StartUp Health Magazine Issue 13: The Alzheimer's Moonshot by StartUp Health

MEET THE NEWEST HEALTH TRANSFORMERS pg 40

THE T1D MOONSHOT CASE STUDY pg 26

JOIN US as we unite a collaborative community of Alzheimer's founders & funders

THE ALZHEIMER'S MOONSHOT

Launched with support from the Alzheimer’s Drug Discovery Foundation (ADDF) and Gates Ventures

FOUNDERS’ LETTER

When Moonshots Are Personal

One of the most meaningful memories of my (Unity’s) life was Thanksgiving dinner at a friend's grandmother’s home about 25 years ago. As we dined at her table, surrounded by a roomful of her cherished belongings, she leaned in with a smile, “You have the most beautiful dining room. It makes me feel so good to be here.” This grand lady had lost the memory that this was her room, but she still remembered how the place made her feel. It was a sad yet beautiful moment I hope never to forget. My own grandmother suffered from a similar affliction and I know too many friends and families going through this now. That’s why we are so grateful to partner with the Alzheimer’s Drug Discovery Foundation (ADDF), Gates Ventures, and several additional founding champions and stakeholders to launch a global Alzheimer’s Moonshot. With the announcement of the Alzheim-

Steven Krein CEO & Co-founder

er’s Moonshot, we are continuing to build on the model we pioneered over the past 13 years and honed over the past year when we launched The T1D Moonshot with the support of The Helmsley Charitable Trust. We now have more than 30 companies and research teams collaborating to speed up progress on T1D . . . and we are just getting started. For Steve and I, the Alzheimer's Moonshot is personal. Too many people have been impacted by these devastating diseases. It's time to bring people together to make the world better for those we love and for generations to come. We know that extraordinary leaps forward are possible when people with purpose and passion collaborate to take on big challenges. We are calling on entrepreneurs, innovators and research teams everywhere to apply to join our Health Moonshot Communities. And we are looking to meet the funding champions who will help us fuel these missions. Learn more at startuphealth.com.

Unity Stoakes President & Co-founder

2 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

THE STARTUP HEALTH IMPACT BOARD Marshaling people, purpose and passion to make health moonshots possible.

Toby Cosgrove, MD Former CEO & President, Cleveland Clinic

Jon Miller CEO, Integrated Media; Former CEO, AOL & IAC

Sue Siegel Former CEO, GE Ventures

Ambassador Attallah Shabazz Diplomat, Author & Speaker

Wayne Kimmel Founder & Managing Partner, SeventySix Capital

Charles "Chuck" Henderson CEO, ADA

Stephen Klasko, MD Former CEO, Jefferson University & Jefferson Health

Margaret Laws CEO & President, HopeLab

Esther Dyson Founder, Wellville; Active Angel Investor

Roger Jansen, PhD Chief Innovation & Digital Officer, MSU Health System

Stefano Bini, MD Endowed Professor Orthopedic Surgery, UCSF; Founder, DOCSF

Nick Turkal, MD Former CEO, Advocate Aurora Health

Robert Gabbay, MD, PhD Chief Scientific & Medical Officer, ADA

Ira Brind, JD Partner, Pulse Equity

Kimmi Grewel GM, Customer Engagement & CoInnovation, Microsoft

Jeff Stewart Managing Director, GPO Fund

Shirley Bergin Senior Advisor, ARPA-H; Former CMO/COO, TEDMED

Peter Kash, PhD Co-founder, Belum Therapeutics

Gloria Caulfield Founder & Executive Director, Lake Nona Impact Forum

Katya Hancock Founding Executive Director, Young Futures

startuphealth.com 3

INTHIS ISSUE

News: Alzheimer's Moonshot Launch 8 Meet Phyllis Ferrell, DrPH, Chief Impact Officer T1D Moonshot Case Study 30 Meet the Newest Health Transformers 40 Health Transformers in the News 102 4 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

105

103 56 46 EDITOR-IN-CHIEF Logan Plaster DEPUTY EDITOR Jennifer Hankin

CONTRIBUTING EDITORS Nicole Kinsey, Lauren Schafer WRITERS Laura Plaster, Susan Johnson, Abe Storer Back cover photo by Carol Kaliff

