Cures for a disease that mostly afflicts Black people seem near, but may come too late for Lisa Craig, who lives with an agony like knives stabbing her bones.
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.”
I will still have to face it with dignity.
The home medical supply market in the U.S. is significant and growing, but the way that Americans go about getting much-needed medical supplies, particularly for those with chronic conditions, relies on outdated and clumsy sales mechanisms that often have very poor customer experiences. New startup Better Health aims to change that, with an e-commerce approach to serving customers in need of medical supplies for chronic conditions, and it has raised $3.5 million in a new seed round to pursue its goals.
Better Health estimates the total value of the home medical supplies market in the U.S., which covers all reimbursable devices and supplies needed for chronic conditions, including things like colostomy bags, catheters, mobility aids, insulin pumps and more, is around $60 billion annually. But the market is obviously a specialized one relative to other specialized goods businesses, in part because it requires working not only with customers who make the final decisions about what supplies to use, but also payers, who typically foot the bill through insurance reimbursements.
The other challenge is that individuals with chronic care needs often require a lot of guidance and support when making the decision about what equipment and supplies to select — and the choices they make can have a significant impact on quality of life. Better Health co-founder and CEO Naama Stauber Breckler explained how she came to identify the problems in the industry, and why she set out to address them.
“The first company I started was right out of school, it’s called CompactCath,” she explained in an interview. “We created a novel intermittent catheter, because we identified that there’s a gap in the existing options for people with chronic bladder issues that need to use a catheter on a day-to-day basis […] In the process of bringing it to market, I was exposed to the medical devices and supplies industry. I was just shocked when I realized how hard it is for people today to get life-saving medical supplies, and basically realized that it’s not just about inventing a better product, there’s kind of a bigger systematic problem that locks consumer choice, and also prevents innovation in the space.”
Stauber Breckler’s founding story isn’t too dissimilar from the founding story of another e-commerce pioneer: Shopify. The now-public heavyweight originally got started when founder Tobi Lütke, himself a software engineer like Stauber Breckler, found that the available options for running his online snowboard store were poorly designed and built. With Better Health, she’s created a marketplace, rather than a platform like Shopify, but the pain points and desire to address the problem at a more fundamental level are the same.
With CompactCath, she said they ended up having to build their own direct-to-consumer marketing and sales product, and through that process, they ended up talking to thousands of customers with chronic conditions about their experiences, and what they found exposed the extend of the problems in the existing market.
“We kept hearing the same stories again, and again — it’s hard to find the right supplier, often it’s a local store, the process is extremely manual and lengthy and prone to errors, they get the surprise bills they weren’t expecting,” Stauber Breckler said. “But mostly, it’s just that there is this really sharp drop in care, from the time that you have a surgery or you were diagnosed, to when you need to now start using this device, when you’re essentially left at home and are given a general prescription.”
Unlike in the prescription drug market, where your choices essentially amount to whether you pick the brand name or the generic, and the outcome is pretty much the same regardless, in medical supplies which solution you choose can have a dramatically different effect on your experience. Customers might not be aware, for example, that something like CompactCath exists, and would instead chose a different catheter option that limits their mobility because of how frequently it needs changing and how intensive the process is. Physicians and medical professionals also might not be the best to advise them on their choice, because while they’ve obviously seen patients with these conditions, they generally haven’t lived with them themselves.
“We have talked to people who tell us, ‘I’ve had an ostomy for 19 years, and this is the first time I don’t have constant leakages’ or someone who had been using a catheter for three years and hasn’t left her house for more than two hours, because they didn’t feel comfortable with the product that they had to use it in a public restroom,” Stauber Breckler said. “So they told us things like ‘I finally went to visit my parents, they live in a town three hours away.’”
Better Health can provide this kind fo clarity to customers because it employs advisors who can talk patients through the equipment selection process with one-to-one coaching and product use education. The startup also helps with navigating the insurance side, managing paperwork, estimating costs and even arguing the case for a specific piece of equipment in case of difficulty getting the claim approved. The company leverages peers who have first-hand experience with the chronic conditions it serves to help better serve its customers.
