StartUp Health Magazine_Issue 04 (2019) by StartUp Health

“Skeptics will give you a million reasons why we can’t accomplish a visionary shift. I can give you a million reasons why we need to. This is a rocketship and we’ve filled it with fuel.” -Howard Krein, MD, PhD (page 29)

Join the Movement Take the first step at startuphealth.com

ISSUE 04

access to care

Iyah Romm on Cityblock’s vision for preventive health

cost to zero

Troy Bannister democratizes personal health data

end cancer

Alex Jimenez-Ness is helping improve breast cancer detection

cure disease

Doug Adams miniaturizes disease intelligence

women’s health

Dorothee Goldman takes on endometriosis

brain health

Mylea Charvat, PhD, upgrades dementia screenings

nutrition & fitness

Navid Rastegar on staying healthy at work

mental health & happiness

Navya Singh, PsyD, opens new channels for employee health children’s health

Michelle Vick brings the baby box tradition to the U.S.

Q&A

startuphealth.com startuphealth.com $5.99 $5.99

Jon Weiner, CEO of HLTH

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addiction

Jim Iversen introduces the Opioid Crisis Working Group

L ongevity Todd and Ed Park are caring for members like they’re family

THE 8 HEALTH MOONSHOT PRINCIPLES OUR BLUEPRINT FOR ACHIEVING THE IMPOSSIBLE

“

IT’S A MASSIVELY EXPANDING

“

ECOSYSTEM OF AWESOME. - TODD PARK, CO-FOUNDER AND EXECUTIVE CHAIRMAN, DEVOTED HEALTH Since 2013, the StartUp Health Festival has gathered Health Transformers, global leaders, changemakers, and innovators to rethink the world’s biggest health challenges. In 2020, we’re sounding off, louder than ever, about the Health Transformers and cutting-edge companies working in concert to achieve health moonshots. Join us in January for a two-day experience, alongside the JP Morgan Healthcare Conference, that will leave you inspired, energized, and equipped to achieve what was previously thought impossible.

#TOGETHERWECAN Previous Speakers:

BERNARD J. TYSON CHAIRMAN & CEO, KAISER PERMANENTE

JILL BIDEN, EdD SECOND LADY OF THE UNITED STATES, 2009-2017

SANJAY GUPTA, MD CHIEF MEDICAL CORRESPONDENT, CNN

JANE METCALFE FOUNDER NEO.LIFE

JOE BIDEN 47TH VICE PRESIDENT OF THE UNITED STATES

TODD PARK CO-FOUNDER & EXECUTIVE CHAIRMAN, DEVOTED HEALTH

JAN 13 -14, 2020 | SAN FRANCISCO, CA Apply to attend at startuphealth.com/festival 2

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StartUp Health Magazine

JESSICA MEGA, MD, MPH CHIEF MEDICAL & SCIENTIFIC OFFICER, VERILY

Founders’ Letter

Opensourcing Our Health Moonshot Blueprint t started with an impossible dream: a 25-year plan to transform global health by investing in and uniting a global army committed to achieving health moonshots. When we launched StartUp Health at the beginning of 2011, we didn’t know the details. Heck, we didn’t even have a website. All we had was a commitment to our vision, an idea for a novel collaborative innovation model, and a belief that if the world could put a person on the Moon and deliver them safely home again – all in only 10 years – then in today’s golden era of innovation and abundance, we should be thinking more boldly about how to solve the world’s most pressing health challenges. But in addition to our vision (that many laughed at), some innovative ideas (mostly way too early) and lots of inspiration (largely originating from outside of healthcare), we had something that to this day is one of our most important assets – a secret roadmap. Deeply inspired by NASA’s successful Apollo program, we deconstructed eight essential ingredients that it took to get to the Moon and back and created our own recipe for achieving a health moonshot. We call these The 8 Health Moonshot Principles. Today we are sharing these principles so that anyone who wants to help achieve health moonshots can benefit from them. They are universal, and we hope that entrepreneurs, investors, world leaders, executives, advocates and patients everywhere will embrace them, so that together we can achieve our impossible dream more quickly.

Steven Krein CEO & Co-founder Managing Partner

THE 8 HEALTH MOONSHOT PRINCIPLES CHANGING THE WORLD Commitment The 25-year vision driving your life and work. Confidence Build an unshakable confidence. Communication Tell your story, tell it well and tell it often. Capabilitly To achieve the impossible, find where you thrive. Collaboration Create collaborations that last. Community Find your people, find your way. Consistency A hundred opportunities to move the needle. Capital Every health moonshot has a bottom line.

Read more about each principle, and the Health Transformers putting them into action, on page 70.

Unity Stoakes President & Co-founder Managing Partner

OMMITMEN

S TA R T U P H E A LT H I N V ES T O R

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Together, we can make a difference. Since 1921, Otsuka has been on a mission to create new products for better health worldwide. Today, our commitment to developing new products and innovative solutions to meet some of healthcare’s most complex challenges has never been stronger. We are especially proud to support patients suffering from mental health and kidney disorders on their journey to wellness and comfort.

Otsuka America Pharmaceutical, Inc. Otsuka Pharmaceutical Development & Commercialization, Inc.

Let’s connect

@OtsukaUS

www.otsuka-us.com Otsuka America Pharmaceutical, Inc. Otsuka Pharmaceutical Development & Commercialization, Inc. © Otsuka America Pharmaceutical, Inc. October 2018 01US18EUK0013

In This Issue

Founders’ Letter

Editor’s Letter

64 25

Takeoff 14

My Aha Moment

Close-Up: Navya Singh, PsyD

Brand Breakdown: Cecelia Health

Nan Gardetto

Innovation Hub: Baltimore

Jerry Levin

Healthy Habits: Office Fitness Hacks

Esther Dyson

Essay: Health Consumer or Health Citizen

Howard Krein, MD, PhD

The Health Conference, Disrupted

Wisdom

Health Transformers 32

Say hello to the new Health Transformers

Health Moonshot Momentum: Top Movers in the StartUp Health Portfolio

37 5

S TA R T U P H E A LT H P O R T FO L I O C O M PA N Y

In This Issue

Features 50

Blood Work

Reinventing Medicaid

Small Wonder

Cityblock: A Pound of Prevention

64 Funding Total Womenâ&#x20AC;&#x2122;s Health Funding Deal Count

$7.8M

$60.7M

$66.8M

$139.2M

$91.6M

Q1 2018

Q2 2018

Q3 2018

Q4 2018

Q1 2019

Masterclass 70

StartUp Health Company Index

The 8 Health Moonshot

108 Active companies in the

Principles

StartUp Health Portfolio, listed by primary health

StartUp Health Insights 87

moonshot

The 2019 midyear report on global health innovation

Imagining the Future

funding

140 David Duncan: Doc Bot The Big Idea 146 Jean Case on the five prin-

146 6

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ciples of fearless innovation

S TA R T U P H E A LT H P O R T FO L I O C O M PA N Y

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S TA R T U P H E A LT H P O R T FO L I O C O M PA N Y

Better care for healthier neighborhoods, block by block. We’re passionate about delivering a radically better experience of care for everyone. It’s why every day at Cityblock, engineers, product designers, and data scientists work side-by-side with clinicians and community providers to build technology-driven solutions, designed to support exactly what matters most to our members. To us, that’s the future of healthcare. Want to help us bring better care to where it’s needed most? Join us!

cityblock.com/careers 8

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StartUp Health Magazine

Editor’s Letter

Lost and Found

Want a free subscription to StartUp Health Magazine? Scan the code and sign up. q

hen I was a teenager, just learning to drive, I got lost. A lot. No cell phone, no Google Maps, just scribbled instructions. If the road changed names or zigged when I thought it should zag, it could mean an hour (or three) of frustrated wandering. These days, you have to work hard to get lost. My children can tap a button, speak the name of a distant land – or a nearby LEGO store – and have up-to-theminute step-by-step instructions read to them in the accent of their choosing. Frankly we’ve become obsessed with directions. Where I used to worry about losing two hours now I worry about “alternate routes” that will dock me two precious minutes. Of course, GPS comes at a cost. We’ve gained global positioning, but you could argue we’ve lost our sense of direction. Growing up there was a large format Rand McNally road map tucked into the pocket behind the driver’s seat of our car. Tracing a route with my finger, my eye would wander west and find a river snaking its way north. Or I’d notice that the dotted state border cut a city in half. Some maps tell you a lot more than how to get from point A to point B. They give you perspective. In this issue, we’re offering you a map of another kind. One that pulls back the focus and helps you think about where you are going and how to get there. It places you, and your company (if you have one), on a broader landscape. But this isn’t a road atlas. It’s a map to the Moon. Hear me out. At StartUp Health we use the term ‘health moonshot’ intentionally. We are rallying and supporting the entrepreneurs, innovators, leaders and organizations needed to tackle the world’s greatest health challenges, like cutting the cost of care to zero and ending cancer. These are distant destinations, yes, but they are within our grasp with the right map in hand. We’ve broken down the health moonshot journey into eight principles that focus on how you think, not just what you think. For instance, do you have a

spirit of commitment, motivated more by long-term progress than short term gain? Teemu Suna and the team at Finnish biotech company Nightingale spent seven years analyzing millions of blood samples from around the world, refining their biomarker analysis, and publishing ground-breaking findings in the name of transparency before taking their single-sample blood test to consumers (read the story on page 50). We also explore the principles of community and collaboration. For Cristian Pascual, co-founder of Mediktor in Barcelona, that meant creating a health innovation hub from scratch, gathering together hundreds of people across the industry, to speed up collaboration in Europe and beyond (story on page 80). This isn’t your typical map. It doesn’t tell you exactly where to go and there’s no estimated time of arrival. In fact, the road is long, often bumpy, and success isn’t guaranteed. But what we know is that the compass heading – to improve the health of everyone in the world – is worth driving towards. Thanks to the supercomputer I hold in my pocket, I rarely get lost anymore. The challenge now is to put down the devices and create the space for a much bigger vision, a greater destination. And then, step by step and shoulder to shoulder, to travel there together. Lost (in thought) with author David Sokol (r), who profiled Cityblock Health in this issue (page 62).

Logan Plaster Editor-in-Chief 9

PUBLISHERS Unity Stoakes / Steven Krein

Join the Movement Take the first step at startuphealth.com

ISSUE 04

access to care

Iyah Romm on Cityblock’s vision for preventive health

cost to zero

Troy Bannister democratizes personal health data

EDITOR-IN-CHIEF Logan Plaster

end cancer

Alex Jimenez-Ness is helping improve breast cancer detection

cure disease

Doug Adams miniaturizes disease intelligence

women’s health Dorothee Goldman takes on endometriosis

brain health

Mylea Charvat, PhD, upgrades dementia screenings

nutrition & fitness

Navid Rastegar on staying healthy at work

mental health & happiness

Navya Singh, PsyD, opens new channels for employee health children’s health Michelle Vick brings the baby box tradition to the U.S.

Q&A

startuphealth.com startuphealth.com $5.99 $5.99

Jon Weiner, CEO of HLTH

addiction

Jim Iversen introduces the Opioid Crisis Working Group

l ongevity Todd and Ed Park are caring for members like they’re family

DEPUTY EDITOR Jennifer Hankin

THE HEALTH MOONSHOT BLUEPRINT 8 PRINCIPLES FOR ACHIEVING THE IMPOSSIBLE

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Subscribe to the magazine dedicated to the Health Transformers changing the world. startuphealth.com /magazine

CONTRIBUTING EDITORS Polina Hanin / Jeremy Lehrer PHOTO EDITOR Paul Newson ASSOCIATE EDITOR Nicole Kinsey CONTRIBUTING WRITERS Morgan Childs / Nicole Clark / Anne Dordai Patrick Macguire / Tara Salamone / David Sokol Sonya Swink / Eisa Ulan / Michael Yockel CONTRIBUTING DESIGNERS Jordan Crane / George Nichols IV / Sam Solomon

STARTUP HEALTH Steven Krein CEO & Co-founder Managing Partner

Unity Stoakes President & Co-founder Managing Partner

Jerry Levin Executive Chairman

Bari Krein, JD, LLM Chief Strategy Officer

Howard Krein, MD, PhD Chief Medical Officer

Jennifer Hankin Chief of Staff

Katya Hancock Investor Relations Director

Polina Hanin Portfolio Director

Logan Plaster Media Director

Piper Leonard Senior Controller

Andrew Isaacs Ventures

Maxim Owen, CFA Ventures

Lauren Doolan Ventures Operations

Callie Fisher Events Manager

Nicole Clark Senior Writer

Max Weiss, JD, LLM Counsel

Anne Dordai Platform Manager

Nicole Kinsey Media Manager

Michael Karelis Head of Video Production

Tara Salamone Media Lead

Aki Koivistoinen Ambassador, Europe

Matthew Batnick Fellow

Alex Belaia-Martiniouk Fellow

Rikuta Komoriya Fellow

Hannah Leadem Fellow

Paige Whittemore Fellow

StartUp Health Magazine is published by StartUp Health Holdings, Inc. Copyright 2019. All rights reserved. StartUp Health and Health Transformer are registered trademarks. Disclosure: StartUp Health is an investor in more than 280 companies, many of which are featured in StartUp Health magazine. For a complete list of our active companies, visit the index which begins on page 130.

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S TA R T U P H E A LT H P O R T FO L I O C O M PA N Y

TAKEOFF Meet the boundary-breaking Health Transformers creating the future of health.

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Aha!

Three founders share their lightning bolt moments.

Close-Up

Navya Singh, PsyD, on how wayForward is opening up access to mental health services.

Brand New

What’s in a name? A lot, when you’re rebranding yourself and expanding your offerings.

The Hub

Meet Sathya Elumalai of Aidar Health, from Baltimore’s growing health innovation community.

Healthy Habits

How fitness entrepreneurs stay active at the office.

Health Citizens

Essay: Do you own your health or merely rent it?

Health Conference, Dirsupted

Sitting down with the founder of HLTH.

23 .

TAKEOFF

My Aha Moment

EVERY HEALTH MOONSHOT BEGINS WITH A SINGLE STEP, and

every entrepreneurial journey begins with a story. We asked three founders to share their lightbulb moment, when the purpose behind their work came into focus.

Beth Sanders

Troy Bannister

Miguel Johns

Founder & CEO, LifeBio

Founder & CEO, Particle Health

Co-founder & CEO, KingFit

“I’ve always been interested in people’s stories. I thought I knew my grandmother pretty well, but after college I was worried she was having the early signs of dementia. I told my mother ‘When are we going to tell grandma’s life story?’ My mother said, ‘You’re the one with the degree in English and journalism, why don’t you tell grandma’s story?’ I took the recorder out with her for about an hour and a half; and in that day my grandmother became a whole person. I had only seen her in one dimension which is ‘Grandma,’ and in that day she became a little girl playing with her sister, she became a young basketball player, she became a high school grad, a college student, then getting her first job and getting married. I thought, ‘Grandma! You’re just like me.’ And I thought: If I don’t know my own grandmother, no one does. In this world where 100 million are going to be over 65 by 2030, there’s a lot of people with a story to tell, and nine out of 10 pass away with no solid legacy. LifeBio started out with the idea that people should have a biography, a legacy, but along the way we’ve impacted peoples’ health and wellbeing.”

“In college, I worked as an EMT on weekends, holidays, and over the summers – whenever I could – and my identity in school was the medical guy. When kids I knew got injured, they’d come to me for help. But then I went to medical school at Georgetown and absolutely hated it. I saw a broken system that I didn’t want to be a part of that drove me to ask: How do we fix this? I finished my master’s degrees in physiology and biophysics, and then worked as a clinical researcher at Mount Sinai. The hospital system had just launched their digital health innovation track and was showing simple digital solutions having outcomes in the same neighborhood as the drugs we were testing in clinical trials. At 22 years old, it started to become really apparent. Data is a giant piece of the puzzle, and it can be used to do so much – the problem is, as a payor, provider, vendor, or even patient, it’s almost impossible to get meaningful access to the data. That experience led to my work at StartUp Health, which then laid the foundation for founding Particle Health.”

"The idea of KingFit was born when my grandmother was diagnosed with diabetes. She thought chocolate milk and orange juice were healthy food options. Today our clients are faced with 88% of their patient population lacking proficient health literacy. There's a disconnect between how people want to learn about their health and how healthcare organizations currently deliver that information to them. We initially wanted to transform how diabetes education programs were delivered. We built an app to start and then produced 85 diabetes education videos. To do so, we had to create a style of video production that was affordable for us. We took that first product to market. Organizations, although they liked the idea of a new diabetes education program, kept pointing out how much they liked our types of videos, and that they'd really like to have us produce more around other topics. The big lightbulb moment for us was to move away from trying to be the next health app to focusing on what do we do really well. Videos ended up being our key that drives revenue now.”

LifeBio, part of the Longevity Moonshot, is an online platform that helps individuals and/or families record a personal history through a series of questions and prompts. LifeBio also offers reminiscence therapy in senior living settings, helping improve mood and behavior.

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Particle Health’s work in the Cost to Zero Moonshot is allowing medical systems to securely access and aggregate fragmented medical records. In the same way financial payment services check balances and transfer on behalf of users, Particle Health’s API allows users to give permission to check and transfer selected health data on their behalf.

KingFit is improving health literacy through educational health videos. The company, working to achieve the Nutrition & Fitness Moonshot, takes written copy and quickly turns it into videos with a combination of text, pictures, or graphics. KingFit’s simple video style allows for quick turnaround on production, as well as the ease to share on social media to audiences needing vital information.

Close-Up

A Way Forward for Mental Health BEFORE NAVYA SINGH, PSYD,

" was an entrepreneur, she worked as a clinical psychologist alongside some of the hardest-hit communities in the world. From inmates in the South Bronx to Rwandan survivors of genocide, Singh saw it all and learned a couple key lessons along the way.

“Globally, there is a lack of awareness and a lack of access to mental health resources that so many people need,” says Singh. Singh realized that it wasn’t just about providing care one on one. To move the needle on mental health access she needed to build a better way to identify mental health needs and direct care for entire populations. So she co-founded wayForward in 2015, a digital behavioral health company that helps people find the right level of behavioral and mental health when they need it, on a platform that is convenient for them. “We’ve identified gaps in mental and behavioral health – and there are many – and we bridge them using evidencebased solutions and delivering them by our technology,” says Singh. Those gaps range from patients not knowing why they are feeling bad to not knowing how to access the right level of care. WayForward handles the spectrum of patient needs, from simple textbased life coaching to video-based counseling with a trained therapist. Building an app was one thing, but in order to move the needle and advance the Mental Health & Happiness Moonshot, Singh knew wayForward needed the right collaborator. They chose Employee Assistance Programs (EAPs), the under-the-radar benefits programs offered to millions of employees across the U.S. – blue and white collar alike. EAPs have historically offered mental health hotlines via hard-to-find 800 numbers. But by collaborating with EAPs, Singh and her team have taken a throwaway benefit (with less than a five percent engagement rate) and created a way to move the needle on mental health. They now cover nearly five million employees with nearly a 20% usage rate. “The EAP brings domain expertise and the employee population. We provide them with engagement, outreach materials, email campaigns, and everything else that they need to provide to the employee to make it easier.” For Singh, it’s a win-win collaboration that sets wayForward up for exponential growth in the years to come.

TAKEOFF

Brand Breakdown

A Rebrand Fit for the Whole Patient "

WHEN DAVID WEINGARD AND THE TEAM BEHIND FIT4D DECIDED

they needed a brand facelift, they turned to long-time collaborator Delta Marketing Group. Together they came up with a name – Cecelia Health – and a logo that told a bigger story about the company’s past and where it’s going next. Here, Delta brand expert David Houston offers a breakdown of the branding refresh.

On the left: The coach, your advocate, is there for you every step of the way.

On the right: The device, the technology, that supports the relationship.

In the middle: The patient, with a droplet of blood signified below.

The raindrop shape: Like a cocoon of support, this outer circle signifies the options that the patient has as they meet the challenges of their condition day by day.

The whole: Taken as a unit, the logo opens up to life, like a flower.

The Logo: The idea was to create a logo that really touches people who have diabetes and communicates how they can improve their lives. If you look at the sketch, you can see how it evolves into something living.

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The Process: It was an agile sprint, appropriate for a startup, rather than the traditional model involving months and months of focus groups. The Name: Before David Weingard founded Cecelia Health (formerly Fit4D), he was a type 1 diabetes patient struggling to find the help he needed. After a lengthy search, he met a health coach named Cecelia who taught him not only how to live with diabetes but how to thrive. That very personal story is now woven into the entire brand. And if your brand can tell a story, you’re ahead of the game. Colors: We knew this person has to feel protected, welcomed, and warm. We wanted the colors to suggest that something holistic is happening, not like a drug. It’s intended to be comforting and approachable. Typography: Even though Cecelia is in essence a B2B company, the logo has to work with the coaches and feel almost like a B2C brand. The font choice and the decision to use lower case letters, signals that the company is personal and welcoming.

a Aidar Health CEO Sathya Elumalai’s vitals monitor is putting a small Baltimore lab on the map and opening up access to care to patients around the world.

Innovation Hub: Baltimore

A Breath of Fresh Air by Michael Yockel photos by Paul Newson

WHEN SATHYA ELUMALAI ARRIVED AT

his office in a research center on The Johns Hopkins Hospital’s sprawling East Baltimore medical campus on a recent weekday morning, he found a steaming cup of coffee awaiting him on his desk. For Elumalai, just off the plane from a business trip to London, the coffee, purchased by a thoughtful coworker, served as a welcome-back gift.

“They must like me here,” Elumalai says with a laugh. “Here” means the headquarters of Aidar Health (formerly Multisensor Diagnostics), which he co-founded and now leads as CEO. Inside, a half-dozen engineers, plus co-founder and CTO Gene Fridman, assemble devices chock-a-block with complex circuitry that, in their finished form, resemble the sleek, handheld communicators used in myriad 1960s and 1970s sci-fi movies and TV shows. A collegial atmosphere permeates the company’s lab, with Elumalai and Fridman mixing freely with their young staff and feeding off the collective positive vibe. They laugh together, go out for beers after work, and celebrate each other’s achievements. In effect, the small group constitutes a kind of family for Elumalai, whose biological one still lives in his native India. The device they’ve created, MouthLab 17

TAKEOFF

– brainstormed and developed by Fridman – has the potential to transform patient care. When someone breathes into it for 30 seconds, MouthLab records that person’s respiratory rate and pattern, pulse rate, ECG, SpO2 (oxygen saturation), temperature, heart rate, heart rate variability, blood pressure, and spirometric lung functions, making the data immediately available to caregivers, both professional and personal. “We’ve taken this multi-parameter, multi-marker approach to rapidly acquire a whole lot of health information,” Elumalai, 33, explains. Elumalai’s initial interest in Fridman’s device was sparked by personal concerns. His mother, then 57 and living in India, suffered from multiple chronic conditions: hypertension, heart issues, and, most critically, diabetes, which adversely affected her eyes, kidneys, and legs. That required her seeing multiple doctors, who, Elumalai explains, did not communicate with each other. Additionally, she was put off by the various “gadgets” – ECG monitor, activity tracker, blood pressure cuff, among others – she needed to measure her vital signs. “Having all these things was a burden to her,” he recalls. “And there was a fear of then looking at all the data: ‘My blood pressure is high! Why?’” As a result, she simply stopped using her devices, manufacturing excuses to Elumalai as to why she had failed to monitor herself. “I really wanted to find a solution that actually communicates what’s happening with my mom to her physician or with me without her having to say anything,” he says. A solution that 18

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Clockwise from top: A mural on the outskirts of the Johns Hopkins campus in Baltimore; Aidar Health CEO Sathya Elumalai; the Aidar Health lab; the Johns Hopkins free shuttle was critical for Elumalai when he was new to Baltimore (and the United States) and working long hours in the lab.

When someone breathes into Aidar Healthâ&#x20AC;&#x2122;s MouthLab device for 30 seconds, it records that personâ&#x20AC;&#x2122;s respiratory rate and pattern, pulse rate, ECG, SpO2 (oxygen saturation), temperature, heart rate, heart rate variability, blood pressure, and spirometric lung functions, making the data immediately available to caregivers.

STARTUP HEALTH

HQ 6

Meet Sathya Elumalai and learn more about Aidar Health on StartUp Health HQ. 6 startuphealth.com

TAKEOFF

When it comes to health, Baltimore is a city of contradictions. It struggles against dismal public health statistics – particularly in West Baltimore – even while it is buttressed by some of the finest medical facilities in the world. With challenge comes opportunity for health innovation. Here are three reasons why Baltimore is a great place to reimagine health. A Mecca for R&D For 39 consecutive years, Johns Hopkins University has spent more on research and development than any other American university. It spent $2.5B on R&D in 2017 alone. Notable Raises In 2018, Baltimore-based Personal Genome Diagnostics raised a $75M Series B while Protenus raised $11M. A Healthcare Town Between Johns Hopkins University and the University of Maryland Hospital System, Baltimore has become a city with a healthcare bent. From 2017 to 2018, the “health services and education” labor sector added around 10,000 jobs.

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would allow him to track her health daily and, if necessary, intervene when warning signs appeared. Elumalai’s mom, now 62, uses MouthLab daily without complications, treating it, he says, the same as she does her electric toothbrush: “That’s the level of simplicity that we want to bring to the device.” Elumalai and Fridman launched what evolved into Aidar Health in 2015, after meeting a year earlier through their respective connections to Hopkins. At the time, Elumalai was working for Inovalon, a healthcare data analytics firm, while also earning a master’s in healthcare management and finance at Johns Hopkins University. For his part, Fridman, an associate professor of otolaryngology (head and neck surgery) at Johns Hopkins School of Medicine with a PhD in biomedical engineering, was encountering difficulty attracting investor interest in his MouthLab prototype. “People referred to it as a ‘lab project,’ not a ‘company,’” Elumalai notes. It didn’t help, he adds, that, back then, before undergoing a major redesign, it “looked like a taser.” Elumalai’s ability to share the story of a life-changing technology with medical institutions, healthcare insurance firms, and major pharmaceutical companies has served to advance MouthLab from a promising

“I really wanted to find a solution that actually communicates what’s happening with my mom to her physician or with me without her having to say anything”

work in progress to a practical reality. In turn Fridman – whom Elumalai calls “a genius” – never gives cause to worry about the technical side of the operation while Elumalai is on the road. To date, Elumalai’s efforts have paid off, kindling interest from Johns Hopkins Medicine, Texas Medical Institute, and others in the U.S., India, and Europe, while cementing an Internal Review Board (IRB) approved patient study with Johns Hopkins

Healthy Habits

Fitness Hacks for the Workplace "

NAVID RASTEGAR AND THE FITBLISS TEAM HAVE MADE THEIR

name connecting a company’s bottom-line productivity to health and wellness activities. We asked the team to share the healthy habits that keep their own workplace going strong.

“Stretching in the middle of a meeting” -Kelsey Radloff, Manager

Hospital. Additional pilot programs have been initiated to examine MouthLab’s usability and efficacy. “I’m going to save my mom from hospitalization,” he says. “I’m going to prevent drastic events from happening to her.” With MouthLab, “We want people to take better control of their health. We’re not looking to make billions of dollars – we’re looking to impact billions of lives.”

Something as small as a few toe flexes can release tight muscles – such as hamstrings that shrink up while sitting at a desk – and relieve stress caused by restricted blood flow, according to research by Harvard Medical School. Stretching can even make the brain larger, enabling it to better work through complex problems, according to a recent study by the Radiological Society of America.

“Going for a short walk when stuck on a problem” -Viji Radhakrishnan, Engineer Walking, whether in the building or outside around the block, can improve creative problem solving by as much as 80% compared to just sitting, according to the Journal of Experimental Psychology. Walking is an easy hack to solve problems, practiced by innovators from Steve Jobs to Beethoven.

“15 minutes of morning meditation” -Navid Rastegar, CEO & Founder Breathing drives neural activity. Control of the breath means control of the mind, even over frontal lobe response, according to The Journal of Neurophysiology. Four or five deep breaths with full exhalation can calm the nervous system and quell anxiety before making a big decision. Believe it or not, according to research from The Journal of Positive Psychology, 15 minutes of meditation can provide the same feelings as a day of vacation.

TAKEOFF

Essay "

AS WE TAKE AN INTERCONTINENTIAL VIEW OF HEALTH

we see more clearly the important balance of rights and responsibilities in the future of healthcare. After all, do you own your health, or are you just a renter?

From Health Consumers to Health Citizens by jane sarasohn-khan

In American healthcare, the patient is now the payor; in the European Union, patients are health citizens. In 2018, I, an American citizen, swore faithfulness to Italy. I stood up and promised, in Italian, to be faithful to the Repubblica Italiana, “to faithfully observe the Constitution and the laws.” In that instant, I became not only a citizen of Italy, but a citizen of the European Union. Moreover, I became one of Europe’s “health citizens.” I was writing a book at the time called HealthConsuming™ and it wasn’t long before my personal and professional lenses bled together, giving me a fresh perspective on the American health system. In HealthConsuming, I track the evolution of the patient to the payor and the consumer. Someone paying for something expects a value exchange for that payment; but what’s the value exchange in healthcare to that person footing the first dollar underneath the high-deductible? As a consumer, that patient lacks access to transparency in prices and the quality of therapeutic alternatives (when available), faces administrative hassles, often receives surprise medical bills for care consumed outof-network. And in terms of patient experience? Not an Amazon Prime moment. As a consumer, the patient expects a level of ser22

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vice akin to other life-flows like making dinner reservations, booking travel, or buying virtually anything. That’s the opportunity those “new entrants” and “new front doors” for healthcare have begun to mine, whether for services (think: primary care booked through ZocDoc or via subscription with One Medical), prescription drugs (through comparing medicines and accessing discount coupons with GoodRx, or contracting with PillPack to receive adherence-packaged drugs by mail), and buying insurance and care (via Bright, Carbon, Clover, Devoted Health or Oscar Health, among others). Alphabet/Google, Amazon, Apple, Facebook and Microsoft, and other Big Tech companies are all working to bake access and innovation into many facets of healthcare. Given their direct pocketbook costs, the patient-payor-consumer is engaging in what I refer to in HealthConsuming as the New Retail Health, an ecosystem of clinics, gro-

cery stores, medical cannabis dispensaries, gyms and YMCAs, hospitality and medical tourism, shopping malls, and the pharmacy – the latter which was, for decades, the textbook definition of “retail health.” But with the blur of CVS + Aetna, and the pharmacy bundled into Walmart’s health, beauty, and fresh food aisles, “retail health” goes well past the dusty back wall of a drugstore. The New Retail Health ecosystem is underpinned by digital platforms and data clouds. Every encounter generates data, much of which currently escapes the traditional electronic health record or medical claims system, and some of it eluding HIPAA protections. That’s a challenge in process of being solved through the growing use of APIs and consumers demanding greater access to personal health records, secured by, say, blockchain. (My association with healthbank, a personal health records cooperative based in Switzerland, has informed my perspective on this). Change is afoot. In the early run up to the 2018 midterm elections, the pulse of the U.S. body politic began a drive among many voters to protect coverage for pre-existing conditions and to demand lower prescription drug cost options, thus launching “the healthcare elections”. By November 2018, across partyIDs whether D, I or R, most Americans told the Gallup Poll that the government had a responsibility to ensure that everyone had access to healthcare. Not to run the system, mind you, but to assure access. Are health consumers becoming health citizens? To realize full-on health citizenship, Americans would need to enjoy rights coupled with responsibilities. On the rights side of the health citizen ledger would be the civil right to healthcare. The health citizen would own and control their own data, with the assurance of a comprehensive privacy law to protect individual data (including the right to monetize that data). On the responsibility

The Health Conference, Disrupted StartUp Health Insights™ Top 5 Non-U.S. Hubs for Health Innovation (2019 YTD) City/Region

Funds Raised

Deals YTD

2018 Deals

Beijing

$486.0M

Paris

$321.0M

Tel Aviv

$181.9M

Bangalore

$178.1M

London

$129.9M

front, health citizens should endeavor to take care of themselves, understanding and appreciating that health is social – that self-care and positive health behaviors inspire others in our social networks, and our network’s networks. Furthermore, a health citizen must exercise their right and responsibility to vote in public elections. Most public policies touch health in some way, including but not limited to agriculture, education, housing, the Interior, labor, and transportation. We know that our ZIP code has a strong influence over our health status and underlying health risks. Digital health innovations must scale to people who most need those innovations. Millions of patients in the U.S. lack broadband connectivity and are challenged by social determinants like food security, clean air, good education from an early age, healthy shelter, and financial security. These patients tend to use disproportionately greater medical resources. Reallocating resources from downstream medical care to social and primary care upstream would move the U.S. toward a more equitable, effective, and engaging health system where, paraphrasing the words of my friend Esther Dyson, people could own and not just “rent” their health. Jane Sarasohn-Kahn is the author of THINK-Health and the Health Populi blog.

“To realize full-on health citizenship, Americans would need to enjoy rights coupled with responsibilities. On the rights side of the health citizen ledger would be the civil right to healthcare. The health citizen would own and control their own data, with the assurance of a comprehensive privacy law to protect individual data.” -Jane Sarasohn-Kahn

JON WEINER, CEO & FOUNDER

of HLTH, on how his company is reinventing the healthcare trade show

Q&A What is the key to a successful health conference in 2019?

The key to a successful health conference is very simple making sure people and organizations get an ROI from the event. Time is the most precious commodity that people have, so as an event, HLTH needs to provide a platform and key programs for different parts of the ecosystem in order for people to have an ROI. If you’re an investor, you’re going to want an entirely different set of experiences at the event than if you’re a CIO from a health system, or an early-stage startup. At HLTH, we make sure that we can provide individualized experiences and an ROI on everyone’s time, depending on your role within the health ecosystem. Why is it important to host in-person conferences in the digital age?