50 startuphealth.com 5

EDITOR’S LETTER

Cognitive Dissonance

When you work with a global community of healthcare innovators, you inevitably engage in some level of cognitive dissonance. On one hand, you watch the headlines and see the world faltering. War and disease seem as prevalent as ever. Health metrics like life expectancy are stagnant. On the business front, investment in health innovation has dropped significantly compared to recent highs. Sometimes the news of the day can feel like a straight-up dumpster fire. These dark clouds – which, by the way, are always present if you’re looking for them – cause some people to hide or retrench, others to obsessively doom scroll. But for some people, the very real challenges of this present world are merely a backdrop for the impact they’re committed to achieving. The hard things are a part of a longer, better story of overcoming the odds and making impossible things a reality. Of making life a little better for everyone around you. This magazine celebrates these people who think differently. We call them Health Transformers. You’ll read about Robin Roberts who is using his training as a Navy Seal to help companies validate their technology and get it to market faster. You’ll read about the team at Bodimetrics, who built a wearable that gives accurate readings regardless of skin color. Multiple founders in this issue have turned their struggle with Type 1 diabetes into a way to help others facing the same burden. You’ll meet Philip Mngadi from Zinacare who is bringing at-home diagnostic testing to Sub-Saharan Africa. And so much more. Whether the markets are down or up, no matter the state of global politics, these folks are putting in the hours to change how other human beings live and heal and thrive. Here’s the secret. They aren’t immune to the negative headlines. They aren’t naive. But they have one of the most important things they need in order to bear up on the hard days. They are part of a "Health Moonshot Community" of like-minded entrepreneurs who can provide support and validation when it's needed most. By reading these stories you’re invited into our broader global community. Come along on the journey as each founder works to make the future better than the past. We’ve included contact information on each founder profile, so you can reach out and get involved, or just send an encouraging word. After all, we can only achieve health moonshots if we do it together.

Logan Plaster Editor-in-Chief 6 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

"We're better together, sharing ideas and learning from each other. This is how things get done. Dr. Toby Cosgrove, former CEO of the Cleveland Clinic and member of StartUp Health's Board of Directors, on the power of Health Moonshot Communities.

startuphealth.com 7

HEALTH MOONSHOT NEWS

0 E S T. 2

’S MMOONS R E OSE, ANAG

T HO& C U R E

ALZHEIM T, D

StartUp Health Launches Global Alzheimer’s Moonshot with Support from the Alzheimer’s Drug Discovery Foundation (ADDF) and Gates Ventures

TUP H

New global initiative created to develop collaborative innovation community alongside leading companies, research teams, and stakeholders with mission to accelerate progress in prevention, diagnosis, and management of Alzheimer’s disease and related dementias.

8 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

LEARN MORE AT STARTUPHEALTH.COM/ALZ

uring the 42nd Annual J.P. Morgan Healthcare Conference, StartUp Health, in partnership with the Alzheimer’s Drug Discovery Foundation’s (ADDF) Diagnostics Accelerator (DxA), and Gates Ventures, the private office of Bill Gates, announced the launch of the Alzheimer’s Moonshot. This initiative aims to break down silos and foster meaningful collaboration between mission-aligned founders, funders, and partners, accelerating progress in preventing, managing, and curing Alzheimer’s and related dementias through the support of entrepreneurial innovation. The Alzheimer’s Moonshot is an invitation to Health Transformers, Alzheimer’s funders, foundations, advocates, and innovators, as well as leading startups and research teams, to unite in pioneering comprehensive, collaborative approaches to Alzheimer’s disease. “Our goal is to seamlessly integrate the diverse network of key players driving Alzheimer’s innovation, fostering more impactful collaboration,” says Steven Krein, CEO and Co-founder of StartUp Health. “We are spearheading a unified global innovation community that connects entrepreneurs, scientists, philanthropists, investors, and patients, all dedicated to Alzheimer’s and related brain conditions. Working in partnership with the ADDF and Gates Ventures, and welcoming future innovators and funders to our mission, we aim to dramatically accelerate progress through unprecedented collaboration.” The Alzheimer’s Moonshot Community

“The ADDF welcomes the opportunity to partner with StartUp Health to launch the Alzheimer’s Moonshot as it is uniquely positioned to bring mission-aligned founders together to collaborate and innovate, accelerating much-needed breakthroughs in Alzheimer’s research.” is powered by StartUp Health and its Health Transformer University, an entrepreneurial mastery program and lifelong learning community for ambitious founders and funders who are solving the biggest health challenges of our time. “There are over 55 million people worldwide living with Alzheimer’s disease, which is a complex, uniformly fatal disease, creating an urgent need to develop novel therapeutics and identify the combination regimens necessary to stop Alzheimer’s in its tracks,” notes Howard Fillit, MD, Co-founder and Chief Science Officer at the ADDF. “The ADDF welcomes the opportunity to partner with StartUp Health to launch the Alzheimer’s Moonshot as it is uniquely positioned to bring mission-aligned founders together to collaborate and innovate, accelerating much-needed breakthroughs in