Already, Better Health is a Medicare-licensed provider in 48 states, and it has partnerships in place with commercial providers like Humana and Oscar Health. This funding round was led by 8VC, a firm with plenty of expertise in the healthcare industry and an investor in Stauber Breckler’s prior ventures, and includes participation from Caffeinated Capital, Anorak Ventures, and angels Robert Hurley and Scott Flanders of remote health pioneer eHealth.
A new auto-injecting pill might soon become a replacement for subcutaneous injection treatments.
The idea for this so-called robotic pill came out of a research project around eight years ago from InCube Labs—a life sciences lab operated by Rani Therapeutics Chairman and CEO Mir Imran, who has degrees in electrical and biomedical engineering from Rutgers University. A prominent figure in life sciences innovation, Imran has founded over 20 medical device companies and helped develop the world’s first implantable cardiac defibrillator.
In working on the technology behind San Jose-based Rani Therapeutics, Imran and his team wanted to find a way to relieve some of the painful side effects of subcutaneous (or under-the-skin) injections, while also improving the treatment’s efficacy. “The technology itself started with a very simple thesis,” said Imran in an interview. “We thought, why can’t we create a pill that contains a biologic drug that you swallow, and once it gets to the intestine, it transforms itself and delivers a pain-free injection?”
Rani Therapeutics’ approach is based on inherent properties of the gastrointestinal tract. An injecting mechanism in their pill is surrounded by a pH-sensitive coating that dissolves as the capsule moves from a patient’s stomach to the small intestine. This helps ensure that the pill starts injecting the medicine in the right place at the right time. Once there, the reactants mix and produce carbon dioxide, which in turn inflates a small balloon that helps create a pressure difference to help inject the drug-loaded needles into the intestinal wall. “So it’s a really well-timed cascade of events that results in the delivery of this needle,” said Imran.
Despite its somewhat mechanical procedure, the pill itself contains no metal or springs, reducing the chance of an inflammatory response in the body. The needles and other components are instead made of injectable-grade polymers, that Imran said has been used in other medical devices as well. Delivering the injections to the upper part of the small intestine also carries little risk of infection, as the prevalence of stomach acid and bile from the liver prevent bacteria from readily growing there.
One of Imran’s priorities for the pill was to eliminate the painful side effects of subcutaneous injections. “It wouldn’t make sense to replace them with another painful injection,” he said. “But biology was on our side, because your intestines don’t have the kind of pain sensors your skin does.” What’s more, administering the injection into the highly vascularized wall of the small intestine actually allows the treatment to work more efficiently than when applied through subcutaneous injection, which typically deposits the treatment into fatty tissue.
Imran and his team have plans to use the pill for a variety of indications, including the growth hormone disorder acromegaly, diabetes, and osteoporosis. In January 2020, their acromegaly treatment, Octreotide, demonstrated both safety and sustained bioavailability in primary clinical trials. They hope to pursue future clinical trials for other indications, but chose to prioritize acromegaly initially because of its well-established treatment drug but “very painful injection,” Imran said.
At the end of last year, Rani Therapeutics raised $69 million in new funding to help further develop and test their platform. “This will finance us for the next several years,” said Imran. “Our approach to the business is to make the technology very robust and manufacturable.”
Parents should not be afraid of managing the child’s pain with opioids when they are needed, but should make sure a child does not have access to leftover doses.
A new study challenges those who care for children to end what researchers say is the common undertreatment of pain in children, starting at birth.
Contact with a puss caterpillar can cause a painful reaction as well as a rash, fever, muscle cramps or swollen glands, experts caution.
Doctors, nurses and therapists have a prescription for helping all of us to get through these difficult times: Try a little laughter.
couMotif has an app that allows patients to monitor themselves for treatments or drug trials which then feeds into a platform allowing a much faster approach to clinical studies. It’s now raised £5 million in a Series A investment round led by existing UK investor AlbionVC, with participation from Oslo-based DNV-GL and existing angel investors. This latest round takes it to a total funding size of £7.5m.
