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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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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Expressable launches with millions for scalable speech therapy

Speaking isn’t simple for at least 40 million Americans, so a new Austin-based startup is scaling a solution. Expressable is a digital speech therapy company that connects patients to speech language pathologists (SLP) via telehealth services and asynchronous support, and it has raised a new $4.5 million seed round.

The early-stage startup is launching with an explicit focus on serving the approximately five million children in the United States that have a communication disorder. What might start as an occasional stutter could turn into a communication disorder over time – so the startup is looking to intervene early to get kids on a clearer path.

Launched in 2019 by married co-founders Nicholas Barbara and Leanne Sherred, Expressable has served thousands of families to date. Today, the duo announced its seed funding, co-led by Lerer Hippeau and NextView Ventures, with participation from Amplifyher Ventures. The money will be used to expand its provider network, go in-network, and focus on its edtech service.

What it does

Put simply, Expressable connects children to speech-language pathologists on a recurring basis. The therapy is done live via Zoom for Healthcare with licensed professionals that Expresssable employs full-time. Clients are matched with a therapist in their area of need, from public speaking to vocal cord paralysis. Parents are able to reach their children’s SLP through secure SMS for coordination, questions, and rescheduling throughout the week.

On top of real-time support, the virtual speech therapy provider has a suite of asynchronous services. The company is building an e-learning platform with homework assignments and lessons, prescribed by the therapist and provided via SMS, for parents to do with their children to reinforce the speech care plans.

The activities are meant to be bite-sized – used when driving to the grocery store or cooking dinner or playing in the backyard – and tailored for interaction with children. The lessons can be as simple as creating opportunities for a kid to ask for juice, or to practice two-word utterances with an imitation game.

A mock secure SMS by Expressable. Image Credits: Expressable

This unique edtech bit of Expressable leans heavily on parent involvement in the therapy process. Parental help has been shown to increase positive outcomes, but notably it could also leave low-income, working class families out of the mix. Its price, on average, is $59 per week, and that’s currently only out of pocket rather than subsidized by insurance.

“There’s a lot of content for speech language pathologists by speech language pathologists, but not a lot of content by [SLPs] for parents, written in a way that is consumable,” Barbara said. “It just felt like a huge opportunity and market gap.”

Part of Expressable’s value is that it’s better than the status quo, which surprisingly often actually amounts to nothing. According to the National Institute on Deafness and Other Communication Disorders, about 8 to 9 percent of children have a speech sound disorder in the country — but only half actually get treatment. What might start as an occasional stutter could turn into a communication disorder over time – so Expressable wants to intervene early to get kids on the right path.

“Public schools are the number-one provider for pediatric speech but they are unfortunately notoriously underfunded,” said Sherred. Children who are lucky enough to be eligible for school services are often provided them in a group setting, she continued, which lengthens the amount of time it takes to make progress.

Sherred witnessed the “incredibly frustrating cycle” created by gaps in school intervention first-hand as a SLP. She has spent the majority of her career in in-home health, where she would work in homes and daycares directly with children.

The majority of Expressable’s user base are children, but about 35% are adults, signaling how speech issues can continue past childhood.

Meagen Lloyst, who sourced the Expressabble deal for Lerer Hippeau, is one example. Lloyst was diagnosed with a speech and voice condition in late 2020 and needed to find remote SLP therapy, which introduced her to the challenges of finding a high-quality specialized SLP.

“Before Expressable, there was no consumer-facing brand out there solving these pain points for individuals with communications disorders,” Lloyst said. “It’s evident that they’re already hiring the best SLPs out there, bringing parents and education into the process to focus on better outcomes for children, and doing so in a cost-effective and convenient way through virtual care.”

Telehealth with a twist

While telehealth usage remains above pre-pandemic levels, visits are on the decline. One challenge for any digital telehealth startup, Expressable included, is how to make a convincing pitch for moving caretaking fully-virtual in a post-pandemic context.

The Expressable co-founders pointed toward consistency, both internally and externally, as a competitive advantage.

First, speech therapy is a recurring service that many patients use once a week, every month, for years. “A lot of other telemedicine plays are these quick, convenient, and direct primary care,” Barbara said. “[We are] a longer tail of treatment plan that requires a close relationship between provider and patient.”

Second, unlike many telehealth startups, Expressable has hired its specialists full-time as W-2 employees. It’s a strategic choice to help ensure to its clients that their SLP of choice is a long-term relationship. The startup has 50 W-2 SLPs currently.

“We have built a career path for SLPs and a value proposition to speech language pathologists where they can work from home, set their own hours [get] paid above the national average, and then receive benefits that may not be obviously not common if you’re working in a contractor position.”

Not relying on the traditional contractor model might be a differentiation, but it’s also a challenge. The startup will have to rapidly (and efficiently) hire SLPs for the variety of speaking conditions out there – and in order to expand into new markets, it has to go through the arduous legal process of local licensing requirements, instead of just going to a white-label solution that helps staff similar companies while offloading individual practitioner certification.

While it has ambitions to become a national practice, Expressable currently operates in 15 states, and employs SLPs that are licensed in all the states that it operates in.

#early-stage, #health, #lerer-hippeau, #nextview, #tc, #tech, #telehealth

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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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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

0

Vietnam-based healthcare booking app Docosan gets $1M seed funding led by AppWorks

Based in Ho Chi Minh City, Docosan helps patients avoid long waits by letting them search and book doctors through its app. The company announced today it has raised more than $1 million in seed funding, which is claims is one of the largest seed rounds ever for a Vietnamese healthtech startup. The investment was led by AppWorks, the Taiwan-based early-stage investor and accelerator program, with participation from David Ma and Huat Ventures.

Founded in 2020, the app has been used by about 50,000 patients for bookings and now has more than 300 individual healthcare providers, ranging from small family pediatric clinics to neurosurgeons at large private hospitals, co-founder and chief executive officer Beth Ann Lopez told TechCrunch. Providers are vetted before being added to the platform and have on average 18 years of clinical experience.

Lopez said advance doctor bookings aren’t the norm in Vietnam. Instead, people who use private healthcare providers have to “choose between over 30,000 private hospitals and clinics spread across the hospital with huge variations in price and quality. This is why people use word of mouth recommendations from their family and friends to choose a healthcare provider. Then they show up at a hospital or clinic and wait in line, sometimes for hours.”

Docosan’s users can filter providers with criteria like location and specialty, and see pricing information and verified customer reviews. It recently added online payment features and insurance integrations. The company, which took part in Harvard’s Launch Lab X plans to launch telehealth and pharmacy services as well.

For healthcare providers on the app, Docosan provides software to manage bookings and ease wait times, a key selling point during the COVID-19 pandemic because many people are reluctant to sit in crowded waiting rooms. Lopez said another benefit is reducing the number of marketing and adminstrative tasks doctors have to do, allowing them to spend more time with patients.

The startup plans to expand into other countries. “Docosan is a solution that works well anywhere with a large, fragmented private healthcare system,” said Lopez. “We would all benefit from a world in which it’s as easy to find a great doctor as it is a book a Grab taxi.”

In press statement, AppWorks partner Andy Tsai said, “We noticed Docosan’s potential early on because of its participation in the AppWorks Accelerator. Docosan’s founders demonstrated strong experience and dedication to the healthcare issues in the region. We are proud to be supporting Docosan’s vision of better healthcare access for all.”

#asia, #docosan, #health, #healthcare, #healthtech, #southeast-asia, #tc, #telehealth, #vietnam

0

On-demand pediatrics app Biloba adds prescriptions and raises $1.7 million

French startup Biloba has raised a $1.7 million funding round (€1.4 million) a few months after launching its pediatrics app that lets you chat with a doctor whenever you have a question. In addition to raising some money, the startup also recently added in-app prescriptions.

Biloba’s concept is surprisingly simple. It’s a mobile app that lets you reach a general practitioner and a nurse whenever you have a medical question about your child. The service is available from 8 AM to 10 PM.

When you start a conversation, it looks like a messaging app. You can send and receive messages but also send photos and videos. There’s no real-time video conversation, no appointment. The company says that you usually get an answer in less than 10 minutes.

Last year, Biloba raised a €1.2 million pre-seed round. This year’s €1.4 million’s seed round is led by Aglaé Ventures and ID4. Existing investors Calm/Storm Ventures, Inventures, Acequia Capital and several business angels are also participating once again.