startuphealth.com 9

HEALTH MOONSHOT NEWS

“History has taught us that collaboration inspired by purpose can produce wonders,” says Unity Stoakes, President and Co-founder of StartUp Health. “Humans have already been to the moon and back; now let’s band together to supercharge this new era of progress for brain health and finally eradicate Alzheimer’s for good.” Alzheimer’s research.” As part of the launch, StartUp Health announced that Phyllis Barkman Ferrell, DrPH, will serve as the Chief Impact Officer of the Alzheimer’s Moonshot and lead its impact board. Dr. Ferrell has three decades of related experience, most recently serving as the Global Head of Alzheimer’s and Neurodegeneration at Eli Lilly and Strategic Advisor to the Davos Alzheimer’s Collaborative. The Alzheimer’s Moonshot Impact Board will include representatives from the ADDF, Gates Ventures, and a diverse group of stakeholders from industry, clinical medicine, academia, investment and patient and caregiver communities. Initial funding to launch the Alzheimer’s Moonshot is provided by Gates Ventures and the DxA, which is a $100 million global research initiative dedicated to fasttracking the development of biomarkers and diagnostic tools. The DxA aims to develop these tools to aid with the early detection and diagnosis of Alzheimer’s. During the inaugural year of the Alzheimer’s Moonshot, StartUp Health is excited to invite twenty innovative companies and research teams who are

committed to advancing their solutions into the realm of commercialization and scalability to join the Health Moonshot Community. Recipients will be awarded Alzheimer’s Moonshot Fellowships to Health Transformer University, StartUp Health’s long-term program designed to accelerate health startups and novel technology solutions through early stages of growth from R&D through commercial scale. Fellowship selection will be driven by the Alzheimer’s Moonshot Scorecard, a criteria and framework that will serve as the foundational measurement for the initiative. Developed in collaboration with the Alzheimer’s Moonshot Impact Board, the scorecard is at the center of a multistep, data-driven process that ensures all prospective fellowship awardees align on mission and mindset. The finalized scorecard will be made available to the public to help catalyze advancements in Alzheimer’s research and innovation. “History has taught us that collaboration inspired by purpose can produce wonders,” says Unity Stoakes, President and Co-founder of StartUp Health. “Humans have already been to the moon and back;

10 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

now let’s band together to supercharge this new era of progress for brain health and finally eradicate Alzheimer’s for good.” CALLING ALL ALZHEIMER’SFOCUSED STARTUPS AND RESEARCH TEAMS

Are you an academic founder, startup, or research team focused on Alzheimer’s innovation who would like to join the Alzheimer’s Moonshot? Discover more and submit your application at www. startuphealth.com/alz. BECOME AN ALZHEIMER’S MOONSHOT CHAMPION

Health moonshots, like the Alzheimer’s Moonshot, are fueled by mission-aligned families, foundations, and organizations committed to solving big challenges. To explore how your organization can become part of the Alzheimer’s Moonshot (or one of our 14 global health moonshots) please reach out to us at alz@startuphealth.com. ABOUT THE ALZHEIMER’S DRUG DISCOVERY FOUNDATION (ADDF)

Founded in 1998 by Leonard A. and Ronald S. Lauder, the Alzheimer’s Drug Discovery Foundation is dedicated to rapidly accelerating the discovery of drugs to prevent, treat and cure Alzheimer’s disease. The ADDF is the only public charity solely focused on funding the development of drugs for Alzheimer’s, employing a venture philanthropy model to support research in academia and the biotech industry. The ADDF’s leader-

ship and contributions to the field have played a pivotal role in bringing the first Alzheimer’s PET scan (Amyvid®) and blood test (PrecivityAD®) to market, as well as fueling the current robust and diverse drug pipeline. Through the generosity of its donors, the ADDF has awarded more than $270 million to fund over 730 Alzheimer’s drug development programs, biomarker programs and clinical trials in 19 countries. To learn more, please visit: http://www.alzdiscovery.org. ABOUT THE DIAGNOSTICS ACCELERATOR (DXA)

The Diagnostics Accelerator, created in July 2018, is a $100 million global research initiative from partners including ADDF co-founder Leonard A. Lauder, Bill Gates, Jeff Bezos, MacKenzie Scott, the Dolby family, the Charles and Helen Schwab Foundation, The Association for Frontotemporal Degeneration, among others, to develop novel biomarkers for the early detection of Alzheimer’s disease and related dementias. This research initiative is dedicated to accelerating the development of affordable and accessible biomarkers to diagnose Alzheimer’s disease and related dementias and advance the clinical development of more targeted treatments. Through translational research awards and access to consulting support from industry experts, this program will challenge, assist and fund the research community in both academia and industry to develop novel peripheral and digital biomarkers.

startuphealth.com 11

12 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

CASE FOR SUPPORT

Alzheimer's Moonshot StartUp Health is on a mission to solve the biggest health challenges of our time by creating and sustaining a global ecosystem of Health Moonshot Communities™. After the successful launch of our Type 1 diabetes moonshot, we're applying our Health Moonshot Community model to combat Alzheimer's disease, establishing and nurturing a global community of founders and funders dedicated to preventing, diagnosing, managing, and ultimately curing it.