The platform is sold into life sciences companies which are gradually replacing centralized studies where patients have to go to a site, such as a hospital, to submit their data. The trend has obviously been catalyzed by Covid-19. The platform is now used by studies taking place in 26 countries from clinical to real-world settings, and across more than 25 therapeutic areas – from dermatology and rare disease to oncology and cardiology. The largest study involved over 13,000 participants tracking their pain levels and the weather. This was featured on the BBC and published in Nature.
Its competitors are almost entirely US-based and include organizations such as SnapIOT, Medable, and ClinicalInk as well as other large platform companies.
“We’re excited to help our customers implement patient-centered research designs by using the uMotif platform to capture high-quality data,” siad Bruce Hellman, CEO and Co-Founder of uMotif in a statement. “This new funding will rapidly accelerate our development and will ultimately help our customers to get new therapies to patients faster”.
Dr. Andrew Elder, deputy managing partner at AlbionVC says: “Now more than ever, having access to reliable patient data during clinical trials is crucial. uMotif’s platform is built with patients in mind; designed to help academics, researchers and healthcare professionals to capture the best quality data in a way that suits the participants. It’s a win-win for all stakeholders and the platform has the potential and momentum to revolutionize the speed and efficiency with which therapies can reach and help millions of patients.”
There are more promising signs from ongoing efforts to develop a vaccine that’s effective in preventing COVID-19: Two early trials, one from the University of Oxford, and one from a group of researchers in Wuhan funded in part by the National Key R&D Programme of China. Both early trials showed efficacy in increasing the presence of antibody responses to SARS-CoV-2, the virus that leads to COVID-19, and also indicated that these prospective vaccines were safe to administer based on available information.
The University of Oxford study is one of the leading vaccine development efforts in the world, and among those that are furthest along in development. The results of their study covered 1,077 participants, all of whom were health adults aged between 18 and 55 with no prior confirmed history of having contracted SARS-CoV-2. That’s important because they received double randomized trials of the vaccine candidate, or an existing vaccine for meningitis as a control acting as a placebo. The results showed that across the group, 100 percent of the participants had demonstrated neutralizing antibody responses by the end of the course, which include a booster does.
Additionally, while some participants exhibited side effects, including “pain, feeling feverish, chills, muscle ache, headache and malaise,” none of these represented what the researchers consider serious reactions, and these were also mitigated with use of paracetamol (standard painkillers available over the counter). Patient reactions were monitored for 28 days following the administration of the vaccine.
Oxford’s team is now ready to move on to its Phase 3 trial, which is a large-scale human trial that is effectively the last major step before it moves on to potential approval, production and distribution. That’s a time consuming process, but it does put this development on pace for a remarkably fast research and development process relative to prior vaccines.
Meanwhile the study in China covered health adults 18 or older, and included 603 participants, screened down to 508 who received either the vaccine candidate or a placebo. The participants also showed no adverse reactions, according to the researchers, and they’re also now likely to move on to a phase 3 development program.
Earlier this month, Moderna also announced promising early results from its phase 1 trial, but that was limited to just 45 participants between 18 and 55, and indicated some potentially serious side effects that will need to be watched in later, larger trials. These new results, while also early and requiring further development and research, are much more encouraging given the scale of both trials.
It is very early to make too many assumptions about what these early trials indicate, however. For instance, we still don’t really know how effective antibodies are in patients that have recovered from having COVID-19 once, so a lot more investigation is required by scientists in better understanding the efficacy of antibodies, and potentially vaccines, over the long term.
Kaia Health, a digital therapeutics startup which uses computer vision technology for real-time posture tracking via the smartphone camera to deliver human-hands-free physiotherapy, has closed a $26 million Series B funding round.
The funding was led by Optum Ventures, Idinvest and capital300 with participation from existing investors Balderton Capital and Heartcore Capital, in addition to Symphony Ventures — the latter in an “investment partnership” with world famous golfer, Rory McIlroy, who knows a thing or two about chronic pain.