A text conversation will never replace a visit to the pediatrician. And there are many medical interactions and milestones after a baby is born. But you may have questions and you don’t want to wait for the next appointment.

And if it’s a relatively harmless issue that doesn’t need an in-person appointment, Biloba can now issue prescriptions. You receive the prescriptions in the app and it is accepted in all French pharmacies. The startup uses Ordoclic for that feature.

Biloba thinks people shouldn’t pay per consultation — even though people are particularly well covered by the French national healthcare system and private health insurance. Instead, the startup has opted for a subscription model.

Parents pay €12.99 per month, €24.99 for a three-month subscription or €79.99 per year. After that, you can start as many conversations as you want. Biloba subscriptions aren’t covered by the French national healthcare system.

Basically, if you can afford a subscription, Biloba can increase the frequency of interactions with doctors, which should lead to better medical advice.

Image Credits: Biloba

#biloba, #europe, #france-newsletter, #fundings-exits, #health, #pediatrics, #startups, #tc, #telehealth, #telemedicine

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Creator economy’s slow burn

Hello and welcome back to Equity, TechCrunch’s venture capital-focused podcast, where we unpack the numbers behind the headlines.

Natasha and Danny and  and Grace were all here to chat through the week’s rigamarole of news. Alex took some well-deserved time off, but that meant we got to poke a little fun at him and create a Special Edition segment to start off the show.

Jokes aside, this week was yet another spree of creator economy, edtech, and new fund announcements, with fresh and unexpected news hailing from Natasha’s home state, New Jersey.

Here’s what we got into:

What a show! We’ll be back with the full trio next week, and until then, stay safe and thank you for listening.

Equity drops every Monday at 7:00 a.m. PST, Wednesday, and Friday at 6:00 AM PST, so subscribe to us on Apple PodcastsOvercastSpotify and all the casts!

#clubhouse, #early-stage, #edtech, #equity, #equity-pod, #health-tech, #healthcare, #index, #masterclass, #mental-health, #netflix, #new-jersey, #patreon, #podcast, #tc, #telehealth, #walnut

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Nabla is building a healthcare super app for women

Meet Nabla, a French startup launching a new app today focused on women’s health. On Nabla, you’ll find several services that should all contribute to helping you stay on top of your health. In short, Nabla lets you chat with practitioners, offers community content, helps you centralize all your medical data and will soon offer telemedicine appointments.

Nabla’s key feature right now is the ability to start a conversation with health professionals. You can send a message to a general practitioner, a gynecologist, a midwife, a nurse, a nutritionist, or a physiotherapist.

While text discussions are not going to replace in-person appointments altogether, they can definitely be helpful. By increasing the number of interactions with health professionals, chances are you’ll be healthier and you may even end up booking more in-person appointments.

Other French startups have been providing text conversations with practitioners. For instance, health insurance company Alan lets you message a general practitioner — but you have to be insured by Alan. Biloba also lets you chat with a doctor — but the company has been focusing on pediatrics.

Nabla has a different positioning and offers this feature for free — there’s a limit as you can only send a handful of questions per month though. If it’s a common question, you may find the answer from the community. Nabla’s doctors will curate community content as well.

Using a free product to talk about your health feels suspicious. But that’s because the startup is well-funded and plans to launch premium features.

Image Credits: Nabla

The startup has raised $20.2 million (€17 million) and is already working with a team of doctors who are ready to answer questions from the company’s first users — or patients. Investors in the company include Xavier Niel, Artemis, Rachel Delacour, Julie Pellet, Marc Simoncini and Firstminute Capital.

One of the reasons why Nabla could raise so much money before releasing its app is that the three co-founders have a track record in the tech ecosystem.

Co-founder and CEO Alexandre Lebrun previously founded VirtuOz, which was acquired by Nuance, and Wit.ai, which was acquired by Facebook. More recently, he’s worked for Facebook’s AI research team (FAIR).

Co-founder and COO Delphine Groll has been heading business development and communications for two major media groups Aufeminin and My Little Paris. And Nabla’s co-founder and CTO Martin Raison has worked with Alexandre Lebrun at both Wit.ai and Facebook.

In addition to text conversations, Nabla shows all your past interactions in a personal log. You can connect that log with other apps and services, such as Apple’s Health app, Clue and Withings. This way, you can see all your data from the same app.

As you may have guessed, the startup truly believes that machine learning can help when it comes to preventive and holistic care. By default, nothing is shared with Nabla for machine learning purposes. But users can opt in and share data to improve processes, personalization and more.

Eventually, Nabla wants to optimize the interactions with doctors as much as possible. The startup says it doesn’t want to replace doctors altogether — it wants to enhance medical interactions so that doctors can focus on the human and empathetic part.

Nabla plans to launch a telemedicine service so that you can interact with doctors in real time as well as a premium offering with more features. That’s an ambitious roadmap, and it’s going to be interesting to track Nabla over the long run to see if they stick to their original vision and find a loyal user base.

#europe, #france-newsletter, #fundings-exits, #health, #healthcare, #nabla, #startups, #telehealth, #telemedicine

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Everlywell acquires two healthcare companies and forms parent Everly Health

Austin-based home lab testing kit startup Everlywell is expanding its scope considerably with two acquisitions, and a transformation that includes the establishment of a new parent company led by Everlywell CEO and co-founder Julia Cheek. The new entity, called Everly Health, will now offers services including at-home lab testing kits and education, population-scale testing through a U.S.-wide clinician network, telehealth and payer-supported/enterprise self-collected lab test.

This is a big move for Everlywell, which was found in 2015 (and which was a finalist in TechCrunch’s 2016 Disrupt SF Battlefield completion). The company has steadily iterated on its offerings, expanding its at-home testing from fertility products, to food sensitivities and allergies, and last year, to at home COVID-19 test collection.

Everly Health’s business now includes not only that kind of at-home consumer diagnostic and personal health education, but also many relationships through PWNHealth, which will rebrand to Everly Health Solutions, with health plans, employers and labs across the U.S.

Everlywell itself was actually a longtime partner of PNWHealth, which is what Cheek told me an in interview actually helped make the acquisition make so much sense to both companies. They’d been working together for years, and that collaboration had only deepened in the wake of the COVID-19 pandemic.

“What we found over the last year, was we were collaborating on all these different enterprise partnerships to offer solutions, and so our cultures are really well aligned, and our teams have worked closely together,” she said. “And we both share this common ethos that we felt the urgent need to help people and to save lives, but also this discipline around consumer-friendly and enabled care, grounded in diagnostics.”

Overall, Cheek said that the decision to go out and acquire the pieces of the puzzle needed to deliver a more comprehensive care offering was partly driven by the pandemic, but that really just drove an acceleration of what Everlywell was already beginning to see before COVID-19. Freshly capitalized with the $175 million it raised last December, the startup was in a position to make some bold moves in order to make the most of the moment.

“Before the pandemic, but especially during and looking out to post-pandemic, we have just seen this massive acceleration of the need for consumer friendly testing services,” she said. “Our business has continued to grow exponentially, even since normal doctor’s appointments resumed, orders of magnitude, 300% growth. We sat back and said, since we believe healthcare is in a watershed moment post-pandemic, where do we think we need to actually be to be able to offer a full-service diagnostic solution as this entire space grows. So it’s Everlywell as a consumer friendly brand, but it’s also this massive enterprise need for home testing, and broader consumer diagnostics.”

The new acquisitions do add some complexity to Everly Health’s business, since its Everly Health Solutions also serves a number of customers that would be considered competitive with Everlywell. Cheek points out that both businesses have a demonstrated track record of security and data integrity, compliant with HIPAA standards, and says that they’re setting up a strict firewall that will result in “complete data independence” of Everly Health Solutions to ensure there’s no possibility of anti-competitive behavior.

The companies will however share customer experience, design and product resources, however, and the plan is to build a unified brand focused on high-quality customer engagement across the board.

Everly Health hasn’t released the financial details of the transaction, but it has shared shared that PWNHealth CEO Sanjay Pingle will be acting in a transitional role in the combined company for the time being, and will serve on the board of Everly Health. Investors in PWNHealth, including Spectrum Equity, and Blue Cross/Blue Shield corporate VC Blue Venture Fund will also retain an ownership stake in Everly Health.