As President Roosevelt so aptly stated: “People don't care how much you know until they know how much you care.” Every aspect of our event is intentionally designed to make every speaker, attendee, sponsor, and exhibitor feel valued that’s why we go to extremes to make our event well worth their time and money. Bottom line is that it’s very hard to build the type of relationships that will shape the industry without that in person connection. What is an example of how HLTH has thought differently about the health conference landscape?

HLTH understands that no one conference can replace all health conferences. We respect that certain parts of the health industry warrant events that are substantive to their unique needs. Our goal is to drive a different conversation one that gets above the competitive divides and focuses on where we can align, how we can raise all boats, and how, together, we can drive transformation that benefits the entire health ecosystem. Join us at the StartUp Health Pavilion at HLTH, October 27-30 in Las Vegas. 23

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StartUp Health: What do you look for in an entrepreneur?

Nan Gardetto

Investing with a Caregiver’s Heart When Nan Gardetto was 27 years old, her father suffered a cerebral hemorrhage while at work. He was the second generation head of Wisconsin-based Gardetto’s, a family-owned bakery that was best known for selling 32inch long breadsticks around the country. Nan was quickly thrust into a leadership role at the company. The following Monday, she walked onto the factory floor and changed its trajectory forever. By inventing and commercializing a new snack mix, she increased sales from $3 million to $116 million before being acquired by General Mills. Then she did it again, growing local Baptista’s Bakery to the point that it was acquired by Snyder’s-Lance. But it was what happened off the factory floor that shaped Gardetto’s next act. Nan lost her husband after a 10-year battle with cancer. Afterwards, two years into a new relationship, her stepson was diagnosed with cancer. Her stepdaughter had type 1 diabetes. The challenges and tragedies turned Nan into a caregiver, and gave her the focus she needed for the next chapter of her life. Rather than cash in her chips and enjoy retirement, Nan started the Every Day Good Foundation and is actively funding organizations that “help people live their healthiest, highest quality of life.” We sat down with Nan to hear more about her investment philosophy, the power of investing in the Midwest, and what she looks for in potential partners.

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President of The Every Day Good Foundation Former CEO of Baptista’s Bakery StartUp Health Investor

Gardetto: There’s the hard technical side and the soft side, which I think is of greater significance. I’m looking for somebody who really believes that this project, company or role is part of their personal mission. Then I look for values that match my own – integrity, kindness, and caring. I look for a good work ethic and people who can see the big picture. I look for people who are empathetic and who have really good listening skills. Also, that their ego is in check. You have to have enough ego to have confidence, but you have to have a willingness to be a beginner, to always be curious. There are plenty of organizations who are looking at getting to their goal as quickly as they can. I’m more concerned with how we get to that goal. That to me is as important as the goal itself. If you’re not embracing people and growing a team as you yourself are learning and growing as a leader, you’re not creating something that is sustainable. StartUp Health: How would you describe your investing philosophy?

Gardetto: It has to be aligned with my mission, to help people live their healthiest, highest quality of life. And I look at this from a whole person point of view – physical health, emotional health, and spiritual health. If I like the idea, then I look at who’s leading this and what’s their vision? If I’m still interested, we have a conversation, and figure out what role I might play, if any. A good example is my investment in the Boys & Girls Club of Greater Milwaukee, one of our largest to date. My whole life, I was blessed with coaches, mentors, and good role models. I know their importance in developing and shaping a person. We’ve got a big group of kids in the Milwaukee area who don’t have this type of role modIllustrations by Lauren Crow

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el in their lives. Coupling that with issues of poverty, they have huge life challenges. By the grace of God they show up every day, sometimes hungry, sometimes abused, but they find themselves somehow on the doorsteps of the Boys & Girls Club after school. I asked what I could do to provide them a coach or somebody to help move them forward. That gave birth to funding the social emotional learning program at the Boys & Girls Club. StartUp Health: How is your strategy different than that of a VC?

Gardetto: What I love about it is that I don’t answer to anybody. I can do what I feel I want to do. It’s my own expectations that I’m managing, not the expectations of others and I can do things for the long term. I’m trying to create wealth, but there could be some altruistic reasons for making an investment. I’m not always doing it to make money. Sometimes I invest just because it’s a good idea and it needs to be done and somebody’s got to do it. I can put my playbook together and have fun doing it. StartUp Health: Why has it been important for you to invest in the Midwest?

Gardetto: There is a lot of focus in the Milwaukee-Madison corridor. There’s a huge amount of technology brewing. The Midwest has a lot to offer and the world has yet to see it. Milwaukee has been my home my entire life. I love my town and I look at this as a way to give back. There’s something about the Midwest, the hard working ethic that we have here and the down-to-earth nature. There’s not a lot of pretense. I have this attitude that we’re not here on earth all that long. Why not take each other as we are, park our egos at the door, and do something great.

Shine the Light of Innovation into the Darkness

Jerry Levin Executive Chairman of StartUp Health Former Chairman & CEO of Time Warner

The term “digital health” can ring cold and academic. Even useful terms like “pain points” and “market opportunities” become paper thin boardroom jargon. But make no mistake – health is personal, and it only gets more so as you age. And the pain points that health innovators have the ability to address are life altering. I offer myself as exhibit A. I have traversed the landscape of epilepsy, cancer, and Parkinson’s with grit and determination. Yet nothing prepared my life force to be taken

down so abruptly and with such shattering consequences as when I received the words “you have allergic interstitial nephritis.” I had a chronic end-stage kidney disease requiring immediate dialysis, presumably in perpetuity. The day after I heard those words, still confused, and with Google research looking even more grim, I was rushed to the sad geriatric ward of an unfamiliar hospital. I learned later that I was within minutes of a complete cardiac shutdown since functioning kidneys not only filter the blood and dispose of unwanted liquid but also maintain a delicate balance of potassium to keep the heart pumping. They operated on me, inserting a catheter dangerously close to my heart. As soon as I recovered, they wheeled a big noisy machine into my room and I was formally introduced to the intimidating, 50-year-old protocol known as dialysis. No brochure or info packet could have prepared me for the burden of dialysis. I must do it three days a week, every week. There are no holidays, no breaks from this incessant routine. The actual procedure takes three hours, but taking into account travel time back and forth to the clinic plus the time for needle insertion and removal and the necessity of protective clotting and blood pressure not dangerously low, your day is shot. It takes anywhere from eight to 20 hours to recover. In other words, the heart of your living human experience is upended. There is the constant danger of infection, so you flinch when touched heartily by a well-meaning family member or close friend. The transformation of your body, no matter how athletic or nutritious you may have been, is compromised with substantial loss of muscle and weight and tarnished by blood blocked in your extremities. There is the degradation of your arm due to the fistula added as an access point. There is the strict di25

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alysis diet taking away high potassium, sodium, and phosphorus foods (yes, we have no bananas). Since I am vegan, the high protein requirement is tough to fulfill. What about travel? Sure, as long as you maintain the three days at an outpatient clinic where you are going, reserved well in advance, and you can schedule your travel visits with those three days observed. Why not get a kidney transplant? It’s an arduous road and not kind to patients my age. Half of dialysis patients are geriatric souls. The most common disease leading to kidney failure is diabetes, which has its own set of malfunctions. Each year 20% of dialysis patients die. I offer my story not as a jeremiad but as a call to arms. The half million women and men who receive dialysis each year in the United States represent a community of patients who suffer in relative obscurity, away from the headlines of health innovation. After all, there’s no sleek wearable or beautifully designed app that can solve renal failure or decrease the risks of a kidney transplant. Not yet at least. To truly transform health, we must put the patient – real patients – at the center of the equation. Rather than address perceived pain points, or merely enter seemingly lucrative markets, let’s uncover the areas of greatest suffering and apply our energies accordingly. What we’re likely to find are large new markets ripe for disruption. Medicare spends about $35 billion each year on care for those with end-stage renal disease, yet dialysis hasn’t changed substantially in decades. Let’s flip the script on even the most intractable problems in health. Bring on the advanced miniature filtering units that would offer a gentler kind of dialysis. While we’re at it, let’s shrink down the machines so that we can finally deliver compassionate care in the one place where patients feel comfortable – their own home. If we can innovate in these hard-toreach areas of health with empathy and compassion, we can do so much more than just improving the system. We can restore hope to patients who have suffered on the margins and replace fear with peace.

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StartUp Health Magazine

Telling a Bigger Story: Health Tech Hinges on Long-Term Impact

Much has been written about the mindset necessary to “reach the Moon” in health. But what about the kind of long-term sustained endeavor necessary to colonize the Moon? In health and wellness, part of the answer lies in working towards keeping people healthy, rather than curing them later. The big challenge is how to measure progress in the short term so that we can invest confidently over the long term in that most precious asset of all: healthy human lives. I saw this challenge up close a few weeks ago at Virgin Pulse’s an-

nual conference for Esther customers – mostly Dyson HR & benefits managers, not specifically Executive health-focused. Vir- Founder of gin Pulse (VP) offers Wellville access to, and support for, a variety of ser- StartUp vices and programs Health Investor & funded by employers Advisor and selected by employees, as well as its own platform and dashboards. These HR & benefits managers are not generally senior employees; they mostly meet budgets rather than set them. They are caught between two masters. One is their “clients,” employees who can improve their own health and wellbeing by taking advantage of the many programs and tools offered and delivered by VP. But the employees can’t just “select” them. These programs

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generally require the employees to do something – to invest their time and/or change behavior. That could mean going to a gym, changing their diets, spending time meditating, or going to bed earlier. Many health startups offer such interventions that rely on users to contribute much of the value through their own behavior. The challenge is to persuade those users to keep contributing that effort, whether that persuasion works through immediate results (rare), the hope/conviction of their long-term effects, or gamification and social support. Those are the enticements that keep them playing. The benefits managers face a similar challenge with their second constituency – their bosses, who need to be persuaded to pay for the VP programs selected by the employees. (Of course, these programs are considered a cost. Imagine if they could be accounted for as an investment and capitalized. Dream on!) Ultimately, the bosses need to believe that their investment in these programs will show some return, or they will lose interest and reduce the offerings the next time quarterly results are threatened. But when I asked the exhibitors about results, most of the answers were vague. Pretty much every company in the crowded VP tradeshow hall had reference accounts and satisfied customers, but actual health results were scarce. For some employers, employee satisfaction counts. (How many employees picked a particular program? That must mean it’s considered a valuable perk.) But increasingly, employers will ask for more than that. They’ll want evidence of some benefit to their company’s top or bottom line. That’s the enticement that will keep them paying. We need to change the wellness business model, and we need to change how society thinks about

such things. Currently, the “wellness” business model consists mostly of selling cool toys to people who can afford them but often don’t need them. They can be sold directly to consumers, or to employers as perks to attract or retain employees. But this model can’t last. People and institutions will tire of paying for things of questionable utility. Or better yet, if health startups do their job right, society’s understanding of health will expand beyond a vague notion of wellness into seeing it as a valuable asset worth investing in – which will open up the market dramatically. Currently, Medicaid waivers are starting to fund pilot projects around everything from diabetes prevention to housing assistance, from mental health apps to transportation to medical appointments. Likewise, there is a movement among commercial payors prodded by CMS (Centers for Medicare & Medicaid Services) to start paying for future utility with bundled payments and the like, but they’re still reluctant to take the risk of investing in future benefits that may not accrue to them. (That’s partly because of “premium slide” – if they save money, the government takes it back by reducing premiums.) But that’s in the future. What can health startups do now to prove the utility – not just the appeal – of their “health tools”? One measure to consider is how their health tools decrease business costs. For example, churn, a measure of employee satisfaction and engagement, is expensive. There are the visible costs: continued benefits for some employees who leave; the costs of finding, hiring, and training new workers; and the inevitable disruptions caused by changing out individuals for new individuals. Similarly, absenteeism is a reflection of job satisfaction and a range of other factors, including the employee’s health status. Productiv-

“When I asked the exhibitors about results, most of the answers were vague. Pretty much every company in the crowded Virgin Pulse tradeshow hall had reference accounts and satisfied customers, but actual health results were scarce.”

ity metrics are harder to define and measure, but they get you closer to the holy grail of corporate metrics: profits per employee. To help with the business case and the overall argument for investing in health tools, there’s the emerging science of attribution – mostly used in advertising to “attribute” a buyer’s purchase to multiple influences. Multiple things affect a person’s health (or their propensity to stay at a job), but with large enough numbers the patterns become clear. Was it the fitness program? Or was it just that the employee got remarried and is now much happier? Or that the new spouse made them join the fitness program? Like individuals, institutions need to change their behavior (what they pay for) and the mental model that underlies it (the discipline to think long term and see health as an investment that will pay off over years rather than quarters). Even though there’s some role for social norms and self-discipline, I believe that employers and governments and other institutions ultimately will (and should) pay for most of these health tools. After all, they are a long-term investment in the country’s human capital. And while both individuals and institutions can be gamed and incentivized to think long term, institutions can also be regulated in a way that individuals cannot and should not be. So, your task as a health startup is clear. It’s not just selling your health tool. It’s modeling out its impact and figuring out how to make that impact visible. It’s making the case for its short-term impact and also for its longer-term outcomes. Help make the world at large understand the long-term impact of what you can measure only in the short term, for now. Everyone will be healthier and wealthier if you succeed.

S TA R T U P H E A LT H P O R T FO L I O C O M PA N Y

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Howard Krein, MD, PhD

Vision Quest

All across the world, the status quo healthcare system isn’t working. People are suffering and dying from very preventable diseases that we have the knowledge to eradicate. How is it that people anywhere in the world today are contracting measles, mumps or polio? Or dying from cervical cancers that could be avoided through HPV vaccinations? We have excess in so many countries, and yet we’re not doing enough to make sure that we share these technologies, money, or vaccinations with countries that aren’t as well-to-do. We need to do better as a global community. That’s why StartUp Health introduced our health moonshots. Looking at the world in the con-

text of community, I see a pervasive “Us vs. Them” mentality. And we’re spending too much time in that paradigm instead of the “We” paradigm. When we strive to achieve a visionary goal, we can’t do it without shifting our values to We. I’ve been thinking extensively about how to accomplish that, about what that shift means in our everyday lives as physicians and entrepreneurs. StartUp Health’s mission is to improve the health and wellbeing of every person on the planet – it’s not every citizen of the United States, or every person over 5’ 10”, it’s everybody. It’s We, it’s Us. I think the shift in our work begins happening when we realize that all of us on this planet are integrally connected. Part of our mission has to involve continually reminding ourselves of this basic fact. When the pioneering generations of astronauts saw the Earth from space, they experienced a radical shift in perception. As vast as

Chief Medical Officer at StartUp Health Head & Neck Cancer Surgeon at Thomas Jefferson University Hospital Senior Director of Health Policy and Innovation, Sidney Kimmel Cancer Center

the Earth seems to most of us, they saw that Earth is this fragile, solitary, life-sustaining globe of water and oxygen hanging alone in the midst of an expansive universe. Most of the borders that distinguish countries aren’t visible from space. From a distance, the Earth is a singular entity, and everything that has happened in the history of humankind has occurred on this little speck. That comprehension of scale, of unity and disunity, conjures a feeling of awe and dissonance; Earth is small yet massive; it’s powerful yet delicate; cohesive yet fractured. We all can be so caught up in our own sense of ourselves – our individual lives, the identities that define us – that we fail to recognize we all have a common humanity, regardless of what individual communities we’re a part of. So how do we shift into that bigger view? As physicians, we have to realize that, first, we are blessed to be able to help others, and secondly, that there are millions of people in this world that don’t get to receive the level of care we get in the U.S. and could benefit from our expertise. My awareness of the inequity – in the face of the talent and resources we have – makes me driven to give back. Thirteen years ago, I landed in Belize, a country that doesn’t have the resources and systems that we have in the U.S. Performing reconstructive surgeries for cancer, trauma, and congenital defects with those limited resources became a defining milestone in my life. It is here where I reconnected with my dedication to improving the lives of as many people as possible. Every year since then, I’ve returned to Belize. While the conditions are limiting, my team and I use this as a call to action. This past trip, we saw over 150 patients and performed over 50 successful surgeries. This year I operated on a child 29

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whose parents came from Southern Belize. To get to the clinic, the child’s mother and father walked three hours from their village in the jungle just to get to a road where they then hitched a three-hour car ride. From where they got dropped off, they took a bus for 2.5 hours to get to the hospital. On the day after the surgery, this family did the reverse trip of their journey – hours on the bus, then hitching a ride, and walking into the jungle for three hours. In the U.S., these kids would be in the hospital for a week. When you see the level of dedication these families have, it’s absolutely inspiring. It’s humbling to witness the will and the persistence of people to thrive and live in all areas of our world – and to take care of each other. It’s not right that we can’t give them basic medical care. We have to think of this basic level of care as essential as food and water for everyone, regardless of where they live. As a physician, I can help one person at a time. On any given day, maybe I can see forty patients. If I work five days a week, I can affect 200 people a week. Through StartUp Health, and a community of Health Transformers, we can effect change for every person on this planet. As much as I emphasize that physicians need to go on these medical missions, it’s not necessary to go someplace else in the world to create the shift we want. The goal is about working together and effecting positive change, by any means. We have to think about how we can accomplish these visionary goals and shifts in building community and innovation. We want to spark those moments of awe and gratitude that we have when we change people’s lives. And we have to create the framework for other physicians and entrepreneurs to have those experiences and to see the benefit of our moonshot thinking. The health moonshots become 30

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“The skeptics will give you a million reasons why we can’t accomplish a visionary shift. I can give you a million reasons why we need to. I say to them, if you’re not going to help, fine— but don’t stand in my way. This is a rocketship, we’ve filled it with fuel. If you don’t want to be on it, then step back.”

STARTUP HEALTH

HQ 6

Share ideas with thought leaders like Dr. Krein on StartUp Health HQ. 6 startuphealth.com

StartUp Health Magazine

possible through a few key principles – through the commitment, confidence, communication, and other elements of manifesting change. When I tell people we’re going to affect the health and well-being of everyone on the planet, they respond, “Yeah, okay, sure.” Much like they do when they say that we’re going to land on Mars and colonize it. In the 1950s when computers were the size of entire rooms, you would have been ridiculed if you said that one day we could hold a computing device in the palm of our hand that was multitudes more powerful. Our visionary work requires us to think of what we want in the future and then work backwards from there. The purpose of StartUp Health is to gather together the visionaries, to build a community that believes in making the seemingly impossible possible. As a collective devoted to the same goals, we’re greater and stronger than we are as individuals.

Thinking in the framework of “Us vs. Them” limits our resources and the perspectives we bring to solving problems. When we bond together into “We,” we’re able to generate a wealth of insight and inspiration. The skeptics will give you a million reasons why we can’t accomplish a visionary shift. I can give you a million reasons why we need to. I say to them, if you’re not going to help, fine – but don’t stand in my way. This is a rocketship, we’ve filled it with fuel. If you don’t want to be on it, then step back. You don’t need to be involved. We are going to do it. And you know what, when we get to what you thought was that impossible milestone, we’ll be happy to celebrate along with you. The victories we accomplish are for all of us: for We. —As told to Jeremy Lehrer

S TA R T U P H E A LT H P O R T FO L I O C O M PA N Y

HEALTH TRANSFORMERS / Say Hello!

Welcome to the Family Meet the latest Health Transformers to join the StartUp Health portfolio. Say hello! By Nicole Clark

The founders and executives on the following pages run the gamut of experience, from consulting Fortune 100 companies to helping new moms nurse their babies. But each shares a very important attribute. These Health Transformers have left the relative comfort of a predictable career in order to invest their time and energy in world-changing ideas. What’s more, they’ve chosen a health moonshot – from opening up access to care to improving children’s health – to pursue with radical commitment and collaboration.

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Michelle Vick, Jennifer Clary & Doug Wadleigh The Baby Box Co. Health Moonshot: Children’s Health Michelle Vick is a selfdescribed mom-trepreneur. After having her first child, she wanted to help all parents get validated advice on their baby’s health and safety. She and her best friend, Jennifer Clary, teamed up with healthcare organizations to create a trustworthy source of expert parenting information: The Baby Box Co. “We’re addressing a universal parenting concern – how to keep children safe,” says Vick. The company combines an 80-year-old “baby box” tradition from Finland – an actual cardboard box that newborns can safely sleep in – with a digital upgrade in the form of online classes and quizzes about prenatal, infant, and child healthcare. Parents earn rewards for participation. Since 2015, the company has registered 20-30% of the pregnant population in the U.S., Canada, and the U.K. with over one million users.

StartUp Health Magazine

Ulises Chesini Bitgenia Health Moonshot: Cure Disease At Bitgenia, Chesini is pushing the limits of our genetic knowledge. Using bioinformatics and AI, his interdisciplinary team partners with large hospitals to analyze massive amounts of genomic data and clinical records. Their interpretations of the data support early diagnosis and more accurate predictions of diseases. Novartis, for example, uses Bitgenia’s genomic analysis software to diagnose autoinflammatory diseases. “We are in the business of turning genomic data into knowledge that clinicians can use. In order to do that, bioinformatic tools and information technologies are needed,” says Chesini. Currently, the company’s tech is being used across Latin America, including at two major public hospitals in Buenos Aires.

Experts say Finland’s baby box tradition – a bin of baby supplies delivered by the state to expectant moms – has helped the country achieve one of the world’s lowest infant mortality rates. The Baby Box Co. is bringing the tradition to North America, with a digital upgrade.

LATE EDITION Meet the Health Transformers who joined StartUp Health while we were on our way to print. (Read more at hq.startuphealth.com and in Issue #5).

Javier Cardona

1Doc3 Health Moonshot: Access to Care This Colombian startup built a free and anonymous platform where verified doctors answer health concerns 24/7.

Sumeet Maniar

WellBrain Health Moonshot: Addiction

Iyah Romm, Bay Gross & Toyin Ajayi, MD Cityblock Health Health Moonshot: Access to Care Since their launch in 2017, Cityblock Health (spun out of Alphabet’s Sidewalk Labs) has raised more than $85M to build the first tech-driven provider for communities with complex needs. Cityblock’s care delivery platform, Commons, ‘makes health local,’ binding together a complex system of community-based care teams, care delivery workflows, and messy data feeds, to improve the health of members and their neighborhoods. “We bring radically better care to neighborhoods where the healthcare system has let people down – delivering care for medical, behavioral health, and the social challenges people face day to day,” says Romm.

Dinesh Samudra, Abhay Chopada, MD, & Nilesh Jain CliniVantage Health Moonshot: Access to Care CliniVantage is bridging the access to care gap for underserved populations in India and beyond. CliniVantage’s flagship platform, ProCare, is designed for providers and supports appointment booking, remote monitoring, and telemedicine services for the country’s geographically hard-to-reach communities. “We provide healthcare solutions that transform the way care is delivered by putting patients at the center of care,” says Samudra. CliniVantage’s app, MyLife, allows patients to manage their health data by connecting to care providers’ information systems. The company has reached more than 6.5 million users and is actively expanding into Africa and Indonesia.

Andrea Riposati Dante Labs Health Moonshot: Longevity This global genome sequencing and data analysis company wants to see advanced genetics made accessible to everyone on the planet. Dante Labs’ Whole Genome Sequencing offers a deep dive into wellness and longevity, coding over 99% of the genome compared to around one percent for the exome tests. The company also offers a number of more limited risk-targeted tests. In 2019, the company launched a B2B service for healthcare professionals and researchers that combines the advanced analytics and access to genetics expertise that individual customers have come to expect from Dante Labs, with new features and exclusive services.

An evidence-based mindfulness & psychological assessment for patients with chronic pain.

Bryan Mezue

Lifestores Pharmacy Health Moonshot: Access to Care This Nigerian startup created a chronic disease management program and pharmacy chain for African markets.

Mohammad Ali, MD

MyRx365 Health Moonshot: Access to Care A tech-enabled and patientfocused pharmacy fulfillment experience.

Rishi Madhok Rejuvenan Global Health Health Moonshot: Cure Disease

A digital personal health platform designed to prevent, treat and reverse lifestyle-induced chronic diseases.

HEALTH TRANSFORMERS / Say Hello!

Sanj Brar DreamThink Health Moonshot: Mental Health & Happiness At DreamThink, Brar has built the first FDA-cleared sonic treatment for chronic pain. The treatment uses “binaural beats” – think massage for the brain – to get the brain into a brain wave state that increases performance and alleviates depression, insomnia, and chronic pain, all without the use of drugs. Users download the app on their mobile device and choose sessions to listen to from modules for stress reduction to pain management to sleep. Prior to DreamThink, Brar launched NOGGIN for Nickelodeon, which became the highest grossing app for preschool during his time there.

Luca Emili, MSc InSilicoTrials Health Moonshot: Cost to Zero A journalist, a professor, and an entrepreneur, Luca Emili’s cross-disciplinary experience gives him a fresh perspective on one of the most cryptic areas of clinical research: drug development. InSilicoTrials is reducing the cost and time of drug approval by 50%. The company collaborates with pharma and medical device companies to create a secure cloud-based computational hub (think GitHub for drug modeling and simulation). On the regulation side, Emili has started a Research Collaboration Agreement with the FDA. Current customers include Merck, Baxter, and Chiesi Farmaceutici.

Issue 4

Brand Newland & John Greenwood Goldfinch Health Health Moonshot: Addiction Navigating surgical procedures as a patient can feel like walking into a minefield: You don’t know what you don’t know and one misstep in preor post-op care can become a huge – not to mention painful – setback. One of the results of better-navigated surgery is a dramatically lower need for opioid painkillers. At Goldfinch Health, Newland and his cofounder Greenwood are on a mission to reduce opioid use post-surgery – whether it’s an appendectomy or cesarean section – by 90%. They’re doing it through a combination of high-tech and high-touch

StartUp Health Magazine

p People want better health, not more healthcare. At Cityblock Health, leaders meet with members on their terms – in-person or through Cityblock’s digital delivery model.

care. “When StartUp Health announced in early 2019 a moonshot to end addiction and the opioid epidemic, we knew the time was right to get involved,” says Newland. Their target customer? Employers. For employers that use Goldfinch’s platform, their employees are matched with a Goldfinch Guide (nurse navigator and advocate) at the time they need surgery. The nurse, in conjunction with an app,

helps the employee to select a provider, prepare for surgery, navigate recovery, and transition back to work.

Stephanie Canale, MD, & Eric Canale Lactation Lab Health Moonshot: Women’s Health Dr. Canale has been a practicing family doctor for over 10 years. In her quest to develop tools for families of all backgrounds, she launched Lactation Lab. Her team of certified lactation experts and toxicology research scientists developed proprietary methods to analyze breast milk with the intent of developing an at-home test to detect mastitis. “As the first company to offer a com-

photo by Paul Newson

field. At Maverick Medical AI, they are empowering providers with clinical AI technology to ensure proper diagnosis codes are recorded and providers are reimbursed properly. Maverick’s natural language processing deciphers medical descriptors via text and spoken word, and runs real-time analyses to ensure patients are accurately diagnosed, resulting in maximized reimbursement for the provider and more effective disease prevention and treatment for the patient. Last year, the Tel Aviv-based company raised $700,000 to support ongoing development of their tech to help elderly populations and expansion into the U.S. healthcare market.

Angela Dayton & John Dayton, MD MedForums Health Moonshot: Access to Care

plete milk analysis, we provide detailed explanations and actionable insights to make a woman’s breastfeeding journey as empowering as possible,” says Dr. Canale. She envisions a new standard of care for all infants that includes testing milk in order to help mothers determine if supplements are needed and providing guidance on effective doses to improve infant health.

Yossi Shahak & Eran Feldhay, MD Maverick Medical AI Health Moonshot: Cost to Zero Shahak and Maverick AI cofounder Dr. Feldhay bring 40 years of combined experience in the medical informatics

For Angela Dayton, education and health have been the constants amidst a career that’s spanned workforce development at Fortune 100 companies to lifestyle and fitness modeling. In 2018, she launched MedForums, a medical education resource review community focused on improving healthcare, provider to provider. By harnessing the power of crowdsourcing, members receive instant access to

customized resource listings based on their occupation, specialty, stage of training, and preferred learning style. “The medical education market is estimated to top $34 billion by 2024,” says Dayton. “MedForums is positioned to become the one-stop platform that healthcare providers use to read, rate, and review medical education resources.”

STARTUP HEALTH

HQ 6

Say hello to the new Health Transformers on StartUp Health HQ. 6 startuphealth.com

Daniel Warner MediSeen Health Moonshot: Access to Care Before launching MediSeen, Warner interviewed over 1,000 Canadian patients about their experience with the country’s healthcare system. His findings affirmed something he’d experienced himself: a lack of access to care due to overburdened hospitals. At MediSeen, he and his team are addressing that problem by creating a home-based care movement. MediSeen’s platform enables providers to have full control of their mobile care schedule, rates, patient records, and billings. Patients, in turn, can book providers, manage payments, and access their medical records through MediSeen’s app or website. “We envision a ‘clinicless’ future, where healthcare is delivered wherever the patient is,” says Warner.

“We envision a ‘clinicless’ future, where healthcare is delivered wherever the patient is.” -DANIEL WARNER, MEDISEEN

Jennifer Meller, MD, & Kavita Mangal Navimize Health Moonshot: Cost to Zero Dr. Meller (pictured) founded Navimize on a simple premise – eliminate the traditional doctor waiting room. “We’ve witnessed great advances in medicine, yet the very basic experience of visiting the doctor’s office has markedly deteriorated,” says Dr. Meller. The Navimize platform engages with patients in real time, using advanced algorithms that integrate with EHRs to predict delays and eliminate waits and no-shows. Prior to a patient’s appointment, the platform sends an automated text message if their doctor is running behind and provides an updated appointment time. Providers can purchase Navimize for $79 per month, with discounts available to those under athenahealth, their official partner.

HEALTH TRANSFORMERS / Say Hello!

Mark Greget NuEyes Health Moonshot: Access to Care In 2014, as augmented and virtual reality (AR/VR) exploded across every industry, Greget, a medical distributor at the time, wondered: What if this tech could help people see? Two years later, after some manual tinkering with AR/VR headsets and 8-megapixel cameras, he launched NuEyes, and introduced the world to his first iteration of the company’s AR glasses. By setting a proprietary NuEyes’ camera system atop a pair of AR glasses equipped with an IoT device, visually impaired patients are able to stream content in a browser or experience their surroundings in real-time with near-zero latency. The company has sold over 2,000 devices. In 2019, the company is gearing up to rollout NuLoupes, an AR-powered headset that will replace the antiquated loupes used by surgeons and dentists.

Issue 4

StartUp Health Magazine

Zikria Syed & Todd Kueny, Jr. PatientWing Health Moonshot: Access to Care Zikria Syed is a serial entrepreneur with multiple exits in pharma, including NextDocs where he raised $22 million and supported some of the largest pharma companies. In his latest venture, PatientWing, Syed is on a mission to fill every clinical trial with the right patients. PatientWing’s end-to-end patient enrollment platform allows online listing and promotion of clinical trials and provides an easy way to enroll patients. Since its beta launch in 2017, the company has signed 15 paying customers including pharmaceutical companies CSL Behring, Oncoceutics, and Deciphera Pharmaceuticals, and research sites Stanford Health, Mass General Hospital, and Beaumont Hospitals, among others.

“Doctors have too little time to help their patients navigate resources, and the Internet’s self-help offerings can be overwhelming” -ANDREW ROSENBERG, RESPONSUM

Sarah Iranpour

Sarah Davidson

PerSoN Clinic

Resility Health

Health Moonshot: Cancer

Health Moonshot: Mental Health & Happiness

At PerSoN Clinic, Iranpour’s aim is to unlock the hidden impact of environment and comorbidities on oncology treatment outcomes. The PerSoN Clinic platform is a healthcare delivery system that gives patients suffering from cancer, depression, and smoking addiction – three highly comorbid conditions – a voice in treating their illness and addiction. PerSoN houses a patient’s clinical and outcomes data, tracks their treatment progress, and allows them to collaborate with their care team and access information through a peer network. The app’s smoking cessation tool was designed in collaboration with the National Institute on Drug Abuse. PerSoN also features an NCI-compliant toxicity-related symptoms tracker for patients going through radiation therapy.

Resility was founded in 2016 after Davidson, who had suffered from chronic pain for years, realized the source of her pain was stress. “People have these health problems, and they try a lot of things that don’t help because they haven’t addressed the root cause,” says Davidson. The company takes proven stress management techniques like mindfulness, visualization, and breathing exercises and pairs them with biofeedback from wearable sensors to generate a Resility™ Score so that people can actually see what’s happening in their body and track changes over time. Using predictive analytics, they customize stress management programs to optimize their effectiveness for each person.

Andrew Rosenberg

Mylea Charvat, PhD

Responsum

Savonix

Health Moonshot: Access to Care

Health Moonshot: Brain Health

A former staff member for Senator Edward M. Kennedy on the Health, Education, Labor and Pensions Committee, Rosenberg has been a DC-based healthcare policy expert for nearly two decades. At Responsum Health, he and his team have harnessed the power of the Internet to better inform patients suffering from rare diseases. Their flagship patient news service, Responsum for Pulmonary Fibrosis, replaces a patient’s own web search with a disease-specific, online experience that culls together content from legitimate news sources and is vetted by medical advisory teams. “Doctors have too little time to help their patients navigate resources, and the Internet’s self-help offerings can be overwhelming and inaccurate,” says Rosenberg. “Responsum’s vision is for a continuously curated and expertly-vetted news feed.”

