StartUp Health Magazine_Issue 05 (2020) by StartUp Health

COLLEC T OR’S EDI T ION – 2020 STARTUP HEALT H FE ST IVAL DEFINING MOMENTS The stories behind the entrepreneurial spark

LEAPFROG TECH Bryan Mezue upgrades the African pharmacy

CONNECT THE DOTS Troy Bannister is making health data portable

JOIN THE MOVEMENT Connect today at startuphealth.com

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ISSUE 05

Th e

COLL ABORATION

Issu e

UNITING THE WORLD TO ACHIEVE HEALTH MOONSHOTS

“A moonshot challenge requires a clear, measurable objective that captures the imagination . . . and fundamentally changes how we view what’s possible. And it requires marshaling the resources and intellect of both the public and private sectors. When we do that, we chart a course for a future that is safer, healthier, and stronger.” - BILL GATES

Founders’ Letter

A New Model for Investing in Health Over the past decade, the Krein and Stoakes families, the StartUp Health team, our partners, and COLLABORATE a community of hundreds of INVEST Health Transformers have worked tirelessly, investing our financial 11 resources and entrepreneurial spirit into HEALTH what many believe is an impossible MOONSHOTS CONNECT dream: improving the health and wellUNITE being of everyone on the planet. Beginning in 2011, we started sharing our long-term plan with the world via this BROADCAST simple equation: Health Transformers x The Network Effect = The Transformation of Global Health We set out to build a global platform to invest in and unite thousands of Health Transformers – the world’s entrepreneurs dedicated to health moonshots – so together we could impact billions of people’s lives. It’s been both challenging and rewarding. There have been roadblocks and surprises at nearly every turn and every hill we climb reveals another valley with a higher peak just behind. Healthcare conglomerates move too slowly and innovation often equates to ‘marketing’ rather than leapfrog transformation. And so called risk takers and financiers – VCs and traditional investors – are incentivized by short-term returns more than investing on the time table required to achieving health moonshots. Legacy players may want change – just not too much nor too fast. You know you’re at a breakthrough when you’re totally exhausted, yet somehow more energized than ever

In spite of the challenges, we are more energized than ever. First, because of the way global tech platforms have matured over the past decade. Companies like Apple, Google, Microsoft, Amazon and Tencent have helped lay a critical foundation that empowers entrepreneurs to transform global health. Combine this with the democratization of access to technologies like artificial intelligence, machine learning and quantum computing, and we believe what’s next will far exceed the linear logic of most ‘industry experts.’ The second reason we are energized is because there is now broad agreement on global health goals. The UN’s Sustainable Development Goal #3 codifies evidence-based metrics for how global health needs to improve by 2030. These align perfectly with our 11 Health Moon-

shots like ending cancer, driving cost to zero and preventing disease. Thanks to organizations like the Bill and Melinda Gates Foundation, there is a financial will to see these global goals and health moonshots through to completion. Finally, we’re energized because we see the accelerating real world impact being made by our global army of Health Transformers. After investing in more than 500 entrepreneurs and 300 companies, our plan is no longer just an equation based on an idea. It’s a scalable platform and community we are proud of, and from which we can keep improving health for all.

With the right mindset, a moonshot vision and the spirit of an entrepreneur, anything is possible.

But goals and financial will are just the foundation. To solve the greatest health challenges of our time, we have to invest in health’s problem solvers. Thousands of them. Tens of thousands of them. These entrepreneurs understand the pain points at the ground level because that’s where they, and their families and friends, live every day. In the 1970s, the economist Muhammad Yunus began work on a concept that he believed could help break the cycle of poverty in his home country of Bangladesh. He created an unconventional bank that gave out small loans – lots of them, mostly to women – in order to augment the borrower’s earning power. The principles at play with micro-lending are, like so many great ideas, elegantly simple. Invest small amounts in everyday entrepreneurs at scale, add in contextual accountability, and the rising tide will lift all boats. By finding and investing in the entrepreneurs – even those at the earliest stages – we grow the world’s problem solvers. Invest in these people, and we invest in the future. These ideas improved financial mobility and ultimately changed the world. Vinod Khosla, founding CEO of Sun Microsystems and venture capital firm Khosla Ventures, called micro-lending “one of the most important economic phenomena since the advent of capitalism.” In 2006, Yunus was given the Nobel Peace Prize. The inspiring possibilities and lessons learned from the micro-finance revolution give us tremendous confidence that there is a leap forward opportunity with a model we call Health Moonshot Investing. Today, we have an opportunity to build on the legacy of Mohammad Yunus, investing in health’s most innovative entrepreneurs – an CONTINUED ON PAGE 4 4

Founder’s Letter

Our Vision 2011 –Today StartUp Health defined Health Moonshot Investing and built a scaleable platform to invest in a global army of entrepreneurs using a dynamic algorithm. We invested in 40-60 new companies each year year, and have invested in more than 300 companies from 25 countries, which have collectively raised $1.7B in capital.

2020-2029 StartUp Health is the partner of choice for every entrepreneur and investor globally who is working on health moonshots. The StartUp Health Collaboratory and 1% Pledge includes the most innovative companies and wealthiest families in the world. Health Moonshot Investing leads to entrepreneurs and organizations in StartUp Health collaborating to achieve the UN Sustainable Development Goal #3.

CONTINUED FROM PAGE 3

index of Health Transformers at scale – while also creating the networks, partnerships and accountability necessary to improve complex health systems. Health Moonshot Investing: An improved equation for a new decade

We realized early on that our initial plan would need to constantly evolve; it needed real world experience and feedback loops. So quarter after quarter and year after year – through brute force, ongoing experiments and non-stop recalibrations – we worked to continually improve our model and create a flywheel that accelerates growth. The result is a new model for transforming global health, and a new equation that includes critical variables for building momentum: Invest x Unite x Broadcast x Connect x Collaborate = The Transformation of Global Health What’s essential and novel about our Health Moonshot Investing model is it requires so much more than just investing capital. It requires several integrated steps of investing, and is driven by collaboration around health moonshots. StartUp Health’s platform is comprised of five key steps: Investing seed and growth capital in vetted health entrepreneurs at scale; investing in uniting the entrepreneurs into a coordinated global army; investing in broadcasting their stories of progress; investing in connecting them to a network of support and finally growing a “collaboratory” of long-term partners who care as much as we all do about

Steven Krein CEO, Co-founder & Managing Partner

2030-2040 Health Moonshot Investing and the StartUp Health Collaboratory leads to entrepreneurs and organizations in StartUp Health collaborating to achieve all 11 Health Moonshots and improving the health and wellbeing of everyone in the world.

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StartUp Health Magazine

achieving health moonshots. Each step in the StartUp Health flywheel strengthens the others: financial commitments from our collaboratory members provide ongoing access to capital for investing in more great entrepreneurs, which means more talented Health Transformers uniting to solve global health moonshots, which leads to more stories of progress thus inspiring more customers and investors to commit resources to the movement and so on and so on. Through Health Moonshot Investing, StartUp Health is changing the equation. We are still early in our plan, but we are investing in a generation of Health Transformers committed to achieving health moonshots. And now, we’re inviting the world’s leading organizations, governments and wealthiest families who care as much about impact as financial return, to join the movement too. We’re asking these organizations to commit to Health Moonshot Investing, so that we can support more entrepreneurs in more countries tackling more of the world’s biggest health challenges. We’ve created a platform to invest in hundreds – ultimately thousands – of transformative health entrepreneurs in order to improve health for all. We believe in the economic power of entrepreneurship, not just in the world’s biggest cities, but in every community and village on the globe. Investing in Health Transformers at scale, connecting the dots between the financiers and a global army of Health Transformers, is how we’re going to achieve what previous generations deemed impossible.

Unity Stoakes President, Co-founder & Managing Partner

Ready to Transform Health With Us?

StartUp Healthâ&#x20AC;&#x2122;s investment platform fuels your health moonshot 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 11 Health Moonshots. Since 2011, we have invested in over 300 innovative health companies, and weâ&#x20AC;&#x2122;re just getting started. Our plan is to invest whatever it takes to support thousands of entrepreneurs who are reinventing the future of health. Learn more at startuphealth.com 5

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Issue 5

StartUp Health Magazine

In This Issue

15 20

Founders’ Letter

StartUp Health Insights

Editor’s Letter

The 2019 Year End Report on

68 Features 68

Health Innovation Funding Takeoff 14

How it works: Oxitone 1000M

Healthy Habits: Wellness Tips from Wellness Pros

My Aha Moment

Cloudbreak, By the Numbers

Strategy: How Zeel Builds Partnerships

How to Disrupt Clinical Trials

Aidar Health on Pitching to Millions on Good Morning

America 22

Q&A: Conversa on Signal v. Noise

Innovation Hub: Lagos, Nigeria

Curatio’s Social Prescription

74 Wisdom 35

Charlotte Yeh, MD

Jerry Levin

Esther Dyson

Ashwini Zenooz, MD

Marty Makary, MD, MPH

No Time to Pause: Jill Angelo on Women’s Health in the Workplace Connecting the Dots: How Troy Bannister’s Particle Health Turned to Fintech to Improve Health Data Portability Current Therapy: How Cala Health is Amping Up Electrical Medicine

Index Masterclass 46

Scorecard 48

The Health Transformer Mindset 108

The Health Transformer Forums Worksheet

110

StartUp Health Portfolio Companies by Health Moonshot StartUp Health Portfolio Companies by Country The Big Idea: Start 2020 with goals that matter

Health Transformers 50 56

Welcome the recent additions to the StartUp Health Portfolio Meet the health innovators making waves

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

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Editor’s Letter

Making the Dream Work I’ll be honest, when we first set out to create “The Collaboration Issue,” my mind leapt to inspirational posters and stock photos. You know the type – the grinning, perfectly diverse group of suited executives. Who are giving a thumbs up to the camera. While jumping in the air. Collaboration has become jargon, a management buzzword. Which is why it is more critical now than ever to lean in and redefine our terms. Because collaboration isn’t just about open offices and slick new collaboration software (though each has its place). It’s about having the self awareness and humility to know where you need help. It’s about being bold enough to break down silos and go against conventional wisdom. It’s about having the empathy and kindness necessary to work with people across the political divide. It’s about having a health moonshot mindset and seeing the end goal as more critical than short term gain. At StartUp Health, we often use the original Moon landing as a metaphor for what we are achieving in health innovation. Neil Armstrong and Buzz Aldrin were the faces of the first Moon landing, but it’s estimated that 400,000 individuals and 20,000 companies collaborated to get them safely to the Moon and back. And those weren’t just aerospace companies. A tire company, a car company, even a bra company, found their way to contribute a necessary ingredient to the mission. That “together we can” spirit is the heartbeat of StartUp Health. We’ve brought together 500 inspiring health entrepreneurs – our army of Health Transformers – representing more than 300 companies from 25 countries. We’re linking them together by health moonshots, pushing them toward audacious goals. In some ways, it feels appropriate to tell the story of these collaborations in a print magazine. In this world of ephemeral Instagram stories and tweets, it’s nearly impossible to consume more than a single slice of a story. One small perspective. But a print magazine places the work of dozens of companies side by side, and is accomplished by a broad team of writers, editors, designers, illustrators and photographers. In a magazine, as in our community of Health Transformers, the sum is greater than its parts. We’ve packed this issue with examples of that collaborative spirit. Alison Harmelin, co-founder of Zeel, shares how the massage-on-demand company has made cross-industry partnerships a centerpiece of business development (story on page 18). In our new section “The Conversa-

t For our cover, we collaborated with artist Steven Wilson, known for his work with brands like Nike, Hermes and Coca-Cola.

tion,” Savonix CEO and founder Mylea Charvat, PhD, One for sits down with Gerald Lee, Chief Product Officer at the Team Sanguine Biosciences, to compare notes on how to best This past fall, we were disrupt the clinical trials market (story on page 20). proud to In our Wisdom section, both Startup Health receive an investor Esther Dyson (page 38) and Salesforce’s Excellence Ashwini Zenooz, MD (page 41) share thoughts in Reporton the power of building a culture and ecosystem ing award for StartUp of collaboration. Truly working as a team might Health not sound revolutionary, but according to Dyson, Magazine, at there are still many startups employing a divide HLTH’s Power and destroy mentality with their investors, board Press Gala. members and even their own teams. “A CEO needs to hire a team that can do most things better than she can,” she writes on page 39. “Her job is to help them learn and work together.” When you read this, it will be the year 2020. While in one way it’s just another year, it’s also a pivotal moment in time. Now is our chance to set the tone and intention for our next decade of work. Join with us in a spirit of entrepreneurial collaboration, so that together we can face the greatest health challenges of our time, achieve health moonshots, and improve the health and wellbeing of everyone in the world. And if we want to give a thumbs up to the camera and jump in the air while we do so, well, that’s just fine.

Logan Plaster Editor-in-Chief 9

The first five issues of StartUp Health Magazine laid the groundwork for our mission and vision.

PUBLISHERS

Unity Stoakes / Steven Krein The IC Breakers (my breakin’ crew from back in the day)

The ‘94 Chicago Bulls

EDITOR-IN-CHIEF

Logan Plaster

For The Collaboration Issue, we asked our team: Name the best dream team of all time.

DEPUTY EDITOR

Jennifer Hankin CONTRIBUTING EDITORS

Polina Hanin / Jeremy Lehrer

Issue 1: The Impossible Dream

John, Paul, George & Ringo

ASSOCIATE EDITOR

Nicole Kinsey

Buffy & the Scoobies

CONTRIBUTING WRITERS

Peter Appleby / Morgan Childs / Nicole Clark Anne Dordai / Jodi Lyons / Patrick McGuire Maxim Owen / Tara Salamone / Taiia Smart Young Michael Yockel Bangers & Mash

CONTRIBUTING DESIGNER

Sam Solomon

ILLUSTRATION

Issue 2: A Global Army for Good

George Nichols IV / Lauren Crow / Chris Philpot / Steven Wilson PHOTOGRAPHY

Joe Buglewicz / Niyi Fagbemi / Gavin Doremus Lauryn Ishak / Gregg Delman

STARTUP HEALTH Issue 3: The Health Moonshot Issue

Join the Movement Take the first step at startuphealth.com

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

ISSUE 04

access to care

Iyah Romm on Cityblock’s vision for preventive health

Steven Krein CEO, Co-founder & Managing Partner

Unity Stoakes President, Co-founder & Managing Partner

Bari Krein, JD, LLM Chief Strategy Officer

Howard Krein, MD, PhD Chief Medical Officer

Jennifer Hankin Chief of Staff

cost to zero

end cancer

Alex Jimenez-Ness is helping improve breast cancer detection women’s health Dorothee Goldman takes on endometriosis

brain health

Mylea Charvat, PhD, upgrades dementia screenings

nutrition & fitness

Navid Rastegar on staying healthy at work

mental health & happiness

Navya Singh, PsyD, opens new channels for employee health addiction

children’s health Michelle Vick brings the baby box tradition to the U.S.

Jim Iversen introduces the Opioid Crisis Working Group

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

THE HEALTH MOONSHOT BLUEPRINT

Q&A

startuphealth.com startuphealth.com $5.99 $5.99

Jon Weiner, CEO of HLTH

8 PRINCIPLES FOR ACHIEVING THE IMPOSSIBLE

1 26 199 6 2 0 7 20 9 19

Issue 4: The Health Moonshot Blueprint COLLEC T OR’S EDI T ION – 2020 STARTUP HEALT H FE ST IVAL DIFINING MOMENTS The stories behind the entreprenurial spark

LEAPFROG TECH Bryan Mezue upgrades the African pharmacy

CONNECT THE DOTS Troy Bannister is making health data portable

JOIN THE MOVEMENT Connect today at startuphealth.com

ISSUE 05

Katya Hancock Investor Network Director

startuphealth.com $5.99

COLL A BO R ATIO N

Rory & Lorelei

Polina Hanin Portfolio Director

Logan Plaster Media Director

Sara Whitfield Community Experiences Director

Lauren Doolan Ventures Operations Manager

Maxim Owen, CFA Ventures Manager

Nicole Clark Senior Writer

Max Weiss, JD, LLM Counsel

Piper Leonard Senior Controller

Anne Dordai Platform Manager

Nicole Kinsey Media Manager

Tara Salamone Media Lead

Ada Lovelace & Charles Babbage

Th e

Jerry Levin Executive Chairman

Troy Bannister democratizes personal health data

cure disease

Doug Adams miniaturizes disease intelligence

01012020

The “Fierce Five” (2012 U.S. Women’s Gymnastics Olympic Gold Medalists)

Is s u e

Andrew Isaacs, CA(SA) Ventures Advisor

Ken Aseme CFO Advisor

Hall & Oates

UNITING THE WORLD TO ACHIEVE HEALTH MOONSHOTS

Issue 5: The Collaboration Issue

Issue 5

StartUp Health Magazine is published by StartUp Health Holdings, Inc. Copyright 2020. All rights reserved. StartUp Health and Health Transformer are registered trademarks. Disclosure: StartUp Health is an investor in more than 300 companies, many of which are featured in StartUp Health Magazine. For a complete list of our active companies, visit the index which begins on page 84.

StartUp Health Magazine

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Now Powering 30% of the Top Hospitals in America 1

• Reduced Readmissions • Increased Same Day Discharge • Over 10% Annual Direct Cost Reduction (CV) • Heart Institute Financial Sustainability

1 US News & World Report: Best Hospitals 2019-2020

Learn more: biome.io 11

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

At Otsuka, our purpose is to defy limitation, so that others can too. We have an unwavering belief in going above and beyond— under any circumstances—for patients, families, providers, and each other. This deep-rooted dedication drives us to uncover answers to complex, underserved medical needs, so that patients can push past the limitations of their disease and achieve more than they thought was possible.

Let’s connect @OtsukaUS www.otsuka-us.com

Otsuka America 12 Issue 5 Pharmaceutical, StartUp HealthInc. Magazine Otsuka Pharmaceutical Development & Commercialization, Inc.

November 2019 01US19EUC0327

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

How It Works The Oxitone 1000M 14

The Conversation Disrupting clinical trials 20

Healthy Habits Wellness entrepreneurs 15

The Pitch Pitching Good Morning America 21

Aha! Moment Stories that change us 16 Infographic Cloudbreak by the numbers 17 Strategy Zeel on partnerships 18

Q&A Conversa’s Murray Brozinsky 22 Innovation Hub Lifestores in Lagos 24 Community Voices Curatio’s “Social Prescription” 28

Alison Harmelin, co-founder of Zeel, shares strategies for building strong cross-channel partnerships on page 18. 13

TAKEOFF

how it works

Oxitone 1000M Forget the bulky, fingerpinching alligator clip of yore. Leon Eisen, PhD and the team at the Israeli medtech company Oxitone have developed the world’s first FDA-cleared, hospital-grade pulse oximeter worn on the wrist like a smartwatch.

Oxitone’s adaptive optical configuration and AI support allows for readings that meet the accuracy requirements set out by the FDA. The device is also covered by five granted U.S. patents.

THIS WRIST-WORN CONTINUOUS PULSE OXIMETER BRINGS THE HOSPITAL INTO THE HOME

The company’s “digital continuous care model” continuously measures the wearer’s blood oxygen levels, giving both themselves and medical staff a detailed insight into the saturation of oxygen in the wearer’s blood – an important signal for potential medical conditions including sleep apnea, heart attack, heart failure and chronic obstructive pulmonary disease (COPD), among others.

PROPRIETARY TECH ENABLES READINGS FROM THE WRIST

Blood oxygen levels have traditionally been monitored from the fingertip because the anatomy allows for easy access to blood vessels. Light is bounced off of the blood in the finger and analyzed in a light detection unit. In order to make this same analysis possible on the far denser anatomy of the wrist, Oxitone had to use what are called back scattered light and forward scattered light measurement modes, supported by a unique flexible sensor which utilizes trans-illumination optical technology to copy and follow the topography of the wearer’s wrist.

TEXT BY PETER APPLEBY / PHOTO BY BRIAN HENN

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StartUp Health Magazine

A GROWING TARGET MARKET

The Oxitone 1000M was created to provide continuous supervision of patients with cardiopulmonary diseases at long-term and post-acute care facilities. COPD, for example, requires exactly this monitoring. Overnight screenings of patients can be carried out and assessed by health professionals to deliver personalized remote support via links to a telemedicine hub. Healthcare savings can be made in a number of ways. The mobile app itself offers patient education, care plan compliance scores and self-monitoring, while the real-time data collection and interpretation allows for early medical intervention when the patient’s health begins to decline.

healthy habits

Wellness Tips from Wellness Pros The journey of an entrepreneur is often filled with unexpected detours, hectic schedules and sleepless nights. Ironically, even the entrepreneurs dedicating their lives to improving health often struggle to take the time to nurture their own healthy habits, and in turn risk burning out. We asked three Health Transformers to share their wisdom for staying strong – physically and mentally – in the midst of the health startup grind. by Tara Salamone / Illustrations by George Nichols IV

Boundaries for exercise We know we need to exercise regularly – The American Heart Association suggests at least 150 minutes per week of moderate aerobic activity – but the rigors of startup life can be punishing. One key is to establish firm boundaries by communicating your health plans broadly. If I commit to exercising three days a week, I need to also set boundaries with my team, even my investors and clients, about when I’m available for calls. Then, in the words of a little shoe company out of Oregon, just do it. -Susan Bratton CEO & Founder, Savor Health

Read more about the companies mentioned in this issue at startuphealth. com/portfolio

Savor Health offers individualized and clinically proven personalized nutrition for cancer patients and their caregivers. The company’s proprietary system addresses the interrelated problems of chronic disease and nutrition through a virtual nutrition assistant named Ina.

Listen to your body Entrepreneurs move so fast that they forget to stop and listen to their own bodies. Try stopping for a few seconds at 5, 6, or 7pm, and honestly ask yourself, how does my head feel right now? Is it foggy or do I have plenty of energy? Think over what you’ve eaten, and how it is affecting your body and your emotions. Assess your true hunger level. According to the Mayo Clinic, learning to listen to cues from your body can be “one of the most powerful ways to manage your weight.” Good or bad, your body is telling a story. Listen to it! -Bentley Adams CEO & Founder, MealShare MealShare and its network of over 600 nutritionists are upending the 60-year culture of “diets” and bringing attention back to the way humans have eaten for thousands of years.