#acquisitions, #articles, #austin, #battlefield, #ceo, #everlywell, #firewall, #healthcare, #ma, #science-and-technology, #spectrum-equity, #tc, #technology, #telehealth, #united-states

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Ro raises $500M to grow its remote and in-home primary care platform

Healthcare tech startup Ro has raised $500 million to help fuel continued growth of its hybrid telehealth/in-home primary care platform, which also includes a growing pharmacy business as the company pursues a strategy of vertical integration to optimize delivery and reduce costs for clients. The company’s latest raise is a Series D round, and means it has now raised over $876 million since its 2017 founding.

That may seem like a lot of money, but as Ro fo-founder and CEO Zachariah Reitano told me in an interview, it’s actually “peanuts” when it comes to the healthcare industry – which is part of why they founded the company in the first place.

“Sometimes people talk about how great it is to be in the healthcare arena, in tech circles,” Reitano said. “They say, ‘Oh, healthcare is a $4 trillion market – it’s so massive.’  But that’s the worst thing in the entire world; it’s awful how large it is. And I think what we have the opportunity to cut it in half with technology.”

That’s what Reitano says will be the primary focus of this round of funding: Fueling its efforts around vertical integration of healthcare services and technology, to further the eventual end goal of reducing costs to patients through the efficiencies realized in that process.

“To me, what I’m really excited about is being able to continue to invest in that infrastructure and add even more,” Reitano told me. “We’ll continue to invest in telemedicine, we’ll continue to invest in our logistics and pharmacy, and continue to invest in in-home care, as well as the connection between the three, and then we’ll also invest in additional diagnostics, remote patient monitoring – so collecting and distributing devices to patients to go from reactive to proactive care.”

Ro’s model focuses on primary care delivered direct to consumer, without involving any payer or employer-funded and guided care programs. The idea is to reduce costs through vertical integration and other efficiency engineering efforts in order to get them to the point where they’re effectively on par with your out-of-pocket expense with co-pays anyway. Reitano explained that the insurance system as it exists in the U.S. now only effectively masks individual costs, making it less clear that much of what a person pays out in healthcare costs comes out of their pocket anyway, whether it’s through taxation, or employers allocating more of the funds they have available for compensation to healthcare, vs. take-home pay.

Image Credits: Ro

That’s what’s behind Ro’s recent push into operating its own pharmacies, and growing that footprint to include more all the time. Reitano told me that the company will have 10 pharmacies by the end o this year, and 15 by the end of next, all placed strategically around the country to ensure that it can provide next-day shipping to patients at ground shipping rates pretty much anywhere in the U.S.

Doing that kind of vertical optimization has enabled Ro to offer 500 common drugs at $5 per month, including treatments for heart disease, anxiety, depression and diabetes — with a plan to ramp it to 1,000 drugs available at that price by year’s end. That’s roughly equal to the co-pay required for many insurers for the same treatments.

Meanwhile, Reitano says Ro has seen big changes in the healthcare system generally that favor its model and accelerate its hybrid care plans owing to the COVID-19 pandemic.

“I would say that there are two most profound impacts of the pandemic on the healthcare system,” he said. “One is that it simultaneously shed light on all of the inequities for the entire country to see, right at the same time where we all cared about it. So those things were sort of known for the people impacted day to day — the geographic inequity, the financial inequity, the racial inequity. If someone felt that that inequity, then they would talk about it, but it wasn’t something everyone cared about at the same time. So this massive spotlight was shed on the healthcare system. And the second was that everyone’s healthcare journey now starts online, even if it is going to end in person, it will still start online.”

Ro’s model all along has espoused this time of healthcare delivery, with remote care and telehealth appointments handling most day-to-day needs, and follow-up in person care delivered to the home when required. That obviously generate a lot of efficiencies, while ensuring that older patients and those with mobility issues also don’t need to leave the house and make a regular trip into their physician’s office for what amounts to a 15-minute visit that could’ve been handled over video.

Ro co-founders Rob Schutz, Zachariah Reitano and Saman Rahmanian (left to right)

Ro co-founders Rob Schutz, Zachariah Reitano and Saman Rahmanian (left to right)

According to most industry observers, Reitano is likely right that healthcare probably won’t go back to the old, inefficient model of favoring primarily in-person care after the pandemic ends. One of the positive outcomes of the COVID-19 situation has been proving that telehealth is more than capable of handling a lot of the primary care needs of a lot of people, particularly when supplemented with remote monitoring and ongoing proactive health measures, too.

While Ro doesn’t work with insurance currently, Reitano points out that he’s not against the concept entirely – he just says that health insurance as it exists now doesn’t actual work as intended, since it’s meant to pool risk against an, expensive, uncertain and rare outcome. Eventually, he believes there’s a place for insurance in the overall healthcare mix, but first the industry needs to face a reckoning wherein its incentive structure is realigned to its actual core customer – patients themselves.

#articles, #ceo, #depression, #diabetes, #funding, #health, #health-insurance, #healthcare, #healthcare-industry, #pharmacy, #physician, #ro, #tc, #technology, #telehealth, #telemedicine, #united-states

0

Y Combinator company Axle Health is bringing on-demand home testing services to telehealth providers

While usage of telehealth services have surged during the COVID-19 epidemic, there are some times when health professionals need to be around in person to conduct diagnostics tests. To help those telehealth companies bridge that gap is Axle Health, a company currently enrolled in the latest cohort from the Y Combinator accelerator.

“In terms of the professionals that we send in home, they’re phlebotomists, NAs, RVNs, and RNs as well,” said Axle co-founder Connor Hailey.

In a sad reflection of the times, most of the calls the company’s getting are COVID-19 related, Hailey said.

And while the company currently doesn’t accept insurance, many of the companies on the platform choose a price they want to charge their patients and then seek reimbursement from insurers from those costs, according to Hailey.

“There are very few patients that are paying cash. Our services in the home are what would come out of pocket,” Hailey said. Those fees vary by the licensure level of the visiting health care worker. An in-home COVID-19 test could be $40 and a phlebotomist providing a blood draw would cost about the same amount, said Hailey.  

The company launched its service at the end of January and is seeking to expand its treatment options to more than just COVID-19 testing, but for now, it’s simply responding to market demand.

Hailey launched the business after spending a few years working at ZocDoc and then spending some time at Uber. What motivates Hailey and company co-founder Adam Stansell is providing similar concierge services at lower costs for a broader base of patients, Hailey said.

“The rich have access to in-home care can we make it economical enough so that we can bring it to everyone,” he said. 

#articles, #co-founder, #science-and-technology, #tc, #technology, #telehealth, #telemedicine, #uber, #y-combinator, #zocdoc

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Bangladesh-based Maya, a startup focused on accessible healthcare, raises $2.2 million seed round

Based in Bangladesh, Maya is dedicated to making it easier for women to get healthcare, especially for sensitive issues like reproductive and mental health. The startup announced today it has raised $2.2 million in seed funding. The round, which Maya said is the largest raised by a Bangladeshi health tech company so far, was led by early-stage fund Anchorless Bangladesh and The Osiris Group, a private equity firm focused on impact investing in Asian markets.

The funding will be used to introduce new products to Maya’s telehealth platform and expand into more countries. Maya recently launched in Sri Lanka and plans to expand into India, Pakistan, Middle Eastern markets and Indonesia.

Maya uses natural language processing and machine learning technology for its digital assistant, which answers basic health-related questions and decides if users need to be routed to human experts. It has about 10 million unique users and currently counts more than 300 licensed healthcare providers on its platform.

Founder and chief executive officer Ivy Huq Russell, who grew up in Chittagong and Dhaka before moving to the United Kingdom for university, started Maya as a blog with healthcare information in 2011. At the time, Russell worked in finance. She had just given birth to her first child and her mother had recently been diagnosed with breast cancer. Russell told TechCrunch she realized how many challenges there were to seeking medical care in Bangladesh, including financial barriers, a shortage of providers and long travel times to clinics.

She began Maya with the goal of providing trustworthy health information, but quickly realized that the site’s visitors needed more support. Many sent messages through WhatsApp, email or the site’s chat box, including survivors of sexual abuse, rape and domestic violence. After receiving a grant from BRAC, a Bangladeshi non-governmental organization, Maya’s team began developing an app to connect users with medical information and experts.