Back in January 2019, when Kaia announced a $10M Series A, its business ratio was split 80:20 Europe to US. Now, says co-founder and CEO Konstantin Mehl — speaking to TechCrunch by Zoom chat from New York where he’s recently relocated — it’s flipped the other way.
Part of the new funding will thus go on building out its commercial team in the US — now its main market. He says they’ll also be spending to fund more clinical studies, and to conduct more R&D, including looking at how to supplement their 2D posture modelling with 3D data they can pull from modern, depth-sensing smartphone cameras.
“We use the smartphone camera to give you real-time feedback on your physical exercises. We are already pretty good at that but there are a lot more sensors in the iPhone so we’ll build out the computer vision team to start with 3D tracking,” he tells TechCrunch. “Including the depth cameras of the latest Samsung and Apple devices — mixing that with the 2D data we basically get from all the devices to see what we can do with these two data sets.”
On the research front, Kaia published a randomized control trial in the journal Nature last year — comparing its app-based therapy with multidisciplinary pain treatment programs for lower back pain which combine physiotherapy and online learning. “We have another large scale trial which is currently in the peer review process,” says Mehl, adding: “There will be a couple of interesting clinical trials getting published in the next six to nine months.
“We already have clinical studies that look specifically at how accurate the motion tracking technology is at the moment and how fast patients can learn exercises with the technology and how correct it is compared to when they learn it with real physical therapists — I think that’s an exciting study.”
He also flags another published app study which examined the treatment link between sleep and chronic back pain.
“We right now have nine clinical studies ongoing — part of the studies have the goal to compare our therapy apps against a lot of care treatments,” he goes on, fleshing out the reason for having such a strong focus on research. “The other part of the studies specifically look at AI features that we have and how they increase the quality of care for patients.
“Because a lot of startups say they have AI for healthcare or for patients but you never know what it exactly means, or if it really helps the patient or if it’s just material for the pitch, for investors. So that’s why we’d really like to do a lot more effort here, even if we already have nine studies ongoing — because it’s just a very powerful way to show how the products work. And it also helps to get more credibility as an industry.”
Kaia retired an earlier direct consumer subscription strand of its business to focus fully on b2b — chasing the “holy grail” of having its digital therapies fully reimbursed via users’ medical insurance.
Though it does still offer a number of free apps for consumers, with a physical trainer type function, as a way to gather movement data to feed its posture tracking models.
Overall it claims some 400,000 users across all its apps at this point.
“Back in Germany we have the majority of the population that can get the chronic pain app reimbursed already so there we do b2c marketing but the insurances reimburse it,” says Mehl. “In the US we mostly sell it to self-insured employers — the big employers.”
“Our goal in the end is always to get reimbursed as a medical claim because if you think back to our strong clinical focus, it just adds credibility — if you do the full homework,” he adds. “In medicine the holy grail is always to get reimbursed as a medical claim, that’s why we focus on that.”
So far Kaia offers app-based therapy for chronic back pain; a digital treatment for pulmonary rehabilitation treatment targeting at COPD (Chronic obstructive pulmonary disease); and is set to launch a new app, in about a month, tackling knee and hip osteoarthritis.
It calls its approach ‘multimodal’ — offering what it describes as “mind body therapy” for musculoskeletal (MSK) disorders which consists of guided physical exercises, psychological techniques and medical education.
Unlike some rivals in the same digital therapeutics for MSK space — notably Hinge Health, which recently raised a $90M Series C — Kaia’s approach is purely software based, with no additional sensor hardware required to be used by patients.
Mehl says it has steered clear of wearables to ensure the widest possible accessibility for its app-based treatments — a point it seeks to hammer home on its website via a table comparing what it dubs a “typical sensor-based system” and its “health motion coach”.
Competition in the digital health space has clearly heated up in the almost half decade since Kaia got started but Mehal argues that major b2b buyers now want to work with therapy platform providers, rather than buying “point solutions” for one disease, giving this relative veteran an edge over some of the more recent entrants.