One step at a time As Health Transformers we are all in such a rush to get things done faster! Slow it down, and take the time to do things you enjoy. Spend time re-centering yourself, whether that means time with a loved one, going on a leisurely walk or simply getting the sleep your body so desperately needs. When was the last time you thought about what it is that fills your soul and re-energizes you? Whether it’s going to a concert, seeing a film or eating an amazing dinner, one thing is certain: Those emails will still be there when you get back. -Marina Borukhovich CEO & Founder, YourCoach YourCoach is a practice management solution designed to enable health and wellness coaches to holistically lead their clients, connecting mind, body and soul through behavior modification and outcomes-based accountability tools.

TAKEOFF

my aha! moment

Subtle Shifts & Massive Moves "

Every health moonshot begins with a single step, and every entrepreneurial journey begins with a story. We asked three founders to share a lightbulb moment.

Kevin Dedner

Kim Gandy, MD, PhD

Sas Ponnapalli

CEO & Co-founder, Henry Health

CEO & Founder, Play-it Health

CEO & Co-founder, Beam Health

“After I give presentations, I often get pulled aside by people who feel connected to our mission to bring mental health services to Black men. Even if they aren’t in our target demographic, they see themselves in what we are doing and ask, “What about me?” They ask about care for Black children, women and other people of color who experience stigma and bias in the healthcare system. I used to answer by saying, “We will expand one day.” But that answer wasn’t satisfactory. These questions caused us to reflect as a company. When we stepped back and thought more deeply about Black men, we were reminded that they are all part of families and communities that also need the support we provide. Our intention has always been to become a leader in providing culturally sensitive teletherapy. That started with Black men – and we will continue to center them in our work – but we have opened our community to welcome men and their families. We are providing both couples and adolescent therapy. This evolution dovetails with our emphasis on building a community that evokes a sense of belonging for members. We don’t just sell therapy – we invite members to join a wellness community that eliminates the barriers to accessing mental health services. It’s a subtle shift, but significant to the future of our business.”

“The initial ‘aha’ for Play-it Health came while I was practicing as a pediatric heart and transplant surgeon. In that field, we had a big problem. We could perform the Hail Mary of transplants, but still lose patients if they failed to follow their prescribed regimens. So we built a platform that made medication adherence easier and more enjoyable. Recently, I’ve had a secondary aha moment. We operate in a health system where incentives are often not aligned. Realizing the full implications of that has been eye-opening. It’s not just how good the idea is; there have to be market forces allowing it to thrive. I was recently in a meeting with more than 100 hospital CEOs. The room was asked how many hospitals had transitioned to value-based care. Only two raised their hands. The business models are there, but the forces needed to move the market at the highest levels are still developing. It’s a very tricky landscape and I’ve learned that this is an endurance sport. This validated the decision we made two years ago to not be dependent on value-based care. We decided to go after a strategy that would allow us to collect revenue on the front end while keeping our overall mission. I understand why it’s so hard; hospitals lose money when they transition to value-based care. But it will open up so much innovation when it happens.”

“Our health moonshot is to bring access to care across the entire population, reducing location as a barrier for high-quality care. I believe telemedicine is an absolutely essential way for us to do this. That conviction began at my first health startup, Plush Care, and has been confirmed again and again at Beam Health. One of our first customers was a truck driver who saw our ad while driving on a highway in rural Pennsylvania. He had a bad cough and wanted to talk to a doctor. He logged on and had a video visit with one of our providers. The doctor was concerned about the wheezing in his cough, and so he directed the driver to the nearest radiology practice for an X-ray. The radiologist sent the X-rays to the doctor on our platform, who called the truck driver for a follow-up video visit. He informed him that they’d found early signs of cancer in his chest. That trucker probably would not have seen a doctor otherwise. If we’re talking about increasing our life span, that kind of bridge between doctors and patients needs to be established.”

Henry Health is a Washington, DC–based teletherapy platform that specializes in providing culturally relevant mental health care to black men and their families.

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StartUp Health Magazine

Play-it Health’s SaaS platform is designed to help clinicians and patients improve medical adherence through increased engagement and remote patient monitoring.

Beam Health is a pay-as-you-scale telemedicine platform that is 100% free for providers and lets patients speak with a physician whenever and wherever they are.

by the numbers

Found in Translation

6 Find out more about Health Transformers like Jamey Edwards online. 6 startuphealth.com

When serial entrepreneur Jamey Edwards teamed up with Andy Panos in 2008 to form what would " eventually become Cloudbreak, hospitals weren’t quite ready to bring a physician to the bedside via video feed. “It was thought of as medicine from the Jetsons,” says Edwards, who is now the company’s CEO. So the company focused its platform on improving care through language services, including an emphasis on live sign language interpretation. Now, with 1,000 hospital partners – and the requisite hardware in place – the company is rolling out comprehensive telemedicine services. ILLUSTRATIONS BY CHRIS PHILPOT

63,000,000 Number of minutes interpreted by Cloudbreak to date

1,000 Hospitals and health systems that rely on Cloudbreak for telemedicine and language access needs

Number of Cloudbreak language centers in the United States

85K Telemedicine encounters per month on the Cloudbreak system

Languages spoken by Cloudbreak’s most multilingual interpreter

450

Unique languages and dialects Cloudbreak has interpreted

TOP 10 LANGUAGES Spanish Arabic ASL Mandarin Somali Vietnamese Russian Nepali Korean Burmese

TAKEOFF

strategy

Six Rules for Building Partnerships How Zeel co-founder Alison Harmelin leverages strategic partnerships to tackle a broad and expanding market. A cursory glance at the leviathan healthcare industry quickly reveals a near universal truth: it’s all about gatekeepers. For better or worse, access to patients is guarded by any number of different interests – payors, providers, employers – many of whom are equal in size and immutability to the mythological counterparts the word ‘gatekeeper’ harkens to. Success in healthcare is largely inconceivable without developing relationships, and then partnerships, with these groups. Zeel – the company that made ordering an in-home (or in-office) massage as easy as calling an Uber – is almost totally unique in this respect. Most early-stage digital health companies are focused on a narrow vertical – e.g., selling a specialty- or function-specific software to insurance companies. Zeel occupies a rare space in the health and wellness ecosystem in that the circles of its Venn diagram cover everything from payors to consumers to large employers, sports teams, hotels and spas. Its work spans more than 95 cities and 2,000 corporate partners including Facebook, Pfizer, Zappos and Park Hyatt Chicago. That’s a lot of different gatekeepers to keep in mind. I had the chance to sit down with Zeel co-founder Alison Harmelin, who started the company in 2012 with Samer Hamadeh and Ed Shen, to gather six tips for making partnerships successful. by Maxim Owen

Issue 5

StartUp Health Magazine

1. Keep a health moonshot statement as your unifying principle Looking across the various Zeel verticals, you could be forgiven for wondering what insurance has to do with professional athletes. The answer is that Zeel is about “meeting people wherever they are,” be that in physical therapy at a hospital, or in the locker room of a professional sports team. Having a unifying principle helps to think through what your partnership landscape looks like and how it all ties together. 2. Partner with people who reflect your core values Zeel’s brand ambassadors include leading public figures such as Venus Williams (who is also a board member and advisor) and Cindy Crawford. In thinking about how to select these individuals, Alison – who spearheads brand strategy – sought people “who embody wellness in every way.” This requires research and diligence to learn about your partner’s values. The same principle applies to corporate partners. In partnering with Four Seasons and Hyatt, the lens shifts to another Zeel tenet: exceptional customer service. Your partners reflect you and will have a huge impact on who you’re able to partner with next. 3. Prioritize opportunities by ROI Obvious yet easy to forget in the age of abundant investment capital: partnership opportunities must absolutely be filtered and prioritized by ROI. Keeping a lean mentality within the organization is crucial, as it prevents the pursuit of low marginal benefit opportunities. This speaks to the methodical way in which Zeel has expanded from direct-to-consumer, to employers and now to insurance companies. PHOTO BY GREGG DELMAN

4. Customers are your biz dev team Zeel’s sports business was born when company leadership started noticing athletes appearing in their customer management software. Zeel’s hotel business was partially born out of serving a very happy hotel group CEO on the consumer side. The lessons here are three-fold. Deliver an exceptional product experience to your customers. Engage them and leverage their own networks. Be nimble enough internally to seize on the embers of an emerging partnership opportunity when it presents itself – you might have your next vertical on your hands. 5. Have a playbook for new markets Whenever Zeel enters a new market, whether it’s a new city or a new vertical, it has a playbook. Partner with local therapists and build the network. Then, flip the switch. Identify what type of stakeholder is critical to your success in a market and be methodical about how you approach and partner with them when the time comes to expand geographically. 6. Don’t forget inwardlooking partnerships We usually conceive of partnerships as outward-facing, as external ‘business development.’ Zeel also pays attention to ‘inward-facing’ partnerships that benefit internal stakeholders. Learning that many massage therapists struggle to find cost-effective health insurance, the company partnered with Stride Health, a benefits platform for gig and independent workers, to bridge the insurance gap for their 11,000 massage therapists. Taking the time to look inwards and making sure the lifeblood of your business is cared for is an extremely valuable exercise.

The multi-channel, cross-platform, bicoastal, ever-expanding world of Zeel

95 CITIES

2,000+ CORPORATE PARTNERS

11,000 MASSAGE THERAPISTS

CORPORATE PARTNERS INCLUDE: Facebook, Pfizer, Zappos, Hyatt, Four Seasons BRAND AMBASSADORS INCLUDE: Venus Williams Cindy Crawford

Read more about Zeel at startuphealth.com/portfolio

TAKEOFF

the conversation

How To Disrupt Clinical Trials There are more than 318,000 healthcare apps available for download, and new health startups are born every day, yet the supportive rigor of clinical trials hasn’t kept pace. A recent study by Nature Digital Medicine suggested that among apps clinically relevant for depression, only 2.6 percent provided evidence to substantiate their claims of efficacy. That isn’t too shocking, given the high logistical hurdles and decades-long time frames traditionally associated with such research. What does it look like to disrupt the clinical trial industry so that health innovations are validated more quickly and effectively? We asked Mylea Charvat, PhD, who has recently launched a landmark Alzheimer’s study with Boston University School of Public Health that will be conducted entirely over connected devices, and Gerald Lee, who is democratizing research through a platform some call the “Uber for clinical trials” that has taken part in more than 500 research projects. "

MYLEA CHARVAT, PHD CEO and founder of Savonix, an evidence-based, mobile-first, dementia assessment tool.

GERALD LEE Chief product officer at Sanguine, an online platform that allows patients to easily take part in clinical trials from their homes.

I got into research for many of the same reasons others do. To help people. But in clinical trials, I found that the majority of our medical knowledge is based on very small samples that are not representative of the population affected by the disease being studied. For example, the majority of Alzheimer’s studies are done on men, but the disease disproportionately affects women. Our samples need to be bigger and more diverse, and our methodologies need to be much faster.

We recently launched ASSIST, a study looking at lifestyle factors impacting the development of Alzheimer’s for 400,000 participants. This will likely be the largest such study in history, and getting those patient enrollment numbers won’t be easy. It comes down to having the right partners — in our case, Boston University School of Public Health. If we had said we were going to do this five years ago, people would have laughed. But now there is a sense that by using digital solutions, we can get these results much faster. Gerald, I love that you mentioned doing these studies from home. With our trial, it just takes a smart device.

A lot of people come into health technology on the “move fast and break things” mantra, but medicine is “move slow and prove things”. Because when you don’t, people can die. It takes time to publish papers and prove things out. There are things you can do to accelerate – you can write your papers faster – but as my CTO says, “nine women can’t have a baby in one month.” Some things just take time. 20

Issue 5

StartUp Health Magazine

Why does the clinical trials market need disrupting?

How do you tackle the problem of increasing sample sizes?

How much can tech speed up the process?

I see the same problems. I also see a barrier to access through basic transportation. I had a patient who had to drive two to three hours for a trial at Stanford. It was tough. He was a younger man and was an advocate for the condition, but he didn’t come as often as he wanted. That negatively affected the patient and the research. At Sanguine, we’re widening that access. We want someone in California’s Central Valley to have the same opportunity to participate in research as someone in Los Angeles.

I couldn’t agree more that it’s all about the right partners. It’s also about building up a coherent retention plan, and building your relationship with community members. You can do a lot of digital marketing, but that community isn’t a big number. You have to build credibility within that community. Go to events. Meet people. Understand the pain points for your patient population. We’re playing the long game.

We work with big pharma, and in that sector, there’s a high barrier to entry. If you’re going to run a trial with one of these big companies, there are going to be high expectations. Expect a 400-page audit about things like privacy policies. This isn’t something that can be built in three months. It takes expertise to gain the trust of these big pharmaceutical companies.

What I Learned Pitching to Millions on ABC’s Good Morning America " Entrepreneurs in health innovation often labor in narrow niches, honing their message to resonate with targeted patient populations. But every now and then, as Sathya Elumalai learned, the doors of the market are thrown wide open. Recently, Elumalai, the CEO and co-founder of Baltimore-based Aidar Health, was invited to pitch his company’s rapid home assessment device, the MouthLab, to five million viewers on Good Morning America (GMA). It was part of a Shark Tank segment, and Elumalai was given a mere 30 seconds to impress shark Daymond John and the world with his handheld device that can capture a broad range of vital signs from a single breath. We asked Elumalai what he learned from the whirlwind experience.

BONUS ROUND!

Advice for entrepreneurs who need to clinically validate their innovation

CHARVAT Surround yourself with people who have deep experience running trials. Or partner with an organization that exists to help startups validate their products

1. Time is Relative Even 30 seconds of visibility on one of the most highly-rated news channels can catapult your exposure in extraordinary ways. 2. Stories for the Win There is no better way to connect with people than through emotion. A true personal story always hits the mark, because in the end people buy ‘from’ people and ‘because’ of people. 3. No Hiding from the Camera The camera is more revealing than a mirror, so if you’re pitching on TV, be honest and genuine in your declarations.

like Gerald’s. Folding these people into your company will also bring foundations of academic ethics and credibility into the center of your business.

4. No Small Moments Looking back, I realize no opportunity we received as a company has been insignificant. It all built towards this crowning moment pitching on GMA. 5. This is Just the Beginning When the Shark Tank segment was over, Aidar Health didn’t win the prize. You won’t always win. Keep your eyes on the ultimate goal, because failure can be part of the beginning, but should never be your end.

LEE Have someone on your team who understands the regulations and how privacy laws work. If you’re expecting the typical quick-to-scale

entrepreneur story, this probably isn’t the right industry for you. A lot of it is proving out your product and running pilots. It can take years to build that credibility.

TAKEOFF

Q&A

Signal Through the Noise Conversa Health’s unique approach to the healthcare chatbot allows it to check in with patients in a structured, evidence-based way while leaving room for patient nuance. StartUp Health chatted with Murray Brozinsky, president of Conversa Health, about why it’s so important to separate the signal from the noise in health, and show some restraint in the use of new technology. interview by Logan Plaster

On “Patient Signals” Patient signals are the wisdom from a patient. When it comes to patient data we start with patient generated health data (PGHD) which historically has meant biometric data (think sensors, remote patient monitoring, wearables, etc). For us, biometric data is a subset of PGHD, which also includes patient-reported outcomes (PROs) and everything else you can ask a patient about (e.g. observations, symptoms, behaviors, social determinants of health). Patient signals adds a layer of context – of wisdom – to this data. Having a spike in blood pressure means something different if you’re on the couch eating a burrito verses having just finished a marathon. Patient signals is where we analyze the data and ask, “What is actionable?” Some of the patient data will be noise. Separating the signal from the noise is the sweet spot.

Issue 5

On Continuous Communication Imagine raising your kids and telling them, “We’re going to meet once a year for seven minutes, unless you have a problem, in which case you can schedule an appointment.” When you see your doctor episodically for some acute incident, they only get a snapshot of information and then send you on your way. To truly understand patients, you need to have continuous check-ins. That’s hard to do without having a two-way conversation. By engaging in these conversations continuously, patients and care teams are getting insights earlier so they can trend problems

StartUp Health Magazine

more effectively and intervene when necessary. Conversely, they know when patients are on track in their health journeys and don’t require unnecessary calls and visits that waste scarce resources. On Conversational AI Conversa is “purpose-built.” We asked ourselves: If we’re going to build a platform that could converse with a patient automatically and autonomously, how would we do it? And then, if we need to nudge the patient, or educate them, or escalate their care, how do we do that? We chose a structured approach. The chatbot asks questions and

6 Find out more about Health Transformers like Murray Brozinsky online. 6 startuphealth.com

“To get the signal instead of the noise requires us to show some restraint in how to apply new advances in tech. The cool new technology might not be the right tool for every use case.”

large numbers of permutations by the Conversa Brain, each patient experiences a personalized chat relevant to their unique health journey. It’s very difficult for an open-ended AI-based chatbot to be evidence-based. You don’t always know what’s going to come out. But our structured approach allows us to follow guidelines and care plans. To get the signal instead of the noise requires us to show some restraint in how to apply new advances in tech. The cool new technology might not be the right tool for every use case. Or it may need to be applied in a different way.

you choose from among multiple choice responses. Our technology is AI-driven, but it’s designed for safety and reliability. There’s no chance for it to misinterpret what a patient is saying. The chatbot asks you questions, but it also knows your electronic health record. Depending on how you answer a question, it takes you down a personalized path, created on the fly for you based on your unique profile. From the perspective of the health system – or payor or pharmaceutical company – the Conversation Modules can be reviewed to ensure the chat will only say what is approved. But because the Modules can be assembled into

PHOTO BY JOE BUGLEWICZ

On Real World Success We have health systems that are seeing significant impact on patient satisfaction, provider burden and burnout, ability to manage more patients with fewer resources and improved health outcomes. For example, we have a cohort of patients on the platform who have head and neck cancer. They’re using the platform as the standard of care for managing their radiation therapy. The health system did a study, the results of which were recently presented at the annual meeting of the American Society for Radiation Oncology, and found that patients report symptoms and side effects - and their severity - via patient reported outcomes (PROs) over chat much earlier than

they do to their oncologist using the common terminology criteria for adverse events (CTCAE) tool to report adverse events. For example, over 35% of patients reported grade 1 or grade 2 dysgeusia, xerostomia and fatigue in week one of treatment through the chat versus virtually none for those patients not using the chat. These patients were also much more adherent to their treatment plan (less than one percent premature treatment termination versus approximately eight percent for those not using chat), which impacts their health outcomes. On the Future We think the future is real-time population health. To do that, you have to take the process for an individual and think about how you would scale it for millions of patients. It’s not about replacing healthcare professionals. You’re augmenting them and figuring out how to offload the activities that AI does well so doctors and nurses can practice at the top of their licenses. As Chess Master Garry Kasparov has said, decisions are computational all the way down. Humans are better at making choices. To make a good choice, you have to know what matters and why it matters. It’s a partnership.

TAKEOFF

innovation hub

Breathing New Life into the African Pharmacy Bryan Mezue, CEO of Nigerianbased Lifestores, is using his digital platform to turn local drug stores into community hubs for connected, wrap-around care.

By Michael Yockel Photos by Niyi Fagbemi

Typically, in the U.S., a person patronizes a drugstore to purchase diapers, snacks, cosmetics, greeting cards, laundry detergent, some other sundry, or an over-the-counter medication. And, occasionally, he or she might pick up a prescription. By contrast, in Nigeria, a person visits a drugstore principally to address a healthcare concern. There, the pharmacist will not only fill a prescription, but can actually write that same prescription after a brief consultation with the individual. Nigerian pharmacists enjoy an elevated role, performing some of the functions ordinarily associated with physicians. “Nigerians see the pharmacy as a first port of call for healthcare,” notes Bryan Mezue, CEO and co-founder of Lagos-based Lifestores Pharmacy, a dual physical/virtual pharmacy company. “Our pharmacies have a lot more power than those in more developed countries.” 24

Issue 5

With an estimated 200 million people, Nigeria boasts Africa’s largest population, with an annual increase of approximately 5.5 million. It also claims Africa’s highest GDP: around $500 billion. But like many African nations, Nigeria suffers from a lack

StartUp Health Magazine

Lifestores pharmacist Gerald Obiakonwa

The Lekki-Ikoyi Link Bridge

The Lifestores team at the Sabo Yaba pharmacy

Traffic in bustling Lagos

Lifestores CEO & co-founder Bryan Mezue

of adequate healthcare infrastructure, with limited access to doctors, especially in rural and low-income urban areas. Nigerians also experience alarming rates of hypertension and diabetes, and less than five percent have health insurance. Those circumstances made for something of a perfect storm for Lifestores to launch in 2017. “Pharmacies were a natural place for us to get started in order to tackle the healthcare challenges the country faces,” says Mezue, 33, a native Nigerian who earned his MBA at Harvard. A “natural place” also because of the fragmented nature of the nation’s pharmacy industry, where, combined, the two largest chains account for only two percent of the market. (Compare that to the U.S., where, together, CVS and Walgreens control more than 40 percent of pharmacies.) With three existing bricks-andmortar pharmacies in Lagos – and two more on tap by the end of 2019 – Lifestores is part of the burgeoning African-wide mHealth industry, whereby mobile phones and the internet play an increasingly important role in delivering healthcare. Accordingly, one of the firm’s pharmacies is located in Lagos’ British colonial-era Yaba neighborhood, home to a hive of tech startups 25

TAKEOFF

and, as a result, dubbed “Yabacon Valley.” At nearby Victoria Island’s Vestar Coffee, a popular venue with tech entrepreneurs, Mezue and Lifestores COO and co-founder Andrew Garza, a 35-year-old born in New Jersey who earned his MBA at Stanford, frequently brainstorm and strategize with core members of their team. The majority of the company’s 21 full-time employees are women, as is a significant portion of its management team and investor base. “The key thing that distinguishes us is that we have a combination of an offline model and a technology-driven online model,” explains Mezue. “A lot of the competition either tries to go purely tech-driven – for example, in the e-commerce space – and have struggled, while much of the old guard do only bricks-and-mortar pharmacies.” Lifestores’ online model markets a software package of what Mezue terms “value-added services” to non-Lifestores pharmacies or “affiliates.” These services help manage a pharmacy’s daily operations: affording greater efficiency in ordering medications from a supplier by tracking inventory levels; improving the quality of pharmacist education, including increased knowledge of medications and advising patients on using them safely; assisting customers/patients with their health-care regimen via an online system that not only records their prescription history but also notifies them when they require refills; and offering VIVA, a current Lifestores’ program that affords telephonic counseling for people who suffer from chronic conditions such as hypertension and diabetes and is available separately to third-party healthcare providers. Such wrap-around services reduced participants’ blood pressure by 15 percent in three months in a recent VIVA study. As for growth, Lifestores plans to 26

Issue 5

expand both its online and offline divisions. “We think it’s helpful to serve our customers fully, from endto-end,” Mezue says. That means gradually opening more bricks-andmortar pharmacies, while keeping vigilant not to compete with affiliates. In addition to Lifestores pharmacists continuing to consult with patients and maintaining its practice 01

Pharmacist Gerald Obiakonwa checks the blood pressure of a regular customer at the local Sabo market.

