StartUp Health Magazine 2021 Q3 by StartUp Health

ISSUE 07

Stronger Together Raj Amin & Dr. Tracy Dennis-Tiwary, co-founders of Wise Therapeutics, have a secret weapon – a time-tested friendship. page 48

The Park brothers raise $1.2B to scale Devoted Health Meet the Newest Health Transformers® Insights: $9.7B raised globally in Q3 alone STARTUPHEALTH.COM HEALTHMOONSHOTS.COM

StartUp Health Moonshot Updates

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ALONE WE CAN DO SO LITTLE; TOGETHER WE CAN DO SO MUCH. HELEN KELLER

2 StartUp Health Magazine / Issue 7

FOUNDERS’ LETTER

Stronger Together

We have always believed that when it comes to great startup founders, 1+1=3. When people are united with purpose, passion and mindset, a magical fusion occurs that makes exponential progress possible. Whether it’s Ed and Todd Park, the brothers who founded Devoted Health; or Iyah Romm, Dr. Toyin Ajayi, and Bay Gross, who lead Cityblock; or our investors like Esther Dyson and Lee Shapiro; or any of the 1,000+ entrepreneurs and investors in our growing global army of Health Transformers, we are stronger together. For a decade we have shared a simple equation, core to our philosophy from inception at StartUp Health, to describe our unique model: Health Transformers (Mobilized to Achieve Health Moonshots) x The Network Effect = The Transformation of Global Health. We see that when a whole community of Health Transformers march together to solve common challenges, success is more likely – and exponential progress begins to add up to something more impactful. To us, that something is improving the health and wellbeing of billions of people by solving the world’s most challenging health goals we call health moonshots. People can achieve extraordinary feats on their own, but it’s rare. To go it alone is slow, and to be honest, doesn’t look very fun. We know from our own experience as business partners for nearly 25 years, through multiple ventures, that the entrepreneur’s journey is long, with constant ups and downs, often in the same day. It’s our partnership, and the relationships and communities around us, that accelerate us forward and give us energy. There’s great strength in numbers, and when organized meaningfully, the compounding effect is transformational. That is why we will never stop working to unite and mobilize all entrepreneurs, investors and collaborators from around the world, who care as much as we do about achieving health moonshots. We hope you will join us too. Learn more at startuphealth.com.

Steven Krein CEO, Co-founder & Managing Partner

Unity Stoakes President, Co-founder & Managing Partner startuphealth.com

EDITOR’S LETTER

Smile-Worthy Partnerships

When I asked Raj Amin and Dr. Tracy Dennis-Tiwary, the co-founders gracing the cover of this issue, how long they’d known each other, they both smiled. Turns out they’d been the best of friends for the better part of two decades. Years ago, Raj even walked Tracy down the aisle at her wedding on a rooftop in Tribeca. Today, their professional paths have crossed to form the startup Wise Therapeutics, a company using mobile games to open up access to mental health services (full story on page 48). When I asked Robhy Bustami how he met his BioticsAI co-founder Salman Khan, another wide grin. Bustami was just a lonely kid in Oakland, California, fresh off the plane from Abu Dhabi. Khan, who’d immigrated from Pakistan a few years earlier, rolled into Bustami’s college cafeteria looking every bit the West Coaster in short shorts and a “Save the Rainforest” t-shirt. They struck up a conversation and have been best friends ever since. Today, the two are using artificial intelligence to supercharge prenatal ultrasound (read the story on page 60). Each month during our Health Transformer Circles – peer-coaching groups of 8-10 founders – we ask members to score themselves on the supportive relationships in their life. We ask questions like, “Can you rely on those around you?” and, “Do you have to spend an inordinate amount of time selling those around you on your vision?” We ask these questions because health moonshots cannot and will not be achieved in isolation. It’s going to take an army of entrepreneurs and investors working side by side over many years to really open up access to care, drive down costs, and do all the other essential things needed to improve health around the world (meet a couple of our investors on page 72). You don’t have to have your best friend as your co-founder – for some people it would be a terrible idea. What you do need to have in order to weather the storms of startup life are bedrock-solid supportive relationships. A co-founder is helpful. Reliable collaborators are essential. And teammates who make you smile when you think about how you met them? That’s the icing on the cake that brings the whole dessert together. And now, let me extend this invitation to you. We might not be best friends – yet! – but we can partner in achieving audacious health moonshots. Find out how you can support and invest in health innovators from around the globe at healthmoonshots.com.

Logan Plaster Editor-in-Chief 4 StartUp Health Magazine / Issue 7

In This Issue 3 Founders' Letter 4 Editor's Letter 6 Health Transformers in the News 12 Meet the Newest Health Transformers 14 care.coach 19 HealthMe 24 Everyplace Labs 28 C3LX 34 Crosscope 38 WeHealth 42 Health Cost IQ 48 Wise Therapeutics 53 Nulife Virtual 56 Juna 60 BioticsAI 65 Medwise.AI 70 Health Transformer News 70 Amwell Acquires Conversa Health 72 Masimo Founder Joe Kiana Backs StartUp Health Moonshots Impact Fund 75 7wire Ventures Founder Lee Shapiro Backs StartUp Healh Moonshots Impact Fund 78 StartUp Health Insights 2021 Q3 Funding Report 90 StartUp Health Investments by Moonshot

EDITOR-IN-CHIEF Logan Plaster DEPUTY EDITOR Jennifer Hankin CONTRIBUTING EDITORS India Edwards Nicole Kinsey COVER ILLUSTRATION Lauren Crow

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Health Transformer News at a glance When you have a global army of 250+ active health innovation companies, there's exciting health moonshot progress every single day. We couldn't print it all, so here are just a few headline highlights from Q3.

For daily health moonshot news, follow StartUp Health on Twitter @startuphealth and read the StartUp Health Insider newsletter startuphealth.com/insider 6 StartUp Health Magazine / Issue 7 6

It’s Hard to Search for a Therapist of Color. Hurdle Wants to Change That. THE NEW YORK TIMES 7/16/21

Telehealth in a PostCOVID World – Wisdom From MedForums and Cloudbreak Health TELEMEDICINE MAGAZINE 7/14/21

Quit Genius Raises $64 Million for Its Addiction Treatment Telehealth Startup FORBES 7/19/21

40 Under 40: Kavi Misri, Rose Health WASHINGTON BUSINESS JOURNAL 7/15/21

Murray Brozinsky, CEO of Conversa Health, which was acquired by Amwell in July.

Amwell Acquires Two Digital Health Startups – Conversa & SilverCloud – for $320 Million as Telehealth M&A Frenzy Continues FORBES 7/28/21

Return on Health Virtual Care Case Study: Complex Care Coordination via Cityblock Health AMERICAN MEDICAL ASSOCIATION 8/1/21

Healthcare Scheduling Platform Gray Oncology Draws C$1.25 Million From Angel Investors BETAKIT 8/5/21

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HEALTH TRANSFORMER NEWS // AT A GLANCE Carolyn Lam, MD Co-founder Us2.ai

Forbes Asia 100 to Watch: Us2.ai FORBES 8/9/21

Beyond Lucid Technologies Announces Integration Between HANDTEVY and MEDIVIEW JOURNAL OF EMS 8/11/21

New Partnership Gives Privia Health Access to Babyscripts’ Remote Monitoring Tools and Educational Content MOBIHEALTH NEWS 8/18/21 8 StartUp Health Magazine / Issue 7

See the Colorado Companies on the 2021 Inc. 5000 List: RxRevu COLORADOINNO 8/25/21

Devoted Health raises $1.2B, the largest private health tech round in history "Proud that StartUp Health is a long-time backer of Devoted Health! Proof that LOVE as a core value in how you treat patients drives value and impact." -Unity Stoakes President & Co-founder StartUp Health

Blue Cross, Cityblock Partner to Deliver Primary Care Through Local Clinics TRIAD BUSINESS JOURNAL 8/19/21

Accenture HealthTech Innovation Challenge Names Phyxable as a Finalist; Gabbi and Gray Oncology Selected as HTIC Rising Stars ACCENTURE 8/30/2 startuphealth.com

Cityblock raises $400M to execute on its vision of opening up access to care, serving 10M members by 2030 [L-R] Co-founders Iyah Romm and Toyin Ajayi, MD

Female Disruptors: Jill Angelo of Gennev on the Three Things You Need to Shake Up Your Industry AUTHORITY MAGAZINE 9/12/21

Babyscripts Secures $12M to Roll Out Its Virtual Maternity Care Model TECHCRUNCH 9/13/21

10 StartUp Health Magazine / Issue 7

Cala Heath poised to shake up tremor treatment market BIOWORLD 9/14/21

The People Behind Healthcare Innovation: Interview With Naheed Kurji, CEO & Co-Founder of Cyclica MCKINSEY & COMPANY 9/16/21

Is Digital Health, Such as Hoy Health, Key to Making the Industry More Efficient? MODERN HEALTHCARE 9/17/21

Joint Academy Helps Manage Our Chronic Health Conditions BBC NEWS 9/19/21

Private Investors Are Pouring Hundreds of Millions of Dollars Into Companies Like Particle Health That Are Quietly Powering the Digital Health Revolution BUSINESS INSIDER 9/21/21

Hurdle Helps Provide Mental Health to People of Color

FT Ranking: Americas’ Fastest-Growing Companies 2021: MouthWatch FINANCIAL TIMES

PhenoBiome Inks US Distribution Deal With Genetic Direction for Gut Microbiome Assay Service GENOMEWEB 9/23/21

Take Your Medicine: Can AdhereTech's ‘Smart’ Pill Bottle Help Combat HIV? WEILL CORNELL MEDICINE 9/30/21

WASHINGTON BUSINESS JOURNAL 9/24/21

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Meet the newest

Health Transformers Each issue we introduce you to the inspiring founders we invested in this quarter. Their work addresses a range of health moonshots, from Women's Health to Curing Disease. Learn how you can back Health Transformers at healthmoonshots.com

12 StartUp Health Magazine / Issue 7

CARE.COACH

HEALTHME

EVERYPLACE LABS

C3LX

CROSSCOPE

WEHEALTH

HEALTH COST IQ

WISE THERAPEUTICS

NULIFE VIRTUAL

JUNA

BIOTICS AI

MEDWISE.AI

65 startuphealth.com 13

HEALTH TRANSFORMER Victor Wang, CEO & Founder care.coach@startuphealth.com 14 StartUp Health Magazine / Issue 7

MEET THE HEALTH TRANSFORMERS

Meet care.coach, the Health Avatar Automating Care for Seniors Victor Wang took his experience at MIT and time working on robotics with NASA and used it to build a tool to solve the senior caregiver crisis. His avatar-based platform combines the latest in artificial intelligence and voice recognition with “human-in-the-loop” technology that leverages available caregiver workforces around the globe.

ACCESS TO CARE MOONSHOT VINTAGE: 2021/Q3 CARE.COACH

When he was a baby, Victor Wang immigrated from Taiwan to the United States with his family. Among the relatives who stayed behind was his maternal grandmother. She had no nearby relatives and as the years went on, became increasingly lonely and isolated. Victor remembers how, as a child, he watched his mother struggle to care for her mother from halfway around the world. His grandmother had a hard time with technology and so even a Skype call was challenging to arrange. Victor grew up and he carried this experience with him, albeit somewhere in his subconscious, as he headed off to grad school at MIT. He’d received a scholarship to study robotics and human-robot interactions, and he was realizing his dream of

working in the lab on cutting-edge machines, bringing science fiction to life. Then two things happened that shifted his trajectory, and his perspective. First, he took on a research assistantship at the MIT Human Systems Laboratory, where he helped coordinate a clinical trial, a sleep study at Brigham and Women’s Hospital exploring the impact of blue light therapy. This opened his eyes to the patient experience and the importance of validating and measuring any hypothesized benefits of technology. Wang’s second awakening came while he was working on his own thesis research for NASA’s telerobotics program about astronaut performance aboard the International Space Station. As he got deeper into the subject, he began to read clinical research around loneliness and isolation in

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MEET THE HEALTH TRANSFORMERS

astronauts and learned how these psychosocial factors could hurt astronaut health and put the space program at risk. He was reminded of his grandmother in Taiwan — who his family still struggled to reach via Skype. His grandmother had suffered a fall in the intervening years, and her loneliness had severely reduced her motivation to self-care, which hindered her recovery outcomes. Suddenly it hit Victor that his work in robotics had applications way beyond NASA and that perhaps his understanding of artificial intelligence could improve senior care in a way that would help millions of people like his grandmother. When Wang finished his Master’s degree, he put his PhD on indefinite hold and decided to leverage his tech skills to transform senior care. the challenge

Wang quickly discovered a number of well-documented but persistent problems. The first was a workforce shortage. There’s a number called the “Caregiver Support Ratio” that represents the number of family caregivers potentially available to care for seniors. AARP calculates that ratio to be around five currently, heading rapidly to three in the coming decades. The fundamental truth in the United States is that every day, more people age into conditions like Alzheimer's and related dementias, or are diagnosed with multiple chronic conditions such as diabetes, hypertension, heart failure, and COPD, or struggle with social isolation, loneliness, depression, and anxiety, each of these factors requiring attentive, day-to-day management. Meanwhile, the senior care workforce fails to keep pace. 16 StartUp Health Magazine / Issue 7

Wang describes it as a “fundamental limitation of resources.” He also discovered that even when the senior care workforce is available, it’s often a frustrating, fragmented experience for patients and caregivers alike. It’s not that senior caregivers aren’t knowledgeable and supportive; they are often heroes. It’s just that 24/7 support requires a constantly rotating cast of nurses and health aids to care for a single individual. That’s a recipe for a fragmented, disconnected patient experience, which is the last thing you want when your patient needs to feel connected, supported, and motivated to self-care. So Wang discovered a workforce shortage, poor patient experience, and then the trifecta: rising costs. We spend the vast majority of healthcare dollars on the oldest, most complex patients. When millions of seniors lack the care they need, their conditions worsen more quickly and compound the cost to the system. The care gap and the cost burden go hand in glove. Thankfully, for Victor Wang, these challenges weren’t dealbreakers, but rather the prompts he needed for his next act: the launch of care.coach. under the hood

When you think about the care.coach product, there’s what the patient sees, then there’s what’s happening behind the scenes. For the patient — let’s say an elderly woman admitted to the hospital after a fall — care.coach arrives as a specially designed tablet attached to an IV pole or set on the bedside table. Onto the screen pops a friendly dog, named “Buddy” by default (though patients often personalize their

avatar with names like “Pony,” “Sparkle,” and “El Capitan”). As the nurse leaves and the patient settles into her hospital stay, Buddy starts a two-way conversation. He asks the patient how she’s doing and gives helpful coaching designed to prevent delirium and falls: “Is the hospital too noisy for you to sleep well? I can ask someone to bring you earplugs,’’ or, “Are you ready for your bed exercises to keep you strong? I can talk you through them,” for example. Then, when the patient is discharged, she’s invited to take Buddy home with her, as a care companion. A Stanford paper published in the Journal of Medical Internet Research shows that this care.coach avatar program mitigates delirium and falls among hospitalized elders while reducing loneliness 3x more than a daily nurse student visit. At home, Buddy sits on a side table and checks in with the patient about everything from pain to medications, to how the grandkids are doing. The University of Washington has published their care. coach avatar research showing that seniors valued having a “friend who is always available and ready to talk when one is lonely,” as well as “the significance of the reminders that the digital companion would provide (for medication adherence or dietary restrictions).” UW’s research found that the seniors had reduced levels of depression thanks to Buddy. And care.coach’s health plan customers have published whitepapers showing how this daily, in-home, relationship-driven support has reduced members’ need for nurse visits to the home, reduced ED/hospital visits, and improved their providers’ ability to deliver care and support the member experience despite

Victor has employed a truly global perspective to solve this problem. The United States has a caregiver workforce problem, but globally, there is no shortage. There are people willing and able to work if the technology can connect them to the need. We’ve seen this geo-arbitrage work in many other industries, and it’s time to leverage it in health.

the COVID pandemic and self-isolation protocols. “The user experience is absolutely critical,” says Wang. “We’re dealing with the most complex patient population out there.” So far so good, but the real magic happens behind the scenes. First, there’s the avatar. Wang chose a dog (or a cat) because the benefits of pet therapy — even when the pets are virtual — have been studied and proven again and again. Then, Wang used his understanding of human-robot interactions to develop the “brain” behind the avatar. By talking naturally with older adults and even people with Alzheimer’s and related dementias, they’ve been able to build speech recognition systems that work better for this population than those created by Google, Amazon, and Microsoft. They use these unique machine learning models to help automate and scale the types of conversations and relationshipbuilding interactions that would traditionally require human staff. For this work, startuphealth.com 17

MEET THE HEALTH TRANSFORMERS

they’ve received a major National Institute on Aging award. One reason that care.coach chose an avatar over a human face is because they are working to scale care globally. Video telemedicine will always be one-on-one, and thus limited by workforce shortages. By using an avatar (and a synthesized voice), care.coach lets the patient form a bond with a single entity while a diverse team of care.coach health advocates work behind the scenes. It also enables Wang to end-run the workforce shortage in the United States through what he calls “geoarbitrage.” Care.coach employs people in Asia and Latin America — regions that don’t have the same caregiver shortages as the United States — to be the eyes, ears, and empathy behind the avatar. It’s a human-in-the-loop model, where portions of dialogue with the avatar are automated. As Buddy asks basic questions, he’s gathering data points and getting smarter through machine learning. Then, as issues inevitably get more complex, they’re put into a triage queue for one of the many health advocates on call. That allows these people, who can be located anywhere in the world, to make the most efficient use of their time. Finally, when a situation warrants it, a remote health advocate can use the avatar to suggest a direct 1:1 telemedicine visit. At that point, and with no need to understand Skype or Zoom, the patient is brought face-to-face with their doctor through care.coach’s very own, ultra-easy Video Visits product, to deal with the issue at hand.

