New funding will allow more medical appointments to take place via video in rural communities, where some of the nation’s oldest and sickest patients live.
Readers offer their thoughts about living and dying. Also: Unvaccinated tennis players; abuse of flight attendants; obsessive-compulsive disorder; ex-offenders.
Homage, the caregiving-focused startup, has raised a $30 million Series C led by Sheares Healthcare Group, which is wholly-owned by investment firm Temasek. Other participants included new investors DG Daiwa Ventures and Sagana Capital, and returning backers East Ventures (Growth), HealthXCapital, SeedPlus, Trihill Capital and Alternate Ventures.
The new funding will be used to develop Homage’s technology, continue integrating with aged and disability care payer and provider infrastructure and speed-up its regional expansion through partnerships with hospitals and care providers. Homage currently operates in Singapore, Malaysia and Australia.
The Singapore-based company’s services include home visits from caregivers, nurses, therapists and doctors; telemedicine; and services for chronic illnesses. One of the reasons Homage’s platform is able to scale up is its matching engine, which helps clients, like older adults and people living with chronic conditions, find providers who are best suited to their needs (the final matches are made by Homage’s team).
The startup says the round was oversubscribed and one of the largest fundings raised by an on-demand care platform in Southeast Asia and Oceania so far. It brings Homage’s total raised to more than $45 million.
As part of Series C, Sheares Healthcare Group chief corporate development officer Khoo Ee Ping will join Homage’s board of directors.
Homage now has a regional network of more than 6,000 pre-screened and trained care professionals. It claims that its business outside of Singapore has grown more than 600% year-over-year in 2021, and it has more than tripled revenue over the past year.
Doctor Anywhere, a startup that takes an “omnichannel” approach to healthcare, announced today it has raised $88 million SGD (about $65.7 million USD) in Series C funding. The round was led by Asia Partners, with participation from Novo Holdings, Philips and OSK-SBI Partners. It also included returning investors EDBI, Square Peg, IHH Healthcare, Kamet Capital and Pavilion Capital.
As part of the round, Asia Partners co-founder Oliver Rippel and Novo Holdings Equity Asia senior partner Dr. Amit Kakar will join Doctor Anywhere’s board of directors. The company’s Series C, which it claims is one of the largest private rounds raised by a Southeast Asian healthtech company, brings its total funding to more than $140 million SGD.
Doctor Anywhere’s omnichannel approach means that in addition to online consultations, it runs in-person clinics, provides home visits, medication deliveries and operates an in-app marketplace for health and wellness products.
Founded in 2017 by Lim Wai Mun, Doctor Anywhere claims it now serves more than 1.5 million users. It is available in Singapore, Malaysia, Thailand, Vietnam and the Philippines, and recently established tech hubs in Bangalore and Ho Chi Minh City.
Lim told TechCrunch in an email that when he started working on Doctor Anywhere, there were already successful telemedicine platforms in the United States, the United Kingdom and China, but the model was still nascent in Southeast Asia. A former investor, Lim began Doctor Anywhere as a side project because he had older relatives who could not leave their homes for medical visits.
Doctor Anywhere launched as an online-only telehealth platform, but “we quickly realized that physical presence is very important in order to build trust with users,” Lim said. As a result, the company started its home care services and physical clinics.
According to Doctor Anywhere’s estimates, the COVID-19 pandemic fast-tracked the adoption of telehealth services in Southeast Asia by at least five years. The company saw more demand for online medical consultations, medication deliveries and marketplace purchases.
“In the past year, we have more than doubled the size of our network, from around 1,000 providers at the start of 2020 to currently close to 2,500 medical professionals across Southeast Asia,” Lim said.
In response to the pandemic, Doctor Anywhere launched an online COVID-19 Medical Advisory Clinic last year to provide on-demand consultations for people with suspected symptoms. It also created an online mental wellness module with psychologists. Lim said the company has seen an increase in demand for mental health-related services, like insomnia and anxiety.
Other telehealth startups in the region include WhiteCoat, Speedoc and Doctor World. Lim said Doctor Anywhere wants to differentiate by quickly launching new products in response to user inquiries, and “cultivating a balance between technology and human touch.”
The funding will be used to deepen Doctor Anywhere’s presence in its current markets and expand into new ones. It also plans to scale its tech infrastructure and big data capabilities for a better online-to-offline user experience, and will introduce new medical specialty modules, shorten medication delivery times and develop personalized healthcare plans.
As more states pass some type of abortion ban, Hey Jane, a virtual clinic startup offering telemedicine abortion care, announced Thursday that it raised $2.2 million in an oversubscribed round from a group of investors, including Koa Lab, Gaingels and Foursight Capital Partners.
The idea for the remote-first company stemmed from a conversation in 2019 that founder and CEO Kiki Freedman had with some friends regarding Missouri being one of six states that has one abortion clinic left. Freedman, who goes by a nickname to avoid violence against abortion providers, explained that, in fact, the clinic was slated for closure that summer, which would have meant Missouri was the first state to not have any abortion care. The clinic was ultimately able to stay open.
“At the time, many of the emerging telemedicine clinics I saw were focused on men’s wellness and didn’t talk about women’s health,” Freedman told TechCrunch. “I thought this virtual model could be used for safe and discreet abortion care.”
One of Hey Jane’s investors, who wished to remain publicly anonymous, “was excited to invest in Freedman and Hey Jane” because he agreed — women’s health was an underserved category. Unlike men’s healthcare, abortion care is segregated from women’s health care. This stemmed from Reagan’s mandates separating abortion care from hospitals.
One in four women will have an abortion by age 45, according to Planned Parenthood. However, just in 2021, over 90 abortion restrictions were enacted in the United States, and there are 1,320 restrictions in total, according to The Guttmacher Institute, a nonprofit research and policy organization committed to advancing sexual and reproductive health and rights. Currently, Arkansas and Oklahoma have near-total abortion bans except when a patient’s life is endangered. Meanwhile, Idaho, South Carolina and Texas ban abortion at either six weeks or with very limited exceptions.
In July 2020, a federal judge granted approval for women to obtain abortion medication without having to see a doctor, which opened the door for companies, like Hey Jane and others, to begin offering “no touch” services for people who were less than 10 weeks pregnant.