Bangladesh-based healthcare app Maya's homescreen

Maya’s homescreen

“We were very focused on two things,” Russell said. “One is how do we built trust in our community, in their language, because it’s very important that they communicate in the language that they’re comfortable using. At the same time, we realized as soon as we started getting hundreds and hundreds of questions, that we’re not going to be able to scale up if we just have 50 experts on computers typing.”

To support Bengali and regional dialects, Maya spent more than two years focused on developing its natural language processing technology. It collaborated with data scientists and linguists and took part in Google Launchpad’s accelerator program, working on tokenization and training its machine learning algorithms. Now Maya is able to provide automated answers in Bengali to basic questions in 50 topics with about 95% accuracy, Russell said. Out of the four million queries the platform has handled so far, about half were answered by its AI tech.

Many have to do with sexual or reproductive health and the platform has also seen an increase in questions about mental health. These are topics users are often hesitant seeking in-person consultations for.

“Growing up in Bangladesh, we got minimum sexual education. There’s no curriculum at school. Recently in the last one or two years, we’ve also started to see a lot of mental health questions, because I think we’ve made a good drive toward talking about mental health,” said Russell. She added, “it’s quite natural that whatever they couldn’t go and ask a question about very openly in traditional healthcare systems, they come and ask us.”

More consultations are coming from men, too, who now make up about 30% of Maya’s users. Many ask questions about birth control and family planning, or how to support their partners’ medical issues. To protect users’ privacy, consultations are end-to-end encrypted, and experts only see a randomly-generated ID instead of personal information.

In order to understand if someone needs to be routed to a human expert, Maya’s algorithms considers the length, complexity and urgency of queries, based on their tone. For example, if someone types “please, please, please help me,” they automatically get directed to a person. The majority of questions about mental health are also sent to an expert.

Russell said Maya’s approach is to take a holistic approach to physical health and mental wellness, instead of treating them as separate issues.

“People don’t just ask about physical health issues. They also ask things like, ‘I wear a hijab and I want to go for a run, but I feel really awkward,’” said Russell. “It sounds like a very normal question, but it’s actually quite a loaded question, because it’s affecting their mental health on a day-to-day basis.”

One of the company’s goals is to make the app feel accessible, so people feel more comfortable seeking support. “We’ve literally have had sweets delivered to our office when a user has a baby,” Russell said. “These are the personal touches that I think Maya has delivered in terms of dealing with both physical as well as mental health conditions combined together.”

The company is currently working with different monetization models. One is business-to-business sales, positioning Maya as a software-as-a-service platform that employers can offer to workers as a benefit. Garment manufacturing is one of Bangladesh’s biggest export sectors, and many workers are young women, fitting Maya’s typical user profile. The startup has worked with Marks and Spencer, Primark and the Bangladesh Garments Manufacturer and Exporters Association (BGMEA).

Another B2B route is partnering with insurance providers who offer Maya as a benefit. On the direct-to-consumer side, Maya recently launched premium services, including in-app video consultations and prescription delivery. Demand for consultations increased sharply during the COVID-19 pandemic, and it now handles about 300,000 video visits a month. Russell expects many users to continue using telehealth services even after the pandemic subsides.

“They’ve really seen the advantage of just having a doctor right in front of you,” she said. “For people with chronic conditions, it’s easier because they don’t have to go somewhere every week, and the fact they have monitoring and their history gathered is helpful for regular users, too.”

#apps, #asia, #bangladesh, #fundings-exits, #health, #healthcare, #maya, #south-asia, #startups, #tc, #telehealth, #womens-health

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Telemedico gets $6.6M to grow the reach of its digital health SaaS

Poland-based Telemedico has closed a €5.5 million (~$6.6M) Series A round of funding. The round is led by Flashpoint Venture Capital, Uniqa Ventures, PKO VC, Black Pearls VC (an existing investor) and Adamed.

Telehealth services specifically, and digital health more broadly, have racked up plenty of growth during the pandemic as demand for remote consultations (and other types of support) has accelerated sectoral uplift.

Telemedico, which was founded back in 2014 — but only launched its current b2b model (which is primarily targeted at insurance firms) in 2017 — says 2020 was a record year for its business.

One million consultations were carried out via its platform during the 12-month period, it told us.

Pawel Sieczkiewicz, founder and CEO at Telemedico, says it’s fielding over 100,000 consultations per month at this stage — and is projecting that to increase to 250,000 by the end of 2021.

The platform has been used by more than 900,000 patients to date. While more than 600 doctors currently provide remote consultations for Telemedico.

Services its platform offers include consultations with a doctor via chat, video, telephone; AI-triaging and coordination; and booking of in-person visits and blood testing.

The business has been growing 3x YoY since 2018, per Sieczkiewicz, who says it has carried out more than 2.5 million appointments in total to-date, spanning 10 languages.

It’s expecting to double the size of its (60-strong) team this year, he adds.

The Series A funding will be put towards international expansion — including eyeing potential growth opportunities in LatAm.

Expanding supported languages is part of that plan. (Currently it supports consultations in English, Spanish, Polish, Czech, Russian, Ukrainian, Serbian, Portuguese, Turkish, Arabic; languages it’ll be adding next are: Italian, French, Greek, German, and Romanian.)

Telemedico’s best markets to date are Poland and Spain, per Sieczkiewicz, who says it’s active in 14 markets in total.

“We aim to increase our presence on the markets where we are already active: Spain, Russia, Portugal, Turkey, and launch on new markets, with new languages — mainly EU Countries, like France, Germany, Greece, Italy, and Romania,” he adds.

While there’s a lot of activity in the telehealth space, Telemedico bills itself as one of the only ‘plug and play’ platforms for insurance companies — offering a whitelabel service geared towards a sector that Sieczkiewicz argues may not want to relinquish so much control to brasher, brand-building ‘digital first’ competitors.

“We provide our enterprise customers with a platform they can customise to meet their needs and a network of over 600 doctors who speak 10 languages that they can mix with their own network,” he tells TechCrunch. “We help our customers strengthen their value chain, so they can stand up against digital-first insurance companies who have been emerging for the last couple of years.

“The top three competitors are Babylon Health, KRY, and Pushdoctor. They represent a B2C approach, with a strong local presence. They are also building strong brand awareness around the service, and force insurance companies to let their customers leave their ecosystem. From the feedback that we receive from insurance companies, this isn’t their favourite way of organizing the patient flow.”

“One major drawback for insurers using the Babylon-style setup is that in the future, Babylon might be able to begin offering insurance cover directly to consumers, cutting out the original insurance companies themselves — similar to how digital-first insurance companies like Oscar Health operate,” he adds.

Telemedico says its system can be deployed within around 48 hours — letting insurance firms and other enterprise customers offer a telehealth platform that gives their users access to web and mobile white-label patient portals; online consultations; medical documentation storage; in person visits; automated triaging; and symptom checker tools.

The startup also offers insurance companies access to an ‘insurance product creator’ to manage variants of their current product suite for specific groups of users.

Telemedico says its platform is used by “a number” of health ministries around the world, as well as PZU, Allianz, AXA, Metrored, Compensa, TU Zdrowie and more than 50 other insurance and medical assistance companies (“mostly” within the telemedicine space).

It does also offer a direct-to-consumer telehealth service in Poland, via the public healthcare system — where consultation fees are covered by the insurance of the publicly funded National Health Fund of Poland (i.e. free at the point of use for patients).

It also offers consultations via a fee-for-service model. Sieczkiewicz says its USP is “that we are built on three foundations: B2B, whitelabel and cross-country services”.

“Telemedico is primarily a B2B company,” he continues. “The majority of our business comes from recurring enterprise customers, such as insurance companies, banks, pharmacies and other companies who either offer health services and want to improve them with a digital layer or want to offer health services to their digital offering.

“We see a huge trend among insurance companies, that add new healthcare products to their offers. We help create those products with our so-called ‘insurance product creator’, providing them with tools for setting up and management of their digital health services, patient flow, and more.”

He also says the ‘plug and play’ style SaaS platform supports a modular approach — enabling the target b2b users to zero in on the most useful aspects of its platform for their particular customer case (be it telemedicine, drug ordering or automated triage).

