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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.”
While use of the gaming technology for improving physical ailments is still in the early stages, it shows promise — and it’s fun.
Hinge Health, the San Francisco-based company that offers a digital solution to treat chronic musculoskeletal (MSK) conditions — such as back and joint pain — has closed a $310 million in Series D funding, according to sources.
The round is led by Coatue and Tiger Global, and values 2015-founded Hinge at $3 billion post-money, people familiar with the investment tell me. It comes off the back of a 300% increase in revenue in 2020, with investors told to expect revenue to nearly triple again in 2021 based on the company’s booked pipeline.
I also understand that Hinge’s founders — Daniel Perez and Gabriel Mecklenburg — retain voting control of the board. I’ve reached out to CEO Perez for comment and will update this post should I hear back.
Hinge’s existing investors include Bessemer Venture Partners, which backed the company’s $90 million Series C round in February, along with Lead Edge Capital, Insight Partners (which led the Series B), Atomico (which led the Series A), 11.2 Capital, Quadrille Capital and Heuristic Capital.
Originally based in London, Hinge Health primarily sells into U.S. employers and health plans, billing itself as a digital healthcare solution for chronic MSK conditions. The platform combines wearable sensors, an app and health coaching to remotely deliver physical therapy and behavioral health.
The basic premise is that there is plenty of existing research to show how best to treat chronic MSK disorders, but existing healthcare systems aren’t up to the task due to funding pressures and for other systematic reasons. The result is an over tendency to use opioid-based painkillers or surgery, with poor results and often at even greater cost. Hinge wants to reverse this through the use of technology and better data, with a focus on improving treatment adherence.
Meanwhile, Hinge’s jump in valuation is significant. According to sources, the company’s February round produced a valuation of around $420 million, so the new valuation is more than a 6x increase.
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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.”
The front lines of the Covid-19 fight have shifted from I.C.U.s to wards where the sickest patients relearn how to walk and eat without choking.
“I spend a lot of time being angry — but I’m still hopeful. Gender bias in medicine is systemic,” says Carine Carmy, the fast-talking CEO and co-founder of Origin, during a condensed chat about her startup mission to make physical therapy for women and mothers accessible and affordable across the US, both online and through a network of physical clinics.
The unexpected arrival of the COVID-19 pandemic led the LA-based startup to rework and accelerate its original launch plan — shifting its first focus to getting a telehealth service up and running fast.
They launched a “virtual care” service at the end of last month — offering “non-invasive, affordable care for commonly overlooked health issues”, from painful sex to postpartum recovery, as they put it in a press release, all of which is currently being served up via socially distanced Zoom video chat, thanks to the coronavirus.
Early growth in visits is running at 100%, month over month, per Carmy.
“We had originally planned to spend more time with in person care and then actually launch our digital platform — telehealth — in 2021. But March hit and it was very clear that we were going to have to close our doors for some period of time. So we decided to accelerate, really dramatically, the launch of our virtual care,” she explains.
“We launched a telehealth product in 48 hours, we converted the majority of our visits for the next month in person online and we had really, really great feedback and customer response — both in terms of adoption but repeat visits as well. And that gave us the confidence to really accelerate both the brand launch but also to be able to serve many more women with telehealth and then ultimately with other digital products down the line.”
Origin’s virtual care offering is nationwide in the sense of being available as a “touchpoint” to women across the U.S., though Carmy notes it’s only “in network” (i.e. accepted by some insurance providers) in California at this point. “That’s a goal of ours — to expand insurance coverage nationwide,” she says.
“We’re rapidly onboarding new providers across the country to be able to serve patients in a deeper way. Right now we offer one-on-one physical therapy online in California, and we’re offering health coaching in other states and are expanding our coverage in the coming weeks. We have folks lined up in New York and Texas and other states that we’re onboarding right now.”
The wider plan — coronavirus pandemic willing — is to start building out a network of physical clinics to go alongside the telehealth service, expanding out from the initial clinic in LA. She says the team is eyeing other locations in California to potentially open up later this year.
“Our model is both in person and online but obviously COVID has accelerated the online component,” Carmy tells TechCrunch. “But, at the core, physical therapy designed for women really means we were looking at women’s anatomy; the hormonal differences that affect women at unique stages in life; and often looking at the very prevalent but overlooked healthcare issues that women experience. So that’s the core of the care delivery that we’ve been tweaking with the team from a client experience perspective.
“That is going to stay the same but our goal is to build a network of practices across the country in partnership with the leading providers in each market. So we’re actually on track to open up San Francisco later this year… and have plans to expand within California and the country in person.”
On the tech side they’re focusing on building “customization around the care delivery experience” — which boils down to building a platform that serves the target female users with “the right education and fitness and exercise content”, as part of an overarching care delivery package.
Origin’s founder clinic is a long-standing LA business, called Bebé Physical Therapy. The team started working with this practice in late 2018, with a formal partnership following on last year. While the clinic’s original founder has left, the entire clinical team was retained — and Origin gained an existing loyal client base. (They say they’ve treated “thousands” of women in Los Angeles and have more than 250 referring providers, such as OB-GYNs, at this stage.)
“For us it was this really big moment of realizing there is this care delivery model that really works,” says Carmy, explaining the startup origin story. “The research shows that physical therapy is the first line of defense for every pelvic floor disorder. But there’s not enough access to these types of providers in a way that makes sense for the modern woman.”
“We really believe in building a clinical-first company,” she adds. “So for us it was really important to partner with really the best team in Los Angeles.”
Origin is angel funded at this stage, with the team taking an undisclosed amount of financing from investors including Assaf Wand, CEO and co-founder Hippo Insurance; Jenny Fleiss, co-founder of Rent the Runway; Josh Zad, founder & CEO of Alfred Inc.; and several others, including some individuals specifically focused on the healthcare space.