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why we're proud to invest

There are many reasons to be excited about Victor Wang and the progress he’s making at care.coach. First, he’s built a novel way to tackle an intractable problem at scale. This is health moonshot thinking at its best. The caregiver shortage is one of the biggest problems facing healthcare today, and Alzheimer's and related dementia are some of the most costly and complex issues in the world. care.coach is leveraging the absolute best technology in artificial intelligence and machine learning to drive directly at these problems. It’s a bold, brave move, and Victor Wang has the passion and know-how to make serious progress. Second, we love that Victor has employed a truly global perspective to solve this problem. The United States has a caregiver workforce problem, but globally, there is no shortage. There are people willing and able to work if the technology can connect them to the need. We’ve seen this geo-arbitrage work in many other industries, and it’s time to leverage it in health. Finally, we’re bullish on care.coach because they are seeing serious market traction and validation, and every patient encounter makes them smarter. care.coach is already working with population health companies, Medicare Advantage plans, and other large organizations and their sales quadrupled this year. The icing on the cake is that every new partnership means thousands of new conversations, and every patient encounter makes the machine learning algorithm smarter. 4 CARE.COACH@STARTUPHEALTH.COM

MEET THE HEALTH TRANSFORMERS

HealthMe Is Bringing a Shopify Experience to Your Doctor’s Office Led by CEO and Founder Michael Havig, MD, this “Shopify for healthcare” platform is helping medical practices make sense of their pricing and then create patientfriendly retail experiences online.

HEALTH TRANSFORMER Michael Havig, MD, CEO & Founder healthme@startuphealth.com

COST TO ZERO MOONSHOT VINTAGE: 2021/Q3 HEALTHMEDOCS.COM

When a patient walks into a medical office of any kind, they’ve got a pretty good idea of what the first question is

going to be. “What’s your insurance?” While most healthcare bills are paid by big insurers, there is a sizeable chunk of society who, whether by choice or lack thereof, need to pay for medical care out of pocket. We call these patients cash-pay or direct-pay patients. According to the CDC, about 10% of total healthcare spending in the United States is out-of-pocket, totaling around $400 billion a year. And that doesn’t include the self-insured employers who essentially purchase services like self-pay patients. There are about 100 million patients that work for a self-insured employer — more people than are covered by Medicaid and Medicare combined. Here’s the rub. According to recent research, only about 10% of medical offices are set up to accommodate direct-pay patients. Why would they turn down cash? Most doctors don’t realize they do, but their practices don’t know how to price their own services, or how to bundle more complex startuphealth.com 19

MEET THE HEALTH TRANSFORMERS

procedures together. “There’s no transparency, no one knows the costs,” says Dr. Michael Havig, CEO and Founder of HealthMe, a startup founded in 2016 to address this problem. “The doctors providing the services don’t know what they are going to get paid, the patient doesn’t know how much the service costs. It’s like going to a restaurant and being given a menu with no prices. You’re told to order and they’ll bill you later. It could be $100, it could be $1,000.” It gets worse. Even if medical practices do know the pricing break-downs for their services, most don’t have the administrative framework to process direct payments. They literally can’t take your money. The result of this gap is as frustrating as it is nonsensical. On one hand, cash-pay patients need care and they have the money to pay for it. On the other, healthcare providers want to treat more patients and get paid appropriately. They’d also like to understand their own unit economics better and spend less time haggling with insurers' over-inflated pricing. Bottom line: Until now, the administrative framework didn’t exist to connect these dots and improve care for millions of direct-pay patients. That’s changing thanks to HealthMe, the startup bringing price transparency and an e-commerce experience to medical practices everywhere. origin story

Dr. Michael Havig is an orthopedic surgeon in Naples, Florida. In his spare time, he coaches little league baseball and it’s not uncommon for parents in the league to approach him with their medical questions. 20 StartUp Health Magazine / Issue 7

Not long ago a fellow coach walked up to him at a game and told him he’d been experiencing chest pain, and asked if he’d help him get in to see a doctor. Havig was confused. Why not just schedule an appointment? Because he was self-employed and wanted to pay in cash, the man said, and no one would take his money. “What do you mean they won’t take your cash,” Havig recalls saying. “That’s nuts!” Havig called up a couple of colleagues and they claimed they’d see the man, but then when it came down to the appointment itself, the practice staff turned him away. They just weren’t set up for cash payments. The icing on the cake came when Havig realized that his own office was turning away cash-pay patients like this coach. “That was a lightbulb moment for me,” says Havig. “I got tired of hearing all the complaining. And I got tired of complaining myself. So I decided to do something about it.” So Havig did some research. They started local, then went to the state, and then nationwide, finally presenting a peerreviewed study to the American Academy of Orthopaedic Surgeons last month. They showed the scope of the problem, that fewer than 10% of doctors accept self-pay patients, even though there are hundreds of millions of people who need that category of care. “It makes no sense. We all complain about how complicated the billing system is, and how little we get paid by insurers, and we are turning away direct payments,” says Havig. Havig tackled the problem piece by

This isn’t just about being able to take online payments. This is about using price transparency to open up access to healthcare for millions of people. This is about enabling millions of self-insured employers to give their employees the care they need without paying surprise bills and exorbitant mark-ups.

piece. First, they had to figure out how to assemble individual medical services (office visits, radiology, labs, therapy) into healthcare bundles that provide comprehensive care for the most frequently treated medical conditions. To price these bundles, algorithms were built using a blended reimbursement model based on typical insurance payments for various billing codes linked to the services in these bundles. “I thought we had it figured out, but even with these bundles in hand we found practices still had issues on the billing and collection side,” says Havig. Inability to collect cash payments has led to the common misconception that “self-pay equals no-pay”. To make sure that wasn’t the case, they simplified the billing and collections process and streamlined digital payments. Step by step, Havig’s office became a living laboratory out of which the HealthMe company and product were born. Once they’d solved the problem of transparent pricing and digital payments for themselves, it was a natural next step to share that with the world. “I didn’t sit down one day and say I was tired of being a doctor and wanted to be an entrepreneur,” says Havig. “We saw a problem, fixed it for our office, then other

providers took note and started asking about it. And then it became a company.” under the hood

HealthMe is a plug-and-play solution for doctors’ offices that turns each clinic website into a 24/7 e-commerce site where services can be reviewed and purchased just like any other retail experience. The best way to explain how it works is through a real story. A woman hobbled into Dr. Havig’s office with a knee in excruciating pain. When Havig told her she’d need surgery, she immediately asked how much it would cost. Before HealthMe, Havig would have hedged, saying he really didn’t know. He would have asked the front desk, who would have called the surgery center, who would have called anesthesia, who would then have given a range of $5,000 to $20,000. Instead, because their office had done the work of bundling services for this particular surgery and figuring out reasonable pricing, Havig was able to tell the woman it would be $4,100 all-in, for surgery plus post-op care. Her eyes went wide with surprise. He then told her she could go online to view the surgery bundle and the pricing and pay using a credit startuphealth.com 21

MEET THE HEALTH TRANSFORMERS

People looking for a standard knee/hip surgery could see a $50,000 difference in price based on where they get their surgery. HealthMe is helping to reduce price variance by bringing greater transparency to shoppable health services. Source: KFF analysis of IBM MarketScan Commercial Claims and Encounters Database

card, which she did immediately. Because the money was already in escrow, the team was motivated to get her taken care of at their earliest possible convenience, which turned out to be that same week. By the time the surgery was over, the money was in the bank. The patient got timely care for a reduced price and the medical center wasted zero time on collections and extra paperwork. Everyone was happy. The front end of the HealthMe platform is simple and predictable. It looks like a menu of services, descriptions, 22 StartUp Health Magazine / Issue 7

and prices and leads the user to an easy way to pay online. But on the back end, Havig and his team have done a number of things that make the platform scalable. First, they’ve connected those consumerfriendly bundles on the front end with the proper CPT codes so that they can show the value of their work. They’ve also done the labor-intensive research necessary to really understand how to price and bundle medical services. They share this with their clients, saving them valuable time. “We’ve got a whole process that guides them through using their own data to ar-

rive at appropriate pricing and bundles,” says David Comiskey, Chief Product Officer at HealthMe. “We teach doctors how to retail their services,” says Havig. “They’ve never originated their pricing before. The pricing was dictated by the insurance company. It’s all jumbled up with medical jargon and codes. Most doctors and patients don’t understand how it works.” HealthMe has started by addressing cash pay in the orthopedic market, because that’s what they know best, but are quickly moving into other specialty areas — anywhere that services could be considered “shoppable,” which has been estimated to be greater than 60% of all healthcare services. why we're proud to invest

On its face, HealthMe, like many great startups, is a simple concept. They’re taking the e-commerce experience we’ve come to expect from every industry from travel to furniture and they’re bringing it to healthcare. But the reason we’re so excited to back Havig and his team this quarter is that HealthMe is a key ingredient in a much, much bigger health moonshot. This isn’t just about being able to take online payments. This is about using price transparency to open up access to healthcare for millions of people. This is about enabling millions of self-insured employers to give their employees the care they need without paying surprise bills and exorbitant mark-ups. Millions of people put off needed healthcare for fear of what it will cost. By making those prices reasonable and

transparent, and easy to compare online, HealthMe removes the anxiety of getting the preventative care they need so they don’t end up with a medical emergency down the road. That will save lives while saving money; doing well while doing good. We’re also bullish on HealthMe because of the team’s unique perspective and experience. Dr. Havig is both an insider and an outsider. As a practicing surgeon and a member of the physician community, he has a front-line perspective on the pain points in the average clinical practice. He’s lived the cash-pay problem and he’s solved it for himself. It’s hard to imagine a founder with a clearer understanding of the challenge at hand. At the same time, Havig isn’t a part of the medical billing establishment or a large hospital system with its legacy thinking. That’s allowed him to have an outsider’s perspective and a willingness to break things that aren’t working. That insider/outsider lens will be critical as he guides his team in disrupting an entrenched piece of the healthcare system. The time is right for medical practices of all sizes to embrace logical, transparent pricing and consumer-friendly digital payments. It’ll open up access to care, drive down prices, and even improve practice economics for physicians. Under the leadership of Dr. Michael Havig, HealthMe is well-positioned to lead this charge, and we’re proud to back them this quarter. Join us in welcoming them to the StartUp Health portfolio. 4 HEALTHME@STARTUPHEALTH.COM

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MEET THE HEALTH TRANSFORMERS

Everyplace Labs Is Building the Diagnostic Testing Kiosk of the Future Michael Tu, Claire Zhou, and Prasanth Bijjam have designed a novel rapid testing device and service that completes the virtual care loop from telemedicine assessment to clinical-grade diagnostic testing.

HEALTH TRANSFORMERS [L-R] Michael Tu, CEO & Co-founder Claire Zhou, COO & Co-founder Prasanth Bijjaim, CTO & Co-founder everplacelabs@startuphealth.com

ACCESS TO CARE MOONSHOT VINTAGE: 2021/Q3 EVERYPLACELABS.COM

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Imagine you’re an essential worker, a warehouse employee making sure that protective gear — or vaccines — are delivered to hospitals on time. One day while you’re eating lunch you start to feel chills and body ache — the dreaded “flulike symptoms.” Most likely, you’ll be sent home to figure out next steps on your own. Typically, people wait out their illness at home until their symptoms get bad enough that they need to see a doctor. Then they drive to an urgent care clinic or emergency room and get the tests they need. In this scenario, not only have you racked up a tidy medical bill,

you’ve delayed care long enough to restrict your options — some treatments only work if you catch the illness early. In a better scenario, let’s say you’re able to dial up a doctor via telemedicine from the comfort of your home. But then the doctor on the screen says you need a flu test and directs you to a clinic or laboratory. You’re back at square one. On one side, virtual healthcare is seeing mass adoption. At the same time, at-home diagnostic testing — like COVID tests — are becoming more accessible and getting cheaper. But these two worlds are running in parallel rather than in sync. Purchasing an at-home test often means going into a pharmacy or mailing samples to a lab for processing. At-home rapid tests aren’t folded into patient records and aren’t used for clinical diagnosis and treatment. Mail-in tests might not return quickly enough for acute issues. For our warehouse employee, the lack of integration between the telemedicine visit and the administration of a diagnostic test means he misses the window to start Tamiflu, the standard of care for early flu treatment. That results in the worker needing an additional sick day (or two) to recover. Extrapolate that out to a workforce of millions and it’s clear how seemingly small inefficiencies in care can snowball not only into more severe illness, but billions of dollars in economic loss. Into this challenge stepped Everyplace Labs, a startup out of Chicago and the Bay Area building a novel, clinically robust way to administer rapid diagnostic tests in the workplace and in the community.

origin story

While Michael Tu and Prasanth Bijjam were engineering grad students at Northwestern University, they were a part of a team that developed a new kind of litter box for cats. The device analyzed the feline’s urine in order to detect kidney disease. When it was successful, it dawned on Michael that they’d built an automated point-of-care diagnostic device for pets. Could they apply the same tech to humans? Around this time, Michael met Claire Zhou, a friend of a friend, at a party. A public policy graduate, Claire had been working as a consultant helping regulated companies bring consumer-centric products and services to market. She quickly picked up on the potential in the technology that Michael and Prasanth had developed. From the start, her passion and perspective on healthcare and entrepreneurship felt complementary to the team’s. The three joined Chicago Innovation Mentors at MATTER, a health tech incubator in Chicago. They interviewed clinicians to better understand their challenges and to see if there was a product-market fit for the kind of diagnostic testing device that they were envisioning. They discovered that in the emergency department, pregnancy testing was creating a bottleneck to patient throughput. So they adapted their technology into a smart toilet that could perform a rapid automated pregnancy test with clinical accuracy. When COVID hit, Michael, Claire, and Prasanth saw that healthcare was decentralizing, so they took their learnings and shifted to a design for a rapid testing kiosk that could startuphealth.com 25

MEET THE HEALTH TRANSFORMERS

Here's how Everyplace Labs will work. When an employee shows certain symptoms, they fill out a quick screening tool on their computer or phone. If a rapid diagnostic test is warranted, they are sent to a quiet wellness room where the Everyplace Labs kiosk is located. The machine’s screen verifies the individual’s identity, delivers the correct test kit, walks the patient through collecting their sample and placing it in a sample cartridge, then automatically processes the sample and delivers a clinically-valid result in a matter of minutes.

be distributed throughout the community. The team’s work won the Silver Award at MassChallenge Boston, and they became a Company-in-Residence at Fogarty Innovation, a highly selective medical device incubator affiliated with Stanford Biodesign. Now, they’ve built up the team and advisors needed to take their concept to market, including a former Abbott R&D leader, an IDEO Chicago founder, a labo26 StartUp Health Magazine / Issue 7

ratory expert, and successful med tech and digital health founders. under the hood

You probably haven’t seen anything quite like the Everyplace Labs kiosk because it doesn’t exist yet. What Michael, Claire, Prasanth, and their team are building is a cross between a telemedicine hub, a lab testing facility, and a vending machine.

Here’s how it works: When an employee (or, in the future, anyone in the community) shows certain symptoms, they fill out a quick screening tool on their computer or phone. If a rapid diagnostic test is warranted — flu test, COVID test, UTI test, you name it — the individual is sent to a quiet wellness room where the Everyplace Labs kiosk is located. The machine’s screen verifies the individual’s identity and then delivers the correct test kit. The kiosk walks the patient through collecting their sample and placing it in a sample cartridge, which is then slid into an intake area on the machine. Everyplace’s proprietary system then automatically processes the sample and delivers a clinically-valid result in a matter of minutes. No need to mail off samples to a lab to re-verify or redo the test at the doctor’s office to ensure clinical accuracy. If the patient consents, the results from the test is immediately shared with a remote physician for next-step decision making, and is added to the patient record. If the test result is positive, the patient is contacted right away by the remote physician, who prescribes a medication. The process is designed to be automated and scalable such that any location, from a warehouse to library, could become an on-demand, point-of-care lab.

stop with telemedicine. We have to use it as a launching pad, and that’s exactly what Everyplace Labs has done. They stand on the shoulders of the telemedicine revolution in a way that really expands what’s possible. We also love that Everyplace is swinging for the fences. This isn’t some quick fix SAAS platform developed over a long weekend. It’s a bold vision for community health that requires inventing and manufacturing a piece of hardware that the world hasn’t seen before. It means creating new ways of clinically validating at-home diagnostic tests. These are big, audacious, health moonshot plans, and Michael, Claire, and Prasanth have the practical experience and advisory team necessary to get it done. Finally, we’re bullish on Everyplace Labs because of its potential to improve health for the communities that need it most. While the initial vision is for these kiosks to live inside of businesses, the future vision is to place them in community centers where healthcare resources are lacking. That means that on-demand diagnostic testing at an Everyplace kiosk could dramatically improve the quality and efficiency of care for people in pharmacy deserts or anywhere where resources are limited. 4 EVERYPLACELABS@STARTUPHEALTH.COM

why we're proud to invest

One thing that’s exciting about Everyplace Labs is that it’s the next evolution in virtual care. Telemedicine adoption in the COVID era was critical for opening up access to high quality care, but it was just the beginning. If we really want to blow the lid off of healthcare access and cost, we can’t startuphealth.com 27

HEALTH TRANSFORMER Andrew Richburg, CEO & Founder C3LX@startuphealth.com 28 StartUp Health Magazine / Issue 7

MEET THE HEALTH TRANSFORMERS

Meet C3LX, Where Patient Engagement & Remote Medicine Fuel Clinical Care Founder Andrew Richburg has leveraged 20 years in healthcare to build a patient engagement platform that superpowers care teams.