The $249 treatment includes screening by a medical doctor, FDA-approved medication prescribed and shipped overnight to the person’s house, follow-up virtual visits and the ability to chat with a doctor during the entire process. The Hey Jane team also checks in frequently with the patient via text message.
The company said removing financial barriers is “a huge priority for us.” Though the company does not accept insurance yet, it is offering financial assistance through a nonprofit abortion fund partner, Reprocare. This organization subsidizes up to $110 of the $249 treatment so that patients can pay as little as $139 for treatment.
The new funding will enable Hey Jane to expand into new states and add to its team of seven to build out the product and automated process and for legal research so the company can stay abreast of telemedicine laws and telemedicine abortion laws for each state.
There are several regulatory requirements Hey Jane must follow in each state, including ensuring that clinicians only provide care to patients in states in which they’re licensed. For this reason, the company has clinicians licensed in each state in which it operates who are ready to prescribe medication when appropriate. It also has on-demand experts for emotional relief.
Hey Jane just launched across California this week and is also in New York and Washington. This means that Hey Jane’s service areas now cover up to 34% of all abortions performed annually in the United States, Freedman said. Those states were chosen first because California and New York have the highest number of abortions performed annually, she added.
“Although people in those states may have easier access to clinics, they could still strongly benefit from treatment with Hey Jane since it’s as safe and effective and half the price of in-clinic care,” Freedman said. “It doesn’t require costs, or time for travel or child care, ensures privacy and discretion and provides additional layers of emotional support.”
Freedman expects to be in 10 states by the end of the year and plans to be able to offer treatment in all 50 states in coming years. However, there are regulatory barriers limiting access to telemedicine abortion in 19 states. Hey Jane is partnering with the Advancing New Standards in Reproductive Health research group out of the University of California at San Francisco to gather information to this end.
“We are working with leading researchers to expand the ample existing evidence that this modality of care is safe, effective and preferred by patients,” she added. “We hope this research can further advance discussions in more restrictive states, ultimately leading to much needed, patient-centric updates to outdated regulations. Existing data on the safety and effectiveness of telemedicine abortion paints a very clear picture that this is the future of abortion care.”
The company is currently seeing 250% quarterly growth in the number of patients using the service. As it has grown, it is focusing more on additional tools for coordinated care and new products.
Abortions are often kept secret due to worries of judgment and discrimination, and Hey Jane will provide a much-needed outlet for patients to discreetly share their experiences and emotion, Freedman said.
“We are focusing on convenience and privacy,” she added. “Two-thirds of women don’t want to talk about their experience, so we want to provide a space for them.”
Matters of women’s health are highly personal. If you or someone you know is struggling with a private women’s health concern, please contact your primary care physician or secular community health clinic for more information.
Intellect, a Singapore-based startup that wants to make mental health care more accessible in Asia, announced it has raised $2.2 million in pre-Series A funding. It is taking part in Y Combinator’s current batch, which will hold its Demo Day at the end of this month.
The round was led by returning investor Insignia Venture Partners and included participation from Y Combinator, XA Network and angel investors like Rainforest co-founder J.J. Chai; Prenetics and CircleDNA founder Danny Yeung; and Gilberto Gaeta, Google’s director of global HR operations.
This brings Intellect’s total funding since it launched a year ago to $3 million, including a seed round announced in December 2020 that was also led by Insignia.
Intellect offered two main product suites: a consumer app with self-guided programs based on cognitive behavioral therapy techniques, and a mental health benefits solution for employers with online therapy programs and telehealth services. The startup now claims more than 2.5 million app users, and 20 enterprise clients, including FoodPanda, Shopback, Carousell, Avery Dennison, Schroders and government agencies.
Founder and chief executive officer Theodoric Chew told TechCrunch that Intellect’s usage rate is higher than traditional EAP helpline solutions. On average, its mental health benefits solution sees about 20% to 45% engagement within three months after being adopted by companies with more than 5,000 employees.
In many Asian cultures, there is still a lot of stigma around mental health issues, but that has changed over the last year and a half as people continue to cope with the emotional impact of the COVID-19 pandemic, Chew said. “From individuals, to companies, insurers and governments, all these different types of people and organizations are today prioritizing mental healthcare on an individual and organizational level in an extremely rapid manner.”
Intellect protects user privacy with zero-knowledge encryption, so the startup and employers don’t have access to people’s records or communications with their coaches and counsellors. Any insights shared with employers are aggregated and anonymized. Chew said the company is also compliant with major data privacy regulations like ISO, HIPAA and GDPR.
Intellect is currently collaborating in 10 studies with institutions like the National University of Singapore, King’s College London, University of Queensland and the Singapore General Hospital. It says studies so far have demonstrated improvements in mental well-being, stress levels and anxiety among its users.
The new funding will be used to expand into more Asian markets. Intellect currently covers 12 countries and 11 languages.
The pandemic has highlighted some of the brightest spots — and greatest areas of need — in America’s healthcare system. On one hand, we’ve witnessed the vibrancy of America’s innovation engine, with notable contributions by U.S.-based scientists and companies for vaccines and treatments.
On the other hand, the pandemic has highlighted both the distribution challenges and cost inefficiencies of the healthcare system, which now accounts for nearly a fifth of our GDP — far more than any other country — yet lags many other developed nations in clinical outcomes.
Many of these challenges stem from a lack of alignment between payment and incentive models, as well as an overreliance on hospitals as centers for care delivery. A third of healthcare costs are incurred at hospitals, though at-home models can be more effective and affordable. Furthermore, most providers rely on fee for service instead of preventive care arrangements.
These factors combine to make care in this country reactive, transactional and inefficient. We can improve both outcomes and costs by moving care from the hospital back to the place it started — at home.
Right now in-home care accounts for only 3% of the healthcare market. We predict that it will grow to 10% or more within the next decade.
In-home care is nothing new. In the 1930s, over 40% of physician-patient encounters took place in the home, but by the 1980s, that figure dropped to under 1%, driven by changes in health economics and technologies that led to today’s hospital-dominant model of care.
