’t there some pretty simple ‘rules of thumb’ that anyone can apply to eat more healthily — i.e. without the need to shell out for a bespoke nutrition plan? Basic stuff like eat your greens, avoid processed foods and cut down (or out) sugar?

“There are definitely rules of thumb,” Hadjigeorgiou agrees. “We’ll be crazy to say they’re not. I think it all comes back to the point that although there are rules of thumb and over time — and also through our research, for example — they can become better, the fact of the matter is that most people are becoming less and less healthy. And the fact of the matter is that life is messy and people do not eat even according to these rules of thumb so I think part of the challenge is… [to] educate and empower people for their messy lives and their lifestyle to actually make better choices and apply them in a way that’s sustainable and motivating so they can be healthier.

“And that’s what we’re finding with our customers. We are helping them to make these choices in an empowering way — they don’t need to count calories, they don’t need to restrict themselves through a Keto [diet] regime or something like that. We basically empower them to understand this is the impact food has on your body — real time, how your blood sugar levels change, how your bacteria change, how your blood fat levels changes. And through that empowerment through insight then we say hey, now we’ll give you this course, it’s very simple, it’s like a game — and we’ll given you all these tools to combine different foods, make foods work for you. No food is off limits — but try to eat most days a 75 score [based on the food points Zoe’s app assigns].

“In that very empowering way we see people get very excited, they see a fun game that is also impacting their gut and metabolism and they start feeling these amazing effects — in terms of less hunger, more energy, losing weight and over time as well evolving their health. That’s why they say it’s life changing as well.”

Gamifying research for the goal of a greater good? To the average person that surely sounds more appetitizing than ‘eat your greens’.

Though, as Hadjigeorgiou concedes, research in the field of microbiome — where Zoe’s commercial interests and research USP lie — is “early”. Which means that gathering more data to do more research will remain a key component of the business for the foreseeable future. And with so much still to be understood about the complex interactions between food, exercise and other lifestyle factors and human health, the mission is indeed massive.

In the meanwhile, Zoe will be taking it one suggestive nudge at a time.

“Sugar is bad, kale’s great but the whole kind of magic happens in the middle,” Hadjigeorgiou goes on. “Is oatmeal good for you? Is rice good for you? Is wholewheat pasta good for you? How do you combine wholewheat pasta and butter? How much do you have? This is where basically most of our life happens.

“Because people don’t eat ice-cream the whole day and people don’t eat kale the whole day. They eat all these other foods in the middle and that’s where the magic is — knowing how much to have, how to combine them to make it better, how to combine it with exercise to make it better? How to eat a food that doesn’t dip your sugar levels three hours after you eat it which causes hunger for you. Theses are all the things we’re able to predict and present in a simple and compelling way through a score system to people — and in turn help them [understand their] metabolic response to food.”

#ahren-innovation-capital, #artificial-intelligence, #biology, #eli-manning, #food, #fundings-exits, #george-hadjigeorgiou, #health, #healthcare, #machine-learning, #microbiome, #personalized-nutrition, #series-b, #tc, #tim-spector, #united-kingdom, #united-states, #wearables, #zoe

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The health data transparency movement is birthing a new generation of startups

In the early 2000s, Jeff Bezos gave a seminal TED Talk titled “The Electricity Metaphor for the Web’s Future.” In it, he argued that the internet will enable innovation on the same scale that electricity did.

We are at a similar inflection point in healthcare, with the recent movement toward data transparency birthing a new generation of innovation and startups.

Those who follow the space closely may have noticed that there are twin struggles taking place: a push for more transparency on provider and payer data, including anonymous patient data, and another for strict privacy protection for personal patient data. What’s the main difference?

This sector is still somewhat nascent — we are in the first wave of innovation, with much more to come.

Anonymized data is much more freely available, while personal data is being locked even tighter (as it should be) due to regulations like GDPR, CCPA and their equivalents around the world.

The former trend is enabling a host of new vendors and services that will ultimately make healthcare better and more transparent for all of us.

These new companies could not have existed five years ago. The Affordable Care Act was the first step toward making anonymized data more available. It required healthcare institutions (such as hospitals and healthcare systems) to publish data on costs and outcomes. This included the release of detailed data on providers.

Later legislation required biotech and pharma companies to disclose monies paid to research partners. And every physician in the U.S. is now required to be in the National Practitioner Identifier (NPI), a comprehensive public database of providers.

All of this allowed the creation of new types of companies that give both patients and providers more control over their data. Here are some key examples of how.

Allowing patients to access all their own health data in one place

This is a key capability of patients’ newly found access to health data. Think of how often, as a patient, providers aren’t aware of treatment or a test you’ve had elsewhere. Often you end up repeating a test because a provider doesn’t have a record of a test conducted elsewhere.