ACCESS TO CARE MOONSHOT VINTAGE: 2021/Q3 C3LX.COM

In spite of the increased adoption of telemedicine and remote monitoring solutions, most primary care providers are still locked into an episodic care paradigm. What that means is that when a patient comes in to see their doctor, perhaps for an annual check-up, or a sick care visit, they might capture a few health metrics and talk about a health goal or two, but the minute they leave the office, care teams have no insight into their patient’s progress or lack thereof. Even if the provider spends significantly more time with the patient discussing the areas he/she needs to focus on, the patient has little in the way of accountability, support, or guidance; and the care team has practically no way to track the health journey. Not surprisingly, the result is that patients struggle to make important changes, healthcare providers are frustrated with the lack of compliance/

adherence, and their work can feel ineffective and inefficient. Part of the issue stems from a business model problem. We still live in a “fee-forservice” world where healthcare is structured around clinical events that are reimbursable. As a result, the primary care workflow is oriented around billable events like doctor's visits, labs, and imaging — even if these aren’t the activities that keep the patient healthy. In order to manage their business, care teams have learned to focus their efforts and technology around the actions and behaviors that pay. More and more healthcare providers and care organizations are pushing back against the fee-for-service model, embracing a value-based approach to care where we pay for outcomes rather than for services. But to date, these organizations have often had to patch together multiple disparate systems, everything from the electronstartuphealth.com 29

MEET THE HEALTH TRANSFORMERS

ic medical record to some form of a patient engagement tool to the remote monitoring program, and the list goes on. For these folks, the desire to focus on outcomes over billable events might be present, but the inefficient or ineffective technology has held them back. Into that gap stepped Andrew Richburg, CEO and founder, and his team at C3LX. His vision was to build a tech platform that could bridge patient engagement and remote patient monitoring with clinical care management in a way that enables valuebased care teams to function effectively and efficiently in a value-based model, as well as to guide patients along the path to improving their health for the better. origin story

Andrew Richburg has been in the healthcare industry for 20 years and spent the majority of that time working in mar-

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keting and strategy for big healthcare systems. For a long time, that meant having a heavy emphasis on growth and maximizing profits. “For a while, my job was to make sure our surgical suites were full, our beds were full and our specialists were backed-up for 90 days,” Richburg recalls. He liked the company and it was growing like crazy, but something about it didn’t sit right with him. At the time the national conversation was increasingly more focused on moving the needle on health, disrupting the current system, and reforming payment models. Even as a not-for-profit, “I was part of the machine that was taking advantage of the existing model and optimizing everything to get the best reimbursement.” Richburg can remember the exact moment when his mindset shifted. He was leading a strategic planning retreat in San Diego and during a break, he walked out-

side and looked out over the waves. As he scanned the horizon, the vague sense of dissatisfaction that he’d been carrying around became something real and undeniable. He had to make a change. “My passion wasn’t for filling up surgery suites. My passion was for understanding and engaging patients in a way that would actually transform the underlying system.” At first, Richburg worked on a patientcentered healthcare platform in partnership with a large software services firm. But after two years, it was clear he needed to strike out on his own and have the freedom to build it his way, with the right team. Thus, C3LX was born. The name, which spells out 360 in Roman numerals, represents the idea of providing a patient with 360 degrees of holistic healthcare in their daily lives — the opposite of episodic care. C3LX was put into a new gear in 2020 when they made their biggest client acqui-

sition to date, a large healthcare system in Ireland. That critical partnership helped C3LX grow and develop their product in the real world, and in the summer of 2021, they inked another major deal, this time a full product integration with athenahealth. under the hood

Imagine you’re a patient seeing your doctor for an annual check-up. You’ve gained 10 pounds, as people are inclined to do. Your doctor suggests that you really pay attention to your weight and if possible lose some pounds in order to stay healthy or reduce risk. In the old paradigm, the patient then leaves the office, has practically zero contact with the doctor, unless sick, and a year later comes back with an additional 10 pounds around their waist. The patient is less healthy, higher risk, and everyone is frustrated.

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On the C3LX platform, called XIAhealth®, this situation would go very differently. When the healthcare provider realizes there is a rising risk or a health goal worth working towards, they introduce and invite the patient to the platform and discuss concrete health goals that can be actively and remotely monitored over time. This could be losing 10 pounds, reducing alcohol consumption, improving sleep, monitoring blood pressure, increasing activity, and focusing on mental health. “The critical part, I believe, is engaging and facilitating the relationship between the patient and their physician in the process of setting health goals, which can happen within the safe and trusted environment of your care team through XIAhealth®,” says Richburg. “When you just get a notice from your insurance company telling you to get on some health or wellness platform, usually for a reward, something just doesn’t feel right about it.” At home, the patient receives an invitation from their physician, downloads the XIAhealth mobile app, and completes an onboarding process that creates a comprehensive patient profile. This helps the care team understand each patient’s core values and priorities, what motivates them, barriers that stand in their way, and confirms priority health goals. That includes important social determinants of health (SDOH) factors like safe places to be active, food security, or access to healthy food options. When the patient opens up the app each day they’re presented with a simple yet engaging dashboard of their goals, their progress, challenges, and a dynamic “get it 32 StartUp Health Magazine / Issue 7

done” checklist for that day’s action items, their care plan for the day — anything from taking medication to measuring blood pressure, to hopping on a scale. The patient is in control of how much data they supply to the platform. C3LX seamlessly integrates with hundreds of remote monitoring devices through Apple Health and individual Fitbit devices. Patients can manually enter their metrics as well. However the data is captured, each patient sees their progress visualized. They can engage in challenges, receive automated recognition, get motivational and targeted educational messages from their care team, can elevate their care to a live chat whenever needed, and more. While we’ve seen some patient engagement platforms that make it fun and visual to track progress towards a health goal, for C3LX, that’s just one side of the coin. The other critical piece is the provider application, connecting actionable and contextual patient-generated health data to clinical care. When a provider logs into the system, their care team dashboard has patients sorted by priority, milestones, and messages, not just reimbursable events. The psychographic segmentation and SDOH data allows care teams to quickly review and triage patients based on their needs and communicate according to their core value propositions. Who is facing the biggest barriers today? Who is having trouble engaging with their path to better health? “Because of smart intuitive dashboards, you’re able to focus on the patients who really need it,” says Richburg. Gone are the days of scanning down a registry or work-

ing an excel spreadsheet. The platform also has a powerful content manager, with over 3,000 pieces of micro-content, that allows providers to easily find and distribute helpful messages to individuals or groups, securely and seamlessly within the platform. Whether a patient is trying to lose weight, increase activity, manage stress, improve sleep… a care team member can search micro-motivational or educational content, modify it, and distribute it effortlessly to the appropriate individuals or groups. Each care team member has their own dashboard, but they’re working on the same master panel of patients, which makes it easy to delegate work on the clinical side and make sure everyone stays on the same page. “We take one clinician and magnify them to the strength of three or four,” says Richburg, because they’re more efficient in their interactions, and are powered by realtime, smart data. why we're proud to invest

The idea of value-based care — that paying for outcomes is ultimately better for patients than paying for services — has been a dream for a long time. But we’ve always known that it was going to take smart, fullstack tech solutions to make it a reality. The old fee-for-service business models were just too entrenched for a quick switch. Platforms like XIAhealth® are making good on that promise and have the ability to usher in a whole new way of providing healthcare. It’s a radical 360-degree approach that, at scale, could be life-changing for millions of people.

Importantly, C3LX is putting a huge premium on engagement. It’s not enough to offer a service — if no one uses it, it’s a waste of space. To that end, Richburg and his team created a unique “health engagement score.” This number helps providers know in real time whether a particular patient is actively engaged in managing their own healthcare. That number is normalized and modeled longitudinally, so the provider can see how the patient’s engagement has changed over time. Keeping a careful eye on engagement improves the patient’s chances of success while also making the provider’s job more satisfying. Finally, we’re also bullish on C3LX because they’re rooted in a global mindset. Value-based care is a big conversation in the United States and has been for more than a decade, but it is frankly behind most of Western Europe in developing the infrastructure to support it. By inking a big partnership in Ireland and entertaining regular inquiries outside the United States, C3LX is in a position to capitalize on cross-border learnings and leapfrog opportunities. With the recent announcement of its integration with athenahealth, C3LX is moving quickly to make its mark on the industry. Join us in welcoming Andrew and his team into the StartUp Health family; we can’t wait to see how they shape health in years to come. 4 C3LX@STARTUPHEALTH.COM

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Meet Crosscope, the AI Platform Bringing Pathology Into the 21st Century Jayendra Shinde, PhD, and Ketan Bacchuwar, PhD, have built the image platform and AI models needed to digitize the pathology workflow and help pathologists make more accurate and efficient cancer diagnoses.

“We found a lump on your Xray. We’d like to run some tests to see if it’s cancer.” Those heavy words can shape a patient’s life in profound ways, but we rarely think about what comes next on the clinical side. When cancer is suspected by a radiologist, a biopsy is taken, and that lump of tissue is sent to a pathology lab. There, a team processes the sample into glass slides for examination by a pathologist. These scientists often sit hunched over microscopes for hours, relying on years of pattern recognition to see if the images before them contain cancerous cells. The field of pathology is critical to both the diagnosis and treatment of many cancers, yet the tools of this trade haven’t been upgraded much in 100 years. We still turn biopsies into physical slides, have pathologists view them on microscopes for hours on end, and rely on memory to find problems. By comparison, radiology went through a digital revolution 20 years ago and now digital X-rays enable remote readings and tele-radiology (including overnight readings from across the globe).

HEALTH TRANSFORMERS Jayendra Shinde, PhD, CEO & Co-founder Ketan Bacchuwar, PhD, CTO & Co-founder crosscope@startuphealth.com

END CANCER MOONSHOT VINTAGE: 2021/Q3 CROSSCOPE.COM 34 StartUp Health Magazine / Issue 7

One of the main reasons pathology lagged behind in the move to digital was the high cost of digitization of slides. Each “slide” has to be incredibly high resolution so that it can be zoomed in on and searched, like a detailed satellite image. So the technology required for pathology image storage has been one that’s needed to catch up with the market need. Four factors came together to make digital pathology a must-have instead of a nice-to-have. First, COVID-19 sent pathologists home and challenged them to figure out new remote workflows. Second, cloud storage got cheaper and more robust, allowing for the sharing of massive images. Third, the development of advanced artificial intelligence has enabled pathologists to gain more insights out of a digital pathology system. Finally, cancer cases are on the rise and pathologists are on the decline, creating a critical gap that’s only going to grow in coming years. Enter Crosscope, a digital pathology platform plus artificial intelligence framework that has the potential to bring the entire industry into the 21st century.

problems with mathematical algorithms. Over the years they collaborated on multiple projects together and became close friends. Shinde’s work came full circle when he realized that the algorithm work he and Bacchuwar were doing could be used to help his own father, and perhaps the whole pathology industry. So they headed back to Pune to gather a data set of cancer images and start training an AI engine to recognize patterns in potentially cancerous cells. Those were the early days of the Crosscope concept, around 2017, but the company really began to take shape when Shinde got an offer to be a post-doc scientist at Stanford. What better way to start his entrepreneurial journey, he thought, so off to California he flew. While at Stanford, Shinde enrolled in the Stanford business school’s Ignite program, which helped him further hone his business plan. “Academics needs to be translated from bench to bedside in order to bring costs down and improve care,” says Shinde. And that is precisely what he and Bacchuwar set out to do.

origin story

under the hood

Jayendra Shinde grew up in a town near Pune, a city on the west coast of India. Born to a family of doctors, Shinde got involved at a young age in the inner workings of his father’s pathology practice. A lover of science and technology, Shinde got an integrated master’s in bioinformatics from the University of Pune and then moved to Paris to get a PhD in computational biology. In Paris, he met Ketan Bacchuwar, who shared his passion for solving real-world

You can think of Crosscope as an endto-end solution for bringing the pathology world into the digital era. Shinde describes it as a “platform plus artificial intelligence” approach that can be used in a variety of pathology settings, from academic institutions to hospitals to diagnostic labs. Crosscope Dx is a digital pathology software platform that allows for viewing, flexible cloud storage, and management of high-resolution biopsy images. By taking startuphealth.com 35

MEET THE HEALTH TRANSFORMERS

Crosscope Dx is a digital pathology software platform that allows for viewing, flexible cloud storage, and management of high-resolution biopsy images. By taking slides out from under the microscope and onto the computer screen, the platform also facilitates telepathology, which enables off-site second opinions and even global collaboration.

slides out from under the microscope and onto the computer screen, the platform also facilitates telepathology, which enables off-site second opinions and even global collaboration. Not to mention that looking at a screen at home is just more comfortable than leaning over a microscope. Digitizing high-resolution pathology images and organizing them on a collaborative, cloud-based platform is a big step forward, but still leaves the problem of information overload. Every digital image requires the pathologist to scan cell by cell, hour after hour, in search of suspicious patterns. 36 StartUp Health Magazine / Issue 7

“Localization of these tumorous regions on these larger images is a routine but a very tedious and time-consuming task that can be automated,” says Shinde. “That’s where we come in.” To handle this, Shinde and Bacchuwar designed artificial intelligence models. Crosscope Dx serves as a backbone technology architecture and a launchpad for a pipeline of AI applications to automate image analysis. With their proprietary algorithms, Crosscope is helping pathologists avoid delays in assessments while managing an ever-increasing cancer workload. Their artificial intelligence tools are designed to

help pathologists improve diagnostic quality and efficiency while providing quantitative data to support the diagnosis. “You might think of it like Google Maps for tissue samples,” says Shinde. “Imagine looking at a full-screen satellite image of a city with no street names and being asked to find a destination. It’s like finding a needle in a haystack.” Crosscope, to continue the metaphor, is like layering on neighborhood and street names as landmarks over that satellite image, so you know where to start zooming in first. A single pathology image might be in the billions of pixels, so in order to be efficient and accurate, pathologists need assistance knowing where to focus their eyes. why we're proud to invest

Like many of the best innovations in health, Crosscope’s vision for digital pathology leaves us asking, “why doesn’t this exist already?” Indeed, nearly every aspect of healthcare delivery has been digitized in a way that makes information sharing and collaboration easier. It also opens the door to greater efficiency and accuracy through the use of artificial intelligence and machine learning. So why not utilize the best technology available in the critical act of reviewing potentially cancerous biopsies and forming personalized treatment plans? These patients facing scary cancer diagnoses deserve the best tech we can deploy. Crosscope is making that a reality. And don’t sleep on how badly this is needed. While about 20% of laboratories in the United States are using digital pathology for secondary diagnosis, less than one percent use it for primary diagnosis.

“You might think of it like Google Maps for tissue samples,” says Shinde. “Imagine looking at a full-screen satellite image of a city with no street names and being asked to find a destination. It’s like finding a needle in a haystack.”

The digitization of pathology labs has accelerated recently due to the requirements of remote work, but there is a lot of work to do. Crosscope is well-positioned to take advantage of this huge need and these market changes. We’re also excited to back Crosscope because of their smart go-to-market strategy. Rather than convince every pathologist that they need to change how they do business, Crosscope is forging deep partnerships with other pathology ecosystem vendors and infrastructure providers to bring in end-to-end digital pathology solutions. They’re inking deals with a few big names in the United States, and they’re fielding requests from around the world, including budding partnerships in the U.K., France, and India. The pathology industry was ripe for disruption and co-founders Jayendra Shinde and Ketan Bacchuwar have the technical know-how and personal passion to lead the charge. Thanks to tele-consults, global collaboration, and AI-assisted diagnosis, digital pathology could improve care for millions of people around the world. 4 CROSSCOPE@STARTUPHEALTH.COM startuphealth.com 37

HEALTH TRANSFORMER Sameer Halai, CEO & Co-founder wehealth@startuphealth.com

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MEET THE HEALTH TRANSFORMERS

WeHealth Is Taking Contact Tracing Beyond Covid19 While Safeguarding Civil Liberties With their app, Sameer Halai and his team are building a platform for mitigating infectious disease that balances public health with personal privacy.

CURE DISEASE MOONSHOT VINTAGE: 2021/Q3 WEHEALTH.ORG

When COVID-19 burst onto the scene in early 2020 it fundamentally changed how we thought about health. It ushered in a new era of virtual care and normalized telemedicine. It also changed how we think about healthcare privacy, and how our personal decisions impact the community around us. It raised a lot of thorny questions, like how can we use technology like smartphones to slow infections without eroding civil liberties. Today, thanks to the lessons of COVID, states and nations are embracing new ways of fighting communicable diseases. We’ve learned that contact tracing is one of the most effective non-pharmaceutical interventions in our toolbox. To make it more feasible, tech giants Apple and Google stepped up with their Exposure Notification Protocol, an API that allows approved

apps to share anonymous information about infection exposure. But even with this new mindset and tools, we’ve seen how contact tracing programs can fail. Some struggle to reach the speed and scale necessary to stop chains of contagion. Some fail because they take a top-down approach and ignore key stakeholders. For instance, Google and Apple might insist on working with a federal agency on a COVID app when public health is handled more locally. In other cases, contact tracing programs don't align well with end users' incentives to participate fully. And what happens when tech companies like Google and Apple decide to move on beyond COVID and ignore the possibility that this technology could be used safely to help during flu season? The apps might simply disappear. Bottom line: contact tracing isn’t a CO-

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VID issue. Building a framework for infectious disease detection while working to protect personal privacy and civil liberties is a global health issue of the highest order, and it requires a different kind of sustained leadership and innovation. These are a few of the challenges being addressed by WeHealth, the company creating a single app solution for exposure notification and public health guidance. origin story

Well before the WHO declared a pandemic in early 2020, James Petrie was hard at work on a whitepaper. A PhD student in applied mathematics, Petrie was exploring what it would take to use Bluetooth proximity detection to create an API protocol that could inform people about COVID exposure while preserving their privacy. This work inspired a band of passionate people spanning tech, public health, and academia, including Sameer Halai, who led efforts building a product around the API. In the spring of 2020, as the pandemic progressed, James’ whitepaper did the rounds on a volunteer Slack channel and ultimately led to conversations with Apple and Google about a collaborative Exposure Notification Protocol. His work, shared openly online, also sparked similar work from a consortium of professors in Europe, based in Switzerland. “We did a victory lap that within months, Apple and Google were using our protocol for decentralized contact tracing,” says Halai. Halai, having co-founded two other impact-focused and VC-backed companies in the past, realized that a lot more 40 StartUp Health Magazine / Issue 7

investment would be needed to bring the technology to market and to sustain its innovation. So he founded WeHealth as a public benefit corporation. WeHealth was the first in the US to pilot an app, COVID Watch, at the University of Arizona using the API after being the first to receive state entitlement from GAEN. After a successful pilot, in August 2020, the University of Arizona decided to roll out the app as part of a comprehensive strategy to help students return back to campus. The results demonstrated an estimated 11% reduction in the rate of transmission and a 47% rate of adoption among those infected. WeHealth’s vision is to “innovate at the pace of disease,” says Halai, “by continuously evaluating and improving its platform. We’re also investing in expanding to other diseases as well as new wearable and beacon technologies.” Since December 2020, WeHealth has co-hosted, with the University of Oxford’s Big Data Institute, The Science of Pandemic Technology Series – the world’s premier exchange of exposure notification technology best practices. They’ve partnered with Doximity, Labcorp, SonoraQuest, and several other labs to build a national API to integrate lab results with exposure notifications. They’ve also collaborated with MIT Lincoln Laboratory and the University of Arizona to evaluate the effectiveness of Bluetooth-based exposure notification. under the hood

WeHealth has built an app that notifies users that they’ve been exposed to a virus and offers customized public health guidance including access to early testing and

treatment. It does this by plugging into the exposure notification API developed by Apple and Google and anonymously detecting when you’ve come in proximity of another person who has been exposed to COVID (or, in the future, another virus). The app runs in the background of your phone at all times using low energy bluetooth technology so it doesn’t kill your battery. One thing that makes WeHealth unique is that the anonymous recommendations a user receives are completely customizable for each community by the public health officials deploying the app, and they can be revised instantly as circumstances and resources change. “One person might get a different suggestion five minutes after you get one because it’s all live. No need to push out updates,” says Halai. “We’re basically a recommendation engine that sits on your device, acting on local data that lives only on your device.” For the public health official, it’s a simple no-code setup that makes it easy to create if-then scenarios. For instance, if you have high exposure, and if you are fully vaccinated, then here are your recommendations. It’s dynamic public health guidance based on real-time anonymous exposure data. That framework makes the platform location agnostic. Whether it’s a state, country, university, or senior living facility, health authorities can quickly customize the prompts and action items for users falling into different exposure categories. “We architected this to be one platform for the world,” says Halai. “That’s the missing link.”