That 50-year shift consolidated costs, centralized access to specialized diagnostics and treatments, and created centers of excellence. It also created a transition from proactive to reactive care, eliminating the longitudinal relationship between patient and provider. In today’s system, patients are often diagnosed by and receive treatment from individual doctors who do not consult one another. These highly siloed treatments often take place only after the patient needs emergency care. This creates higher costs — and worse outcomes.
That’s where in-home care can help. Right now in-home care accounts for only 3% of the healthcare market. We predict that it will grow to 10% or more within the next decade. This growth will improve the patient experience, achieve better clinical outcomes and reduce healthcare costs.
To make these improvements, in-home healthcare strategies will need to leverage next-generation technology and value-based care strategies. Fortunately, the window of opportunity for change is open right now.
Five factors driving the opportunity for change
Over the last few years, five significant innovations have created new incentives to drive dramatic changes in the way care is delivered.
- Technologies like remote patient monitoring (RPM) and telemedicine have matured to a point that can be deployed at scale. These technologies enable providers to remotely manage patients in a proactive, long-term relationship from the comfort of their homes and at a reduced cost.
Covid made things worse for many people with obsessive-compulsive disorder. But it also came with a silver lining.
Every woman will go through menopause some time during her life, but like many other femtech topics, this one is still not talked about as much as it should be.
Enter Elektra Health, a women’s health technology company startup that raised $3.75 million in seed funding to continue developing its platform that provides evidence-based care, education and a community for women going through the various stages of menopause.
Co-founders Alessandra Henderson and Jannine Versi told TechCrunch that more than 50 million women in the United States are currently in some stage of menopause, while the industry itself represents a $600 billion global market opportunity.
CEO Henderson, whose background includes business creation platform Human Ventures, called menopause a “cultural zeitgeist” that is coming into its own in terms of the conversation and having investors believe in Elektra’s mission. The company is also personal for Henderson — she went on a hormonal health journey that began four years ago after experiencing symptoms that went unexplained by specialists.
Several years later, she wanted to start a company in femtech. There was so much already in the reproductive space, yet no one was talking about what comes next or the phases for moving through menopause, Henderson said. It was when she was introduced to her co-founder Versi, whose background is in digital health, that the idea for Elektra came together.
Menopause is a hormonal health transition that typically starts in women when they reach their 40s or 50s. There have been up to 34 identified symptoms of menopause, and research has found that 80% of women say menopause symptoms have negatively impacted their quality of life in some way. At the same time, less than 20% of obstetrics/gynecology residency programs educate doctors about menopause.
Elektra’s platform is picking up that slack by offering clinical care via telemedicine and its proprietary “Meno-morphosis” program that features evidence-based guidance on symptoms, a community of support and access to a 1:1 dedicated menopause expert. The program will open completely to the public in 2022.
“We are all about caring for women by providing content, education, care, coaching and counseling, especially working in the arc of their journey,” Versi said. “This is such an intimate topic, but we have referral rates of 40% where women are talking about it themselves and then bring a friend along. Sustaining that is important to us. We are seeing clusters of friends come along and really bond with the community.”
The New York-based company’s seed funding was co-led by Alexis Ohanian’s Seven Seven Six and Flare Capital Partners, with participation from City Light Capital, January Ventures, Human Ventures, The Fund, Community Fund and a group of angel investors, including Hannah and Guy Raz, Claire Diaz-Ortiz and Jenny Fielding.
This new round of funding will be used to grow its team and to expand its integrative, evidence-based solution to millions of women in the U.S., and beyond.
Since launching the company in 2020, more than 1,800 women have participated in Elektra’s private beta educational programming.
“Last year was about learning and growing the things that women want,” Henderson said. “We are making an impact in the way women deserve.”
Much of women’s health technology is aimed at fertility, but Elektra Health is not alone in tackling this issue: new startup Peppy recently reported funding to address menopause in employee health; meanwhile, Vira Health raised £1.5 million in seed funding for a U.K. platform. Other startups, like The Cusp, Clue and CurieMD, are also targeting this space with products and services.
Katelin Holloway, founding partner at Seven Seven Six, said in her previous roles leading compensation and benefits for companies, she became increasingly aware that the need for menopause care was just as desired by employees as fertility benefits.
When her employees began requesting desk fans, she started investigating the source of the requests and found it was from the company’s non-Gen Z employees, and all women.
“I realized I had a decent cohort of women experiencing menopause,” Holloway said. “The fan on the desk was kind of a ‘bat signal’ to other employees, unlocking conversations between them where they had previously been experiencing these symptoms in silos.”
Once she became an investor, she put out the call again looking for a company providing that kind of care and was introduced to Elektra. Holloway said there is a whole new group of women entering their 40s who want to talk about menopause and have the technology available, while also wanting privacy for care and a community to share in the experience.
She called Elektra’s co-founders “incredible women who care deeply about this space and have amazing credentials and background to bring to this company.” She also said she was sold on their approach of care, community and content, which aligns with what was working in the pregnancy and fertility spaces.
MedRhythms secured $25 million in Series B funding to advance its digital therapy platform aimed at measuring and improving someone’s ability to walk after they have experienced a neurologic injury or disease.
Morningside Ventures and Advantage Capital co-led the round, with participation from existing investor Werth Family Investment Associates, to give the Portland, Maine-based company $31 million in funding to date.
Company co-founder and CEO Brian Harris was a neurologic music fellow at Spaulding Rehabilitation Hospital in Boston, treating people with stroke and brain deficits with music. He began getting questions from patients and families on how they could access similar care outside of the hospital. Not seeing a suitable alternative, he started MedRhythms with entrepreneur Owen McCarthy in 2016.
The company’s platform uses sensors, music and software, along with an evidence-based intervention called “rhythmic auditory stimulation,” to target the neural circuitry that controls movement. The technology taps into “entrainment,” a neurologic process in which the auditory and motor systems of the brain are coupled in synchrony with an external rhythmic cue, which over time, can lead to improved walking functionalities.
“There is no other stimulus that engages the brain like music does,” Harris said. “When someone is engaging in music, it aids in neuroplasticity to create new connections and strengthen old ones. Neuroplasticity is how we can learn new things or why people with brain deficits can improve.”