#artificial-intelligence, #cloud-computing, #column, #drug-discovery, #ec-column, #ec-consumer-health, #ec-market-map, #enterprise, #food-and-drug-administration, #health, #health-systems, #healthcare, #healthcare-data, #machine-learning, #startups, #united-states

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Healthcare is the next wave of data liberation

Why can we see all our bank, credit card and brokerage data on our phones instantaneously in one app, yet walk into a doctor’s office blind to our healthcare records, diagnoses and prescriptions? Our health status should be as accessible as our checking account balance.

The liberation of financial data enabled by startups like Plaid is beginning to happen with healthcare data, which will have an even more profound impact on society; it will save and extend lives. This accessibility is quickly approaching.

As early investors in Quovo and PatientPing, two pioneering companies in financial and healthcare data, respectively, it’s evident to us the winners of the healthcare data transformation will look different than they did with financial data, even as we head toward a similar end state.

For over a decade, government agencies and consumers have pushed for this liberation.

In 2009, the Health Information Technology for Economic and Clinical Health Act (HITECH) gave the first big industry push, catalyzing a wave of digitization through electronic health records (EHR). Today, over 98% of medical records are digitized. This market is dominated by multi‐billion‐dollar vendors like Epic, Cerner and Allscripts, which control 70% of patient records. However, these giant vendors have yet to make these records easily accessible.

A second wave of regulation has begun to address the problem of trapped data to make EHRs more interoperable and valuable. Agencies within the Department of Health and Human Services have mandated data sharing among payers and providers using a common standard, the Fast Healthcare Interoperability Resources (FHIR) protocol.

Image Credits: F-Prime Capital

This push for greater data liquidity coincides with demand from consumers for better information about cost and quality. Employers have been steadily shifting a greater share of healthcare expenses to consumers through high-deductible health plans – from 30% in 2012 to 51% in 2018. As consumers pay for more of the costs, they care more about the value of different health options, yet are unable to make those decisions without real-time access to cost and clinical data.

Image Credits: F-Prime Capital

Tech startups have an opportunity to ease the transmission of healthcare data and address the push of regulation and consumer demands. The lessons from fintech make it tempting to assume that a Plaid for healthcare data would be enough to address all of the challenges within healthcare, but it is not the right model. Plaid’s aggregator model benefited from a relatively high concentration of banks, a limited number of data types and low barriers to data access.

By contrast, healthcare data is scattered across tens of thousands of healthcare providers, stored in multiple data formats and systems per provider, and is rarely accessed by patients directly. Many people log into their bank apps frequently, but few log into their healthcare provider portals, if they even know one exists.

HIPPA regulations and strict patient consent requirements also meaningfully increase friction to data access and sharing. Financial data serves mostly one-to-one use cases, while healthcare data is a many-to-many problem. A single patient’s data is spread across many doctors and facilities and is needed by just as many for care coordination.

Because of this landscape, winning healthcare technology companies will need to build around four propositions:

#column, #ec-column, #ec-consumer-health, #enterprise, #health, #healthcare, #healthcare-data, #healthcare-technology, #information-technology, #united-states

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Kaia Health grabs $75M on surging interest in its virtual therapies for chronic pain and COPD

New York headquartered Kaia Health, which offers AI-assisted digital therapies via a mobile app for chronic pain related to musculoskeletal (MSK) disorders and for Chronic Obstructive Pulmonary Disease (COPD), has raised a $75 million Series C.

The round was led by an unnamed leading growth equity fund with support from existing investors, including Optum Ventures, Eurazeo, 3VC, Balderton Capital, Heartcore Capital, Symphony Ventures (golfer Rory McIlroy’s investment vehicle), and A Round Capital.

The funding fast-follows a $26M Series B closed last summer. The pandemic has accelerated the uptake of telemedicine, generally — and Kaia has, unsurprisingly, seen a particular surge of interest in its virtual treatments.

After all, DIY home working set-ups are unlikely to have done much good for the average information worker’s back in the pandemic-struck year. Kaia’s real-time feedback generating motion coach is also able to offer treatment for neck, hip, knee, shoulder, hand/wrist, and foot/ankle pain.

A digital health solution may have been the only lockdown-friendly option for treating conditions considered ‘elective care’ during COVID-19 — meaning suffers of chronic pain may have faced restrictions on accessing physical healthcare provision like in-person physiotherapy. Kaia says it grew its business book 600% in 2020.

Given the U.S. healthcare sales cycle is heavily focused on January onboarding of new medical benefits by employers — who are key customers for Kaia in the market, where it now has around 50 employer and health plan clients — it’s expecting another big onboarding bump next January. And while it hadn’t been looking to raise again so soon after the Series B, doing so was “a very easy process”, says co-founder and CEO Konstantin Mehl.

“We actually planned to start the raise in the end of this year and then the pandemic happened and of course we had a huge boost because the healthcare system was pretty much shut down for in person elected treatments and chronic diseases are considered to be elected treatments which I think is a bit of a mistake.

“The thing is that the big b2b partners they are really scared that they will have this big backlog of surgical interventions that are very expensive… Pre-pandemic I think 20% of employers in the US were even interested in offering a digital therapy and then that changed to 100% immediately. So that was a big boost,” he goes on. “The other thing is that our market got really hot. We don’t really need the money right now but we met these investors and it was a very easy process.”