In 2014, Dr. Charvat walked away from a path to professorship as a clinical psychologist and translational neuroscientist in order to answer this question: How do we assess the mental health of patients on a large scale? At Savonix, Dr. Charvat has assembled a community of leading scientists – Alzheimer’s researchers, learning sciences experts, the author of ‘The Female Brain’ – who’ve developed the world’s first app for neurocognitive assessments, Savonix Mobile. The app makes notoriously pricey brain health screenings available to the masses, improving prevention and treatment of dementias like Alzheimer’s. “At Savonix, we believe there is no mental health or physical health – there is just health,” says Charvat. The 30-minute assessment is available via a license from healthcare organizations and other third-party partners. Savonix recently raised a $9.6M extension round bringing their total Series A raise to $14.7M.

Savonix Mobile is just the tip of the iceberg when it comes to Charvat’s efforts to revolutionize brain health. The company is embarking on a landmark population health study to collect cognitive and brain health data digitally from 400,000 individuals. The patient registry will offer new insights into risk factors for dementias like Alzheimer’s.

HEALTH TRANSFORMERS / Say Hello!

Laura Yecies & Jamshid Ghajar, MD SyncThink Health Moonshot: Brain Health At SyncThink, Yecies is using her more than 25 years in tech product development to go after a brain health moonshot. The neuro-technology and brain health analytics company was founded in 2009 and develops eye-tracking technology analytics that give medical professionals objective metrics. SyncThink’s first product, EYE-SYNC, uses eye tracking to evaluate for the two most common and serious components of a concussion. “Despite the importance and frequency of brain health conditions, the current diagnostic tool set is highly subjective and inaccurate,” says Yecies. “SyncThink is going beyond diagnosis to provide recovery and performance maximizing tools that help people be their best selves.”

Arif Quronfleh & Ziad Ghannoum Tahmo Health Moonshot: Access to Care Quronfleh knows what it’s like to be up in the middle of the night tending to feverish children. His sleepless nights were the catalyst for developing smart technology that remotely monitors a patient’s temperature and humidity levels, whether they’re inside the walls of a hospital or in the comfort of their own home. “We wanted solutions for problems we faced with our

Issue 4

own children and we knew others shared our pain,” says Quronfleh. Their first product, Tempi, is a wearable Bluetooth device that measures temperature and humidity, displays the data on your smartphone, and can expand its monitoring range when connected to wifi via the Tahmo Hub. Currently in development, Tahmo Thermi is a wearable body thermometer that will allow for continuous tracking of body temperature. All of the products are designed with the aim of helping underdeveloped countries where availability of medical personnel is limited.

StartUp Health Magazine

helping patients visualize their pain management progress and enabling providers to monitor treatment progress from a mobile platform. Ouchie connects patients to a supportive community and their clinicians, helping them better manage their symptoms and treat their pain. The platform is the official patient engagement app of the U.S. Pain Foundation.

Alex Jimenez-Ness & Carlos Garcia Welwaze Medical Health Moonshot: Cancer

Rachel Trobman, Jason Trobman & Rachel Brandt Upside Health Health Moonshot: Access to Care The Trobmans developed Upside Health’s mobile companion for chronic pain management, Ouchie, while simultaneously running a production company, remodeling their first home, advising other startups, and raising a two-year-old. At Upside Health, the Trobmans, along with co-founder and product management expert Brandt, are

After watching many friends and family members suffer from breast cancer, JimenezNess, a long-time private equity investor, decided to invest his time and resources into early breast cancer detection technology. Together with Garcia, most recently the former president of Novartis Pharmaceuticals for the Latin America and Canada Region, they have developed a portable, noninvasive device that consists of two disposable pads with photochromic sensors that are self applied to each breast for 15 minutes. Celbrea’s Thermal Mapping Device (TMD) works by reporting average temperature differences between breasts, which indicates a potential underlying pathology such as breast cancer. Celbrea TMD can be used by physicians as an adjunct to routine physical examinations like mammograms and other established procedures for the detection of breast disease.

S TA R T U P H E A LT H I N V ES T O R

WHERE BIG IDEAS TAKE FLIGHT

Together we can discover new paths in health care, explore uncharted territories and guide the future of health.

guidewell.com 39

HEALTH TRANSFORMERS

Moonshot Momentum A progress report on Health Transformers and companies making leaps within the StartUp Health portfolio. By Eisa Ulan & Anne Dordai

Access to Care Cityblock Health Iyah Romm, co-founder & CEO, was a C-suite partner at Commonwealth Care Alliance, an integrated provider with $1B+ revenue. Cityblock Health is providing better care for neighborhoods, block by block. With its recent $65M Series B investment led by Redpoint Ventures, with participation by StartUp Health, Cityblock is the first tech-driven provider for communities with complex needs. The company scales primary care, behavioral health, and social services with custom-built technology and invests upstream in highly personalized, prevention-oriented health and social care to drive down costs and improve outcomes. Through collaborations with EmblemHealth, ConnectCare, and Blue Cross and Blue Shield of North Carolina, Cityblock has exceeded projections while bringing better care to lowerincome neighborhoods in the states that these three leading

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health plans serve. (Read more about Cityblock Health on pages 33 and 64.)

Cloudbreak Health Jamey Edwards, co-founder & CEO, is a 4x Ernst & Young Entrepreneur of the Year honoree and grew his last health company to $150M in revenue. Cloudbreak Health is on a mission to remove the distance and language barriers within healthcare that reduce patient care. What began as a leading solution for video remote interpretation is now a unified telemedicine platform delivering multiple specialties over their proprietary broadband network. Today, Cloudbreak provides solutions to more than 1,000 hospitals across the U.S. and supports more than 85,000 patients each month in an effort to #HumanizeHealthcare.

StartUp Health Magazine

Doctor.com

MouthWatch

Andrei Zimiles, co-founder & CEO, previously co-founded and sold Dimestore Media and was an early employee at Game Trust.

Brant Herman, co-founder & CEO, was a Bullwater Health & Fitness founding member and Prestige Intl. director.

At a time when 80% of consumers are going online to find care, Doctor.com empowers healthcare organizations with the first true platform for patient-provider connections. More than 25% of U.S. physicians trust Doctor.com as the â&#x20AC;&#x153;source of truthâ&#x20AC;? for their online identity, including physician data, patient reviews, and online appointment scheduling. Doctor.com has hundreds of thousands of detailed provider profiles complete with photos, biographies, and patient ratings, and is integrated with nearly every major consumer healthcare destination, including Google, Yelp, Healthgrades, and Vitals, as well as 50+ EHR platforms and multiple credentialing, CRM, and patient survey solutions.

MouthWatch is on a mission to develop dental products and telehealth solutions that increase access to care, boost practice revenue, and improve the dental experience. For dental professionals, large group practices, public health programs, and managed care settings, MouthWatch extends care to patients with limited access and boosts treatment understanding and acceptance. Their intraoral camera boasts nearly universal compatibility with the digital x-ray software used by oral health professionals. The company has increased the presence of MouthWatch Intraoral Cameras to four of the top five Dental Service Organizations in the U.S. Last year MouthWatch started the Teledentistry Innovation Awards, and this year MouthWatch launched a redesigned teledentistry platform, TeleDent 2.0.

t Particle Health CEO Troy Bannister and CTO Dan Horbatt outside the companyâ&#x20AC;&#x2122;s HQ in Dumbo, Brooklyn.

SAFE Health Lauren Weiniger, co-founder, previously worked at Citigroup, Abraxis Bioscience (acq. By Celgene $2.3B), Global Viral Forecasting, TAU investment, and Grameen. For sexually active singles who want to protect themselves and their partners from STDs, the SAFE App from SAFE Health lets people show their verified STD status on their phone and confirm their partnerâ&#x20AC;&#x2122;s status, removing the stigma and limiting the spread of sexually transmitted diseases. Since the SAFE App launch in April 2019, there are now 16,000 users on iOS, growing 120%+ month-overmonth. In the last two quarters, SAFE signed three dating apps for SAFE Badge integration and, during WorldPride in NYC, announced the first ever SAFE Badge on dating app HUD (7M DAU). Consistent with their goal of reducing the costs of low complexity diagnostics and care, SAFE Health partnered with the Mayo Clinic and American College of Gynecologists to further develop the Care Automation Framework, beginning with the complex protocol for prescribing birth control.

t SAFE Health co-founder Lauren Weiniger is on a mission to remove the stigmas surrounding STDs by empowering people to easily share their STD test status.

HEALTH TRANSFORMERS / Momentum

Trusty.care

Cost to Zero

Joseph Schneier, founder & CEO, has two exits and more than 10 years of leadership in health and education. He’s a TED speaker and board member of the Stonewall LGBT Aging Org. Trusty.care is a data-driven platform designed to save seniors from bankruptcy caused by healthcare costs. Trusty.care uses predictive analytics to track and notify organizations of ways their older customers can save. In just one year of operation, Trusty.care has integrated with the Center for Medicare & Medicaid Services’ (CMS) Blue Button 2.0 to help simplify the Medicare comparison plan process and is listed on CMS’s page of recommendations for beneficiaries to organize and share medical information – one of only 17 organizations to do so. (Read more about Trusty. care on page 56.)

@Point of Care Robert Stern, founder & CEO, spent 40 years as Projects in Knowledge CEO and sold MedPage to EverydayHealth. Providing rapid, targeted, evidence-based clinical decision support, @Point of Care offers over 300,000 physicians access to more than 30 therapeutic categories during the practice day. This evidence-based information is updated daily with the guidance of over 300 physician thought leaders. For providers who need to improve quality outcomes, @Point of Care provides a comprehensive knowledge base and allows patients to share data with their clinician. A completely revenue-funded company with no outside investors, @Point of Care enables moment-of-care connectivity with validated measures, EMR integration and data analytics.

Biome Analytics Stuart Jacobson, founder & CEO, is the former CEO of Gehry Technologies and Kivera, a telecommunications system. Biome’s mission is to help doctors and hospitals work together to provide better, lower-cost care to the 27 million Americans suffering from heart disease. The company delivers a new generation of clinical performance applications that bring hospitals and doctors together around a trusted data source, clinically relevant benchmarks, and actionable insight. In less than a year of use, Biome clients have discovered millions in savings: $2M percutaneous coronary intervention (PCI) direct cost savings, $3M transcatheter aortic valve replacement (TAVR) direct cost savings, and identification of $1.7M cost misallocation. They’ve also seen a three-day reduction for the length-ofstay after a TAVR and and a decrease in mortality by 35.7%.

CliniVantage Healthcare

In transcatheter aortic valve replacement (TAVR), Biome Analytics has seen $3M in direct cost savings, a three-day reduction for the length-of-stay and a 35.7% decrease in mortality.

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StartUp Health Magazine

Nilesh Jain, co-founder & CEO, served as CEO at more than five companies, guiding healthcare organizations in tech implementation. With a goal of “One Citizen, One Record,” CliniVantage is a smart future facing healthcare solution that was designed to transform the way healthcare stakeholders interact with each other. This digital data mobility platform empowers consumers with mobile applications and health providers with an end-toend PaaS-based solution that integrates operational, clinical, administration, financial, and consumer-centric services. With presence in India and

expansion into Africa, CliniVantage already reaches 6.5 million patients with its future-facing system. (Read more about CliniVantage on page 33.)

Inbox Health Blake Walker, co-founder & CEO, was the co-founder at iQCoPay where he designed and built consumer bill management and payment tools. By reducing paper bills by 95% and increasing patient support, Inbox Health makes every patient payment experience convenient and clear. A patient revenue platform founded in 2014, Inbox Health delivers a personalized patient billing experience that minimizes waste and improves payment metrics. The company grew 500% in the last 12 months while helping more than 200,000 people have a better billing experience.

Particle Health Troy Bannister, MS, founder & CEO, studied physiology & biophysics. He ran five clinical trials at Mt. Sinai and vetted hundreds of startups at StartUp Health. Particle Health believes medical records should be available to every person for free. Particle offers an integrated HIPAA authorization platform that finds, aggregates, and normalizes digital medical records for healthcare solutions that require medical data. Particle Health’s Smart Consent tool tracks and unlocks patient information for clinical trials and life insurance underwriting. The company was backed by Collaborative Fund this year in a $2.5M Seed round, with participation by StartUp Health. (Read more about Particle Health on page 14.)

t AdhereTech’s proprietary software analyzes realworld adherence data and uses the information to improve patient care and provide actionable insights into the patient journey.

Cure Disease AdhereTech Josh Stein, co-founder & CEO, is a Wharton MBA graduate and TEDMED speaker.

Vive (fka emPower Health Equity) Ronald Weidner, founder & CEO, spent 35 years in financial services. He was the CIO at Allianz and co-founder of WestWind Capital Partners. This health plan management application and medical payment card seeks to universalize financial security by insuring patients covered by high deductible health plans and giving them access to care in times of need. Vive is backed by a credit program that supplements health savings accounts for employees and is set to

launch a second pilot with an organization based in Nashville in October 2019.

Wellthie Sally Poblete, founder & CEO, has 20+ years of experience in leading teams in VC-backed startups and Fortune 500 companies. Wellthie provides the largest health insurance marketplace for small businesses to modernize their healthcare shopping experience. By combining its powerful, enterprise-grade platform with a simple, smart digital experience and the sup-

port of expert brokers, Wellthie offers business owners the largest aggregated plan library of health insurance products. Recognized as one of Digital Insurance’s Top 30 Innovators of 2019, Wellthie raised a $5M Series A from investors including IA Capital Group and Aflac Ventures.

AdhereTech connects patients to better care through the use of clinically-proven patient support programs and connected devices. Used by tens of thousands of patients through partnerships with some of the largest healthcare companies in the world, the AdhereTech platform helps patients stay on their medication longer and with increased adherence while they are receiving therapy, driving additional fills of medication per patient per year. AdhereTech’s proprietary software analyzes real-world adherence data and uses this information to improve patient care and provide actionable insights into the patient journey. Partnering with many of the world’s largest pharmaceutical companies, AdhereTech is distributed by seven of the top 10 specialty pharmacies in the U.S.

HEALTH TRANSFORMERS / Momentum

Cecelia Health David Weingard, founder & CEO, has 20+ years of sales experience and previously worked in business development at Microsoft. With a goal of transforming the lives and significantly improving the health outcomes of people living with the trilogy of chronic diseases that impact patients – diabetes, cardiovascular disease, and obesity – Cecelia Health is a tech-enabled diabetes and chronic disease management coaching solution that enables Certified Diabetes Educator Clinicians to scale their reach and offer 1:1 costeffective, high-volume care. Today Cecelia has expanded into the self-insured / employer marketplace and secured new medical device and pharmaceutical partnerships, as well as partnerships with the Jaeb Center for Health Research (JCHR) and the Helmsley Charitable Trust. These relationships allow Cecelia to test the “Geek Squad” concept with patients – a vision of JCHR to move beyond just support and become a more fully-integrated virtual clinic that includes clinicians capable of writing prescriptions, and to combat the lack of access to CGM systems in rural America. (Read more about Cecelia Health on page 16.)

Cohero Health Joe Condurso, CEO, has 20+ years of health operations experience and was previously VP at Motorola Healthcare Group and Cardinal Health.

function and track adherence, and it enhances clinician decision-making through its connected HeroTracker® devices and BreatheSmart® mobile application. Cohero has expanded BreatheSmart functionality to all modes of medications types, including inhaled medications, nebulizers, tablets, and injectables; and the platform was chosen as the subject of a 2017 NIH observational study – the largest asthma clinical study of its kind. In 2018, Cohero launched a direct-to-consumer (DTC) channel for pediatric asthma patients and caregivers and, in May 2019, achieved ISO 13485 Certification.

Conversa Health West Shell III, co-founder & CEO, was formerly chair and CEO of Healthline, CEO of Netcentives, and founder & CEO of Sapias. Conversa’s goal is to make conversation the cornerstone of health. Utilizing AI technology to draw from a robust library of over 500 “clinically intelligent” conversations, Conversa employs behavioral science methodology to spark deeper motivation in patients that need it most. With personalized, automated virtual care based on dynamic patient profiling in order to monitor, manage, and engage populations at scale, Conversa is being selected for enterprise commitments by large innovative health systems and partners, including Northwell Health, University Hospitals, and Allscripts.

Cohero Health envisions a world without respiratory disease. The medical technology manufacturer empowers patients to measure their lung

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StartUp Health Magazine

Cyclica

Joint Academy

Naheed Kurji, CEO, specializes in corporate finance and has M&A and investor experience.

Jakob Dahlberg, co-founder & CEO, has an extensive product and business background.

With a goal to reduce the time of drug discovery from seven years to two years, and to get the best medicines with greater precision and efficacy in the hands of patients, this Torontobased company enhances how scientists design, screen and personalize medicines. With its recently launched Ligand DesignTM platform that complements its existing Ligand ExpressTM technology, Cyclica provides the pharmaceutical industry with an integrated, holistic, end-to-end enabling platform focused on polypharmacology. Cyclica’s integrated, cloud-based, AI-augmented platform has raised $12.5M to date, and the company was recently named one of the World’s Top 20 AI Drug Development Companies by Forbes.

With $10M raised and presence in four markets – Sweden, Norway, the U.K., and the U.S. – Joint Academy has treated 10,000 patients since its founding in 2014. Joint Academy’s mission is to empower and support people to restore movement by connecting patients with physical therapists to deliver an evidence-based online treatment for osteoarthritis, covered by health plans. With six peer-reviewed articles published and 100 physical therapists working on the platform, Joint Academy brings together science, technology, and empathy.

Ten years ago, Leif Dahlberg created Sweden’s Gold Standard for arthritis treatment, then his son, Jakob (pictured), digitized it. Now, the father-son duo are deploying their platform in the United States. q

Nightingale Health

SOLIUS

Teemu Suna, co-founder & CEO, MS in Industrial Engineering and Management, with over 15 years of IT experience.

Rick Hennessey, CEO, has five successful exits. The last exit was $116M+ in four years on $7M capital raised.

Nightingale is a biotech company solving the global burden of chronic diseases by providing a metabolic profiling technology that measures blood biomarkers. For life sciences researchers, healthcare professionals, and individuals, Nightingale enables comprehensive insights into future disease risk and the effects of lifestyle factors on health. The European Investment Bank recently provided €20M in funding, and Nightingale earned certification for its laboratory from the Finnish Accreditation Service, a testiment to its test precision. (Read more about Nightingale on page 50.)

Qura Doug Adams, founder & CEO, has 15+ years of ophthalmic experience and founded SOLX. Using wireless implantable pressure sensors and data analytics, Qura offers physicians more information about their patients’ needs through “disease intelligence.” Micro-injectable implants give doctors real-time data about their patients, reduce office visits, and allow doctors to anticipate disease progression. Qura has more than $8M in funding led by Infocus Capital Partners and Santen Pharmaceuticals, with participation by StartUp Health; a pre-clinical study demonstrating safety; more than 60 issued, licensed, or pending patent applications; and a team of more than 40 executives, scientists, and researchers. (Read more about Qura on page 60.)

Sanguine Biosciences Brian Neman, founder & CEO, is an adjunct instructor of digital health at the USC Price School of Policy. Sanguine Biosciences puts patients in charge of their health data in order to accelerate medical research and make precision medicine the standard-of-care. For pharmaceutical companies developing precision medicine solutions, Sanguine’s Trial Match® is a platform that builds Sanguine Verified Patients® communities for its pharma clients, enabling them to complete clinical trial enrollment and launch their products ahead of schedule. Sanguine was awarded a National Science Foundation Small Business Innovation Research grant to conduct research and development work on creating a data platform that stores and organizes electronic patient data.

To achieve the health moonshot of preventing disease without the use of pharmaceutical drugs, SOLIUS is using advanced light science in a revolutionary way. Starting with Vitamin D deficiency, SOLIUS’ self-care machines provide over 10 times more Vitamin D than an hour of midday summer sunlight, with only nine secondsworth of exposure to UVR. Winner of a National Football League “1st and Future” Innovations to Advance Athlete Health and Safety Competition prize, SOLIUS successfully launched in Canada in 2018.

Vheda Health Shameet Luhar, co-founder & CEO, was an early member at Resolution Health (acquired by Anthem for $200M). With high-touch, tech-enabled services, and partnerships with the nation’s top three Medicaid payers, Vheda Health is on a mission to eliminate costs from the health insurance system. For Medicaid and Medicare health plans that need to decrease hospitalization and ER expenses for non-compliant chronic members, Vheda Health is a member compliance company that saves an average of $17,175 per member per year by automating care plan compliance. Since 2013, Vheda Health has delivered an average 51% reduction in per member per year cost and demonstrated an average 40% reduction in ER visits, inpatient admissions, and inpatient days. (Read more about Vheda Health on page 56.)

HEALTH TRANSFORMERS / Momentum

Women’s Health Babyscripts Juan Pablo Segura, co-founder & president, has more than five years of accounting and finance experience, and was previously a consultant at Deloitte. To fulfill their health moonshot mission to make better pregnancies possible for all women, especially the most vulnerable, Babyscripts helps providers deliver an enhanced pregnancy experience for their patients with the most comprehensive and clinically validated maternity program that helps manage expecting moms virtually. The company recently partnered up with Penn Medicine to develop a product that is able to remotely monitor postpartum hypertension and get new moms the care they need more quickly. The Babyscripts team has raised $6M, led by Philips, with participation from INOVA and StartUp Health.

Children’s Health CareDox Heskey Kutscher, founder & CEO, served 8 years as chairman of High Gear Media, which was acquired by Internet Brands. CareDox’s mission is to be the most effective system to engage families, communities, and providers in the coordination of quality healthcare. An activation and care coordination platform for American schools, CareDox enables all stakeholders in the pediatric healthcare ecosystem to work together to achieve optimal outcomes for kids by delivering crucial health information more efficiently

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and safely for public schools that serve as the frontline of pediatric care. Since its 2014 launch, CareDox has grown to provide 4.9 million health records across 7,100 schools in more than 30 states.

The Baby Box Co. Douglas Wadleigh, CEO, spent 18 years leading global creative & business development teams, managing billion dollar portfolios for Mattel, Warner Bros & Loot Crate. The BabyBox Co. is creating a safer world for all kids through confident, well-educated parents. The Baby Box Co. is an educational platform that provides interactive educational materials and rewards for all new parents and caregivers. Once a parent has completed a lesson, they gain access to exclusive rewards (including BabyBoxes, safety and care products, and product vouchers) to help assist them on their journey through parenthood.

StartUp Health Magazine

p In 2014, Dr. Mylea Charvat (right) walked away from a path to professorship as a clinical psychologist and translational neuroscientist in order to answer a question: How do we assess the mental health of patients on a large scale? The result? Savonix, a company on a mission to democratize brain health.

They have registered 20-30% of all pregnant women within the U.S., Canada, and the U.K. with a total of over one million users. They are able to support parents and caregivers even further by rewarding them with products from partners like Michelin, Fair, Lansinoh, Nurx, Thrive Market, Huggies, and many more. (Read more about The Baby Box Co. on page 32.)

“We’re addressing a universal parenting concern – how to keep children safe.” -Michelle Vick, The Baby Box Co.

Brain Health Savonix Mylea Charvat, PhD, cofounder & CEO, has several peer reviewed publications, completed a fellowship in clinical neuroscience at Stanford & is a lecturer at Stanford, USF & San Francisco State University. The Savonix vision is a world without dementia. A neurocognitive assessment and data centralized system, The Savonix Digital Cognitive Assessment Platform provides a simple and cost-effective way to gauge cognitive function, to organize, store, and gather insights from cognitive data and to provide clinical support to improve patient outcomes and accelerate medical innovation. This year they will launch a landmark study in partnership with a top-tier school of public health to collect cognitive and brain health data from 400,000 individuals and create a patient registry that drives improved pre-clinical classification of risk factors for dementia, including Alzheimer’s Disease. (Read more about Savonix on pages 37 and 77.)

SyncThink Laura Yecies, CEO, is the former CEO of Catch and SugarSync, as well as a former VP at Netscape, Yahoo, and CheckPoint. SyncThink aims to accurately diagnose brain conditions and optimize performance. A VRbased eye tracking platform that can access brain health and improve brain performance, SyncThink provides objective metrics and proven methods to optimize performance for sports medicine clinicians,

neurologists, athletes, and patients. In addition to clinical partnerships with Houston Methodist, NeuroSport, DC Children’s Hospital, and Stanford, SyncThink has secured multiple athletic partnerships, including the Premier Lacrosse League and Tulane Athletics. To deliver their next-generation hardware platform, SyncThink partnered with Magic Leap and is providing unique brain health data access for student athlete research with QuesGen. (Read more about SyncThink on page 38.)

Mental Health & Happiness Valera Health Thomas Tsang, MD, co-founder & CEO, is a former Merck CMO, congressional staffer who rolled out the ACA, and medical director at ONC. 25 million Americans have untreated behavioral healthcare needs. Valera Health wants to take care of all of them. Valera is an analytics and technologyenabled behavioral health service company that delivers team-based care for patients with health conditions, such as depression and schizophrenia. The Valera team has partnered with various payers and provider organizations, including Montefiore Health System, Northwell Health, Carisk Partners, and Group Health Eau Claire, to reach 1.2M lives covered. With Valera, organizations and plans can scale impact, empower self-care, and connect to patients when it matters.

Longevity CarePredict Satish Movva, founder & CEO, is a serial entrepreneur who grew his last startup ContinuLink to $700M in transactions before sale. CarePredict enables seniors to age independently, at a lower cost, and to live longer at home or in group living settings by using continuous machine observation, remote sensing, and deep learning of activity and behavior patterns to trigger early observations. CarePredict launched in the U.S. private pay home care market with multiple franchisors and recently in Japan with the country’s largest senior living operator. A member of the CES/CTA AI in Healthcare standards body along with Phillips, the company won the CES/CTA 2019 Accessibility Award for Senior Care. CarePredict announced at CES 2019 the launch of a B2C product in the U.S. and raised a $9.5M Series A round, with participation by StartUp Health.

Devoted Health Ed Park, co-founder & CEO, previously co-founded athenahealth, where he served as COO and president of services. Devoted Health is on a mission to build a healthcare solution “good enough for Mom.” They help members navigate the healthcare system with personal guides, by utilizing world-class technology to enable a simplified experience, and by partnering with top providers for better health outcomes. Devoted Health launched in Florida, following a $362B Series B raise in 2018, led by Andreessen Horowitz,

with participation from Venrock, F-Prime Capital Partners, and StartUp Health. (Read more on page 56.)

LifeDojo Chris Cutter, founder & CEO, previously led a White Housesupported NYC public health program. LifeDojo is on a mission to deliver the right health solutions, at the right time, in a way that works for every individual, by focusing on small wins. LifeDojo solves the employer’s crisis of under-utilized disease management, behavioral health, and wellbeing benefits through an all-encompassing employee behavior change engine that encourages employees to make small lifestyle changes before taking on the more intense ones. In 2018, LifeDojo grew more 400%, and counts Airbnb, Goodyear, and Adobe as its partners.

Zeel Samer Hamadeh, co-founder & CEO, is an entrepreneur with over 20 years of experience and several successful exits (Dotmenu Inc, Get Maid). In 2012, Zeel became the first company to bring same-day, ondemand massage to customers in their homes, hotels, spas, and offices. When customers book a massage through Zeel, a licensed, experienced massage therapist delivers a menu of options where they live, work, and travel nationwide. Now, Zeel is a rapidly-growing global brand transforming wellness, recently adding yoga and meditation options for their 2,000 corporate wellness partners in 100+ cities.

FEATURES

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StartUp Health Magazine

Blood Work

Teemu Suna and his team at Nightingale are reinventing chronic disease diagnostics.

Medicare 3.0

How Health Transformers are partnering with Medicare to improve health outcomes.

Small Wonder

Doug Adams of Qura is poised to usher in a new era of disease intelligence.

A Pound of Prevention

Iyah Romm, Bay Gross and Toyin Ajayi, MD, co-founders of Cityblock Health, are proving the value of personalized preventive care for underserved populations.

The 8 Health Moonshot Principles

Our blueprint for achieving the impossible

Blood Work

With Nightingale, Teemu Suna and His Team Are Reinventing Chronic Disease Diagnostics

After five years of perfecting their tech, the Finnish blood testing startup is ready for a global roll-out.

By Nicole Clark

Aki Koivistoinen made his way to a clinic for Nightingale’s new biomarker test, Virta 360, clinicians were already well-versed in the single-sample ‘blood check-up.’ It was June 2019, and even though Koivistoinen was fighting a summer cold, he was eager to give the test a whirl. Six months earlier, when Nightingale announced at Slush Helsinki 2018 (a 25,000 attendee startup and tech event) that event attendees could have a blood test taken at their Virta 360 booth, Koivistoinen, a native of Helsinki, was ready with credit card in hand. But time slots sold out within two hours. Everyone from the UN Assistant Secretary-General for Strategic Coordination, Fabrizio Hochschild Drummond, to the Former Finnish Prime Minister, Alexander Stubb, made stops at the kiosk. Koivistoinen would have to wait. The company’s comprehensive blood BY THE TIME

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StartUp Health Magazine

panel gives extensive metabolic snapshots of a person’s health, like a sort of molecular xray. The cost is €89, or around $100. That’s twenty times less than what labs would typically charge for the same panel, so the tests flew off the proverbial (digital) shelves at Slush. Half a year later, Nightingale’s blood analysis was being rolled out to health facilities like Helsinki’s downtown Aava Medical Centre where Koivistoinen went to have his blood drawn. After a quick check-in at Aava, a nurse took a 2ml blood sample and reminded a feverish Koivistoinen that his elevated temperature may impact results. His sample was sent to an NG Health Lab for analysis, and two working days later, his health report was in his email inbox waiting for him. “Nightingale’s test is a prime example of how new digital health tools give you, the patient, the ability to directly monitor

changes in your health,” says Koivistoinen. “With this metabolic analysis I can make lifestyle changes and take action to protect my health before anything happens.” Finnish health and wellness enthusiasts like Koivistoinen aren’t the only ones with access to the new metabolic test. After five careful years of refinement, Nightingale’s analysis, which can improve the prediction of diseases like heart disease and diabetes – Europe’s answer to the Theranos debacle – is coming to a lab near you. Weeks after Nightingale sold out of the blood check-up test at Slush in December 2018, the company received a €20 million European Investment Bank loan to accelerate R&D. Founder, CEO, and Chairman of Nightingale, Teemu Suna spent the winter jet-setting from Tokyo to Hong Kong to Singapore, introducing his company’s technology to insurance carriers that want to

Photos courtesy of Nightingale

add the company’s blood test service to their offerings. By summer of 2019, Nightingale was exporting their tech across the pond. In June, while Koivistoinen was reviewing his Virta 360 health analysis report in Helsinki, Nightingale was expanding its operational capacity to receive and process samples within the U.S. It’s a step towards actualizing the company’s ultimate vision: integrating their blood analysis technology into global clinical practice. The new regional service is made available through PerkinElmer Genomics’ clinical laboratory in Pittsburgh, which is certified through the College of American Pathologists and CLIA (Clinical Laboratory Improvement Amendments). The lab processes more than 500,000 blood samples a year. Setting up shop on the U.S.’ East Coast removes the need to transport samples to the European Union, with all sample handling, shipping, and analysis being carried out domestically. Nightingale’s ability to quickly scale the blood biomarker tech in a world still reeling from the Theranos fallout tells us two things: 1) the company is doing something

“Because Nightingale has such large amounts of data, we can build more individual risk models for different age groups, different genders, different ethnicities, and so on.”

markedly different than their counterparts in the direct-to-consumer blood test race; and 2) patients are ready for a paradigm shift in healthcare, moving from reactionary to preventative care. “People are really interested in their health, but right now we have ‘sick care’ not healthcare,” says Suna. “The reason for the pilot in Finland was to counter the chatter that we’ve heard claiming people are not interested in their own health. I disagree with that quite strongly. I think the problem is that people are not being offered the tools to understand the status of their health.” Here’s how it works. Once someone, like Koivistoinen’s, blood sample is received, Nightingale’s technology analyzes blood samples using nuclear magnetic resonance (NMR) spectroscopy. Think of NMR as

a cousin to the MRI, which uses similar principles of magnetic resonance to create pictures of the inside of the body. The blood analysis is converted and combined into a spectrum that Nightingale’s advanced statistical software transposes into readable measurements. The measurement of biological molecules, or biomarkers, present in blood (e.g. glucose, lipids, and amino acids) provides a bird’s eye view of a person’s health. Nightingale’s biomarker analysis technology uses a technique that measures over 220 biomarkers from a single blood sample, which is about 40 times more than what the average clinician assesses. The result of this wizardry under the hood? Nightingale’s biomarkers can detect a disease 10 years before its onset. Metabolic blood tests like Nightingale’s

Across: Founder Teemu Suna. This Page: Suna and the Nightingale team have put a premium on transparency. They published their ground-breaking findings (in 170+ journals) for all to see, and use.

are far more accurate than DNA tests that use saliva, like what 23andMe offers. Our metabolism affects more than our girth. Metabolism involves any way our bodies convert or use energy. That includes digestion, breathing, circulation, and the functioning of our organs, muscles, and nervous system. Metabolic blood panels show us how well our body is keeping all of its systems humming along. For Koivistoinen, he was pleased to see that based off of his Virta 360 analysis, it was all-systems-go. Detailed lipid measurements confirmed that his cholesterol and triglycerides were all within normal range, which places him in a low-risk category for type 2 diabetes and cardiovascular disease. The fatty acid panel showed that he could stand to work omega-3’s into his diet a little more. Although Koivistoinen previously studied medical biochemistry and gene transfers and is a health innovator himself, he noted that the report was easy enough for his dad – not a health scientist – to read. “We haven’t had this kind of 360-view of health before,” says Koivistoinen. “If we started to use Nightingale’s metabolic test

from birth, along with genome analyses, and mapped out our health every few years, we would be unstoppable in a move to predictive health.”