A year ago, MedRhythms’ digital therapeutic product received Breakthrough Device designation from the U.S. Food and Drug Administration to treat chronic walking deficits resulting from a stroke. It is the first in the company’s pipeline, which is also looking at using music to treat neurological conditions like Parkinson’s, acute stroke and multiple sclerosis. To that effect, it is participating in a neuroimaging study with Massachusetts General Hospital.
Harris intends to use the proceeds from the Series B funding to get the product to market, expand the team and the treatment pipeline. The company is preparing for submission to the FDA so it can do a commercial launch of the technology and begin clinical trials.
Stephen Bruso, investment partner at Morningside, said he has known the team at MedRhythms for a year. The firm is active in the digital health space and has followed the company closely since then.
COVID served to fundamentally shift healthcare in how to deliver care. The hospital and clinic models were robust, but resistant to change until the pandemic forced care to telemedicine visits at home, he said. It also forced innovation on the industry, and at-home therapy is an area where Bruso expects to see improvement in both patient compliance and recovery, and MedRhythms is capitalizing on that trend of shifting care to the home.
What intrigued the firm for the last couple of months was the idea of affecting the brain via non-pharmaceutical needs.
“MedRhythms using musical intervention to drive changes and improvements in neurologics is compelling,” Bruso added. “Emotional memory is tied to music. Its use provides a richer experience than taking a drug, and the company exists to tap into that.”
When it comes to health issues like menopause, fertility, pregnancy, and even early parenthood, the data tells us that people typically turn to search engines and social media for advice to ask about symptoms or concerns they have. They tend not to go to a medical practitioner, in the first instance. The suggestion, therefore, is that there is plenty of room for startups to fill that gap This is effectively the verticalisation of the model first pioneered by startups like KRY, Babylon Health, and Ada Health.
Peppy, a B2B digital health platform addressing just these concerns, has now raised a £6.6M/$10M Series A funding round led by Felix Capital, with previous investors including Outward VC, Seedcamp, and Hambro Perks, also participating.
Peppy is a little like a ‘Babylon Health before you need Babylon Health’. The company says it provides expert-led support to individuals before they need to see a doctor.
Founded in London in 2018 by co-founders Evan Harris, Max Landry, and Mridula Pore, the startup address major life and family moments: menopause, fertility, pregnancy, and early parenthood.
It offers its services to a corporate customer base, which then incorporates Peppy into its employee health programs, enabling it to acquire some large employers in the UK and grow – it says – by 20 percent month-on-month for the past 12-months. Customers include BNP Paribas, Santander, DFS, Wickes, NHS trusts, the University of Sheffield.
The startup is pushing at an open door: Women of menopausal age are the fastest-growing demographic in the UK, and most say their work is negatively impacted, but – and here’s the crucial bit, they’d rather not talk about it to their line manager. Peppy says this is one of their biggest selling points into companies, which can now address the problem and help employees back to work more easily.
Just as with other telemedicine products, there are features such as access experts via a secure mobile app, with instant messaging, group chat, video consultations, live events, evidence-based articles, videos and programs. Furthermore, users can join a community of people who are experiencing similar challenges.
Mridula Pore, Co-Founder of Peppy, said: “The pandemic has shown us that employers can’t just talk about supporting their employees’ health and wellbeing anymore, they have to take action. More and more leading businesses are turning to us to provide the support their people really need – not a one-size-fits all solution, but support that is trustworthy, personalized, and delivered by experts. We’re still at the surface of what is possible for Peppy.”
Susan Lin, Investor at Felix Capital, said: “Since Felix started, ‘aspiration for a better life’ has been a core theme and we believe in the strong opportunity for digital health and wellness solutions to improve this. Peppy is at the forefront of three huge market trends and we believe is positioned to become a category-defining brand. First, massive growth in targeted employee benefits, driven by increasing awareness of the importance these have in boosting morale, productivity, and retention. Second, demand for much more convenient ways to access healthcare, which has been further accelerated by COVID-19. And finally, a need for much more personalized solutions, especially in critical life stages such as menopause and early parenthood.”
Speaking to TechCrunch, Pore expanded on the problem: “Today, people’s alternative is to go to their GP/MP. They may be lucky, have a GP who knows a lot about the issues to offer the support the patient needs. We know that a lot of women aren’t getting the support they need, they suffer, they struggle, they’re embarrassed to talk to their manager about what’s going on. They muddle through and they’re worried about being fired because for ‘women’s problems’. Some women quit. All the surveys suggest that people either switch their working arrangements, make different decisions or quit. It’s a big headache for employers, and we know the same thing happens for new parents.”
She added: “We’ve seen a real tidal change, especially in the last two years and I think COVID has massively accelerated companies putting menopause policy into line manager training. But none of those really address what the individual needs are because ultimately they still go to their GP and they’re back at square one. And so what we’re doing with Pepe is giving them access to our nurses and counselors on our programs, so they can get informed, educated on what their options are, medical and nonmedical, have the information they need to be able to go and seek out the right options for them, try them and they get that support over months, because we know that it will go up and down over time and you know everyone’s health journey evolves.”
She told me that the tech solution means Peppy allows people to connect to human experts “through the way that suits them in a personalized way and convenience so they can get child support, they can get video consultations, they’ll get content that’s tailored for them, they can join in live sessions on topics that are relevant for them. That can be anything from the basics of menopause, to your sex life. You can do it on your own time, in short bursts, or if you need it, for a 45-minute phone consultation.”
Just as many other employee services have gone digital, so too is mental health. In the consumer space there are growing startups like Equoo, but the race is now on for the employee.
And since telemedicine has gone digital and video-based, so too is mental health provision. A number of companies are already playing in this space, including Spill Chat, On Mind, Lyra Health, Modern Health, Ginger and TalkSpace For Business.
Oliva’s take on this is not to create a marketplace or pre-recorded videos, but to put trained professionals in front of employees to talk directly to them. And there is even science to back it up. Indeed, some research suggests Psychotherapy via the internet is as good if not better than face-to-face consultations.
Oliva’s on-demand, professional-led mental healthcare for employees and managers has now attracted investment to the tune of a $2.2m pre-seed investment round, led by Moonfire Ventures, the new seed-stage VC firm from Atomico co-founder Mattias Ljungman.