Bryan Mezue at Vestar Coffee, a local hangout for entrepreneurs

StartUp Health Magazine

03 01

Pharmacist Gerald Obiakonwa with a customer

Andrew Garza, Gerald Obiakonwa and Bryan Mezue

of hosting visiting hours for outside professional MDs, the company is exploring furnishing in-store telemedicine capability that links customers with physicians. Over time, Lifestores hopes to expand to other African nations. “Access is not just a Lagos problem. It’s a Nigerian problem and it’s an African problem,” says Mezue. “There is an appetite for digital services, especially through mobile phones. We see lots of opportunities to use data to provide more standardized and consolidated services.”

TAKEOFF

community voices

Curatio’s Social Prescription Private social networks bring patients together for a dose of support and understanding

Social media is a good place to ask friends for seafood recommendations in New Orleans, but is it the best environment to receive health advice? It is, if you’re posing a question or comment via Curatio, a privacy and regulatory compliant social network that connects patients for peer-to-peer support, education and empowerment. Think of Curatio’s effort as no patient left behind, or better yet, no patient "

Why is a global community important to a person’s health?

Issue 5

left alone. Their condition-specific community boards motivate patients to adhere to treatment plans and strive for a better quality of life. Under the leadership of CEO and co-founder Lynda Brown-Ganzert, Curatio is now available in 85 countries and five languages. We asked three Curatio community managers why a global community is important to a person’s health. by Taiia Smart Young

Agnes Cartier Heart Community CANADA

Beverly Sudbery Multiple Sclerosis Community CANADA

Buddhadev Goswami ThaliMe English Community INDIA

“Where you live in the world, your socioeconomic status, your level of education or your beliefs are insignificant when it comes to connecting with others who are coping with the same health concerns. This type of bond and support cannot be replicated by a healthcare professional or even a family member. Simply put, those who understand and best relate to the challenges you are faced with, are often those who have walked in your shoes. Curatio has made it possible to have a worldwide circle of support — ensuring that no one feels alone with their health challenge.”

“When a person has a chronic disease, especially one that has symptoms that aren’t easy to understand, the person feels alone. I remember when I connected with a young lady in Barbados. She was diagnosed with multiple sclerosis (MS) and in the Caribbean, MS is not a well-known disease. She had searched online and as we all know, some information on the Internet is helpful, some is scary. She was frightened by what she saw, which is understandable. I was able to talk to her about my experiences and give her information and resources. She was able to see that you can still have a life full of hopes, dreams, desires, fun and happiness.”

“To know what’s going on in different parts of the world, global communication is needed. A mother from Papua New Guinea joined our community and her baby has Thalassemia, a rare blood disorder that causes the body to produce inadequate amounts of hemoglobin – red blood cells are destroyed, leading to anemia. Thalassemia requires prolonged treatment. The mother was completely unaware of a treatment known as chelation therapy. Our community members informed her about the basics and suggested that she talk to her doctor about it. Now she’s trying to arrange treatment for her baby.”

StartUp Health Magazine

StartUp Health Insights

™

A quarterly report on health innovation and the health moonshots transforming the world. 2019 ytd data 1/1/19 – 12/6/19

ABOUT STARTUP HEALTH INSIGHTS™

Report Authors Nicole Clark | Polina Hanin

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

Contributors Tara Salamone | Jennifer Hankin Nicole Kinsey | Anne Dordai Sign up to receive weekly funding insights at startuphealth.com/insider

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

STARTUP HEALTH INSIGHTS

$65.5B Raised in Health Innovation Since 2010 Health innovation funding continued its strong upward trend, a curve we’ve been tracking for almost a decade. While you can parse each rise and dip in our quarterly insights report online (where we go into more granular detail) these year-over-year numbers tell a simple yet compelling story – health innovation is robust and growing. In a mere decade, 4,300 startups got funded, and funding levels increased by a factor of 10, with similar growth in the number of investors (see page 34). And from our vantage point, we’re just getting started.

Data as of 12/6/19. See startuphealth. com/insights for EOY report.

$14.7B

Health Innovation Funding, Year Over Year

876

$11.7B

Deal Count

785

686 643

$12.1B 683

610 567

475 $8.2B 287

$7.1B $6.2B

152

$2.8B $2.1B

$2.2B

2019 YTD

2018

2017

2016

2015

2014

2013

2012

2011

2010

$1.1B

Source: StartUp Health Insights | startuphealth.com/insights. Note: Report based on publicly available data through 12/6/19 on seed (incl. accelerator), venture, corporate venture, 30 Issue 5 funding StartUp Health tracked Magazine and private equity only. Companies in StartUp Health Insights may fall under multiple moonshots and therefore will be represented throughout the report.

Download the full report at startuphealth.com /insights

Funding Trends Spark Calls for Innovation At StartUp Health, we slice health innovation funding data differently than anyone else. We categorize every deal by the health moonshots – the audacious goals – that the founders and companies are striving to achieve. What we found in 2019 was continued robust funding into the foundational health moonshots of opening access and lowering costs. We were pleased to see particularly strong investment into women’s health, which had the highest year-over-year growth in funding and deal count. We hope entrepreneurs and investors alike will see the gaps in funding in addiction and children’s health a clarion call for renewed innovation.

$5.5B

341

$4.3B

2019 Funding by Health Moonshot (YTD) $3.6B

Deal Count

227

174

93 $2.0B 58

40 27 9

20 $1.2B $1.0B

$536M $308M $96M

$109M

Addiction

Children’s Health

Brain Health

$375M

Women’s Health

Mental Health & Happiness

Nutrition & Fitness

End Cancer

Longevity

Cure Disease

Cost to Zero

Access to Care

Source: StartUp Health Insights | startuphealth.com/insights. Note: Report based on publicly available data through 12/6/19 on seed (incl. accelerator), venture, corporate venture, 31 and private equity funding only. Companies tracked in StartUp Health Insights may fall under multiple moonshots and therefore will be represented throughout the report.

STARTUP HEALTH INSIGHTS

A Surge in the East Boasting four out of 2019’s top 10 most-funded cities, China cemented its place as a hub for health innovation, and is positioned for continued growth. When it comes to total deals, London topped the charts, while Paris and Tel Aviv posted significant gains over 2018. It’s noteworthy that no city in South America or Africa has yet made the list, though innovation in the southern continents abounds (check out our index of companies listed by country on page 108). It’s time for investors to broaden their field of vision.

Most-Funded Non-U.S. Hubs

Top Non-U.S. Deals

City/Region

Funds Raised

Deals YTD

2018 Deals

Company

Amount

Beijing

$855.4M

Babylon Health

$550M

London

$777.6M

Tencent Trusted Doctor

$250M

Paris

$445.6M

PharmEasy

$220M

Mumbai

$280.5M

Doctolib

$170M

Tel Aviv

$250.5M

Waterdrop

$145M

Bangalore

$182.6M

Cure.fit

$120M

Shanghai

$151.1M

AllinMD

$100M

Singapore

$103.7M

Weimai

$100M

Guangzhou

$103.0M

DocPlanner

$90M

Hangzhou

$100.0M

Dingdang Medicine Express

$89M

Source: StartUp Health Insights | startuphealth.com/insights. Note: Report based on publicly available data through 12/6/19 on seed (incl. accelerator), venture, corporate venture, 32 Issue 5 funding StartUp Health Magazine and private equity only. Companies tracked in StartUp Health Insights may fall under multiple moonshots and therefore will be represented throughout the report.

Download the full report at startuphealth.com /insights

Coasts with the Most New year, same song. San Francisco, New York and Boston showed no signs of diminishing as juggernauts of health innovation. Looking at the 2019â&#x20AC;&#x2122;s top deals (10 over $100M) itâ&#x20AC;&#x2122;s clear that mega deals are becoming the new normal. Multiple cities showed signs of increased activity. Chicago, Salt Lake City, Seattle, Denver and San Diego all showed significant increases in deal count over 2018. With only three non-coastal cities represented on this list, we see major opportunities for finding innovation in untapped markets.

Most-Funded U.S. Cities

Top U.S. Deals

City/Region

Funds Raised

Deals YTD

2018 Deals

Company

Amount

San Francisco

$2.9B

115

139

Clover Health

$500M

New York City

$1.4B

Gympass

$300M

Boston

$934.2M

Collective Health

$205M

Chicago

$384.3M

Capsule

$200M

Salt Lake City

$318.6M

Tempus

$200M

Seattle

$152.0M

Freenome

$160M

Denver

$127.6M

Beam Therapeutics

$135M

San Diego

$109.4M

PathAI

$135M

Philadelphia

$101.6M

Recursion Pharma

$121M

Los Angeles

$91.3M

Calm

$115M

Source: StartUp Health Insights | startuphealth.com/insights. Note: Report based on publicly available data through 12/6/19 on seed (incl. accelerator), venture, corporate venture, 33 and private equity funding only. Companies tracked in StartUp Health Insights may fall under multiple moonshots and therefore will be represented throughout the report.

STARTUP HEALTH INSIGHTS

Download the full report at startuphealth.com /insights

Most-Active Investors We’ve come a long way in the last decade when it comes to the depth and breadth of health innovation investors. In 2010 we took roll and counted 168 investors in the market. In 2019 that number hit 1,282. At StartUp Health we’re proud to have such a diverse portfolio, but we’re not alone in that trait. Investors like F-Prime, Khosla, Y Combinator and GV all spread their funds across five or more health moonshots. This particular view of the market also let’s us see the gaps in activity, making it clear that it’s time to marshall resources around the moonshot to end addiction and the opioid epidemic.

2019 YTD Deals

2018 Total Deals

1. StartUp Health

2. F-Prime Capital

2. Khosla Ventures

2. Y Combinator

5. GV (fka Google Ventures)

5. Maverick Capital (Maverick Ventures)

7. Optum Ventures

7. Felicis Ventures

7. Echo Health Ventures

10. Sequoia Capital

10. Tencent

10. ARCH Venture Partners

10. Greycroft Partners

10. Data Collective (DCVC)

10. Founders Fund

10. Lux Capital

10. HEP

10. GreatPoint Ventures

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Source: Health Insights | startuphealth.com/insights. Note: Report based on publicly available data through 12/6/19 on seed (incl. accelerator), venture, corporate venture, 34 StartUp Issue 5 StartUp Health Magazine and private equity funding only. Companies tracked in StartUp Health Insights may fall under multiple moonshots and therefore will be represented throughout the report.

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In the Longevity Moonshot, Solve for Independence, Not Fear Charlotte Yeh, MD Imagine you’re working in the emergency department and you see two 80-year-olds come in, each with a broken hip. You look at one and know she will walk out just fine. You see the same injury in the next room over and you know this is likely the end of the road. In healthcare we keep going after the failure to thrive, instead of focusing on the secret sauce of the people who are thriving. This matters now more than ever because we are rapidly aging. It’s not just about living to 65 anymore. Our fastest growing population is Illustrations by Lauren Crow

Chief Medical Officer, AARP Services, Inc.

85 and older and the second fastest is 100 and older. Upwards of 80% of boomers expect to work past 65 and not just for money but for purpose. When I look at these changing dynamics, it’s clear we need to remodel our mental image of aging. Studies show that if you have a positive view of aging, you live seven and a half years longer and you’ll be 44% more likely to fully recover from a disability. You have less brain plaques and tangles on autopsy indicative of dementia. You have a 55% lower risk of hospitalization. And there’s one study out there that says we could save $63 billion in healthcare costs by de-stressing the aging process. If you think about it, when you’re 64, you’re viewed as a productive member of society, then at 65 suddenly you’re seen as a dependent. What does that do to our self-image? Historically, people have used the term “aging in place” because the idea was that we’d rather grow old at home. But that term doesn’t need to mean sitting in a wheelchair and staring out the window. In reality, we know that vibrancy and vitality in age means you’re mobile and physically active. And if you’re not physically active, you’re cognitively active and learning things. And even if you’re not cognitively active, you are spiritually or emotionally active. You’re anything but static. Instead of only talking about the decline and dependency and challenges of aging, we need to be talking about resilience and adaptation and how we can get the most out of aging. There are assets to aging! You get wiser. You have better pattern recognition, you’re better at problem solving. You have a better vocabulary, more empathy, better emotional control. That’s why entrepreneurs over 45 are two and a half times more likely to be successful. They have the

experience needed to make something work. So much of the energy in health innovation is around aging in place safely. Safety monitors, fall detection, smart refrigerators that can tell you when you’re not eating. But if we make the home perfect, it becomes a prison. The next real breakthrough in aging is not aging in place, it’s independence on the go. We need to use health technology and innovation to offer a new vision of what aging looks like. What are we doing for mobility, and this isn’t just about transportation. People are working on exoskeletons that you can strap on to allow you to walk, even if you’ve had a stroke. Companies are using virtual reality technology to give people with macular degeneration the ability to see. Nobody wants to get a hearing aid because they think it makes them seem old. That’s why hearing aid manufacturers are investing in all-new designs and also adding new features such as fall detection and sleep monitoring that take advantage of emerging technology. Often, health innovators fall into the trap of only addressing fears: Don’t forget to turn the stove off, don’t fall in the bathroom, don’t forget to eat. All of that is important, particularly for family caregivers who live remotely. But what about the person who’s sure of themselves and wants to be independent? We have to balance the need to solve for problems with the need to solve for independence. For instance, a woman and her husband designed a walker with bicycle wheels so she can take a walk in the woods and see the beauty of Maine with her husband. One of my seminal moments happened when I was a medical student. I was in a rehabilitation facility and there was a man in his 60s who was 35

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quadriplegic. He was an editor for a top national newspaper. He was incredibly insightful, smart, productive and dressed in a suit every single day for work. I thought to myself, I see all these terrible accidents that come through the emergency department and I think it’s the end of their life. In fact, this man’s life is just beginning. Images are powerful. AARP has worked with Getty to launch a new series of stock photos that portray aging with diversity and vibrancy. We have opportunities in the images we choose to use. There’s a lot we can learn from opening up to a global perspective on aging; some countries just get it right. One of the things they’re doing in France is not asking the older generation, “how can we help you?” They are asking, “how can you help us?” In one example, there’s an older woman living in a house on a residential street. And you can wonder, how do you help this woman, who lost her husband and now lives alone, get out of the house and get transportation? Well, what they do in this community in France, since there are many professional families with school-age children living in the neighborhood, the families give their house keys to this woman. When the kids come home from school and the parents are still at work, they go to her house to pick up the keys to their home. The parents know that their child got home safely from school and checked in with the woman to see how they were doing. She gets interaction by seeing the children, and maybe gets to play or talk with them about their day. She is playing a critical role in this community because they need her. Health innovators need to challenge their assumptions. Don’t design for old, design for all. Don’t solve for fears, solve for independence.

Issue 5

5 Moves That Will Transform Health Investing

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

StartUp Health Magazine

During almost six decades of working in corporate settings, including the startup of HBO and my time as CEO of Time Warner, I’ve witnessed, and navigated how new businesses get financed. I’ve observed companies, some of which I’ve led, seeking to fund the rapid growth of startups. In all my years, I have yet to witness a financing strategy that truly matches need with entrepreneurial discovery. Everyone is playing by the same book, and the book needs to get rewritten. This is particularly true in healthcare, where the range of financing models from VC to lever-

aged buyouts to impact investing are simply inadequate. Simply put, the allocation of financial resources does not support our global needs for health and wellness innovation. In our conversations at StartUp Health, we’ve been asking ourselves: How do we shift funding strategies and coordinate sometimes scattershot investments to have more global impact. In the current landscape, capital investments are deployed ad hominem around the globe instead of being allocated to those sectors, large and small, most in need of financing and interconnected development. For the next revolution to happen, we need to enlarge the pattern of capital infusion and be guided by a humane yet algorithmic sense of collective, collaborating scale. Here are five specific ways that health innovation financing needs to be unlocked and unleashed to do the most good for the most people. New models for fund allocation

Today’s system for financing health innovation relies on a relatively small community of banks and investors who play by one basic set of rules: Invest in the most profitable markets with the biggest returns. This is not a system designed to recognize basic human issues impacting health and happiness, but to maximize generally accepted return metrics. The capital market system will not seek out and finance high impact innovations when they happen to have an initially low profit margin. An entity of some kind, endowed with purpose and mission, must emerge to help in that allocation of available funds, balancing human thriving with investment methodologies. Imagine an algorithmic approach to understanding the health needs of every village, town and city regardless of location, political structure

“For the next revolution to happen, we need to enlarge the pattern of capital infusion and be guided by a humane yet algorithmic sense of collective, collaborating scale.”

and ethnicity. True needs, assessed equitably and impartially, lead to innovation and the most trusted allocation of resources. Lean on entrepreneurs

We must lean on entrepreneurs and those with the entrepreneurial mindset to identify society’s most critical pain points. In today’s financing models, massive investment firms and consulting agencies create spreadsheets and decks about market opportunities. Meanwhile, entrepreneurs on the ground, around the world, live those problems and have their souls in the game. Today’s financing gurus live and die by expectations of profit and loss, immutable metrics that steer ships of influence. But often health innovation exists outside the typical realm of returns. The potential impact for, say, a women’s health program in the slums outside Mumbai, won’t necessarily appear on a spreadsheet at an international investment firm. The insights we need to improve health for all will come from entrepreneurs and those with that unique way of seeing the world. New investment vehicles

If we are to allocate resources according to need, and finance entrepreneurs at scale, the old financing models need to change. We need to think completely differently about how we finance health and wellness, developing new investment vehicles that are not constrained by the same rules. After all, investing in giving people a healthy life shouldn’t

require the same framework as investing in fossil fuels or real estate. It means investing with an eye towards time (long-term improvement vs. get rich quick), and towards collaboration (global goals vs. survival of the fittest). Instead of showing typical financial return, let’s look at health moonshot returns. This financing model can’t be about crushing competing investors, but about lifting the whole market. This is why StartUp Health puts such a strong emphasis on entrepreneurs and investors committed to health moonshots. New sources of funding

In this new age of health investing, the money needs to come from new places. Who has a stake in the health and wellbeing of everyone in the world? Everyone! It’s certainly not the privileged few investors who happen to see a hot health tech deal cross their desk. The doors to health innovation investing need to be thrown wide open. Big investments and small, it doesn’t matter – whatever is meaningful to the individual. When the money comes from nontraditional structures, the dynamics change, the pressures change, and that opens up new opportunities for entrepreneurs. When financing is democratized, when average people put their money where their hearts are, it imbues the investment with the character and morality of the community. This isn’t just money, and it’s not just about profit and loss. It becomes, in its purest form, about the hopes and desires of a community.

Health innovation funding requires commitment and continuity

Investment in health innovation requires commitment. So much of our current financing structure is designed around getting in and getting out, scoring the exit that will strengthen your market position. But for health investing to flourish, the element of participation needs to be elevated. Continuity is critical to success, leveling the playing field and democratizing health innovation. Long-term investing also builds personal commitment. We continue our support into the future not because of specific benchmarks, but because of continued conviction. We founded StartUp Health to inspire individuals and companies to realize an ambitious healthcare agenda. We first established our health moonshot aspirations to define the major areas where we need to shift. We’ve been funding and coaching the entrepreneurs who we believe can solve the planet’s major healthcare conundrums. Our health moonshot is to improve the health and wellbeing of everyone on earth. And we believe this impossible dream is achievable if we invest in entrepreneurs at scale, unite them into a global army for good, broadcast their stories of progress, and connect them with like-minded partners and investors. Together we can beat disease and old ways of thinking, embracing a new equation for health innovation. We hope you’ll join us.

6 Find more wisdom from thought leaders like Jerry Levin online. 6 startuphealth.com

WISDOM

Moving From a House Divided to Divide and Conquer

S Somewhat sanitized, here is the last email from Alice the angel investor to Juan, the startup CEO who has run out of cash: “I’m trying to make this clear. I do not want to make a commitment so that you can then go find someone else to make a commitment. I would like to join a group that commits together - straightforwardly. What that means for you: Write to 38

Issue 5

Esther Dyson Executive Founder of Wellville StartUp Health Investor & Advisor

StartUp Health Magazine

all of us, at the same time, with CCs, and invite us to join the group. Why not CC everyone if you plan to tell everyone the same thing?“ Juan replies: “My issue is the different timelines, stages of the diligence process, and existing investors vs. new investors. It will not help me close and needs to happen on more of a rolling basis. I’m trying to understand how this helps with the raise as it’s not this straightforward from this end.” No, it’s not straightforward, and Alice knows he’s telling each party something different. She declines to invest. If you think maybe I’m writing about you, Juan – yes, take a look in the mirror. But don’t out yourself by complaining. Instead, just keep reading and pretend you’re learning from what the other guy did wrong. This “divide and destroy” mentality is pervasive in the startup world. I see it when startups engage with investors, but that’s not all. We talk so much about the importance of cross-silo collaboration in health innovation, and rightly so, but collaboration also needs to happen within teams and within boards. Here’s a sampling of what can go wrong when “divide and conquer” turns into “divide and destroy” and some ways to fix the problem. Investors

As the case of Juan and Alice shows, investors’ interests are not always aligned, especially when it comes to transactions. And Juan made it worse by playing his investors off one another. He wanted the highest valuation he could get, so he kept telling one potential investor about better offers from other investors. Except those weren’t real offers; those were indications of interest. Or perhaps Juan was just believing what he thought he heard; there were no other investors pres-

ent to provide a reality check. The latest I heard, he still hasn’t gotten his bridge funding. What could he have done better? He could have told all his investors the gory truth – together. They would have asked questions, and everyone would have heard the same answers. They could have negotiated with him for a realistic valuation; one that all of them would accept. And though Juan might have gotten a lower valuation, it would have set him and the company up for success, with a united group of investors with the same expectations, working together. In other situations, where the deal is hotter (or at least not cold!), some investors get preferences for being the last money in, while others refuse to play. That creates divided motivations at best, and unrealistic valuations. In theory all these preferences are disclosed, but in practice they are not clearly visible. And then there are the cases where existing investors badmouth the company so that they can buy into the next round more cheaply, or so that another of their portfolio companies can acquire it. At the extreme, this is fraud… and yes, I have seen such cases. Bottom line: the CEO should be working to keep all the investors’ interests aligned, telling all of them the same story, and encouraging them to communicate together as a group. Board members

As Uber and WeWork discovered, yes, the board’s job may be to support the CEO, but when things go south, the board is invested in the company, not the CEO. There’s a lot of wishful thinking, and probably some selfidentification, when board members coach startup CEOs. It’s natural for the chairman of the board to meet one-on-one with the CEO and to reassure them they’re the greatest. But when the board meets together,

The Team

“The directors need to work as a team, sharing their doubts as well as their enthusiasm for the company, its mission and its amazing CEO.” "

it’s harder to ignore the facts (unless you have a dangerously self-deluding board). Diversity doesn’t just mean gender and race, but also true believers and skeptics, subject-matter experts and naïve questioners. Each member of the board, ideally, asks different questions, and each member of the board usually learns the most from the questions they didn’t think to ask. Things go poorly when certain members of the board establish close personal relationships with the CEO and start to defend rather than question them. The syndrome is broad; often the CEO attends the board meeting on their own; the board doesn’t get to hear much from the other team members. Everything is filtered through the CEO. In short, the CEO never needs to confront reality. Running a startup is tough; lately we’ve been hearing a lot about the mental stress and depression it can cause. CEOs do need support, but they also need a clear grip on reality for their own and their companies’ long-term good. Enabling directors are not doing their job. How to do it better? The directors need to work as a team, sharing their doubts as well as their enthusiasm for the company and its mission and its amazing CEO (sarcasm intended). They need to practice radical candor (H/T Kim Scott and her book of that name), letting the CEO know they have his/her back but offering constructive criticism and advice. For example, less “You’re a terrible manager,” and more “We’d like to invest in making you a better manager and offer you a coach.” The board should regularly meet with other members of the team, and depending on the company, use the product or sample its services for themselves. (Don’t you wish the boards of the companies you regularly buy from did that?)