“We now have three therapies against three very big diseases so I think that helps us,” he says. “We we started 4.5 years ago it was pretty unsexy to start something in digital therapies and now there are so many startups getting started for digital therapies or digital health. And what we’re seeing is that the big b2b customers now move away from wanting to buy point solutions, against one disease, more towards buying a couple of diseases — in the end they want to work more with platforms.”
“The important thing here is we never invent any therapy — we just digitize the best in class therapy and that’s important because if not you have very different requirements of what you have to prove,” he adds. “Now we always just prove that the digital delivery of the best in class therapy works as good or better than the offline role model.”
A key focus for Kaia’s business in the US is working directly with health insurance claims payers — such as Optum — who manage budgets for the employers providing cover to staff, with the aim of getting its digital therapy reimbursed as a medical claim, rather than having to convince employers to fund the software as a workplace benefit.
“We focus on working directly with these payers to be reimbursed by them so that we help them reduce the costs and stay on budget,” he explains. “We already have some really interesting partnerships there — obviously Optum Ventures invested in us, and Optum is the biggest player with [its parent company] UnitedHealth… So we have a very big partner there.
“Once you get reimbursed as a medical claim, the employer doesn’t really have to pay you anymore out of the separate benefits budget — which includes all kinds of other benefits, and which is relatively small compared to the medical claims budget. So if you’re reimbursed it’s a no brainer for an employer to basically buy your therapy. So it’s a fast-track through the US healthcare system.”
The team is also positioning the business to work with the growing number of telemedicine providers — and its app-based therapy something those services could offer as a bolt on for their own patients.
Mehl argues that the coronavirus crisis has transformed interest in digital care provision, and, again, contends that Kaia is well positioned to plug into a future of healthcare service provision that’s increasingly digital.
“Our goal is to not only have a therapy app that works in parallel to the healthcare system but to integrate in a full treatment pathway that a patient goes through. The obvious first thing is that we integrate more with doctors — we are currently talking with a lot of different players in the market how we can do that because if you use one of the many apps where you can talk to a doctor, what do you do afterwards?
“If they prescribe you in person physical therapy or even surgery you can’t really do that at the moment. So to have this full treatment pathway in the digital world just became mass market now. Before the crisis it was more like an early adopter market and now people have no other choice or don’t really want to go out even if the restrictions are lifted because they just don’t feel safe.”
There have been a surprising number of studies in recent years examining the effects of swearing, specifically whether it can help relieve pain—either physical or psychological (as in the case of traumatic memories or events). According to the latest such study, published in the journal Frontiers in Psychology, constantly repeating the F-word—as one might do if one hit one’s thumb with a hammer—can increase one’s pain threshold.
The technical term is the “hypoalgesic effect of swearing,” best illustrated by a 2009 study in NeuroReport by researchers at Keele University in the UK. The work was awarded the 2010 Ig Nobel Peace Prize, “for confirming the widely held belief that swearing relieves pain.” Co-author Richard Stephens, a psychologist at Keele, became interested in studying the topic after noting his wife’s “unsavory language” while giving birth, and wondered if profanity really could help alleviate pain. “Swearing is such a common response to pain. There has to be an underlying reason why we do it,” Stephens told Scientific American at the time.
For that 2009 study, Stephens and his colleagues asked 67 study participants (college students) to immerse their hands in a bucket of ice water. They were then instructed to either swear repeatedly using the profanity of their choice, or chant a neutral word. Lo and behold, the participants said they experienced less pain when they swore, and were also able to leave their hands in the bucket about 40 seconds longer than when they weren’t swearing. It’s been suggested (by Harvard psychologist Steven Pinker, among others) that it is a primitive reflex that serves as a form of catharsis.
Four years ago, Adnan Asar, the founder of the new addiction prevention service Lucid Lane, was enjoying a successful career working as the founding chief technology officer at Livongo Health. It was the serial senior tech executive’s most recent job after a long stint at Shutterfly and he was shepherding the company through the development of its suite of hardware and software for the management of chronic conditions.
But when Asar’s wife was diagnosed with non-Hodgkin’s Lymphoma, he stepped away from the technology world to be with his family while she underwent treatment.