“WeHealth has worked to understand the barriers to successful contact tracing from speed and scale to equity and trust,” says Joanna Masel, WeHealth’s head of science. “We are building leading technology and products backed by science and research that incentivize users to help protect themselves and members of their community.”

The WeHealth app never shares any personal health information (PHI). The underlying protocol is such that the data lives on the device and never leaves unless you choose to send it somewhere. why we're proud to invest

Sometimes in health, having the right technology isn’t enough. You have to have the wisdom to know how to use it, both now and in planning for the future. Covid taught us that we need contact tracing, but we don’t want to be tracked by the government. We want to use our phones for infection control if it helps us get back to our lives, but we don’t want a tech giant to know our every move. We’re proud to back a company that’s taking those significant ethical challenges head-on, while also creating the tech infrastructure to fight future pandemics. We also love WeHealth because they were born out of a crowded Covid contact tracing market, and that has made them startuphealth.com 41

MEET THE HEALTH TRANSFORMERS

stronger. They’ve responded to advances in the contact tracing market by doubling down and expanding their vision, defining a new sphere of “effective altruism.” Put another way, WeHealth is nimble enough to take the mistakes being made by the tech giants and quickly adapt. Like how Google and Apple’s well-intentioned approach of working with federal agencies led WeHealth to work with smaller clusters of populations, like senior living homes and universities. “WeHealth has worked to understand the barriers to successful contact tracing from speed and scale to equity and trust,” says Joanna Masel, WeHealth’s head of science. “We are building leading technology and products backed by science and research that incentivize users to help protect themselves and members of their community.” The future of contact tracing requires thoughtful leadership and a commitment to global equity. WeHealth has collaborated with public health departments, leading scientists and large corporations because they believe that infectious disease is a solvable problem. They also believe that by focusing deeply on science, privacy and human-centered design they can build products that are as trustworthy as they are impactful. We believe Halai has assembled a team that is up to the challenge and we’re excited to see how they shape global health for years to come. Join us in welcoming WeHealth to the StartUp Health family. 4 WEHEALTH@STARTUPHEALTH.COM

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Health Cost IQ Is Helping Employers Cut Wasteful Healthcare Spending Jude Odu and his team are using proprietary smart algorithms to shine a light on massive inefficiencies and wasteful spending within the employer healthcare system. They’ve already saved several employers millions of dollars to date, and they’re just getting started.

In any big enterprise, there’s bound to be inefficiencies and waste. Nowhere is this more painfully evident than in healthcare. According to studies published by the Journal of American Medical Association (JAMA) and others, it’s estimated that 25% to 30% of all healthcare spending in the US can be categorized as “wasteful spending.” In the private sector, specifically within employer health plans, it’s even worse. According to Health Cost IQ’s analysis of health plan spending of more than 1,500 employers, more than half of the money spent on healthcare by

COST TO ZERO MOONSHOT VINTAGE: 2021/Q3 HEALTHCOSTIQ.COM

HEALTH TRANSFORMER Jude Odu, CEO & Founder healthcostiq@startuphealth.com

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private employers could be categorized as wasteful or inefficient. OK, so the devil is in the details. What is wasteful healthcare spending? It includes things like spending money on expensive brand-name drugs when identical, less expensive generic options are available. It could be unintentionally paying providers more than they actually billed for. It could be picking up medical claims that should have been billed to auto insurance companies in the event of a car crash. And it covers outright fraud and abuse, such as when providers send in the same bill for payment multiple times. And the list goes on. Private employers, who foot the bill for most healthcare services in the United States, aren’t set up to identify and trim such waste and inefficiency in their healthcare spending. It’s just too complex. So then the insurer should catch it, right? Not so fast. Many insurers operate under Administrative Services Only, or ASO, agreements. Under an ASO contract, the insurer is hired to simply pay the claims as they come in. No questions asked. So the employer might know that something’s not right with their spending, but they don’t have the tools to see what exactly is going wrong. The insurers themselves simply don’t have an incentive to investigate because it would just raise their admin costs. Besides, the funds are coming out of someone else’s bank account, not theirs, so why bother? This runaway wasteful spending leads to skyrocketing costs for employers and ever-increasing insurance premiums and patients are left holding the bag. What if a health technology company could shine 44 StartUp Health Magazine / Issue 7

a bright light on wasteful and inefficient health spending and help insurers lower premiums and improve care? What if technology exists today to provide a more accurate and actionable risk profile of not just an employer’s entire population but also its population subgroups, down to individual members? That’s precisely what Jude Odu and his team at Health Cost IQ have brought to market. origin story

Jude Odu has been in healthcare IT for more than two decades. While working at United Healthcare about 19 years ago he got an inside look at how healthcare payments work from the insurer side, and then while working at University Hospitals in Cleveland, he learned how the system works on the provider side. After stints in various impactful healthcare software development projects, he had acquired a wellrounded view of the problem and decided to look for a solution. “I like to say that I’ve run the gamut and I’ve seen it all in health data,” says Odu. But it was when Odu was working on his PhD dissertation at Cleveland State University that his work really came into focus. He was researching Medicare reimbursement rates and their correlation with hospital outcomes of care as a way to predict hospital quality of care and potential wasteful spending. His first revelation was the sheer amount of waste being tolerated within Medicare reimbursement. He was also struck by the lack of transparency in payment methodology and rampant inconsistency in Medicare payments to hospitals and individual providers.

Odu shares the story of one client who got a particular savings boost from their risk profile computed on the HCQ platform. It was a consortium of about 110 public school districts and they had grown used to paying a very high rate for their catastrophic insurance coverage. Their first year using Health Cost IQ’s risk modeling tool, they were able to challenge that their risk category was too high. It saved them $750,000 the first year and $650,000 the second.

“One hospital would get paid $5,000 for a hip replacement and another would get paid $15,000 for the exact same DRG procedure with no rhyme or reason to explain the difference,” noted Odu. “In many cases, the providers with higher reimbursement rates had worse outcomes of care for that procedure than those with lower reimbursement rates.” As part of his doctoral research using vast amounts of Medicare administrative data, Odu developed his own data methodologies that eventually became algorithms. He quickly realized what he had could be molded into a powerful tool that will make a huge difference within the private sector where inefficiencies and wasteful spending were even more rampant. He set his PhD dissertation on hold to launch Health Cost IQ and went to work developing proprietary methodologies and algorithms to shed light on wasteful healthcare spending. Odu’s first step was to surround himself with healthcare industry veterans. His cofounder is a surgeon with 40 years of medical and surgical experience and the rest of his core team has anywhere from 15 to 20 years of direct experience in healthcare IT and health insurance. One of his team

members used to run their own health insurance company. “These are people who have seen it all, just like me. Our collective experience is reflected in the quality of the product we have built.” under the hood

The Health Cost IQ (or HCQ) SaaS platform, which has been live for three years, can be broken down into two main parts. The first part is the risk modeling piece. This is where they profile every member of an employer’s population across multiple risk attributes and then produce and assign a risk score and risk category to every member of that population, enabling employers to intervene quicker and more accurately where the most help is needed. Odu likes to share the story of one client who got a particular savings boost from their risk profile computed on the HCQ platform. It was a consortium of about 110 public school districts and they had grown used to paying a very high rate for their catastrophic insurance coverage. For years, they’d seen an automatic 20–25% increase in this premium every single year. They never questioned the increase because they startuphealth.com 45

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didn’t know how. The first year that the client used Health Cost IQ’s risk modeling tool, says Odu, they learned that their risk profile was remaining flat year over year. They printed out the report from the HCQ platform, took it to the insurer, and challenged that they were being put into an unnecessarily high (and extraordinarily expensive) risk category. “That one report saved them $750,000 their first year with us,” says Odu. “The second year they did the same thing and saved $650,000. When this client saw us at a regional conference, they came running up to us and screaming that they couldn’t believe that one single report could help them save so much!” The second part of the platform, known as Opportunity Discovery, is entirely driven by more than 110 (and counting) distinct algorithms that are constantly churning through employer health plan data fed into the system by payer, insurer, and pharmacy systems and uncovering every manner of inefficiencies and wasteful spending that even the employers themselves are not aware exist within their networks. The algorithms uncover issues such as claims overpayment, duplicate payment, waste, fraud, abuse, and more. The resulting insights and savings opportunities are quantified in precise dollar amounts and specific recommendations are given to the employer via secure, interactive dashboards. “What our reports say is: if you do this, this is how much you’ll save next year,” says Odu. “It’s very precise. What we’re doing is putting data validation and payment accuracy on autopilot.” 46 StartUp Health Magazine / Issue 7

What makes Health Cost IQ’s SaaS platform unique are the proprietary algorithms layered in behind the scenes, helping employers get much deeper insights out of their population profile than is possible with any other competing product. Their platform is also differentiated in that it’s the only enterprise SaaS solution of its kind that can be deployed into both the payer and provider spaces with absolutely no code modification required. The platform integrates data from wearable devices such as Fitbits, as well as data from labs such as LabCorp, wellness companies such as Livongo, various HRA companies, dental, vision, life data, and more. To further cement the superiority of its SaaS platform, the HCQ team spent considerable time and resources to automate its backend client implementation technology. This home-grown client onboarding technology automates the onboarding of new clients onto the HCQ platform as well as automates the generation of client dashboards and analytic content, thereby reducing the onboarding timeline for new clients from four to six weeks to less than one week. Planned enhancements to this proprietary technology would reduce total new client onboarding time to one to two days from receipt of data, putting the company in an extraordinarily strong position to exponentially grow its client base without any technological restrictions. The platform has achieved HIPAA compliance and is SOC 2 certified by reputable thirdparty auditors. Health Cost IQ works with larger employers, focusing on those with 1000 or more employees, and their SaaS solu-

The Opportunity Discovery platform is driven by more than 110 (and counting) distinct algorithms that are constantly churning through employer health plan data fed into the system by payer, insurer, and pharmacy systems and uncovering every manner of inefficiencies and wasteful spending.

tion works particularly well with consortiums of employers such as Professional Employer Organizations (PEOs), public school consortiums, and similar organizations. They’ve gone all-in on the private employer market, saving government-run programs such as Medicare and Medicaid for another day. “Most Americans get their healthcare from their employers,” says Odu. “That’s where the most money is being spent, so that’s where there’s the most waste, and consequently the most opportunity for savings. This is a sector underserved with software technology and services. No one is helping these employers stem their runaway spending. We now have the tool and are ready to help.” why we're proud to invest

The best health innovations just make sense. When faced with the reality that half of healthcare spending within employer health plans is wasteful or inefficient, rational people cry out for transparency and ac-

countability. That is exactly what Jude Odu saw, and what he was uniquely qualified to build. He not only had the vantage point to observe wasteful spending up close, but he had the passion and skills to say, “if not me, then who will fix the problem?” We’re incredibly bullish on Health Cost IQ because there’s just so much to gain, and so much low hanging fruit. Every little overpayment and inefficiency that’s avoided is money back in the pockets of employers, which can then translate into lower premiums for workers. They’ve already identified and saved their employer clients millions of dollars, and they haven’t spent a single dollar on marketing yet. We’re also excited to see that Odu and his team are putting healthy pressure on the insurance industry. They’re causing a little friction, no doubt, but in the kind of way that makes everyone stronger. By bringing a flashlight and shining it into areas of neglect and waste, Health Cost IQ can ultimately make all insurers better. Insurers might balk at first — no one likes being told they’re wasting money — but everyone knows that transparency, accuracy and accountability are good for patients, and good for the entire health system. “At the end of the day, insurers recognize that everything we do is in the interest of their employer clients and ultimately, the patient,” says Odu. Jude Odu and his team at Health Cost IQ are an inspiring new addition to the Cost to Zero Health Moonshot and we’re excited to see what they build next. 4 HEALTHCOSTIQ@STARTUPHEALTH.COM

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Wise Therapeutics’ Science-Backed Games Help People Fight Anxiety Raj Amin and Dr. Tracy Dennis-Tiwary want to prescribe mobile games which could lower the barriers to mental health care for millions.

MENTAL HEALTH & HAPPINESS VINTAGE: 2021/Q3 WISEDTX.COM HEALTH TRANSFORMERS Raj Amin, CEO & Co-founder Tracy Dennis-Tiwary, PhD, CSO & Co-founder wisedtx@startuphealth.com 48 StartUp Health Magazine / Issue 7

Over the last couple of years, we’ve seen a perfect storm form around mental health at a population level. Anxiety and depression are up: one in five Americans report having a mental health diagnosis. Healthcare providers are down: 60% of US counties don’t have a single psychiatrist. And the COVID pandemic tripled down on the problem — worsening anxiety and stress and making it even harder to see a doctor. Thankfully, we’ve also seen the rise in digital mental health solutions, including the new category of digital therapeutics. We collectively realized that healthcare doesn’t always have to be conducted in a

clinic, and the telemedicine doors swung wide open. Grabbing the headlines recently was the Ginger plus Headspace merger (creating a new digital mental health juggernaut worth $3B) but there are countless examples. Within StartUp Health’s portfolio alone, we’ve seen companies such as Valera Health, Rose Health, Hurdle, and Butterflly Health all help to bring the power of therapy to patients in a digital, virtual format. Most of these solutions could be described as cognitive-behavioral therapy (CBT) plus telemedicine, or mindfulness plus telemedicine. But what about the person — and there are millions around the world — who is stressed and anxious, but has zero interest

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in therapy, mindfulness, or even breathing exercises. Many people who struggle with anxiety and depression don’t have words to explain what they’re feeling, so they don’t seek help. Or maybe they know, but their community or family has told them to ignore the feelings or to be ashamed of them. For these people, mental health care — even modern virtual care — is out of reach because the barrier to entry is too high. What if a patient could take the first steps towards mental health care without even realizing it? What if, through a simple game on your phone, you could unconsciously begin the process of cognitive therapy, thus lowering the barrier to mental health care. That’s precisely what the team behind Personal Zen, by Wise Therapeutics, has done. origin story

When Tracy Dennis-Tiwary, PhD, and Raj Amin first met, neither thought that they would one day be business partners. At first, they were just close friends — so close that Amin walked Tracy down the aisle at her Hindu wedding in 2005. “I always knew Tracy was an incredibly smart scientist, but I didn’t know our paths would intersect,” says Amin. Those paths did look pretty different at the time. Amin walked the road of a serial entrepreneur, building and selling multiple tech companies like Mana Health, HealthiNation, and N2 Broadband. While he was getting deeper into operations and product development, Dr. Dennis-Tiwary was in the lab, doing research on Attention Bias Modification (ABM), a field of psychology that targets unconscious biases in order to 50 StartUp Health Magazine / Issue 7

retrain the brain. Her work led her to conduct seven NIH-backed randomized clinical trials, which together confirmed her hypothesis that ABM could be gamified and used as a first-line defense and gateway to mental healthcare. It was after Amin sold Mana Health to Comcast that he took a closer look at his friend’s research. He’d been consulting for a pharmaceutical company in the digital therapeutics space and better understood both the impact of, and business case behind, her work. “It’s very hard to find a scientist like Tracy who knows the science inside and out and has done the research,” says Amin. He knew that if he combined his business and product experience with Tracy’s scientific background they could build game-changing products. “It was a big idea, and I knew it could have an incredible health moonshot-sized impact,” says Amin. “We’re talking about changing the way that mental health treatments are done,” says Dr. Dennis-Tiwary. “The reason I’m not just sitting in a lab doing more research is that we psychologists and psychiatrists have profoundly failed people. We’ve given people treatments that are too onerous, that create stigma, that make them feel broken. We can do as many randomized trials as we want, but if we’re not putting tools into people’s hands that work, that they want to use, nothing will help.” Together, the two founded Wise Therapeutics and came to market with their first app, Personal Zen. They successfully raised an initial round of funding during the COVID pandemic which gave them the op-

portunity to look beyond the app and focus on integrating mental health data into a physician-facing dashboard. Next up: use the science behind Personal Zen to build FDA-approved prescription digital therapeutics (PDTs) that target specific conditions, like social anxiety disorder, alcohol use disorder, or perinatal anxiety. under the hood

Wise Therapeutics’ first product is an app called Personal Zen. The first thing that happens on the app is that two little faces pop onto the screen, one happy and one angry. Then, the user is told the rules of the game: as soon as the two faces appear on the screen, swipe the happy face to clear it away as quickly as possible. It’s an incredibly simple game that users can pick up intuitively in seconds, but there are years of science behind it. “It seems like it’s too simple,” says Dr. Dennis Tiwary. “But in that simplicity is a beauty.” The psychological framework behind Personal Zen is Attention Bias Modification (ABM). According to ABM research, the happy and angry faces present our minds with an immediate conflict. Which will we pay attention to? Will we prioritize the good or the bad? Our unconscious filters push us one way or the other. The game, says Dennis-Tiwary, trains you to choose the positive stimulus over and over again. “By strengthening the filter that chooses the positive, it trains your brain to know that it can let go of the negative. I can face it, and I can let it go,” says Dennis-Tiwary. “Personal Zen is not only a rigorous sci-

The psychological framework behind Personal Zen is Attention Bias Modification (ABM). According to ABM research, the happy and angry faces present our minds with an immediate conflict. Which will we pay attention to? Will we prioritize the good or the bad? Our unconscious filters push us one way or the other. The game, says Dennis-Tiwary, trains you to choose the positive stimulus over and over again.