Finally, there’s the CEO and their team. Juan’s brother Carlos was also a CEO. For the two years he ran his company, I later discovered, he never once held an all-hands meeting. Instead, he met only one-on-one with his direct reports, of which there were way too many. Each one got a different story, and each one told a different story, which Carlos pretended to believe. In fact, this was the ideal way of creating confusion and dissension. He played them off one another, catering to each of them individually but creating an environment of fake news within the company. Each one believed themselves favored and criticized the others, but in the end no one knew what to believe. Problems were hidden, and when they were discovered, they were always someone else’s fault. The company was riven with conflicting versions of what the CEO had promised to each individual. One interesting real-world, real-name example of the need for teams is Elon Musk… or rather, the two Elon Musks. One runs Tesla, single-handedly. And by all accounts, despite its wonderful cars, the company is bit of a mess inside. This CEO smokes weed on TV, and fires people with abandon. The other Elon Musk is a collaborative founder of SpaceX who listens to and leaves much of the work to COO (and director) Gwynne Shotwell, a mature and experienced aerospace executive – if only because he’s spending so much time on Tesla. The difference between the two Elons – and the two companies – comes down to collaboration style.

himself, a team that asks questions of one another, but also of outsiders so that all can learn together. In general, a CEO needs to ask for advice as well as to give it. She needs to hire a team that can do most things better than she can; her job is to help them learn and work together. The CEO needs to create an atmosphere of trust, where people can count on one another and solve problems together, rather than blaming the other person. And yes, the team members should be diverse, with different backgrounds, points of view and styles. Together, they will amount to much more than any single CEO could ever hope to offer. Last month I attended the wonderful BrainMind conference at Stanford. Of all the interesting ideas I heard, the one that struck me the most was from Patricia Kuhl of the University of Washington, about how babies learn best. It’s not by watching something on an iPad, certainly, but it’s also not by listening to their parents. They learn best by learning together, by watching one another’s reactions to what an adult is saying. (Home-schoolers, take heed!) In short, people need to share the same story. One-on-one communication has its place, but it’s no way to run a company or to raise money. Business is fundamentally a group activity.

How to solve it

The best way for a CEO to manage, in fact, is not to manage but to collaborate. What Carlos should be doing is building a team around 39

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â&#x20AC;&#x153;The best way for a CEO to manage, in fact, is not to manage but to collaborate. In general, a CEO needs to ask for advice as well as to give it. She needs to hire a team that can do most things better than she can; her job is to help them learn and work together.â&#x20AC;?* -esther dyson 40

Issue 5

StartUp Health Magazine

Find more bursts of wisdom on the Health Transformer blog, at startuphealth .com/blog

WISDOM

Partnering to Create Value in the Healthcare Ecosystem

I In my years as chief medical officer leading digital modernization at the Department of Veterans Affairs, I often played the role of convener and connector. Whether it was modernizing our electronic health record system or pushing for interoperability, my work involved bringing together innovators, clearing away obstacles and championing healthcare transformation. Although

Ashwini Zenooz, MD Senior Vice President and General Manager, Healthcare and Life Sciences, Salesforce

worlds apart in many respects, the fundamentals of my current role with Salesforce are not very different. I spend a great deal of my time meeting with colleagues who work at the lively intersection of technology innovation and healthcare. Many of them lead startups and are making the rounds seeking funding, partnerships or sometimes just gathering perspectives from the world of “Big Tech.” My motivations for these conversations perfectly mirror theirs: sourcing innovation, scouting solutions to invest in or integrate with and absorbing as much insight and learning as possible from these entrepreneurs on the front lines of healthcare disruption. Convening and connecting. Too often, Big Tech and startups are presented in opposition to each other, as polar extremes on the innovation spectrum: sclerotic vs. nimble, incumbent vs. disruptor. But these are false dichotomies. In today’s world of platform economics, value is increasingly co-created and co-distributed across an ecosystem of partners. And nowhere is this more true than in healthcare, where we are each playing our part to achieve the same critical goals: improving health outcomes and experiences while lowering the overall cost of care. To dig into how this model works in the real world, let’s look at how Salesforce partners with startups to create value and promote better outcomes in healthcare. Filling the White Space

Salesforce recognized early on that its success hinged on building a vibrant ecosystem. As Joy’s Law states (credited to Bill Joy, co-founder of Sun Microsystems), “no matter who you are, most of the smartest people work for someone else.” In other words, the best ideas and breakthrough innovations are often “out there” and smart organizations figure out how to bring them in and con-

nect them to customer needs. Our approach at Salesforce is rather simple. We look at the healthcare landscape and our customers’ needs to identify opportunities and gaps: problems to be fixed, efficiencies to be gained, processes ripe for overhaul. If we can’t solve it ourselves we look to partners who can fill the white space, and in turn, improve outcomes and value. We bridge supply with demand through AppExchange, the world’s largest enterprise marketplace, with thousands of pre-vetted and preintegrated apps and services each filling some gap or need. To target particular challenges we also invite promising startup partners to combine forces by building their offerings directly on top of Salesforce. Take the transition to value-based care, for example. Every health system is re-tooling and re-training to address the unique challenges of these new payment plans and care models. To help our customers with this transition, we partnered with the analytics and services company Geneia to marry their care management platform with Salesforce Health Cloud’s workflow, member engagement and communications tools. With this joint solution, care managers are equipped to identify high-risk patients, their utilization, cost drivers and care opportunities — then engage them to close care gaps, monitor their progress and keep them on track. Likewise, every health system and patient suffers from the symptoms of what’s often called the “patient access paradox.” Patients in need of care are forced to endure unreasonable wait times for appointments while the very same health systems lose money from excess capacity. To address this chronic breakdown, we partnered with and made a strategic investment in Kyruus, an industry leader in provider search and scheduling. This integration now allows access to 41

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healthcare centers to deliver an endto-end personalized patient experience by combining Kyruus’s robust provider matching, appointment booking and provider data management capabilities with Salesforce’s 360-degree view of the patient. A Platform for Change

One of the things that drew me to Salesforce was the company’s commitment to social impact. We at Salesforce believe that the business of a business is to improve the state of the world. One of the ways we follow through on this commitment is through an ecosystem of partners. As a company and technology platform, we’re in a privileged position to help catalyze the growth of organizations that are actively benefiting society. Through the Salesforce Ventures Impact Fund, we regularly identify and invest in companies that are fostering change in areas ranging from equality to sustainability to public health. With this venture funding and through integration with our platform, we have an opportunity to advance their missions and turn business into a platform for change. There is clearly a reason why top companies in the world today are platform businesses. By connecting buyers, sellers and partners, they have the potential to create enormous value, to start a rising tide that lifts all boats. But their long-term success hinges on two core principles identified by the authors of an extensive study of platform businesses: put trust front and center, and avoid hubris. I try to remain mindful of these principles with every partnership conversation I find myself in. The challenges facing healthcare are daunting. The only way to tackle them is through trust, partnership, humility, and a shared commitment to change. Together.

Issue 5

CASE STUDY FitBliss and the Salesforce ecosystem Navid Rastegar (pictured) and the team at FitBliss used the Saleforce ecosystem to launch a wellness platform that links bottom-line productivity to healthy activities.

StartUp Health Magazine

In the Quest to Reduce Health Costs, the Truth Can Set Us Free In The Price We Pay: What Broke American Health Care – and How to Fix It, New York Times bestselling author Dr. Marty Makary pulls back the curtain on healthcare economics, and it’s safe to say that he doesn’t like what he finds. And neither will you. Through detailed, transcontinental reporting, the Johns Hopkins surgeon exposes the kinds of predatory billing practices and price gouging that sends hard working families into bankruptcy over surprise medical expenses. While to an American reader some of these themes will sound familiar, what is surprising about this volume is Makary’s deep and abiding optimism. His experience reporting for the book taught him – among a number of lessons we’ll get into below – that most people in healthcare want to do what is right. They want to return to the noble roots of compassion and care that drew them to medicine and healthcare in the beginning. They just need a little nudge. Interview by Logan Plaster

Marty Makary, MD, MPH Surgeon & Professor of Health Policy at Johns Hopkins

New York Times bestselling author

StartUp Health: You highlight a lot of things that are broken about America’s healthcare system. What’s the top line takeaway?

Dr. Marty Makary: The fundamental issues are pricing failures and inappropriate care. If airlines billed us after the flight and there were no prices listed on travel sites, guess what? They’d be gouging people left and right. You’d have stories all over the country coming out on every media outlet about the $50,000 flight to Chicago and the $800 surprise bill for an in-flight beverage. We have a system that enables price gouging. As a result, we have a bunch of rational actors who are following ugly market incentives to price gouge people at a time when they are blindfolded from pricing information. What are you hoping the book achieves?

If there’s one theme that my team and I are committed to, it’s rebuilding the public trust in American hospitals. 64% of Americans report avoiding or delaying care for fear of the bill. We can have the cure for cancer, but if half the public doesn’t trust us to come in, what good is the cure to those people? Not long ago a patient got charged $689,000 for a back operation because of some technicality on their insurance. People hear those stories and become afraid to go to the hospital for fear that that could be them. We need to build bridges and mend fences. We need to address the outlier behavior. We need to use plain English to talk about what’s happening and stop using these wonky terms that we use in academic circles of health policy. We need to call out price gouging and predatory billing for what it is. It’s taking advantage of people when they’re at their most vulnerable.

What has been the response to the book?

I’ve been blown away at the positive response that I’ve gotten from folks who have said, yes, my part of healthcare is broken, I want to fix it. Hospital CEOs have reached out to ask for help making their prices transparent. For me personally, I don’t want to just collect a paycheck every two weeks. I want to see this system change. The number of people that have come up to me, wanting to be a part of something that’s larger than themselves has been really invigorating for my entire research team. In the book you blow the whistle on all of these terrible practices, yet you have an overriding positivity. How do you square the two?

I think we can get a lot done if we appeal to the best in people. Many American hospitals were built by churches and had a commitment to care for the community regardless of one’s race, ethnicity or ability to pay. It was written into their founding charters. If we can remind people why we chose to go into medicine – to help people – great things start to happen. There is a root compassion and a great altruism that attracts people to healthcare. I remind people about people like Jonas Salk. He refused to get a patent for the polio vaccine because he wanted as many kids in the world to get it as possible. You have these stories of doctors paying for patients to take the train to come see them because they couldn’t afford transportation. There was a guy here at Hopkins who never charged clergy, police, firefighters or teachers. Yet today, doctors cannot even perform charity care if they want to. They’re bound by their institutions and their billing protocols. In the main entrance to the

historic Johns Hopkins Hospital dome, there’s a statue of Jesus Christ with his arms outstretched. At the base there is an inscription: “Come unto me all ye that are weary and heavy laden, and I will give you rest.” That’s our great heritage. Not price gouging when patients are at their most vulnerable. What I’m finding is that appealing to the best in people works. Healthcare leaders are changing their ways. They want to be better. They don’t want to be a part of a system that has turned into a monster. The system never intended to be this harsh with people who are sick. I spoke with the people at Mary Washington Hospital, a hospital that I challenged in the book for their practice of relentlessly suing patients who couldn’t afford to pay their hospital bills. We had civil conversations with them in which we begged them to remember their own mission statement and why we all went into medicine. Immediately after that conversation, they announced that they are going to stop all lawsuits against patients after previously suing 25,000 people in a town that has a population of 28,000. That’s appealing to the best in people.

BUY THE BOOK Dr. Makary’s The Price We Pay: What Broke American Health Care – And How To Fix It (Bloomsbury Publishing)

You talk a lot about the hidden costs and markups in healthcare. What role can health innovators play in increasing transparency?

The current way that we’ve measured quality of care within the system is entirely broken. We’ve been measuring value using readmission rates, infection rates and chargemaster prices. Those are unreliable indicators of quality. The new disruption is centered on the appropriateness of care, measuring patient reported outcomes, using practice patterns in big data, doing case reviews and optimizing the patient experience. We’re seeing new young companies 43

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be extremely successful in disrupting healthcare by getting at real quality and real prices, not artificial quality and artificial prices. There are basic metrics of billing quality that my Hopkins colleagues and I have developed to create more public accountability for American hospitals. After all, hospitals are community institutions, many of them were built on the backs of laborers and funded by philanthropy. There’s a lot of ways to disrupt markets. For instance, when you search for a hospital on the Internet, what you should be seeing instead of just the name and the address is the average markup of their prices and the hospital’s billing quality score. Recently I was working on fighting the bill of a police officer in Carlsbad, New Mexico. I went into the hospital to try to see if the hospital could provide an honest price for a service from the radiology department. I went to the reception desk and asked the very nice person there how much a CAT scan would cost me. We went back and forth, with me giving her the exact type of CAT scan I was looking for. She said it’s going to be about $5,000 to $10,000. After she gave me that price, she whispered to me that if I went to a website, called www.mdsave.com, I’d see their hospital listing the same service for $500. You can go in there and click on it. Same procedure. Why would that hospital put the service on that website, which is like an online open marketplace? Because they would rather be paid upfront and not have to spend all that money on coding, collections and billing. They obviously find that $500 to be profitable, or they wouldn’t do it. Why aren’t more centers doing that right now? We’re on the brink of a massive disruption when it comes to price and quality transparency in the United States and it’s driven by the entrepreneurs. 44

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Where in the market are you seeing the most innovation?

Employers right now are the most exciting space in healthcare. They’re fed up with the money games. They’re fed up with the many middlemen and they are now partnering with entrepreneurs to bypass these games. Employers are now saying we can measure quality and price using new generation metrics. Employers are saying we don’t need the molasses medical establishment to endorse these metrics and we don’t need the insurance industry to tell us where we can go for care. Employers are saying, look, we want to choose our preferred doctors and centers of excellence. We want to do our own primary care and we can steer patients to high-quality specialists. They are also saying they want to manage their health plan with a lower deductible. They are investing in innovative primary care clinics around the country that are growing like wildfire by understanding that food is medicine and we need to take care of the whole person. We need to take the time to consider factors like sleep, which is a driver of high blood pressure, obesity and possibly Alzheimer’s. What’s your message to healthcare leaders reading this?

There’s a disconnect between hospital leaders and physicians and the people they serve who are living paycheck to paycheck. We don’t live like those who are struggling to pay their bills. Life has been good to me. I don’t sweat when my car has a $500 repair bill. I have learned that you need to be proximate and hear these stories and sit in these homes. Fully half of America has less than $400 of cash in their savings account. When they get a $2,000 egregious surprise bill at an in-network facility, that is a disgrace

StartUp Health Magazine

6 Share ideas with thought leaders like Dr. Marty Makary online. 6

to our system. We don’t have bad people in healthcare. We have good people working in a fragmented system who are sometimes disconnected from people who live paycheck to paycheck. It is ironic that those of us working in healthcare have never been educated in basic healthcare literacy. We also have few leaders who are speaking up about the real drivers of healthcare’s cost crisis, who are unbeholden to any stakeholder. Even academics are afraid to upset their university hospital’s leadership. Almost every authority in healthcare is beholden to a special interest. And right now there’s a major money grab. Everyone says they need more money or the system’s going to fall apart. And yet, you say there’s more that connects us than divides us?

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If we can turn off cable news, there’s actually broad consensus in American healthcare. We’re not a divided country as the media and politicians would tell us we are. Who supports corruption? Who supports secret pricing? Who supports wild variations in price and opioid overprescribing? There’s broad consensus on healthcare. We just need to create the healthcare literacy so people can see what the real issues are and not just what the sound bites are on cable news.

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MINDSETS

THE HEALTH TRANSFORMER MIN MINDSETS

To Achieve Health Moonshots, Master These 8 Mindsets

LEARN MORE

6 Explore what it means to be supported by a global army of Health Transformers. 6 startuphealth.com

Here we are sharing the Health Transformer Mindset Scorecard so you can get started and benchmark your mindset. Though it may only take 10 minutes to get started, these mindsets require a daily practice for true mastery.

Take the 10 Minute Mindset Audit at startuphealth.com/mindset

Long-term Commitment

You are not “all in” at all and not sure what you want to do or how you want to spend your time.

Supportive Relationships

You don’t feel like you can rely on others, would rather do everything yourself, and have no long-term relationships on your team.

Quarterly Progress

You are heads down and don’t feel the need to step back, celebrate wins or recalibrate to figure out what’s working/ not working.

Confidently Ambitious

You have an interesting idea but given everyone’s skepticism you aren’t 100% sure if it’s really good.

Self Aware

You talk more than you listen and aren’t able to articulate what your unique ability is.

Healthy Habits

You don’t have time to take care of yourself and have accepted it because that’s just the life of an entrepreneur.

Value Creator

You obsess about the past, feel sorry for yourself and are increasingly worried that other people are going to cheat you in business and life.

Batteries Included

You find yourself in frequent nonconstructive arguments with your team and advisors, draining the energy of those around you.

FAILURE (8-24) 46

Issue 5

StartUp Health Magazine

It’s not what you think, it’s how you think.

The words you choose and your energy are directly related to whether you attract or chase away the very people – customers, investors and talent – you want and need to help you succeed. At StartUp Health we focus on mastering the Health Transformer Mindset™ so that entrepreneurs become magnets to attract the people and organizations needed to achieve health moonshots.

NDSET 4

SCORECARD™ 5

Score Yourself Where are you today? Where do you want to be in 30 days and how will you get there?

You are working on other things until you have more certainty that you’re on the right path.

You are fully committed to a short-term mission and don’t have clear vision beyond the next 12-24 months.

You are “all in” on your life’s mission and you are excited, fascinated and motivated to work on it for the next 25 years.

You have some good people around you and try to rely on them, but spend too much of your time convincing or “selling” them.

You have great people around you but still feel lonely, like no one quite understands why you always want and push for more.

You continually surround yourself with people, personally and professionally, with shared values and mindset and who support and encourage you.

You constantly feel like you haven’t accomplished “enough” so you try to catch up over weekends, with each week and month blending into the next.

You intuitively know what you need to do each week and each quarter but Fridays arrive and quarters end without you achieving what you planned.

You recalibrate quarterly, reflecting on and sharing your top achievements and priorities for ongoing personal and professional growth.

You haven’t sold yourself 100% on achieving your vision and people can see that you’re feeling beat up by daily challenges.

You keep hearing reasons why your idea won’t succeed, so you keep making your plans more “realistic” and less transformative.

You always convey confidence and a growing ambition for your life’s work, regardless of how difficult it is or how many times you get knocked down.

You are working really hard, doing things that you hate doing and aren’t really good at but “someone” has to do it.

You know what your “unique ability” is but are not really leveraging other people’s unique abilities often enough to amplify your efforts.

You are coachable, self-aware and living in unique ability, leveraging the unique abilities of others to achieve results through meaningful collaborations.

You know you need to take better care of yourself but don’t have the time, which negatively impacts your cherished relationships.

You make time for your family and yourself but occasionally slip into old habits when work gets too busy.

You take care of yourself physically and mentally every day, practicing gratitude and carving out regular time for personal, friends and family connection.

You know how to create value for yourself and others but are continually frustrated by lack of progress and current resources.

You find yourself continually referencing past achievements, deriving happiness from money or material possessions, appearance and status.

You continually make your future bigger than your past, expanding your happiness from personal growth, relationships and helping others.

You are often told you give energy to those around you, but constantly feel your interactions with others drains your energy.

You provide energy to those closest to you, but have not eliminated people from your life and business that drain your energy.

You are always providing energy to others and have no tolerance for those who drain energy so you fill your life with only “batteries-included” people.

FRUSTRATED (25–48)

TRANSACTIONAL (49–72)

TRANSFORMATIONAL (73–96) 47

MINDSETS

THE HEALTH TRANSFORMER FORUM WORKSHEET™ Collaboration Through Quarterly Recalibration

The Health Transformer® Forum Worksheet NAME:

COMPANY:

MY HEALTH MOONSHOT: HEALTH TRANSFORMER MINDSET™ CHECK-IN (Rate each mindset on scale of 1-12 for both today and next 90 days) 1

Mindsets Long-Term Commitments Supportive Relationships Quarterly Progress Confidently Ambitious

10 | 11 | 12

NOT ALL IN

HALF IN / HALF OUT

ALL IN FOR NOW

ALONE

UNRELIABLE SUPPORT

DECENT SUPPORT

FULLY SUPPORTED

TOO BUSY

INTUITIVELY KNOW

RECALIBRATE ENOUGH

RECALIBRATE QUARTERLY

NOT SOLD MYSELF

SHRINKING AMBITION

REALISTICALLY CONFIDENT

CONFIDENTLY AMBITIOUS

TALK MORE THAN I LISTEN

TRYING TO LISTEN MORE

LISTEN MORE THAN I TALK

THINK ABOUT MY THINKING

Healthy Habits

NO TIME FOR MYSELF

WISH I MADE TIME FOR MYSELF

SOME HEALTHY HABITS

PRACTICE HEALTH HABITS

Value Creator

STUCK IN THE PAST

PAST IS BIGGER THAN FUTURE

FOCUSED ON SHORT-TERM

FUTURE BIGGER THAN PAST

BATTERIES NOT INCLUDED

DRAINED BY OTHERS

TOLERATE OTHERS

ALWAYS BATTERIES INCLUDED

FAILURE (8-24)

FRUSTRATED (25-48)

TRANSACTIONAL (49-72)

TRANSFORMATIONAL (73-96)

Self Aware

Batteries Included

ACHIEVEMENTS CHECK-IN

Next 90

TOP PRIORITIES NEXT 90 DAYS, I’M EXCITED ABOUT…

Business Personal

Q__ 20____

Business

LAST 90 DAYS, I’M PROUD OF…

Today

ALL IN LONG-TERM

Personal

Every 90 days, entrepreneurs in the StartUp Health community gather in HEALTH TRANSFORMER FORUMS — virtual, small group sessions where they recalibrate on their mindset while sharing their top achievements, goals and priorities. In addition to increased accountability and connection, they get to explore issues where LEARN MORE they might be stuck, 6 Explore what benefiting greatly from it means to be the collective wisdom supported by and experiences of their a global army of Health peers. Here’s an example Transformers. of our strategic thinking 6 tool we use to guide our startuphealth.com discussion:

DATE:

ISSUE EXPLORATION / WHERE I’M STUCK Based on your check-in’s, what would you like to explore?