The Problem with Blood Tests Today it would have been near impossible for Koivistoinen to get the same blood panel that Nightingale’s test offered. Not just because of the steep price to run the 200+ assays, but because healthcare systems, whether in Finland or the U.S, simply weren’t designed to offer that level of health data to patients. This is what blood testing looks like today: A patient with high cholesterol pays a visit to their doctor and is prescribed a lipid panel of lab tests to check their cholesterol, triglycerides, and glucose levels. Many times, these blood tests are being sold by the diagnostics providers and are priced per test, creating a financial knee-jerk that pans out in one of two ways: a doctor orders the bare minimum tests to save the patient dollars, or BEFORE NIGHTINGALE,

they order numerous tests and the patient receives a pricey medical bill. “The current model inhibits a doctor’s ability or willingness to prescribe additional tests that will give them a fuller picture of the patient’s health,” says Suna. According to Nightingale’s comparative cost analyses, running diagnostics on the biomarkers that Nightingale offers as a part of their blood check-up would cost more than $2,000 if done using existing industry technology. Using Nightingale’s NMR technology and proprietary software, the same panel is sold for €89, or around $100. “We are not interested in selling these individual biomarkers as different tests. We always provide everything,” says Suna. “This is completely against the business model in the diagnostics industry.” This paradigm shift in affordability which effectively democratizes blood testing specifically hit resistance as Nightingale worked through its pilot in Finland. “It is a massive change from how we’ve traditionally considered blood diagnostics,” says Suna. “However, we are addressing a very real problem: How can the doctor

This page: Nightingale’s single-sample blood test is 20 times cheaper and three times more accurate than current clinical tools at detecting chronic illnesses like early heart disease and diabetes. Across: In 2018, Nightingale analyzed half a million blood samples from the U.K.’s Biobank and took on the world’s largest blood-based prospective cohort study in Latin America.

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StartUp Health Magazine

know beforehand what is needed for the patient? The only way to know the individual differences, is to capture a greater number of biomarkers at once.” Nightingale’s blood analysis results can also be easily combined with other results received from different analytical methods or studies, making it possible to analyze large numbers of blood samples. The company has been involved in some of the world’s largest metabolomics projects, including being selected to analyze the entire UK Biobank cohort of 500,000 samples. In another study, Nightingale’s technology was used to analyze blood from over 50,000 samples for the University of Cambridge. “With this level of data, when we analyze a single sample of blood, we can further enhance the evidence that is already known,” says Suna. “Because Nightingale has such large amounts of data, we can build more individual risk models for different age groups, different genders, different ethnicities, and so on.”

The Road Ahead NIGHTINGALE’S PROGRESS IS BEING

watched closely by major media outlets, like Forbes and WIRED, and the medical community as one of a handful of digital health companies that is successfully paving the way for chronic disease prevention through a blood analysis platform. That’s because in a post-Theranos world, even when a company has sound science and a discerning business model, the conversation quickly moves from altruism to tactics. How will you succeed where others have failed? Suna’s globe trotting to set down roots for Nightingale’s technology parallels a wave of media about the blood diagnostics startup space, namely about Elizabeth Holmes, founder of the now dismantled health tech company Theranos. Holmes made big promises to the world that the company had developed a technology to prevent diseases, performing many standard medical tests using only a single drop of blood from a finger prick. But, in March 2018 the SEC charged Holmes and Theranos “with raising more than $700M from investors through an elaborate, years-long fraud” in which

Holmes misled investors on how much revenue the company was going to make and faked demonstrations of her lab equipment to keep the charade going. Despite Holmes epic fraudulent flub – the company was once valued at $9 billion – Theranos was awarded five new patents in 2019. All of these patents were filed between 2015 and 2016, around the time when questions on Theranos’ blood-testing technology first surfaced. Consequently, investors in this space are speculative and have become more scrupulous, applying greater scrutiny to founders and startups that are attempting to make the leap in health innovation that Theranos claimed to have made. While Suna says the Theranos scandal has slimmed down the number of investors in the niche area of blood diagnostics R&D, he sees a silver lining: It’s filtered investors from the market who are not experts in this area. “What Theranos demonstrated is if you want to change the big things in healthcare, like primary care, you have to do it with true medical science,” says Suna. “You cannot do it by hiding your research, then claim that you’ve found the silver bullet. When we received funding, we created boundaries to prevent the product from being pushed to market when it wasn’t ready.” “We started with the science and took the long way to build a solid foundation for our technology,” says Suna. “From the very beginning, even the first €2 million in funding

that we received, we have taken the time to build within regulation.” Nightingale’s commitment to transparency when it comes to sharing their research methodologies and findings over the years (they’ve been published in over 170 publications) is another differentiator. For example, when the company found several amino acids that can be used to predict the onset of type 2 diabetes, Suna could have made a play to patent the biomarker association. But he didn’t. Instead the company published the results. “If you want to bring this kind of technology to everyone in primary care, not just the richest one percent, then you need to provide the medical findings for the medical community,” says Suna. “When you do that, the medical community can utilize the findings in the public domain.” From there, the questions to answer are: Who can deliver the biomarkers in the most efficient way? Who can be very competitive with quality? Who can be competitive with speed and scaling? Who can actually serve the customers with the new medical findings? “Every player in the healthcare value chain can benefit from this technology and the ability to understand the future risks of chronic diseases,” says Suna. “If you want to change the global model of medicine you need technology that can absolutely be utilized around the world.”

Medicare 3.0

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StartUp Health Magazine

As millions of Baby Boomers age into their Medicare years, a handful of Health Transformers are partnering with the staid government insurance program to improve health outcomes while increasing efficiency, adding technological clarity, and helping consumers navigate the organization’s labyrinth. By Morgan Childs

Illustration by Sam Solomon

Several years ago, Joseph Schneier conducted hundreds of interviews to discover the challenges families face in caring for aging parents and relatives. At the time, he was CEO of a company that offered a digital training platform for caregivers, and the project was essential research. What began as a fact-finding mission quickly evolved into something more personal. “Whenever I would mention to anybody that I was working in senior care, people would start telling me their story,” Schneier recalls. ¶ Those stories revealed common problems extending far beyond faltering health: the strain of paying for medications and care out-of-pocket, the stress of relocating a loved one out of their home, and then, overlaying it all, the Kafkaesque process of signing up for Medicare. ¶ Around the same time that he was interviewing caregivers, Schneier endured a saga of his own, when his younger brother landed in the ICU with a broken neck and shattered pelvis—and without any health insurance. Schneier stepped in to sign him up for Medicaid, but that only added to his stress. “I kept feeling like, ‘I wish there was a checklist of things that I should be thinking about,’” he recalls. “And I didn’t even have any frame of reference of how to make informed decisions for him, because I didn’t know what the decisions I was making meant for him.” ¶ Schneier wasn’t the only one feeling the need for innovation in the Medicare space. Since the signing of the Affordable Care Act (ACA) and the launch of the Center for Medicare and Medicaid Innovation (CMMI) in 2010, a wave of startups has sought to reimagine healthcare for seniors. The effort was a necessary counterpoint to the bureaucratic inertia of the system. As Medicare analyst Philip Moeller observed in a New York Times article, “Moving into Medicare from other kinds of health insurance can be so complicated that it should be a required chapter in Retirement 101.” Rather than revamp or overturn traditional Medicare—a longtime political point of contention—these startups are forming partnerships with insurance companies or with Medicare itself to cut the bureaucratic red tape and often unnecessarily exorbitant expense of healthcare for seniors, by augmenting existing care for seniors. ¶ An additional common theme amongst the startups is they do what Medicare doesn’t: they foster proactive interventions and ongoing care regimens so that health crises are avoided; they provide seniors with individualized attention and customized, sometimes at-home care;

they use technology as a support to physicians and seniors alike; and their employees act as guides and coaches to help clients navigate the maze of options and ensure treatment. On a more fundamental level, the companies analyze the existing trove of Medicare-gathered data to develop care strategies for individuals and populations alike. The entrepreneurs leading these businesses believe that better care, and more assertive health management, will result in lower costs—and ultimately higher profits—for these businesses as compared to traditional Medicare partnerships. Schneier’s stressful days at the hospital planted the seeds to simplify the process of signing up for and taking advantage of Medicare. Trusty.care, which launched in early 2018, increases the efficiency of the Medicare experience from signup to system navigation with a suite of highly personalized benefits-management products. Schneier has called the platform “TurboTax for Medicare,” a compelling metaphor for anyone who’s had to navigate the pervasive uncertainties of the government insurance program. Since the launch of the CMMI in 2010, the trend to augment Medicare and Medicaid has snowballed. Joining Trusty.care in the innovation arena is Devoted Health, a Medicare Advantage plan cofounded by former U.S. Chief Technology Officer Todd Park and his brother Ed Park, former athenahealth CTO and COO. In what they’ve described as a Disney-level of service, the company offers each of its members an individual representative to guide them through the complexities of the Medicare system. Vheda Health, a care plan compliance platform, brings better health management to Baby Boomers with chronic illnesses and cost savings for insurance providers via personal health coaches and remote monitoring. Conversa Health’s conversational artificial intelligence (AI) technology allows healthcare organizations to deliver automated doctor-patient conversations that lead to more informed and meaningful patient relationships, effective population health management and, ultimately, better clinical outcomes for patients at lower cost. By bringing focused attention to their members and sourcing and deploying individualized data, each of these startups is able to bring a dose of humanity to the complex federal insurance program. “If you provide the right tools—the human touch and the technology—the results can be transformative,” says Shameet Luhar, Vheda Health CEO and co-founder. This isn’t the first time the government tried to give Medicare an upgrade. In the decade prior to the passage of the ACA, the Medicare Health Support Program was launched to create new ways of providing low-cost care to individuals with chronic conditions. The program received only modest outcomes and was discontinued in 2008 after a three-year pilot phase. Two years later, the ACA established the CMMI “to test innovative payment and service delivery models to reduce program expenditures...while preserving or enhancing the quality of care” for beneficiaries of Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). The program’s latest Report to Congress, published earlier this year, estimates that nearly 27 million individuals receive care or will soon receive care via CMMI models and initiatives, primarily under traditional Medicare, rather than a private insurer. Other companies are jumping into the effort to “hack” Medicare, following a broader trend across the U.S. government to inject federal bureaucracies with entrepreneurial energy and innovative thinking. 58

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Hoy Health is on a mission to engage the Spanish-speaking and medically underserved populations. Swift Shift is on a mission to attract five million nurses and caregivers to address nursing shortage, while Careteam offers coordination and navigation across the entire care team for patients with complex, chronic diseases, reducing the fragmentation of care. Valera Health, which received a grant from CMS’ Innovation Center, is now enabling large health systems to provide behavioral health at scale. Like Vheda Health, these companies are betting that building a framework of accessibility and proactive care will result in savings and improved health outcomes. The need to upgrade Medicare to find efficiencies and improve quality grows more pressing every day. About one in seven Americans has already celebrated their 65th birthday, and nearly 10,000 individuals age into that population every day. The U.S. Census Bureau’s Supplemental Poverty Measure indicates that 14% of seniors are currently living in poverty. As the nation’s Baby Boomers age into their golden years, requiring more and more medical intervention, prescription drugs, and caregiving, the current challenges threaten to grow into a full-blown health crisis. Senior citizens are staying employed longer than ever—some by choice, some by necessity—yet their earnings may only begin to offset the burden of medical costs not covered by a given Medicare plan. The complicated signup process, however, may make it difficult to understand where and to what extent an individual’s needs will be covered. “The biggest problem is that people sign up for a Medicare product without checking to make sure whether or not it covers their doctors, especially the doctors that are critical for them,” Schneier says. “If they have a certain health condition that is more complicated, there are certain plans that are going to be better for them.” He also notes that medication costs vary significantly from plan to plan. And then there is the conundrum of affordability. An alarming report published by the Social Science Research Network in summer 2018 concluded that out-of-pocket medical spending accounts for 20% of seniors’ income. On average, those costs will eventually total some $200,000 for a retired couple over 65 with Medicare—to say nothing of those who miss the Initial Enrollment Period and pay lifelong penalties. The report notes that medical costs are among the leading causes of bankruptcy, regardless of age. This needn’t be the case, Schneier argues. “When we started doing a root cause analysis, we were able to see that in most instances, the bankruptcies were preventable,” he says. In developing Trusty.care, the key questions for his team became, “How can we create both fi-

“I think that people would be surprised at how open they are to partnerships and innovation as long as you have something that is truly serving Medicare beneficiaries.”

Joseph Schneier

nancial stability among the Boomer population and also help them to improve their healthcare outcomes?” Schneier explains. “Because that’s the biggest way that you can reduce your healthcare costs.” As a “Blue Button 2.0” app, Trusty.care belongs to a small cohort of companies benefitting from a data partnership with the Centers for Medicare and Medicaid Services (CMS), which shares with them health information for third-party apps, platforms, and research programs. “They’re really explicit that they want to change the way that they’ve been working, in order to open up avenues for startups to work with them, work with their data, innovate on what CMS has available,” Schneier says. The program allows Trusty.care to access the claims data of 53 million Medicare users and to generate personalized plan recommendations, monitor drug pricing and changes to care plans, and ensure that all of a patient’s doctors are in-network. Trusty. care’s Monitor tool analyzes all of an individual’s medications and provides recommendations for preventative care and stress reduction. Access to Blue Button information and the data sets of other startups has allowed Trusty.care to define more targeted interventions for Medicare beneficiaries. These tools save users an average of $750 per year, according to the company, and simply offer more precise health recommendations than most standalone care plans are structured to provide. “Every stakeholder in health has its weaknesses and strengths; rapid innovation, being able to look at how to use data well to serve members—that’s hard for a large bureaucracy,” Schneier says. “Whether or not the bureaucracy is the Medicare Advantage plan, which is a private entity, or it’s the Center for Medicare and Medicaid Services.” He adds that both CMS and private care plans have demonstrated enthusiasm for new platforms in the space: “I think that people would be surprised at how open they are to partnerships and innovation as long as you have something that is truly serving Medicare beneficiaries.” Vheda Health, founded in 2013 with the stated vision of “humanizing healthcare through technology,” reduces healthcare costs by ensuring that individuals follow the medical regimens outlined by their doctors. The company places a particular focus on individuals with chronic conditions and within the Medicare and Medicaid populations. According to Luhar, 75% of healthcare spending goes toward the treatment of chronic conditions, and $150 billion each year goes to

unmanaged chronic illnesses—including $75 billion on diabetes alone. After signing up through an insurance provider, each Vheda member receives a care package that contains a smartphone preloaded with the Vheda Health app and a Vheda care manager on speed dial. The package also comes with biometric monitoring tools so that the company can track progress and compliance with a given care plan. Packages are tailored to the individual needs of members and come complete with tools to help manage everything from high-risk pregnancies to behavioral health. But according to CEO Luhar, tech is just one piece of the puzzle. “What we’ve seen over the last five, six years is a lot of companies tend to push a technology solution. With the Medicaid and Medicare population, you can’t just throw a technology to them and expect them to adopt it.” That’s why Vheda assigns each member a health coach who regularly checks in with them via the app. In an effort to reduce cultural and socioeconomic barriers to compliance, coaches are generally located near their Vheda members and can recommend local resources and communicate in members’ native languages. “The coach that we want is someone who is loving, who can show empathy, who can show emotion. If you can show those characteristics...the member really opens up, and this is how you’re able to really create results,” says Luhar. In Vheda’s case, the results speak volumes: The company delivers an average savings of $17,175 per member per year. Devoted Health launched in its first market—eight counties in Florida—in October 2018 with the mission to give Medicare members “the kind of care that we all would want for our own family.” That means a healthcare experience that’s more attentive and more personal, involving a mix of home visits and telemedicine. While the company is still early in development, and is keeping many of its moves quiet, it made headlines by raising $300 million in a Series B funding round in late 2018. Those funds, combined with the company’s all-star cast of serial health entrepreneurs, means Devoted is well positioned to disrupt even this most convoluted government program. Devoted Health’s recognition that higher upfront costs can result in lower long-term spending on healthcare was evident in a May announcement that members in Florida would be able to purchase insulin with a $0 copay. The shift responded to a sharp increase in insulin prices that has led to a crisis among diabetics, some of whom find that their only viable option is to skip some injections. Neil Wagle, MD, chief medical officer at Devoted Health, explained the company’s thinking in a press release: “We make it easier for members to take their insulin, so they stay healthier,” he said. “That means they’re less likely to need more expensive healthcare services, which benefits them, their families, and Devoted, too.” For the most part, Luhar suggests, Medicare health plans are receptive to innovative companies like Vheda and Devoted: “I see a lot of opportunity and optimism whenever I go,” he says. “There are always going to be skeptics, just because of the industry that we sell into.” Health insurance has a history of being a risk-averse arena, he adds, and to counterbalance that skepticism, startups have to lead with their value to get care providers onboard. “You have to hit them with the hard financial impact that your capabilities can provide for them in a short amount of time,” Luhar says. “And if you’re able to communicate that in a very effective, streamlined way, everybody sits up in their chair, their ears perk up, and you’re ready to go.” 59

Small Wonder.

From a Microwave to a Grain of Rice – With Qura’s Miniaturized Implantable Technology, Doug Adams Is Poised to Usher in a New Era of “Disease Intelligence” By Patrick McGuire 60

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a sign advertising a local auction caught Doug Adams’ attention. Adams had never been to an auction before, so he decided to check it out. In the span of one hour he purchased a farm. “It was my first introduction to entrepreneurship,” Adams says with nostalgia in his voice. “I had no money, no assets, and my parents had nothing. I asked myself, ‘If I want to keep this thing, what do I need to do?’” “What’s dumb at 16 is brilliant at 32,” Adams continues. “They built an 18-hole country club across the street and I had the only undeveloped tract of land on the river.” Adams’ teenaged foray into entrepreneurship combined luck with tenacity, and it set the stage for events to come. His property sold before he had the chance to fully assume the identity of a farmer, so Adams funneled his ambition and business savvy into a sales position at a medical device company. A decade later he was a CEO. The sense of imagination that inspired a teenaged Adams to buy a farm he knew nothing about has remained with him ever since. He now heads up Qura, a Massachusetts-based medical technology company developing sensors that it hopes will usher in a new era of disease prevention and unprecedented medical insight. The company is engineering a tiny, implantable medical monitoring sensor that, on its surface, appears to be the stuff of science fiction. Qura’s team of engineers began working with a device the size of a microwave a decade ago. Now it’s down to a grain of rice that can be implanted with a minimally-invasive surgical procedure. “Today, doctors have drugs, devices, and surgical procedures. What I’m suggesting is that some time in the future, a fourth treatment comes into play. It’s what I call ‘disease intelligence,’ the ability to look at large amounts of critical data and predict disease progression.” Implantable medical device technology is T 16 YEARS OLD,

nothing new. From artificial hips to spinal fusion hardware, implantable devices have been used to treat patients for over half a century. But new pioneering technology shrinking implantable sensors down to such a small scale could impact disease comprehension and treatments in ways never before seen in the healthcare industry. Qura’s initial case for their tiny implantable sensor is for treatment of glaucoma, which is the leading cause of irreversible blindness around the world. The condition is associated with a buildup of pressure that damages the optic nerve, the part of the eye responsible for transmitting images to the brain. According to the Bright Focus Foundation, in the U.S. alone, over three million people are afflicted with the disease. Qura’s device is designed to address and interpret the pressure-related issues associated with glaucoma in an unprecedented way. Qura’s device can drive a change in glaucoma management, facilitating timely and targeted medical or surgical intervention by cataract and glaucoma specialists. “A person with glaucoma will go to an eye doctor three to four times a year, and as part of those exams, a physician will measure their intraocular pressure,” Adams says. “Based off of one measurement, the doctor might plan an entire year of therapy without any regard to what else is happening the other 23 hours a day. We started our work at Qura with the premise that the missing link in glaucoma management was

data. Patients are being treated based on one measurement, but literally hundreds of measurements could give a true indication of disease progression.” According to Adams, information like micro-spikes in pressure or consistent changes during specific times of the day or night could help physicians address the disease in more effective ways. The glaring lack of data absent from current glaucoma treatments inspired Adams and a team of engineers to design a device capable of measuring the intraocular pressure of a patient not just once a day but hundreds of times a day. Currently in development, Qura’s wireless implant includes a pressure sensor, antenna, integrated circuit, and battery, all packaged together in a device that’s the size of a grain of rice. Adams calls the development pathway that made the device’s small configuration possible “extreme miniaturization.” “I used to tell people the device’s pressure sensor was so small it was the size of a period at the end of a sentence. Today, you need a damn microscope to see it,” Adams tells me proudly. Shrinking the implant’s core components down to such a small size was a paramount challenge, but ensuring the device could stay intact inside the human body over an extended period of time was just as tricky. “These implants have to last for 10-20 years,” Adams tells me. “So how do you do that? We developed a unique and proprietary coating to ensure safety and biocompatibility of

“I used to tell people the device’s pressure sensor was so small it was the size of a period at the end of a sentence. Today, you need a damn microscope to see it.” 62

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the device and technology to address this.” The device’s layers of coating are designed to minimize inflammation and the formation of fibrins, which are proteins associated with blood clots. Qura’s wireless implant is just one component of a platform called QSmartTM. The platform is designed to record up to 860 unique pressure measurements each day and transmit detailed data to physicians in real time with the hope that damaging spikes in pressure can be addressed and treated in real time. Pressure data will be sent to computers, smartphones, and tablets digitally, and measurements can be taken anywhere in the world as long as the patient keeps their implant charged. The implant’s battery, which Qura claims lasts up to 20 years, is recharged with a hockey puck-sized device that can sit on a patient’s nightstand. The patient needs to simply be within a couple of feet of the recharging device in order to recharge the implant, and this can easily be achieved while a patient is sleeping. QSmart leverages passive patient involvement, the idea that patients can manage certain aspects of their health with little or no action. Qura hopes that its technology will translate to fewer glaucoma patients having to make visits to the doctor. Miniature implantable technology could result in physicians being able to devote more time and resources to the patients who need the most attention. The medical device industry has experienced a great deal of public scrutiny in recent years. Netflix’s 2018 documentary The Bleeding Edge highlighted device-related complications in patients, and the Food and Drug Administration (FDA) recently announced plans to strengthen safety and effectiveness within the industry after facing criticism. Former FDA Commissioner Scott Gottlieb called the proposed rule changes the “most significant in a generation.” Most medical devices are currently cleared through the FDA by demonstrating that they’re similar to another legally marketed device – called the 510(k) process. Since nothing like Qura’s device is currently on the market, Adams’ team will seek premarket approval, requiring clinical studies. Qura plans to start human studies in 2020.

Qura’s wireless implant includes a pressure sensor, antenna, integrated circuit, and battery, all packaged together in a device that’s the size of a grain of rice.

Qura says it’s less than a year out from their first product launch, but its first targeted patients aren’t humans. “We’re starting with veterinary medicine,” Adams says. “Who would’ve known that there are ten million dogs in the U.S. diagnosed with glaucoma? Canines have the exact same treatment patterns as humans and the same lack of pressure data.” In addition to offering QSmart as a product in veterinary medicine, Qura also has plans to deploy its implantable technology for pre-clinical research in monkeys, rabbits, and dogs with the goal of launching clinical trials in humans in the U.S. in the near future. The company’s miniature implantable technology is poised to bring new treatments to canines and humans suffering from glaucoma, but for Adams, the eyes are just the beginning. Qura believes QSmart can be used to treat patients suffering from cardiovascular disease and neurological disorders due to the need for more frequent and accurate pressure data measurement in those

fields. Adams envisions a not-so-distant future where tiny implantable sensors will be able to measure other aspects of patient health, with multiple devices capable of networking and treating patients internally. “To me, that’s how you transform chronic disease,” says Adams. “How would you like to have real-time cholesterol measurements every time you eat a juicy steak? Or what about a sensor with 100,000 electrodes that can test your blood and send the information to your cell phone every few minutes? A physician could put your entire blood profile online without ever seeing or touching you. All this is going to happen, and we’re seeing the evolution of these things now. The next frontier of healthcare is data.” Qura is part of a small but growing field focused on miniaturizing medical technologies. The German company Implandata is also currently developing a wireless implantable pressure sensor for ophthalmic use, but Qura claims its device is approximately 100

times smaller than theirs. Last year, Santen Ventures and InFocus Capital Partners publicly announced that they invested in Qura. The company recently announced it had signed a license agreement with Purdue Research Foundation, a tech-based organization aimed at product and business development sponsored by Purdue University. When asked how he went from being a 16-year-old kid buying a farm at an auction to developing sci-fi worthy medical technologies, Adams is quick to reply that he’s not an inventor, scientist, engineer, or doctor. “I’m only an entrepreneur,” he says. “What I’ve learned over the course of my career working with different medical device companies is how to combine labor and capital to solve unmet needs.” While Adams may be downplaying his own role in it, Qura’s potential role in a moonshot to end disease is anything but small.

Pound

Prevention

Cityblock Health CEO Iyah Romm is on a mission to improve the health of underserved populations, one block at a time.

Co-founders Iyah Romm, Bay Gross and Toyin Ajayi, MD are proving the value of personalized, tech-enabled, value-based preventive care for underserved communities. By David Sokol Photographs by Paul Newson

When Iyah Romm was a first-year medical student at Boston University, he fell down a flight of stairs and landed on his head. The fall left him legally blind for three years. “I was a patient for the first time, said Romm, “and it was a miserable experience.” He walked with a cane and had trouble navigating the hospital tower where he would receive care. He found himself confounded when healthcare staff handed him a stack of papers to convey from one specialist to another. The experience gave him a front-row view of clinical medicine’s fragmented data and the system’s refusal to treat the whole person. “Nobody asked me how I was living at home, getting to appointments, or paying rent,” he remembers, “They only asked me about my eyes.” This wasn’t the first time Romm had seen the barriers to quality healthcare up close. Growing up in Atlanta, Romm’s mother provided midwife services to women of Caribbean descent in their community. Through that lens, Romm saw firsthand how race, socioeconomic status, and other identifiers created barriers to care. Romm left medical school to pursue a career that allowed him to tackle the policy behind these healthcare problems. He studied biology and health policy at Brandeis University and then landed a job working for the Commonwealth of Massachusetts. While there, he met Dr. Toyin Ajayi. Ajayi

was working for the Massachusetts-based Commonwealth Care Alliance (CCA), where she recalls, “I was helping to build a community care model that allowed us to provide 24/7 care in homes as an alternative to hospitals.” The not-for-profit wanted to dispatch paramedics to its Medicaidand Medicare-eligible members’ homes on evenings and weekends as an alternative to traditional PCP delivery, which required special dispensation from the state government. Based on her conversations with Romm, Ajayi adds, “We realized we had a shared passion for solving hard problems and for improving timely high-quality care to underserved and difficult-to-reach communities.” Romm eventually went on to work for CCA, alongside Ajayi, where he focused on improving care delivery as Chief Transformation Officer. But together they began to envision something much bigger – a personalized, high-touch, value-based healthcare delivery model that could operate at scale. “We both had a fantastic experience at CCA,” says Romm. “But the organization served thousands of people at the time, and we had to figure out how to do this at 100 times the scale in order to have a meaningful impact.” That vision began to come into focus in November 2016, when Romm received

a phone call from Google’s parent company, Alphabet. One of their companies, Sidewalk Labs – whose mission it is to “transform urban life” – recognized the potential in Romm and Ajayi’s work. They also recognized that someone was missing from their team. I N T E R S ECTI NG PATH S —

Bay Gross was a former Google product manager working at a venture capital firm in summer 2016 when Alphabet invited him back to the fold, to participate in its initiative called Sidewalk Labs. The tech giant’s new company was largely focused on next-generation cities’ buildings and infrastructure, splashily announcing that it would develop a neighborhood of the future in Toronto. Yet Sidewalk Labs also had allotted a small number of staff to incubate other businesses related to the intersection of technology and urban life. Gross jumped at the chance to apply his computer-science 66

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L-R: Cityblock co-founders Iyah Romm, CEO; Toyin Ajayi, MD, Chief Health Officer; Bay Gross, Head of Product (photo courtesy of Cityblock Health).

and investment expertise to disruptive urban public safety and social services. “I spent some time digging into Medicaid, because it is the singular social safety-net program from which everything else is downstream,” Gross recalls. “I saw a bunch of private equity– and venture capital–backed programs in the Medicare space that had high growth as well as high output. I also saw that nobody had tried to translate that success to Medicaid, and yet urbanization trends, growth in the elderly population, and increasing income gaps all underscored a growing reliance on Medicaid.” Was there indeed an untapped business opportunity in delivering better care for individuals covered by Medicaid, and could

Sidewalk Labs leverage Alphabet’s seed money and technology infrastructure to tap it? Gross decided that a scalable solution depended on partnering with a healthcare delivery expert who believed, in Romm’s words, “that everybody in this country deserves access to high-value, experientially positive services.” Gross posted for an entrepreneur-in-residence, fielded responses, and ultimately found Romm through word of mouth, suggesting that he apply for the gig in that November phone call. “As we met with Iyah and got to know CCA, we saw this singular background that we were looking for,” says Gross. The timing of the conversation felt uncanny, Romm says, thanks to the recent presidential election. Campaigns had been fought and won on the prospect that the Affordable Care Act could get dismantled, “and virtually every conversation we were having was about what that would mean for Medicaid in particular.” Although Romm

Crown Heights, Brooklyn, where Cityblock first trialed its approach to personalized preventative health. They’ve since partnered with ConnectiCare to care for members in the Waterbury, Connecticut, area, and are gearing up to do so in North Carolina in partnership with Blue Cross and Blue Shield of North Carolina.

prefers to not weigh in on the politics surrounding Medicaid, he notes, “As someone who believes firmly in the value that Medicaid generates for the economy and for individual members, I was interested in spending every bit of my energy to demonstrate that the program is necessary and cost-effective and sustainable.” Sidewalk Labs’ interest in cities further dovetailed with Romm’s understanding that the consequences of systemic racism, classism, and other generation-spanning forces that created barriers to quality healthcare were felt the most by people living in lower-income neighborhoods. Romm arrived at Sidewalk Labs in March 2017, and Ajayi followed suit two months later. Cityblock spun out from Sidewalk Labs in October 2017, with Romm as CEO, Ajayi as Chief Health Officer, Head of Product Mat Balez, and Bay Gross initially in the role of VP of Operations and Strategy. By July of the following year, Cityblock

had begun delivering services to patients in Brooklyn’s Crown Heights neighborhood, with EmblemHealth as its first partner – and using an all-new proprietary healthcare technology platform called Commons to manage the switch from intriguing business concept to sustainable reality. UN D ER THE HO O D —

Cityblock’s introductory group of potential clients comprised 10,000 members of the vaunted not-for-profit insurer EmblemHealth. To illustrate Cityblock’s financial model, Gross replays the company’s pitch to the 3.1 million-member company. Surveying Emblem’s New York members, “We see about 100,000 people on Medicaid in Brooklyn who are costing Emblem a lot of money,” Gross told the company’s execs. “This is where data analysis comes in: Give us four to five years of medical claims for these 100,000 people, so that we can iden-

tify the ones who have a real complexity of healthcare whom we think we can help – people who cost $30,000 to $50,000 a year, who take a dozen or more medications, who seek care in hospitals, and who are poorly actualized in terms of results.” From its initial shortlist, Cityblock identified 10,000 Emblem members who had a confluence of longitudinal chronic disease and social determinants of health. Cityblock offered to take over these members’ primary care and to finance patient management through the cost savings achieved via high-touch prevention. Under this value-based model, Cityblock planned to save insurers millions, and then receive a share of those savings. Cityblock was confident that by bringing together primary care, behavioral health care, and social services under one valuebased care model, they could address multiple factors of a member’s health at once, improving outcomes while driving down costs. After all, as Gross says, “One day in 67

the hospital is equivalent to several months of food stamps or 20 Uber rides to the doctor’s office. Utilization is so expensive compared to caring for somebody from a social perspective.” From a patient perspective, the core Cityblock experience involves meeting with an interdisciplinary team of professionals to create a plan for their overall health; and this includes managing the events of their dayto-day life. “Think of a person who is struggling to work a couple of jobs, has diabetes, has hypertension, has some depression,” Ajayi says, painting a picture of a hypothetical new Cityblock member. “That person has seen their PCP over a few years and has gotten 10 minutes at a time, half the time typing at the computer, and gotten advice to eat nutritious food and exercise more. But that person leaves feeling judged and unable to explain that they eat McDonald’s three times a week because they can’t afford to buy leafy vegetables. And that exercise is hard to do when there’s no gym and your community isn’t safe enough to put on some jogging shorts and go running around.” The Cityblock experience provides the antithesis to that all-too-common scenario. Crafting an action plan requires a care team to listen closely to a member – about family history and recent symptoms, sure, but also about seemingly disparate concerns like the availability of fresh produce, household income, and transit equity – and to envision health goals and measurable improvements collaboratively. Nor is the Cityblock member left on their own to effect change. Besides meeting with members at home or wherever else it is most convenient, the care team will help with budgeting, access to food stamps, transportation, or whatever other daily concern that can influence health. A cornerstone of Cityblock’s tech infrastructure is Commons, the platform designed to assist care teams on the job. Collaboratively designed by care providers and engineers, Commons processes data from a range of sources in order to help streamline care between interdisciplinary teams in the field and improve the decision-making responsibilities they share with patients. Commons consolidates a pa68

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Trust is the thing that unlocks the door to the outcomes and attributes in the system we want to build. -TOYIN AJAYI, MD CHIEF HEALTH OFFICER

tient’s medical, behavioral health, and social background information – from electronic health records, pharmacy claims, community data, and other sources – into one holistic view, and it keeps care providers apprised of a member’s wellbeing in real time by way of hospital admission alerts, a video portal, and other means. The platform also offers workflow tools like clinical decision support and evidence-based protocols, so that teammates may make informed choices about a member’s course of action. The platform even makes new suggestions for care as all the underlying data are refreshed. Of course, Cityblock’s leadership acknowledges that all the technology in the world is useless without the right people driving it, and the company is building a workforce of determined, indefatigable believers in its vision. They certainly have

heavy lifting to do, starting with enrollment. Patients can be difficult to reach, thanks to the social factors like housing or job insecurity. In the end, for the Cityblock team, it’s all about meeting potential members where they’re at. That said, even when located, someone might not buy into the Cityblock message, says Gross. A Community Health Partner – the person who leads one of Cityblock’s interdisciplinary care teams – may have to show up at the ER or visit and chat with a person five or six times before achieving enrollment. If enrolling a member is an exercise in building trust, the care team has to work hard to maintain it. “Trust is the thing that unlocks the door to the outcomes and attributes in the system we want to build,” Ajayi says. “By systematically asking about social needs and non-medical health-related drivers, and following the logical threads of those answers, we can deploy and prioritize interventions, coach behavioral changes, and champion healthcare resources for better outcomes.” Romm calls Cityblock “a fundamentally new type of health system.” Although he is careful to note that the business is constantly evolving and willing to take growth very slowly, there are undeniable signs that Cityblock’s invention is striking a chord in the industry. In addition to EmblemHealth, the company recently partnered with ConnectiCare to care for members in the Waterbury, Connecticut, area, and it is gearing up to do so in North Carolina in partnership with Blue Cross and Blue Shield of North Carolina later this year. “I would say that we continue to receive really positive reception, and our member experience scores are higher than anyone on our team has seen before,” Romm says. “We would all benefit from more holistic, more compassionate, more person-centered healthcare,” Ajayi agrees, “but resourced, educated people are empowered to both demand and create those services. We’re building something for the people who frequently get left behind.” Today, Cityblock is not only filling a critical gap in the healthcare industry, but it also may become a rallying cry for even more systemic change.