He did not know at the time that the decision would set him on the path to founding Lucid Lane. The company’s mission is to help give patients who have been prescribed medications to address pain and anxiety ways to wean themselves off those drugs and avoid addiction — and its purpose is born from the struggle Asar witnessed as his wife wrestled with how to stop taking the medication she was prescribed during her illness.
Asar’s wife isn’t alone. In 2018, there were roughly 168.2 million prescriptions for opioids written in the United States, according to data from the Centers for Disease Control and Prevention. Lucid Lane estimates that 50 million people are prescribed opioids and another 13 million are prescribed benzodiazepines each year either after surgery or in conjunction with cancer treatments — all without a plan for how to manage or taper the use of these highly addictive medications.
For Asar’s wife, it was the benzodiazepine prescribed as part of her cancer treatment that became an issue. “She was hit by very severe withdrawal symptoms and we didn’t know what was going on,” Asar said. When they consulted her physician he gave the couple two options — quitting cold turkey or remaining on the medication.
“My wife decided to go cold turkey,” Asar said. “It was really debilitating for the whole family.”
It took nine months of therapy and regular consultations with psychiatrists to help with tailoring medication dosages and tapering to get her off of the medication, said Asar. And that experience led to the launch of Lucid Lane.
“Our goal is to prevent and control medication and substance dependence,” Asar said.
The company’s telehealth solution is built on a proprietary treatment protocol meant to provide continuous daily support and interventions, along with proactive monitoring of a personalized treatment plan — all on an ongoing basis, said Asar.
And the COVID-19 pandemic is only accelerating the need for telehealth services. “COVID-19 has made telehealth a mandatory service instead of a discretionary service,” said Asar. “There’s a surge in anxiety, depression, substance use and medication use. We’re seeing a surge of patients who are reaching out to us.”
Asar sees Lucid Lane’s competitors as companies like Lyra Health and Ginger, or point solutions building digital diagnostics to detect anxiety and depression. But unlike some companies that are launching to treat addiction or addictive behaviors, Asar sees his startup as preventing dependency and addiction.
“A lot of people are sliding into these addictions through something that happens at the doctor’s office,” said Asar. ” Our solution does not prescribe any of these medications.”
The company is working on clinical studies that are set to start at the Palo Alto VA hospital, and has raised $4 million in seed funding from investors including Battery Ventures and AME Cloud Ventures, the investment firm founded by Jerry Yang.
“We see great potential for Lucid Lane, as it has developed a scalable solution to one of the biggest problems facing society today,” said Battery general partner Dharmesh Thakker, in a statement. “Telehealth solutions have emerged as highly capable of addressing complex problems, and Lucid Lane has embraced remote care from its beginning. Its design enables care anytime, anywhere for patients in their moment of need. This can make a tremendous difference in the battle between recovery and relapse. We believe that it will help millions of people lead better lives.”
Joining Asar in the development of the company and its healthcare protocols are a seasoned team of health professionals, including Dr. Ahmed Zaafran, a board certified anesthesiologist at Santa Clara Valley Medical Center and assistant professor of anesthesiology (affiliated) at Stanford University School of Medicine; and advisors like Dr. Vanila Singh, who was also previously chairperson of the HHS Task Force in conjunction with the DOD and the VA to address the opioid drug crisis; Dr. Carin Hagberg, the chair of anesthesiology, perioperative and pain medicine of MD Anderson Cancer Center; and Sherif Zaafran, the president of the Texas Medical Board and chair of multiple national committees on pain management, including the subcommittee Taskforce on Pain Management Services for HHS, as well as the department’s Pain Clinical Pathways Committee.
“Lucid Lane provides a patient-centered solution that allows for the best clinical outcomes for patients after surgery and those bravely finishing chemotherapy,” said Dr. Singh, in a statement. “For the many patients who require short-term opioids and benzodiazepine medications, Lucid Lane’s treatment can limit the risk of prolonged dependence of these medications while also ensuring effective pain control with a resulting improved quality of life and functioning.”