entific intervention. It’s a metaphor: You follow the joy (with a swipe of your finger) and your brain learns to follow the joy too.” ABM is about creating habits. Like any habit, when we repeat an action, we lay down neural circuitry in the brain. We strengthen certain neural connections and weaken others. ABM is about addressing the habits of how a person views the world. What do you filter in and what do you filter out. Dennis-Tiwary’s research has shown that even a single session of this gamified ABM therapy can reduce anxiety and stress and that over time it can build new habits for taking in the world and gaining mental flexibility. In addition to the core game, Personal Zen introduces users to practical tools like mindfulness, journaling, and mood tracking, and gives educational resources through what they call “nudge content.” There’s also a GAD-2 survey built-in, startuphealth.com 51

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which is a quick anxiety assessment used by physicians to gauge mental health risk. All of that data will soon be delivered to physicians on a dashboard that can help them manage their patients and take action when necessary. why we're proud to invest

The first thing that caught our attention about Wise Therapeutics was the team. Raj Amin is an accomplished serial entrepreneur who has built and sold businesses for decades. Dr. Tracy Dennis-Tiwary is an accomplished psychologist with 20 years of experience and multiple clinical trials under her belt. The two bring a rare combination of skills together, but what’s even better is that their business is founded on a 25-year friendship. That love will give them the mutual support needed to weather the startup storms to come. We’re also keen to invest in Wise Therapeutics because they’re addressing a huge yet underappreciated market. We all know mental health challenges are on the rise, and we’ve all seen virtual therapy services rise to meet the challenge. But telemedicine therapy is still too high of a barrier for so many people who need help. In light of this, global regulatory and reimbursement frameworks have shifted to support a new class of products; digital therapeutics. So rather than compete with telemedicine services, Wise’s game-based approaches to treatment, like Personal Zen, act as an onramp to care, an adjunct for folks who aren’t quite ready to take the leap. “If we can give people an easy first step, then if they need more care, we can prepare them for what comes next.” 52 StartUp Health Magazine / Issue 7

That means putting a hyper-focus on engagement, and on evidence. In an early trial, by using their Personal Zen approach, Wise Therapeutics was able to get 30% of the employees at a large construction company to engage with the platform. These are mostly people who had never thought about their mental health, says Dr. DennisTiwary, yet here they were, unconsciously working on stress reduction. “Evidence is at the core, but so is ease of use and low time commitment,” says Amin. “Mindfulness is great, but often has single-digit engagement. You’re leaving out a lot of people.” In the end, we’re proud to back Wise Therapeutics because their team is building a truly scalable, global way to help millions of people reduce stress and anxiety. By leveraging years of academic research, and by meeting people where they’re at, Amin and Dr. Dennis-Tiwary have the ability to achieve audacious health goals. “We really can change the world if we give people the tools to have self-awareness and to take action,” says Amin. 4 WISEDTX@STARTUPHEALTH.COM

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NuLife Virtual Puts Addiction Treatment and Recovery in the Palm of Your Hand When serial tech entrepreneur J.D. Meints hit a wall with his addiction and started on the road to recovery, he discovered his new life’s work. Now he’s building a virtual behavioral health platform that makes addiction treatment and supportive communities scalable.

END ADDICTION MOONSHOT VINTAGE: 2021/Q3 NULIFEVIRTUAL.COM

HEALTH TRANSFORMER J.D. Meints, CEO & Founder nulife@startuphealth.com

According to the National Survey on Drug Use and Health, more than 20 million Americans suffered from a substance use disorder in 2019. In 2020, drug overdoses killed a record number of Americans, jumping up by nearly 30%. But no one needs faceless statistics to know that addiction problems — whether alcohol, illegal drugs, or pharmaceuticals — rage like a wildfire, a pandemic even, in the United States and around the world. We see it in our communities and often in our own families. And yet the approach to treating addiction hasn’t changed much in 100 years. When someone finally hits rock bottom, they’re sent to a rehab clinic (if they can afford it). There, they’re taken through a standard detox process and prepared to reenter the world. After a few weeks, they’re thrust back into their previous life and put on a rigorous schedule of AA or NA meetings and group therapy sessions. This system — which, it deserves to be said, has helped countless thousands of

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people — can create a disconnect between life and rehab. That harsh line between in-patient care and home can make it difficult to re-integrate into the world. Further complicating matters, the regime of therapy sessions and meetings post-rehab can be incredibly time-consuming, to the point of being prohibitive for a recovering addict who has a family or job or both to consider. These were just a few of the issues facing J.D. Meints when he made the decision to grow from running a brick-and-mortar rehab facility to building a “click-and-mortar” rehab platform called NuLife Virtual. origin story

J.D. Meints has been an entrepreneur in tech for more than 20 years, first in the real estate sector and then in an e-commerce company. He was successful as a businessman, and that success led in part to a lifestyle of drinking and drug use. For years he kept it together, partying hard, feeding his addiction, then recovering enough to operate his business and keep his family intact. But in 2012 the walls began to crumble around him. First, he was kicked out of his own business. Then, after a particularly hard night, his wife confronted him with an ultimatum: Get sober or get out. “That was the last straw,” says Meints. That night he drove around their California neighborhood trying to decide what to do next. For a week he drove around town to different Alcoholics Anonymous meetings but couldn’t get up the nerve to walk inside. Then he’d go home and lie to his wife that he’d been to the meeting. “A week later, I finally went into a meeting, and I never looked back,” says Meints. 54 StartUp Health Magazine / Issue 7

Baring his soul with honesty and vulnerability to a group of strangers was eyeopening for Meints, and it was also just the beginning. Pretty quickly, his entrepreneurial nature was triggered once again, and he dove headlong into in-person treatment centers. He launched his own brickand-mortar clinic in California, and the experience of helping others face the demons he was so familiar with changed his life. “I’ll never forget picking up our first patient from the airport. To watch him go through this transition was amazing, and then to get these phone calls from moms, dads, or brothers, saying, you gave them their life back. I knew everything in my life had led me to this point.” Once he had a few years of running physical rehab clinics under his belt, Meints decided it was time for a platform upgrade. From his experience in tech as a serial entrepreneur, he knew there were ways to improve care and lower costs, and that addiction recovery was lacking in its tech infrastructure. Thus, Nulife Virtual was born. under the hood

NuLife Virtual is a behavioral health platform that extends the benefits of a close-knit rehab (and post-rehab) community into the home. Rehab clinics and therapists can use NuLife as their integrated practice platform. To that end, it can handle scheduling, privacy forms, assessment tools, and telemedicine visits. It also comes with a built-in library of educational content, and a readyto-access community of recovery-minded individuals. This “click-and-mortar” model

helps therapists improve the continuity of care as clients transition from rehab into their normal lives. Those touchpoints not only improve the likelihood of treatment success, but they improve the practice’s bottom line as telemedicine reimbursement continues to expand. For people recovering from addiction, the NuLife platform integrates rehab therapy into everyday life, extending it beyond the walls of the clinic or AA meeting. One way it accomplishes that is by cultivating a new kind of social network. Instead of projecting a picture-perfect version of ourselves in a Facebook group or on Instagram, the NuLife community creates the space for people to get real about their challenges. At the same time, we’re each more than our struggles. So NuLife aims to provide tools that are person-centered not necessarily treatment-centered and help people come together around hobbies and passions as well. You may want support about your recovery from alcohol abuse, but you also love baseball, or knitting, or entrepreneurship, and you may be more likely to stick to your recovery plan when surrounded by people who understand you. From a tech stack standpoint, NuLife is familiar territory. We’ve seen this kind of user-friendly interface in workflow apps, social media, and e-commerce. But until now, it hasn’t been applied to addiction treatment and recovery. What that means is that users will adapt to the technology quickly. The difference is in the underlying framework of care, empathy, and support for recovery.

why we're proud to invest

Recovering from an addiction isn’t something we do alone. Pushing recovery into the virtual realm and building out the tech tools to scale it globally means that that supportive community can come from anywhere and is available around the clock. It means opening up access to treatment while driving down costs. Meints and his team are on a health moonshot mission to break the stigma around mental health and addiction and impact one million lives in the United States. NuLife is also working to combat the epidemic of suicide by building up mobile-friendly community resources that go with you wherever life takes you. While NuLife is launching in the US, it has global aspirations. They’ve had early success recruiting patients in Africa and the United Kingdom. That’s welcome news because addiction is a global health crisis, and a virtual community built on the foundations of recovery could extend to any region with an internet connection. No longer will addiction treatment and recovery be the exclusive opportunity of the wealthy. Finally, we love the collaborative spirit behind the NuLife product. Already Meints has teamed up with youturn, an addiction startup that joined StartUp Health in 2020, to provide high-quality educational content on the app. We see this idea of extending community from the product to collaborative business practices as critical to long-term success and to achieving health moonshots. We are truly in this together. 4 NULIFE@STARTUPHEALTH.COM

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HEALTH TRANSFORMER Peter Arian, CEO & Founder juna@startuphealth.com 56 StartUp Health Magazine / Issue 7

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Meet Juna, the App Making STI Testing Accessible For Young People Peter Arian, the CEO and founder of Juna, is on a mission to “make safe sex sexy.” He’s starting with discrete at-home STI testing and an unfiltered sexual wellness media platform that meets Gen Z’ers where they’re at. ACCESS TO CARE MOONSHOT VINTAGE: 2021/Q3 HEYJUNA.COM

It doesn’t take a very deep dive into the sexual habits of college students to see the recipe for a healthcare crisis. It’s estimated that 70% of students were sexually active in 2019 (Journal of American College Health). According to the CDC, one in five people in the United States has a sexually transmitted infection (STI) on any given day, and fully half of new infections in a given year occur in people 24 years and younger. And yet, despite high sexual activity and rampant STIs, condom use is spotty at best, and regular STI testing is a fringe concept. Of the estimated 32 million Gen Z’ers who need to get tested every year for an STI, only eight percent of men and 20% of women get tested. And those numbers are for people with one to two sexual partners. As those numbers go up, the need for testing goes up. There are a lot of unknown variables in this mix, but the need for much more STI

testing in young people is undeniable. For Peter Arian, a student at the University of British Columbia and the founder of the sexual health startup Juna, this isn’t an academic exercise. As a freshman, he looked around and observed how sexually active everyone was, and how few people were getting tested for STIs. It just didn’t add up. It’s not that organizations don’t know or care about this problem. There are enough pamphlets about safe sex and STIs to fill a library. They just haven’t been successful at reaching young people. “Young folks, on the whole, want to get tested,” says Arian. “They just haven’t been able to connect with a company that normalizes the idea of being proactive.” That proactive piece is critical as most STIs are asymptomatic and the vast majority of people hold off getting tested until they show visible signs of infection. The reasons for lack of STI testing aren’t startuphealth.com 57

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hard to understand. It’s expensive, inconvenient, and awkward. After all, who wants to be spotted in the STI clinic waiting room? The whole process has been stigmatized and equated with extreme illness versus being a normal step in sexual health. That’s the challenge being addressed by Peter Arian, CEO and founder of Juna. With their app, Arian and his team are working to “make safe sex sexy” and bring at-home STI testing kits to Gen Z’ers in a generationally contextual way. origin story

Peter Arian was born in Iran and immigrated to Montreal, Canada, when he was five. As an immigrant and the son of a single mother, he felt like he had to figure a lot of things out for himself. Never was that more true than when he darkened the door of a high school sex ed class. “I basically had to break these doors down,” says Arian. That sex ed class he attended didn’t exactly help. It consisted of the decades-old banana-and-condom schtick and it just didn’t land. “It’s ineffective and totally cringe and not inclusive. They just weren’t connecting with young adults.” Arian tucked that memory away and headed off to college at the University of British Columbia. He hailed from a family of physicians and healthcare workers, so he always had a sense he’d work in the field in some way, but he wasn’t sure how. During college Arian worked in sales and then started his own organization called The Artist Block. He would arrange events with photographers, painters, and other artists and then throw curated exhib58 StartUp Health Magazine / Issue 7

its at spaces around Vancouver. The events quickly grew in notoriety; young people around the city would flock to the shows by the hundreds. Around this time, another event occurred in Arian’s life that catalyzed his experience and what he was observing around him. He went through a breakup and decided to get tested for an STI. He looked at his options and realized the last place he wanted to go was the local clinic where he might bump into friends living across the facility. So, like so many young people in this situation, he drove miles out of his way and got tested across town. It was awkward, long and uncomfortable. That ordeal opened Arian’s eyes up to the broader struggle faced by young people who don’t have access to convenient and culturally relevant sexual health services. In that serendipitous way that our experiences collide, Arian’s work running The Artist Block helped him see how he might address the STI testing problem. He’d experienced the power of community, and of youth culture, and he realized that if he could direct that energy towards sexual health, and combine it with convenient and inexpensive at-home STI testing, he could improve the health of a generation of people. under the hood

Juna, founded in mid-2021, makes it quick and easy for anyone to order a discrete at-home STI testing kit. But the Juna user experience really starts long before a test is ordered. Arian’s vision is to build a community of people on the app who want to be sexu-

ally aware and sexually healthy. To do that, they’re developing sex ed content that’s entertaining, clinically accurate, and designed for young people. They’re calling it Health Club, and Arian describes it as HeadSpace but for sexual wellness and mental health. In order to build this out, Arian is in talks with an unusual cross-section of practicing physicians and sex ed influencers on Tik Tok. Their edgier, unfiltered approach – evident in their NSFW podcast called “Better Safe Than Horny” – covers ground that traditional testing labs or STI organizations just can’t or won’t. “That’s why our waitlist has been growing so fast,” says Arian. “Because we’re having the conversations openly. It’s about that sexual liberation that Gen Z’ers can connect to.” When the moment comes when a young person does need an STI test – hopefully as a proactive measure thanks to what they’ve been hearing on Health Club – they simply tap a button on the app. Juna has partnered with a CLIA-certified lab to deliver tests to the user’s door. The kit comes with easy instructions on how to gather a biosample – blood, urine, spit, or swab – and send it back to the lab. Testing takes less than 10 minutes and results are back in two to five days, logged securely on the app. If the test pops positive, Juna’s physicians can treat the individual over the app, via telemedicine, and give a prescription for any necessary medications. This isn’t a deep tech company as much as it is a lifestyle brand re-imaging now we reach young people and make testing more accessible and proactive. It’s not unlike how Hims and Ro repackaged Viagra for

a new generation. The tools and tech exist; it’s a matter of getting them into the right hands with innovative business models. During launch, Juna is focusing on PrEP testing (the “pre-exposure prophylaxis” care protocol for HIV prevention). People who are on PrEP have to be tested every three months. Until now, no company has made this testing process inclusive and LGBTQ friendly. Other at-home STI tests are targeted towards those sexually active in the straight community. why we’re proud to invest

A lot of legacy brands are wringing their hands about how to connect with young consumers, and the results are often ineffective and inauthentic. While Peter Arian is a young founder and relatively new to the healthcare arena, we’re proud to back him and his team because they represent an essential move towards creating health solutions from within a community, not handed down from above. “There are a lot of so-called Gen Z brands that aren’t pushed by Gen Z’ers,” says Arian. “They’ll just invite 20 young people into a room and ask them a bunch of questions and call it a day. We have this advantage because our average age in the team is 23. We’re all young and we understand how the next generation thinks. We represent that community. I know what works and what doesn’t for this market. And that has borne out on our Tik Toks and podcasts. We’re not even selling the kit yet, we’re just building the hype and it’s working.” We’re also bullish on Juna because they’re serving a sorely underserved marstartuphealth.com 59

MEET THE HEALTH TRANSFORMERS ket. The number of young people in need of regular STI testing is staggering. There is a green field of positive health benefits – and profits – that are waiting to be realized by the company that can connect with young people and change the culture around proactive STI testing. Arian’s approach to this challenge is both market-tested (the at-home testing sector is booming) and also incredibly fresh (building a media brand around Gen Z sexual wellness is more art than science). Finally, we’re excited to back Arian and his team because the Juna app and STI testing are just the beginning of a much bigger health moonshot mission. Once they build the framework of a Gen Z lifestyle brand built around accessibility and convenience, it will be easy to scale to other areas of health. “If you want to prevent diseases, you have to start with convenience,” says Arian. “Getting people tested proactively isn’t something people want to do. But creating a lifestyle brand around that changes how people approach the problem.” That philosophy is true for a wide range of diseases and conditions, and we’re proud to back Arian as he helps lead that cultural shift. 4 JUNA@STARTUPHEALTH.COM

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BioticsAI Uses Machine Learning to Supercharge Prenatal Ultrasound Founders Robhy Bustami and Salman Khan are using AI to give an instant second opinion to ultrasound techs, offering a lifeline to overworked OB/GYNs.