BIGGEST INSIGHTS: ™ & © 2020 StartUp Health, LLC. All rights reserved. Health Transformer Forum Worksheet™ is an integral concept of StartUp Health and may not be reproduced in any form, or by any means whatsoever, without written permission from StartUp Health. Made in the United States. StartUp Health is a registered trademark of StartUp Health, LLC.

Issue 5

StartUp Health Magazine

WHAT’S YOUR HEALTH MOONSHOT? ACCESS TO CARE COST TO ZERO CURE DISEASE END CANCER WOMEN’S HEALTH CHILDREN’S HEALTH NUTRITION & FITNESS BRAIN HEALTH MENTAL HEALTH & HAPPINESS LONGEVITY ADDICTION #TOGETHERWECAN

STARTUPHEALTH.COM

HEALTH TRANSFORMERS / WELCOME

The Growing Army of Health Transformers Each month StartUp Health welcomes inspiring entrepreneurs into our portfolio. Meet the teams that are now collaborating to achieve health moonshots. By Nicole Clark

The Health Transformers on the following pages are data-driven, community-focused, taboo-breaking entrepreneurs and innovators that hail from Australia, Central and South America, Africa and the U.S. They’re pushing boundaries in children’s health, early cancer diagnosis, and nutrition, and working to unlock the mysteries of the brain to end addiction and add 50 healthy years to every human life.

Issue 5

Javier Cardona

Alan Gale

1DOC3

Aimee Health

Health Moonshot: Access to Care

Health Moonshot: Longevity

Cardona got his start at Telefónica, one of the largest multinational telecommunications companies on the planet. Now, he’s the founder of 1DOC3, an e-health platform that’s helping 500 million Spanish speaking people in LATAM get answers to their most personal medical questions. 1DOC3 users pose health questions anonymously to doctors on the app, and in turn, the Q&As are analyzed to reveal health insights for insurers, pharma, and even governments. In Cardona’s home country, Colombia, 1DOC3 queries logged by teenagers on issues of sexuality provided the needed data to encourage public policy improvements that opened up access to contraceptives.

StartUp Health Magazine

Before entering the health innovation space, Gale was an early pioneer in public WiFi and grew one of the largest national networks, Deep Blue Communications. At Aimee Health he’s teamed up with nutritionists, machine learning techies and doctors to develop an AI-driven personal health concierge that evaluates an individual’s biology through biomarker testing in order to create physician-grade recommendations for vitamin supplements. After completing a short assessment in which customers note their primary health goal – stress management, focus, sleep or energy – Aimee mails customers BioPacks, 30-day kits of personalized vitamins. Using image recognition technology, their digital app can analyze

p Cala Health CEO Renee Ryan (L) with the company’s founder and chief scientific officer Kate Rosenbluth, PhD

the nutritional content of a customer’s diet with a photograph, and provide food suggestions that compliment their supplement subscription.

Renee Ryan & Kate Rosenbluth, PhD Cala Health Health Moonshot: Brain Health In 2019, Cala Health raised $51M from investors that included Novartis, Baird Capital, Johnson & Johnson Innovation, Lux Capital, GV and StartUp Health, to fund the market introduction of Cala Trio, a wristwatch-like device that delivers peripheral nerve stimulation as a remedy for essential tremors. Compared

to current treatment options – implants or meds – the tech is non-invasive and customized to each patient’s nerve activity. Prior to joining Cala Health in 2019 as the startup’s CEO, Ryan was a veteran life sciences venture capitalist, most recently at Johnson & Johnson. As an early investor in Cala Health she says: “it continues my journey to get closer to patients.”

Vipin Pathak Care24 Health Moonshot: Access to Care Despite a growing senior population, home healthcare remains a green market in India, being served by standalone,

small players. But as purchasing power grows in the country, demand for quality healthcare has increased significantly. Enter Pathak, CEO and founder of Care24. Founded in 2014, Care24 has helped more than 50,000 families heal at home in Mumbai and Delhi with its one-stop-shop home care platform and network of nurses, physiotherapists and health attendants. In 2019, Pathak’s company had 1,500 caregivers serving over 1,100 patients per day, with plans to launch services in five additional cities in India.

Nikhil Pooviah & Simon Holland Elly Health Health Moonshot: Access to Care Before Elly, Pooviah created CancerAid, the first cancer app in the world to integrate symptom tracking directly into the EMR workflow. His work there earned him a spot on the IBM Watson Health Advisory Board. At Elly, the radiation-oncologist-turned-entrepreneur has teamed up with Holland, a serial entrepreneur and startup advisor, to create an empathetic audio companion for patients living with cancer and chronic diseases. Elly promotes long-term clinical outcomes through a tiered, high-tech/

HEALTH TRANSFORMERS / WELCOME

high-touch approach: tailored audio content for each patient; insights from historical and supplementary health data; and learning, coaching and community support for longterm outcomes.

Abeer Ali HeartRite Health Moonshot: Nutrition & Fitness After a stint at Deloitte as a consultant in the health industry, Ali spent several years in California’s Orange County Health System as a project manager at Hoag Hospital. After learning to manage his own high blood pressure through a series of lifestyle changes, Ali started HeartRite, a digital health solution intended to support patients with lifestyle changes and medication adherence, particularly for those with hypertension. The company’s platform allows patients to log and track simple lifestyle metrics to learn how they can take control of their hypertension and their health in concurrence with their prescribed medications.

Bryan Mezue & Andrew Garza Lifestores Pharmacy Health Moonshot: Access to Care Nigeria’s economy offers a unique opportunity for mass market pharmacies: to be the first. Mezue and Garza’s aim is to break into this market, and make Lifestores Pharmacy the first pharmaceutical household name in Mezue’s home country. To do this, they’re opening brick n’ mortar drug stores in Lagos and using custombuilt software that also tracks patients’ drug records and

Issue 5

p Bryan Mezue (L) and Andrew Garza, co-founders of Lifestores Pharmacy in Lagos, Nigeria (read the full story on page 24).

medical advisors had refined MyRx365’s automated suite of software and fulfillment tools to fill over 30,0000 prescriptions with an average gross profit per prescription of $153. That’s 14 times more than the industry average – $11. By combining RealTime Clinic with MyRx365, Ali has created a care triangle of physician, pharmacy and patient. Patients can synchronize their health data in the MyRx365 app and authorize sharing, including appointments, lab results, prescriptions and medical history, from fitness trackers, the pharmacy or doctor’s offices.

Sina Chehrazi & Akash Magoon Nayya Health Health Moonshot: Access to Care

offers health management recommendations for chronic diseases like hypertension. To gain market share, they’ve cut out the supply chain middlemen. Instead, they work directly with manufacturing companies to lower the cost of drugs. To date, Lifestores has three stores in the Lagos neighborhoods of Yaba, Festac and Ilupeju, with plans to expand.

Nicolas Rosencovich, Cristian Waitman & Emilio Goldenhersch Mindcotine Health Moonshot: End Addiction Rosencovich, Waitman and Goldenhersch help smokers kick the habit using MindCotine’s VR-based tobacco addiction therapy. The Argentinanatives developed the smoking cessation device using a series of VR experiences that imitate

StartUp Health Magazine

social triggers for smoking, along with biofeedback sensors that help patients learn to control impulses. It’s meant to be used 20 minutes per day along with tools and resources in a companion app that help smokers deal with nicotine withdrawal systems. In early clinical trials with the University of Flores and the Research Laboratory in Neuroscience and Social Science in Argentina, thirty-three percent of MindCotine users remained abstinent, including co-founder Cristian Waitman.

Mohammad Ali, MD & Nehal Swami MyRx365 Health Moonshot: Access to Care In 2019, MyRx365 acquired Dallas-based RealTime Clinic, a StartUp Health portfolio company. Prior to the acquisition, Ali and a team of over 10

At Nayya Health, Chehrazi and Magoon have developed a real-time data visualization module to track granular shifts in the demand for health plan offerings. By monitoring shifts in the supply and demand of plans, they are helping payors and health systems optimize their provider network at the community level, and helping employers and brokers choose the most suitable health insurance for employees. Nayya scores the suitability of every major plan in the U.S. against micropopulations across the country. Using this population intelligence across 150 million Americans, they help health systems understand financial wellness and health gaps to proactively create the right mix of locations, providers, and products. Their aim? To prevent health and financial decline within neighborhoods or employee groups.

t awesome caption for Quantgene Health awesome caption for Cala Health awesome caption for Cala Health awesome caption for Cala Health

Brandon McCutcheon, Jack Schneeman & Logan Marcus, MD Phraze Health Moonshot: Cost to Zero Phraze is an AI-driven medical scribe aimed at reducing the effort needed for medical documentation. The platform collects data from initial patient onboarding and then listens to patient:provider conversations during the appointment and creates the first draft of medical charting. While the provider still reviews the AI-generated notes to verify accuracy, Phraze reduces documentation time by almost three hours per day, helping to solve the massive problem of physician burnout. The Minnesota healthcare startup was co-founded by McCutcheon, MD, a Neurosurgery Resident at Mayo Clinic; Logan Marcus, MD, a former Radiation Oncology Resident

at Stanford Health Care, and Jack Schneeman, Phraze’s co-CEO. The company recently graduated from UnitedHealthcare Accelerator, powered by Techstars.

Everardo Barojas Prescrypto Health Moonshot: Access to Care An electrical engineer by trade, Barojas designed, coded and deployed the first iteration of Prescrypto within six weeks, processing 1,000 electronic prescriptions in the first month. “With that traction, we secured our pre-seed capital,” including $100,000 from UNICEF. Prescrypto provides a blockchain-based infrastructure that physicians, patients and others in the health care system in LATAM can use to pass sensitive information, like a history of medications, back and forth. It has more

than 700 physicians in its network and its app, RexChain, has been the conduit for over 75,000 prescriptions, at a rate of 5,000 new prescriptions per month. In 2019, Prescrypto was named Blockchain Impact Award Winner by Blockchain in Healthcare Today.

p Jo Bhakdi (center) and his team at Quantgene are part of a wave of innovation in medical AI. Their DNA-centric approach helps determine a person’s genetic disposition to cancer.

Jo Bhakdi Quantgene Health Moonshot: End Cancer Bhakdi’s work at Quantgene falls within the new field of DNA-centric approaches to cancer detection. By using machine learning to analyze mutations in cell-free DNA (cfDNA) – a type of DNA that is expelled into the bloodstream from cells that have died or been killed – Quantgene can determine a person’s genetic disposition to cancer, whether they have cancer and in what part of the body. This is in contrast to hereditary testing, which evalu-

ates whether a person has a hereditary variant in their DNA. Bhakdi’s tech will allow for greater flexibility and versatility in complex, cancer patterndetection than neural networks, which currently attract most of the attention in cancer care. “Every time we stray away from neural networks we see huge advances,” says Bhakdi.

HEALTH TRANSFORMERS / WELCOME

Fred Nazem & Rishi Madhok, MD Rejuvenan Health Moonshot: Longevity Nazem, a health tech VC since the 1970s, built a reputation as a turnaround specialist after his successful reorg of Oxford Health Plans, which later sold to United Healthcare for more than $6B. In 2019, Rejevenan acquired BitMed, a StartUp Health portfolio company, and Nazem joined forces with Madhok, BitMed’s founder, to deliver wellness and medical care support wherever and whenever it’s needed. Their digital platform processes individual biomarkers and generates preventative health plans for patients, who in turn, can manage their plans via telehealth consultations with Rejuvenan’s ecosystem of board certified physicians and nutritionists. Plans cost $10/ month, and through a rewards program powered by the company’s partner, Kinesis, patients earn tokens that can be used toward wellness checks, urgent care visits, and disease management.

Jessica Corbin & Kristi Britto

Allison Kasirer

Health Moonshot: Children’s Health

Health Moonshot: Women’s Health

Health Moonshot: Nutrition & Fitness At Revita5, Corbin and Britto are using your employer as a conduit for serving up databacked lifestyle recommendations that manage stress and burnout. Revita5 employee-users take a 55-second assessment in the morning with an armband that comes with the Issue 5

to have a family. Her platform serves as a digital companion in a woman’s journey to parenthood and provides access to a network of providers in fields like nutrition, acupuncture and mental health, while offering a community of support where users can share, learn and gain accountability for healthy choices during pre-pregnancy and beyond.

Robyn

Revita5

app subscription, and receive a Heart Rate Variability Score (HRV). Scores are aggregated in order to provide a group health analysis to employers, along with recommended lifestyle interventions that address health challenges related to focus, energy, stress and sleep. “Now employers can be scientifically certain where the collective resilience is at on the stress spectrum, and what interventions actually move the needle,” says Corbin.

During Kasirer’s fertility journey, she remembers some really tough Mother’s Days. “You are surrounded by pregnant bellies, pictures of other peoples’ babies, and reminder after reminder that you are not yet ‘in the club,’” she says. At Robyn, she’s committed to destigmatizing and democratizing one’s right

StartUp Health Magazine

Danny & Jess Hui

p Says Revita5 co-founder Jessica Corbin: “The behaviors that created many of my health challenges as a youth originated in the belief that I had to achieve greatness in order to be worthy of love and respect. Once I learned how to embrace my inherent worth, the places my choices came from inside of myself changed. And so did my health, for the better.”

sameview

The Hui’s youngest son, Monty, was born with a complex disability which required care coordination with a team of over 30 different professionals. “We met families struggling with this same issue. sameview was born from our desire to provide others with the disability support and interventions we knew were needed to achieve each family’s goals,” says Danny. The online platform streamlines care coordination,

providing one place to connect and share information between therapists, educators, support workers and families. Prior to sameview, Danny developed the emergency management capabilities and processes used today by Australia’s leading power distribution provider.

t Special X founder Jason Lehmbeck (pictured with his family) built a platform connecting families of children with special needs with experienced Care Navigators.

Jason Lehmbeck & John Zimmerman

Dr. Ruben Kalra, MD & Sumeet Maniar

Special X

Wellbrain

Health Moonshot: Children’s Health

Health Moonshot: End Addiction

Lehmbeck’s son, Noah, has a genetic disorder that introduced the family to the challenges of navigating the world of disabilities. At Special X, Lehmbeck and his co-founder Zimmerman are building the kind of digital health platform that his family would want, one that connects parents raising children with disabilities to a curated network of health and education resources. The heart of the platform is a community of Care Navigators who help parents access the best care possible and build searchable, shareable digital health and education records for their kids. Prior to launching Special X, Lehmbeck co-founded the digital marketing startup DataPop (acquired by Criteo) with Zimmerman and was a vice president at Yahoo!.

Kalra, a Harvard-trained physician, along with a Buddhist monk and two Stanford- and Mayo Clinic-trained pain management specialists founded WellBrain in order to offer patients non-opiate treatment options for pain. Wellbrain’s chronic pain and addiction management digital platform enables pain doctors to give psychological evaluations and to digitally prescribe customized mindfulness therapies that are medically proven to reduce chronic pain, anxiety and depression. Maniar joined the company as CEO in 2016, and in 2019, the company expanded its reach to 17 states and over 30,000 patients using the platform.

Shireen Abdullah

LATE EDITION

Yumlish

Meet the Health Transformers who joined StartUp Health while we were on our way to print. (Read more at startuphealth.com)

Health Moonshot: Nutrition & Fitness After spending most of her career in finance and project management, Shireen changed paths to become what she calls a “food-preneur.” At Yumlish, she’s developed a social recipe video sharing platform that enables users with chronic diseases to discover recipes based on diet restrictions and preferences and share cooking experiences with one another. Yumlish connects registered dietitians to patients to ensure they have a personalized diet plan that works for them.

Amir Bozorgzadeh

Virtuleap Health Moonshot: Mental Health & Happiness This Portugal-based startup provides brain training via VR.

Andrea Wilson Woods

Cancer University Health Moonshot: End Cancer Cancer University is an online membership platform for cancer patients and caregivers.

Tanya Yarkoni & Sherman Sall

Rezilient Health Moonshot: Mental Health & Happiness Rezilient is a science-based, mental health coaching platform for family caregivers.

HEALTH TRANSFORMERS / MOMENTUM

Making Waves A progress report on Health Transformers and companies making leaps within the StartUp Health portfolio. By Patrick McGuire & Anne Dordai

Access to Care Cityblock Health CEO: Iyah Romm Cityblock Health combines primary care, behavioral health and social services into a comprehensive healthcare solution to bring better care to communities where it’s needed most. The Brooklyn-based company extends care past traditional doctor visits by partnering with local community-based organizations and building technology that delivers robust healthcare services to its members. Cityblock’s platform streamlines communication for its members, while compiling and analyzing large swaths of healthcare data to better understand patient health. The company recently teamed up with EmblemHealth, ConnectiCare and Blue Cross North Carolina to expand its reach to thousands of people living in low-income neighborhoods.

Issue 5

CliniVantage Healthcare Technologies CEO: Dinesh Samudra CliniVantage Healthcare Technologies builds end-to-end tech products and medical devices designed to enhance safety, quality of care and reduce costs throughout the healthcare industry. Based in Mumbai, India, CliniVantage creates solutions benefiting the entire healthcare ecosystem, from individual patients to public and private health systems. Their “MyLife” mobile app allows consumers to manage their healthcare appointments and prescriptions, while CliniVantage’s ProCare

Cityblock Health’s new Mobile Health Hub in North Carolina.

StartUp Health Magazine

platform features data management for large hospitals, clinics and physicians. A HIMSS Innovations Award recipient, the company currently has over 600 customers with 1.4 million patients registered, and has processed over 2.5 million transactions.

Cloudbreak Health CEO: Jamey Edwards Cloudbreak Health connects disparate hospital networks and healthcare professionals through its proprietary platform. Cloudbreak aims to increase patient care and cut costs by providing telemedicine technology that delivers integrated video and language services across a multitude of medical specialities. The California-based company connects over 1,000 hospitals across the U.S. and facilitates an average of 90,000 encounters monthly. Cloudbreak recently won the MedTech Breakthrough’s Best Overall MedTech Software Award, LA Business Journal’s 2019 Health Care Supplier of the Year and was featured on the Columbus Smart 50 List.

Doctor.com CEO: Andrei Zimiles Described as a “Yelp for the medical world,” Doctor.com is on a mission to modernize the way patients and doctors connect across the healthcare industry. Offered to private practices and hospitals, the New York City-based company’s platform facilitates appointments, analyzes patient reviews, and improves online searchability, powering more than 100 solutions for every type of stakeholder in the system. The platform features provider directories and data points that paint a broad picture of a medical practice or hospital’s reputation online. Doctor.com has built relationships with 30% of doctors in the U.S., with a consumer network reaching over 100M patients nationwide. Doctor. com is actively expanding its recently-launched life sciences division to empower patients to find and connect with proper specialists for care.

James Hare teamed up with cardiologist Dr. Carolyn Lam to start eko.ai and automate the fight against heart disease. q

PHOTO BY LAURYN ISHAK

HEALTH TRANSFORMERS / MOMENTUM

MouthWatch CEO: Brant Herman The New Jersey teledentistry company MouthWatch develops solutions designed to improve access for patients and boost revenue for practices. MouthWatch’s offerings include an intraoral camera that snaps high-quality images and TeleDent, a platform that delivers live-streaming, real-time data-sharing, and bespoke staff management features. TeleDent enables trained dentists to serve underserved communities by advising health professionals in places they aren’t able to be physically present in. MouthWatch, which hosted the

Issue 5

Second Annual Teledentistry Innovation Awards, recently expanded its services to school screenings, geriatric care and rural outreach initiatives.

StartUp Health Magazine

Ride Health

CEO: Imran Cronk

At Doctor.com, CEO Andrei Zimilies has built relationships with 30% of doctors in the U.S., with a consumer network reaching over 100M patients nationwide.

Founded by American Cancer Society Board Member Imran Cronk, Ride Health partners with healthcare organizations and ride services to provide transportation for patients who struggle to travel to receive care. The New York-based company has built a proprietary, tech-driven medical transportation ecosystem that coordinates logistics across organizations and streamlines transitions of care such as hospital discharges. Additionally, the platform takes into account the patient’s unique clinical and social needs, ensuring greater

access to care. Ride Health currently partners with healthcare organizations and transportation providers across 30 states. The company recently closed a $6.2M series A round led by Activate Venture Partners, with participation from New York Ventures, Newark Venture Partners and StartUp Health.

Trusty.care CEO: Joseph Schneier In an effort to address skyrocketing healthcare costs in the U.S., Trusty.care acts as a guide and translator for people stuck in the mire of applying for Medicare or Medicaid benefits. Trusty.care’s AI-driven tech is designed to help healthcare and insurance providers reduce the out-ofpocket costs of their members and help them make informed decisions about their health and benefits. The company’s proprietary software is now integrated into a network of over 400 credit unions, and the company recently partnered with the Center for Medicare and Medicaid Services, with a feature on medicare.gov.

Cost to Zero Biome Analytics CEO: Stuart Jacobson Biome delivers a new generation of performance applications designed to help physicians and hospitals deliver higher quality care at a lower cost, to every patient. The company combines clinically relevant benchmarks and assessments that include comprehensive libraries of clinical measures, risk stratification algorithms and performance improvement templates to guide both individual doctors as well as hospitals during crucial moments of care. Biome’s products, which are currently focused on cardiology are in use at over 40 hospitals across the country, and the company reports $3.2M in direct cost savings for its customers.