Kaia says that globally its digital MSK platform is accessible to 60M patients — which it claims makes it by far the biggest player in the space in terms of covered lives. (Other startups in the space include Hinge Health and Sword Health which are both also focused on MSK; and Physera, a virtual physical therapy provider that was acquired by Omada last year.)

The plan for Kaia’s (unexpectedly rapid) funding boost is “to be much more aggressive in building out our commercial team”, Mehl tells TechCrunch. “We are very proud of being a product focused company but it also gets a bit stupid at the point where you just need to bring the product in front of the relevant customer so we are investing a lot in that and also in computer vision because it’s still our USP.”

Kaia’s digital therapies rely on using computer vision to digitize proven treatments so they can be delivered outside traditional healthcare environments, with the app helping patients perform exercises correctly by themselves.

The user only needs a smartphone or tablet with a camera for the app to do real-time, posture-tracking and provide feedback. No wearables are required. Although Kaia is researching how 3D data from depth-sensing cameras which are now being embedded in higher end mobile devices may further feed the accuracy of its body tracking models.

“We basically can have the same correction functionality in your home that you have can have with a PT [personal trainer],” says Mehl. “We want to invest a lot more in computer vision and build out that team so we can also do that more aggressively now [with the Series C funding] which is cool.”

Kaia has started to use motion-tracking in another way in its patient-facing chronic pain app — as a way to track progress. So as well as asking patients to quantify their pain (which is a subjective measure) it can have an objective biomarker alongside patients’ pain assessments by getting them to do regular tests that track their body movements.

“We started to use motion-tracking besides the correction-tracking functionality also as a biomarker. So we basically can measure your body functionality. Now we can, for example, see which body parts are less flexible and that’s how we can measure the disease progression, instead of asking you how is the pain level today,” he explains. “Pain is the number one cause for work disability and the reason is because your body functionality decreases so if we can measure that correctly then we can also escalate it to the right speciality doctor, for example.”

Kaia can also quantify the progress of COPD patients in a similar way — by tracking them performing a sit-down, stand-up test.

Care for COPD has had a particular imperative during the pandemic as people with the chronic inflammatory lung disease who catch COVID-19 have the highest mortality rate among COVID-19-infected patients, per Mehl.

At the same time, pulmonary rehabilitation centers have been shut down during the pandemic because of the risk of infection to patients. So, once again, Kaia’s app has provided an alternative for suffers of chronic conditions to continue their rehab at home.

In the US Kaia focuses on activation rate as a percentage of the employer population — and Mehl says this stands between 5%-10%, depending on how the app is communicated to potential users. “We also had a company that had 15% of their population active it one year but you always have these outliers,” he adds.

Looking ahead to the coming 12 months, he says he expects to be able to grow revenue 5x-10x as a number of bigger partnerships kick in.

In Germany, where Kaia plans to start prescribing its app (via doctors), he’s hopeful they’ll be able to get 10,000 prescriptions done over the same period, once it has approval to do so under a national reimbursement system.

Plugging Kaia into wider healthcare provision

Integrating into a wider care pathway by being able to loop in healthcare providers where appropriate has been a big recent focus for Kaia.

In February it kicked off a major integration of its patient-facing MSK therapy/pain-management app with a referral system that plugs into services offered by other healthcare providers — using an escalation algorithm and screening and triage system, which it calls Kaia Gateway — to identify patients at risk of needing more invasive or intense treatment than the digital therapies its app can provide. It’s working with a number of premium partners for this referral path (i.e. within an employer or health plan’s ecosystem).

Its partners can provide additional medical services to relevant patients, both general and specialty care solutions, including disease management programs, PT, telemedicine, care navigation, and expert medical opinion services. Partners also get access to detailed treatment history on referred patients from Kaia, including via APIs.

“Besides being just an app-based therapy we want to expand more down the treatment path,” explains Mehl. “And also work with external medical providers — doctors etc — and bring our users at the right point to the right doctor to prevent any deterioration in pain that we cannot treat in the app. I think that brings a lot of trust, also, to the app.

“Because I think what’s happening now is that there’s so many digital therapies popping up everywhere. And one thing that is happening in the beginning when you’re small, like us three years ago, we just offered this app and said we don’t really know what’s happening before or after… Now we really want to integrate.”

“We have some cool partnerships coming up in the U.S. — partner with bigger medical providers that have thousands of medical providers on their payroll,” he goes on. “And then integrate with them so we can optimize the full treatment path. Because then the patients can really feel safe and say hey they don’t keep me in the app-based therapy when they know I should actually see somebody else because it’s not the best care anymore.”

“We have this platform approach but then we saw now it really makes sense to go deeper in these two diseases,” Mehl adds. “We start with our chronic pain approach in the U.S. and say we really want to go down the treatment path. And because the main problem is if people then start to be frustrated in our app and say I need something else and then they get back to this, for example, pain killers, opioids, surgery, cycle, and then they’re back in the system where we actually wanted to help them getting out of it so that’s why we say it’s not really possible to not integrate with healthcare professionals.