For expectant moms, the prenatal ultrasound is a rite of passage. During the first trimester, it’s the ultrasound tech who first identifies a heartbeat and prints out the inscrutable scans to be shared far and wide as proof of what is to come. In the second trimester, things get even more real with the highly anticipated 20-week ultrasound. This scan paints a fuller picture of the baby’s health and overall status. This is also when healthcare providers are able to detect the vast majority (about 90%) of fetal abnormalities. So far so good. The problem is that there is a critical shortage of the Obstetric and Gynecological physicians (OB/ GYNs) needed to interpret these sec-

HEALTH TRANSFORMERS Robhy Bustami, CEO & Co-founder Salman Khan, COO & Co-founder bioticsai@startuphealth.com

WOMEN'S HEALTH MOONSHOT VINTAGE: 2021/Q3 BIOTICS.AI

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Salman Khan, COO & Co-founder

ond-trimester scans. The American Congress of Obstetricians and Gynecologists puts the shortage at roughly 9,000 OB/ GYNs in the United States. More than half of the counties in the US don’t have a single Obstetrician. In many countries around the globe, it’s much, much worse. That means that expectant mothers in these regions have to either drive hours away for care or work with a local ultrasound tech and arrange a long-distance consult. These kinds of arrangements are often still conducted with photocopies and fax machines. The result is wasted time, money, and sometimes critical errors of judgment. The OB/GYN shortage is only getting worse. It’s projected that the US will have a deficit of 22,000 by 2050 due to an aging workforce and a vicious cycle of long hours and an overabundance of malpractice suits. According to a recent Medscape report, 85% of OB/GYNs will be sued during their career, with most getting sued multiple times. As if the picture 62 StartUp Health Magazine / Issue 7

wasn’t dim enough, add on new reporting requirements each year and you end up with exhausted clinicians who get less and less time with their patients, which is the whole reason they got into the practice in the first place. Into this gap steps BioticsAI, a startup using artificial intelligence to improve how we read second trimester ultrasounds while smoothing out compliance workflows and giving precious time back to physicians. origin story

Robhy Bustami was sitting in a common room at a community college in Oakland, California when Salman Khan sidled up, looking every bit the West Coast native in short shorts and a “Save the Rainforests” tshirt. Bustami had just moved to San Francisco from the United Arab Emirates and knew no one, so he showed up at an event sponsored by the school’s Muslim Students Association. “I remember this like it was yesterday,”

says Khan, flashing a wide grin. “Robhy was this 17-year-old kid fresh off the plane from Abu Dhabi. We sat down next to each other and started talking. We’ve been best friends ever since.” Bustami’s studies took him through computer science into computer vision where he focused on object detection and augmented reality. After graduating he worked at IBM Watson. Khan dreamed of becoming a lawyer or politician, but then post-grad jobs at Oracle and Kaiser changed his mind and set him on the road towards tech and business. It wasn’t long before both men were bitten by the bug of the nearby Silicon Valley startup scene. “We really wanted to tackle major issues that were personal to all of us,” says Bustami. That’s when something important happened: they realized they were both carrying around a similar story about our broken healthcare system. Stories about anxious parents, misdiagnosis, and fatal consequences for children. Salman Khan was born in Karachi, Pakistan, and as early as he can remember, he was told how his elder sister had died because of a misdiagnosis at the age of one. Bustami was a grown-up when he watched a misdiagnosis play out with his childhood best friend who was expecting a baby. When the friend and his wife went in for initial ultrasound scans, the ultrasound tech incorrectly informed the parents that their unborn child had serious health defects — abnormalities of the heart and brain. Later, the obstetrician found that the tech was wrong and that the baby was fine. But emotionally, a lot of damage had

been done. The stress on the mother led to increased high blood pressure which in turn led to further complications and premature birth. These might have remained mere stories, related tales of medical misdiagnosis, had Bustami and Khan not met Dr. Hisham Elgammal, a professor of Maternal Fetal Medicine. Teaming up with his brother, Hamdy Elgammal, a data & machine learning engineer, Dr. Elgammal had done extensive research into AI-powered fetal diagnosis and published an award-winning paper on the topic. The Elgammal brothers opened up for Bustami and Khan the specific challenge of using technology to improve fetal ultrasound and through their machine learning research saw their vision for impact come into focus. under the hood

Once Bustami and Khan decided to create an AI platform for improving prenatal ultrasound they knew what they had to do first: Teach the machine. So they built a medical data and machine learning team and partnered with three health clinics. For almost three years, they fed more than a million second trimester ultrasound images into their machine learning algorithms so that they could recognize abnormalities and significant anatomical regions accurately. Once the two founders felt that their AI engine was robust enough to begin trials, they officially launched BioticsAI. While the back-end math is complex, the front-end concept is simple. BioticsAI integrates with the normal ultrasound process and uses artificial intelligence to automatically detect fetal abnormalities

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and flag them up for both techs and OB/ GYNs. The AI identifies individual scans to review but also highlights the specific region of the scan that is problematic. It’s an instant, automatic second opinion, another pair of eyes making sure you didn’t miss anything important. Research has shown that a second opinion reduces misdiagnosis by 77%. The platform also automates documentation and reporting, saving techs and physicians precious time. “We’re assisting doctors and techs, we’re not replacing them at all,” says Khan. “We’re also helping with documentation. Compliance is a huge issue. They have to take images of 20 different planes and store it in their PACS system.” That’s a labor-intensive process that can be largely automated, says Khan. BioticsAI’s early case studies have shown that they can reduce reporting time from around 15 minutes down to less than five minutes. BioticsAI integrates through a standard API with a hospital’s PACS system, which is the most common way that radiology images are stored in healthcare. why we're proud to invest

When we met Robhy Bustami and Salman Khan this quarter, there were a number of reasons why we were excited to back them. Right off the bat, we could see that in their partnership they had some of the critical ingredients for success. Their combination of experience at IBM Watson, Oracle, and Kaiser gives them a crosssectional view of the tech industry and how tools like AI and the cloud are being used at an enterprise level. Bustami brings 64 StartUp Health Magazine / Issue 7

a deep understanding of the core technology while Khan offers a range of business development skills honed while scaling Oracle’s cloud services division. All of that is layered on top of a true friendship that has stood the test of time, and which will bolster them when they hit setbacks. We’re also excited to back BioticsAI because the need is so pressing, and by all accounts, it’s getting worse. We’re facing a dramatic OB/GYN shortage and its reaching crisis levels in rural America and many parts of the globe. By giving these overworked and over-litigated physicians an automatic second opinion, we have the ability to not only improve care for moms but to improve the practice of physicians and reduce burnout. Tools like BioticsAI have the ability to create a more inviting atmosphere for would-be OB/GYNs and potentially turn the physician shortage around. Finally, we’re bullish on BioticsAI because delivering more accurate prenatal ultrasounds is a health moonshot-sized global health issue. Bustami and Khan are starting in the United States, but with their family and friends in the Middle East, they’re quick to understand the global potential for their platform. After all, in parts of the world, prenatal ultrasound isn’t just hard to come by, it’s completely non-existent. A tech-enabled ultrasound solution like BioticsAI could one day extend the life-saving technology of advanced ultrasound to regions in desperate need of prenatal care, opening up critical access to care for millions.. 4 BIOTICSAI@STARTUPHEALTH.COM

MEET THE HEALTH TRANSFORMERS

Meet Medwise.ai, the AI-based Platform Providing Instant Answers to Your Clinical Questions Led by co-founders Dr. Keith Tsui (R) and Luis Ulloa this question-answering search tool is designed to help doctors and other medical professionals with clinical decision making at the point-of-care. ACCESS TO CARE MOONSHOT VINTAGE: 2021/Q3 MEDWISE.AI

HEALTH TRANSFORMERS Dr. Keith Tsui, CEO & Co-founder Luis Ulloa, CTO & Co-founder medwiseai@startuphealth.com

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MEET THE HEALTH TRANSFORMERS Imagine you’re at a doctor’s appointment and you notice your physician is Googling something. How do you feel? Are you worried, concerned, uncertain? All of the above? Rightfully so. The internet is filled with inaccurate information, so watching your doctor Googling a diagnosis can feel frightening. According to NewsGuard, a website committed to fighting misinformation in journalism, more than one in 10 medical news websites accessed by Americans include bad data, meaning that when a patient or a provider is seeking medical information, there’s a good chance it’s incorrect. A 2013 survey conducted by the Pew Research Center read that 72% of American adult internet users admitted they looked online for health information in the previous year, while 35% of American adults admitted to going online for the sole purpose of finding a medical diagnosis for themselves or a loved one. According to Dr. Keith Tsui, CEO & co-founder of Medwise.ai, Google provides a lot of patient-oriented information because a majority of users trying to access medical information are patients. Research shows that more than 70% of physicians use Google at least once daily for professional purposes. This means that if a physician is looking to Google for medical information, which many doctors around the world rely heavily upon, they won’t be accessing the latest, most accurate medical information effectively. Even further, if a physician does find

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the right page in search, they have to actually locate the right solution, which is completely ineffective and can cost valuable time. “This problem is going to increase exponentially,” says Dr. Tsui. “The amount of research and innovation right now is great. But, clinicians just can’t keep up. Fifty years ago, there were probably one — maybe two — drugs to treat diabetes, now the list is endless. We really need a smart tool to support the healthcare workforce so that patients get the best care possible.” That’s changing, thanks to Dr. Tsui and his team at Medwise.ai. They’ve combined information retrieval technologies with the latest transformer-based neural networks to allow physicians to find the clinical answers they need instantly at the point of care. origin story

When Keith began practicing medicine in Hong Kong, he worked 36 hours shifts. In the middle of the night at 2 am, he’d have to search for information to find what’s the best way to manage patients. On one hand, Dr. Tsui had an old, beat-up booklet filled with approaches written by his seniors that he could refer to during his shifts. And on the other hand, he had Dr. Google. However, Google is not the best tool for clinicians working under pressure and is time-poor. Google results are organized by clicks and search volumes, and may not bring up the most up-to-date, accurate, and relevant information. Visible use of Google during consultation can also worry patients, and instill a lack of

Keith and Luis are on a health moonshot mission to improve the quality of care for every patient, no matter where they are in the world. The team has partnered with an NGO to pilot their solution in Africa and other places outside of the UK and US to provide these healthcare professionals with immediate access to up-to-date medical information on best practice care pathways and protocols.

confidence in their doctor’s knowledge and decision-making. “I started to question myself,” Dr. Tsui says. “Is this information really up to date?” “Is this information evidencebased?” “Is this the best practice that I can provide to my patients?” That self-doubt was the exact spark that led Dr. Tsui on a moonshot mission to solve one of the healthcare industry’s most common problems: access to accurate and relevant medical information. In 2019, he teamed up with original co-founder Dr. Daniel Duma and got to work. Now, two years later, Luis Ulloa joined the company as CTO and co-founder and began leading the tech teams at Medwise.ai. Luis is an entrepreneur with extensive experience working on AI’s hardest challenges. He previously co-founded Bloomsbury AI, which was acquired by Facebook AI in 2018. And for the past 10 years, he has been leading applied research and development teams, pushing the limits of the state of the art. Medwise was well on its way to putting Dr. Google into retirement, where it belongs. “We realized that there was so much opportunity to really bring technology into healthcare and how that would re-

ally make the lives of clinicians and healthcare professionals much better, allowing them to really focus on what matters most — delivering compassionate care to patients.” Enter Medwise.ai. under the hood

Medwise.ai is simple. It’s a questionanswering search platform that supports healthcare professionals at the point of care by quickly finding and curating the latest, accurate, and most importantly, most relevant medical information to provide the best care for patients. The best part? It’s 100% free for end-users. Here’s how it works. Doctors and organizations can simply go to the Medwise.ai website and type a keyword or question into the query bar. Using the latest artificial intelligence and natural language processing technology, Medwise.ai searches its entire library of curated trusted sources, like the NICE Clinical Knowledge Summaries and other professional knowledge bases, which are all vetted by clinicians. The algorithm then selects the most appropriate sentences or keywords from those sources to provide an answer to a question within seconds. startuphealth.com 67

“This is significantly more advanced than Google which will likely point you to the right website, but will still require navigation and reading of the site or page to find the required information.” Dr. Tsui says. “Our AI actually goes through that information and gives healthcare professionals a correct and specific answer. ” Using transformer-based neural network technology, Medwise.ai can classify almost any query, breaking down what the implied search or inputted keywords actually means. It provides answers to almost any question and aggregates the most commonly asked questions for even quicker reference to trending topics. In addition to the existing web browser format, the platform has a desktop app so that any information that clinicians may need is only a click away. “We will be developing a mobile app version of this as well in the near future. We want clinicians from anywhere in the world to have access to the platform,” Dr. Tsui says. why we’re proud to invest

Like many great health innovations, Medwise.ai was born from personal experience and a desire to put the patient back at the center of care. Dr. Keith Tsui has dedicated his career to solving a problem that he personally encountered as a practicing physician — the difficulty in finding actionable and concise evidence-based answers at the point of care. One reason we’re excited about backing the team at Medwise.ai is that there

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is endless opportunity. Medical information is constantly being updated and revised, but accessing it is laborious. Medwise.ai is leveraging the best technology to drive that process and help doctors and physicians gain access to accurate medical data from anywhere in the world. We’re also backing Medwise.ai because Keith and Luis are on a health moonshot mission to improve the quality of care for every patient, no matter where they are in the world. The team has partnered with an NGO to pilot their solution in Africa and other places outside of the UK and US to provide these healthcare professionals with immediate access to up-to-date medical information on best practice care pathways and protocols. “The greatest impact Medwise could have is in developing worlds,” Dr. Tsui says. “With the local resource constraints and high population-low clinician ratio, a tool like Medwise can really support those healthcare professionals and improve the lives of millions of patients across the world.” 4 MEDWISEAI@STARTUPHEALTH.COM

Ready to Transform Health With Us?

StartUp Health’s investment platform fuels health moonshots To the Health Transformers of the World: We created StartUp Health to help you, the entrepreneur, thrive, scale and ultimately achieve health moonshots. StartUp Health is investing in a global army of Health Transformers to achieve 12 Health Moonshots. Since 2011, we have invested in over 380 innovative health companies, and we’re just getting started. Entrepreneurs, learn how to apply to StartUp Health at startuphealth.com/gettingstarted Investors, learn how you can back a diverse portfolio of private health innovation companies at healthmoonshots.com

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Amwell Acquires Conversa Health Conversa Health, a virtual care platform first backed by StartUp Health in 2014, announced in July that it was acquired by Amwell, a national telehealth leader (NYSE: AMWL). The deal, which also includes the purchase of SilverCloud Health, was priced at approximately $320M.

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Eight years ago, West Shell III and Phil Marshall, MD, MPH, founded Conversa with the vision of improving health outcomes and lowering costs by improving communication between patients and providers between visits. They built a platform that used automated, text-based chat to check in on patients, nudge them towards healthy choices, and escalate their care when necessary. That health moonshot vision, which StartUp Health first backed in 2014, is poised for rapid expansion thanks to the announcement that Amwell, a publicly traded leader in telehealth (NYSE: AMWL), has agreed to acquire Conversa Health. The deal, which includes the acquisition of SilverCloud,

a provider of digital cognitive behavioral health programs, has an aggregate purchase price of approximately $320 million. “Conversa Health pioneered automated virtual care to transform traditional care delivery and dramatically improve patient access, experience, and outcomes while lowering cost,” said Murray Brozinsky, CEO of Conversa. “We’re thrilled to join forces with Amwell, the clear telehealth platform leader, and together to usher in the hybrid care delivery model of the future.” According to the official announcement, the acquisition will allow Amwell to “leverage Conversa Health’s proprietary patient profiling and health signals engine and library of evidence-based digital pathways to advance initiatives aimed at longitudinal care, clinical quality, and population health.” In addition, Conversa Health’s automated patient outreach and engagement tools will help Amwell improve care coordination, cost management, patient experience, and outcomes. This news comes after an intense 18-month period of hard decisions and growth for Conversa Health. When COVID hit in early 2020, it was a shock to the entire health innovation ecosystem. “The big scary thing is we immediately ran out of beds,” recalled Brozinsky. “We ran out of ventilators. You can manufacture more ventilators; beds are harder. But it’s the people that are the problem. We’re going to have a shortage of nurses and primary-care physicians. That’s where we came in on the virtual side: How can you do a better job of keeping those people out who can be kept out? How do you do selfcare?”

In the face of these challenges, the prevailing wisdom was for healthcare startups to cut employees and conserve cash. Conversa did the opposite — they hired more people and doubled down on addressing COVID challenges. As a result, Conversa saw significant growth in adoption and revenue. They acquired 30 new customers over that time, including enterprise agreements with some of the most influential healthcare organizations in the world. Conversa was named Best Remote Diagnostics Company by UCSF Digital Health Awards in September 2020. In 2021, Conversa was chosen as the #1 Healthcare AI Chatbot by CB Insights. They’ve been featured recently in the Wall Street Journal, Forbes, Beckers Hospital Review, and TechCrunch. In June, Conversa was named one of the top 50 fastest growing companies by The Silicon Review. At StartUp Health, the news that Conversa’s vision for virtual care is expanding is welcomed not only because it’s validation for a deserving portfolio company, but because it expands the capabilities of three visionary Health Transformers. “We’ve known West, Murray, and Phil more than two decades and it’s been an absolute thrill to be an investor and collaborator on their amazing journey with Conversa,” says Steven Krein, CEO and Managing Partner at StartUp Health. “We first backed them in 2014 not simply because we liked their vision, but because they had the health moonshot mindset necessary to transform healthcare in fundamental ways. Now, under the umbrella of Amwell, Conversa can help make hybrid care delivery models a reality.”

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meet the investors

Joe Kiani, CEO & Founder of Masimo, Backs Health Moonshots Joe Kiani built Masimo from an idea in a Mission Viejo garage to a global medical device powerhouse worth billions. Now, he’s investing back into the entrepreneurs shaping the future of health through StartUp Health’s Moonshot Impact Fund. We caught up with Kiani to learn a few high points about his investing philosophy and why Masimo backed StartUp Health.

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StartUp Health: Joe, you started your career as a health tech entrepreneur just like all of the Health Transformers in our portfolio. What did that early period teach you? Joe Kiani: There were many times when I thought we weren’t going to make it. I took out a $40,000 loan on my condo in order to start Masimo. It was hard to raise money. I was excluded from presenting at some of the major meetings because I didn’t have the right background or experience. I can remember times when I would stretch out on the ground in front

of my desk and just feel the earth and feel my own humanity. And then, after we did raise money and invent our technology, we still hit roadblocks. When I think about our story, it’s a story of persistence. When you know you have something that can help people, you just don’t give up. Ultimately we made it — bigger than I ever expected — but the first 15 years, if we’d stopped moving forward, we would have gone out of business. But we refused to give up. StartUp Health: How did your experience as a boots-on-theground entrepreneur impact how you currently invest?

to work the way you did when you were 24, so you need to find the new entrepreneurs who are putting everything they’ve got into it. They say that when you push a spaceship up into space, it burns half its fuel in the first few feet. That’s where we need to invest.

StartUp Health: As you know, StartUp Health has set out 12 strategic health moonshots, audacious goals around which we organize and support our portfolio companies. Is there I GOT INVOLVED a particular health moonshot mission WITH STARTUP that you’re passionate HEALTH BECAUSE about?

OF THE TEAM, AND BECAUSE OF THEIR TRACK RECORD.