Join our mission.

, MANA

4 2

0 E S T. 2

T HO& C U R E

ALZHEIM T, D

here is a good chance you know mercializable innovation in this fight. The urgency is palpable. We stand at a how devastating Alzheimer's discritical juncture in the innovation curve, ease is. How awful it is to watch where technology now holds the key to people you love struggle as the disease exponential improvements in the lives of robs them of their mental capacity and those affected by the disease. If we hesitheir very self. Perhaps you’re even tate, we risk losing an entire generaready to roll up your sleeves and MOON S R’S tion to its clutches. We owe it to E do something about it. ourselves, to our loved ones, and That kind of optimistic, to future generations to seize collaborative, can-do mindset this moment and channel our is why we founded StartUp ST resources, expertise, and deterE Health in 2011. AR TUP H mination into a collaborative misRight now, we’re marshaling a sion to corral the effects this devasglobal army of entrepreneurs, innovatating disease. tors, scientists, and philanthropic funders Let’s be the generation that breaks the committed to overcoming Alzheimer’s cycle, ushering in an era of hope and healdisease. ing for all. The time is now to become Researchers, startups, industry, and part of the community of funders in our philanthropic funders all need to come Alzheimer’s Moonshot. together, because this disease really affects us all. An investment from a moonshot champion will break down silos, creating WE INVITE YOU TO LEARN MORE AT a pathway for intentional collaboration, STARTUPHEALTH.COM/ALZ OR which we know will ignite a wave of com- EMAIL ALZ@STARTUPHEALTH.COM startuphealth.com 13

ALZHEIMER'S MOONSHOT CASE FOR SUPPORT

Health Moonshot Communities: Our Blueprint for Impact Our proven blueprint, outlined on the following pages, follows a multi-step, community-driven collaboration framework designed to ultimately accelerate the commercialization and scaling of breakthrough health innovations in Alzheimer’s and related dementias.

14 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

Partner With Mission-Aligned Health Moonshot Champions

The true catalyst for the health moonshot, our champions, provide critical funding to support the Alzheimer’s Moonshot Community. They also guide the thesis and help accelerate momentum. Supporting the Alzheimer’s Moonshot are the Alzheimer's Drug Discovery Foundation (ADDF) and Gates Ventures, with additional champions under consideration.

WHAT IS A 'MISSION-FIT' PARTNER? --Key to our Health Moonshot Community model is collaborating with missionand-mindsetaligned families, foundations, and organizations who are already committed to supporting startups and/or research teams but who want to do even more to help them succeed. We are always looking for mission-fit partners who are: 1. Impact-Driven 2. Ambitious 3. Successful 4. Optimistic 5. Respected 6. Collaborative 7. Committed 8. Adaptable

startuphealth.com 15

ALZHEIMER'S MOONSHOT CASE FOR SUPPORT

Assemble Alzheimer's Moonshot Impact Board Mission control for the health moonshot, the Impact Board consists of a cross-section of individuals all of whom have made significant contributions in the Alzheimer’s space. It will be comprised of 10 innovative, mission-focused members from six key domains: entrepreneurship, philanthropy, academia, industry, investment, and patient advocacy.

Academic Philanthropist

Entrepreneur

Patient Advocate

Industry Expert Investor

16 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

The Impact Board Focuses On Six Key Objectives: The Alzheimer’s Moonshot Scorecard

Develop the Alzheimer’s Moonshot Scorecard – the strategic cornerstone of the Alzheimer’s Moonshot Focus and Strategy

With management, set the overall focus and strategy for Alzheimer’s Moonshot Share the Mission

Advocate for the Alzheimer’s Moonshot within their circle of influence

Develop Alzheimer’s Moonshot Scorecard

This foundational measurement tool is at the center of a multi-step, data-driven process that ensures all prospective Health Transformers meet the criteria set out by the impact board. It serves as a guideline for selecting companies and research teams, as well as specific programming. The Alzheimer's Moonshot Scorecard is currently under development.