“You need to integrate them. If not you cannot always offer best care and then the patients realize at one point this app is not enough — but I also don’t get directed to a medical professional who could offer a new diagnosis or a different prescription. And then your trust is lost.”

“The other point is when you think about different levels of chronification, because we’re so scalable we can catch people much earlier in their chronification journey when the disease is still reversible. And even if our app is still the best treatment it helps to get an additional medical professional involvement to validate a diagnosis — or to just talk with a patient so that they really know that they’re safe here. So just reassuring, motivation and also diagnosis, to really say okay just to be sure we should make this diagnosis just to be sure you are getting best care. So I think that’s a huge product task and operational task for us.”

Kaia is starting by doing case referrals manually in-house — by setting up a medical case review team, staffed by doctors and therapies it employs — aided by a triage system that automatically flags patients for the team to review. But Mehl hopes this process will be increasingly assisted by AI.

“We assume yellow flags from what they told us in the entry test or from their exercise feedback or therapy feedback. Or from the interactions they have with their motivational coaches,” he explains of how the case review system works now. “Then [the case review team] has a look at them and decides if they should see an external medical provider partner and at what time.”

“Over time this should get more and more automated,” he adds. “We hope that we can make this better and better with machine learning over time and show that we can optimize the treatment path much better than just having this manual oversight. And that’s a huge challenge. If you think about what you need to do to get there I think it will define our product roadmap for years… But that’s also where the most value is to increase the quality of care. If not you just have siloed solutions everywhere… and the patient suffers because the treatment path is torn apart and it doesn’t feel like one thing.

“We will always need this clinical oversight. But where we can use machine learning is to help these medical professionals to look at the right patients at the right time. Because they cannot look at everybody all the time so there needs to be some filtering. And I think that filtering — or that triage — that can be really done by machine learning.”

Would Kaia ever consider becoming a healthcare provider itself? Combining a telemedicine service with some digitally delivered treatments is something that Sweden’s Kry, for example, has done — launching online cognitive behavioral therapy (CBT) treatments in its home market back in 2018 while also offering a telehealth platform and running a full healthcare service in some markets.

Mehl suggests not, arguing that telemedicine companies are by necessity generalists, since they are catering to “the top of the funnel”, handling and filtering patients with all sorts of complaints — which he says makes them less suited to focus deeply on catering to specific disease.

While, for Kaia, it’s deeply focused on building tech to treat a few specific diseases — and so, likewise, isn’t best suited to general medical service delivery. Partnering with medical service providers is therefore the obvious choice.

“I think about the patient journey and for the telemedicine companies… they might have some treatment paths integrated but they’re never as good as completely owning one chronic disease as we can be,” he says. “Most of chronic disease patients they just want to start a treatment because they talked with so many doctors. They want to find something that helps them and then at the right moment talk to the right medical professional. So that’s a difference in how telemedicine companies are doing it.

“The other question is how much of the medical provider job of the treatment path do we want to internalize? And we really are a tech company. We’re not very keen on becoming a medical provider. And we see that there are so many amazing medical providers in the landscape here — in different countries — that during COVID-19 had to become more digital, so it’s easy to partner with them, and why would we want to learn how to run a hospital where there are all these people who did it for decades and are really good at it, and we are really good at tech.”

“It’s really cool for the patient in the end. They know they get the best of both worlds and it’s optimized and ideally these offline medical providers get data from us so they can make better decisions — so they can also have a higher quality of decision-making because they have more data than just talking with a patient for two minutes. They can see our complete dashboard and how the patient progressed over time and everything — so the quality of decision-making gets higher.”

The U.S. overtook Europe as Kaia’s biggest market in recent years so it’s inexorably been focusing a lot of energy on serving its growing number of U.S. customers. The size of the addressable market in the U.S. is also massive, with ~100M chronic pain patients in the country, or around a third of the population.

But Kaia continues to develop its proposition in a number of European markets, including Germany which was where the business started. Mehl says its team in Munich is looking at how to make a recent reimbursement law for app-based health treatments will work for it in practice. It hasn’t yet obtained the necessary reimbursement code for doctors there to start prescribing its tech to their patients but it’s taking steps to change that.

At the same time, Mehl concedes that learning how to make doctors want to prescribe its app is an “open challenge” in the market.

“Some startups started doing it but — at scale — I still think there have to be some learning to be made to really scale it up,” he says of the German app prescriptions, adding that it’s preparing to hand in its application in relation to its COPD app which it will be bringing to market in Europe with a pharma partner.

“We also closed a partnership with a pharma company for Germany, UK and France to distribute our app through the pulmonologists — which is pretty cool. So we’re launching that partnership now,” he adds. “That will be exciting to see where the prescriptions start.”

Mehl professes himself a fan of Germany’s approach to digital healthcare — saying that it makes it easy to obtain a general reimbursement code which then gives the app-maker a year to prove any cost savings and deliver the care they say they do — couching that as a compromise between the “really long” process of getting approval for a medicine and the data-driven needs of startups where founders need to be able to show traction to get investment to build and grow a business in the first place.