The software can be completely integrated into a customer’s platform or run as a stand-alone product, he adds.

“Telemedicine is no longer an add-on to insurance packages but in many countries the first touchpoint with medical services — a way to increase patients satisfaction and decrease costs for the insurer,” Sieczkiewicz suggests.

Commenting on the Series A funding in a statement, Michael Szalontay, general partner at Flashpoint VC, said: “We are convinced that telemedicine will become a primary distribution channel for medical services in the next decade and Telemedico is poised to become a European leader in this domain. We are proud to become Pawel’s partner in Telemedico, he has an amazing energy and conviction, and in our experience, such gumption is a prerequisite for success.”

“This decade will be the Golden Twenties for telemedicine,” added Dr. Andreas Nemeth, general partner at UNIQA Ventures, in another supporting statement. “The potential is enormous and telemedi.co is already setting standards here today. telemedi.co has the right product, the right team and the right culture to support insurers in providing seamless telemedicine services. We are therefore delighted and proud to be able to follow the path together in the future and pleased to be able to become a part of the company’s international growth story.”

#covid-19, #digital-health, #europe, #flashpoint-venture-capital, #fundings-exits, #health, #saas, #telehealth, #telemedicine, #telemedico

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K Health expands into virtual childcare and raises $132 million at a $1.5 billion valuation

K Health, the virtual health care provider that uses machine learning to lower the cost of care by providing the bulk of the company’s health assessments, is launching new tools for childcare on the heels of raising cash that values the company at $1.5 billion.

The $132 million round raised in December will help the company expand and help pay for upgrades including an integration with most electronic health records — an integration that’s expected by the second quarter.

Throughout 2020 K Health has leveraged its position operating at the intersection of machine learning and consumer healthcare to raised $222 million in a single year.

This appetite from investors shows how large the opportunity is in consumer healthcare as companies look to use technology to make care more affordable.

For K Health, that means a monthly subscription to its service of $9 for unlimited access to the service and physicians on the platform, as well as a $19 per-month virtual mental health offering and a $19 fee for a one-time urgent care consultation.

To patients and investors the pitch is that the data K Health has managed to acquire through partnerships with organizations like the Israel health maintenance organization Maccabi Healthcare Services, which gave up decades of anonymized data on patients and health outcomes to train K Health’s predictive algorithm, can assess patients and aid the in diagnoses for the company’s doctors.

In theory that means the company’s service essentially acts as a virtual primary care physician, holding a wealth of patient information that, when taken together, might be able to spot underlying medical conditions faster or provide a more holistic view into patient care.

For pharmaceutical companies that could mean insights into population health that could be potentially profitable avenues for drug discovery.

In practice, patients get what they pay for.

The company’s mental health offering uses medical doctors who are not licensed psychiatrists to perform their evaluations and assessments, according to one provider on the platform, which can lead to interactions with untrained physicians that can cause more harm than good.

While company chief executive Allon Bloch is likely correct in his assessment that most services can be performed remotely (Bloch puts the figure at 90%), they should be performed remotely by professionals who have the necessary training.

There are limits to how much heavy lifting an algorithm or a generalist should do when it comes to healthcare, and it appears that K Health wants to push those limits.

“Drug referrals, acute issues, prevention issues, most of those can be done remotely,” Bloch said. “There’s an opportunity to do much better and potentially cheaper. 

K Health has already seen hundreds of thousands of patients either through its urgent care offering or its subscription service and generated tens of millions in revenue in 2020, according to Bloch. He declined to disclose how many patients used the urgent care service vs. the monthly subscription offering.

Telemedicine companies, like other companies providing services remotely, have thrived during the pandemic. Teladoc and Amwell, two of the early pioneers in virtual medicine have seen their share prices soar. Companies like Hims, that provide prescriptions for elective conditions that aren’t necessarily covered by health, special purpose acquisition companies at valuations of $1.6 billion.

Backing K Health are a group of investors led by GGV Capital and Valor Equity Partners. Kaiser Permanente’s pension fund and the investment offices of the owners of 3G Capital (the Brazilian investment firm that owns Burger King and Kraft Heinz), along with 14W, Max Ventures, Pico Partners, Marcy Venture Partners, Primary Venture Partners and BoxGroup, also participated in the round. 

Organizations working with the company include Maccabi Healthcare; the Mayo Clinic, which is investigating virtual care models with the company; and Anthem, which has white labeled the K Health service and provides it to some of the insurer’s millions of members.

#articles, #boxgroup, #burger-king, #drug-discovery, #ggv-capital, #health, #healthcare, #healthcare-industry, #israel, #k-health, #kaiser-permanente, #kraft, #machine-learning, #max-ventures, #mayo-clinic, #pharmaceutical, #primary-care, #primary-venture-partners, #tc, #technology, #teladoc-health, #telehealth, #telemedicine, #valor-equity-partners

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Prioritizing tech in 2021 will be the path to pandemic recovery for mental health

This year, Americans grappled with fear of infection, incredible loss of loved ones, financial stress, isolation and fatigue from constant uncertainty to name a few. Even though we are getting closer to returning to normality as vaccines start to roll out, we can’t write COVID-19 off just yet. We are only now beginning to see the long-lasting effects of the pandemic, specifically its dramatic impact on the mental health crisis in the United States and unfortunately, mental illness has no vaccine.

Nearly 45 million American adults live with mental illness, which has only been exacerbated this year as more than two in five U.S. residents reported struggling with mental health issues as a result of COVID-19.

Even more concerning, according to the World Health Organization, prior to the pandemic, countries around the world were spending less than 2% of national health budgets on mental health, while struggling to meet their populations’ needs. It’s evident that there is not only a lack of focus on mental healthcare, but a lack of access as well.

We’ve seen a recent influx in telemedicine and telehealth services, and provided these solutions are evidence-based and effective, this is the only way for us to scale the widespread demand for support. Put simply, we don’t have enough clinical staff to go around.

When I practiced psychiatry in the U.K.’s National Health Services (NHS), I quickly realized that we were seeing patients too late, sometimes years too late, such that they had far more serious needs than if they had been able to access good quality care earlier. Back then it was clear to me this level of supply-demand gap could only be resolved by deploying technology at scale, and the events of the last year have only reinforced that.

Investors have taken note as well, with many mental health startups raising capital. It’s clear that business leaders have begun to prioritize innovation as a way to pull ourselves out of crisis, with a renewed focus on products adapted to a changed world. We’ve already seen a massive uptick in digital mental health solutions with about 76% of clinicians solely treating patients via telemedicine. The clearest path for managing mental health at scale will be evidence-based, ethical and personalized digital solutions.

Not only will this influx help those who desire flexible care options, but telehealth has also increased the access to care for people who may have limited options in their local communities.

While increasing in popularity, digital mental health solutions have some important challenges to overcome. For one, they must win consumer trust and prove that they can handle personal data ethically and responsibly. With 81% of Americans feeling that the risks of sharing personal data outweigh the benefits, providers must show that they can responsibly secure users’ personal health data due to the sensitive nature of the information and ultimately gain that trust.

This must go beyond compliance with HIPAA and, in Europe, GDPR, and require the development and implementation of an ethical framework to underpin a provider’s digital mental health solutions. However, such efforts must be genuine and avoid falling into the trap of “ethics washing,” so I encourage providers to have the ethics frameworks audited by external experts and to commit to publishing the results.

Digital solutions must also be able to meet the needs of users on an individualized and personalized basis. Many apps meant to help manage mental health take a one-size-fits-all approach and don’t take enough advantage of the technology’s ability to adapt to peoples’ unique symptoms and personal preferences. This is not simply about offering more than one type of intervention, although that is important, it’s the recognition that people engage in technology in different ways.

For instance, at Koa Health we know that some users love going through a program in a step-by-step fashion, whereas others prefer to dip into activities as they need them, and it’s important that we cater equally well for both of these preferences. Generic approaches simply won’t work well for everyone.

Not only do digital solutions need to be responsible with data and be tailored to users, they must work harder to prove their efficacy. Recent research has shown that 64% of mental health apps claimed efficacy yet only 14% included any evidence. The growth in the adoption of technology is encouraging, but positive impact will only result from products designed for efficacy — and able to demonstrate it in high-quality trials. The stronger the evidence base for effectiveness and cost-effectiveness, the more likely healthcare providers and insurers will be to distribute the solutions.