The UK and Spain-based startup has also attracted angel investment from tech executives from Amazon, Booking.com, DogBuddy, Typeform, Hotjar, TravelPerk, and more.
Oliva is founded by Javier Suarez, who previously co-founded TravelPerk, and Sançar Sahin, who previously led marketing teams at Hotjar and Typeform, so both are well blooded in startups.
Suarez says he was inspired to create a mental health startup after the rigors of TravelPerk: “Employees are a company’s greatest asset – the better they feel, the better your company performs. But organizations are not set up to support their employees’ mental health in and outside of the workplace, which creates a massive problem for teammates, managers, and the organization as a whole. We’ve launched Oliva to give employees access to comprehensive online mental healthcare and to help organizations overcome the related challenges—from attracting & retaining talent and training managers to supporting remote workers.”
Privacy is addressed via the use of a secure and encrypted personal portal, where employees can chat with a care provider who matches them with a professional. They get 1-to-1 video therapy sessions from a range of mental health professionals, and can also track their progress.
The team has also attracted Dr. Sarah Bateup, who has spent over two decades teaching and training mental healthcare professionals, who is now Chief Clinical Officer.
She said: “Oliva improves the way mental healthcare is accessed, supported, and paid for, while also adding more ongoing oversight and accountability to the process. Our ambition is for Oliva to be viewed as a badge of quality and set a new standard for workplace mental healthcare.”
Mattias Ljungman, Founder at Moonfire Ventures, added: “Mental health has been an overlooked area of care and wellbeing, especially in the workplace. Oliva’s founders are the only team we’ve seen taking a holistic, impact-driven approach to supporting mental health. While employer-funded mental health is becoming a well-established model in the US, Oliva is the first to bring a truly comprehensive approach to UK and European businesses.”
Oliva platform is integrated with Slack, providing employees with mental health drop-in sessions, therapy courses, and dedicated training and support for managers.
Telehealth platform Eucalyptus raised a $22.3 million Series B round of funding to build a digital health portfolio for primary care in Australia.
NewView Capital led the round with participation from existing investors Blackbird Ventures and W23, and new investor AirTree Ventures. As part of the investment, Ravi Viswanathan, NewView founder and managing partner, will be joining the Eucalyptus board.
The new round gives the Sydney-based company a total of $32.8 million raised since it was founded in 2019 by Tim Doyle, Benny Kleist, Alexey Mitko and Charlie Gearside.
Australia’s healthcare system is a two-payer model, where most of the care is paid for by the government, and there is a smaller insurance coverage that is owned by individuals. Eucalyptus fits into these models as a private-pay option selling directly to consumers. In some cases, the company is able to charge lower copays for care than the average $25 per doctor visit, Doyle told TechCrunch.
He touts the company as the “largest vertically integrated telehealth platform in Australia,” serving more than 200,000 patients across four demographic-focused brands: contraception and fertility, skincare, men’s health and sexual wellness. Each brand has its own core platform of healthcare providers, patient data repository, remote monitoring tools and partnerships with pathology labs and pharmacies.
All of that results in a higher touch and higher quality relationship between doctor and patient, Doyle said.
“We are seeing an opportunity to shorten the amount of time between identification of a condition and diagnosis,” he added. “We also want to go more in-depth into diabetes, heart conditions and mental health. People are dropping out of diabetes and mental care because there are not enough touch points that are easy to use. If we can build a hub, it will make it easier to treat those conditions.”
In addition to product development, the new funding enables Eucalyptus to build toward being a major player in the telehealth industry. The company will introduce new brands in the next year around chronic care like behavioral health, weight management and diabetes.
Eucalyptus grew its revenue between 200% to 300% year over year since 2019, Doyle said. This is not unlike other startups in the digital health sector, where 2020 saw another record year for venture capital investment. He expects similar growth in 2021, including adding about 20 employees to be over 100 by the end of the year.
Meanwhile, Doyle said he is excited to work with NewView, especially with Viswanathan and associate Christina Fa, who said Eucalyptus is proving that Australia can lead in digital healthcare.
“The team is impressive in terms of clarity of vision and execution, especially in the way they brought in people to manage the brands,” she told TechCrunch. “It is unique being based in Australia where they don’t have the Teledocs and other digital health companies. Instead, Eucalyptus had to build all of that in-house and do the hard work upfront. In addition, they curated a network of health providers and four brands, each with their own personalities that can be fully vertically integrated and own the customer journey.”
The magazine’s Ethicist columnist on mitigating risk from Covid-19 without punitive measures —and more.
People with alcohol use disorder are often seen in clinics and hospitals, but medical professionals too often ignore the condition.
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.
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.
Indonesian healthcare startup Prixa has raised $3 million led by MDI Ventures and the Trans-Pacific Technology Fund (TPTF), with participation from returning investors including Siloam Hospitals Group.
This brings Prixa’s total raised to $4.5 million since it launched in 2019. Co-founder and chief executive officer James Roring M.D., told TechCrunch in an email that the new funding will enable Prixa to scale its platform and customer base. Prixa uses a B2B model, partnering with healthcare payers like insurance providers and corporations. Through its B2B customers, it currently serves about 10 million patients.
Prixa currently works with four major insurers and has six additional insurers in its short-term pipeline. It also works with Indonesia’s largest third-party administrators, Roring said, allowing it to reach more policyholders.
Prixa’s platform includes a digital health assistant to answer patients’ questions, telemedicine consultations, pharmacy deliveries and on-demand lab diagnostics. Usage increased during the COVID-19 pandemic as more patients sought online consultations for primary care.
Other telehealth startups in Indonesia include Halodoc and Alodokter (which is also backed by MDI). Both connect patients directly with healthcare and insurance providers. Roring said Prixa differentiates by focusing on greater cost control for healthcare payers and positioning itself as a digital primary care platform.
“By symptomatically managing patients outside of tertiary care facilities and caring for chronic non-communicable diseases online, Prixa is able to effectively reduce the amount of outpatient claims and downstream inpatient cost incurred by healthcare payers,” Roring said. “Additionally, the combination of a growing and robust medical database, as well as proven clinical guidelines, contribute to cost efficiency and service optimization through the standardization of treatment by our healthcare providers.”