“Healthcare’s already tough because you have to do clinical trials and it’s already a bit slower. So a longer approval process makes it even more difficult to launch something useful and I can see the UK, France, the Nordics bringing out some similar legislation to facilitate that,” he adds.

“We expect in other European countries — and in other countries in generally, like Canada, Australia and in Asia too — that they update their regulation to cover digital therapies. And then that will be good because we will know how to get apps prescribed and we know the other way, like in the U.S., [i.e. without needing to go through a doctor first]… And so with our app being so scalable we could easily launch in these countries compared to other companies in the market that are more reliant on one specific healthcare system or on hardware or anything that limits the scalability.”

 

#artificial-intelligence, #balderton-capital, #canada, #chronic-disease, #chronic-pain, #digital-health, #eurazeo, #europe, #fundings-exits, #germany, #health, #healthcare, #heartcore-capital, #kaia-health, #machine-learning, #mobile-devices, #munich, #new-york, #omada, #optum-ventures, #pain, #physera, #physical-therapy, #telehealth, #telemedicine, #united-states

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Vista Equity takes minority stake in Canada’s Vena with $242M investment

Vena, a Canadian company focused on the Corporate Performance Management (CPM) software space, has raised $242 million in Series C funding from Vista Equity Partners.

As part of the financing, Vista Equity is taking a minority stake in the company. The round follows $25 million in financing from CIBC Innovation Banking last September, and brings Vena’s total raised since its 2011 inception to over $363 million.

Vena declined to provide any financial metrics or the valuation at which the new capital was raised, saying only that its “consistent growth and…strong customer retention and satisfaction metrics created real demand” as it considered raising its C round.

The company was originally founded as a B2B provider of planning, budgeting and forecasting software. Over time, it’s evolved into what it describes as a “fully cloud-native, corporate performance management platform” that aims to empower finance, operations and business leaders to “Plan to Growtheir businesses. Its customers hail from a variety of industries, including banking, SaaS, manufacturing, healthcare, insurance and higher education. Among its over 900 customers are the Kansas City Chiefs, Coca-Cola Consolidated, World Vision International and ELF Cosmetics.

Vena CEO Hunter Madeley told TechCrunch the latest raise is “mostly an acceleration story for Vena, rather than charting new paths.”

The company plans to use its new funds to build out and enable its go-to-market efforts as well as invest in its product development roadmap. It’s not really looking to enter new markets, considering it’s seeing what it describes as “tremendous demand” in the markets it currently serves directly and through its partner network.

“While we support customers across the globe, we’ll stay focused on growing our North American, U.K. and European business in the near term,” Madeley said.

Vena says it leverages the “flexibility and familiarity” of an Excel interface within its “secure” Complete Planning platform. That platform, it adds, brings people, processes and systems into a single source solution to help organizations automate and streamline finance-led processes, accelerate complex business processes and “connect the dots between departments and plan with the power of unified data.”            

Early backers JMI Equity and Centana Growth Partners will remain active, partnering with Vista “to help support Vena’s continued momentum,” the company said. As part of the raise, Vista Equity Managing Director Kim Eaton and Marc Teillon, senior managing director and co-head of Vista’s Foundation Fund, will join the company’s board.

“The pandemic has emphasized the need for agile financial planning processes as companies respond to quickly-changing market conditions, and Vena is uniquely positioned to help businesses address the challenges required to scale their processes through this pandemic and beyond,” said Eaton in a written statement. 

Vena currently has more than 450 employees across the U.S., Canada and the U.K., up from 393 last year at this time.

#banking, #business-process-management, #canada, #coca-cola, #enterprise, #exit, #finance, #funding, #fundings-exits, #healthcare, #information-technology, #ma, #manufacturing, #private-equity, #recent-funding, #startups, #tc, #united-kingdom, #vista-equity-partners

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Brazil’s Positive Ventures closes on $10M fund for impact investing

Positive Ventures, a Sao Paulo-based venture firm, has secured $10 million for its latest fund.

Positive Ventures has raised the capital from an impressive list of LPs including investor Luis Stuhlberger, founding partner of Verde Asset Management and Cândido Bracher, former chairman and CEO of Itaú-Unibanco, Brazil’s largest bank.

The Brazilian venture firm’s self-described mission is to “invest in startups where every dollar of revenue is also delivering environmental or social impact.”

I spoke with co-founder and co-CEO Fabio Kestenbaum who emphasized the importance of such an investment strategy in a country like Brazil that has had its share of corruption over the years. (Kestenbaum co-founded the firm with Andrea Oliveira and Bruna Constantino.

Positive Ventures prides itself on being guided by the United Nations as part of its Global Compact initiative. It also has a top tier B Impact Score, meaning as a B Corp. that makes impact part of its core strategy, it’s doing pretty darn good.

The firm’s sweet spot is early-stage — Seed and Series A — ventures “that can deliver outsized impact and financial return,” according to Kestenbaum. Its average investment size is $500,000, but the firm can go up to $1.5 million in follow-on rounds. 