While vaccines are on their way, the mental health impacts of the pandemic may soon overshadow the direct impacts of the pandemic. While health tech has made promising progress, it’s imperative that digital mental healthcare places a stronger emphasis on effective, ethical and personalized care to avert an even larger mental health crisis.

#column, #covid-19, #health, #mental-health, #mental-illness, #opinion, #telehealth, #telemedicine

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Index ventures into Latin America to back Sofia, a Mexico City-based telemedicine and health insurer

Arturo Sanchez and his co-founders have spent the past two years developing the telemedicine and insurance platform, Sofia, as a way to give customers across Mexico better access to quality healthcare through their insurance plan.

Along with his co-founders, Sebastian Jimenez, a former Google employee who serves as the company’s chief product officer, and Manuel Andere an ex-Patreon employee who’s now Sofia’s chief technology officer, Sanchez  (a former Index Ventures employee) is on a path to provide low-cost insurance for middle class consumers across Latin America, starting in Mexico City.

Backing that vision are a clutch of regional and international investors including Kaszek Ventures, Ribbit Capital, and Index Ventures. When Index Ventures came in to lead the company’s $19 million round earlier this year, it was the first commitment that the venture firm had made in Latin America, but given the strength of the market, it likely won’t be their last.

In Sofia, Index has found a good foothold from which to expand its activity. The company which initially started as a telemedicine platform recently received approvals to operate as an insurer as well — part of a long-term vision for growth where it provides a full service health platform for customers.

Founded by three college friends who graduated from the Instituto Tecnológico Autónomo de México (Mexico’s version of MIT), the company initially launched with COVID-19 related telemedicine service as the pandemic took hold in Mexico.

That service was a placeholder for what Sanchez said was the broader company vision. And while that product alone had 10,000 users signed up for it, the new vision is broader.

“We registered as an insurance company because we want to go deeper into people’s health. We have built a telemedicine solution, which is a core component of the product. The goal is to be an integrated provider that provide primary care and handles more significant types of illnesses,” said Sanchez.

The company already has a core group of 100 physicians in Mexico City and initially will be serving the city with 70 different specialist areas.

All the virtual consultations are covered without an additional payment and in-person or specialty consultations come at a 30% reduced rate to an out-of-pocket payment, according to Sanchez.

Fees depend on age and gender, but Sanchez said a customer would typically pay around $500 per-year or roughly between $40 and $50 per-month.

The company covers 70% of the cost of most treatments that’s capped at $2,000 per-year and coverage maxes out at $75,000. “In Mexico that covers north of 98% of all illnesses or treatment episodes,” said Sanchez.

In Mexico, insurance is even less common than in the US.

90% of private health spend happens out of pocket. The problem that we’re trying to solve is for these people that are already spending money on healthcare but doing it in an unpredictable and risky way,” said Sanchez. “They buy [our service] and they have access to great quality healthcare that they buy it and it’s a significant step up from what they’ve been living with.”

 

#articles, #chief-technology-officer, #google, #heal, #healthcare, #insurance, #kaszek-ventures, #latin-america, #mexico, #mexico-city, #mit, #ribbit-capital, #science-and-technology, #tc, #technology, #telehealth, #telemedicine, #united-states

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Medable raises $91 million for its clinical trial management software

The clinical trial management software developer Medable has raised $91 million in a new round of financing as life sciences companies struggle with how to conduct the necessary validation studies of new drugs and devices in a pandemically challenged environment.

Digital and decentralized clinical trials are becoming a necessity given the health and safety guidelines that have been adopted to respond to the COVID-19 pandemic, the company said. And those changes are driving a shift to services like Medable’s as companies move through the approval process, the company said in a statement.

The company’s new $91 million financing was led by Sapphire Ventures, with follow-on investment from existing investors GSR VenturesPPD, Inc. and Streamlined Ventures.

Medable’s software manages recruitment, remote screening, electronic consent, clinical outcomes assessment (eCOA), eSource, telemedicine, and connected devices, the company said.

Its software is already being used to work on vaccines and therapeutics targeting COVID-19 specifically in addition to facilitating the development of other potentially life-saving therapies and treatments.

“The pandemic has made the world aware of the importance of clinical drug development,” said Dr. Michelle Longmire, CEO and co-founder of Medable, in a statement. “We need transformative technologies that break down critical barriers to improve patient access, experience and outcomes. This new funding will enable Medable to continue our aggressive pursuit of new technologies that improve clinical trials to benefit all patients.”

Trials underway in more than 60 countries are using the service and Medable has inked partnerships with companies like Datavant, to integrate multiple data sources for decentralized trials; MRN, to handle home and remote visits, and AliveCor, to track in-home health with electrocardiograms. 

 

#alivecor, #articles, #drug-development, #gsr-ventures, #health, #medable, #sapphire-ventures, #streamlined-ventures, #tc, #telehealth, #telemedicine

0

Why are telehealth companies treating healthcare like the gig economy?

Telehealth has taken off.

Spurred by the pandemic, many doctors in the U.S. now offer online appointments, and many patients are familiar with getting live medical advice over the internet. Given the obvious benefits, many experts have concluded that telehealth is here to stay. “It’s taken this crisis to push us to a new frontier,” said Seema Verma, administrator of the Center for Medicare and Medicaid Services. “But there’s absolutely no going back.”

Now the question is, where are we going? Telehealth has played an essential role during the pandemic, and it could do even more good in the years to come. But we are still in the very early days of its development. And if we are to realize telehealth’s full potential, then we must first reckon with the fact that there are serious flaws in the predominant way it is delivered today — flaws that endanger patients themselves.

Legacy telehealth services like Teladoc and others were built for a time when telehealth was a fringe phenomenon, mostly used to support acute needs like a bad cold or a troubling rash. They largely offer, in effect, randomized triage care. Patients go online, wait in a queue and see the first doctor who happens to be available. These companies market this as a virtual house call, but for patients, the experience may feel more like being stuck on a conveyor belt. Too often, they get funneled through the system with little to no choice along the way.

Insurance companies love this model because it is cheap to operate. But patients bear the cost. Doctors, in this arrangement, get paid to work the assembly line. Every minute they spend listening to patients — learning about their lives, building a personal relationship — is a minute they’re not moving them down the line, seeing the next patient and earning their next fee. The system doesn’t reward doctors for providing care; it rewards them for churning through patients.

As we build telehealth’s future, doubling down on this model would be a worrisome mistake since it is antithetical to how our healthcare system should operate. Healthcare has long been premised on the idea that you should have an ongoing relationship with a local care provider — someone with a holistic, longitudinal view of your health, who you trust to help navigate difficult or sensitive medical issues.

The randomized triage model breaks this bond and replaces it with a series of impersonal interactions that feel more like ones you have with an Uber driver — polite but transactional, brief and ephemeral. Healthcare, however, should not be treated in the same way as the gig economy.

As a physician, I am troubled by the prospect of what happens when you scale this model up. Every time a patient gets passed from one doctor to the next, there is a chance that critical information is lost. They won’t understand your baseline mood, your family context or living situation — all critical “intangibles” for informed treatment. That lack of longitudinal data leads to worse outcomes. This is why the healthcare system has long been designed to minimize patient handoffs — and why it would be a mistake for us to choose a telehealth infrastructure that increases them.

What, then, does a better approach look like?

We are at the very dawn of telehealth’s integration into our country’s healthcare system, and I won’t claim to know the full answer. But I do know that patients are far better stewards of their own health than a random doctor generator. A more effective approach to telehealth puts the power in patients’ hands. Because when we give them choices and then listen to them, patients tell us what they prefer.

Data gathered by my company makes clear that by a substantial margin, people want to make this decision themselves: Nine out of 10 telehealth patients prefer to schedule an appointment with a provider of their choosing rather than see a randomly assigned doctor after waiting in a digital queue.

Not only that: When given this choice, most patients — about seven in 10 — make an appointment with a nearby doctor when booking a virtual visit. Patients instinctively know that at some point, they’ll want or need to physically be in the same room with their doctor. And they know that choosing a local provider makes it possible to pick up the conversation in-person right where it left off online. They don’t want to be forced to choose between telehealth and an ongoing relationship with a trusted provider. And they’re right — they shouldn’t have to.