PHOTO BY JOE BUGLEWICZ

For their work lowering health costs by upgrading medical billing, Sift Healthcare recently won the Wisconsin Innovation Award. Hindsait

Inbox Health

CEO: Pinaki Dasgupta

CEO: Blake Walker

Based in New Jersey, Hindsait’s AI-driven platform is designed to reduce waste, unneeded health services, preventable human errors and fraud in healthcare systems that is costing U.S. taxpayers $1.2T every year. Hindsait’s proprietary technology analyzes large swaths of healthcare data to inform clinical decision-making, ensure billing-coding accuracy and root out errors, anomalies and fraud. Through machine-learning and predictive analytics, Hindsait’s technology reduces costs and improves efficiency in complex health systems. The company recently entered into a strategic partnership agreement with SAP to broaden its reach.

Inbox Health, a medical billing company based in Connecticut, creates proprietary algorithm-driven technology that streamlines and personalizes the patient billing process. The company endeavors to reduce waste and improve payment metrics through a platform that communicates with patients through optimized messaging, timing and channels. Frustrated with how needlessly complex paying his own medical bills was, Blake Walker founded the company with a desire to remedy the problem through technology and design. The company added 300 practices to its platform in 2019, and facilitated more than four million payments.

Particle Health CEO: Troy Bannister Particle Health’s proprietary, HIPAA-integrated platform is reinventing data access for patients and consumers. Through the Particle Health ecosystem, patients share medical information without having to go through gatekeepers, and healthcare providers, physicians and insurance companies are provided with direct, uncomplicated access to the robust data network when they need it. The company raised a $2.3M seed round, led by Collaborative Fund with participation by StartUp Health, and it now has access to over 200 million patient records, 600,000 providers and >90% of acute EHRs including Epic, Cerner, Allscripts and athenahealth.

Sift Healthcare CEO: Justin Nicols Sift Healthcare’s medical billing platform is driving medical billing costs to zero for healthcare providers by collecting complex sets of payment data and making it easier to understand and predict future payment. Led by Justin Nicols, an industry expert in data analytics technology, the platform allows users to track payor behavior, view payment trends and identify claim denials in real time. An official presenter at the 2019 Cleveland Clinic Medical Innovation Summit, Sift Healthcare recently scored over three million healthcare claims from their partners and has been onboarded to support two top30 health systems. In addition, the company recently won the Wisconsin Innovation Award.

SWIFT SHIFT CEO: Assaf Shalvi SWIFT SHIFT’s platform gives homecare agencies the power to attract talent, fill shifts and onboard new patients through a suite of mobile apps to create a better experience for all individuals involved in the industry -- agencies, caregivers and patients. The company aggregates and displays available shifts from multiple providers and matches them with local nurses through its proprietary recruitment marketplace. Operated on a paid subscription model, SWIFT SHIFT’s platform is designed to deliver convenience and reliability to nurses, patients and homecare agencies. The company recently completed a pilot program with a top-ten homecare provider, and is now expanding to the entire skilled nursing unit.

HEALTH TRANSFORMERS / MOMENTUM

Vive Benefits CEO: Ron Weidner Vive Benefits offers a suite of financial and administrative services designed to reduce complications and risks associated with traditional High Deductible Health Plans. The Utah-based company aims to stand in as a better substitute for health savings accounts through its health plan management app and medical payment card. Vive Benefits provides liquidity to employees during medical events, automates tax optimization and reduces borrowing costs by offering low-interest loans for healthcare services. Vive has developed carrier partnerships and broker relationships to deploy their novel financial solution to reach their first commercial goal of 100K members, and have closed multiple partnerships with leading financial institutions, getting it closer to eliminating medical bankruptcy.

u Sally Poblete, CEO and founder of Wellthie, is using her decades of experience as an insurance executive to modernize the health insurance industry and help small businesses.

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StartUp Health Magazine

Wellthie

Cecelia Health

Conversa Health

CEO: Sally Poblete

CEO: David Weingard

CEO: West Shell III

Wellthie delivers cloud-based, SaaS marketing and analytics tools designed to help insurance companies better sell to consumers and improve retention rates. The New York Citybased company modernizes the small business insurance shopping experience by offering the largest health insurance marketplace for small businesses, combining an enterprise-grade platform with direct access to expert broker support. A massive marketplace of over 12,000 products from more than 200 national carriers combined with an instant quote feature give small businesses a convenient one-stop shopping experience for all their insurance needs.

Cecelia Health, a New York City-based company, transforms lives and significantly improves the health outcomes of people living with chronic diseases. The platform streamlines patientphysician communication and is designed to help healthcare professionals increase patient volumes without sacrificing quality of care. Cecelia’s app allows doctors to not only coach their patients, but to also monitor and understand their health through collected data. Cecelia Health recently appointed former president of MetroPlus Health Plan, Dr. Arnold Saperstein, as its chief medical officer, as the company expands its products and services to customers across pharmaceutical, medical device and health plan market segments.

Headquartered in Portland, Oregon, Conversa’s Conversation Platform delivers personalized, automated virtual care that monitors and manages populations at scale. Through AI technology built to converse with patients, the Conversa Conversation Platform draws from comprehensive clinical libraries in order to engage patients on health topics such as chronic care, pre and post-surgical care, medication adherence and a myriad of others. Customers working with Conversa reported a reduction in costly readmissions by over 30%, improved care plan adherence by 72% and a 30-50% reduction in unnecessary calls. In 2019, Conversa landed 10+ new clients including Northwell Health, UCSF, Davita, UNC Health and more, bringing the company closer to making conversation the cornerstone of health.

Cure Disease AdhereTech CEO: Josh Stein AdhereTech is a New Yorkbased company building tools to address prescription adherence. Sourced with data published by various large international healthcare companies, the company offers a proprietary medication adherence platform designed to help patients stay on their medication longer. AdhereTech’s massive data analytics offering allows pharmaceutical companies to better understand why patients discontinue, change or pause therapy. AdhereTech works with many of the world’s largest cancer drugs and multiple sclerosis drugs, and through these partnerships impacts tens of thousands of patients.

PHOTO BY JOE BUGLEWICZ

Cyclica

eko.ai

CEO: Naheed Kurji

CEO: James Hare

Cyclica’s cloud-based, AIaugmented technology is built to help scientists design, screen and personalize medicines to shorten drug discovery from seven years, down to two years. The Canadian-based company pioneered Ligand Express, a proprietary computationally biophysical platform that delivers insights into a drug’s polypharmacology, and has developed other technologies designed to map and optimize medicines. Cyclica recently partnered with Yuhan Corp, one of Korea’s premier pharmaceutical companies, to advance the discovery of first-in-class medicines for oncology. And most recently, Cyclica and Biotech ATAI Life Sciences formed a new joint venture aimed at battling mental health by designing and synthesizing new compounds.

This Singapore-born company is automating the fight against heart disease. Serial entrepreneur James Hare teamed up with cardiologist Dr. Carolyn Lam to develop software that transforms the labor intensive process of developing and reading echo exams, reducing it to a one click, two-minute experience. The automation technology has gotten the attention of hospitals wanting to improve care as well as pharmaceutical companies hoping to speed up clinical trials. Eko.ai raised a $4M seed round, led by Sequoia, EDBi, with participation from StartUp Health. In 2019, the company won the Parkway Pantai Hospital Group’s Innovation Award and the Johnson & Johnson JLABS Innovation Award.

This year eko.ai beat out 2,400 applicants from more than 120 countries to win the grand prize at the SLINGSHOT 2019. 61

HEALTH TRANSFORMERS / MOMENTUM

Joint Academy

Qura

Sanguine Biosciences

CEO: Jakob Dahlberg

CEO: Doug Adams

CEO: Brian Neman

Qura develops wireless, implantable, pressure-monitoring technology designed to collect and analyze healthcare data in real time. Hailing from Sudbury, Massachusetts, Qura aims to usher in a new era of “disease intelligence” in healthcare through implantable devices smaller than a grain of rice that can detect spikes in pressure in glaucoma and heart disease patients, adding data and analytics as an additional dimension for treatment. The company has 70 issued, licensed or pending patent applications, and has signed a manufacturing and supply agreement in support of their launch in the U.S. They are now accepting pre orders from veterinary ophthalmologists.

Founded in Los Angeles, CA in 2010, Sanguine is on a mission to put patients in charge of their health data to accelerate medical research. Using what might be called an “Uber-forclinical-trials” model, their Trial Match platform makes it easy for patients to find and sign up for clinical trials and then sends a phlebotomist to their door. The company uses this interface to build what they call Sanguine Verified Patients communities, which then enable pharma partners to enroll and complete clinical trials more quickly. To date, Sanguine has worked with more than 30,000 patients on more than 500 research projects (and has been profitable since 2017).

Joint Academy connects patients suffering from osteoarthritis with personalized treatment plans through a “digital clinic”, setting a new global standard for treatment of osteoarthritis. Patients are paired with licensed physical therapists who track treatment progress and prescribe pain management exercise plans. The company aims to provide healthy, sustainable treatment alternatives to substitute pain medication that can benefit patients without them ever having to visit physical therapists in person. Joint Academy has already treated over 10,000 patients and has secured cornerstone clients with payors and health systems in the U.S.

Vheda Health CEO: Shameet Luhar

Nightingale Health CEO: Teemu Suna Born in Finland, this health company is tackling the global burden of chronic disease by predicting diseases earlier. The team’s proprietary blood test acts as an “early warning system,” allowing patients to understand their future risk of diseases like cardiovascular diseases and diabetes. After a sell-out launch in 2018, Nightingale has expanded to the U.S., with partnerships through PerkinElmer Genomics’ CLIA and a CAP-certified clinical laboratory in Pittsburgh, and into Asia through a collaboration with National University of Singapore to realize the prevention of chronic diseases in South East Asia. Most recently, the company launched My Nightingale, an app that provides personalized and comprehensive health data based on an individual’s blood, so that they can understand how their lifestyle affects their body.

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StartUp Health Magazine

Health insurance industry veteran Shameet Luhar heads Vheda Health, a company focused on cutting healthcare costs for underserved populations through a combination of high touch care and technology services. Vheda Health reduces costly emergency room expenses by designing tools that automate care plan compliance within patient populations. Plans enrolled with Vheda Health are proven to save an annual average of more than $17,000 per member per year. The Maryland-based company boasts a 41% ER and admit utilization reduction, as well as a 76% Medicaid member retention rate.

Women’s Health Babyscripts CEO: Anish Sebastian Babyscripts empowers providers and payors to improve the health of their pregnant and postpartum mothers through digital tools and remote monitoring experiences. With a moonshot goal of eliminating maternal mortality and morbidity in the U.S. by 2030, Babyscripts’ platform features American College of Gynecology (ACOG), CDC and NIH resources as well as customization features allowing physicians to upload videos and handouts to guide mothers throughout their pregnancies. As mothers interact with the platform through the “Mommy Kit” that includes a smartphone app and internet-connected medical devices, physicians are able to adjust care plans and intervene when needed without face-to-face visits. Babyscripts currently works with over 50 health systems in 24 different states that see more than 200K pregnancies a year, and it was recently named a Top 4 Femtech Company by UCSF Digital Health Awards.

Gennev CEO: Jill Angelo Founded by former Microsoft executive Jill Angelo, Gennev is a Seattle-based company that offers telehealth services, products and education resources for women experiencing menopause. Self-described as an “online clinic,” Gennev empowers women to take control of their health in the second half of life through a digital platform that connects women with physicians, builds personalized treatment plans

and sells products that deliver menopause relief. Named one of Fast Company’s 2019 Health Trends of the Year, the womenowned company raised $4M in its seed round, led by Blue Run Ventures with participation by StartUp Health.

therapy for hand tremors. Cala Health recently raised $51M in its series C funding from investors including Novartis, Baird Capital, Johnson & Johnson Innovation, Lux Capital, GV and StartUp Health.

Savonix

Children’s Health Special X CEO: Jason Lehmbeck Founded by the father of a child with special needs, Special X provides families with special needs children with “Care Partners” to navigate legal work and insurance while also building a digital health and education record. The Special X app enables parents to connect with care providers, educators, insurance experts and other special needs families. The company recently launched a closed beta program for families living in Los Angeles.

Brain Health

CEO: Mylea Charvat, PhD Based in San Francisco, Savonix’s proprietary Digital Cognitive Assessment Platform assesses the cognition of dementia patients through gamelike versions of neurocognitive tests. After analyzing a patient’s test results, Savonix’s platform provides clinical decision support and care-planning tools in accordance to their Diagnostic and Statistical Manual of Mental Disorders. Savonix and the Boston University School of Public Health recently partnered to launch the ASSIST study, a 400,000 individual, three-year study of brain health to identify how a wide range of factors influence our risk of developing dementia.

Cala Health CEO: Renee Ryan Headquartered in the San Francisco Bay Area, Cala Health’s innovations are designed to deliver personalized peripheral nerve stimulation for patients suffering from a wide range of ailments. Cala merges wearable neuromodulation therapies with neuroscience technology to treat hand tremors, and the company is currently also developing treatments in the fields of neurology, cardiology and psychiatry. A pioneer in the bioelectronic medicine field, the company’s wearable Cala Trio product is the first non-invasive

Mental Health & Happiness wayForward CEO: Ritvik Singh wayForward, a New York-based company, simplifies access to emotional wellness and behavioral healthcare to give people the care they need, when they need it. Navigating complex systems in order to receive behavioral health treatment is a major hurdle for many patients. wayForward addresses this problem by offering streamlined mental health services ranging from a self-guided program designed by clinicians to text coaching and video therapy. Now covering over five million employees through 13 partners including Humana, the company works with Employee Assistance Programs (EAPs) throughout the U.S. “We’ve identified gaps in mental and behavioral health – and there are many – and we bridge them using evidence-based solutions and delivering them by our technology,” says Ritvik Singh.

Longevity CarePredict CEO: Satish Movva CarePredict creates machinesensing technology designed to discreetly monitor the health of aging populations. It reduces staffing costs and increases the quality and speed of care in single and group living homes by alerting health professionals and care providers when a senior’s daily living patterns differ from usual. Through noninvasive, wearable technology, CarePredict monitors patterns such as sitting, drinking, bathing, toileting, walking, sitting and sleeping to assess, predict and address health issues facing vulnerable seniors. In 2019, CarePredict signed contracts with 15 senior living facilities, four homecare franchises and a distributor, with access to 12,000 patients in the U.S.

LifeBio CEO: Beth Sanders Founded by healthcare journalist Beth Sanders, LifeBio is a digital storytelling platform for seniors designed to integrate into assisted living facilities, hospices, hospitals and residences that facilitate long-term care. The platform allows seniors to tell personal stories through text, photos and music about their lives, health and memories which reduces loneliness and increases social connectedness and wellbeing. Caregivers can access the platform to better understand their patients and improve their quality of care. In 2019, LifeBio’s sales exceeded $1M.

Read more about Savonix’s partnership with Boston University’s School of Public Health on page 20.

HEALTH TRANSFORMERS / MOMENTUM

Devoted Health CEO: Ed Park Founded by brothers Todd and Ed Park, Devoted Health is a next-generation Medicare Advantage plan guided by a deep belief that every member should be treated like family. The company provides dedicated guides that shepherd members through the plan and the healthcare system at large, including everything from obtaining information about local doctors and pharmacies to finding fitness classes and eyeglasses. Devoted Health aims to be a one-stop shop that meets

Issue 5

the healthcare needs of seniors and limits unnecessary trips to the doctor. The company is actively enrolling members into two new plans across four counties in the Houston metro area.

Zeel CEO: Samer Hamadeh Zeel is credited for pioneering the first mobile on-demand massage service through an app that delivers therapeutic massage, assisted stretching and yoga to customers at homes, hotels, spas and workplaces. Easily described as a “Lyft for massage”

StartUp Health Magazine

service, Zeel dispatches vetted, licensed and insured wellness professionals to its served locations in as little as an hour, seven days a week, 365 days a year. Zeel is also home to Zeel Spa, an on-demand staffing solution that allows spas to book appointments that normally would have gone unfulfilled due to last minute call-outs and appointment unavailability. Recently, the company signed a 138-hotel deal with Hyatt to power in-room massage at their hotels without spas. In 2019, Venus Williams joined the company’s Board of Directors and Cindy Crawford joined as brand

p Samer Hamadeh founded Zeel with his wife, journalist Alison Harmelin. Read Harmelin’s “Six Rules for Building Partnerships” on page 18.

ambassador, collaborations that fuel the industry’s understanding of how massage impacts health.

PHOTO BY JOE BUGLEWICZ

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

60% of maternal deaths are preventable.

Better Pregnancies.

Learn more about our virtual care platform for obstetrics: babyscripts.com @babyscripts 65

FOR THE BENEFIT OF ALL -NASA MOTTO 66

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StartUp Health Magazine

FEATURES No Time To Pause

What corporate America still needs to embrace about women’s health – particularly menopause – for the good of society and the bottom line.

Connecting the Dots

How startups like Particle Health are borrowing concepts from fintech to open up access to patient data.

Current Therapy

Cala Health takes on neurological conditions with a novel approach – by reverse engineering the nervous system.

NO TIME TO PAUSE What corporate America still needs to embrace about women’s health – particularly menopause – for the good of society and the bottom line.

Interview with Gennev CEO & founder Jill Angelo. By Nicole Clark Photo by Gavin Doremus

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StartUp Health Magazine

My mother was in her late forties when she began to experience hot flashes and sleeplessness. She was a public-school teacher in Chicago at the time, and her menopause symptoms didn’t care that she was in the prime of her career. They came, ready or not. And she didn’t hide her stage of life. Instead, she taught her class of prepubescent sixth graders how to support a working woman who was doing her best to manage menopausal symptoms. When a hot flash came on, her skin would flush, and she’d fan herself with the nearest piece of paper or magazine. This was the students’ cue to throw open the windows, “for Pete’s sake.” When she’d had a rough night’s sleep, I’d find her on the couch in the mornings, “just squeezing in a nap” before work. For many working women, figuring out how to keep an edge in the workplace as their body prepares for a new, physical way of being (read: menopause) has required grit, if not an all-together scrappy DIY attitude. Much like my mother’s. While our knowledge of menopause and how to offer symptomatic relief for this inevitable phase of a woman’s life have evolved, there are still many unknowns and cultural barriers when it comes to understanding it. One of the most uncharted territories? Knowing how to support menopausal women in the workplace. I had the privilege of sitting down with Jill Angelo, CEO and founder of Gennev, to understand the challenges menopause symptoms can pose in the workplace, but more importantly, to learn what employers need to do to ensure they are creating a work environment that allows women to reach their fullest potential. Gennev is a Seattle-based company that runs an online clinic for women experiencing menopause. To date, they have 16,000 women in their community of customers and 70,000 per month consuming free education. They recently launched a third tier of services, called HealthFix, on their digital platform that gives women unlimited access to a menopause health coach and wellness programs for hot flashes, anxiety, nutrition and fitness. Other tiers include a telehealth portal, as well as products created to help women find relief for menopause symptoms like vaginal dryness and insomnia. While the company’s model is direct-toconsumer, Angelo believes the guiding philosophies of Gennev – community, awareness and support – can be a roadmap for transforming the workplace into a more empowering environment for women experiencing menopause.

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StartUp Health Magazine

MENOPAUSE 101

Nicole Clark: What are some common symptoms of menopause and how do they interfere with work? JILL ANGELO: Perimenopause can be the most symptomatic time for working women. In this stage, there are symptoms that can either interfere with or become aggravated by working conditions. Some of these symptoms include irregular menstrual cycles, difficulty sleeping or insomnia, mood swings and hot flashes. When it comes to menstrual changes, like heavy flow or irregularity, many women have said to me, “I didn’t want to get up from the chair,” or “I waited for everyone to leave the meeting room for fear of what might be there.” I’ve heard countless stories of women who have experienced that kind of humiliation in the workplace. Postmenopausal women can also have symptoms to manage. One woman who is a senior executive shared how every time she steps on stage, she gets a hot flash. She’s in her early 60s and is a seasoned presenter, but there’s something about stress that triggers a hot flash. It is something she has to be mindful of, in addition to nerves or any normal stress that comes with being in the spotlight. With regards to anxiety and brain fog, many women say that they feel like they’ve lost their edge, simply because they can’t focus, or find it hard to keep their energy level up because they are not sleeping well. Or, their anxiety is up for reasons they can’t quite explain.

Why aren’t we talking about menopause in the workplace? In all of these symptoms, there is humiliation baked into them. Many women feel that if they ask for workplace flexibility in any one of these areas, then they are admitting they aren’t capable of doing the

job they’ve been asked to do. So, women hide it. We mask it. And that is what makes progress – getting to a place where we have workplace benefits and wellness programs for women – such a stretch. When I talk to HR directors or benefits managers, they say, “Women aren’t asking for that.” My counter to them is, “Would you, if you were in this scenario?” And they say, “Probably not.” Until women feel comfortable talking about this, or feel they won’t suffer diminishing returns if they voice their needs, creating a menopause-friendly workplace will be out of reach.

What does a menopausefriendly workplace look like? There are three things that the team at Gennev has found to be effective: Education & Awareness. Employers can start normalizing menopause by building awareness through education. Content in all of its forms is the number one way menopause education can start to be a wellness service for employees. Discreet Wellness Services. Access to menopause experts is lacking in the U.S. Giving women access to Gennev’s coaching services is an example of how they can offer a self-help service for women to get the support they need. And it’s very cost-effective. Employers all over the place are offering preventative telemedicine and coaching services to ensure their employee base stays well. It’s a no-brainer to align those services in this segment of health as well. Community. More and more, communities form in the workplace across a range of topics and identities – for those trying to quit smoking, or parents of foster children, or ethnic-based communities. People need community to feel like they aren’t alone, to ask questions and to cope. The same goes for women in menopause. This is an opportunity to support a group of workers that is growing.

Nicole: I feel like I should know this, but what is menopause, exactly? Jill: Menopause is defined by the Mayo Clinic as a permanent end to menstruation, occurring after a woman has no period for 12 months. Nicole: Got it. When do women experience it? Jill: It hits at the average age of 52 in North America and Europe, 49 in Latin America, and 46 in Asia (environmental and cultural conditions account for the variation). But the transition leading up to menopause, called perimenopause, can begin several years earlier. Nicole: No periods – sounds nice. What else happens? Jill: Shifting hormone levels during menopause can yield symptoms like hot flashes and heavy sweating, trouble sleeping, brain fogginess, urinary problems and mood swings.