Positive Ventures seeks to back impact-oriented early-stage companies “building breakthrough solutions to tackle massive challenges related to inequality and climate change.”

Partner and CIO Murilo Johas Menezes is based out of the Bay Area and leads the firm’s offshore strategy and investments in companies.

Investments

Positive Ventures is sector agnostic but keeps three impact megatrends in mind when sourcing deals: 

  • Planetary Boundaries, such as recycling, carbon, sustainable systems
  • Social Resilience, such as financial services, credit, workforce upskilling and 
  • Institutional Voids, focused on emerging economies’ most pressing challenges such as education, health and rising technologies.

“If you want to bring private capital to the game to help address social and environmental challenges, we have to reward this capital,” Kestenbaum told me in a previous interview. “As such, we recognize that we have to invest in good businesses that can provide financial returns as well.”So far, Positive Ventures has backed five companies from its new fund.

One of its first investments, Labi Exames, went on to become a “yardstick for fighting Covid in Brazil,” Kestenbaum said, by delivering a fair-priced and quality alternative to test millions of uninsured low-income families in vulnerable communities.

Another portfolio company, Labi, helped support companies in reopening safely by continually testing their workforce. 

“This hybrid value proposition made Labi the most admired health tech in Brazil and resulted in MRR growth beyond 600%, accelerating their Series B, which will happen in the upcoming months,” Kestenbuam noted.

Another cornerstone investment for Positive Ventures was Slang, an AI-driven app to challenge the English illiteracy in Latin America backed by Chamath Palihapitiya of Social Capital and Mexico’s AllVP. 

“Less than 3% of Brazilians speak English with proficiency, and such a void hammers their chances to get a decent job and improve income,” Kestenbau said. “The same happens in all LATAM’s countries.”

Positive Ventures recently went on to close its largest investment thus far — in Provi, a B-Certified fintech providing education-driven loans to enable upskilling and employability for LATAM’s workforce, starting in Brazil. The company’s mission is to revolutionize education by delivering hassle-free and impact-oriented credit.      

Provi has pioneered income-share agreements (ISAs) in the region and already generated over $30 million in credit, most of which will go toward technology and healthcare courses.

Next up for Positive Ventures is a $30 million growth fund.

#artificial-intelligence, #b-corp, #bank, #brazil, #chamath-palihapitiya, #cio, #financial-services, #funding, #healthcare, #impact-investing, #itau, #latin-america, #mexico, #sao-paulo, #social-impact, #startups, #united-nations, #venture-capital

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Kry closes $312M Series D after use of its telehealth tools grows 100% yoy

Swedish digital health startup Kry, which offers a telehealth service (and software tools) to connect clinicians with patients for remote consultations, last raised just before the pandemic hit in Western Europe, netting a €140M Series C in January 2020.

Today it’s announcing an oversubscribed sequel: The Series D raise clocks in at $312M (€262M) and will be used to keep stepping on the growth gas in the region.

Investors in this latest round for the 2015-founded startup are a mix of old and new backers: The Series D is led by CPP Investments (aka, the Canadian Pension Plan Investment Board) and Fidelity Management & Research LLC, with participation from existing investors including The Ontario Teachers’ Pension Plan, as well as European-based VC firms Index Ventures, Accel, Creandum and Project A.

The need for people to socially distance during the coronavirus pandemic has given obvious uplift to the telehealth category, accelerating the rate of adoption of digital health tools that enable remote consultations by both patients and clinicians. Kry quickly stepped in to offer a free service for doctors to conduct web-based consultations last year, saying at the time that it felt a huge responsibility to help.

That agility in a time of public health crisis has clearly paid off. Kry’s year-over-year growth in 2020 was 100% — meaning that the ~1.6M digital doctors appointments it had served up a year ago now exceed 3M. Some 6,000 clinicians are also now using its telehealth platform and software tools. (It doesn’t break out registered patient numbers).

Yet co-founder and CEO, Johannes Schildt, says that, in some ways, it’s been a rather quiet 12 months for healthcare demand.

Sure the pandemic has driven specific demand, related to COVID-19 — including around testing for the disease (a service Kry offers in some of its markets) — but he says national lockdowns and coronavirus concerns have also dampened some of the usual demand for healthcare. So he’s confident that the 100% growth rate Kry has seen amid the COVID-19 public health crisis is just a taster of what’s to come — as healthcare provision shifts toward more digital delivery.

“Obviously we have been on the right side of a global pandemic. And if you look back the mega trend was obviously there long before the pandemic but the pandemic has accelerated the trend and it has served us and the industry well in terms of anchoring what we do. It’s now very well anchored across the globe — that telemedicine and digital healthcare is a crucial part of the healthcare systems moving forward,” Schildt tells TechCrunch.