In press statement about the funding, Aditia Henri Narendra, MDI Ventures’ general manager of legal and corporate communication, said, “MDI co-led this financing because Prixa has demonstrated its ability to support insurance companies and hospitals in making medical services more accessible and affordable through its AI telemedicine platform.”
For this morning’s edition of The Exchange, Alex Wilhelm studied information recently released by mobile gaming studio Jam City as it prepares to go public in a $1.2 billion blank-check deal with DPCM Capital.
“Jam City is a bit like Zynga, but unless you are a mobile-gaming aficionado, you might not have heard of it,” he writes.
Since its launch, Jam City has raised upwards of $300 million, including a $145 million round in 2019. At the time, the company was riding high after signing a deal with Disney to adapt some of the media giant’s intellectual property, which includes brands like Marvel, Fox and Pixar.
Almost half of all Americans play mobile games, so Alex reviewed Jam City’s investor deck, a transcript of the investor presentation call and a press release to see how it stacks up against Zynga, which “has done great in recent quarters, including posting record revenue and bookings in the first three months of 2021.”
(Full disclosure: the second time I worked at a startup founded by Mark Pincus, Zinga slept behind my desk and I was one of her favorite dog-sitters.)
Thanks for reading Extra Crunch; I hope you have an excellent weekend!
Senior Editor, TechCrunch
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5 ways to raise your startup’s PR game
The ability to effectively communicate can make or break your launch. It will play a role in determining who wins a new space — you or a competitor.
So how do you make a splash? How do you stay relevant?
For one, you have to stop thinking that what you are up to is interesting.
Every early-stage startup must identify and evaluate a strategic advantage
Whether you’re building a company or thinking about investing, it’s important to understand your strategic advantage.
In order to determine one, you should ask fundamental questions: What’s the long-term, sustainable reason that the company will stay in business?
As M&A accelerates, deal-makers are leveraging AI and ML to keep pace
The global pandemic has changed the way we work, including how and where we work. For those involved in the mergers and acquisitions (M&A) industry, a notoriously relationship-driven business, this has meant in-person boardroom handshakes have been replaced by video conference calls, remote collaboration and potentially less travel in the future.
The pandemic has also accelerated digital transformation, and deal-makers have embraced digital tools to help them execute effectively.
The quickening pace of digital transformation is no longer about ensuring a competitive edge. Today, it’s also about business resilience. But what’s on the horizon, and how else will technology evolve to meet the needs of companies and deal-makers?
There are still many inefficiencies in managing M&A, but technologies such as artificial intelligence, especially machine learning, are helping to make the process faster and easier.
New Relic’s business remodel will leave new CEO with work to do
Lew Cirne, New Relic’s founder and CEO, is stepping into the executive chairman role. He will be replaced by Bill Staples on July 1.
Cirne spent the last several years rebuilding the company’s platform and changing its revenue model, aiming for what he hopes is long-term success.
TechCrunch decided to dig into the company’s financials to see just what challenges Staples may face as he moves into the corner office. The resulting picture is one that shows a company doing hard work for a more future-aligned product map and business model, albeit one that may not generate the sort of near-term growth that gives Staples ample breathing room with public investors.
Fast growth pushes an unprofitable no-code startup into the public markets: Inside Monday.com’s IPO filing
At long last, the Monday.com crew dropped an F-1 filing to go public in the United States. TechCrunch has long known that the company, which sells corporate productivity and communications software, has scaled north of $100 million in annual recurring revenue (ARR).
The countdown to its IPO filing — an F-1, because the company is based in Israel, rather than the S-1s filed by domestic companies — has been ticking for several quarters.
The Exchange has been riffling through the document since it came out, and we’ve picked up on a few things to explore.
The battle for voice recognition inside vehicles is heating up
Until recently, integrating affordable voice-recognition software into an automobile was something from science fiction.
But last year, the percentage of vehicles offering in-car connected services reached 45%. By 2024, analysts predict cars with voice recognition will comprise 60% of the market.
Considering how much time many of us spend behind the wheel, there’s an infinite number of applications for the technology. For our latest Extra Crunch market map, we sized up the general market opportunity before creating a roster of major players and reaching out to investors to see where they’re placing bets.
Industrial automation startup Bright Machines hauls in $435M by going public via SPAC
Bright Machines is going public via a SPAC-led combination that will see the 3-year-old company merge with SCVX, raising gross cash proceeds of $435 million in the process.
After the transaction is consummated, the startup will sport an anticipated equity valuation of $1.6 billion.
The Bright Machines news indicates that the great SPAC chill was not a deep freeze. And the transaction itself, in conjunction with the previously announced Desktop Metal blank-check deal, implies that there is space in the market for hardware startup liquidity via SPACs. Perhaps that will unlock more late-stage capital for hardware-focused upstarts.
We took a look at what Bright Machines does, and then the financial details that it shared as part of its news.
Want to double your rate of return? Seek counsel from experienced executives
As a rule of thumb, it takes 7-8 years for a successful startup to achieve an exit. But there’s a simple way to speed up the clock: Bring in one or more founders who have previous executive experience.
According to data gathered by Rob Olson, partner and head of data strategy at venture engine M13, startups that have two or more experienced founders tend to exit 33% faster and raise 34% less capital.
“Combined, these two improvements can nearly double an investor’s rate of return,” says Olson.
Should startups build or buy telehealth infrastructure?
Digital health in the U.S. got a huge boost from COVID-19 as more people started consulting physicians and urgent care providers remotely in the midst of lockdowns. So much so that McKinsey estimates that up to $250 billion of the current healthcare expenditure in the U.S. has the potential to be spent virtually.
The prominence of digital health is undoubtedly here to stay, but how it looks and feels from provider to provider is still a debate among sector startups.
But for providers who want to deliver care virtually across the country, it’s not as simple as adding a Zoom invite to an annual check-up. The process requires intention every step of the way — right from the clinicians delivering remote care to the choice of payment processor.
Help TechCrunch find the best email marketers for startups
Email marketing has been with us for decades, but today it has been refined to a science and an art form.
If you’re an early-stage founder, it is one of the best ways to build and grow your direct relationship with your customer. You know how fickle the platforms can be. You can’t afford to mess this up.