S TA R T U P H E A LT H P O R T FO L I O C O M PA N Y

The office visit experience redefined. Customized mobile solutions that enhance patient engagement, improve provider throughput and create more capacity for care centers everywhere. Yosi is redefining the traditional office visit experience for both patients and care providers. Learn more at yosicare.com. 69 Simplifying Healthcare

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THE 8 HEALTH MOONSHOT PRINCIPLES OUR BLUEPRINT FOR ACHIEVING THE IMPOSSIBLE By Steven Krein In 1960, the United States, and ultimately the world, set out to do something amazing. We committed to landing a person on the Moon and returning them safely home again. The Moon landing became a clarion call to dream big and act collaboratively with intention and purpose. Hundreds of thousands of people, billions of dollars, dozens of universities, and titans of industry and science all coalesced around a singular mission – and it worked. To this day, it’s one of history’s greatest examples of massscale collaboration and achievement. To us, the ‘health moonshot’ is a powerful metaphor for meeting the great health challenges of our time. If we put a person on the Moon, then we know we can also transform global health by curing diseases and delivering care to all people regardless of location or income. But moonshot thinking isn’t enough on its own. By dissecting the original Moon landing we can see key ingredients that made the dream possible. We also see pretty clearly why

Illustrations by George Nichols

we haven’t been back to the Moon, and why we find achieving health moonshots so difficult. Moonshots take a long time – they take commitment. The bottom line is this: If you want to really bring hope to seven and a half billion people – everyone on the planet – and improve the health and wellbeing of everyone in the world, it’s not going to happen by happenstance or by crossing our fingers. Solving the world’s biggest health challenges is possible; but to do so we must work in a coordinated, collaborative way, with clear communication, investment of capital, and a rock solid commitment. On the following pages we’ve outlined eight key principles that contributed to sending humankind to the Moon, and which we believe are essential to achieving health moonshots today. The eight principles, taken together and used to guide you quarter after quarter, and year after year, become a transformative roadmap to the Moon.

THE 8 HEALTH MOONSHOT PRINCIPLES

1. COMMITMENT

What 25-Year Vision is Driving Your Life and Work? D

o you think about your life in terms of months and years, or in terms of decades? Are you in a sprint or a marathon? What commitments have you made in your life, whether personally or professionally? Have you spoken those commitments out loud, declaring them to the world? When John F. Kennedy announced to the world that the United States was going to send a person to the Moon, it may have sounded at first like mere rhetoric. But what quickly followed the speeches was an all-in years-long commitment that tore down barriers and expanded our idea of what was possible. When you embrace the long view for your life and business, you let go of knowing the details of every turn. What you gain is a destination, where every decision that you make has a specific purpose. Rather than a series of ad hoc activities, each step gets you one step closer to the ultimate mission. Ask yourself: How will the world be different 25 years from today because I existed? By the way, if this question scares you, you’re on the right track. Commitments are hard. Saying them out loud as a promise makes them real. At StartUp Health, we are driven by health moonshots, and so is every person we collaborate with – from Health Transformers to investors to industry stakeholders to consumers. But beyond the declarations and audacious goals, it’s the commitment, pushing from years to decades, that’s going to transform that moonshot from a lofty idea into a transformative reality.

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– Dorothee had already used flower petals as Ph indicators while she was in the Peace Corps and upon her return, continued to wonder if the pigment principles in her flowers could apply to humans. She tested her hypothesis on female neighbors by recording how color responses in flower pigments would change when they came into contact with saliva samples taken at different times of the menstrual cycle. She discovered that, like flowers, a woman’s fertility could be mapped by measuring color changes in these indicators over Principles in Action time. This project – which accuORATEL DIAGNOSTICS rately predicted when women were ready to conceive as well A Founder’s – resulted in another important finding. Goldman discovered Commitment to that a different color response Patients with in some of these women, who Endometriosis had difficulty in conceiving, could be predictive to identify Brought the endometriosis. Diagnosis Wait Time The differences in the from Seven Years to color responses that Dorothee observed were so drastic, that 20 Minutes she went to Johns Hopkins University to discuss her findHeadquartered in the middle of ings. There she met with two a vineyard in Upstate New York, professors who were interOratel Diagnostics is teeming ested in what she was doing, with life. Founder Dorothee however government funding Goldman points to a vivid blue had recently been cut and was Chicory in a bouqeut of flowers not available for the research. on the table. “Do you notice the Learning how many women center of this flower?” she could benefit from her asks with a knoing a discovery – the 187 smile. “See how it is “25 years million women in darker than this from now millions of the world who one?” Flowers, women will no longer be have endomeshe explains, suffering from endometriotriosis are not show color sis because Oratel Diagnosbeing treated differences tics has figured out how to or getting the to attract diagnose the disease using an healthcare pollinators. easy and affordable test they need – The dark petals that all women will Dorothee’s comwere preparing have access to.” mitment deepened for fertility while and she continued on the pallid ones had just her own. completed the fertility stage. “You have to do a lot of the This observation, Goldman work yourself,” says Goldman. added, was precisely what led “There will be people and supto the eventual founding of port to help you. But to make it Oratel Diagnostics. really happen, you have to pave A person of deep curiosthe road. Eventually you will ity – and training in biology

Moonshot Check-In --

25 years from today, how is the world different because you existed? find your partners…” and that is what happened this year. Oratel Diagnostics will partner with a company that makes synthetic flower pigments, to generate new assays for fertility evaluation. Today, Oratel utilizes a simple saliva test that, when exposed to a strip of paper, generates a color that can be read on a smartphone. The smartphone then takes a digital photo and uses machine learning to analyze the color response. In a recent study funded by Bayer’s G4A program, 105 samples were analyzed and achieved 92% specificity and 84% sensitivity, significant numbers for a first-of-its-kind noninvasive diagnostic test. Partnering with Dr. Stacey Missmer, scientific director for a Boston Children’s Endometriosis Center, Goldman’s next big step is commercialization. Potentially a scientific game changer, Dorothee is hopeful for Oratel’s future. Says Dorothee, ”I feel committed because I feel the need to address this problem. 25 years from now millions of women will no longer be suffering from endometriosis because Oratel Diagnostics has figured out how to diagnose the disease using an easy and affordable test that all women will have access to.”

2. CONFIDENCE

Build an Unshakable Confidence

n 1903, on a stretch of beach in Kill Devil Hills, Orville Wright climbed atop the wing of a new machine he’d built with his brother. It was a glider with an engine, and, if the morning went as planned, promised to give the Wright Brothers the first powered flight in history. Orville clocked the air speed (an ideal 27 mph), checked the engine one last time, and then he was off, into the air and into the books. Confidence is one of the most understated principles in entrepreneurship, and in achieving health moonshots. That’s because it is foundational, a structural underpinning. Like a strong scent, confidence is an invisible force that actively attracts or repels the partners, investors and customers that we need to succeed. There are a couple kinds of confidence which we see frequently at StartUp Health. The first – and this is common – is that confidence which is built on a recent success, like landing a new client. It’s completely understandable to operate this way, but long term this kind of confidence is shifting sand. After all, how long will that high last? The moment there is a loss that takes the attention away from that win – which will happen with frightening speed in any business – your confidence is shattered. Then there is a confidence that transcends circumstances. We know it when we see it, and we can’t help but be drawn towards it. Are these people super human? Are they delusional? We believe the key difference is this: Your confidence shouldn’t be something someone gives you, but something you’ve build and something you fight for. It’s dynamic, not static. We remind our entrepreneurs regularly: if you lack confidence, figure out why and get it back quickly. Maybe you lack confidence because your product isn’t working. Use that realization as an impetus to go back to the drawing board and get the product right. Identify the mindsets that need attention, and then move forward with intentionality to regain the confidence you’ve lost. Don’t lean on a fickle confidence based on recent achievements or ego. Build and maintain a slow-burning intrinsic confidence through knowledge, recalibration, and by celebrating small wins along the way. Few things could be more critical to your longterm success.

THE 8 HEALTH MOONSHOT PRINCIPLES CONFIDENCE, CONT’D Principles in Action LIFEWIRE

Howard Rosen Reinvented Himself, Then Reimagined Doctor-Patient Communications Howard Rosen, CEO & founder of LifeWIRE, holds a unique distinction in the world of health innovation. “I might be the only entrepreneur in health IT with an IMDB (Internet Movie Database) profile.” Before creating LifeWIRE, a healthcare communication platform that allows automated, device-agnostic communication between patients and clinicians, Rosen spent 20 years producing television and film. Then one day in 2004, while working on a promotional campaign for a Motorola flip phone, he had a realization – this phone could one day be used to manage

illnesses. Less than two years later, Rosen filed his first patent, and LifeWIRE was born. Since then, Rosen’s platform has enabled clinicians to increase active caseloads by six times and reduce addiction relapse rates. At one site, LifeWIRE helped increase the number of vets being treated for PTSD from 25 to 150 per clinician, all while improving the quality of care.

Q&A StartUp Health: What gave you the confidence you needed to put aside a lucrative career in film to innovate in health? Rosen: I was working on a diabetes marketing campaign and learned just how pervasive diabetes was. Looking at the market, I saw a lot of great solutions, but only 1820% of people were maintaining their diabetes with these solutions. And being a cardcarrying arrogant producer, I knew the answer to this. All

you gotta do is come up with a solution that engages and ties in to an individual’s lifestyle, which integrates with what they’re already doing. StartUp Health: When did you realize the value that LifeWIRE could bring to patients? Rosen: The turning point came early, after a phone call from my very first client. We had deployed LifeWIRE at a home that worked with veterans suffering from PTSD and mild traumatic brain injury. Less than a month into the trial, the executive director of the facility called and told me our system helped save a life. I thought there was a business good, certainly a social good. But never in my wildest dreams did I imagine it could help save a life. And now that it’s done that, how could I not try to do this again and see if we could help save another life? I just morally couldn’t live with myself otherwise.

The Health Transformer Mindset Check-In True confidence comes as the result of doing the hard work of self reflection and recallibration, not from “faking it until you make it.” Here are the eight mindsets of a Health Transformer. Use this checklist to see where you need to focus attention over the next 90 days. I have a long-term commitment to transform health. I surround myself with supportive relationships. I recalibrate every 90 days and celebrate weekly wins. I am confidently ambitious about my Health Moonshot. I am coachable and self-aware of my unique abilities. I practice healthy habits and express gratitude. I am creating a bigger future than my past. I am batteriesincluded — always providing energy.

This checklist is an abbreviated version of the Health Transformer Mindset Scorecard™, one of dozens of strategic thinking tools created by StartUp Health and available to StartUp Health portfolio companies. 8 Startuphealth.com/academy

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StartUp Health Magazine

3. COMMUNICATION

Tell Your Story, Tell It Well, Tell It Often

hen John F. Kennedy made his famous commitment to reach the moon, he didn’t do it in his sitting room among a few close friends. He spoke directly to 40,000 people in a sports arena, and was broadcast to millions around the world. And then he repeated his message in speech after speech, year after year. When it comes to achieving a moonshot, sometimes how and when you communicate is as essential as what you communicate. Bottom line: tell your story early and often. Do you feel like the best kept secret in your market? Start telling your story! Shout your mission to the world. And not just the ultimate goal; share the journey. Tell the story of who is on your team, and what keeps them motivated. Tell the story of your technology and how it is creating a brighter future for everyone. And then do it again, and again. Sharing your story of progress with your current and prospective champions enables them to see that you are well on your way to achieving your health moonshot. Write your story of progress down. Then make sure people see it, hear it and read about it on a continuous basis. The true power of storytelling is that when done well, it’s self perpetuating. By putting yourself and your company in the context of a journey, one where you are getting closer to your goal with every 90 days, you can make naysayers believers, while empowering others to be your champion. If your story is memorable and repeatable, then your closest allies and advocates will want to share it. Those are the stories that change the world.

photo by Agata Storer

Principles in Action HELPAROUND

Broadcasting a Better Way to Cure Diseases with Specialty Prescriptions The more we know about diseases, the more complex our drug therapies become, and it’s causing a massive problem. There are now 10 mutations of every type of cancer, where once there was one. Each mutation responds differently to drug treatments and demands a finely tuned specialty drug therapy. The price per patient for these specialized interventions is high and getting higher. While specialty drugs make up less than two percent of prescriptions, they account for more than 50% of all drug spending. Getting on these specialty drugs isn’t just expensive, it’s complicated, says Yishai Knobel, CEO and co-founder of Helparound (pictured). “You can’t just walk into

CVS.” According to Knobel’s analysis, due to the difficulty obtaining and maintaining specialty drugs, about one in four patients abandon their prescription entirely. That’s a lose-lose for patients and pharmaceutical companies alike. Enter Helparound. This mobile patient concierge streamlines and personalizes the specialty drug process so patients and get the care they need and stay in therapy. Knobel and team have found strong applications in kidney disease, hemophilia and oncology, but they’re tackling rare disease as a category. “Anywhere there are a lot of bumps on the road on the way to therapy and a lot of logistics that make it difficult for the patient and the caregiver to get on the drug and stay on the drug,” says Knobel. Through a partnership with NxStage Medical, Helparound was able to increase support program engagement by 9x, showing 45% patient engagement after 90 days. On the patient side, the app has more than 35,000 registered users with type-1 diabetes and kidney disease.

THE 8 HEALTH MOONSHOT PRINCIPLES COMMUNICATION, CONT’D

Q&A Yishai Knobel CEO & Co-founder of Helparound StartUp Health: How do you communicate your journey and milestones with the world? Knobel: LinkedIn is a very powerful platform these days. I use it as our blogging platform. I’ve found it’s the best way to get people to notice us. Plus, it’s very actionable. When an email is sent out, you land in an inbox along with a million other messages. In LinkedIn, you read the content and then you can immediately message me or you can immediately add me as a contact.

Moonshot Check-In --

What are the Top 3 points of progress that you have yet to share with your champions?

StartUp Health: You’re an American company born out of Israel, with a team based in Israel. How would you communicate what the “Made in Israel” brand means today? Knobel: Constraint yields innovation. Shlomi (Helparound co-founder) and I served together for eight years as officers in the Israeli army cyber units, where we operated under constraints all the time. We had constraints in time and resources. You can’t just go and staff up. Timelines are typically very aggressive, to a fault. And the leadership is extremely young. By 22 I had a team of 10 or 11 engineers and at the age of 19 Shlomi was an instructor of around 80 new soldiers in the cyber unit. The expectation is figure it out, improvise, be creative. You’re not taught how to solve everything. Our ability to pull together a fairly robust platform long before raising a big round was a result of that attitude. Operate within scarcity. That’s the Israeli angle.

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StartUp Health Magazine

4. CAPABILITY

To Achieve the Impossible, Find Where You Thrive

t took the efforts of around 20,000 companies, each playing to their strengths, to get a man to the Moon. One of those companies was Playtex. In his book Spacesuit: Fashioning Apollo, author Nicholas de Monchaux tells of how Playtex, a bra company, bucked the odds to win the contract to build the first spacesuit. As it turned out, this unlikely team of seamstresses and engineers had a unique ability in their way of crafting garments that was critical to sending a man to the Moon. And they weren’t alone. “A spacesuit is made out of a flight suit, a Goodrich tire, a bra, a girdle, a raincoat, a tomato worm,” writes Monchaux. It’s doubtful that Playtex, Goodrich, or any of the other companies involved in the spacesuit project saw themselves as being able to land a man on the Moon, and yet there they were. By contributing the skill that each company had perfected, this ad hoc team made a whole that was greater than its parts. To achieve a health moonshot, you and your company have to operate within your unique abilities, while partnering with others to complement and supplement your own. The activities you love doing and are great at should be where you spend 80% of your time. By drilling into these zones - rather than over-extending you’ll quickly identify and free yourself of areas that are outside of your scope that you can either outsource or simply not worry about. Have confidence in the unique skills you’ve built, and learn how to recognize them in others, so that you can move faster, together.

Principles in Action SAVONIX

Meet the Neuroscientist Democratizing Dementia Screenings Mylea Charvat, PhD, was a teenager living in Belle Plaine, a small town of 1,500 in Kansas, when her grandmother, who had dementia, was diagnosed with Alzheimer’s. Over time, her grandmother became less and less lucid as the disease inflicted brain damage beyond repair. “Personality changes, lapses in judgement, disorientation – it’s really disturbing when it happens,” says Charvat, a board-certified neuropsychologist and CEO and Founder of Savonix. “Be it age-related or a secondary effect from medication, losing one’s mind or watching a loved one experience it is incredibly scary.” Currently estimated at 47 million, the World Health Organization reports that by 2030 there will be 75 million people with dementia, and it’s estimated to triple by 2050. Alzheimer’s is the most common type of dementia. It disrupts the life-supporting communication among the tens of billions of neurons in the brain, eventually leading to cell death and the kind of disturbing symptoms Charvat’s grandmother experienced. While scientists are still learning about the role of genes, lifestyle and environment in the devastating disease, early detection can ease

Unique Ability Checklist

the downward slide. “It profoundly affected me,” says Charvat. “It was one of the hardest things, watching this person I loved gradually fade away.” Like so many other entrepreneurs in health innovation, Charvat turned her personal life experience into fuel for her life’s work. In 2014, she launched Savonix, a startup specializing in digital cognitive assessments. Within five years, she and her team of neuroscientists and gaming experts have raised $16.2 million to fund a digital upgrade to the classic pen and paper neurocognitive tests. Their flagship app, Savonix Mobile, increases the access for millions to brain health screenings that have the potential to reduce the impact of dementia and other cognitive impairments. “If my grandmother was alive today, it would take her

People know, notice, rely on and value your unique abilities.

nine months to get an appointment to see me. And if she did, she couldn’t afford me,” says Charvat. Since the company’s launch, Charvat’s work has quickly gained the attention of key players in the brain health space. Along with the company’s $1.5M Seed round in 2014 and $5.1M Series A round in 2017, this year, Savonix raised an additional $9.6 million with the help of new lead investors Fusion Fund and Wavemaker Partners. Additional support came from DEFTA Partners, Rethink Impact and DigiTx Partners. Savonix’s momentum speaks to the dire state of the current cognitive assessment model. The standard battery of tests used to assess patients for cognitive decline are costly and in most cases, unavailable due to a lack of qualified experts. The Savonix Mobile app

You have a commitment and passion for your unique abilities.

You love being in unique ability, and the activities come second nature.

is narrowing this care gap. It is the first mobile, clinically valid tool to screen for cognitive decline. The tool is based on existing clinical guidelines and procedures, but designed to replace a costly, often time-consuming brain health screening that involves a clinician working with pen and paper to assess patients. The app was engineered to account for touchscreen variances like device type, screen lag times, and average response time by motion (swipe, tap, draw) and by age group. Unlike other digital tests on the market, Savonix uses 3D technology to more accurately mimic pen and paper test conditions with questions that require a person to execute a range of psychomotor functions like tapping, drag and drop tasks, scrolling and drawing.

You’re continuously improving your unique capabilities each time you perform them.

THE 8 HEALTH MOONSHOT PRINCIPLES

Principles in Action THE OPIOID CRISIS WORKING GROUP

5. COLLABORATION

Creating Collaborations That Last

o single skill set was enough to send a man to the Moon. While Neil Armstrong is the symbol of the first moonshot, 400,000 individuals participated from 1962 to 1969 to get Armstrong, Michael Collins and Buzz Aldrin there and back again. What’s more, 20,000 companies and universities collaborated together. And not just the kind of space companies you’d think of, companies like Whirlpool, Westinghouse, IBM and General Motors. Even Playtex – then just a bra company – helped make the spacesuits. Tire companies, seamstresses, designers – every human who was interested in joining the achievement of landing a man on the Moon could be part of this collaboration. Today, we live in an age of amorphous digital relationships. The average LinkedIn user has more than 1,000 connections, not to mention their networks on Facebook, Instagram, etc. But connections aren’t enough. To achieve health moonshots, we need to graduate from connection to action. Collaboration is about actively figuring out how we can bring real value to those around us. It’s about helping others overcome their challenges. We need a global army of entrepreneurs, investors, customers and partners who are creating value for one another in pursuit of an ultimate goal. So how do you discern if a connection is a collaborator? How do you find your people? It starts with a mindset – both yours and theirs – and with a simple set of questions. Start here: “What are you trying to achieve?” When we find mission alignment, and figure out how we can truly create a win for those around us, there’s no limit to what’s possible.

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StartUp Health Magazine

A Radically Collaborative Approach to Ending the Opioid Epidemic By Jim Iversen CEO and Co-founder, Sen-Jam Pharmaceutical As an entrepreneur who spent my first career building missioncritical supply chain solutions, I understand the importance of getting the right product to the right location at the right time, as cost effectively as possible. Over the last 30 years a major shift has taken place in the supply chain from manufacturers “pushing” to consumers “pulling.” This seismic shift forced supply chain collaboration and the connecting of multidisciplinary systems, with a focus on improving quality and delivery outcome, while driving inefficiencies and cost out of the system. We’ve watched in amazement as collaborative logistics streamlined everything from Walmart to Amazon to Uber. Unfortunately, some of the most friction-filled areas of our society have yet to undergo this transformation. One such harrowing space is the opioid epidemic – the deadliest drug crisis in American history. Imagine if Amazon or Walmart didn’t have visibility into where your package was, yet you still paid for it. One thing is for certain: you and the Better Business Bureau wouldn’t stand for it. But the friction that’s slowing down our progress fighting addiction is starting to go away, thanks to a group of dedicated changemakers. Today, a multidisciplinary group of entrepreneurs have come together to

form the Opioid Crisis Working Group (OCWG) to end addiction and the opioid epidemic (one of StartUp Health’s health moonshots). The OCWG is on a mission to develop an evidencebased, end-to-end solution set of products and services that will stop the cycle of addiction by focusing on the whole person: biology, pharmacology, psychology, and sociology. It is this mission that unites the members of the OCWG to complete the continuum of care puzzle. By focusing on the needs of the whole person throughout the continuum of care, we can improve individual outcomes, rid society of this crisis, and achieve our moonshot. The OCWG believes that positive change can only happen when the many facets of the cycle of addiction are addressed. No one solution is a silver bullet, but an elegantly orchestrated system of service can have the impact required. In short, caring for the whole person is essential if we are to truly turn the tides on addiction. In 2017, more than 47,000 people died of opioid related deaths. It was the leading cause of death in people under 50 years old and the cause for a decrease in life expectancy for a third year in a row. In November 2017, the Council of Economic Advisors published a report estimating that in 2015, the economic cost of the opioid crisis was $504 billion or 2.8% of GDP that year. With numbers so large (and outdated), and a crisis so staggering, we need to use the tools that have disrupted other industries and apply them to the current opioid epidemic. Having more accurate and timely data will lead to further innovation and investment, bringing an end to the opioid crisis. The OCWG’s momentum is already building. Members of the OCWG have formed a relationship with an outpatient facility to provide a mobile application for their clients (patients). This mobile application will help the outpatient facility better manage their business and provide a higher level of interaction

with their clients. The data collected will allow us to measure against desired outcomes and provide a means for constant improvement. Another group of members is sharing technology in order to provide nutritional data via an API to a recovery platform whose clients will receive targeted evidence-based dietary suggestions based on their health conditions. But this collaboration needs to get much, much larger. I believe that current efforts to solve the opioid crisis are only addressing the symptoms and we need to move upstream and start addressing the problem with a long-term comprehensive plan. This shift could occur by opening up a Wikipedia page or interactive website for knowledge sharing, collaboration, and as our means to communicate the latest evidence-based findings to interested parties around the world. In addition, the creation of “tax exempt opioid crisis bonds” could unite the country for a common cause and be the catalyst for spurring innovation and investment for entrepreneurial groups like the OCWG, where early-stage investment is almost nonexistent! Need an economic argument to invest in fighting the opioid epidemic? Currently, the U.S. labor participation rate (eligible workers between the ages of 16-64) is down 10M+ people partly due to the opioid crisis. Reversing this trend would not only restore dignity and hope to those who have lost their way by getting them back to work, but it would also significantly increase the federal and state tax revenue base. The lessons learned here can lead to other groups collaborating and sharing best practices. Gaining clarity, by seeing beyond the noise, and turning data into actionable knowledge can lead to constant improvement and illumination of the solution. Working together we can end addiction and the opioid epidemic!

Moonshot Check-In --

Three years from today, what value towards the collective moonshot have you and your partners created together?

6. COMMUNITY

Find Your People, Find Your Way

as the world ever felt like it was small and getting smaller? It’s easy to fall into the pattern of sending small emails from small offices, setting small goals and fretting over small

problems. But the world is not small. We are a part of something massive, whether we realize it or not. We are a global community of billions of people who have more in common than that which divides us. We each have a need and desire for health and wellbeing. We love and seek love. It took 400,000 workers to send men to the Moon, but that doesn’t count the millions of family, friends and advocates who supported the mission along the way. We don’t achieve greatness in a vacuum. Community is at the heart of every health moonshot because it is both the object of the mission as well as the means to get there. We must recognize the community that we serve, and the humanity on the receiving end of any product or service. But we must also build cohorts of supportive relationships, recognizing our own unique abilities and where we need help, if we’re to have any hope of achieving the impossible. Being an entrepreneur can be incredibly lonely. By their very pursuits, entrepreneurs are isolated, out ahead of the market, carving new paths for others to walk in. This makes it all the more essential for entrepreneurs to find and maintain supportive community in order to thrive. Do you have a moonshot-sized dream? Find your people! Share your passion and your ideas, even if they feel unfinished. Identify the multiple communities that exist naturally around you and get involved. Finding batteries-included collaborators – and a broader community that supports your mission and pushes you forward – could mean the difference between success and failure. And while you’re at it, make sure you give back. Supportive community is a two-way 79

THE 8 HEALTH MOONSHOT PRINCIPLES

The Mediktor team, outside of the Barcelona Health Hub.

COMMUNITY, CONT’D street. Entrepreneurs often put themselves in the gap of not having achieved enough, so taking that step back and seeing the impact that you, personally, have had on various communities is significant.

Moonshot Check-In --

When was the last time that you paid it forward toward the communities you’re a hero to?

Issue 4

Principles in Action MEDIKTOR

One CEO’s Search for Office Space Birthed a European Hub for Health Innovation When Cristian Pascual upgraded his company to a new office, he saw an opportunity that could impact a whole city. The founder of Mediktor, an online symptom-checker that had already performed more than three million evaluations globally, knew he wanted to be in the heart of Barcelona, his home city. However, he also envisioned something bigger. “We wanted to interact with the rest of the community.” said Pascual. “So we started talking about it to everybody. Would you move to the same building with us? And everybody said

StartUp Health Magazine

yes. We found this incredible venue where we have the perfect space and it’s close to one of the main hospitals in Barcelona.” Thus was born the Barcelona Health Hub (BHH), a nonprofit association located in the heart of Barcelona in the restored 120-year-old Hospital de Sant Pau. Anyone who has set foot on the campus that Hospital de Sant Pau inhabits feels some sense of inspiration from the beautiful modernist architecture. More importantly though, there is a sense that people are honing in on a bigger inspiration and message. The Hub’s mission is simple: to improve and accelerate innovations in digital health, in Barcelona and beyond. It’s fair to say that Pascual’s desire for community – and attractive office space – sparked something of a movement. Since its founding, it has grown to house more than 25 resident startups and corporations and more than 170 members. More than 80 associated startups and corporations are members of the broader network, and

Pascual forecasts that number to reach 100 before the end of this year. And it’s not just early stage startups making the Hub their home. Insurance company DKV has set up shop and is building out an eHealth lab, a large space to showcase their latest innovations. HIMSS has established a presence here, as have a couple of top European pharma companies. The Hub hosts pitch nights, think tanks, conferences, and other networking events that link startups directly with buyers and top industry decision-makers. The next big event will be the BHH Summit on October 3 (more information at BHHSummit.com). “This is a rapidly growing industry,” says Pascual, “and there is a willingness of the health ecosystem to have a communal place to work and gather. We have great professionals, great institutions, and a great ecosystem. As a result, a lot of people are moving to and seeing Spain as a very interesting place to invest.”

7. CONSISTENCY

A Hundred Opportunities to Move the Needle

here are few things more boring than compound interest. And few things more powerful. In his book Atomic Habits, James Clear explores how the principles of compounding extend from your bank account to your personal life. “If you can get 1 percent better each day for one year, you’ll end up thirty-seven times better by the time you’re done,” writes Clear. “What starts as a small win or a minor setback accumulates into something much more.” At StartUp Health, our Health Transformers embrace this idea of consistent improvement by aligning themselves with 25-year health moonshots. For some, that’s the moonshot to end cancer as we know it. For others, it’s to open up access to care for all people, regardless of geography or income. To most people, 25 years sounds like a long time, but here are two reasons why it’s essential. First, changing the world takes time. Second, you’re going to have down days (and quarters). Twenty five years breaks down into 100 quarters. That’s 100 chances to adjust your course. 100 chances to review your progress. 100 chances to recalibrate. 100 chances to celebrate. Recognize that when you have a down period, there’s another quarter around the corner. After all, health moonshots are a marathon, not a sprint. Of course, the long view only works if you regularly assess what’s working and what’s not. Ask yourself honestly: What do I need to do next quarter to stay on the path, or get back on the path? The consistency of regular recalibration becomes easier if it becomes a daily habit. We need a spirit of consistency and sustainability, with weekly and quarterly rhythms – in order to identify troublespots quickly and adjust our course. MOONSHOT CHECK-IN: Over the last 90 days, what are you most proud of achieving? What are you most excited about over the next 90?

Principles in Action BUDDY HEALTHCARE

For One Finnish Entrepreneur, Strong Leadership Means Flexibility and Smart Quarterly Rhythms It’s the start of the summer season in Finland and Jussi Määttä is looking forward to spending the upcoming weekend by the sea, a few hours drive from Helsinki. For the CEO and co-founder of Buddy Healthcare, achieving a sense of balance is critical to everything he does, and it starts outside the office. Määttä (pictured, far right is a father of three young children, a three-year-old and twin one-year-olds. In order to be the kind of dad he wants to be – the kind that picks up his daughter from daycare almost every day, regardless of work deadlines – Määttä has had to do something many founders find difficult: give up some of the reins. “You can’t do it alone,” said Määttä. ”You need people you can trust and many entrepreneurs want to do everything themselves. Once you start delegating, everyone has room to grow. I want people to feel appreciated at work and feel trusted. I want them to

feel they have all the ability to make decisions related to their work.” The result, says Määttä, is an executive team that has grown in flexibility and stability. He credits much of Buddy Healthcare’s recent success to this new way of operating. Their care coordination platform is being used by 65% of Finnish hospitals and providers (13 out of 20 public facilities) and they’re actively expanding into new markets in Europe, like Germany. But delegation was only step one, says Määttä. Every 30 days, he and his leadership team of four meet to look back and assess what happened within the company, what has to be done in the next quarter, and reframe the mission. It’s a two-hour commitment that they keep month after month, quarter after quarter, to refine and refocus. Once a formal fill-in-the-form affair, now it is a time for honest dialogue. “It’s a conversation mostly,” says Määttä. “Then we just write down a couple of words. What are the most important things to focus on in the future? We do we want to learn from the past? How do we work better with customers?” As Buddy Healthcare expands beyond Finland, Määttä proudly touts the ‘Made in Finland’ name as a testament to quality. As a straight-tothe-point, product-oriented country, Määttä says, “If Fins tell you something, you can trust them. We deliver what is promised. That is what ‘Made in Finland’ means.“

THE 8 HEALTH MOONSHOT PRINCIPLES

8. CAPITAL

Every Health Moonshot Has a Bottom Line

oney. It has a way of making headlines, and of making people crazy. IPOs, unicorns, Series D – it’s easy to get caught up in the comparison game. Because of this, capital is often the first thing on the mind of an entrepreneur. What we’ve learned is that as necessary as it can be, it should be the last principle on this list. Not that capital isn’t important. NASA committed $23 billion dollars to the effort of sending a man to the Moon between 1961 and July 1969. That comes out to more than $160 billion in 2019 dollars. That’s what you’d call putting your money where your mouth is, and it worked. In 2018 we tracked $14.6B in health innovation funding across all health moonshots. Some call that a big number – it’s certainly on a positive upward trajectory – but we believe each health moonshot, from ending cancer to opening up access to care, deserves massive individual investment. In the Children’s Health Moonshot, for example, we tracked a mere $110 million invested in 2018. We have to commit more capital if we’re to make strides towards health moonshots globally. While most conversations about capital hinge on an investment into a company, few discuss that capital (time or money) needs to be smart. And that investors, whether they are VCs, CEOs of large corporations, or volunteers in a community should evaluate their own purpose and how they contribute whatever they have to the collective achievement of a moonshot. Capital is the last principle on our list because it is the result of the other seven. Capital flows out of confidence in your achievements and abilities – your own, and that of your collaborators. It hinges on the humanity of your story and in the collaboration that you engender by creating value for others. Instead of asking for capital, tell people where you are going. The right partner will ask you what you need in order to get there and how they can join. That’s a very different conversation about capital. Know where you are heading. Be bold in seeking the capital that will get you there. But never let the money drive the moonshot.