What are the biggest obstacles to moving the needle on women’s health in the workplace? In my conversations with HR directors and managers, I often hear, “We create wellness incentives based on the loudest request.” If they don’t see the risk of losing more senior women in the workplace because of what they’re experiencing in menopause, they’re not going to react to it. Menopause is a mystery to most, even though every single woman will go through it and women have gone through it since time immemorial. The first few steps we have to take to make adjustments in the workplace are small. It’s not rocket science – just start the conversation.

If every woman will experience menopause and the number of menopausalaged women in the workforce is growing, is change inevitable? Women are working longer because we can and because we want to. So many social dynamics are in play to bring the menopause conversation into the workplace. But a quick study of women’s health initiatives tells us that roadmaps are needed to create change. We had to raise awareness and advocate for change to gain things like maternity and paternity benefits. Now they’re normal. Then, fertility benefits normalized. There are examples of companies, namely in the U.K., that have instituted workplace policies with accommodations like flexible work arrangements and paid leave for female employees going through menopause, but these policies are not widespread. Those types of menopause benefits in the workplace have to go through that same change cycle. Five to 10 years from now, we’ll be saying, “Why wouldn’t we have menopause benefits?” But that requires moving from awareness to action, and actually creating menopause wellness programs.

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StartUp Health Magazine

“It wouldn’t be change without a little discomfort at first.” Are we gaining changetraction anywhere? I’m hearing some excitement from plan providers and benefits managers who are intermediaries for big companies and who have added menopause wellness programs to their benefits roadmap. Plan creators tend to be more interested because their ability to innovate on plan offerings helps them better support their clients. With any measure we put in place that might expose where we’ve been lacking, or expose an inequality, we bring about some level of discomfort. It wouldn’t be change without a little discomfort at first. But you will never know how much better something can be – in this case a better working environment for menopausal women – unless you’re willing to experience some of that initial discomfort in exploring the unknown. When it comes to this issue, time is of the essence. It – time – is the one thing that’s finite. Women will never get more time to work or to do more, any more than their male coworkers will. The only way women can reach their potential is if we create an environment or a way of working that enables us to do so. The more provocative we can be with the kind

of wellness offerings for women, the more women will be able to rise up to a level they might otherwise never have gotten to. And eventually, the employer will be the winner, along with the women, because they’ll have healthier, more productive employees.

Did women in your family talk about how to manage menopause in the workplace? I grew up in the Midwest, and the women in my family were experts at practicing mind over body. When it came to menopause and other women’s health topics, the general guidance was to get through it, be discreet and never let people know you are suffering in any way. In the Gen X, Millennial and Gen Z generations, we’re more inquisitive and thankfully my mom and grandmother were open if I asked them a question. They didn’t brush it under the rug. That’s where this next generational shift can happen, in conversations about menopause with our mothers, grandmothers, aunts and friends.

Any words of wisdom on learning not to fear the changes that come with menopause? (Asking for a friend.) I’m just starting to go through perimenopause. I don’t have any bigger or bolder words of wisdom, other than, thankfully, I come from a very optimistic family and I learned to look at this transition in life for its benefits, and what it will give me. What women experience as we age is a normal thing. Even more than normal, it prepares us for the second stage of life, offering so many new freedoms, courage and confidence than before. We have the opportunity to flip this thing from being negative, to empowering women to come into their own.

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

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CONNECTING

THE

DOTS

Troy Bannisterâ&#x20AC;&#x2122;s Particle Health is following fintechâ&#x20AC;&#x2122;s lead to close the gaps in data sharing. By Morgan Childs

“Can you Venmo me?” It’s amazing how quickly the extraordinary becomes common. Within the last decade, and without much fanfare, we entered a brave new world where personal financial data is securely accessible to third party apps – like Venmo – at the tap of a screen. More and more of us are reaching for our smartphones to reimburse friends for a shared meal or keep a monthly budget in check. This is all possible because of advances in technology that have made financial data sharing – across a vast range of platforms – both easy and secure. Where once society preferred the security of brick-and-mortar banks, now, modern financial institutions can’t thrive without providing free and instant digital access to accounts. And then there is the world of healthcare. Consider this: If your primary care physician needs a set of test results, they call the lab to submit a request. After a lag of hours

or days, the results get printed and faxed to your doctor. That’s right – faxed. Fax machines still account for around 75 percent of all medical communication, according to reporting by Vox in 2018. After the hard copy pulses out of the machine, someone has to manually transfer the results into a computer system. And in the unfortunate event that you wind up in the hospital, there’s no guarantee that your data will follow. It’s not that hospitals aren’t keeping digital records. Most are. It’s that each system is incompatible with the next. The transfer of financial data is a complex and highly sensitive process, yet developers, fintech companies and banks have created a system that allows financial transactions to proceed with ease and security. In contrast, the transfer of health data remains mired in decades-old technology and methodology, leading to a massive disconnect between providers, hospitals and other healthcare entities. When data doesn’t move quickly, patients can suffer. Drawing inspiration from financial markets, entrepreneurs in health are bringing healthcare out of the museum and into the present.

FROM HEALING PATIENTS TO HEALING THE SYSTEM

Troy Bannister has always been “the medical guy.” He worked as an EMT in college, and when friends got injured, they went to him for help. After graduation, medical school at Georgetown was a logical next step. “I hated it,” Bannister recalls. “I saw a bro-

PA R T I C L E H E A LT H B Y T H E N U M B E R S

600K providers

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StartUp Health Magazine

ken system that I didn’t want to be a part of.” So he pivoted his attention from treating people to treating the system. Bannister finished a master’s degree in physiology and biophysics, but it wasn’t until he worked as a clinical researcher at Mount Sinai Hospital that the pieces began to come together. He observed firsthand both the power of data to improve health outcomes, and the difficulty that payors, providers, vendors and patients have in meaningfully accessing that data. That experience led to working at StartUp Health for several years, evaluating entrepreneurs for investment and writing health industry funding insights. Bannister was in close contact with companies pioneering extraordinary technologies, and time and again, he heard that these companies didn’t have access to the data they needed. “I was talking with a lot of entrepreneurs, pharmaceutical companies, payors, providers, you name it, and saw that no one could easily access medical information. I was seeing startups either have to transfer data by fax or patient portal, or have to integrate directly into a hospital, which costs tons of money.” Bannister decided to create a solution to the data access problem he observed, and in 2018, he launched Particle Health, taking on the role of CEO. At a recent pitch competition, he explained the company this way: “With Particle Health, we allow you to share your medical records with third parties securely and simply over the web. We have a ‘HIPAA Auth’ tool that makes us compliant, just as a fax would be, and just like the paper you’d sign at your insurance

40K clinics

company.” That layer of compliance allows Particle to instantly pull data through an API with nothing more than the user’s first name, last name, zip code and date of birth. For example, when an individual gives an insurer access to their health records, that company can use Particle’s API to pull their data from any EMR. Particle’s consent tool even makes it possible to pull data needed for life insurance underwriting. According to Bannister, any company struggling to gain access to patient data could plug into the API and be integrated in a couple days. Right now, Particle has over 600,000 providers, 40,000 clinics and 1,700 hospitals on its system. The company has access to more than 200 million records currently, including records on EPIC, Cerner, Intersystems, athenahealth and other EMR providers.

INSPIRED BY PL AID

Bannister drew inspiration from Plaid, a company that provides the digital infrastructure to connect developers – and thus, consumers – with financial institutions. Most consumers don’t know about the role Plaid plays in facilitating the exchange of their financial data, even if they use Plaid-powered apps like Venmo, Mint and Robinhood on a daily basis. Founded in 2013 and currently valued at $2.7 billion, Plaid integrates with more than 10,000 banks and connects to more than 20 million consumer accounts. “We kind of looked at [Plaid] and said, hey, this is really interesting from a few standpoints,” says Bannister. “One, it’s solv-

1700 hospitals

ing the fragmentation problem. It’s one API that connects to all the banks, and that’s what we wanted to do, build one API that can connect all the EMRs. What’s also really smart about the way Plaid did it was they’re not building solutions. They’re powering solutions.”

THE ROLE OF THE CONSUMER IN DATA PORTABILITY

Particle Health is resonating with consumers. At a pitch competition at the 2019 HLTH conference, Bannister took home an Audience Choice award of $25,000. The company’s reception underscores an important shift taking place in the conversation about health data and interoperability. Until now, interoperability initiatives focused on computers talking to computers and hospitals talking to hospitals. But the reality – and the future that Particle Health is painting – places the individual at the center of the equation. A consent-driven platform like Particle Health puts patients back in the driver’s seat with their data. That’s not to say it’s all on the consumer, says Bannister. There is a midpoint where people control their data but aren’t burdened by its management. That’s Particle’s sweet spot. It doesn’t hurt that the law, and recent regulations, are tipping in Particle’s favor. The 21st Century Cures Act, signed into law at the end of 2016 and designed to promote medical innovation, calls for the “real world” testing of technology that promotes data exchange “without special effort on the

part of the user.” The legislation also explicitly restricts information blocking. In another promising push forward, in early 2019, the U.S. Department of Health and Human Services put forward new standards to improve health data interoperability. Then there’s this oft-neglected fact: “The P in HIPAA stands for portability, not privacy,” Bannister points out. He notes that in September 2019, the Office for Civil Rights announced that it had fined a hospital for failing to provide a mother with the fetal heart monitor records of her unborn child in a timely fashion, the first such enforcement action under HIPAA’s Right of Access Initiative. At the moment, Bannister adds, “there’s a big push for the portability part.” Particle’s API would allow important data to inform decisions throughout an individual’s healthcare narrative. Pharmacists could receive and review a patient’s full health history – including allergies and chronic health conditions – before dispensing a new drug. Or by analyzing data and medical histories embedded in EMRs, an AI platform could make targeted recommendations about what insurance plan a person should select, or when they should go in for skin cancer screenings. Bannister notes that interest is already trickling in from potential partners hoping to build on the technology and establish new avenues for care. “What we’re really excited about is what could be built on top of this,” says Bannister. “What kinds of amazing tools could be developed if companies could access your medical records at the click of a button?”

200M records

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CURRENT THERAPY

C A L A H E A LT H TA K E S O N NEUROLOGICAL CONDITIONS WITH A NOVEL APPROACH — BY REVERSE ENGINEERING T H E B O DY ’ S NERVOUS SYSTEM.

B Y J O D I LY O N S

romodulation device called the Cala Trio. This sleek wrist wearable delivers electrical stimulation through the median and radial nerves to the brain, providing relief for essential tremor, a condition that affects up to 10 million people in the U.S., according to the NIH. The device garnered De Novo FDA clearance in April 2018. N EU RO M O DU L AT I O N 1 0 1

Or at least I attempted to play, unsuccessfully, as I had for the last 10 weeks. Ever since I’d suffered a stroke at the age of 50, I hadn’t been able to pinch my fingers to grab the plastic game pieces and drop them into the grid. Other patients recovering from stroke, most of them in their 80s, were scattered throughout the open, colorless space, doing their own various exercises. The series of wires attached to my right hand led to a large beige device that resembled an old toaster. Sitting at my right side, Casey, my therapist, turned up the dial on the “toaster” to send electrical currents to my hand. On the first turn nothing happened. A little higher and I thought I felt something, but decided that my brain was playing tricks on me. Finally, Casey increased the power even more, and my thumb contracted. Then my fingers also contracted, and I made a fist. I stared at my hand, astounded. I shouted, “I can’t believe that worked!” After a long period of recuperation, this was the first time I felt hope that I might regain my fine motor skills. I was happy with the progress but also intrigued by the science of using electricity 80

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in treatment. As a consultant and author in the area of elder care and aging, I help elders find the healthcare they need. I work with people’s brains for a living, and I’m licensed to administer screening tests to see if my clients have cognitive issues. I’d seen so many others deal with the challenges of stroke recovery. And now here I was, getting a closer look than I’d ever bargained for. The electrodes and the beige “toaster” represented a therapy called “E-stim,” short for electrical stimulation, which has been available in one form or another for decades. E-stim devices send mild electrical pulses through the skin to help stimulate injured muscles. Often used for stroke patients, e-stim therapy causes repeated muscle contractions, improves blood flow and helps to increase muscular strength. The stimulation retrains muscles to respond to the body’s natural signals to contract and relax. Having seen firsthand the power of electrical stimulation in stroke recovery, I read with interest about new developments in a type of electrical medicine called neuromodulation. This year, California-based Cala Health raised $51 million as it rolled out a neu-

Where e-stim activates skeletal muscles via motor nerves to generate movement, neuromodulation signals the nervous system by directly activating neurons in the brain. This can be done invasively through surgery, or by activating sensory nerves in the peripheral nervous system. Neuromodulation is used to treat a wide range of ailments varying from chronic pain to depression, angina and urinary disorders. Neuromodulation isn’t exactly new – in 1st century Rome, a well-known physician recommended that individuals suffering from gout could ease their pain by standing on a torpedo fish, which gave off an electric charge. In the 1960s, parallel evolutions in neurosurgery, implantable devices and batteries led to a wave of innovation in the field of neuromodulation. In 1967, the physician Norman Shealy spearheaded the development of a system that sent current into the dorsal column of the spinal cord; in its first use, the system, which used a modified cardiac pacemaker, eased the pain of a terminal cancer patient. In 1973, the researcher Yoshio Hosobuchi developed the neuromodulation technique of deep brain stimulation, through sending current into the somatosensory thalamus, initially to treat denervation facial pain. Through additional research, physicians and neurobiologists discovered that electrical stimulation directly in the brain could have a therapeutic effect for various conditions. Deep brain stimulation has now been successfully used to treat conditions including epilepsy, depression and the movement dysfunction associated with Parkinson’s. As the neuromodulation field evolves, the treatment’s uses continue to expand, and the neuro-

modulation device industry is expected to grow from $8.4 billion in 2018 to $13.3 billion in 2022. THE HE ALTH TRAN S FO R M E R

Kate Rosenbluth had been studying this sort of “electrical medicine” for years when she hit on a potentially novel approach, one that would pair the impact of neuromodulation with the high technology of wearables. Rosenbluth was perhaps ideally suited to make this insight: She studied mechanical engineering at Stanford as an undergraduate, then followed that with a PhD in bioengineering at a joint program between Berkeley and UCSF. As she progressed further in her graduate research, she began to see what she describes as “a tremendous unmet need” in diseases related to aging and neurodegeneration, among them Alzheimer’s disease and multiple sclerosis. As a postdoc fellow in neurosurgery at UCSF, she became involved with cuttingedge gene therapy treatment for Parkinson’s

disease and Alzheimer’s in which the team used imaging to view the infusion of drugs into the brain. She contributed to research into optogenetics, which uses gene therapy to make neurons sensitive to light, and worked at Munich-based Brainlab, building surgical planning software that helped neurosurgeons plan and perform surgery. During a span of years ranging from her graduate to post-graduate studies, she worked with Genentech on its Alzheimer’s drug translation initiative. While contributing to these investigations, Rosenbluth started to question the nature of the treatments: “I stepped back and said, ‘Why on Earth are we injecting viruses and implanting devices when the nervous system was designed to be accessed?’” She became convinced that there was a better way to interface with the nervous system, and she returned to Stanford as a biodesign fellow to figure out what that would be. “I spent a few months literally following around every doctor, surgeon, back office billing specialist, home health care provider willing to have THE HISTORY OF NEUROMODUL ATION

THE CAL A HEALTH TRIO

According to the neurosurgeon and Baylor College of Medicine professor Philip Gildenberg, the history of neuromodulation goes way back to Roman times of 15 AD, when the court physician Scribonius Largus recommended in his Compositiones Medicinae that contact with a torpedo fish, which emits an electric charge, eases the pain of gout. The medical scholar Avicenna wrote in the 11th century about the salutary effect of the fish’s charge for headaches, seizures, and depression. In the 1700s, Benjamin Franklin researched electrical stimulation for alleviating pain, though he used a voltage so high that it led to injuries. Scientists and physicians in subsequent decades discovered how electricity causes muscular movement when applied to muscles and directly to the brain, setting the stage for later evolutions.

me along,” she recalls, “and came up with a list of hundreds of unmet needs based on my primary observations.” On the list was the condition, essential tremor. ESSEN TI AL TREMOR

While it can occur in almost any part of the body, essential tremor usually affects the hands, causing rhythmic shaking that is sometimes severe. This makes performing simple tasks — like holding a spoon to one’s mouth, tying shoelaces, or drinking from a glass — challenging if not impossible. Through my own ordeal, I saw how daunting these challenges were. The exact neurological mechanism of essential tremor is unknown, but researchers have determined that the ventral intermediate nucleus in the thalamus, known as the VIM, is involved. The condition – often confused with Parkinson’s disease – seems to have a genetic basis, since it is inheritable if one parent has the condition. There currently are two primary treatments for essential tremor: drug treatments that are systemic and combine limited efficacy with the potential for side effects; or deep brain stimulation, in which an implant that generates electrical currents is placed into the VIM, requiring brain surgery. Rosenbluth felt that each of these options had significant limitations. (A more recent approach relies on a technology called Neuravive, which physicians use to target ultrasound energy at the VIM, guided by magnetic resonance imaging; the therapy is a Medicare covered benefit in 38 states.) In thinking about a more effective treatment, Rosenbluth became intrigued by the notion of “reimagining the nervous system as wires connecting different parts of the body.” Conceived this way, the nervous system provides two-way connectivity. “We knew from the literature and from clinical practice that deep brain stimulation at that specific location, the VIM, worked,” she says. “I started considering, ‘Why do we stimulate in the brain to treat the hand? Why can’t we reverse engineer that loop and stimulate at the hand to treat the brain?’” 82

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CAL A H E A LT H I S B O RN

That concept wired into a broader manifesto about the potential for electrical medicine to address other health issues. With that in mind, Rosenbluth founded Cala Health in 2014, with Scott Delp, a Stanford professor who is founding chairman of the school’s Department of Bioengineering as well as director of the National Center for Simulation in Rehabilitation Research; and Serena Wong, a Stanford PhD who had experience developing medical devices. Over a five-year development process, the company created a unique breed of technology – Rosenbluth describes it as “wearables meet neuromodulation.” The Cala Trio was born. The Cala Trio is customized to each patient. Using its motion sensor, the device first gathers data on the extent of the patient’s tremor. Trio continuously collects data in the same way that Fitbit or Apple Watch do. Based on the data about tremor frequency measured along the x-, y- and z-

axes for each patient, the device develops an individualized stimulation pattern. Even as it introduces the device, the company is continuing to conduct several studies with the Trio. During a recent study, the Trios collected a total of 22,000 data points for 263 participants over a three-month period, with the data gathered before and after two daily stimulation sessions. Results, published in October 2019, showed that 60% of patients reported improvement at three months, with 62% of the participants’ tremor severity improving from severe/moderate to mild/slight. With the product rolling out in four specific markets – Austin, San Francisco, San Diego and Seattle – Cala Health is examining several specific questions. “How to support physicians who prescribe it, how to support patients who use it, how to connect patients who are interested in it to doctors who know about it,” explains Kristie Burns, the company’s chief marketing officer. And

in January, Cala Health will be applying to the Centers for Medicare and Medicaid Services (CMS) to determine if Cala Trio will be covered for reimbursement. Cala Health does not intend to be pigeonholed to one treatment. While the company remains mum on the specifics, it is already exploring additional applications in neurology, psychiatry and cardiology – all of them based on stimulating neural networks through accessible peripheral nerves. It is conducting research on these applications with physician investigators based in the Bay Area. IN CONSIDERING CAL A HE ALTH ’S

FINDING FUNDING

In finding investors for the company, Rosenbluth specifically sought partners who could help the nascent company to navigate the complexities of prescription logistics, technology development and device regulations, since the product is prescribed like a drug, used as a wearable and regulated as a device. The company raised series A funding from Johnson & Johnson Innovation (JJDC) and Lux Capital, and it has now completed series C funding, with participation from dRx Capital and GV (StartUp Health participated in that latest round). “As a small company doing fairly breakthrough new products, we said, ‘How do we bring around the table leaders in the field who actually span the space of pharma and device and tech,” Rosenbluth explains, noting that GSK, Novartis, Google and Qualcomm were in the B round. “It has been absolutely invaluable in having the team who has done everything from new coding and reimbursement, new market creation from the lenses of data science, hardware and prescription drugs, and distribution of devices.” In September, Cala Health gained a significant affirmation of its proposition and strategy: Renee Ryan, previously a vice president of venture investments at JJDC, joined the company as its CEO.

focus on essential tremor, I thought back to my own health crisis, which began with a stroke after triple bypass surgery and led initially to complete paralysis on my right side. As my functioning slowly began to return, the most distressing part of the aftermath was the severe impairment of my ability to

move my right hand. And so I could understand why, of all the conditions Cala Health decided to focus on, they chose essential tremor. There’s something about being able to use your hands, particularly in this day and age, that many of us take for granted. Without them, you can’t work your TV or your iPad, or pay your bills. And voice recognition and dictation software don’t replace the more seamless functionality of typing. While I still don’t have complete control of my fine motor skills, I can at least function at a basic level. I can pinch my thumb and forefinger together, make a fist, and slowly wiggle my fingers. I can type with eight of my 10 fingers and hold a toothbrush. I’ve even begun to relearn how to handwrite with my right hand. When you’ve got an essential tremor, none of these tasks come easily. As I’ve seen from my own experience, better control of my fine motor skills has led to a tremendous confidence boost, and a regaining of independence.