“Now profitability is sexy,” jokes Carmy, when asked about its approach to financing the business and whether it’s looking to go down a typical startup VC funding route or not. “For us, we’ve always wanted our locations to be profitable. I think it’s the most important thing to control your own destiny. Really focus on building a sustainable business from day one has been our goal.”
While bricks-and-mortar clinics where women can go for personal, physical, and potentially very intimate therapy are clearly a vital component of such a service, Carmy argues there’s plenty of good work that can be done virtually to support women with their health issues.
She says one major component to tackle when targeting women’s health is simply awareness and education — given how relatively overlooked the area is. And of course there’s no barrier to imparting knowledge over a Zoom call (albeit that particular videoconferencing tool’s platform’s security is something the Origin team may want to take a closer look at).
“So much of what we offer can be done remotely,” says Carmy. “And I think, especially if you’re a busy working mother, to be able to come into the clinic every week is not always feasible. So we do think you can actually achieve better outcomes and better adherence if we have continuous care online and in person.”
“A lot of patients are coming to us with issues that have never been named before,” she adds. “So some of the core value we offer is actually providing medical valuation — there’s a medical diagnosis and there’s a plan and there’s something we can do about it,” she adds.
“How women understand what’s going on with their bodies. And that’s not just in one session — that’s really over time, increasing body awareness and knowledge that women have so that they can also take care of themselves better in the future. That happens in every visit and can happen online.”
Carmy has a background in digital marketing but a very personal interest in women’s health after suffering painful sex during her twenties. She recounts the frustration of having to see multiple doctors before finally being able to get effective treatment for the problem.
While her long time friend and co-founder, Nona Farahnik Yadegar, suffered similar health issues after delivering her son — which led her to the Bebé Physical Therapy practice. Inspired, the friends joined forces to set up Origin, enlisting the help of Farahnik Yadegar’s husband, David, as their third co-founder.
“Pregnancy and postpartum, particularly postpartum, women’s needs are fundamentally ignored after they deliver,” Carmy continues. “We’re expected to just kind of ‘snap back’ — which is this huge fallacy which creates a whole set of other emotional issues and challenges as we try to live our lives.
“There’s a huge need. There’s a historical gender bias in medicine — but there has to be a way to solve this.”
It looks like a timely moment to build such a platform, with telehealth seeing a huge demand spike as a result of the coronavirus. While femtech, as a category, is now well established — commanding an increased share of attention from VCs who have historically lagged on understanding the opportunities for products and services that cater to women’s health (given their own gender bias problem).
Where women’s health is concerned the penny of opportunity does seem to be dropping. Not just for businesses narrowly focused on fertility, either, but for founders who are thinking far more holistically about women’s issues and well-being (including very overlooked yet universal transitions such as the menopause).
The Origin team’s decision to accelerate launching their telehealth platform actually occurred before a COVID-19 triggered shift in US regulations — which has nonetheless helped their accessibility mission by opening up digital healthcare platforms for insurance coverage, including for physical therapy.
“My hope is that this continues, even beyond whatever crisis period we’re in right now,” says Carmy, noting how physical therapy was one of the last areas to be covered for telehealth.
Origin contends that its approach to women’s health and physical therapy prevents and treats conditions that costs the system “billions of dollars across maternity and MSK” — by reducing unnecessary surgeries; improving musculoskeletal outcomes; and also by supporting women at work, thereby reducing absenteeism and promoting postpartum return.
“We’ve systemically ignored many parts of women’s bodies. There’s so much more research on erectile dysfunction than there is on female sexual pain,” Carmy adds, discussing why the insurance industry has also historically failed to pay proper attention to women’s health. (She notes, for example, that the Bebé Physical Therapy practice is an exception in Southern California in accepting insurance for this type of therapy.)
“If the medical community is telling you, through their actions, by only getting one visit six-weeks postpartum or by me needing to see six doctors to figure out what’s wrong with my pelvic floor, which is a large part of my body, even I think that this is maybe ‘normal’ or not an issue.
“The number of women I’ve talked to who assume that leaking or incontinence is just something that happens to all women after they give birth and can’t be dealt with… So I think we’ve normalized what is probably one of the largest healthcare issues in the country. That is maybe not an acute issue causing a tonne of surgeries but it really is if you look at pelvic organ prolapse.
“One in two adult women experience some level of prolapse and surgery is still perceived to be ‘the option’. And even with surgery you need physical therapy so…”
There’s respected science underpinning physical therapy as an effective treatment for a range of women’s health issues (Carmy, for example, points to this Stanford study on pelvic floor dysfunction). But, at the same time, the historic failure of the medical research community to focus on women’s health issues means there’s an ongoing paucity of data — which is something Origin hopes to be able to treat in time.
“We’re one of the only practices, we’re seeing thousands of visits a months, so we’re able to actually have a very large population that, hopefully in partnership with a research institution, we can actually show the real value of what’s being done — especially from a prevention stand point,” says Carmy.
“I think that’s where healthcare is going,” she adds, on the dual-sided — online, offline — nature of the business: In person physical therapy supplemented by ongoing online care, where therapists treat patients in their homes (and can even, therefore get a peek at extra environmental context, by getting eyes on a patient’s surroundings, that might be useful for further customizing physical treatments).
“In the future we’re not going to call it ‘telehealth’ we’re going to call it healthcare… It’s really just the future of care delivery.”
Another healthcare trend that’s clearly signalled by a startup like Origin is that women are increasingly rejecting a male-skewed status quo within medicine — and making it their own business to take better care of women.
Parents and educators have embarked on a desperate scramble to avoid dire academic outcomes for some of the city’s most vulnerable students.