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StartUp Health Magazine

Health Moonshot Check-In -Capital can come in the form of time as well as money. Regardless of whether you’re an entrepreneur or an investor, your time is an investment in your moonshot.

Principles in Action STEPHANIE MARRUS

5 Ways to Stand Out When You’re Pitching for Capital Raising capital is a fact of startup life. It’s also an important element of almost any major project, from improving your local park to contributing to a political campaign. As the head of a major Silicon Valley

friend. What you don’t know is that the firm doesn’t invest before there’s demonstrable traction in the marketplace; an alpha doesn’t qualify. Know whom you’re talking to. Are you in their area of focus? Is this the right person in the partnership? Is there money available? Do they invest in your stage of development?

entrepreneurship center, Stephanie Marrus has helped start dozens of companies, creating business plans and searching for investors. Here are her five tips for standing out when making your pitch for capital. Engage with emotion and passion Investors are people and like us, they find dry, fact-based pitches boring. An investor may see eight pitches in a day and suffer from serious pitch fatigue by afternoon. Use storytelling to break through the noise. Here’s a true founding story: “In November 2015, my

childhood friend Mark Duntley died of cardiac arrest in his sleep at age 40. Technology could have saved him. Because of Mark, I started iBeat and created a watch that continually monitors your heart for life-threatening emergencies.” This emotional pitch made investors consider the opportunity, knowing the founder was committed in a significant manner. Do your homework Imagine you are working on the alpha version of a healthcare app. You’re meeting with a partner at a major venture capital firm, a friend of a

Be likeable and coachable Investors fall in love with entrepreneurs. Maybe you remind them of their kids, or the kids they never had. An investor will be with you for years, as long as it takes to make a return. The founder of one of my portfolio companies is a relationship builder. He stays in touch, asks for my advice and generally takes it. I feel valued and will happily spend time coaching him the next time he calls. Bottom line: you’re in a relationship. Investors want to use their expertise and make connections for you. They want you to listen to their advice and be coachable, not just hand over money. If you choose your investors carefully, their advice will be invaluable. Give investors the info they need Investors are all about avoiding risk. They focus on three things: the problem you’re solving and your solution, the market size, and the team. First, how well do you un-

derstand the problem you’re solving? Does your solution fit the market’s need? I love it when a founder says, “I’ve interviewed 100 customers and they confirmed it’s a huge problem and there’s nothing out there that addresses it.” Second, how big is the opportunity? Is the market big enough to support a scalable startup? Will you be able to grow your business to critical mass and provide the investors with a big exit? Third, how strong is the team? Speaking of your team, make it a good one People make the business and investors bank on them. Sell your experience, domain knowledge, leadership skills, and vision. Find co-founders who compliment your skillset and working style. It’s impressive when you can say, “Tim and I worked together in our last two companies. We know how to be partners and we’re going to do it again in this startup.” Pitches that start with a powerful team slide give context. You want investors thinking, this team just might be able to pull it off. Stephanie Marrus is the director of the Entrepreneurship Center at UCSF.

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86 Issue 4 StartUp Health Magazine Stock Code: 01833.HK

2019 Midyear

StartUp Health Insights

™

A quarterly report on health innovation and the health moonshots transforming the world.

ABOUT STARTUP HEALTH INSIGHTS™

Report Authors Nicole Clark | Polina Hanin

StartUp Health collects and shares market insights because these data points tell a critical part of the health innovation story. More than simply chronicling the flow of money, this report provides a glimpse into the overall health of our health moonshots. The story beneath the top-line figures opens up new challenges as well as opportunities. Health moonshots require radical collaboration, so we encourage you to dig into this report and then bring your own insights to the table at hq.startuphealth.com.

Contributors Tara Salamone | Jennifer Hankin Nicole Kinsey | Anne Dordai Sign up to receive weekly funding insights at startuphealth.com/insider © 2019 StartUp Health Holdings, Inc. StartUp Health and Health Transformer and associated logos are registered trademarks of StartUp Health LLC.

ABOUT STARTUP HEALTH At StartUp Health we believe that with the right mindset, a moonshot vision, and the spirit of an entrepreneur, anything is possible. We also know that something magical happens when you bring together people who are passionate about impacting lives for the better around common goals. That’s why, since 2011, we’ve been investing in a global army of Health Transformers to solve the world’s biggest health challenges. Join the movement at startuphealth.com.

STARTUP HEALTH INSIGHTS

Overview

2019 MIDYEAR

Health Innovation Highlights The Year of the Patient

ast quarter, we gave the StartUp Health Insights™ Report a makeover. It was time for a change. In our tenth year of tracking the funding, investors, companies and technology that’s propelled health innovation forward, we’ve seen median deal size reach $9.3M (up from $6.6M last year), an uptick in IPOs from big, financially successful health tech firms like Livongo and Peloton, and technologies like artificial intelligence and predictive analytics open up entire new sectors in the healthcare marketplace. We’re still tracking the same funding and investor numbers you’ve come to expect. Now, we’re going deeper. We’ve drilled down on progress within StartUp Health’s 11 health moonshots and key areas of health and wellness that have the potential to improve life for everyone on the planet. This is what we can tell you about health innovation in 2019: It is shaping up to be the Year of the Patient. In truth, the patient has always been the soul of the healthcare revolution. The founders of the health companies we follow and support are themselves patients. The investors in this market are patients. And ‘We the Patients’ are tired of care systems that value quantity over quality. This year, we see serious money flowing toward this change. Mega deals like Tencent Trusted Doctor’s $250M raise to expand quality health services to China’s 1.3+ billion patients and Thrive Earlier Detection’s $100M raise to advance patient-specific assays put personalized health at the top of the list for most-funded health functions in Q2 2019. Patient empowerment was a runner up with over $680M raised. A look at the Access to Care Moonshot reveals a 68% increase year-overyear in funding, while the Women’s Health Moonshot saw the highest overall increase in funding and deal count – both testaments to investors’ desire to back entrepreneurs improving care for historically underserved populations. There is still more work to do when it comes to offering moonshots like Children’s Health and Addiction funding stability, but progress is being made. Here are the topline takeaways.

StartUp Health Insights

HEALTH INNOVATION KEEPS PACE WITH LAST YEAR’S RECORD FUNDING

Despite seeing a decrease of 23% in deal counts from the first half of 2018 to the first half of 2019, the market continues to rebound. A deal slump that started in Q3 of last year, has now increased for the second quarter in a row. Thanks to mega deals like Tencent Trusted Doctor’s $250M raise, capital investment remains strong.

A WAVE OF IPOs AND CONTINUED CONSOLIDATION

In 2019, health-related IPOs are preparing their rush onto Wall Street after a three-year drought. Livongo, a Bay Area diabetes management platform, became the latest company to begin its public market pursuit, joining Change Healthcare, Health Catalyst, Phreesia, and Peloton. Meanwhile, massive pharma mergers like Botox-maker Allergan’s $63B sell to AbbVie and the planned Bristol-Myers Squibb and acquisition of Celgene became plot points along the industry’s consolidation curve. With mega deals holding steady and large-scale consolidations happening, be on the lookout for global industry powerhouses emerging.

MEGA DEALS THE NEW NORM?

Last year, Q3 2018 was the most lush quarter in the history of our tracking health innovation funding with a cluster of mega deals like Peloton’s $550M raise and 23andMe’s $300M round. Since then, mega deals ($100M+) have made a consistent appearance each quarter. Median deal size continues to rise to $9.3M for the year as 40 companies have raised over $50M rounds in 2019 thus far. Looking ahead, diversifying the flow of these mega deals to bolster health moonshots that have historically lagged in funding, like Addiction and Mental Health & Happiness, is sorely needed in order to tackle these complex health challenges. As the market matures and new companies emerge across an increasingly diverse spectrum, there’s room for mega deals in every category.

PERSONALIZED HEALTH

Personalized health had the biggest jump in quarter-over quarter funding from $115M in Q1 to $752M in Q2 2019. As InsureTech giants like Clover Health and Collective Health align with the Centers for Medicare and Medicaid Services’ launch of improved reimbursement models for digital solutions, so do companies that focus on digital treatments and diagnostics. These two functions, acting simultaneously, push to make sure that available personalized therapies will actually be available to patients.

BEST IN CLASS HEALTH MOONSHOTS Women’s Health, Brain Health, and Access to Care broke away from the pack with noteworthy bumps in funding from 2018 to 2019, showing that investors are recognizing the needs of traditionally underserved patients. On a year-over-year basis, the Women’s Health Moonshot shows the highest increase in funding (114%) and in deal count (67%). Access to Care has a 67% increase on a year-over-year basis in the first two quarters. On a quarter-over-quarter basis, top prizes for increases in funding and deal count go to the Nutrition & Fitness and Brain Health Moonshots.

MOVING THE NEEDLE ON MENTAL HEALTH + ADDICTION

If U.S. politicians can get on the same page when it comes to fighting the country’s opioid epidemic, then the health innovation community should be able to as well. Despite the passing of a sweeping legislative package in Q3 2018 that lawmakers and public health experts believe could help curb the growing addiction crisis in the U.S., the Addiction Moonshot has seen minimal funding action, save for Pear Therapeutics’ $64M Series C raise in Q1 2019. And while the Mental Health & Happiness Moonshot received a boost from unicorn wellness company Calm’s $88M raise, there is a lack of funding-focus on population health, clinical workflows and research health functions. If we’re going to move the needle on these issues, we’re going to need to see the world’s best entrepreneurs and innovators step in to invent new solutions combined with a strong financial commitment from the market.

STARTUP HEALTH INSIGHTS // THE MARKET

Funding

2019 MIDYEAR

THE STORY After 2018’s blockbuster year for health innovation, funding held steady in the first half of 2019. $6.8B was invested across Q1 and Q2 2019, which is ahead of the pace in 2018. This is the third quarter in a row where deal volume has increased and is now at Q3 2018 levels. Q2 2019 may have had 18% fewer total deals than Q2 2018, but the market

is rebounding from a Q4 2018 slump. A deeper look at health functions reveals a growing, global resistance to “one-size-fits-all” healthcare. Patient empowerment and personalized health saw increased funding levels quarter over quarter. Personalized health funding led with a 6.5x increase over Q1 2019 and had the second highest increase in deal count

Total Funding Q1 Q2

863

Largest U.S. Deals [Q2]

$14.6B

Company

769

Q3 Q4

DEAL COUNT 688 $11.7B

645

in the same period. The spike came from four mega deals including the biggest deal of the quarter, China’s Tencent Trusted Doctor’s $250M raise. Population health led in the quarterly increase for deal counts for 143%, and patient empowerment led in the overall deal count for the year at 72.

606 571

474 $8.3B

Amount

Function

01 Collective Health

$205M

Insurance

02 Tempus

$200M

Research

03 Thrive Earlier Detection $110M

Personalized Health

04 Encoded Therapeutics

$104M

Research

05 BostonGene

$100M

Research

06 Ro (fka Roman)

$85M

Patient Empowerment

07 BlackThorn Therapeutics

$76M

Personalized Health

08 Omada Health

$73M

Patient Empowerment

09 Frontier Medicines

$67M

Research

10 Jawbone Health

$65M

Patient Empowerment

339 $7.1B

286

$6.6B

$6.8B

$6.2B

Company

154 $4.3B $3.3B $2.8B

2019 YTD

2018

2017

2016

2015

2014

$1.2B

$1.5B

2013

$0.9B

2011

2010

$0.6B $1.2B

$3.0B

$2.3B

2012

$2.1B $1.2B

Largest Non-U.S. Deals [Q2] Amount

Function

01 Tencent Trusted Doctor

$250M

Personalized Health

02 CureFit

$120M

Wellness

03 DocPlanner

$90M

Patient Empowerment

04 1mg

$70M

Patient Empowerment

05 CarePay International

$45M

Patient Empowerment

06 Elvie

$42M

Wellness

07 Biofourmis

$35M

Personalized Health

08 Zava

$32M

Clinical Workflow

09 DayTwo

$31M

Personalized Health

10 LetsGetChecked

$30M

Patient Empowerment

Source: StartUp Health Insights | startuphealth.com/insights. Note: Report based on publicly available data through 6/30/19 on seed (incl. accelerator), venture, corporate venture, and private equity funding only. Companies tracked in StartUp Health Insights may fall under multiple moonshots and therefore will be represented throughout the report.

STARTUP HEALTH INSIGHTS // THE MARKET

Investors

2019 MIDYEAR

Total Investors [YoY] 1238

THE STORY 200

With 737 total investors, the first half of 2019 was about level with 2018’s midyear number (757). We’re proud to say, StartUp Health took the top place with eight deals as the most active investor in the first half of 2019, nearly six months after closing our second fund. For the third year in a row, Khosla Ventures and New Enterprise Associates expanded their portfolio of health innovation companies, with five deals apiece in H1 2019. We’re keeping an eye on investors backing two or more companies – this year has the opportunity to surpass 2018 on this data point. So far, 18% of investors backed two or more companies, compared to 25% by the end of 2018.

921

497

150

INVESTOR COUNT

1228

614

645

2014

2015

737

306

100

2012

2013

# OF DEALS BY INVESTOR

2016

2017

2018

2019 YTD

TOTAL UNIQUE INVESTORS

Most Active Investors [2019 YTD] re

2019 YTD Deals

2018 Total Deals

01 StartUp Health

02 GV

03 Khosla Ventures

03 New Enterprise Associates

03 F-Prime Capital Partners

03 Echo Health Ventures

03 Sequoia Capital

08 Y Combinator

08 ARCH Venture Partners

08 Optum Ventures

08 Maverick Capital

08 Health Enterprise Partners

08 Section 32

08 pi Ventures

08 Bain Capital Ventures

Issue 4

StartUp Health Magazine

s Co

o er

r Cu

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’s en om th W eal H

s n’ re ild lth h C ea H

on iti s tr nes Nu Fit &

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th al He ess l y ta in vit en pp ge M Ha n Lo &

STARTUP HEALTH INSIGHTS // THE MARKET

Hubs of Innovation

2019 MIDYEAR

Most Active Metro Areas in the United States City/Region

Funds Raised

Deals YTD

2018 Deals

$2.0B

137

San Francisco Bay Area

Boston

$668.9M

New York City

$558.6M

Chicago

$230.2M

Salt Lake City

$125.0M

Denver

$113.4M

Columbus

$75.2M

Seattle

$72.9M

Boulder

$60.0M

Phoenix

$48.0M

THE STORY The San Francisco Bay Area, Boston, and New York held their positions from Q1 2019 as the top three most-funded cities in the U.S., with San Francisco raking in nearly twice that of its east coast counterparts, combined. New York City held onto the number two spot for total deals, while Boston led with total funding. Salt Lake City jumped into fifth place with $125M in funding this year with the help of data analytics company Health Catalystâ&#x20AC;&#x2122;s $100M Series F. Three new entrants to the U.S. Top Ten List: Columbus (14th in 2018), Boulder, and Phoenix were also propped up by deals over $40M. Time will tell whether they will hold their spots or if budding health innovation hubs like Nashville, Minneapolis, or Los Angeles will climb back into the top ten.

STARTUP HEALTH INSIGHTS // THE MARKET

Hubs of Innovation

2019 MIDYEAR

Most Active Non-U.S. Metro Areas City/Region

Funds Raised

Deals YTD

2018 Deals

Beijing

$486.0M

Paris

$321.0M

Tel Aviv

$181.9M

Bangalore

$178.1M

London

$129.9M

Guangzhou

$103.0M

Warsaw

$102.5M

National Capital Region, India

$85.0M

Zhejiang

$80.0M

Lausanne

$77.0M

StartUp Issue 4HealthStartUp Insights Health Magazine

THE STORY Paris held its place near the top of this list, coming in second place (a drop from first place in Q1 2019), bested only by the traditional leader in international health funding – Beijing. Beijing’s dominance in health funding, combined with a year-over-year trend of big money fanning out to Chinese cities like Guangzhou and Zhejiang is indicative of the country’s exploding health marketplace. Tech firms like Tencent Trusted Doctor continue to penetrate China’s overburdened public healthcare market, with a rising number of affluent consumers willing to pay for better access to health services. London, another top ten regular, closed the most deals year to date. It’s worth noting that Bangalore and National Capital Region (NCR) of India collectively brought in 12 deals this year, making India a country worth watching.

2019 MIDYEAR

STARTUP HEALTH INSIGHTS

The Quest to Achieve Health Moonshots At StartUp Health, we believe that radical collaboration around audacious heatlh goals will change the world. Here are the Health Moonshots that we are currently working towards, and which we use to categorize the market. (Data presented is YTD unless otherwise noted.)

Access to Care Moonshot Together we can deliver quality care to everyone, regardless of location or income

Women’s Health Moonshot Together we can improve the health of every woman, closing the gender gap

Brain Health Moonshot Together we can unlock the mysteries of the brain to improve health and wellness

Cost to Zero Moonshot Together we can reduce the cost of care to “zero”

Children’s Health Moonshot Together we can ensure that every child has access to quality care

Cure Disease Moonshot Together we can rid the world of disease

Nutrition & Fitness Moonshot Together we can ensure access to food, water and a healthy lifestyle

Mental Health & Happiness Moonshot Together we can connect mind, body and spirit in the pursuit of wellbeing

Cancer Moonshot Together we can end cancer as we know it

Longevity Moonshot Together we can add 50 healthy years to every human life Addiction Moonshot Together we can end addiction and the opioid epidemic

149 138

2019 Midyear Funding by Health Moonshot Deal Count 79 52

$2.7B

$2.0B

$675.6M

$238.9M

$60.8M

$530.6M

$235.3M

$336.6M

$1.2B

$69.6M

Access to Care

Cost to Zero

Cure Disease

Cancer

Women’s Health

Children’s Health

Nutrition & Fitness

Brain Health

Mental Health & Happiness

Longevity

Addiction

93 93

STARTUP HEALTH INSIGHTS // HEALTH MOONSHOTS

Access to Care THE STORY The Access to Care Moonshot continues to grow, with a 67% increase from the first half of 2018 to the first half of 2019 in funding and a 23% increase in deal count (the second highest increase behind Women’s Health). Already, companies in the moonshot have raised 55% of what they raised in all of 2018. There was a surge of early-stage raises, with Seed and Series A rounds accounting for 62% of deals, as compared to 40% overall, and 59% of this quarter’s deals were below $10M. This moonshot enjoys a wide breadth of investment: all ten of the tracked health functions are represented. Following the broader Q2 trend, the personalized health function saw the biggest uptick in funding from Q1, while deals inked in the name of patient empowerment represented one third of Access to Care’s top deals. (Data is YTD unless noted)

2019 MIDYEAR

Funding Deal Count

$516M Q1 2018

$1.1B Q2 2018

Investment Spectrum

Number of Deals By Round*

How Funding Is Balanced Across 10 Functions 27

Series A

Series B

Series C

Series D

Series E or later

Under $1M

$1M–$5M

$5M–$10M

$10M–$25M

11 Deals ($237.2M)

Research

3 Deals ($90.6M) 50 Deals ($924.0M)

$1.4B Q2 2019

DEALS

150 MEDIAN DEAL SIZE

Admin Workflow

17 Deals ($161.8M)

$8.8M

Clinical Workflow

29 Deals ($436.6M)

INVESTORS

Personalized Health

12 Deals ($380.6M)

Population Health

12 Deals ($185.0M)

Biometric Data Acquisition

9 Deals ($159.3M)

3 Deals ($7.7M)

MOST ACTIVE INVESTORS Ranking

Top Deals Company

305

3 Deals ($89.0M)

Round Size $250.0M

Function Personalized Health

Tencent Trusted Doctor

Doctolib

$170.0M

Patient Empowerment

$100.0M

Patient Empowerment

$25M–$50M

Hims

$50M–$100M

DocPlanner

$89.8M

Patient Empowerment

Ro (fka Roman)

$85.0M

Patient Empowerment

Taimei Medical Technology

$80.0M

Research

$100M+

$1.3B Q1 2019

Deal Count

Education + Content

Frequency of Deal Size**

$1.2B Q4 2018

2019 QUICK STATS

Insurance

Dollars

$2.2B Q3 2018

Wellness Patient Empowerment

Rounds Seed

Total Access to Care Funding

pi Ventures

Tencent

Echo Health Ventures

IDG Capital

Kae Capital

Khosla Ventures

Sequoia Capital

StartUp Health

94 94

Source: StartUp Health Insights | startuphealth.com/insights. Note: Report based on publicly available data through StartUp Insights Issue 4HealthStartUp Health Magazine6/30/19 on seed (incl. accelerator), venture, corporate venture, and private equity funding only. Companies tracked in StartUp Health Insights may fall under multiple moonshots and therefore will be represented throughout the report.

STARTUP HEALTH INSIGHTS // HEALTH MOONSHOTS

Cost to Zero

2019 MIDYEAR

THE STORY As deal counts barely grew from the first half of 2018 to the first half of 2019, funding for the Cost to Zero Moonshot topped off at $2.7B for the year, a 45% increase. Leading the funding was a combined $705M from two insurance deals which comprised 26% of overall funding for the moonshot. In fact, this moonshot held the unique distinction of five deals above $100M, more than any other moonshot in the first half of 2019. But despite the mega deals, median deal size remained at $10M, trailing behind moonshots like Cure Disease and Cancer, and just ahead of the overall median of $9.3M. Patient empowerment and wellness had the biggest increases in funding thanks to deals like Thrive Earlier Detection and Beam Dental. Admin and clinical workflow continued to dominate this moonshot, outpacing all other functions.

Funding Deal Count 66

$1.0B Q1 2018

$875M Q2 2018

Investment Spectrum

Number of Deals By Round*

How Funding Is Balanced Across 10 Functions 24

Series A

Series B

Series C

Series D

Series E or later

$1.1B Q4 2018

$1M–$5M

$5M–$10M

$10M–$25M

$25M–$50M

$50M–$100M

10 3

$1.5B Q1 2019

$1.2B Q2 2019

2019 QUICK STATS

5 Deals ($252.0M)

Research

5 Deals ($85.0M)

DEALS

138 MEDIAN DEAL SIZE

Patient Empowerment

15 Deals ($255.4M)

Biometric Data Acquisition

10 Deals ($130.1M)

Admin Workflow

43 Deals ($490.6M)

$10M

Clinical Workflow

44 Deals ($538.7M)

INVESTORS

Personalized Health

6 Deals ($62.1M) 7 Deals ($805.8M) --

01 02

Clover Health Collective Health

MOST ACTIVE INVESTORS Ranking

Top Deals Company

322

3 Deals ($121.4M)

Education + Content

Under $1M

$100M+

$1.2B Q3 2018

Wellness

Insurance

Frequency of Deal Size**

Deal Count

Population Health

Dollars

61 43

Rounds Seed

Total Cost to Zero Funding

Round Size $500M

Bessemer

Function

BIP

Insurance

Cultivation

Echo F-Prime

$205M

Insurance

1 1

HEP

Maverick

Thrive Earlier Detection

$110M

Personalized Health

Health Catalyst

$100M

Admin Workflow

1 McKesson

Hims

$100M

Patient Empowerment

MemorialCare

Meridian Street

Dingdang Medicine Express

NEA

Norwest

Section 32

StartUp Health

$89M

Wellness

* Deals that were not associated with a specific round are not included in this particular breakdown. **Raises without a publicly disclosed dollar amount are counted in the total number of deals, but not represented in frequency of deal size analysis. Source: StartUp Health Insights | startuphealth.com/insights. Note: Report based on publicly available data through 6/30/19 on seed (incl. accelerator), venture, corporate venture, and private equity funding only. Companies tracked in StartUp Health Insights may fall under multiple moonshots and therefore will be represented throughout the report.

95 95

STARTUP HEALTH INSIGHTS // HEALTH MOONSHOTS

Cure Disease THE STORY

While funding and deal counts for the Cure Disease Moonshot had been on a multi-quarter decline, we saw an increase of activity in June 2019. Quarter-overquarter funding saw a 90% increase, and the number of deals supporting the Cure Disease Moonshot shot up by 55%. Cure Disease is one of the more mature health moonshots, with mid-stage deals making up 45% of total deals cut in the first half of 2019. This comes as no surprise, as companies working to tackle some of healthcare’s thorniest issues – medication adherence, speeding up drug research, and precision medicine – typically require more capital and runway to refine their tech before taking it to market. In this quarter, Series A median deal sizes for the Cure Disease moonshot reached $15.5M.

2019 MIDYEAR

Funding Deal Count 63

$1.2B Q1 2018

$1.2B Q2 2018

Investment Spectrum

Number of Deals By Round*

How Funding Is Balanced Across 10 Functions 5

Series A

Series B

Series C

Series D

Series E or later

$1.0B Q3 2018

$1M–$5M

$5M–$10M

$10M–$25M

$25M–$50M

$50M–$100M $100M+

$980M Q4 2018

$689M Q1 2019

Deal Count 2 Deals ($55.2M)

Research

12 Deals ($720.1M)

Patient Empowerment

11 Deals ($300.6M)

Biometric Data Acquisition

15 Deals ($164.6M)

Admin Workflow

4 Deals ($67.2M)

Clinical Workflow

15 Deals ($286.9M)

Personalized Health

Tempus

MEDIAN DEAL SIZE

$15.5M INVESTORS

244

10 Deals ($194.0M) -2 Deals ($11.0M)

Top Deals Company

$1.3B Q2 2019

DEALS

9 Deals ($212.5M)

Education + Content

Under $1M

2019 QUICK STATS

Insurance

Frequency of Deal Size**

Wellness

Population Health

Dollars

Rounds Seed

Total Cure Disease Funding

MOST ACTIVE INVESTORS Ranking

Round Size $200M

Function Research

Beam Therapeutics

$135M

Research

Encoded Therapeutics

$104M

Research

BostonGene

$100M

Research

Taimei Medical Technology

$80M

Research

Sophia Genetics

$77M

Clinical Workflow

ARCH Venture Partners

3 Altitude Life Science Ventures 3 Aphelion 3 F-Prime 3 Greycroft 3 Illumina Ventures

96 96

STARTUP HEALTH INSIGHTS // HEALTH MOONSHOTS

Cancer

2019 MIDYEAR

THE STORY After a dramatic drop in funding at the end of 2018, the Cancer Moonshot continued to rebound, increasing by over 120% since Q1 of this year. Top deals focused on the “front end” of cancer, expanding precision medicine and personalized care to support early diagnosis and targeted treatments. Median deal size remained high ($14M), even though 64% of the deals YTD were early stage. Similar to funding rounds in the Cure Disease Moonshot, cancer research and treatments generally requires a higher threshold of early-stage funding to perfect the science and pass layers of regulatory approvals. There was a noticeable gap of investments this year in patient empowerment and education, health functions that are necessary to improving quality of life for patients battling the disease.

Funding Deal Count

$423M Q1 2018

$330M Q2 2018

Investment Spectrum

Number of Deals By Round*

How Funding Is Balanced Across 10 Functions 1

Series A

Series B

Series C

Series D

Series E or later

$584M Q3 2018

$257M Q4 2018

Under $1M

Wellness

Research

4 Deals ($284.0M)

Patient Empowerment

$1M–$5M

$5M–$10M

$10M–$25M

$25M–$50M

$50M–$100M

$100M+

$470M Q2 2019

Biometric Data Acquisition

1 Deal ($6.0M)

Admin Workflow

Clinical Workflow

4 Deals ($76.4M)

Personalized Health

MEDIAN DEAL SIZE

$14M INVESTORS

3 Deals ($205.0M) 3 Deals ($80.2M) -1 Deal ($7.0M)

Top Deals Company

DEALS

1 Deal ($17.0M)

Education + Content

$205M Q1 2019

2019 QUICK STATS

Insurance

Frequency of Deal Size**

Deal Count

Population Health

Dollars

Rounds Seed

Total Cancer Funding

MOST ACTIVE INVESTORS Ranking

Round Size

Function

Tempus

$200M

Research

Thrive Earlier Detection

$110M

Personalized Health

DNAnexus

$68M

Population Health

Frontier Medicines

$67M

Research

ArcherDx

$60M

Personalized Health

Medbanks Network Technology

$59M

Clinical Workflow

Section 32

Tencent

3 69 Investors

97 97

STARTUP HEALTH INSIGHTS // HEALTH MOONSHOTS

Women’s Health THE STORY In a relatively flat first half of the year for health innovation funding, the Women’s Health Moonshot continued to show steady growth – from the first half of 2018 to the first half of 2019, it had the highest increase in funding and in deal count. This moonshot is in its infancy, with 76% of YTD funding coming from Seed and Series A rounds and median deal size hovering at $6.8M, well below some of the more mature moonshots. Most of YTD funding in the Women’s Health Moonshot was concentrated in personalized health and patient empowerment – not surprising given the recent debates over women’s reproductive health in the U.S. Worldwide, closing the gender gap and widening the aperture on the definition of women’s health will require sustained funding momentum across all functions, from research, to education, to new levels of patient empowerment.

2019 MIDYEAR

Funding Deal Count 5

12 7

Investment Spectrum

Number of Deals By Round*

How Funding Is Balanced Across 10 Functions 3

Series A

Series B

Series C

Series D

Series E or later

Frequency of Deal Size** Under $1M

$1M–$5M

$5M–$10M

$10M–$25M

$25M–$50M

$50M–$100M

$100M+

$141M Q4 2018

$106M Q1 2019

Deal Count 1 Deal ($42.0M)

Research

Patient Empowerment

9 Deals ($77.3M)

Biometric Data Acquisition

3 Deals ($23.7M)

Admin Workflow

Clinical Workflow

2 Deals ($34.0M)

Personalized Health

4 Deals ($59.3M)

DEALS

MEDIAN DEAL SIZE

$6.8M INVESTORS

1 Deal ($2.6M)

Insurance

Education + Content

-MOST ACTIVE INVESTORS

Top Deals Company

$133M Q2 2019

2019 QUICK STATS

Wellness

Population Health

Dollars

$20.7M $90.7M $96.9M Q1 Q2 Q3 2018 2018 2018

Rounds Seed

Total Women’s Health Funding

Ranking

Round Size

Function

46 Investors Including:

The Pill Club

$51M

Patient Empowerment

Elvie

$42M

Wellness

NEA

Zava

$32M

Clinical Workflow

Octopus Ventures

Cleo (fka Lucy)

$28M

Personalized Health

Sherpa Capital

BillionToOne

$15M

Biometric Data Acquisition

Modern Fertility

$15M

Personalized Health

98 98

STARTUP HEALTH INSIGHTS // HEALTH MOONSHOTS

Children’s Health THE STORY With the Children’s Health Moonshot, we have the opportunity to put the next generation on a firm foundation. CareDox (a StartUp Health company) came in strong with a $24M raise this year (40% of YTD funding for this moonshot) but children’s health funding remains unpredictable. Since 2015, funding has been up and down and limited to population health and personalized health functions. 2019 is no exception. This is commensurate for a moonshot whose deals this year have been 75% early stage. Expanding the investor pool and directing funding toward additional health functions like clinical and administrative workflows, education, and research will be critical to giving children worldwide equal access to safe and healthy lives.

Funding 12 7

$9.0M Q1 2018

Number of Deals By Round*

How Funding Is Balanced Across 10 Functions

Series A

Series B

Series C

Series D

Series E or later

Frequency of Deal Size** Under $1M

$1M–$5M

$5M–$10M

$10M–$25M

$25M–$50M

$50M–$100M $100M+

0 0

Deal Count 1 Deal ($5.0M)

Research

Patient Empowerment

Biometric Data Acquisition

2 Deals ($16.5M)

Admin Workflow

Clinical Workflow

Personalized Health

DEALS

MEDIAN DEAL SIZE

$5.5M INVESTORS

2 Deals ($6.6M) 4 Deals ($32.7M)

Insurance

Education + Content

-MOST ACTIVE INVESTORS

Top Deals Company

2019 QUICK STATS

Wellness

Population Health

Dollars

$75.2M $30.1M $24.8M $40.8M $20.0M Q2 Q3 Q4 Q1 Q2 2018 2018 2018 2019 2019

Investment Spectrum 2

Total Children’s Health Funding

Deal Count

Rounds Seed

2019 MIDYEAR

Ranking

Round Size

Function

Caredox

$24M

Population Health

BillionToOne

$15M

Biometric Data Acquisition

Mightier

$7M

Personalized Health

GoCheck

$6M

Population Health

Astarte Medical Partners

$5M

Wellness

Pr3vent

$2M

Biometric Data Acquisition

35 Investors Including: 7Wire B Capital Group Founder Collective StartUp Health

99 99

STARTUP HEALTH INSIGHTS // HEALTH MOONSHOTS

Nutrition & Fitness THE STORY The Nutrition & Fitness Moonshot saw the second highest increase in funding from the first half of 2018 to the first half of 2019 (Women’s Health was first), with a 82% jump from this time last year. The moonshot was first place in quarter-over-quarter growth, just ahead of Brain Health, and doubled its deals in the same period. Raises like India’s CureFit $120M round reflected this sector’s focus on wellness and the global interest in a holistic approach to health – CureFit operates gyms, healthy food offerings, mental wellness, and diagnostic centers all under their ‘Fit’ brand. Deal size so far this year has been with a high median of $13.3M, as 36% of the deals have topped out above $50M. This year, only the Cancer Moonshot has had a higher share of deals at 41%.