So when and how should you think about doing email marketing, versus all of your other frantic priorities?
Here at Extra Crunch, we’re helping you find the answers. We launched a survey of founders who want to recommend a great email marketer or agency they have worked with to the rest of the startup world.
For companies that use ML, labeled data is the key differentiator
When a company chooses supervised learning, it needs to have a strategy that allows it to label data as quickly as it acquires it.
Supervised learning is currently the most practical approach for most ML challenges, but it requires the crucial additional step of making raw data smart by labeling it.
How Expensify got to $100M in revenue by hiring ‘stem cells’ and not ‘cogs in a wheel’
The influence of a founder on their company’s culture cannot be overstated. Everything from their views on the product and business to how they think about people affects how their company’s employees will behave, and since behavior, in turn, informs culture, the consequences of a founder’s early decisions can be far-reaching.
So it’s not surprising that Expensify has its own take on almost everything it does when you consider what its founder and CEO David Barrett learned early in his life: “Basically everyone is wrong about basically everything.”
As we saw in part 1 of this EC-1, this led him to the revelation that it’s easier to figure things out for yourself than finding advice that applies to you. Eventually, these insights would inform how he would go about shaping Expensify.
Inside Marqeta’s fascinating fintech IPO
Marqeta, long a darling of the fintech market though less well known than some companies in its sector due to its infrastructure nature, filed to go public late last week
If you are not familiar with Marqeta, it powers the payment card tech behind products that you use, like Square, a key customer and driver of the unicorn’s growth. Marqeta exhibits a number of fascinating fintech characteristics (majority revenue from interchange, a rabidly competitive market) that make it very interesting to unspool.
May Mobility’s Edwin Olson and Nina Grooms Lee and Toyota AI Ventures’ Jim Adler on validating your startup idea
When a founder has a work history that includes the name of the parent company of one of their key investors, you probably assume that was one of the first deals to come together. Not so with May Mobility and Toyota AI Ventures, which connected for the company’s second seed round after May went out and raised its original seed purely on the strength of its own ideas and proposed solutions.
That’s one of the many interesting things we learned from speaking to May Mobility co-founder and CEO Edwin Olson, as well as Chief Product Officer Nina Grooms Lee and Toyota AI Ventures founding partner Jim Adler on an episode of Extra Crunch Live.
Meanwhile, read on for highlights from our chat with Olson, Grooms Lee and Adler, and then stay tuned at the end for a recording of the full session, including our live pitch-off.
WalkMe is going public: Let’s stroll through its numbers
WalkMe is the second Israel-based technology company to file to go public this week: No-code startup Monday.com is also pursuing an American IPO.
WalkMe’s software provides visual overlays on websites that help users navigate the product in question. Per the company’s F-1 filing, other elements of its service that matter include its onboarding system, Workstation, or its “single interface to the applications within an enterprise and simplifies task completion through a natural language conversational interface and automation.” We’re including that last feature because it says “automation,” which, in the wake of the UiPath IPO, is a word worth watching. Investors are.
At a high level, WalkMe is a SaaS business, which means that when we digest its results we are digging into a modern software company. Let’s do just that.
Can Squarespace dodge the direct-listing value trap?
Squarespace’s reference price has been set at $50 per share.
We went over Squarespace’s recently disclosed Q2 and full-2021 guidance and asked how its expectations compare to its reference-price-defined pre-trading valuation. Then, we set some stakes in the ground regarding historical direct-listing results and what we might expect from the company as it adds a third set of data to our quiver.
Let’s get into the numbers!
Mapping out one edtech company’s $200M bet on lifelong learning
Mumbai-based Emeritus, an edtech company that works with universities to create online upskilling courses for employed folks, just spent a big chunk of cash to break into K-12.
Emeritus, which is part of the Eruditus group, announced this week that it plans to acquire iD Tech, a STEM education service for children. The acquisition, which has not yet closed, is estimated to be around $200 million and leaves iD Tech operating as an independent brand for now.
ID Tech brings a whole different set of customers to its umbrella: The startup offers courses for elementary through high-school students across the globe taught by college students in the U.S.
5 innovative fundraising methods for emerging VCs and PEs
According to Versatile VC founder David Teten, five new strategies are gaining traction among fund managers looking to raise capital from family offices and high-net-worth individuals:
- Online communities and virtual events.
- Platforms that help other investors access your fund.
- Soliciting under the 506(c) designation.
- Launching a rolling fund.
- Crowdfunding from retail investors into a general partnership.
In a summary of a class he taught for the Oper8r VC fund accelerator, Teten offers actionable advice for anyone who wants to connect with pre-qualified investors.
Dear Sophie: What’s happening with visa application receipt notices?
Our startup employs several individuals who are on work visas or have employment authorization. Many of them have been waiting for quite a while for the government to tell them their applications have been received.
Why? When will things be back on track? We have a few employees who are waiting for green cards, and a few F-1 visa holders who will be extending their OPT to STEM OPT.
Is there anything we can do?
— Patient in Pasadena
Arrival’s Denis Sverdlov on the new era of car manufacturing
Electric vehicle company Arrival wants to break the current auto manufacturing model. Instead of one giant factory and an assembly line, Arrival’s commercial electric vans, buses and cars are robotically built in small, regional microfactories, of which the company wants to open 31 by the end of 2025.
If you want to achieve something radically more efficient, you have to go deeper, into complex, high-level computational algorithms that are not normally used in consumer-facing products.
The London-based company, founded in 2015, joined the ranks of EV companies going public via SPAC, merging with blank-check company CIIG Merger Corp. in March. UPS has already ordered 10,000 of Arrival’s robotically engineered vans, and the company recently signed a deal with Uber to create purpose-built EVs for ride-hail drivers.
Arrival founder Denis Sverdlov has been at the intersection of technological advancement and societal change before.
Chasing hype is human nature: The tyranny of startup trends
The fear of missing out (FOMO) spreads faster than wildfire and often overwhelms rational decision-making.
In the VC community, investors look for lessons from disruptive startups they can use to identify other potential winners. But hype leads to bad decision-making, rushed due diligence and wishful thinking.