Kiani: What I realized is that it’s important for successful companies to invest back into startups. If you look at why the San Francisco Bay area is home for so many startups, it isn’t the venture capitalists that makes the difference, it’s the successful entrepreneurs who keep going back in and investing. In Orange County, once people make it, they head off to Hawaii. Investing back into startups is the right thing to do. Also, it’s important to realize that success comes from desperation, and from perspiration. I worked for seven years only taking two four-day weekends. I’ve seen so many people make it and think it’s something special about them. Then they go try it again and they fail. By the time you’re at my level, you’re not going

Kiani: I’m passionate about the Children’s Health Moonshot. If you can help a child, you can help 80–100 years of life. I appreciate StartUp Health’s focus on Children’s Health because previously, since kids are only a small fraction of the total population getting sick, people haven’t developed many products for them. They end up using things that are designed for adults. They might not work right, or even be safe. So I’m excited that StartUp Health has this Children’s Health Moonshot, and it’s going to get more entrepreneurs to join in the mission. StartUp Health: Where are you seeing exciting opportunities in health tech today?

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Kiani: Telehealth is very interesting. COVID forced us to do a lot of things virtually. With medicine, in many ways, virtual care came out just as good, if not better, for patients. And that’s without all the tools that one day we will have. In terms of our virtual care toolkit, the world is going to change. The thermometer isn’t going to be the only tool at home to gauge your health. We’re going to have a lot of tools in homes to help us self-diagnose with the help of an online clinician. StartUp Health: Joe, Masimo could have invested their money anywhere. Why back the StartUp Health Moonshots Impact Fund? Kiani: I got involved with StartUp Health because of the team, and because of their track record. When I got involved, they had shown that this model not only helped the entrepreneurs move faster but was making StartUp Health successful as an investment vehicle. Plus, I thought it would be really cool to meet some of these entrepreneurial companies through StartUp Health. Before COVID, I met founders in person at the StartUp Health Festival, and today, my team is in regular contact with the StartUp Health Portfolio. It’s a win-win-win. StartUp Health: What’s a parting piece of advice for a StartUp Health founder innovating in health today? Kiani: You just can’t give up. If you have a good idea that’s going to really help people, and if it has a good business model,

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don’t give up. One thing I’m really proud of at Masimo is that I believe that if Masimo wasn’t here, some of the innovations that are now available around the world wouldn’t exist. It wasn’t like “if we don’t do it, someone else will.” We tackled the problem of making pulse oximeters accurate during motion when everyone else had given up on the problem. Our invention was truly unique and has saved babies’ eyesight, has helped detect congenital heart defects in newborns, and now helping people survive Opioid addiction. If what you’re doing is needed, and no one else is going to do it, that’s enough evidence that you should keep pushing. But even if you don’t have that answer, if you enjoy what you’re doing and think you can make a successful company, don’t give up either! In the end, you’ve got to use your gut. Your gut tells you things that the data may not. Finally, surround yourself with great people. It’s taken me years to have the kind of team I need so I can do justice to my company while also doing the other things I do. There was a time I was there for every step. Now I’m just there for the vision and strategy, sometimes the courage. My team executes. But I had to grow into those skills. If there was one positive side effect to Masimo not being an overnight success, it was that it allowed me to grow, to become the leader the company needed at different stages of development.

meet the investors

Lee Shapiro, Managing Partner at 7wireVentures, Backs StartUp Health Moonshots Impact Fund Lee Shapiro, an icon of digital health investing, has worn a few hats. In addition to heading up 7wireVentures, he served as President of Allscripts and stepped in as CFO of Livongo to lead its 2019 IPO. Now, Shapiro is backing a diverse portfolio of early-stage health founders through the StartUp Health Moonshot Impact Fund. We dialed him up to learn what makes a great health investment and find out why he’s backing StartUp Health now.

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StartUp Health: How did you first get into health innovation investing? Lee Shapiro: Glen Tullman and I have been investing together for more than 25 years. When we started, the idea was to use technology to fix broken business processes. We did that in several industries before we got to healthcare. Once we got to health, we realized there were enough things that were broken to last us a lifetime. It was a target-rich environment and it met our double bottom line of doing well while doing good. We thought we could really make a difference in health by working with passionate founders. StartUp Health: How would you describe your health investment focus? Shapiro: We focus on the hassles we all face as health consumers. None of us want to be a patient; we all want to be healthy. Our investment focus is on leveraging techenabled care delivery to address common health challenges, such as getting access to or managing care regardless of location, to empower Informed Connected Health Consumers. When we look for challenges to address at 7wire, we go through a process we call “hassle mapping” to break down the market challenges. For instance, we’ve looked at investing in wearables over the years, but we always start by asking, “What kind of problem is the product solving, and for whom?” Helping people run a little faster on the weekend isn’t as interesting to us as helping seniors live independently.

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StartUp Health: You’ve been investing in health for decades. Has your investment thesis evolved over time? Shapiro: Glen and I have been engaged in building many companies over the years. One was Allscripts, where Glen led the IPO and which started by addressing prescription adherence. However, as we listened to our provider clients, we learned that they were challenged with more than prescribing, so we began adding offerings to our solution set and found ourselves developing a stealth EMR. During this time we were embedded inside the medical practice and worked on everything from scheduling to prescribing to billing. We realized that if we’re ever going to really improve care, we need to understand the individual consumer and how the care received impacts them personally. For instance, two people might present with similar symptoms but respond to treatment in two very different ways. That means health information must flow seamlessly and inform care in nuanced ways. In terms of refining our thinking, we’ve gone from this broad brush of helping systems provide better care for individuals, to now investing in companies that give individuals more control. StartUp Health: You recently decided to back the StartUp Health Moonshots Impact Fund. Where does this fund fit into your thesis? Shapiro: The StartUp Health Moonshots Impact Fund is very much aligned with our investment thesis at 7wire. As a largely Series A investor, our greatest impact is in helping companies at early stages. While

we could have raised a big fund for later rounds, we think the real value is helping founders understand things like productmarket fit and how to meet the needs of customers. This approach allows us to use all the mistakes we’ve learned from over the years — our cumulative team’s experience — to help the founders we work with scale and grow. We spend a lot of time working directly with those teams and this hands-on approach is at the core of our investment approach. Part of the idea behind StartUp Health Moonshots Impact Fund is this notion of taking risks, of not being afraid to do something bold, and taking steps in something you believe in. We love founders who have personal stories and passions. When we founded Livongo, Glen Tullman was motivated by his relationship with his son, Sam, who had Type 1 diabetes. This personal connection was the source for the empathy that was infused in the business. The StartUp Health Moonshot Impact Fund does just that by finding great founders who have stories of impact. Every Sunday it’s so rewarding to get my email from StartUp Health about another company that we’ve collectively invested in, reading those stories, and understanding why someone is innovating in a particular area. Selfishly, it gives us at 7wire an early look at companies we might want to invest in later stages. We love the network that StartUp Health has connected us into, and how it is creating opportunities for further investment. StartUp Health: Has your personal experience motivated your investment focus?

Shapiro: One company we built through our Hatch model, which is when we build companies from the ground up, is called Homethrive. This company came out of the experiences I had with my own mother, when she was alive, dealing with all the activities of daily living. It wasn’t just about getting her to the doctor and making sure she took her medications. It was about what to do when there’s a leak in the basement, or when the refrigerator needs repair. Those are the types of issues that Homethrive is solving for family caregivers. StartUp Health: What advice would you give to today’s health innovators on how to thrive in a COVID and Post-COVID environment? Shapiro: It’s been said that culture eats strategy for lunch. It’s challenging to build culture in a remote environment. Many startups have remote teams which are great because people can work anywhere. It allows us to tap into different pools of resources, among other benefits. But you still need to have a common sense of purpose and mission. Why do your people get up each morning and want to build great things with your company? I would encourage founders today to spend a lot of time with their team members, talking about that common sense of purpose, telling user stories, sharing the good work that’s being done by their company, so you can draw like-minded spirits into the company. It’s really challenging to build out a team over Zoom, so you need to find ways to build off what got you passionate in the beginning. startuphealth.com 77

StartUp Health Insights | 2021 Q3 REPORT

With $30B+ Raised in Three Quarters, Global Health Innovation Funding Is on Pace for 100% YOY Growth

For the latest in health innovation funding go to startuphealth.com/insights-reports 78 StartUp Health Magazine / Issue 7

We tracked $9.7B in global health innovation funding this quarter, continuing the sector’s steep growth and setting 2021 up for a record-breaking year-end total.

78 Total Funding Year Over Year

84 Innovation Hubs (US)

81 Top Deals (US)

85 Innovation Hubs (Non-US)

82 Top Deals (Non-US)

86 Most Active Investors startuphealth.com 79

StartUp Health Insights | 2021 Q3 REPORT

In the third quarter of 2021, StartUp Health tracked $9.7B in health innovation funding globally, bringing the year’s total funding to just north of $30B, which is significantly higher than any previous full year on record. Those record-breaking numbers continue the sector’s multi-year

Global Health Innovation Funding Year Over Year Q1

More Health Innovation Funding in Q3 2021 than 2011-2013 Combined

$7.1B $5.4B

$2.1B

$2.3B

$2.8B

2011

2012

2013

2014

$6.1B

$8.

$6.

$4.9B

2015

201

Source: StartUp Health Insights | startuphealth.com/insights. Note: Report based on publicly available data through 6/30/21 on seed (incl. accelerator), venture, corporate vent

80 StartUp Health Magazine / Issue 7

.2B

growth trajectory and set health innovation funding on a course for 100% yearover-year growth. If you’re a regular reader of StartUp Health Insights, you’d be forgiven for having a bit of deja vu all over again. For a decade we’ve been tracking, and sharing,

our quarterly dossier on health innovation funding, and the theme has been consistent: aggressive growth. In fact, since 2013, the year-over-year growth in funding has averaged 26%. That growth appears to be accelerating. One year ago, in Q3 2020, our Insights

$31.3B 2021 On Track to Surpass 2019-2020 Combined

$21.9B $16.7B

$15.2B $11.8B

$14B $10.9B

$9.3B

.5B

2017

2018

2019

2020

2021 YTD

ture, and private equity funding only. Companies tracked in StartUp Health Insights may fall under multiple moonshots and therefore will be represented throughout the report.

startuphealth.com 81

StartUp Health Insights | 2021 Q3 REPORT Report published a then-record-high at StartUp Health we also believe in the $6.6B in funding. StartUp Health CEO, power of the upstarts and the innovators, co-founder, and managing partner Steven so we’d like to see the total deal count conKrein called it “a tipping point for health tinue to climb. innovation investing.” We closed out 2020 56% higher than 2019. This year, in historical perspective: what a just three-quarters, we’re already up 39% difference 10 years makes over the previous full year. If funding reFor more than a decade, StartUp Health mains at current levels, we’re likely to see has been tracking health innovation funda year-end total around ing data from every $40B. That would be corner of the globe and double what was raised sharing those trends WE CLOSED OUT in 2020. That’s mature, and insights with the 2020 56% HIGHER sustained, and increasworld. In 2011, we ing growth over more tracked $2.1B in fundTHAN 2019. THIS than a decade of data ing. We were excited YEAR, IN JUST collection. then about how more than two billion dolTHREE-QUARTERS, deal size continues to lars in funding could be WE’RE ALREADY UP grow leveraged to achieve au39% OVER THE PREFor yet another quardacious health moonter, the upward trajectoshots, but we also knew VIOUS FULL YEAR. ry of health innovation that digital health was funding is due to very still in its infancy, taklarge deals — a whole ing its first shaky baby new category of mega steps, and that the best deals over $100M. But as the deals have was yet to come. In 2014, we celebrated gotten bigger, the total number of deals four years of successive growth, declaring has remained relatively flat, resulting in in our Insights report that health innoa rapidly increasing median deal size. vation funding “continues to accelerate” We actually saw higher deal counts as far year over year. back as 2017 when the median deal size Looking back now at those first years of was about $14M. So far in 2021, we’ve funding reports, we were right about the tracked 738 deals, making the median trend, but the scale we couldn’t anticipate. deal size in health innovation globally Did we know that a few years later, in north of $41M. That’s nearly a 3x increase 2021, we’d track a year’s worth of funding in average deal size in just four years. ($1.1B in 2010) in just two deals (ComWhile the larger deal size is a bellwether mure and Olive)? Or that in 2021 we’d that health innovation is being taken track 738 deals in three quarters, a nearly more seriously, and is valued more highly, 4x increase in activity compared with all 82 StartUp Health Magazine / Issue 7

Top Health Innovation Deals (US) Company

Function

Commure

Patient Empowerment

$500M

Cityblock Health

Population Health

$400M

XtalPi

Research

$400M

Olive

Admin Workflow

$400M

Carbon Health

Population Health

$350M

Exo

Personalized Health

$220M

Reify Health

Research

$220M

WHOOP

Wellness

$200M

Mammoth Biosciences

Patient Empowerment

$195M

Spring Health

Patient Empowerment

$190M

of 2011? Over the course of our decade of reporting, we’ve shown a 17x increase in quarterly funding. In fact, the sector raised more in one quarter this year than 2011–2013 total funding combined. And this quarter we saw more raised than the annual totals as recently as 2016.

Amount Raised

top deals (us)

In a time when we can’t seem to go five minutes without hearing the word “infrastructure” we’re seeing a quarter dominated by investments in the “pipes and roads” of healthcare. In the past, our “top deals” list was skewed towards consumer products like wearables and fitness gear — think Fitbit, Peloton and ClassPass. This startuphealth.com 83

StartUp Health Insights | 2021 Q3 REPORT

Top Health Innovation Deals (Outside the US) Company

Country

Miaoshou Doctor

China

$232M

Deep Genomics

Canada

$180M

InferVision

China

$140M

Palta

$100M

Elvie

$97M

Oviva

Germany

$80M

HealthifyMe

India

$75M

YuLife

$70M

AIDoc

Israel

$66M

Doctor Anywhere

Singapore

$65M

quarter, while we did see one fitness wearable (WHOOP), the top six deals have to do with smoothing out the administrative side of healthcare, from ultrasound workflows (Exo) to speedier clinical trials (Reify Health). The largest investment of the quarter goes to interoperability software compa84 StartUp Health Magazine / Issue 7

Amount Raised

ny Commure, which raised half a billion dollars for its “FHIR-compliant development platform for health systems, vendors and startups.” With its API and data services, Commure represents an investment in an ecosystem of innovation, not just one point solution. A large health infrastructure deal also

came in for Olive ($400M), which brings cross-border innovation, greater interopenterprise AI to hospitals. They’re tackling erability, and opportunities for leapfrog issues like prior authorization, and now, progress. through acquisitions, they’re moving into This quarter our list of top deals outsurgical suite automation, and even into side the United States is topped by Miaobilling automation. XtalPi brought in shou Doctor out of Guangzhou, China. $400M for their AI drug discovery plat- Miaoshou Doctor is the latest healthcare form and Carbon Health raised $350M infrastructure investment from Chinese for re-imagining primary care. Leverag- powerhouse Tencent, and establishes the ing their tech platform, Carbon provides company as a catch-all ecommerce platits patients with “omform for everything nichannel care” across from prescriptions multiple access points, to doctor consults. IT IS OUR from in-person to teleCombined with InferBELIEF THAT TO medicine to employerVision’s $140M raise based care. (based in Beijing and ACHIEVE HEALTH number three on our MOONSHOTS, WE top deals (ous) list), this also solidifies For a decade, StartChina’s place back on HAVE TO THINK — Up Health has been the top deals leaderAND INNOVATE, AND dedicated to trackboard. ing and reporting on Also making the FUND — AS GLOBAL global health innovalist of mega deals outCITIZENS. tion funding, not just side the United States the activity within the is Deep Genomics, United States. Of the the Toronto-based companies in our Insights database that company that raised $180M to expand we’ve tracked deals on, 2,667 (70%) are their AI drug discovery platform. Then inside the United States and 1,121 (30%) there’s London-based Palta, which raised are outside the United States. StartUp $100M for their preventative health platHealth is one of the few companies that form that is helping folks live healthier track health innovation globally, and lives through diet and exercise. that’s been by design from the beginOne notable addition to this top deals ning. It is our belief that to achieve health list was the $97.5M raise by Londonmoonshots, we have to think — and in- based Elvie, a women’s health company novate, and fund — as global citizens. selling tech-enabled breast pumps and Health access is a global issue, not an pelvic floor exercisers. We’ve seen a few American issue. Bringing down the cost larger deals lately in the women’s health of care is a global issue, not a regional is- moonshot, but they’ve focused on fersue. And every year that goes by this real- tility or maternity, so Elvie represents ity becomes more evident as we see more a breakout in the category. After years startuphealth.com 85

StartUp Health Insights | 2021 Q3 REPORT

Hubs of Health Innovation (US) City/Region

Funds Raised

Q3 YTD Deals

San Francisco

$2.3B

New York City

$1.9B

Boston

$1.1B

Columbus

$405M

Baltimore

$272M

Austin

$242M

Denver

$195M

Seattle

$180M

Nashville

$175M

Los Angeles

$156M

of being massively underfunded, entrepreneurs and investors are thinking bigger, and more holistically about women’s health. But there is much more work to be done as we look to advance care in women’s health chronic conditions. Looking at both lists of top deals, inside and outside the United States, there’s one notable absence: direct telemedicine. Despite having the COVID-19 pandemic 86 StartUp Health Magazine / Issue 7

elevate the need for virtual doctor’s visits, this quarter, only two top deals covered what we’d categorize as traditional telemedicine, Doctor Anywhere and Carbon Health. This may suggest that the market is maturing beyond the reactionary phase of virtual care brought on by COVID and moving to a more integrated approach that weaves telemedicine into every aspect of healthcare.

Hubs of Health Innovation (OUS) City/Region

Funds Raised

Q3 YTD Deals

London

$494M

Toronto

$248M

Guangzhou

$232M

Tel Aviv Metro Area

$177M

Bengaluru

$141M

Beijing

$140M

Singapore

$140M

Zurich

$80M

Cambridge

$58M

Stockholm

$35M

innovation hubs

While San Francisco, New York City, and Boston continue to dominate both in dollars raised and in deals completed, there are a few notable entrants to the health innovation hubs lists, both in and outside the United States. Columbus, Ohio, punches above its weight this quarter, bringing in $405M in health innovation funding. That amount would place

it in the second position on our international list, behind only London. In fifth position, Baltimore bests the more obvious tech hubs of Austin, Denver, Seattle, and Los Angeles. With eight deals for the year so far, Los Angeles is the most active city for health innovation funding outside of the big three (San Francisco, New York, and Boston). Outside the United States, London has startuphealth.com 87

StartUp Health Insights | 2021 Q3 REPORT

2021 Investments YTD

2020 Total Investments

General Catalyst

Tiger Global

Oak HC/FT

Khosla Ventures

Optum Ventures

F-Prime Capital

Andreessen Horowitz

Insight Partners

Polaris Partners

Investor

taken its place decisively at the top of our innovation hub list. In years past, London has been surpassed by the likes of Beijing and Tel Aviv, but with nearly half a billion raised, it’s firmly on top. With 16 deals completed for 2021 so far, it’s also the most active hub outside the United States by a long shot. With seven deals, Tel Aviv remains a very active center for health innovation as well.