Funding 17

$172M Q1 2018

$120M Q2 2018

Number of Deals By Round*

How Funding Is Balanced Across 10 Functions

Series A

Series B

Series C

Series D

Series E or later

Dollars

Investment Spectrum 4

Under $1M

$1M–$5M

$5M–$10M

$10M–$25M

$25M–$50M

$50M–$100M

$100M+

$1.0B Q3 2018

$126M Q4 2018

$76M Q1 2019

Deal Count

Wellness

17 Deals ($376.0M)

Research

Patient Empowerment

$455M Q2 2019

DEALS

MEDIAN DEAL SIZE

3 Deals ($115.6M)

Biometric Data Acquisition

1 Deal ($2.5M)

Admin Workflow

Clinical Workflow

Personalized Health

2019 QUICK STATS

$13.3M INVESTORS

3 Deals ($71.0M)

Population Health

Insurance

Education + Content

Frequency of Deal Size**

Total Nutrition & Fitness Funding

Deal Count

Rounds Seed

2019 MIDYEAR

1 Deal ($670K) MOST ACTIVE INVESTORS

Top Deals

Ranking

Company

Round Size

Function

CureFit

$120M

Wellness

1mg

$70M

Patient Empowerment

Noom

$58M

Wellness

Tonal

$45M

Wellness

Whole Biome

$35M

Personalized Health

DayTwo

$31M

Personalized Health

Sequoia Capital

2 Kae Capital 2 Khosla Ventures 2 Redwood Global Healthcare Fund 5 85 Investors

100 100

Source: StartUp Health Insights | startuphealth.com/insights. Note: Report based on publicly available data through StartUp Insights Issue 4HealthStartUp Health Magazine 6/30/19 on seed (incl. accelerator), venture, corporate venture, and private equity funding only. Companies tracked in StartUp Health Insights may fall under multiple moonshots and therefore will be represented throughout the report.

STARTUP HEALTH INSIGHTS // HEALTH MOONSHOTS

Brain Health

2019 MIDYEAR

THE STORY The funding narrative behind the Brain Health Moonshot took a turn for the better in Q2. After a lag from Q4 2018 to Q1 2019, the sector rallied, pumping almost $200M across a range of health functions, everything from BlackThorn Therapeutics neurobehavioral drug development ($76M) to Savonix’s (a StartUp Health company) digitized neurocognition tests. The Brain Health Moonshot also had the second highest number of mid-stage deals, right behind the Cure Disease Moonshot, suggesting that for company’s focused on demystifying brain health, moving from ideation to honing their product/market fit will be essential to attracting ongoing funding.

Funding Deal Count 8

$116M Q1 2018

Number of Deals By Round*

How Funding Is Balanced Across 10 Functions

Series A

Series B

Series C

Series D

Series E or later

Frequency of Deal Size** Under $1M

$1M–$5M

$5M–$10M

$10M–$25M

$116M Q3 2018

Deal Count 3 Deals ($48.5M) -1 Deal ($150K)

Biometric Data Acquisition

4 Deals ($29.0M)

Admin Workflow

Clinical Workflow

2 Deals ($51.0M

Personalized Health

2 Deals ($97.0M)

DEALS

MEDIAN DEAL SIZE

$9.4M INVESTORS

1 Deal ($9.6M)

Insurance

Education + Content

-MOST ACTIVE INVESTORS

Top Deals Company

$199M Q2 2019

2019 QUICK STATS

Research Patient Empowerment

$36.6M $36.8M Q4 Q1 2018 2019

Wellness

Population Health

Dollars

$104M Q2 2018

Investment Spectrum 3

Rounds Seed

Total Brain Health Funding

Ranking

Round Size

Function

BlackThorn Therapeutics

$76M

Personalized Health

Cala Health

$50M

Clinical Workflow

$25M–$50M

Theranica

$35M

Wellness

$50M–$100M

Neural Analytics

$22M

Biometric Data Acquisition

$100M+

Neurotrack

$21M

Personalized Health

Savonix

$10M

Population Health

48 Investors Including: ARCH GV Khosla Ventures StartUp Health

101 101

STARTUP HEALTH INSIGHTS // HEALTH MOONSHOTS

Mental Health&Happiness THE STORY The Mental Health & Happiness Moonshot is one of extremes. Poor mental health saps billions of dollars from income growth each year – $53 billion annually in the U.S. alone – yet deals in this moonshot have a relatively low $4M median deal size. That said, while many of the deals funded are early-stage raises (61%) and a majority fall under $5M, we saw the first mental health unicorn at the beginning of the year when Calm raised $88M, valuing the company at $1B. Here’s the rub: Companies like Calm boost wellness and patient empowerment, but there’s a lack of funding-focus on population health, clinical workflows, and research. Moving the needle on mental health will require market stability and a build-up of administrative support systems so that the patient isn’t shouldering the burden of their own improvement.

Funding Deal Count 32

$86.9M Q1 2018

$379M Q2 2018

Investment Spectrum

Number of Deals By Round*

How Funding Is Balanced Across 10 Functions 6

Series A

Series B

Series C

Series D

Series E or later

Dollars Under $1M

$1M–$5M

$5M–$10M

$10M–$25M

$25M–$50M

$50M–$100M

$100M+

$53.1M Q4 2018

$131M Q1 2019

Wellness

10 Deals ($194.1M)

Research

Patient Empowerment Biometric Data Acquisition

MEDIAN DEAL SIZE

$4M

Admin Workflow

2 Deals ($8.0M)

Clinical Workflow

1 Deal ($60.0M

INVESTORS

6 Deals ($57.7M)

Population Health

Insurance

-3 Deals ($11.1M) MOST ACTIVE INVESTORS

Top Deals Company

DEALS

7 Deals ($5.7M)

Personalized Health

$206M Q2 2019

2019 QUICK STATS Deal Count

Education + Content

Frequency of Deal Size**

$130M Q3 2018

Rounds Seed

Total Mental Health & Happiness Funding

Ranking

Round Size

Function

Calm

$88M

Wellness

Quartet Health

$60M

Clinical Workflow

Talkspace

$50M

Wellness

Vida Health

$30M

Wellness

Cleo (fka Lucy)

$28M

Personalized Health

Neurotrack

$21M

Personalized Health

Sound Ventures

Y Combinator

3 78 investors Including: Khosla Ventures Lux Capital NEA Norwest

102

Source: StartUp Health Insights | startuphealth.com/insights. Note: Report based on publicly available data through

6/30/19 onIssue seed (incl. accelerator), venture,Magazine corporate venture, and private equity funding only. Companies tracked in 102 4 StartUp Health StartUp Health Insights may fall under multiple moonshots and therefore will be represented throughout the report.

STARTUP HEALTH INSIGHTS // HEALTH MOONSHOTS

Longevity

2019 MIDYEAR

THE STORY The Longevity Moonshot saw a dip in funding and deal volume in 2019 from Q1 to Q2. This moonshot is as personal as it is technical, and the funding shows it – deals cut in the name of patient empowerment jumped from $4.5M in Q1 to $301M YTD. Aging with vitality is a necessary part of adding 50 healthy years to everyone’s life. Ro and Hims followed on the heels of Clover Health’s $500M raise in Q1 2019, raking in a collective $185M in Q2. Both companies offer online prescriptions for erectile dysfunction medications, and both are expected to use recent funding to expand lines of women’s health products. This moonshot continues to have one of the most diverse spreads when it comes to health functions, with wellness leading the pack, propped up by four of the moonshot’s top deals.

Funding Deal Count 41

$471M Q1 2018

Investment Spectrum

Number of Deals By Round*

How Funding Is Balanced Across 10 Functions 12

Series A

Series B

Series C

Series D

Series E or later

$599M Q2 2018

Rounds Seed

Wellness

10 Deals ($162.9M)

Research

2 Deals ($32.0M)

Patient Empowerment

9 Deals ($301.2M)

Biometric Data Acquisition

10 Deals ($61.2M)

Admin Workflow

1 Deal ($5.2M)

Clinical Workflow

$1M–$5M

Personalized Health

$5M–$10M

$10M–$25M

$25M–$50M

$50M–$100M

$100M+

$834M Q1 2019

$378M Q2 2019

DEALS

MEDIAN DEAL SIZE

$5.4M INVESTORS

112

10 Deals ($108.8M) 2 Deals ($2.7M) 2 Deals ($505.0M) 2 Deals ($2.3M)

MOST ACTIVE INVESTORS

Top Deals Company

4 Deals ($30.4M)

Education + Content

Under $1M

$703M Q4 2018

Deal Count

Insurance

Frequency of Deal Size**

$818M Q3 2018

2019 QUICK STATS

Population Health

Dollars

Total Longevity Funding

Ranking

Round Size

Function

Clover Health

$500M

Insurance

Hims

$100M

Patient Empowerment

Ro (fka Roman)

$85M

Patient Empowerment

Jawbone Health (fka Jawbone)

$65M

Patient Empowerment

Beam Dental

$55M

Wellness

Quip

$40M

Wellness

Khosla Ventures

2 120 Investors Including: First Round Capital NEA Optum pi Ventures

103

StartUp Health Insights

Source: StartUp Health Insights | startuphealth.com/insights. Note: Report based on publicly available data through 103 6/30/19 on seed (incl. accelerator), venture, corporate venture, and private equity funding only. Companies tracked in StartUp Health Insights may fall under multiple moonshots and therefore will be represented throughout the report.

STARTUP HEALTH INSIGHTS // HEALTH MOONSHOTS

Addiction

2019 MIDYEAR

THE STORY The potential impact of investment into the Addiction Moonshot remains enormous. An already fragile sector saw a significant quarter-over-quarter drop (-94%), with Boston-based DynamiCare Health’s $4.1M raise representing the solo act for Q2. The year started with a bang with Pear Therapeutics’ $64M Series C raise, which was announced just one year after the digital therapeutic maker (also Boston-based) landed $50 million in Series B funding to expand their prescription software-based treatments. With bipartisan support behind new U.S. policies to curb the opioid epidemic, it’s time for health innovators to begin thinking about how their tech might be applied to the Addiction Moonshot.

Funding Deal Count

$51.8M Q1 2018

$0 Q2 2018

$0 Q3 2018

$0 Q4 2018

Rounds

Investment Spectrum

Number of Deals By Round*

How Funding Is Balanced Across 10 Functions

Seed

Series A

Series B

Series C

Series D

Series E or later

Frequency of Deal Size** Under $1M

$1M–$5M

$5M–$10M

$10M–$25M

$25M–$50M

$50M–$100M $100M+

$65.5M Q1 2019

Research

Patient Empowerment

DEALS

MEDIAN DEAL SIZE

3 Deals ($65.5M)

Biometric Data Acquisition

Admin Workflow

Clinical Workflow

Personalized Health

$4.1M Q2 2019

2019 QUICK STATS

Wellness

$4.1M INVESTORS

1 Deal (Undisclosed) 1 Deal ($4.1M)

Insurance

Education + Content

-MOST ACTIVE INVESTORS

Top Deals Company

Deal Count

Population Health

Dollars

Total Addiction Funding

Ranking

Round Size

Function

19 Investors Including:

Pear Therapeutics

$64M

Patient Empowerment

DynamiCare Health

$4.1M

Population Health

Arboretum Ventures

Tempest (fka Hip Sobriety)

$1.5M

Patient Empowerment

JAZZ Ventures

Workit Health

Personalized Health

PursueCare

Patient Empowerment

Lux Capital RRE Temasek

104 104

Source: StartUp Health Insights | startuphealth.com/insights. Note: Report based on publicly available data through StartUp Insights Issue 4HealthStartUp Health Magazine 6/30/19 on seed (incl. accelerator), venture, corporate venture, and private equity funding only. Companies tracked in StartUp Health Insights may fall under multiple moonshots and therefore will be represented throughout the report.

S TA R T U P H E A LT H P O R T FO L I O C O M PA N Y

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106

Issue 4

StartUp Health Magazine S TA R T U P H E A LT H P O R T FO L I O C O M PA N Y

S TA R T U P H E A LT H P O R T FO L I O C O M PA N Y

STARTUP HEALTH

The StartUp Health Company Index Active companies in the StartUp Health portfolio, listed by primary health moonshot.

ACCESS TO CARE MOONSHOT

1Doc3 is a free, anonymous platform where verified doctors answer health concerns 24/7. CEO: Javier Cardona Bogota, Colombia 1doc3.com

access.mobile improves care in underserved markets through intelligent mobile engagement. CEO: Kaakpema “KP” Yelpaala Denver, CO accessmobile.io

AdviceCoach disrupts how we receive and follow health and wellness instructions. CEO: Susannah Bailin Woodbridge, CT advicecoach.com

Aidar Health changes the culture around patient monitoring to simplify healthcare. CEO: Sathya Elumalai Baltimore, MD multisensordiagnostics.com

108

Issue 4

StartUp Health Magazine

AlemHealth gives everyone worldwide access to world-class radiologists at affordable prices. CEO: Aschkan Abdul-Malek Singapore alemhealth.com

AppointmentNotify improves the appointment experience for both providers and patients. CEO: Ali Nayyar New York, NY appointmentnotify.com

AzaadHealth prevents death and suffering caused by medical errors. CEO: Syed Abrar Ahmed Karachi, Pakistan azaadhealth.com

Beam Health gives every patient in the world access to their own doctor. CEO: Sas Ponnapalli New York, NY beamhealthgroup.com

Care Advisors eliminates all barriers to navigating the healthcare system. CEO: Chris Gay Chicago, IL care-advisors.com

6 Connect with Health Transformers and dive into each company’s profile on StartUp Health HQ. startuphealth.com

Careteam enables patient-centered care collaboration and system navigation for patients with complex, chronic diseases. CEO: Alexandra Greenhill, MD Vancouver, BC careteam.me

Chabla allows patients and consumers with hearing disorders to access care. CEO: Marko Vuoriheimo Helsinki, Finland chabla.me

Cityblock Health provides better care for healthier neighborhoods. CEO: Iyah Romm Brooklyn, NY cityblock.com

Cloudbreak Health is on a mission to #HumanizeHealthcare. CEO: Jamey Edwards Los Angeles, CA cloudbreak.us

Cubismi delivers a trusted health data exchange cloud for 3D body precision clinical insights. CEO: Moira Schieke, MD Madison, WI cubismi.com

3 The HelpAround Team

Healthbanc will provide one billion people with affordable access to care. CEO: Ken Lee San Jose, CA / Australia healthbanc.com

DirectDerm provides on-demand, top-quality dermatology care for all people. CEO: David Wong, MD Palo Alto, CA directderm.com

Doctor.com provides every patient with a trusted healthcare journey. CEO: Andrei Zimiles New York, NY doctor.com

eHealthAnalytics eliminates the safety risk of medical devices. CEO: Gail Port New York, NY ehealthanalytics.net

Electronic Health Network transforms healthcare delivery in the US and Africa. CEO: Charles Williams Columbia, SC ehnusa.com

Force streamlines the connection between surgeons, care teams, and patients. CEO: Bronwyn Spira New York, NY forcetherapeutics.com

FutureDocs provides free mHealth technologies and digital education for every patient and doctor. CEO: Santiago Troncar Buenos Aires, Argentina futuredocslatam.com

GoodLife Technology digitizes physical rehabilitation for better outcomes. CEO: Henrik Jurgens Helsinki, Finland goodlife.technology

Helparound untangles access to specialty medical prescriptions. CEO: Yishai Knobel Tel Aviv, Israel helparound.co

Hoy Health provides any consumer with their primary care needs for $100 per month. CEO: Mario Anglada Morristown, NJ hoyhealth.com

imoonlite is eliminating hospital readmissions for chronic/elderly patients by 2028. CEO: Brian Weirich West Lafayette, IN imoonlite.com

inHealth Medical Services revolutionizes obesity treatment. CEO: Aubrey Jenkins Los Angeles, CA inhealthonline.com

109

The StartUp Health Company Index

Jiseki Health solves social determinants of health and low-clinical needs issues for all Americans. CEO: Tushar Vasisht San Francisco, CA jisekihealth.com

Julota creates a holistic community ecosystem to improve the whole population’s health. CEO: Scott Cravens Denver, CO julota.com

KingFit increases health literacy worldwide. CEO: Miguel Johns Wichita, KS kingfit.io

LeaLabs revolutionizes healthcare for chronic conditions, using blockchain and AI. CEO: Deepak Patri & Madhav Puvvena San Antonio, TX lealabs.com

Lifestores Pharmacy democratizies healthcare access by redefining the role of the pharmacy in emerging markets. CEO: Bryan Mezue Lagos, Nigeria lifestorespharmacy.com

110

Issue 4

StartUp Health Magazine

LifeWIRE Corp extends the point of care to engage any patient, any place, any time, on any device. CEO: Howard Rosen Richmond, VA lifewiregroup.com

Livigro unites providers to make healthcare accessible and affordable in India. CEO: Alban Michael Madurai, India livigro.com

LucidAct empowers every care team to be heroes with AI. CEO: Grace Chen Palo Alto, CA lucidact.com

M&S Biotics automates surgical processes in the operating room. CEO: Joshua Mecca Houston, TX msbiotics.com

Medcloud revolutionizes the patient experience around imaging. CEO: Dimas Francisco Silva Jr. Ponta Grossa, Brazil medcloud.co

Medebound ensures medical care can transcend borders. CEO: Sheena Liu, PhD Shanghai, China medebound.co

MedForums organizes the chaos associated with medical education. CEO: Angela Dayton Draper, UT medforums.com

MediSeen provides healthcare, anywhere. CEO: Daniel Warner Toronto, ON mediseen.ca

MediSprout brings doctors and patients together, improving patient care and reducing healthcare costs. CEO: Samant Virk, MD New York, NY medisprout.com

MirrorMe3D unlocks patient’s 3D data so surgeons and patients have access to critical care. CEO: Jordan Mills New York, NY mirrorme3d.com

Mobidoc improves access to healthcare in Africa. CEO: Zara Dilli, MD Abuja, Nigeria mobidoc.ng

S TA R T U P H E A LT H P O R T FO L I O C O M PA N Y

Connecting Your Community In the U.S., 5% of the population uses 60% of the healthcare resources, resulting in an annual cost to taxpayers of $1.8 trillion. A signiﬁcant portion of this could be saved if local resources were properly networked, deployed, and accessed. The name Julota is an acronym for “Just Love On Them Always”. This statement reﬂects our creed to provide case management, patient navigation, and data sharing around the most vulnerable people in society while at the same time lowering the cost of care. For more information, visit

WWW.JULOTA.COM

Julota’s patented award-winning technology operates standalone or between each organization’s existing systems to enable continuous feedback collaboration and case management while maintaining a HIPAA-, SAMHSA (42 CFR Part 2)-, CJIS-compliant longitudinal record across all interactions.

111

The StartUp Health Company Index

MouthWatch 6 Quantextual reimagines decentralized bio-behavioral research and clinical trials. CEO: Satvinder Dhingra Atlanta, GA quantextual.co

MouthWatch develops accessible, affordable dental products and telehealth solutions. CEO: Brant Herman New York, NY mymouthwatch.com

MyRx365 disrupts the pharmacy fulfillment space by creating a technology-enabled and patientfocused experience. CEO: Mohammad Ali, MD Jamaica, NY myrx365.com

Quick’rCare ensures that no sick patient has difficulty finding immediate medical care. CEO: Alex Guastella Orlando, FL quickrcare.com

Navimize eliminates waiting at the doctor’s office. CEO: Jennifer Meller New York, NY navimize.com

NuEyes implements mass adoption of augmented reality for surgeons around the world. CEO: Mark Greget Newport Beach, CA nueyes.com

Omnia Salud is bringing all healthcare in Latin America into the digital era. CEO: Matias Spanier Buenos Aires, Argentina omniasalud.com

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StartUp Health Magazine

openDoctor provides digital access to schedule complex exams and procedures. CEO: Joe Marino New York, NY opendr.com

Path Surgery bridges the gap between international hospitals and patients. CEO: Robert Rantapere Helsinki, Finland pathsurgery.com

PatientWing matches every clinical trial with the right patients. CEO: Zikria Syed Philadelphia, PA patientwing.com

Ride Health ensures no patient will forego care and miss appointments due to addressable social determinants. CEO: Imran Cronk New York, NY www.ride-health.com

SAFE Health works to stop the spread of sexually transmitted diseases (STDs) in our lifetime. CEO: Ken Mayer Los Angeles, CA safehealth.me

SimpleVisit eliminates barriers to care by empowering providers with intuitive, direct-to-patient telemedicine solutions. CEO: Chris Knotts Crofton, MD simplevisit.com

S TA R T U P H E A LT H M E D I A PA R T N E R

113

The StartUp Health Company Index

Tahmo builds transformative healthcare products using temperature & humidity sensing technology. CEO: Arif Quronfleh Irvine, CA tahmo.io

Valhalla Healthcare helps providers leverage technology to deliver affordable, accessible, and effective healthcare. CEO: Alex Baqui, MD Houston, TX valhalla.healthcare

Tickit Health optimizes communication between patients and providers to transform outcomes.Â CEO: Sandy Whitehouse, MD Vancouver, BC tickithealth.com

Xverity assures an uninterrupted continuum of care. CEO: Joe Cellucci Bethlehem, PA xverity.com

Treat Health is creating the largest healthcare marketplace. CEO: Yasir Ali New York, NY

Yosi makes healthcare paperless. CEO: Hari Prasad New York, NY yosicare.com

Trusty.care Trusty.care reduces the chance of seniors going through bankruptcy because of healthcare costs. CEO: Joseph Schneier New York, NY trusty.care

Upside Health is eliminating the devastation of chronic pain. CEO: Rachel Trobman New York, NY upside.health

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StartUp Health Magazine

YourCoach empowers coaches to lead their clients, connecting mind, body, and soul. CEO: Marina Borukhovich Dusseldorf, Germany yourcoach.health

Zeleo gives everyone the tools and knowledge necessary to take care of themselves and their loved ones. CEO: Ben Flynn Boston, MA zeleo.io

Zentist provides the dental market with transparent pricing and accessibility. CEO: Ato Kasymov Los Angeles, CA zentist.io

Zubia eliminates the healthcare information gap. CEO: Bryan Butvick New York, NY zubialive.com

COST TO ZERO MOONSHOT

@Point of Care gives clinicians access to the right information, at the right time. CEO: Robert Stern Livingston, NJ atpointofcare.com

Aver makes value-based healthcare universal. CEO: Bill Nordmark Columbus, OH aver.io

Beyond Lucid Technologies empowers fire & EMS agencies with better data, faster. CEO: Jonathon Feit Walnut Creek, CA beyondlucid.com

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Person-Centered Care

Social Connections

Engagement Solutions Evidence-Based

Lasting Legacy HIPAA Compliant

Improve Quality of Care ReduceÂ Loneliness & Isolation

LifeBio captures life stories & creates life story books and engagement tools. This web-based approach teaches communities & organizations to use the power of individualsâ&#x20AC;&#x2122; life stories to improve overall quality, health outcomes, relationships, and care.

www.lifebio.com 937-303-4576 info@lifebio.com

The StartUp Health Company Index

Hindsait is getting rid of unnecessary, costly, and wasteful health services. CEO: Pinaki Dasgupta Englewood, NJ hindsait.com

Biome helps doctors and hospitals work together to provide better care to Americans suffering from heart disease. CEO: Stuart Jacobson San Francisco, CA biome.io

Cognotion provides dignity in work and dignity in care through native mobile, story-based training solutions. CEO: Jonathan Dariyanani New York, NY cognotion.com

CoverUS makes healthcare more affordable for everyone, everywhere. CEO: Andrew Hoppin New York, NY coverus.io

Docola transforms doctor-patient communication from verbal conversation to a digital resource throughout the care continuum. CEO: Eran Kabakov Tampa, FL doco.la

Etyon Health lowers healthcare administrative cost using health data. CEO: Derek Foster Chicago, IL etyon.com

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Pinaki Dasgupta, CEO & founder of Hindsait, has been working with big data since the Big Data ‘Big Bang’ in the early 2000s. Since 2013, Dasgupta and his team of doctors, data wizards and astrophysicists have led the way in applying AI to healthcare data, helping payors and providers improve patient health at a much lower cost, touching 20 million lives across 70 health plans. The company’s natural language processing software lifts clinical data from EHRs and doctor’s notes – messy handwriting and all – uses AI and machine learning to analyze it against clinical guidelines, and applies predictive analytics to established business rules that enable clinicians to improve care.

Flosonics Medical resuscitates hypotensive patients non-invasively. CEO: Joe Eibl Sudbury, Canada flosonicsmedical.com

Healthwide Solutions improves the emotional connection between patients and providers. CEO: Patricia Kloehn Edwards, CO healthwidesolutions.com

iCoreConnect enables healthcare professionals to securely exchange patient information with one another. CEO: Robert McDermott Winter Garden, FL icoreconnect.com

Inbox Health makes every patient payment experience convenient and clear. CEO: Blake Walker Bridgeport, CT inboxhealth.com

Indago creates the OR of the future through smart surgical tools. CEO: Eugene Malinskiy Cleveland, OH indago.io

iShare Medical provides secure nationwide sharing of medical records. CEO: Linda Van Horn Kansas City, MO isharemedical.com

Kinetxx revolutionizes rehabilitation by providing the fastest and most effective physical therapy solutions. CEO: Brad Galle Boston, MA kinetxx.com

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ManageUp eradicates workplace inefficiencies. CEO: Lan Nguyen Santa Clara, CA manageupprm.com

Maverick Medical AI empowers providers and payers to realize the full potential of value-based care. CEO: Yossi Shahak Tel Aviv, Israel maverick-med.com

MDOps simplifies clinical documentation. CEO: Avinash Kodey Melville, NY mdops.com

MedXCom is the next generation of afterhour doctor-patient communication. CEO: Michael Nusbaum, MD New York, NY medxcom.com

Open Health Network empowers healthcare organizations to help patients manage their own health. CEO: Tatyana Kanzaveli Los Altos, CA openhealth.cc

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Particle Health empowers patients to fully control their health data, without the responsibility of managing it themselves. CEO: Troy Bannister New York, NY particlehealth.com

Patientory streamlines and secures medical record sharing, giving patients more control. CEO: Chrissa McFarlane Atlanta, GA patientory.com

Pocket Anatomy creates accurate and beautiful software that impacts health and medical literacy for the future healthcare practitioners and their patients. CEO: Mark Campbell Galway,Â Ireland pocketanatomy.com

Prognos will be the first to predict disease before it happens. CEO: Sundeep Bhan New York, NY prognos.ai

QwikScript brings prescriptions to patients at a click of a button. CEO: James Richards New York, NY qwikscript.com

RxRevu empowers health systems and providers to make effective prescription decisions at the right time. CEO: Carm Huntress Denver, CO rxrevu.com

Saturn Care helps providers eliminate chronic disease using data and patient engagement. CEO: Philip Heifetz Conshohocken, PA saturncare.com

Sift Healthcare is driving medical billing costs to zero. CEO: Justin Nicols Milwaukee, WI sifthealthcare.com

SmartyPerks drastically reduces patient premiums by eliminating billions of dollars in fraudulent claims. CEO: Scott Kimmel Deerfield Beach, FL SmartyPerks.com

Swift Shift is attracting the next five million nurses and caregivers to the homecare industry. CEO: Assaf Shalvi New York, NY swiftshift.com

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TedCas makes voice and gesture control the standard for all operating theaters. CEO: Jesus Miguel Perez Pamplona, Spain tedcas.com

Vive universalizes financial security to all by empowering patients to pay medical bills.Â CEO: Ronald Weidner San Francisco, CA vivebenefits.com

Vivor empowers healthcare providers to connect patients with the financial resources they deserve. CEO: Ian Manners New York, NY vivor.com

Wellthie modernizes the small business insurance shopping experience. CEO: Sally Poblete New York, NY wellthie.com

ZenSnapMD makes communication between providers effortless. CEO: Manabu Tokunaga Palo Alto, CA wingumd.com

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Zignifica brings precision evidence to the point of care. CEO: Kim Kristiansen, MD Richmond, VA zignifica.com

CURE DISEASE MOONSHOT

AdhereTech provides clinicallyproven support programs to patients on specialty medications. CEO: Josh Stein New York, NY adheretech.com

Althea Health makes rare disease drugs more affordable and available. CEO: Manu Kodiyan San Francisco, CA altheahealth.com

AsiaBiome is curing the root cause of IBS, autism, ALS, and multiple sclerosis. CEO: Jonathan Krive Hong Kong asiabiome.com

Bitgenia provides precise diagnostics through genomic analysis. CEO: Ulises Chesini Buenos Aires, Argentina bitgenia.com

BreathResearch improves early detection and tracking of respiratory diseases. CEO: Nirinjan Yee San Francisco, CA breathresearch.com

Cecelia Health improves the health and enriches the lives of people with diabetes and chronic conditions. CEO: David Weingard New York, NY ceceliahealth.com

Cohero Health transforms respiratory disease management through smart mobile technology. CEO: Joe Condurso New York, NY coherohealth.com

Conversa makes conversation the cornerstone of health. CEO: West Shell III Portland, OR conversahealth.com

Curacase delivers point-of-care management to the fingertips of all patients. CEO: Lance McCulloch Boulder, CO curacase.com

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CHARGE UP YOUR MOBILE DEVICE.

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Cyclica aims to reduce the time of drug discovery from seven years to two years. CEO: Naheed Kurji Toronto, Ontario cyclica.com

Mediktor automates and improves patients’ access to the right healthcare, anywhere. CEO: Cristian Pascual Barcelona, Spain mediktor.com

5Dr. Carolyn Lam, eko.ai Dante Labs analyzes 100% of your DNA so that you can own your entire genome. CEO: Andrea Riposati New York, NY us.dantelabs.com

Dynofit makes physical therapy affordable and engaging to all. CEO: Maria Schneider Los Alamos, NM dynofit.com

eko.ai automates the fight against heart disease. CEO: James Hare Singapore eko.ai

Gene by Gene gives clinicians and researchers access to actionable genetic information. CEO: Bennett Greenspan Houston, TX genebygene.com

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InSilicoTrials democratizes simulations in healthcare. CEO: Luca Emili, MSc Milan, Italy insilicotrials.com

Joint Academy is preventing and reversing chronic joint pain worldwide. CEO: Jakob Dahlberg Stockholm, Sweden / San Francisco, CA jointacademy.com

KnowNOW is solving the national epidemic of STDs and HIV. CEO: Marcelo Venegas, MD Teaneck, NJ knownowhealth.com

LabLink transforms the black box of medical lab tests to drive cooperative, value-driven applications of clinical lab data. CEO: Adam Glassman Columbus, OH lablink.org

Nightingale is solving the global burden of chronic diseases. CEO: Teemu Suna Helsinki, Finland nightingalehealth.com

Oxitone keeps people healthier at home through hospital-grade digital continuous care. CEO: Leon Eisen, PhD Kfar Saba, Israel oxitone.com

Parallel Profile uses genetic insight to put an end to adverse drug reactions. CEO: Cathy Cather Boca Raton, FL parallelprofile.com

Play-it Health makes adherence to healthy behaviors more understandable and enjoyable. CEO: Kim Gandy, MD Kansas City, KS playithealth.com

Better Decisions • Better Outcomes

Connecting Physicians and Patients During the Moment of Care So What? Real Patient-Reported Outcomes at the Moment of Care Paired with Our Clinical Decision Support Tool cian

Clini

Patient

Plug-n-Play • AI cognitive and machine learning provides immediate access to data • Upload to EMR • Shared decision making engages clinicians with patients For more information, visit http://atpointofcare.com

S TA R T U P H E A LT H P O R T FO L I O C O M PA N Y

STARTUP HEALTH

HQ 6

Connect with Health Transformers and dive into each company’s profile on StartUp Health HQ.

PreventScripts is transforming primary care to become the true front line of defense against chronic disease. CEO: Brandi Harless Paducah, KY preventscripts.com

Qura revolutionizes chronic disease management where changes in pressure indicate changes in disease progression. CEO: Doug Adams Sudbury, MA qura.bi

Rejuvenan Global Health is a digital personal health platform designed to prevent, treat and reverse lifestyleinduced chronic diseases. CEO: Rishi Madhok New York, NY rejuvenan.com

Responsum Health harnesses the promise of the Internet to better inform and engage patients with chronic diseases. CEO: Andrew Rosenberg Washington, DC responsum.com

Sanguine Biosciences puts patients in charge of their health data. CEO: Brian Neman Los Angeles, CA sanguinebio.com

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SOLIUS uses advanced light science to treat and prevent disease. CEO: Rick Hennessey Bainbridge Island, WA solius.com

Velóce brings wireless personalized drug delivery to every patient in the world. CEO: Robert Niichel Denver, CO velocedigital.com

Vheda Health eliminates costs through lifesaving, tech-enabled services that give members attention. CEO: Shameet Luhar Baltimore, MD vheda.com

startuphealth.com

OTAWA transforms cancer assistance care, improving treatment quality for millions of patients around the world. CEO: Sergio Gusmao Sao Paulo, Brazil otawa.net

PerSoN Clinic enables holistic virtual care for cancer patients. CEO: Sarah Iranpour Rockville, MD person.clinic

CANCER MOONSHOT

GenID Solutions prevents hereditary cancers by identifying everyone who should be screened. CEO: Anita Singh Santa Clara, CA genidsolutions.com

MyPeople Health reduces the burden of cancer by addressing risk upfront. CEO: Alex Vealitzek Chicago, IL mypeoplehealth.com

Savor Health revolutionizes the treatment of cancer by addressing patients’ nutritional issues. CEO: Susan Bratton New York, NY savorhealth.com

Welwaze prevents breast cancer deaths. CEO: Carlos García Miami, FL welwaze.com

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Jails

ERs People with serious mental illness and substance use are caught in a failed cycle of non-treatment and readmission, wasting billions each year.