When and if those startups actually do well, “irrational FOMO takes over” because the initial assessment was based on bad information, says Victor Echevarria, a partner at Jackson Square Ventures. “Trends are addictive; to remain disciplined and avoid hype is to deny our innate instincts.”
It’s natural for investors to follow the crowd, but in the race to the bottom, FOMO can be high-octane fuel.
Robinhood’s epic Q1 growth explains its fundraising boom
The Exchange explores Robinhood’s financial results using the lens of payment for order flow (PFOF) income, which the company said during a congressional hearing constitutes the majority of its revenues.
This particular revenue growth — or the lack thereof — is a good way to understand not only Robinhood’s own results but also its larger market. If Robinhood is seeing rapid growth and strong trading volumes, we can infer with some confidence that others in its space are enjoying a related, if not similar, level of interest.
For Public.com, eToro and others like Freetrade (as well as our own understanding), how Robinhood performed recently is key. So, let’s explore the data.
How to ensure data quality in the era of Big Data
A little over a decade has passed since The Economist warned us that we would soon be drowning in data. The modern data stack has emerged as a proposed life-jacket for this data flood — spearheaded by Silicon Valley startups such as Snowflake, Databricks and Confluent.
Today, any entrepreneur can sign up for BigQuery or Snowflake and have a data solution that can scale with their business in a matter of hours. The emergence of cheap, flexible and scalable data storage solutions was largely a response to changing needs spurred by the massive explosion of data.
Currently, the world produces 2.5 quintillion bytes of data daily (there are 18 zeros in a quintillion). The explosion of data continues in the roaring ‘20s, both in terms of generation and storage — the amount of stored data is expected to continue to double at least every four years. However, one integral part of modern data infrastructure still lacks solutions suitable for the Big Data era and its challenges: Monitoring of data quality and data validation.
Investors help Procore build a decacorn valuation in public debut
Watching construction tech software company Procore go public Thursday after pricing above its range makes the IPO slowdown look like the deceleration that wasn’t.
Investors quickly bid up the company’s value in trading, giving Procore a higher valuation than it might have anticipated, along with a boost of confidence for the IPO market in general.
Construction tech may not be as glamorous as space travel, but it’s a massive industry that’s fraught with inefficiencies.
Procore initially set an IPO range of $60 to $65 per share before pricing at $67 per share Wednesday night. Its debut was worth gross proceeds north of $600 million and a fully diluted valuation of $9.6 billion. As of early afternoon Thursday, shares were trading at a solid $85.25.
In light of Procore’s debut, TechCrunch is digging quickly into the company’s new valuation and its resulting revenue multiples.
Telemedicine startups are positioning themselves for a post-pandemic world
It’s impossible to predict how healthcare institutions will operate post-pandemic, but with so many people now accustomed to telemedicine, startups that provide services around virtual care continue to be poised for success.
Telemedicine has faced an uphill battle to become more relevant in the U.S., with challenges such as meeting HIPAA compliance requirements and insurance companies unwilling to pay for virtual visits. But when COVID-19 began raging across the globe and people had to stay home, both the insurance and healthcare industries were forced to adapt.
Now that people see the benefits and conveniences of “dialing a doc” from the kitchen table, healthcare has changed forever.
Telemedicine, in its original form of the phone call, has been around for decades. For people in remote or rural areas without easy access to in-person care, consulting a doctor over the phone has often been the go-to approach. But for a large swath of the world used to taking half a day off work just for a 15-30 minute doctor’s appointment, it may seem like telemedicine was invented only last year. That’s mostly because it wasn’t until 2020 that telemedicine, in its myriad forms, debuted into the mainstream consciousness.
It’s impossible to predict how healthcare institutions will operate post-pandemic, but with so many people now accustomed to telemedicine, startups that provide services around virtual care continue to be poised for success.
Telemedicine has faced an uphill battle to become more relevant in the U.S., with challenges such as meeting HIPPA compliance requirements and insurance companies unwilling to pay for virtual visits. But when COVID-19 began raging across the globe and people had to stay home, both the insurance and healthcare industries were forced to adapt.
“It’s been said that there are decades where nothing happens, and then there are weeks when decades happen,” said StartUp Health co-founders Steven Krein and Unity Stoakes in the company’s 2020 year-end report. That statement couldn’t be truer for telemedicine: Around $3.1 billion in funding flowed into the sector in 2020 — about three times what we saw in 2019, according to the report. A health tech fund and insights company, StartUp Health counts Alphabet, Sequoia and Andreessen Horowitz as some of its co-investors.
Now that people see the benefits and conveniences of “dialing a doc” from the kitchen table, healthcare has changed forever. It’s impossible to predict how healthcare institutions will operate post-pandemic, but with so many people now accustomed to telemedicine, startups that provide services around virtual care continue to be poised for success.
The state of telemedicine
Major players in the field now look at the state of healthcare as, “before COVID and after COVID,” Stoakes told Extra Crunch. “In the post-pandemic world, there’s a significant transformation that’s occurred,” he said. “It’s all accelerated; the customers have shown up. There’s more capital than ever and consumers and physicians have adapted quickly,” he added.
In the U.S., healthcare is first and foremost a business, so while there are treatment approaches that have long been proven to improve patient outcomes, if they didn’t make sense financially, they weren’t instituted at scale. Telemedicine is a great example of this.
A 2017 study by the American Journal of Accountable Care showed that telemedicine can be quite useful for managing healthcare. “The use of telemedicine has been shown to allow for better long-term care management and patient satisfaction; it also offers a new means to locate health information and communicate with practitioners (e.g., via e-mail and interactive chats or video conferences), thereby increasing convenience for the patient and reducing the amount of potential travel required for both physician and patient,” the study reads.
But as we’ve seen, it took a global healthcare emergency to drive widespread adoption of virtual healthcare in the U.S. Now that investors recognize the potential, they are increasingly pouring money into startups that promise to take telemedicine to the next level. Some of the investors backing these newer companies include StartUp Health, Andreessen Horowitz, Sequoia, Alphabet, Kaiser Permanente Ventures, U.S. Venture Partners, Maveron, First Round Capital, DreamIt Ventures, Human Ventures and Tusk Venture Partners.
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.
Covid-19 made virtual medicine a popular investment. But patients should beware.
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.”
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.”