“Demand has been increasing during the year, most obviously, but if you look at the broader picture of healthcare delivery — in most European markets — you actually have healthcare usage at an all time low. Because a lot of people are not as sick anymore given that you have tight restrictions. So it’s this rather strange dynamic. If you look at healthcare usage in general it’s actually at an all time low. But telemedicine is on an upward trend and we are operating on higher volumes… than we did before. And that is great, and we have been hiring a lot of great clinicians and been shipping a lot of great tools for clinicians to make the shift to digital.”

The free version of Kry’s tools for clinicians generated “big uplift” for the business, per Schildt, but he’s more excited about the wider service delivery shifts that are happening as the pandemic has accelerated uptake of digital health tools.

“For me the biggest thing has been that [telemedicine is] now very well established, it’s well anchored… There is still a different level of maturity between different European markets. Even [at the time of Kry’s Series C round last year] telemedicine was maybe not something that was a given — for us it’s always been of course; for me it’s always been crystal clear that this is the way of the future; it’s a necessity, you need to shift a lot of the healthcare delivery to digital. We just need to get there.”

The shift to digital is a necessary one, Schildt argues, in order to widen access to (inevitably) limited healthcare resources vs ever growing demand (current pandemic lockdown dampeners excepted). This is why Kry’s focus has always been on solving inefficiencies in healthcare delivery.

It seeks to do that in a variety of ways — including by offering support tools for clinicians working in public healthcare systems (for example, more than 60% of all the GPs in the UK market, where most healthcare is delivered via the taxpayer-funded NHS, is using Kry’s tools, per Schildt); as well as (in a few markets) running a full healthcare service itself where it combines telemedicine with a network of physical clinics where users can go when they need to be examined in person by a clinician. It also has partnerships with private healthcare providers in Europe.

In short, Kry is agnostic about how it helps deliver healthcare. That philosophy extends to the tech side — meaning video consultations are just one component of its telemedicine business which offers remote consultations for a range of medical issues, including infections, skin conditions, stomach problems and psychological disorders. (Obviously not every issue can be treated remotely but at the primary care level there are plenty of doctor-patient visits that don’t need to take place in person.)

Kry’s product roadmap — which is getting an investment boost with this new funding — involves expanding its patient-facing app to offer more digitally delivered treatments, such as Internet Cognitive Based Therapy (ICBT) and mental health self-assessment tools. It also plans to invest in digital healthcare tools to support chronic healthcare conditions — whether by developing more digital treatments itself (either by digitizing existing, proven treatments or coming up with novel approaches), and/or expanding its capabilities via acquisitions and strategic partnerships, according to Schildt.

Over the past five+ years, a growing number of startups have been digitizing proven treatment programs, such as for disorders like insomnia and anxiety, or musculoskeletal and chronic conditions that might otherwise require accessing a physiotherapist in person. Options for partners for Kry to work with on expanding its platform are certainly plentiful — although it’s developed the ICBT programs in house so isn’t afraid to tackle the digital treatment side itself.

“Given that we are in the fourth round of this massive change and transition in healthcare it makes a lot of sense for us to continue to invest in great tools for clinicians to deliver high quality care at great efficiency and deepening the experience from the patient side so we can continue to help even more people,” says Schildt.

“A lot of what we do we do is through video and text but that’s just one part of it. Now we’re investing a lot in our mental health plans and doing ICBT treatment plans. We’re going deeper into chronic treatments. We have great tools for clinicians to deliver high quality care at scale. Both digitally and physically because our platform supports both of it. And we have put a lot of effort during this year to link together our digital healthcare delivery with our physical healthcare delivery that we sometimes run ourselves and we sometimes do in partnerships. So the video itself is just one piece of the puzzle. And for us it’s always been about making sure we saw this from the end consumer’s perspective, from the patient’s perspective.”

“I’m a patient myself and still a lot of what we do is driven by my own frustration on how inefficient the system is structured in some areas,” he adds. “You do have a lot of great clinicians out there but there’s truly a lack of patient focus and in a lot of European markets there’s a clear access problem. And that has always been our starting point — how can we make sure that we solve this in a better way for the patients? And then obviously that involves us both building strong tools and front ends for patients so they can easily access care and manage their health, be pro-active about their health. It also involves us building great tools for clinicians that they can operate and work within — and there we’re putting way more effort as well.

“A lot of clinicians are using our tools to deliver digital care — not only clinicians that we run ourselves but ones we’re partnering with. So we do a lot of it in partnerships. And then also, given that we are a European provider, it involves us partnering with both public and private payers to make sure that the end consumer can actually access care.”

Another batch of startups in the digital healthcare delivery space talk a big game about ‘democratizing’ access to healthcare with the help of AI-fuelled triage or even diagnosis chatbots — with the idea that these tools can replace at least some of the work done by human doctors. The loudest on that front is probably Babylon Health.

Kry, by contrast, has avoided flashy AI hype, even though its tools do frequently incorporate machine learning technology, per Schildt. It also doesn’t offer a diagnosis chatbot. The reason for its different emphasis comes back to the choice of problem to focus on: Inefficiencies in healthcare delivery — with Schildt arguing that decision-making by doctors isn’t anywhere near the top of the list of service pain-points in the sector.