Courts

Streets

Our nation can no longer ignore or arrest our way out of this problem. We now have sweeping mental health and criminal justice policy reform and funding.

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Cloud 9’s mobile app connects public health systems to local helps public health and public safety agencies keep high risk first responders. Mental health clinicians can provide better patients in treatment, and out of crisis situations, while also care to patients, including when patients encounter officers diverting away from ineffective, costly services and facilities. & EMS in the field. We are changing a massive broken system. Join us on Cloud 9!

www.Cloud9Psych.com

The StartUp Health Company Index WOMEN’S HEALTH MOONSHOT

CHILDREN’S HEALTH MOONSHOT

BabyMed educates women to end preventable pregnancy or childbirth problems. CEO: Bryan Okello Nairobi, Kenya jabotech.co.ke

Aerobit Health reminds and guides asthma patients on taking their medications. CEO: Ali Moiyed Manchester, England aerobithealth.com

Babyscripts makes better pregnancies possible for all mothers, particularly the most vulnerable. CEO: Anish Sebastian Washington, DC getbabyscripts.com

genneve empowers every woman to take control of her health in menopause. CEO: Jill Angelo Seattle, WA genneve.com

Oratel Diagnostics transforms current diagnosis for pelvic pain in women. CEO: Steven Brown Hammondsport, NY orateldiagnostics.com

Pregistry provides product-specific pregnancy-exposure prescription drug data. CEO: Diego Wyszynski, MD Los Angeles, CA pregistry.com

The Baby Box Co creates a safer world for all kids through confident, well-educated parents. CEO: Doug Wadleigh Los Angeles, CA babyboxco.com

CareDox improves children’s health by connecting schools, families, payers, and healthcare providers. CEO: Hesky Kutscher New York, NY caredox.com

NUTRITION & FITNESS MOONSHOT

Edamam offers nutrition data for all health, wellness, and food businesses worldwide. CEO: Victor Penev Los Angeles, CA edamam.com

FitBliss optimizes employee productivity by connecting consumer health data and work performance. CEO: Navid Rastegar San Jose, CA fitbliss.com

FitFetti is building the largest opt-in population health support community to measurably impact health. CEO: Lucy Reynales Mohan San Francisco, CA fitfetti.com

FitTrace gives you the tools and analytics to better understand your body. CEO: Michael DiChiappari Los Angeles, CA fittrace.com Lactation Lab optimizes infant nutrition and maternal health. CEO: Stephanie Canale Santa Monica, CA lactationlab.com

PigPug creates simple, medicationfree ways to treat childhood developmental disorders. CEO: Vitali Karpeichyk Brooklyn, NY / Belarus pigpug.co

Fruit Street Health helps prevent type II diabetes and saves lives around the globe. CEO: Laurence Girard New York, NY fruitstreet.com

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Mealshare improves health through better eating choices. CEO: Bentley Adams Cardiff, CA mealshare.pro

MetaLogics is putting an end to the obesity epidemic. CEO: Greg Guettler Edina, MN metalogicscorp.com

Myontec helps companies and sports teams reduce muscular-level sick leave and the risks for potential injury. CEO: Janne Pylväs Helsinki, Finland myontec.com

Palette helps reverse the type II diabetes and obesity epidemic using lifestyle data and machine learning. CEO: Yulin Li Kansas City, MO thepalette.io

Personal Remedies empowers chronic illness patients everywhere via the world’s first e-dietitian. CEO: Mory Bahar Boston, MA personalremedies.com

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BRAIN HEALTH MOONSHOT

Cerora diagnoses disorders of the brain accurately in realtime across the globe. CEO: Adam Simon, PhD Bethlehem, PA cerora.com

HealthTechApps gives screenagers and physicians superpowers to prevent costly re-injuries after a concussion. CEO: Kyle Chang Honolulu, HI healthtechapps.com

Life Recovery Systems recovers the quality of life for all stroke, heart attack, and cardiac arrest patients. CEO: Robert Freedman, Jr., MD Kinnelon, NJ life-recovery.com

RC21X wants to become the global standard for measuring and assessing brain performance. CEO: Clarence Carlos Corapolis, PA rc21x.com

Savonix places the brain at the center of health. CEO: Mylea Charvat, PhD San Francisco, CA savonix.com

SyncThink accurately diagnoses brain conditions and optimizes performance. CEO: Laura Yecies Palo Alto, CA syncthink.com

MENTAL HEALTH & HAPPINESS MOONSHOT

Cloud 9 brings mental health care to those who need it most. CEO: JC Adams Austin, TX oncloud911.com

Curatio assures that no patient is left alone. CEO: Lynda Brown-Ganzert Vancouver, Canada curatio.me

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Improving outcomes by eliminating the barriers of disparity and distance.

We seamlessly bring uniďŹ ed telemedicine and expert interpretation to the point of care. Itâ&#x20AC;&#x2122;s how we #HumanizeHealthcare

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DreamThink provides drug-free alternatives for increasing brain performance and improving mental health. CEO: Sanjeev Brar New York, NY dreamthink.co

Eco-Fusion uses stress reduction to treat most chronic illnesses. CEO: Oren Furst, PhD Tel Aviv, Israel eco-fusion.com

Henry Health works to increase the life expectancy of black men by 10 years within the next 25 years. CEO: Kevin Dedner Washington, DC henry-health.com

Neolth makes stress management a routine part of chronic disease treatment. CEO: Katherine Grill, PhD San Francisco, CA neolth.com

Powercall unlocks your superpower on demand. CEO: Richard Lee Anaheim, CA powercall247.com

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Promena VR heals, educates, and empowers individuals by delivering VRpowered behavioral therapy. CEO: Thomas Overly Grand Rapids, MI promenavr.com

Valera Health is taking care of the 25M Americans with untreated behavioral healthcare needs. CEO: Thomas Tsang, MD New York, NY valerahealth.com

wayForward PSYCHeANALYTICS cures the behavioral health crisis with primary care. CEO: David Haddick Palo Alto, CA psycheanalytics.com

Resility Health unlocks every personâ&#x20AC;&#x2122;s power of resilience to improve physical and mental health. CEO: Sarah Davidson Jacksonville, FL resilityhealth.com

SageSurfer improves global behavioral health by transforming insight into action. CEO: Anupam Khandelwal Fremont, CA sagesurfer.com

TQIntelligence transforms mental healthcare for at-risk youth. CEO: Sandeep Yadav Atlanta, GA tqintelligence.com

wayForward is curing mental illness around the globe. CEO: Ritvik Singh New York, NY wayforward.io

LONGEVITY MOONSHOT

CarePredict scales senior care beyond reliance on human observation, planet-wide. CEO: Satish Movva Palo Alto, CA carepredict.com

Devoted Health helps seniors navigate the healthcare system. CEO: Ed Park Waltham, MA devoted.com

Help-Full wipes out loneliness in older age and empowers seniors to thrive. CEO: Jenny Gallagher Oakland, CA help-full.com

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The most common brain Assess. Recover. Perform. health conditions lack objective data and diagnostic tools The first non-invasive, virtual reality (VR) eye tracking platform designed to monitor and improve your brain's health and performance. Developed over a decade of clinical research, we are on a mission to improve brain health for all. To learn more, visit www.syncthink.com

The eyes are the window to the brain Quick, mobile assessment platform

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Target dificiencies and train to improve them

StartUp Health Magazine

Chart improvement made over time

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Optimize function for work and play

The StartUp Health Company Index

Hormone Therapeutics wants to add 50 healthy years to everyoneâ&#x20AC;&#x2122;s life by decoding their personal health map. CEO: Hunter Howard Dallas, TX hormonetherapeutics.com

HLI leverages genomic and clinical information to build a KnowledgebaseTM. CEO: David Karow La Jolla, CA humanlongevity.com

LifeBio captures the lasting legacy and memories of life stories. CEO: Beth Sanders Columbus, OH lifebio.com

LifeDojo solves the crisis of preventable disease within large populations in a way that works for every individual regardless of circumstance. CEO: Chris Cutter San Francisco, CA lifedojo.com

Lyf Lynks

LyfLynks redefines when, how, and from where families engage in supporting their loved onesâ&#x20AC;&#x2122; independence. CEO: Donald Vetal Columbia, MD lyflynks.com

LymphaTouch is creating the gold standard treatment method for lymphedema and rehabilitation patients. CEO: Kristo Kivilaakso Helsinki, Finland lymphatouch.com

Sandstone Diagnostics is making blood plasma tests universally available. CEO: Karen Drexler Minneapolis, MN sandstonedx.com

SUPA is converting the body into a new asset class. CEO: Sabine Seymour, PhD New York, NY supa.ai

Tome fights the sedentary lifestyle by promoting and measuring being active at work. CEO: Jake Sigal Detroit, MI tomesoftware.com

UnaliWear extends independence with dignity for millions of vulnerable people. CEO: Jean Anne Booth Austin, TX unaliwear.com

Zeel brings you wellness on demand. CEO: Samer Hamadeh New York, NY zeel.com

ADDICTION MOONSHOT

Goldfinch Health reduces post-surgery opioid use by 90%. CEO: Brand Newland Austin, TX goldfinchhealth.com

inRecovery helps people beat addiction and reintegrate as thriving members of society. CEO: David E. Sarabia Santa Monica, CA inrecovery.org

Sen-Jam Pharmaceutical brings relief to the opioid epidemic. CEO: Jim Iversen Huntington, NY sen-jam.com

WellBrain empowers patients with chronic pain to live a better life. CEO: Sumeet Maniar Pleasant Hill, CA wellbrain.io

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www.G4A.health

@grants4apps

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S TA R T U P H E A LT H M E D I A PA R T N E R

SEPTEMBER 16-18, 2019 | CALIFORNIA S A N TA CL A R A CO N VE N T IO N C E NT E R

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DESIGNING FOR HEALTHY HABITS AND BETTER OUTCOMES October 16-18, 2019 | Boston, MA

The Connected Health Conference exists to pave the path for health interactions that are nimble, insightful, personalized, consumer- and providerfriendly, and enabled by innovative, market-ready technologies. Save $200 on registration fees using discount code: 19CHC200 Presented By

In Partnership With

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Connectedhealthconf.org | #Connect2Health

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Over 300,000 patients had a better billing experience with Inbox Health in the last 12 months

A smarter, simpler patient billing communication platform Inbox Health will transform how millions of patients pay their medical bills in the next year. We personalize each patientâ&#x20AC;&#x2122;s experience to be as unique as they are, reaching them on the right channel, with the right message, at the right time.

Imagining the Future

Doc Bot Who would have guessed that in your future we would fall in love so fast with our robot physicians? Sure, in the beginning we reacted like we did with other newfangled gizmos that initially confused us but looked really cool. Remember when we got our first iPhone and wondered what was going on with that sleek plastic slab that had only one giant button? It took us less than a minute to figure them out and to fall so madly in love with our phones that we couldn’t put them down, not even in bed. Humans in the future don’t literally sleep with their doc bots, although some of the health data collected by our ultra-smart phones happens while we sleep. That’s when they track our REMs, heart rates, daily steps, and the temperature of our skin. Later, our super-duper-smart phones were equipped with micro-photon-lasers that used light waves (no needles!) to continuously monitor levels of hormones, proteins, and metabolites in our blood that change as we eat, sleep, have sex, and get stressed, hopefully not in that order. It’s hard to remember that

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An excerpt from Talking to Robots: Tales from Our Human-Robot Futures

By David Ewing Duncan

in the early twenty-first century, people didn’t have micro-photon-lasers on their phones. Seriously! Which makes you wonder how people back then knew when to eat what, or when one’s hormones were optimal for copulation or for falling in love, also not necessarily in that order. But this came later, after we got over our initial anxiety about doc bots. Which, truth be told, was far more challenging for us than our confusion over our smartphone’s big button. After all, doc bots in the future are not merely a delivery system for apps that help us find a great taco shack nearby or a potential date on OkCupid. Doc bots are our caregivers. We place our lives, and those we love, in the hands of these healers made out of circuits and silicon, with no buttons at all. The hardest part was trusting our robodocs to show compassion and empathy. We wondered: Could a machine really provide the wise and steady eye contact that we expected from a flesh-and-blood physician? Or the caring touch of a human palm resting gently on our shoulder as we poured out our health secrets, hopes, and fears? We agreed with David Agus, a famous oncologist back in 2018, when he said, “Empathy is one of the key things in medicine.” Agus wrote bestselling books on how to stay healthy.

He also was one of the docs who kept Apple co‑founder Steve Jobs’s cancer at bay for longer than most people believed possible. “My job as a doc is not necessarily to make a diagnosis,” he said, sitting in a no‑nonsense office in Los Angeles just off Beverley Drive back in 2018. “My job is to give you the right treatment for your value system, to make you comfortable, to have optimism, and to have a good outcome.” Regrettably, most people back then didn’t have David Agus as their physician. The closest they got to the sort of interactions he described, and humans wanted from flesh and bloods, was on television when actors played wise and caring doctors in dramas and soap operas – like George Clooney when he played the gentle, all-knowing Dr. Doug Ross on television’s ER, before his hair turned gray and his chin more rugged. Or the no‑nonsense Meredith Grey on Grey’s Anatomy, played by Ellen Pompeo. People also saw smiling, good- looking physicians who seemed kind and understanding in commercials for pink and purple pills that seemed so helpful to other very attractive people with anxiety disorders or with ED (erectile dysfunction) – as long as you tuned out the gibberish about horrible side effects the announcer said really fast at the end of each ad.

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An Excerpt from Talking to Robots

In the real world back in Agus’s day, people had to wait weeks or months for doctor’s appointments, and then hours more in an aptly named waiting room when their doc inevitably ran late. (It was kind of baffling why this always happened – were these hypereducated experts unable to use the latest scheduling apps or read the time on an Apple Watch?) Patients sat waiting on chairs designed for Stoics in the nineteenth century, reading magazines that were years out of date. (Ditto about doctor’s offices that never seemed to have recent issues of Good Housekeeping or National Geographic Kids.) When patients finally got in to see their doc, the MDs seldom looked rested and joyous like on TV as they felt our kidneys, listened to us breathe through a stethoscope, and asked us how we were doing as they took up half the allotted twelve-minute exam gazing at our medical history and labs on a computer screen before dashing off to see the next patient. People in those days were also forced to pay small fortunes for insurance policies that seemed designed by sadists. Medical bills made people think of a Rube Goldberg contraption, breathtakingly convoluted and baffling contraptions that were so ridiculous they were funny, except that medical bills back then were no laughing matter. Not that physicians didn’t aspire to be like Doug Ross or Meredith Grey. Many of them originally got into medicine to help their fellow humans and to heal and comfort them – doctors like David Agus. This made it all the more upsetting when too many human physicians back then complained of feeling burned out and unhappy with their jobs, with some suffering from “compassion fatigue.” By the last quarter of the twentieth century, physicians in the U.S. felt as though they were increasingly becoming ensnared by a medical system that treated them like machines – or cogs in machines, or cogs within cogs. This came about as the multitrillion-dollar business of healthcare increasingly rewarded docs for spending less time with patients and more time clicking on digital boxes to verify billing codes, which brought in more reimbursements (cash)

from insurers – all while they tried to fend off pharmaceutical reps who cajoled them to stock buckets of those little pink and purple pills. Never mind that they cost thirty times as much as the generic version of the exact same drug. Docs were also expected to write detailed notes to avoid malpractice suites, something they called CYA medicine, for Cover Your Ass. Around this time, a family care physician named Jordan Shlain in San Francisco talked about something that was regrettably missing from most doctor-patient interactions. “I believe that the fundamental unit of humanity is a conversation,” said Shlain back in 2018, “a story with a beginning, middle, and end. I think that people get anxious when they get cut off. You don’t get to finish. We don’t give doctors a chance to have a beginning and an end from patients. Or they get a beginning and an end and no middle. Patients leave unsatisfied. Doctors are unsatisfied.” Shlain was a vibrant and fortyish man with close-cropped blond hair and a perpetual three-day beard, a live wire crackling with energy and optimism. He cared about his patients and their stories. He also was what people called a “concierge doc” back in the early twenty-first century – meaning that he had only a few patients in a posh area of the City by the Bay, each of whom paid thousands of dollars a year (a lot back then) to make sure he was always there for them. This meant that Shlain’s patients got to tell endless stories if they wanted to. Unlike those who could not afford thousands of dollars out of pocket. They got to tell maybe half of a beginning of a story in the brief time their doc had to spend with them, or possibly three- fourths of an ending if they talked really fast. Another huge factor in doctor dissatisfaction back in Agus and Shlain’s time was the realization that not even the smartest human brain can know even a tiny fraction of all the medical records, studies, protocols, and standards of care that they need to know. “There’s no way that my brain can be as good at the data as a computer; it’s just not possible,” said David Agus. “There’s no

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way I could be up‑to‑date on everything going on. There’s no way I can look at the trends of all the labs and interpret the context of the others. It’s literally impossible to memorize exabytes [that’s 1018] of data.” Still, docs could dream. Which led Agus, Shlain and others to imagine a future where AI and robo-helpers would be available to help them look up stuff like drug‑on-drug interactions, genetic profiles, obscure diagnoses for why a patient had green splotches on their skin, and the latest outcomes data for that new laparoscopic procedure. “I’d love to have a robot that was able to be with me at every visit,” said David Agus, “to interpret the data and the context; to look at your condition compared to every other patient with similar characteristics; to predict the trends; to tell me: what are the possibilities. Then I can have a real discussion and discuss your value system and what’s best for you. “To me, this doc bot is at my side helping me make decisions,” Agus continued. “And it’s telling me I could do treatment x, y, or z. This one will work a little bit better, but it’s not going to last as long. Or this one may have more side effects; here are the numbers. And the fact that given your trends and your labs, I’m going to actually predict that you’re not going to be like the average, you’re going to be a little bit less than average or more than average. So, that helps the doctor make the right decisions.” Agus envisioned a partnership between machines and flesh-and-blood healers: “I really believe it’s the hybrid of the human and the robot that’s going to be the answer in our field. Because, again, I have to make you understand things. I have to look at your face, and your culture, and your background to give you the right explanation, to give you the right empathy, to give you the right understanding to do it right.” This partnership sounded wonderful, except that as the future unfurled, it took longer than Agus, Shlain and others thought it would, in part because the smart devices that were supposed to foster a budding human- machine hybrid weren’t all that smart back then. Why? Because the tech in those days was mostly designed by engineers who

actually knew very little about biology, medicine, and human physiology – or about empathy in a caregiver setting, or the thick book of rules in a heavily regulated industry. We had to wait while the IT folks figured out that they weren’t going to disrupt medicine overnight like they did travel, banking, and home furnishings, and that it would take more than merely being brilliant at coding and entrepreneurship and having engineering degrees and MBAs from Stanford, Harvard, and MIT. Underlying this mismatch of expectations was a philosophical divide between engineers, who designed the circuits, gates, and chips they worked with, and the docs and biologists who worked with biological “machines” – i.e., humans – that were constructed by nature over the course of three and a half billion years of evolution. This made humans and their components – brains, cardiovascular systems, genes, and so forth – wildly complicated, quirky, and unpredictable compared to, say, a smartphone, with or without a micro-photon-laser. A famous example of this engineeringbiomedical divergence back in Agus and Shlain’s day was IBM Watson. In 2011, this powerful super-computer beat human champions playing Jeopardy!, a feat that the company was sure could be transposed into helping physicians manage human health. Programmed to access vast troves of information with astonishing recall – which worked really well when remembering obscure geographic locales and sports stars – Watson struggled when tasked with searching through vast medical databases to help physicians diagnose and treat patients. “IBM Watson thought they could understand the medical literature,” said Eric Topol, a famed cardiologist and digital health guru back in the early twenty-first century. “But it’s not possible for Watson to understand which studies are to be believed and which are more speculative. You also need humans to extract what is important in these papers for a particular patient, which is unstructured data that a human doc can easily glance at and make sense of, and Watson often struggles with.”

0.42

According to this report, physicians and surgeons had a mere 0.42 percent risk of being replaced by a machine by 2035. Thankfully, there were experts like Eric Topol who worked to bridge the gap between IT and bio-medicine. These were docs who learned a little IT, and engineers who learned a little about medicine and healthcare, with everyone working to grasp not only how to effectively use health data but also how it could be used to better understand the nuances of human health, behavior, emotions, hopes, and fears. “You have to use this data to understand all the different layers of a human being,” said Topol, a very tall, lean man with large hands and a sternness that could suddenly give way to a broad smile. “You need to create data layers that start with their genome, metabolome, and microbiome. You also monitor their environment. And you need all the medical literature that’s applicable, and it’s continually being updated. And lifestyle, and behavior, and emotions – and of course their EMRs,” which was med-speak for electronic medical records. “To have a doc bot, I think we will need a neural network with thousands of convo-

luted layers of data assembled, plus what it all means for individuals,” said Topol, chatting in 2018 while sitting in his La Jolla, California, office, which overlooked the Pacific Ocean. “What makes your data different from mine, and what, if anything, should be done medically or with your diet? Or how did breaking up with your boyfriend impact your health?” Slowly, as the future unfurled, the algorithms and artificial neural-brains got better as docs and IT engineers – and all those would‑be disruptors – stopped thinking they were smarter than the other guys and worked together to build machines that were truly brilliant. This started with a massive effort to sync up all the amazing devices that were gathering reams of health data about each of us but had never been integrated – all those apps on the phone we slept with, plus info being collected by Fitbits and by portable brain monitors tucked into stylish headbands – plus smart mirrors that measured our body fat and our gait in 3‑D space, and smart toilets that collected sam-

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An Excerpt from Talking to Robots

Doc Bot

ples of our bodily waste and analyzed in real time that treasure trove of data, which might have been gross and smelly but which said a great deal about what was happening inside our bodies. Environmental sensors collected data about airborne and waterborne chemicals in our houses, offices, stadiums, and airliners. At first doctors loved it, as these emerging AI/robo-health systems started to provide them with real and mostly useful info and feedback when they saw patients. Mostly, all this assistance was provided via wireless earbuds tucked discreetly into a physician’s or nurse’s ear, which meant that they didn’t have to look away from patients anymore to consult a screen. What the human docs didn’t realize until later was how this emerging “Doc Bot” was slowly taking on more and more of what they once did, even as physicians kept saying with great confidence that they didn’t see themselves ever being completely replaced. “I cannot envision there ever being a time when there would cease to be human doctors,” David Agus had said. “I think there always will be a role for a doctor, but I still want that computer so I can have the data, the numbers to have an appropriate conversation with the patient. At the same time, there’s no way now or I think in the future, where someone’s going to be able do what I do – I can look at your face and I’m very good at identifying whether you’re comfortable or you’re not. I can start to get cues.” Jordan Shlain agreed: “Doctors will be among the last to go, to be replaced by robots. I think rabbis and priests are the last people that go away, and one cut underneath them is doctors.” Those predictions were backed up by the 2013 Rise of the Robots study out of Oxford that we discussed earlier (see “The %$@! Robot that Swiped My Job”). According to this report, and the Rise of the Robots website that was powered by the study, physicians and surgeons had a mere 0.42 percent risk of being replaced by a machine by 2035 – one of the smallest risks in the survey. This is because docs scored very low on “job variables predicting automation risk,” attributes

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Talking to Robots By David Ewing Duncan Penguin Random House David Ewing Duncan is the bestselling author of ten books. He is a columnist for the Daily Beast and the chief correspondent for NPR Talk’s Biotech Nation. David writes for The New York Times, Atlantic, Fortune, Wired, National Geographic, Discover, and Outside, among others.

that robots back then were supposed to be very good at compared to humans. For instance, under the variable of “assisting and caring for others,” docs got 83 out of 100, because, according to the authors of the study, robots back in 2035 would be pathetically bad at this. Thus for a few magical years it appeared that Drs. Agus, Shlain, and Topol – and the Oxford researchers – were right. That human docs were not only going to keep their jobs, they were also going to realize their dream of robots and humans working together to create healthcare that mattered for them and their patients. Unfortunately, the docs neglected to fully take into account the machinations of the money side in healthcare, which was still being run by the same bean counters who loved it when docs spent all day long checking off boxes that would bring in more revenue. Never mind the time this was taking away from patients and the emotional toll this took on docs who actually wanted to spend their time keeping people healthy. That’s when the bean counters had a revelation: that it would be a whole lot cheaper to take humans completely out of

the caregiver loop. They gave the usual reasons: highly trained flesh and bloods were expensive; they demanded bonuses, played too much tennis and golf, and needed to occasionally sleep; they sometimes burned out; and all the rest of the excuses that led so many industries in the future to replace humans with robots (see “The %$@! Robot that Swiped My Job”). As an added bonus, said the bean counters – who by then were mostly robots and AI systems – the doc-bot systems were peerless masters at checking off little boxes. Suddenly, human doctors found themselves getting laid off in droves, along with nurses and physician assistants. Orderlies and lab techs were already long gone by then. At first patients were confused, even if the robo-bean counters did use a small part of the savings gained by dumping human docs to update the chairs in waiting rooms to be slightly less uncomfortable. This was when the innovators at Apple, who hadn’t had a runaway hit like the first iPhone for decades, announced the first-ever iDoc. It was an almost instant hit, making people so desperate to have one that Apple couldn’t keep up with all the orders. In part this

was because the geniuses at Apple cleverly designed the iDoc to look like the original sleek, black, slab-like iPhone that so many of us long ago had fallen in love with (another nostalgia craze in the future). Except that the iDoc didn’t fit in your hand. No, this handy device was human-size, coming in various heights, from five feet to six three, and around eighteen inches wide. They used Apple’s patented iHoverX technology to float vertically just above the floor, standing upright, with screens displaying images of a virtual physician chosen by the patient. (Weirdly, the screens still easily cracked and cost you plenty to get replaced.) The basic package of possible screen docs included Doug Ross, Meredith Grey, David Agus, Eric Topol, and Jordan Shlain – or all of them combined. For a small monthly fee, you could add just about anyone else whose image you could find online that made you feel comfortable, loved, and listened to. (Apple was forced to delete some images after the estate of George Clooney sued and demanded to be paid for his likeness and personality-imprints.) After the initial anxiety about accepting nonhuman doctors in the future came the phase of loving, just loving our doc bots. They looked so sleek and cool hovering there in the exam room or in your home. Doc bots also oozed empathy, which could be turned up and down with a simple voice command. They seemed to really know their stuff as they tapped into exabytes of data on biomedicine, behavior, and God knew what else coming in from dozens of monitoring devices that surrounded each of us like a protective, virtual cocoon. Having such thorough medical care made us catch our breaths with wonder and excitement, feeling as though we had access to almost godlike powers that would surely make us healthier and live longer, happier lives. But as usual, that sense of godlike powers that often accompanies the sudden appearance of disruptive and seemingly amazing tech began to wear off as we learned more about Doc Bot’s real impact. Soon enough there were disquieting revelations of biased programming that was snuck in by various

healthcare stakeholders and advertisers, like when Doc Bots kept ordering those expensive branded drugs when generics were available for a fraction of the cost. Or when the soothing dialogue delivered by Doc Bot to comfort us began sounding eerily similar, if not identical, to advertisements we saw on our daily neural feeds from MSNBC and Fox – those annoying commercials that in the future were still trying to sell us those pink and purple pills with all the terrible side effects – plus AI-enhanced catheters and bioengineered, fat-eating bacteria that would have us looking svelte in no time or your money back! Then came the wave of state-sponsored Russian and Chinese trolls hacking into our health data, just like they had hacked into social media and email accounts back in the day. Those foreign agents launched a series of brazen Doc Bot-hacking campaigns designed to scare the gee-willies out of us by manipulating and subtly altering, say, a genetic result for one’s DNA risk of getting bladder cancer from low risk (which was a relief ) to high risk (which was scary). And we all remember when hackers altered cholesterol scores so that millions of people suddenly started taking tenth-generation superstatins that they didn’t really need (there was a suspicion that some unscrupulous drug companies might have colluded with the Russians and Chinese with the superstatins). The result was that some of our greatest leaders – those who took a hard line with Russian and Chinese bio-hacking – became so anxious with all this fake news about their health, and the health of their friends and families, that they stopped paying attention when the Russians invaded small, helpless neighboring countries, or when the Chinese cyber-stole our intellectual property. Lots of people stopped voting and attending PTA meetings as we became obsessed with the constant flow of alarming data emanating from our smart toilets and smart mirrors and other gizmos, all verified by our oozingly empathetic, anthropomorphic Doc Bot. Fortunately, we discovered this foreign treachery before it was too late. We also real-

ized that we had gotten way too infatuated with our Doc Bots, just like we once were besotted with our smartphones before everyone got a crick in their neck from leaning their head down to stare endlessly at the device’s little screen. Congressional hearings were held, books and articles were written, and secret reports were prepared and leaked to what was left of the real media (see “Journalism Bot”). The resounding conclusion was that people who once thought they adored their Doc Bots now didn’t entirely trust them. Some even feared them. This caused the robot CEOs running healthcare to upgrade the bean counter’s programming to better balance empathy with the bottom line. This triggered a realization among healthcare-executive bots that maybe it wasn’t such a great idea to lay off all those human docs, nurses, and PAs. So they sent out requests, asking some of them come back. The laid-off human physicians, who had been trying to adjust to a paltry universal basic income (see “The %$@! Robot that Swiped My Job”), responded with an eager yes! They would be happy to come back, having had plenty of time to catch up on sleep and to mull over how to find more joy in medicine. Doc Bots didn’t go away entirely. Not at all. But after the great callback of human docs, they were limited to performing those tasks that David Agus, Jordan Shlain, and Eric Topol had originally wanted them to do: working as helpers that could crunch massive amounts of data and provide analysis and options to human physicians, who then made the decisions and interacted with patients. The bean-counter bots, working with Apple and other doc-bot manufacturers, also embarked on an expensive but ultimately successful campaign to fortify all doc bots with the latest anti-trollware and with retaliatory cyber counter-hacker- attack programs borrowed from the military (see “Warrior Bot”). This ended the troll attacks, at least for a while. The upshot was that human docs finally had time to sit and hear a patient’s story – beginning, middle, and end.

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the BIG idea This book is a call to action for those who seek to live 1. Make a Big Bet. extraordinary lives. Maybe that’s you. So many people and organizations are naturally cautious. They If you think that only a rare genius, an exceptionlook at what seemed to work in the past and try to do more of it, ally privileged individual, or a massively funded orgaleading to only incremental advances. Every truly history-making nization can launch a breakthrough product or bring transformation has occurred when people have decided to go for a world-changing movement to life, I’ll introduce you in these pages revolutionary change. to the fearless people from all walks of life who have made the unimaginable 2. Be bold, take risks. possible. You might be dazzled by their Have the guts to try new, unproven achievements, and it’s easy to assume things and the rigor to continue exthey possessed extraordinary abilities or perimenting. Risk taking is not a blind advantages that set them apart from orleap off a cliff but a lengthy process of dinary strivers. But I have news for you. trial and error. And it doesn’t end with Their single common trait was this: they the launch of a product or the start of were all passionate about making the a movement. You need to be willing to world better. They seized an opporturisk the next big idea, even if it means nity and kept at it in spite of daunting upsetting your own status quo. barriers, frequent failures, and loud objections—and they succeeded. Today we 3. Make failure matter. look at them, our most iconic creators, Great achievers view failure as a necand wonder how the world ever existed essary part of advancing toward success. without their contributions. But, as you No one seeks it out, but if you’re trying will see here, many of their stories pronew things, the outcome is by definivide inspiration and helpful hints on tion uncertain. When failure happens, how we can all make a greater impact great innovators make the setback matin every aspect of our lives, and serve as ter, applying the lessons learned and beacons of fearlessness for others. sharing them with others. Today’s global challenges—poverty, civil unrest, political stalemates, eco4. Reach beyond your bubble. nomic divisions, climate change—play Our society is in thrall to the myth out daily against the backdrop of our of the lone genius. But innovation hapliving rooms. But if these problems seem pens at intersections. Often the most too big and complex—easier to ignore original solutions come from engaging than to even attempt to solve— know with people with diverse experiences that there has never been a better time to forge new and unexpected partnerto engage. An explosion of technologiships. cal innovation is transforming the way we live. And if we’re going to keep up BY JEAN CASE with the rapid pace of change, we need 5. Let urgency conquer fear. CEO OF THE CASE FOUNDATION to rethink the old ways of doing things. Don’t overthink and overanalyze. My husband, Steve, and I started the It’s natural to want to study a problem Case Foundation in 1997 with a fearless from all angles, but getting caught up in mission: to invest in people and ideas that can change the world. This questions like “What if we’re wrong?” and “What if there is a better means we’re always investigating and experimenting to find the best way?” can leave you paralyzed with fear. Allow the compelling need ideas out there, the best leaders, the best models for innovation. A to act to outweigh all doubts and setbacks. few years ago, we engaged a team of experts to determine the “secret These five principles can be summarized in two words: Be Fearless. sauce” that propelled those rare leaders, organizations, and moveTaken together, they form a road map for effective changemaking for ments to success. They discovered five principles that are consistently people from all walks of life, but it’s important to note that they aren’t present when transformational breakthroughs take place. To spark “rules.” They don’t always work in tandem or sequentially, and none is this sort of change, you must: more important than another. Think of them as a set of markers that

5 Principles of Fearless Innovation

can help identify when decisions are being made fearlessly.

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Exerpted from Be Fearless (Simon & Schuster, 2019), printed with permission.

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