None of the legacy telehealth companies focus on this imperative. Instead, while the pandemic rages on, they are rushing to scale while their randomized triage model is still viable. And the markets may reward them in the near term for being in the right place at the right time. But long-term value will be derived from listening to, responding to and iterating on what patients want.

Experience suggests patients will reward whoever can give them the most control over their healthcare. That’s where I’m placing my bet, too.

#column, #gig-economy, #health, #healthcare, #opinion, #physician, #startups, #telecommunications, #telehealth, #telemedicine

0

Passion Capital backs UK fertility workplace benefits provider, Fertifa

UK-based Fertifa has bagged a £1 million (~$1.3M) seed to plug into a fertility-focused workplace benefits platform. Passion Capital is investing in the round, along with some unnamed strategic angel investors.

The August 2019-founded startup sells bespoke reproductive health and fertility packages to UK employers to offer as workplace benefits to their staff — drawing on the use of technologies like telehealth to expand access to fertility support and cater to rising demand for reproductive health services.

Challenges conceiving can affect around one in seven couples, per the UK’s National Health Service (NHS).

In recent years fertility startups have been getting more investor attention as VC firms cotton on to growing market. Employers have also responded, with tech industry workplaces among those offering fertility ‘perks’ to staff. Although the access-to-services issue can be more acute in the US — given substantial costs involved in obtaining treatments like IVF.

In the UK the picture is a little different, given that the country’s taxpayer funded NHS does fund some fertility treatments — meaning IVF can be free for couples to access. Although how much support couples get can depend on where in the country they live, with some NHS trusts funding more rounds of IVF than others. There can also be access restrictions based on factors such as a woman’s age and the length of time trying to conceive.

This means UK couples can run out of free fertility support before they’ve been able to conceive — pushing them towards paying for private treatment. Hence Fertifa spotting an opportunity for a workplace benefits model around reproductive health services.

It signed up its first employers this spring and summer, and says it now has a portfolio of corporate clients with an employee pool from a few hundreds to >10,000 — although it isn’t breaking out customer numbers. Rather it says its services are available to around 700,000 UK employees at this point.

“At Fertifa we want to make fertility services more widely accessible to people,” says founder and CEO Tony Chen. “Some levels of fertility services can be provided by the NHS but every single NHS trust is different with eligibility, requirements and resources, and so unfortunately it can too often be reduced to a ‘postcode lottery’.

“We believe that everyone should have easy access to information, resources, education and services relating to fertility — and that working with workplaces is one way to start. With our efforts and partnerships we hope to normalise the conversations about fertility at work, just as other forms of health are openly discussed and provided for.”

Passion Capital partner Eileen Burbidge — who is joining Fertifa’s board (along with Passion’s Malin Posern) — has been public about her own use of IVF and takes a very personal interest in the fertility space.

“The unfortunate fact that over recent years, even though success rates have increased and of course more and more patients are exploring the benefits of IVF, NHS funding has been declining and the number of patients using the NHS for their first cycle has also been decreasing,” she tells TechCrunch.

“This doesn’t take away from the fact that it’s brilliant what we get from the NHS here in the UK, but there’s clearly a lot more which can be done to further increase accessibility and affordability — given less and less funding for the NHS in the face of increasing demand of both the NHS and private routes.”

Fertifa says its model is to provide direct care and support to employees — rather than being a broker or acting as part of a referral system. So it has two in-house clinicians at this stage (out of a team of 10-15 people). Although it also says it “partners” with clinicians and clinics across the UK. So it’s not doing everything in-house.

It offers what it bills as a “full range” of fertility and gynaecology services — from assisted reproductive technology such as IVF, IUI and more; fertility planning such as egg, sperm and embryo freezing to donor-assisted and third-party reproduction such as donor eggs and sperm; as well as surrogacy and adoption.

Its doctors, nurses and “fertility advocates” are there to provide a one-to-one care service to support patients throughout the process.

“We use technology in a number of ways and are ambitious about how it will help us to maintain an advantage over others in the sector and provide the best customer experience,” says Chen, noting it’s developed “a full end-to-end” app for patients to guide them through the various stages of their fertility journey.

“On the employer side we have a full employer portal as well which provides educational resources, support options and access to services for HR/People teams to use and share with their workforces. Additionally, we use telehealth to enable more efficient, convenient (particularly in the age of COVID-19 restrictions) and immediate consultations with clinicians and nurses. Finally, we are refining our machine learning algorithms to help drive more informed decision making for patients and clinicians alike.”

It’s not currently applying AI but says that over time its in-house medical experts will use artificial intelligence to aid decision-making — with the aim of reducing clinic visits, enhancing the patient experience and yielding better clinical pregnancy rates.

Chen points to the UK’s Human Fertilisation and Embryology Authority having already made its data publicly available on more than 100,000 couples and their treatment and outcomes — suggesting such data-sets will underpin the development of new predictive models for fertility.

“With additional insight and data sources could more accurately predict probability of success for a patient — or the best type of treatment for them,” he adds.

While Fertifa’s current focus is UK expansion — targeting workplaces of all sizes and scale — it’s also got its eye on scaling overseas down the line. Although it will of course face more competition at that point, with the likes of Y Combinator backed Carrot already offering global fertility benefits packages for employers.

“Fertility and reproductive health is important to people all over the world,” says Chen. “Globally one in four women experience a miscarriage, every LGBT+ individual requires support to become a parent, and everyone needs to be increasingly empowered to take control of their reproductive health through fertility preservation treatment.”

#artificial-intelligence, #europe, #fertifa, #fertility, #fundings-exits, #health, #passion-capital, #recent-funding, #startups, #telehealth

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Twentyeight Health is a telemedicine company expanding access to women’s health and reproductive care

New York’s Twentyeight Health is taking the wildly telemedicine services for women’s health popularized by companies like Nurx and bringing them to a patient population that previously hadn’t had access. 

The mission to provide women who are Medicaid or underinsured should not be deprived of the same kinds of care that patients who have more income security or better healthcare coverage enjoy, according to the company’s founder, Amy Fan.

The mission, and the company’s technology, have managed to convince a slew of investors who have poured $5.1 million in seed funding into the new startup. Third Prime led the round, which included investments from Town Hall Ventures, SteelSky Ventures, Aglaé Ventures, GingerBread Capital, Rucker Park Capital, Predictive VC, and angel investors like Stu Libby, Zoe Barry, and Wan Li Zhu.

“Women who are on Medicaid, who are underinsured or without health insurance often struggle to find access to reproductive health services, and these struggles have only increased with COVID-19 pandemic limiting access to in-person appointments,” said Amy Fan, co-founder of Twentyeight Health, in a statement. “We are fighting for healthcare equity, ensuring that all women, particularly BIPOC women and women from low-income backgrounds, can access high quality, dignified and convenient care.”

To ensure that its catering to underserved communities, the company works with Bottomless Closet, a workforce entry program for women, and the 8 colleges in the City University of New York ecosystem including LaGuardia College, which has 45,000 students with 70% coming from families making less than $30,000 in annual income.

The company’s services are currently available across Florida, Maryland, New York, New Jersey, North Carolina and Pennsylvania and it’s the only telemedicine company focused on contraception services to accept Medicaid.

In another example of how awesome this company is, it’s also working to provide free birth control for women who aren’t able to pay out of pocket and are uninsured through a partnership with Bedsider’s Contraceptive Access Fund. The company also donates 2% of its revenue to Bedsider and the National Institute for Reproductive Health. (Y’all, this company is amaze.)

To sign up for the service, new customers fill out a medical questionnaire online. Once the questionnaire is reviewed by a US board-certified doctor within 24 hours customers can access over 100 FDA-approved brands of birth control pills, patches, rings, shots, and emergency contraception and receive a shipment within three days.

Twentyeight Health provides ongoing care through online audio consultations and doctor follow up messages to discuss issues around updating prescriptions or addressing side effects, the company said.

“Today, low-income women are three times more likely to have an unintended pregnancy than the average woman in the U.S., and nearly one-third of physicians nationwide aren’t accepting new Medicaid patients,” said Bruno Van Tuykom, co-founder of Twentyeight Health, in a statement. “This underscores why offering high-quality reproductive care that is inclusive of people across race, income bracket, or health insurance status is more important than ever.”