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top investors

The names on our top investors list come as no surprise. What is newsworthy is that seven of the top 10 most active investors in health innovation have already surpassed their 2020 total numbers, and there’s still a whole quarter to go. General Catalyst, Tiger Global, and Oak have blown by their 2020 numbers, a sign that firms are growing considerably more bullish on digital health.

m&a

As we predicted earlier in the year, mergers and acquisitions are hot and getting hotter in health innovation. We’ve tracked 92 acquisitions in 2021 to-date, compared to 54 acquisitions as of our mid-year report. That Q3 spike continues what has been a major move towards consolidation as companies use large raises to build out end-to-end platform solutions. Notably from the StartUp Health portfolio, this July, Amwell announced that it would purchase Conversa Health, which StartUp Health first backed in 2014. The deal which rolled up the purchase of SilverCloud Health, was priced at approximately $320M. According to the official announcement, the acquisition will allow Amwell to “leverage Conversa Health’s proprietary patient profiling and health signals engine and library of evidence-based digital pathways to advance initiatives aimed at longitudinal care, clinical quality, and population health.” final word

the attention and investment it deserves. But — and we can’t stress this enough — we’re still just scratching the surface. We’re seeing first-mover innovations in the world’s richest economies. We need investments to scale the best ideas globally so that tech-enabled healthcare can help billions of people around the globe get the care they need. To do that, we can’t take our foot off the gas. We have to double down. We have to be relentless about supporting entrepreneurs, assessing and re-investing in the tools that are working, and putting patients at the center. We’ll be back in January with a full yearend Insights report, and each week you can find funding analysis on our blog at HealthTransformer.co. Join our health moonshot mission at StartUpHealth.com. This Insights Report was written and designed by Logan Plaster with research and analysis by Anne Dordai and Priya Reddy. Editing and data support by Jennifer Hankin, Nicole Kinsey, Tara Salamone, Lauren Schafer, India Edwards, and Juwan Belle.

For more than a decade StartUp Health has tracked health innovation funding around the globe as a way to understand and support the future of health. In 2010, we believed that digital health was massively underfunded and that the conditions were aligned for a technological revolution in health. By tracking nearly $10B in funding this quarter and being on pace for a $40B funding year, we’re finally seeing health innovation get startuphealth.com 89

HEALTH MOONSHOT SNAPSHOTS

Access to Care Cost to Zero Disease Prevention & Cures End Cancer Women’s Health Children’s Health Nutrition & Fitness 90 StartUp Health Magazine / Issue 7

Brain Health & Alzheimer’s Mental Health & Happiness Healthy Longevity & Aging Addiction & Opioid Crisis Pandemic Response startuphealth.com 91

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

Sheena Franklin CEO & Founder K'ept Health

PORTFOLIO SPOTLIGHT

Iyah Romm CEO & Co-founder Cityblock Health

Founded in 2017, Cityblock Health is a transformative, value-based healthcare provider for Medicaid and lowerincome Medicare beneficiaries. They partner with community-based organizations and health plans to deliver medical care, behavioral health, and social services virtually, in-home and in communitybased clinics. Modern technology is at the core of the model, with custom-built tools to support care team operations and member interactions. Cityblock currently serves 70k members across four metro areas and partners include EmblemHealth, BCBS of NC, and Tufts Health Plan. The company was named a 2021 CNBC Disruptor 50.

*Data as of September 30, 2021. Sample of portfolio company investments and may not be representative of larger portfolio.

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132

ACTIVE PORTFOLIO COMPANIES

NOTABLE PORTFOLIO INVESTMENTS 2021

2020

2019 2018

(Acquired by Press Ganey) 2017

2015

2014

(Acquired by AmWell) 2013

(Acquired by Press Ganey)

(Acquired by Sharecare & Generali)

“StartUp Health is my home base as a founder. StartUp Health has provided exposure to investors and customer that I’d never have gotten on my own. They’ve given me support to accelerate faster and with more confidence.” -Troy Bannister CEO & Founder, Particle Health

startuphealth.com 93

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

Shameet Luhar CEO & Co-founder Vheda Health

PORTFOLIO SPOTLIGHT

Ed Park CEO & Co-founder Devoted Health

Devoted Health is on a mission to dramatically improve the health and wellbeing of older Americans by caring for each and every person like they are family. Devoted Health combines into a single, seamless service: a best-in-class Medicare Advantage insurance product; partnerships with leading providers; and Devoted Medical, the company’s own advanced virtual and in-home care provider. They currently serve ~40k seniors in five states, more than double from the first half of 2020. Devoted Health recently raised a $1.2B Series D, the largest private health tech financing deal in history.

*Data as of September 30, 2021. Sample of portfolio company investments and may not be representative of larger portfolio.

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ACTIVE PORTFOLIO COMPANIES

NOTABLE PORTFOLIO INVESTMENTS 2021

2020

2019

2018

2017

2015

2014

2013

“It’s powerful to have conversations with my fellow Health Transformer Circle members every month to make sure my thought process is heading in the right direction.” -Bill Nordmark CEO, Aver

startuphealth.com 95

Disease Prevention & Cures M Together we can rid the world of disease

Naheed Kurji CEO & Co-founder Cyclica

PORTFOLIO SPOTLIGHT

Lynda Brown-Ganzert CEO & Founder Curatio

Curatio develops private social health networks to connect and empower patients, increase adherence and improve outcomes using AI and peer support. They are the only global privacy and regulatory compliant social platform designed specifically for healthcare and is available in 15 languages and currently used in 102 countries. Their recently launched StrongerTogether app, in partnership with Cloud DX, is designed to support COVID-19 patients and long-haulers with their unique health needs and has 13 additional programs and communities including prostate cancer, joint replacement, stroke recovery, and pre-diabetes.

*Data as of September 30, 2021. Sample of portfolio company investments and may not be representative of larger portfolio.

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Moonshot

ACTIVE PORTFOLIO COMPANIES

NOTABLE PORTFOLIO INVESTMENTS 2019

2020

2018

2017

(Acquired by Labcorp) 2016

2014

2013

(Acquired by FamilyTreeDNA)

“We wouldn't be where we are today without the help of StartUp Health. They introduced us to our Series A investor and have made many intros to companies that became really important customers of ours, driving seven figures in revenue.” -Josh Stein Co-founder & President, Adheretech startuphealth.com 97

End Cancer Moonshot Together we can end cancer as we know it

Susan Bratton CEO & Founder Savor Health

PORTFOLIO SPOTLIGHT

Nikhil Pooviah, MD Co-founder Elly Health

For patients living with a chronic disease, including cancer, Elly is the world’s first empathetic audio companion. Elly helps motivate, educate, and support patients to live healthier lives through improved participation in their own health. Elly is purely digital (no reliance on human intervention or connected devices), encompasses condition-specific content (unlike only meditation and sleep), and has a high level of QA processes. Their Phase I clinical study in oncology showed that Elly achieved $9k per patient per year in predictive cost savings, user retention was 86% with user engagement of 2x per day, and Elly scored a 79 NPS.

*Data as of September 30, 2021. Sample of portfolio company investments and may not be representative of larger portfolio.

98 StartUp Health Magazine / Issue 7

ACTIVE PORTFOLIO COMPANIES

NOTABLE PORTFOLIO INVESTMENTS

2021

2020

2019

2018

2016

2014

“We were in the process of rolling out and preparing a launch of the world’s first blood-based, multi-cancer detection system. That launch brought us to a lot of questions, where StartUp Health was tremendously helpful.” -Jo Bhadki CEO & Founder, Quantgene 99 startuphealth.com 99

Women's Health Moonshot Together we can improve the health of every woman

Allison Kasirer CEO & Founder Robyn

PORTFOLIO SPOTLIGHT

Anish Sebastian CEO & Co-founder Babyscripts

Babyscripts is the most comprehensive and clinically validated maternity program to help manage expecting moms virtually, before and after birth. The Babyscripts technology is a combination of a smartphone app and internet-connected medical devices delivered via their “Mommy Kit,” which remotely monitors patients and allows providers to risk-stratify care, offering specific experiences to manage different risk conditions (e.g. diabetes, hypertension). Babyscripts works with more than 75 health systems in 32 states and the company is monitoring 250k women each year. Babyscripts has raised $26M to date.

*Data as of September 30, 2021. Sample of portfolio company investments and may not be representative of larger portfolio.

100 StartUp Health Magazine / Issue 7

ACTIVE PORTFOLIO COMPANIES

NOTABLE PORTFOLIO INVESTMENTS 2021

2020

2019

2015

2013

2018

“I thought dedicating a few hours a month to participate in Health Transformer Circles would be tough, but a year into it, it's something that I can't image functioning without. It's part of my mental health and wellness as an entrepreneur.” -Jill Angelo CEO & Founder, Gennev

101 startuphealth.com 101

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

Javier Evelyn CEO & Founder Alerje

PORTFOLIO SPOTLIGHT

Stephanie Canale, MD CEO & Co-founder Lactation Lab

For breastfeeding mothers who want to optimize their infants’ health, Lactation Lab provides testing kits that analyze breast milk to show exactly what nutrition their infant is getting, allowing mothers to recognize and replenish deficient nutrients. The test collects milk over a 24-hour period and comes in three different kits to measure different levels of nutritional information. Lactation Lab also offers a telehealth and online consulting service to provide additional guidance. In the last 2,000 samples tested, ~21% were low in at least one nutrient. In late Q4 they’ll be launching their at-home testing with channel partners including Salesforce, Disney, and Hulu.

*Data as of September 30, 2021. Sample of portfolio company investments and may not be representative of larger portfolio.

102 StartUp Health Magazine / Issue 7

ACTIVE PORTFOLIO COMPANIES

NOTABLE PORTFOLIO INVESTMENTS 2020

2019

2018

2017

2013

“We traveled from Australia to attend the StartUp Health Festival, and the minute we arrived we knew we were home with an amazing cohort of valuealigned entrepreneurs and stakeholders all solving big complex problems. The two days enabled us to establish global collaborative opportunities that will shape our company’s progress.” -Danny Hui CEO & Founder, sameview

103 startuphealth.com 103

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

Shireen Abdullah CEO & Founder Yumlish

PORTFOLIO SPOTLIGHT

Victor Penev CEO & Co-founder Edamam

Edamam organizes the world’s food knowledge and provides nutrition data services and value-added solutions to health, wellness, and food businesses. Using a proprietary semantic technology platform, it delivers real-time nutrition analysis and diet recommendations via APIs. Edamam has built the most extensive recipe database in the industry with 5M+ recipes and 800k individual foods, each tagged for 40+ diets and 130+ nutrients to address over 200 chronic conditions. Edamam’s partners and clients include Nestle, Amazon, Microsoft, The Food Network, The New York Times, and Barilla.

*Data as of September 30, 2021. Sample of portfolio company investments and may not be representative of larger portfolio.

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ACTIVE PORTFOLIO COMPANIES

NOTABLE PORTFOLIO INVESTMENTS 2021

2020

2019

2018

2017

2014

2016

2013

(Acquired by Zimmer Biomet)

“StartUp Health is such a credible resource for investors, entrepreneurs, and healthcare professionals. They’ve built a great culture, which is no small task. The team is authentic and passionate about what they do and it comes through in every encounter we have.” -Aubrey Jenkins President & Co-founder, inHealth 105 startuphealth.com 105

Brain Health & Alzheimer’s M Together we can unlock the mysteries of the brain to improve health and wellbeing

Sidney Collin CEO & Co-founder De Oro Devices

PORTFOLIO SPOTLIGHT

Renee Ryan CEO, Cala Health

Cala Health is on a mission to transform the standard of care for patients living with chronic diseases using noninvasive wearable neuromodulation therapies. Cala Health’s lead product, Cala Trio“, is the only non-invasive prescription therapy for essential tremor and is now available through a unique digital business model of direct to-patient solutions. New therapies are under development in neurology, cardiology, and psychiatry. In Q4 2020, the FDA granted Breakthrough Device Designation to Cala Trio“ for the treatment of action tremors in the hands of adults with Parkinson’s disease.

*Data as of September 30, 2021. Sample of portfolio company investments and may not be representative of larger portfolio.

106 StartUp Health Magazine / Issue 7

Moonshot

ACTIVE PORTFOLIO COMPANIES

NOTABLE PORTFOLIO INVESTMENTS 2020

2021

2017

2016

2014

“Pitching at the Health Transformer Showcase was a highlight for us this year. The opportunity to present our solution to an audience finely attuned to the digital therapeutics sector has been invaluable: the number of follow-up meetings that resulted from the event are a testament to that fact.” -Amir Bozorgzadeh CEO & Co-founder, Virtuleap

107 startuphealth.com 107

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

Thomas Tsang, MD CEO & Co-founder Valera Health

PORTFOLIO SPOTLIGHT

Raj Amin CEO & Co-founder Wise Therapeutics

Wise Therapeutics uses breakthrough neuroscientific research to improve mental health through casual, accessible mobile games. Their first product is an app called Personal Zen. With a decade’s worth of NIH-backed clinical R&D, Wise is the first to apply mobile gamebased cognitive training techniques to therapeutic areas such as anxiety, distress, and addiction. To date, they’ve published seven RCTs with 288 patients studied in published trials. Research collaborators and partners include NIH, NAMI, NYU Langone Health, and Soterix Medical.

*Data as of September 30, 2021. Sample of portfolio company investments and may not be representative of larger portfolio.

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Moonshot

ACTIVE PORTFOLIO COMPANIES

NOTABLE PORTFOLIO INVESTMENTS 2021

2020

2019

2018

2017

2014

2015

(Acquired by Dario Health)

“I want to thank StartUp Health for the 1,2 publicity punch that Help-Full received recently. About a dozen inquiries came in from investors, large healthcare payors, and health systems from the media coverage.” -Jenny Gallagher CEO & Co-founder, Help-Full

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Healthy Longevity & Aging M Together we can add 50 healthy years to every human life

Satish Movva CEO & Founder CarePredict

PORTFOLIO SPOTLIGHT

Bob Wise CEO Solius

SOLIUS uses advanced light science as a revolutionary way to treat and prevent disease by stimulating the production of hormones, such as vitamin D, which are critical for supporting human health. They’re currently developing their second product — an at-home device that will have the same level of efficacy as their commercial product, at a fraction of the size and cost. Trials show that their light science produces 10 times more vitamin D than the sun, but with 100 times less energy. SOLIUS has been awarded a Medical Device License by Health Canada and is currently operating in Canada, aiming for US FDA approval later this year.

*Data as of September 30, 2021. Sample of portfolio company investments and may not be representative of larger portfolio.

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Moonshot

ACTIVE PORTFOLIO COMPANIES

NOTABLE PORTFOLIO INVESTMENTS 2020

2021

2018

2017

2016

2015

2014

2013

(Acquired by Sharecare & Generali)

“Health Transformer Circles has been one of the most helpful experiences I’ve had as an entrepreneur. It’s a safe place to share some of our deepest emotions together — the joy of our companies and also the insecurities, fears, and uncertainties that need to be addressed.” -Beth Sanders CEO & Founder, LifeBio

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Addiction & Opioid Crisis Mo Together we can end addiction and the opioid epidemic

Rachel Trobman CEO & Founder Upside Health

PORTFOLIO SPOTLIGHT

Yusuf Sherwani, MD CEO & Co-founder Quit Genius

Quit Genius is the world’s first digital clinic for tobacco, alcohol, and opioid addictions. Their model allows employees and health plan members to access a proven treatment program 100% remotely. Quit Genius is the only digital addiction program validated in a randomized-controlled trial (RCT) and six peer-reviewed studies. Their academic partners include Imperial College London and Cambridge University. To date they’ve enrolled hundreds of thousands of participants across multiple geographies and industries and partners include NHS, Corning, and Yokohama. In July 2021, they raised a $64M Series B.

*Data as of September 30, 2021. Sample of portfolio company investments and may not be representative of larger portfolio.

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oonshot

ACTIVE PORTFOLIO COMPANIES

NOTABLE PORTFOLIO INVESTMENTS 2021

2020

2019

2018

2017

2013

“I’m proud to be part of the StartUp Health community of Health Transformers. There is so much to learn from other entrepreneurs and time is so limited. Every week someone will share their story, their learnings, and their struggles.” -Emilio Goldenhersch CSO & Co-founder, The Mind Company

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Pandemic Response Moonsho Together we can prevent, mitigate, and manage pandemics

Cristian Pascual CEO & Co-founder Mediktor

PORTFOLIO SPOTLIGHT

Kim Gandy, MD, MPH CEO & Founder Play-it Health

Play-it Health provides education and remote patient monitoring in a rich communication and incentive platform, achieving some of the highest engagement and adherence rates in the industry. They offer a comprehensive virtual care solution that allows one to move from tracking symptoms through spot checking vitals to continuous remote patient monitoring. Notable partners include Duke University Health System, University of Nebraska Medical Center and Universal Software Solutions. Additionally, in light of Covid-19, they’re working with with UC Merced to address vaccine hesitancy in the student body and surrounding community.

*Data as of September 30, 2021. Sample of portfolio company investments and may not be representative of larger portfolio.

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ACTIVE PORTFOLIO COMPANIES

NOTABLE PORTFOLIO INVESTMENTS 2021

2020

2019

2017

2018

(Acquired by AmWell) 2016

2014

2013

(Acquired by AmWell)

“The StartUp Health Festival probably saved us a year of networking. Being able to connect with industry leaders and influencers — everyone from a global CEO to the CIO of pharma company to a hospital system CEO to our peers who we can share intelligence with — was invaluable.” -Jonathan Dariyanani President & Founder, Cognotion

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In 1913, Susan La Flesche Picotte, one of the first Indigenous peoples to earn a medical degree, opened a selffunded hospital on her reservation that would care for all people, regardless of race or ethnicity.

"My office hours are any and all hours of the day and night." –Susan La Flesche Picotte

Dream Impossible At StartUp Health we help Health Transformers achieve health moonshots. Learn more at healthmoonshots.com 116 StartUp Health Magazine / Issue 7