“We’re obviously using what would be considered AI or machine learning tools in all products that we’re building. I think sometimes personally I’m a bit annoyed at companies screaming and shouting about the technology itself and less about what problem you are solving with it,” he tells us. “On the decision-support [front], we don’t have the same sort of chatbot system that some other companies do, no. It’s obviously something that we could build really effortlessly. But I think — for me — it’s always about asking yourself what is the problem that you’re solving for? For the patient. And to be honest I don’t find it very useful.

“In many cases, especially in primary care, you have two categories. You have patients that already know why they need help, because you have a urinary tract infection; you had it before. You have an eye infection. You have a rash —  you know that it’s a rash, you need to see someone, you need to get help. Or you’re worried about your symptoms and you’re not really sure what it is — and you need comfort. And I think we’re not there yet where a chatbot would give you that sort of comfort, if this is something severe or not. You still want to talk to a human being. So I think it’s of limited use.

“Then on the decision side of it — sort of making sure that clinicians are making better decisions — we are obviously doing decision support for our clinicians. But if it’s one thing clinicians are really good at it’s actually making decisions. And if you look into the inefficiencies in healthcare the decision-making process is not the inefficiency. The matching side is an inefficiency side.”

He gives the example of how much the Swedish healthcare system spends on translators (circa €200M) as a “huge inefficiency” that could be reduced simply — by smarter matching of multilingual clinicians to patients.

“Most of our doctors are bilingual but they’re not there at the same time as the patient. So on the matching side you have a lot of inefficiency — and that’s where we have spent time on, for example. How can we sort that, how can we make sure that a patient that is seeking help with us ends up with the right level of care? If that is someone that speaks your native language so you can actually understand each other. Is this something that could be fully treated by a nurse? Or should it be directly to a psychologist?”

“With all technology it’s always about how do we use technology to solve a real problem, it’s less about the technology itself,” he adds.

Another ‘inefficiency’ that can affect healthcare provision in Europe relates to a problematic incentive to try to shrink costs (and, if it’s private healthcare, maximize an insurer’s profits) by making it harder for patients to access primary medical care — whether through complicated claims processes or by offering a bare minimum of information and support to access services (or indeed limiting appointment availability), making patients do the legwork of tracking down a relevant professional for their particular complaint and obtaining a coveted slot to see them.

It’s a maddening dynamic in a sector that should be focused on making as many people as healthy as they possibly can be in order that they avoid as much disease as possible — obviously as that outcome is better for the patients themselves. But also given the costs involved in treating really sick people (medical and societal). A wide range of chronic conditions, from type 2 diabetes to lower back pain, can be particularly costly to treat and yet may be entirely preventable with the right interventions.

Schildt sees a key role for digital healthcare tools to drive a much needed shift toward the kind of preventative healthcare that would be better all round, for both patients and for healthcare costs.

“That annoys me a lot,” he says. “That’s sometimes how healthcare systems are structured because it’s just costly for them to deliver healthcare so they try to make it as hard as possible for people to access healthcare — which is an absurdity and also one of the reasons why you now have increasing costs in healthcare systems in general, it’s exactly that. Because you have a lack of access in the first point of contact, with primary care. And what happens is you do have a spillover effect to secondary care.

“We see that in the data in all European markets. You have people ending up in emergency rooms that should have been treated in primary care but they can’t access primary care because there’s no access — you don’t know how to get in there, it’s long waiting times, it’s just triaged to different levels without getting any help and you have people with urinary tract infections ending up in emergency rooms. It’s super costly… when you have healthcare systems trying to fend people off. That’s not the right way doing it. You have to — and I think we will be able to play a crucial role in that in the coming ten years — push the whole system into being more preventative and proactive and access is a key part of that.

“We want to make it very, very simple for the patients — that they should be able to reach out to us and we will direct you to the right level of care.”

With so much still to do tackling the challenges of healthcare delivery in Europe, Kry isn’t in a hurry to expand its services geographically. Its main markets are Sweden, Norway, France, Germany and the UK, where it operates a healthcare service itself (not necessarily nationwide), though it notes that it offers a video consultation service to 30 regional markets.

“Right now we are very European focused,” says Schildt, when asked whether it has any plans for a U.S. launch. “I would never say that we would never go outside of Europe but for here and now we are extremely focused on Europe, we know those markets very, very well. We know how to manoeuvre in the European systems.

“It’s a very different payer infrastructure in Europe vs the US and then it’s also so that focus is always king and Europe is the mega market. Healthcare is 10% of the GDP in all European markets, we don’t have to go outside of Europe to build a very big business. But for the time being I think it makes a lot of sense for us to stay focused.”

 

#accel, #artificial-intelligence, #canadian-pension-plan-investment-board, #covid-19, #digital-health, #digital-healthcare, #europe, #fundings-exits, #germany, #health, #healthcare, #johannes-schildt, #kry, #machine-learning, #machine-learning-technology, #national-health-service, #nhs, #sweden, #tc, #telehealth, #telemedicine

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