Launched in 2018, Twentyeight Health said it would use the new cash to continue to expand its services across the U.S.

 

#articles, #birth-control, #co-founder, #contraception, #fda, #florida, #health, #health-insurance, #health-services, #maryland, #medicaid, #new-jersey, #new-york, #north-carolina, #pennsylvania, #tc, #telehealth, #telemedicine, #town-hall-ventures, #united-states

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Building a white label tool for telemedicine services nabs OnCall Health $6 million

As medical providers across the world turn to digital delivery of consultations and services, OnCall Health a Toronto-based provider of back-end services for telemedicine is having a moment.

The company, which competes with services like Truepill to offer physicians, pharmacies and other potential point of care services a way to consult online, has grown exceptionally quickly since the onset of the COVID-19 pandemic.

OnCall Health’s services include the ability to schedule a video or text appointment with a physician, hosting those video consultations on its secured servers, and the integration of back end billing systems so physicians can get paid.

Services like OnCall and TruePill’s have increased exponentially since the advent of lockdown orders put in place to combat the COVID-19 pandemic. In a sign of how hungry investors are for these kinds of deals, Truepill just raised $75 million to expand its own health services offerings.

“Since COVID-19, telemedicine has shifted from a nice-to-have revenue source for primary care, mental health, and home care and chronic conditions to a need-to-have,” said Base10 Partners principal Chris Zeoli, who led the investment into OnCall.

Joining Base10 in its $6 million investment into OnCall were several existing investors from the company’s $2 million seed round, including Ripple Ventures, Panache Ventures, and Stout Street Capital.

The bulk of the company’s customers come from small and medium-sized physician’s practices, according to Zeoli. Roughly 500 of the company’s existing customers consist of offices with less than ten practicing doctors.

Capturing this long tail is important because it actually represents a huge proportion of healthcare providers.

“OnCall provides everything that healthcare brands like pharmaceutical companies, insurers, and direct to consumer digital health startups need to get into the space and launch their own virtual care programs, often for the first time,” said Nicholas Chepesiuk, founder and CEO of OnCall Health. “Meanwhile, we are well positioned to help conventional healthcare clinics and systems adopt virtual care technology in the context of their operational processes. In the past year we have been able to roll out our technology with two global insurance companies, several leading pharmaceutical brands, and many rapidly growing digital health startups.”

OnCall now has over 30 employees and supports 7,000 primary care, mental health, and paramedical service providers across North America.

#articles, #base10-partners, #ceo, #digital-health, #insurance, #north-america, #pharmaceutical, #physician, #tc, #telehealth, #telemedicine, #toronto

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Homage announces strategic partnership with Infocom, one of Japan’s largest healthcare IT providers

Homage, a Singapore-based caregiving and telehealth company, has taken a major step in its global expansion plan. The startup announced today that it has received strategic investment from Infocom, the Japanese information and communications technology company that runs one of the largest healthcare IT businesses in the country. Infocom’s solutions are used by more than 13,000 healthcare facilities in Japan.

During an interview with TechCrunch that will air as part of Disrupt tomorrow, Homage co-founder and chief executive Gillian Tee said “Japan has one of the most ageing populations in the world, and the problem is that we need to start building infrastructure to enable people to be able to access the kind of care services that they need.” She added that Homage and Infocom’s missions align because the latter is also building a platform for caregivers in Japan, in a bid to help solve the shortage of carers in the country.

Homage raised a Series B earlier this year with the goal of entering new Asian markets. The company, which currently operates in Singapore and Malaysia, focuses on patients who need long-term rehabilitation or care services, especially elderly people. This makes it a good match for Japan, where more than one in five of its population is currently aged 65 or over. In the next decade, that number is expected to increase to about one in three, making the need for caregiving services especially acute.

The deal includes a regional partnership that will enable Homage to launch its services into Japan, and Infocom to expand its reach in Southeast Asia. Homage’s services include a caregiver-client matching platform and a home medical service that includes online consultations and house calls, while Infocom’s technology covers a wide range of verticals, including digital healthcare, radiology, pharmaceuticals, medical imaging and hospital information management.

In a statement about the strategic investment, Mototaka Kuboi, Infocom’s managing executive officer and head of its healthcare business division, said, “We see Homage as an ideal partner given the company’s unique cutting-edge technology and market leadership in the long-term care segment, and we aim to drive business growth not only in Homage’s core and rapidly growing market in Southeast Asia, but also regionally.”

#asia, #caregiving, #digital-health, #elderly, #fundings-exits, #healthcare, #homage, #infocom, #japan, #malaysia, #seniors, #singapore, #southeast-asia, #startups, #tc, #telehealth

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Closing on $75 million in new cash, Truepill plans at-home testing service as it nears $175 million in annual revenue

Truepill, the white-label healthcare services company that provides telehealth and pharmacy fulfillment services, is adding at-home medical testing as the third branch of its services powering the offerings of companies like Hims and Hers, Ro, and other direct-to-consumer healthcare companies. 

Financing this expansion of services is a new $75 million round of financing from investors led by Oak HC/FT, with participation from Optum Ventures, TI Platform Management, Sound Ventures and Y Combinator.

“With the change in reimbursement for telemedicine, it changed the trajectory of the direct to consumer companies,” said Annie Lamot, the co-founder and managing director of new lead investors Oak HC/FT. “When we talked to every one of them they all seemed to be using Truepill .”

With its expansion into lab testing, Truepill can provide a full suite of services that used to be confined to the doctor’s office remotely. As more patients adjust to remote delivery of care, these kinds of options will become more attractive.

The move to telemedicine isn’t just something for new entrants either. Incumbents are also finding that they need to provide the same care as their direct to consumer competition, especially as the priority shifts to value-based care rather than fees for services on the reimbursement side — and consumers start demanding lower cost options on the direct pay side.

“I think it enables health plans to provide better care in targeted programs,” said Lamont, a longtime investor in healthcare.

Truepill’s executives certainly hope so.

The two co-founders, Umar Afridi and Sid Viswanathan met over LinkedIn where Viswanathan cold-emailed Afridi. At the time, Afridi was working as a pharmacist filling prescriptions at a Fred Meyer near Seattle).

Initially, Truepill’s growth came from acting as the pharmacist to companies like Hims, Ro, Nurx, and other direct-to-consumer healthcare companies focused on serving the elective health needs of people who wanted hair loss treatments, erectile dysfunction medication, and birth control.

Image Credits: Truepill

As the company has grown, so have its ambitions. By the end of the year, Truepill expects to book up to $175 million in revenue, according to Viswanathan, and that revenue will come from a more evenly distributed mix of customers among direct to consumer companies, insurance companies, and healthcare providers.

“Everything we do is white labeled from our pharmacy to the lab testing component. You can go to teladoc and use that service. What we like to think early. 80 percent of healthcare is going to happen on a digital channel.. We’re in a perfect position to build the platform company in that space,” Viswanathan said. 

At-home testing is a critical component of that platform. Expected to launch before the end of the year, Truepill is working with lab testing providers to offer hundreds of at-home tests. The company said it will focus on tests to manage chronic conditions like diabetes, heart disease, chronic kidney disease. Incidentally these are areas which have attracted a lot of interest from investors who are backing companies that provide direct to consumer or digital therapeutic solutions to treat or help address these conditions.

“To create a comprehensive, effective digital healthcare experience, there are three essential pillars: pharmacy with extensive insurance coverage, at-home lab testing and telehealth,” said Viswanathan, in a statement. “By adding diagnostics to our suite of solutions, we’ll be able to deliver direct-to-patient healthcare at scale through one platform – Truepill. We envision a future where 80% of healthcare is digital. With diagnostics, telehealth and pharmacy built on our foundation of API-connected infrastructure, Truepill will power that reality.” 

#articles, #birth-control, #diabetes, #erectile-dysfunction, #heal, #healthcare, #hims, #insurance, #lamont, #linkedin, #nurx, #optum-ventures, #pharmacy, #ro, #seattle, #sound-ventures, #tc, #teladoc-health, #telehealth, #telemedicine, #truepill, #y-combinator

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