The StartUp Health Company Index Active companies in the StartUp Health portfolio, listed by primary health moonshot As of December 13, 2019

ACCESS TO CARE MOONSHOT

1DOC3 is the healthcare gateway for patients from Latin American markets to the medical knowledge they need. CEO: Javier Cardona Bogota, Colombia 1doc3.com

AC Health replaces every paper handout given to patients with a personalized digital plan. CEO: Susannah Bailin Woodbridge, CT ac-health.com

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

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

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

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

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

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

Buddy Healthcare transforms care coordination in hospitals and clinics. CEO: Jussi Määttä Helsinki, Finland buddyhealthcare.com

Care24 provides medical care at home with mobile app support at every step. CEO: Vipin Pathak Mumbai, India care24.co.in

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

Careteam solves the fragmentation of healthcare by enabling patientcentered care collaboration. CEO: Alexandra Greenhill, MD Vancouver, BC careteam.me

Cityblock brings better care to communities where it’s needed most. CEO: Iyah Romm Brooklyn, NY cityblock.com

CliniVantage creates one record for every patient. CEO: Dinesh Samudra Pune, India clinivantage.com

Cloudbreak Health humanizes healthcare by reducing barriers to care. CEO: Jamey Edwards Los Angeles, CA cloudbreak.us

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

Doctor.com empowers healthcare organizations to deliver a better customer experience at every step of the patient journey. CEO: Andrei Zimiles New York, NY doctor.com

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

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

Elly is the world’s first empathetic audio companion for patients living with a chronic disease. CEO: Nikhil Pooviah Los Angeles, CA ellyhealth.com

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

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

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

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

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

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

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

STARTUP HEALTH COMPANY INDEX

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

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

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

Julota eliminates siloed patient information and connects the broader care community. CEO: Scott Cravens Denver, CO julota.com

LeaLabs revolutionizes healthcare for chronic conditions using blockchain and AI. CEOs: Deepak Patri & Madhav Puvvena San Antonio, TX lealabs.com 86

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Lifestores Pharmacy democratizes access to quality healthcare in emerging markets. CEO: Bryan Mezue Lagos, Nigeria lifestorespharmacy.com

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

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

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

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

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

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

MedForums streamlines the connection between clinicians, education and credentialing. CEO: Angela Dayton Draper, UT medforums.com

Mediseen eliminates barriers to entry for all physicians. CEO: Daniel Warner Toronto, ON mediseen.ca

Medisprout creates a future where patients can access most of their care virtually. CEO: Samant Virk, MD New York, NY medisprout.com

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

A fresh approach to stress reduction Zeel@Work® delivers on-location employee wellness solutions that reduce stress, activate engagement, and create a culture of health and wellbeing. Through our nationwide network of licensed and vetted wellness professionals, Zeel@Work® can help you craft a flexible, scalable, tech-powered program that’s tailored to your business.

“Partnering with Zeel has made implementing a wellness program simple! Our employees continually express their excitement about the chair massages.” M E L I S SA B., H AW K E M E D I A

“Love the convenience of feeling relaxed at work, made possible by wonderfully talented massage therapists!” M O N A W., P F I Z E R

MASSAGE

MINDFULNESS

ASSISTED STRETCH

YOGA

Decreases physical tension and promotes calm relaxation

Proven to enhance creativity while reducing stress

Eases the physical strains of daily seated or standing work

A healthy way to foster team morale and increase energy

F I N D O U T M O R E AT Z E E L .CO M /CO R P O R AT E -W E L L N E S S 87

STARTUP HEALTH COMPANY INDEX

Medtep helps people adopt behavioral changes through clinically-validated, digital, personalized care plans. CEO: Joima Panisello, MD Barcelona, Spain medtep.com

MyRX365 increases medication adherence through digital pharmacies. CEO: Mohammad Ali, MD Jamaica, NY myrx365.com

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

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

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

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

MyPurpleFolder provides patients and their caregivers with free, easy and seamless control of their healthcare information. CEO: Kelli Thomas-Drake Dallas, TX mypurplefolder.com.com

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

Nayya Health optimizes the design and distribution of health and benefits plans for micro-populations. CEO: Sina Chehrazi New York, NY nayyahealth.com

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

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

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

Phraze removes the screen between doctor and patients. CEOs: Jack Schneeman & Brandon McCutcheon Minneapolis, MN phraze.co

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

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

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

A patient-centered approach to medical transportation. From clinical complexities to social determinants of health, coordinating rides goes far beyond just ordering a vehicle. Patients are faced with numerous barriers that impact their ability to access care whether itâ&#x20AC;&#x2122;s urban/rural factors, age-related mobility or socioeconomic and psychosocial nuances. Through partnerships with healthcare organizations and transportation providers, Ride Health is reimagining traditional approaches by blending technology and data with a higher-touch approach.

Our platform ingests multiple data points to map out each individual patientâ&#x20AC;&#x2122;s unique needs and preferences to ensure the best ride experience. Beyond increased patient satisfaction and greater access, our solution alleviates some of the biggest challenges providers and payers face today by improving efficiencies, lowering costs and achieving better outcomes.

Key Performance Indicators

35%

No-Show Reduction

98%

Patient Satisfaction

30%

Average Ride Cost Reduction

96%

On-Time Arrival Rate

STARTUP HEALTH COMPANY INDEX

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

Ride Health ensures every patient has access to the care and resources they need to ensure good health. CEO: Imran Cronk New York, NY ridehealth.com

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

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

Tahmo provides temperature and humidity devices to diagnose patients at the first degree. CEO: Arif Quronfleh Irvine, CA tahmo.io

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Tickit Health enables individuals to share their story and personal information with the organizations that support them.Â CEO: Eric Gombrich Vancouver, BC tickithealth.com

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

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

Yosi creates the waiting room of the future now, for medical professionals and hospitals. CEO: Hari Prasad New York, NY yosicare.com

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

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

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

Zentist improves dental care affordability. CEO: Ato Kasymov Los Angeles, CA zentist.io

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

COST TO ZERO MOONSHOT

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

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

Beyond Lucid Technologies connects ambulances and care facilities even before the patient arrives. CEO: Jonathon Feit Walnut Creek, CA beyondlucid.com

Biome helps physicians and hospitals deliver higher quality care, at lower cost, to every patient. CEO: Stuart Jacobson San Francisco, CA biome.io

Caremerge ensures the aging experience is filled with peace of mind and joy. CEO: Nancy Koenig Chicago, IL caremerge.com

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

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

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

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

Flosonics non-invasively and simply monitors patient fluid responsiveness. CEO: Joe Eibl Sudbury, Canada flosonicsmedical.com

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

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

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

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

STARTUP HEALTH COMPANY INDEX

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

ManageUp eradicates workplace inefficiencies through a comprehensive management platform. CEO: Lan Nguyen Santa Clara, CA manageupprm.com

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

Prognos prevails over disease by driving the best actions learned from the world’s data. CEO: Sundeep Bhan New York, NY prognos.ai

Particle Health reinvents data access for patients and consumers. CEO: Troy Bannister New York, NY particlehealth.com

RewardsMD allows patients to earn rewards for helping payors lower costs. CEO: Scott Kimmel Deerfield Beach, FL rewardsmd.com

Maverick Medical AI captures a patient’s true clinical status. CEO: Yossi Shahak Tel Aviv, Israel maverick-med.com

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

MDOps simplifies clinical documentation using smartphone NLP dictation. CEO: Avinash Kodey Melville, NY mdops.com

Pocket Anatomy impacts health and medical literacy for future healthcare practitioners and their patients. CEO: Mark Campbell Galway, Ireland pocketanatomy.com

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

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Prescrypto generates and administers medical prescriptions for free. CEO: Everardo Barojas Mexico City, Mexico prescrypto.com

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

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

Sift Healthcare revolutionizes healthcare payments with AI. CEO: Justin Nicols Milwaukee, WI sifthealthcare.com

SWIFT SHIFT creates a better experience for all individuals involved in the home healthcare industry. CEO: Assaf Shalvi New York, NY swiftshift.com

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

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

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

AsiaBiome cures the root cause of IBS, Autism, ALS, and MS through the gut microbiome. CEO: Jonathan Krive Hong Kong asiabiome.com

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

tedcas.com

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

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

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

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

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

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

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

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

STARTUP HEALTH COMPANY INDEX

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

Cubismi puts the power of health big data into the hands of patients and doctors. CEO: Moira Schieke, MD Madison, WI cubismi.com

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

Cyclica empowers pharma to more efficiently discover novel medicines for human diseases through AIaugmented technologies. CEO: Naheed Kurji Toronto, Canada cyclica.com

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

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DiabetesCare provides any Spanishspeaking consumer with their diabetes education needs. CEO: Miguel Johns Wichita, KS diabetescare.io

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

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

KnowNOW solves the national epidemic of STDs and HIV by coordinating community care. CEO: Marcelo Venegas, MD Teaneck, NJ knownowhealth.com

Healthimation provides people with the tools to understand and manage their chronic disease. CEO: Seavey Bowdoin Boston, MA healthimation.com

HeartRite makes hypertension management accessible and easy. CEO: Abeer Ali Irvine, CA heartrite.com

InSilicoTrials aims to develop drugs and medical devices at 4x the current speed. CEO: Luca Emili, MSc Milan, Italy insilicotrials.com

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

Nightingale solves the global burden of chronic diseases through blood analysis. CEO: Teemu Suna Helsinki, Finland nightingalehealth.com

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

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

A HIMSS Event

March 11, 2020 | Orlando

Early stage tech, highly vetted startups and data-driven ideas revolutionizing the next frontier of health tech. himssconference.org/health20 Save $100 with code: VPLUS20SUH100

STARTUP HEALTH COMPANY INDEX

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

Play-It Health improves adherence and engagement by over 50%, even in the most challenging populations. CEO: Kim Gandy, MD Kansas City, KS playithealth.com

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

Qura revolutionizes real-time glaucoma management using wireless implantable pressure-monitoring devices. CEO: Doug Adams Sudbury, MA qura.bi

Rejuvenan empowers you to define YOUR version of health, while living longer, better. CEO: Rishi Madhok New York, NY rejuvenan.com

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

Sanguine Biosciences puts patients in charge of their health data by bringing clinical trials into the home. CEO: Brian Neman Los Angeles, CA sanguinebio.com

SmartTab by Velรณce Digital Health brings wireless personalized drug delivery to every patient in the world. CEO: Robert Niichel Denver, CO velocedigital.com

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

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Vheda Health provides the people who need care the most with lifesaving technology. CEO: Shameet Luhar Baltimore, MD vheda.com

END CANCER MOONSHOT

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

LS CancerDiag saves lives through early detection of lynch syndrome. CEO: Minna Nystrom, PhD Helsinki, Finland lscancerdiag.com

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

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

vheda health is a member compliance company saving insurers an average of $17,175 per member per year by automating care plan compliance.

We focus on Medicaid, Medicare, and Duals populations. Manage your entire population across every chronic condition and risk level. By combining human touch and technology, we create more compliant member populations.

learn more about vheda health - www.vheda.com | 1-866-878-4332 | sales@vheda.com 97

STARTUP HEALTH COMPANY INDEX

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

PerSoN Clinic gives all patients with chronic disease a voice in treating their own disease. CEO: Sarah Iranpour Rockville, MD person.clinic

Quantgene unlocks the power of the Deep Human Genome to save lives through early detection of disease. CEO: Jo Bhakdi Santa Monica, CA quantgene.com

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

Welwaze prevents breast cancer deaths. CEO: Carlos García Miami, FL welwaze.com 98

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

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

Pregistry empowers women and providers with the information they need to have healthy pregnancies and babies. CEO: Diego Wyszynski, MD Los Angeles, CA pregistry.com

Robyn makes sure you’re not alone on your journey to parenthood. CEO: Allison Kasirer Los Angeles, CA wearerobyn.co

CHILDREN’S HEALTH MOONSHOT Gennev empowers every woman to take control of her health in menopause. CEO: Jill Angelo Seattle, WA gennev.com

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

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

CareDox improves children’s health by connecting schools, families, payors and healthcare providers. CEO: Brett Shamosh New York, NY caredox.com

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

Understanding Alzheimer’s Begins With All of Us Boston University School of Public Health and Savonix are partnering to study how Alzheimer’s develops in adults.

JOIN THE STUDY Take the test from home in 45 minutes

Visit AssistStudy.org

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

Edamam CEO & Founder Victor Penev

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PHOTO BY JOE BUGLEWICZ

STARTUP HEALTH COMPANY INDEX

NUTRITION & FITNESS MOONSHOT Lactation Lab optimizes infant nutrition and maternal health. CEO: Stephanie Canale, MD Santa Monica, CA lactationlab.com

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

sameview provides one place to connect and share information between therapists, educators, support workers and family supporting a child with a disability. CEO: Danny Hui Sydney, Australia sameview.com.au

Special X unleashes the collective power of families of children with disabilities to help every child live their best life. CEO: Jason Lehmbeck Los Angeles, CA teamspecialx.com

Edamam helps everyone on the planet eat better and live healthier, happier, longer lives. CEO: Victor Penev Los Angeles, CA edamam.com

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

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

FitTrace gives you the tools and analytics to better understand your body. CEO: Michael DiChiappari Los Angeles, CA fittrace.com

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

MealShare impacts health and happiness through healthy eating. CEO: Bentley Adams Cardiff, CA mealshare.pro

Lume by MetaLogics puts an end to the obesity epidemic through an armband and scale, driving lab-grade metabolic insights. CEO: Greg Guettler Edina, MN metalogicscorp.com

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

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

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STARTUP HEALTH COMPANY INDEX

Personal Remedies empowers chronic illness patients everywhere via individualized dietary regimens. CEO: Mory Bahar Boston, MA personalremedies.com

YourCoach is on a mission to have nine billion people live healthy lifestyles. CEO: Marina Borukhovich Dusseldorf, Germany yourcoach.health

Yumlish provides healthy recipes for chronic illnesses and dietary restrictions. CEO: Shireen Abdullah Dallas, TX

Curatio CEO Lynda Brown-Ganzert

BRAIN HEALTH MOONSHOT

Cala Health merges innovations in neuroscience and technology to deliver individualized peripheral nerve stimulation. CEO: Renee Ryan San Francisco, CA calahealth.com

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

HealthTechApps helps prevent costly re-injuries after a concussion. CEO: Kyle Chang Honolulu, HI healthtechapps.com 102

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

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

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

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

Virtuleap provides brain training in VR. CEO: Amir Bozorgzadeh Lisbon, Portugal virtuleap.com

MENTAL HEALTH & HAPPINESS MOONSHOT

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

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

DreamThink cures stress and sleeplessness through sound. CEO: Sanjeev Brar New York, NY dreamthink.co

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

PowerCall unleashes our own ability to power each otherâ&#x20AC;&#x2122;s happiness, health and success. CEO: Richard Lee Anaheim, CA powercall247.com

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

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

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

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

REVITA5 solves the human energy crisis by changing the way organizations manage stress. CEO: Jessica Corbin Santa Monica, CA revita5.com

Neolth improves access to holistic care to prevent stress-related complications for people with chronic disease. CEO: Katherine Grill, PhD San Francisco, CA neolth.com

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

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STARTUP HEALTH COMPANY INDEX

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

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

wayForward wayForward cures mental illness globally through a comprehensive behavioral health solution. CEO: Ritvik Singh New York, NY wayforward.io

LONGEVITY MOONSHOT

Aimee Health uses nutritional intervention to extend brain span and lifespan of every person by 25 years. CEO: Alan Gale San Francisco, CA aimeehealth.ai

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

LifeBio captures life stories to transform care for seniors. CEO: Beth Sanders Columbus, OH lifebio.com

Devoted Health delivers Medicare Advantage plans for simple, seamless, affordable healthcare. CEO: Ed Park Waltham, MA devoted.com

LifeDojo improves the physical and mental health of millions of employees, patients and consumers around the world, one healthy habit at a time. CEO: Chris Cutter San Francisco, CA lifedojo.com

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

Lyf Lynks

Hormone Therapeutics wants to add 50 healthy years to everyone’s life by decoding their personal health map. CEO: Hunter Howard Dallas, TX hormonetherapeutics.com

HLI revolutionizes human health intelligence by creating the world’s largest database of sequenced genomes and phenotypic data. CEO: Wei Wu Hei, PhD La Jolla, CA humanlongevity.com

LyfLynks redefines when, how and from where families engage in supporting their loved ones’ independence, health, and wellbeing. CEO: Donald Vetal Columbia, MD lyflynks.com

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

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STARTUP HEALTH COMPANY INDEX

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

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

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

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

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

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

MindCotine helps you live a life free of smoke today. CEO: Nicolás Rosencovich San Jose, CA mindcotine.com

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

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

WellBrain eliminates dependencies on painkillers and halts the opiate epidemic. CEO: Sumeet Maniar Pleasant Hill, CA wellbrain.io

Learn more about the inspiring Health Transformers in the StartUp Health Portfolio – and the impactful companies they run – online at startuphealth.com

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

Where Your Precision Health Moonshot Begins. TRANSFORMING YOUR HEALTH STARTS WITH A DEEP UNDERSTANDING OF YOUR HEALTH STATUS. In celebration of StartUp Health, Human Longevity is offering special promotional access to the Health Nucleus, one of the most advanced multi-modality precision health platforms.

STARTUP HEALTH NETWORK OFFER The Health Nucleus “CORE” Assessment, regularly priced at $7,500, is now available at $5,500 to StartUp Health Network members who mention promo code ‘StartUp2020’ and complete their assessment by May 31, 2020.

HUMAN LONGEVITY’S “CORE” PRECISION HEALTH ASSESSMENT INCLUDES: • Whole body and brain MRI • Whole genome sequencing • Blood chemistry testing • A strategic array of other diagnostics integrated and analyzed to generate a health intelligence report that provides deep insights into your overall health, including your risk analysis for cardiac, cancer, metabolic and cognitive issues as well as pre-symptomatic diagnosis.

For more information and to start your consultation, please call 844-838-3322 or clientservices@healthnucleus.com

HUMANLONGEVITY.COM

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The StartUp Health Company Index Active companies in the StartUp Health portfolio, listed by country As of December 13, 2019

ARGENTINA

HONG KONG

SPAIN

LucidAct Health

Bitgenia

AsiaBiome

Mediktor

ManageUP PRM

Medtep

Mealshare

TedCas

MindCotine

FutureDocs INDIA

Omnia Salud

Care24 AUSTRALIA

CliniVantage Healthcare Technologies

Healthbanc

Livigro

Sameview

IRELAND

BELARUS PigPug

Pocket Anatomy

BRAZIL

ISRAEL Eco-Fusion

Medcloud OTAWA

Maverick Medical AI

CANADA

Rezilient

Oxitone Medical

Careteam Technologies Curatio

ITALY InSilicoTrials

Cyclica Flosonics Medical

KENYA

MediSeen Tickit Health

BabyMed

CHINA

MEXICO Prescrypto

Medebound

NIGERIA

COLOMBIA

Lifestores Pharmacy

1DOC3

Mobidoc

FINLAND

PAKISTAN

Buddy Healthcare Goodlife Technology LS CancerDiag LymphaTouch Myontec Nightingale Health GERMANY YourCoach 108

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AzaadHealth PORTUGAL Virtuleap SINGAPORE AlemHealth eko.ai

StartUp Health Magazine

Neolth SWEDEN

NuEyes Technologies

Joint Academy

Open Health Network PowerCall

UNITED KINGDOM

Pregistry

Aerobit Health

PSYCHeANALYTICS Quantgene

UNITED STATES

REVITA5

ALABAMA

Robyn

Cancer University

SAFE Health SageSurfer

CALIFORNIA

Sanguine Biosciences

Aimee Health

Savonix

Althea Health

Special X

Beyond Lucid Technologies

SyncThink

Biome Analytics

Tahmo

BreathResearch

Vive Benefits

Cala Health

Zentist

CarePredict

WellBrain

Cloudbreak Health

WinguMD

DirectDerm Edamam

CONNECTICUT

Elly Health

AC Health

FitBliss

Inbox Health

FitFetti FitTrace

COLORADO

GenID Solutions

access.mobile

Healthbanc

Curacase

Heartrite

Healthwide Solutions

Help-Full

Julota

Human Longevity, Inc

RxREVU

inHealth Medical Services

SmartTab by Veloce Digital Health

inRecovery Jiseki Health Lactation Lab LifeDojo

FLORIDA Docola

iCoreConnect

HelpAround

MediSprout

RC21X

Parallel Profile

Lyflynks

MedXCom

Saturn Care

Quickâ&#x20AC;&#x2122;rCare

PerSoN Clinic

MirrorMe3D

Xverity

Resility Health

SimpleVisit

MouthWatch

RewardsMD

Vheda Health

MYRX365

SOUTH CAROLINA

Navimize

Electronic Health Network

Welwaze Medical MINNESOTA

Nayya Health

GEORGIA

MetaLogics

openDoctor

TEXAS

Patientory

Phraze

Oratel Diagnostics

Cloud 9

Quantextual.co

Sandstone Diagnostics

Particle Health

Goldfinch Health

Prognos

Hormone Therapeutics

TQIntelligence MISSOURI

QwikScript

LeaLabs Corporation

HAWAII

iShare Medical

Rejuvenan Global Health

M&S Biotics

HealthTechApps

DiabetesCare

Ride Health

MyPurpleFolder

Palette

Savor Health

UnaliWear

ILLINOIS

Sen-Jam Pharmaceuticals

Valhalla Healthcare

CareAdvisors

NEW JERSEY

SUPAspot

Yumlish

Caremerge

@Point of Care

SWIFT SHIFT

Etyon Health

Hindsait

Treat Health

UTAH

MyPeople Health

Hoy Health

Trusty.care

MedForums

KnowNOW Health

Upside Health

Life Recovery Systems

Valera Health

VIRGINIA

Vivor

LifeWIRE Corp Zignifica

INDIANA imoonlite

NEW YORK

wayForward

KANSAS

AdhereTech

Wellthie

Play-it Health

AppointmentNotify

Yosi

WASHINGTON

Beam Health

Zubia

Gennev

KENTUCKY

CareDox

Zeel

SOLIUS

PreventScripts

Cecelia Health Cityblock Health

OHIO

WASHINGTON, DC

MASSACHUSETTS

Cognotion

Aver

Babyscripts

Devoted Health

Cohero Health

Indago

Henry Health

Kinetxx

CoverUS

LifeBio

Responsum Health

Healthimation

Dante Labs

Personal Remedies

Doctor.com

OREGON

WISCONSIN

Qura

DreamThink

Conversa

Cubismi

Zeleo

eHealthAnalytics

Sift Healthcare

Force Therapeutics

PENNSYLVANIA

MARYLAND

Fruit Street Health

Cerora

Aidar Health

MDOps

PatientWing 109

the BIG idea

Let’s Dream Impossible, Together When was the last time you sat down and wrote a list of your biggest dreams – the things that matter most to you, and why? This is something we do every January with the intention of getting a few steps closer to our goals. Some of these dreams are as impactful as helping billions of people improve their health (as codified in our manifesto printed on the next page), and others as personal as transforming our own. At StartUp Health, we map out big dreams called health moonshots. We facilitate quarterly forums with our army of Health Transformers where we set goals and milestones. Together we measure progress, hold one another accountable, and recalibrate when needed. We’re always inspired by what the community is accomplishing, quarter after quarter, year after year. Feel free to use the same strategic thinking tools we use – you can download them for free at startuphealth.com. Let’s dream impossible, together.

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StartUp Health executive chairman Jerry Levin and co-founders Steven Krein and Unity Stoakes meet to celebrate another year of progress.

WWW.STARTUPHEALTH.COM

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In 1984, Dr. Anna Lee Fisher became the first mother in space as a member of NASA’s Space Shuttle Discovery flight on mission STS-51A. Her daughter was only 14 months old.

Dream Impossible At StartUp Health we help Health Transformers achieve health moonshots. What’s your impossible dream? 112

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Photo by John Bryson/Sygma

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