Nominate Fellows

Nominate potential companies and research teams to join the Alzheimer’s Moonshot Community Visiting Faculty

Teach Masterclasses, coach Office Hours, advise on clinical/digital viability and create bridges to potential investors. Nominate Champions

The Alzheimer's Moonshot Scorecard is part of a larger philosophy and framework at StartUp Health. In all of our health moonshots – and indeed across all part of the business – we're driven by data-driven scorecards. This allows us to set the bar for success and measure our progress.

Help identify and nurture potential “right fit” funders in order to expand the Health Moonshot Community

startuphealth.com 17

ALZHEIMER'S MOONSHOT CASE FOR SUPPORT

Unite Alzheimer’s Moonshot Community We aim to supercharge and increase the likelihood of success of the research teams and companies working on breakthrough Alzheimer’s innovation. This is a unique opportunity to transform an ordinary portfolio into an extraordinary collaborative community through our structured entrepreneurial coaching program, designed to help them navigate the process of validating, commercializing, and scaling their innovation. Founders and researchers working on Alzheimer's innovation can apply at startuphealth.com/alz

Empower Alzheimer’s Moonshot Companies

Connect Community Into Global Network

All of the entrepreneurs, innovators, and research teams in the Alzheimer’s Moonshot Community participate in a dedicated track within Health Transformer University, a community-powered entrepreneurial mastery program.

StartUp Health uses a range of events, both live and virtual, to speed up connections between Health Transformers and our broader ecosystem of partners. We've also developed an industry-leading media operation that allows us to amplify the stories of health moonshot progress to an audience of hundreds of thousands of potential partners, investors and customers. By focusing on powerful storytelling, and teaching our community to use the same tools, we help Health Transformers attract the right collaborators and investors.

18 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

UNITING AND EMPOWERING THE ALZHEIMER’S MOONSHOT COMMUNITY

Alzheimer's Moonshot Fellowships // In Brief Health Transformer Digital Hub

While numerous academic institutions advance science, technology, and biology, none focus globally on training startup founders for the challenges of building, commercializing, and scaling a digital health, biotech or life sciences company. That's why we launched Health Transformer University (HTU). HTU serves as the nucleus of our health moonshot ecosystem, fostering collaboration globally. Tailored for entrepreneurs and innovators, it offers essential tools, structures, and networks to accelerate innovation cycles and guide transformative solutions through all growth stages. We accomplish this training through

Quarterly Growth Workshops Office Hours & Masterclasses Brand Amplification Program Events & Conference Activations $500,000 in perks and discounts

Quarterly Growth Workshops, Office Hours and Masterclasses, as well as through tailored events, both live and virtual.

We aim to supercharge research teams and companies working on breakthrough Alzheimer’s innovation. This is a unique opportunity to transform an ordinary portfolio into an extraordinary collaborative community through our structured entrepreneurial coaching program. The program is designed to help founders and researchers navigate the process of validating, commercializing, and scaling their innovation.

Let’s usher in an era of hope and healing for all. Contact us to learn how you can become part of the Alzheimer’s Moonshot Community. CHAMPIONS: Contact our team at alz@startuphealth.com FOUNDERS AND RESEARCH TEAMS: learn more and apply at startuphealth.com/alz startuphealth.com 19

"There's never been a better time to be part of an Alzheimer's Moonshot and the startup community than right now."

4 0 E S T. 2

ALZHEIM T, D

ALZHEIMER'S MOONSHOT // IMPACT BOARD

T HO& C U R E

’S MOON ERO S E , M A N A G S

TUP H

Meet Phyllis Ferrell, Chief Impact Officer for StartUp Health's Alzheimer's Moonshot Shortly after Phyllis Ferrell, DrPH, MBA, transferred from a marketing and sales role at Lilly to leading their Alzheimer's division, her father was diagnosed with the devastating disease. She threw herself into the work and eventually became a leading voice in Alzheimer's research and drug development. She's served as a strategic advisor to mulitple high profile Alzheimer's organizations, and now she's marshaling her experience to help launch StartUp Health's Alzheimer's Moonshot. We caught up with her to get a better understanding of where she sees this initiative going, and why this is such a unique moment in time for Alzheimer's innovation.

Before becoming the Chief Impact Officer of StartUp Health's Alzheimer's Moonshot you worked at Eli Lilly for 30 years. Tell us a bit about your career.

Phyllis Ferrell, DrPH, MBA: The first half of my career at Lilly was on the commercial side, mostly looking at getting new drugs launched and making sure that whatever we were doing was going to meet the needs of patients. But 13 years ago, the company tapped me to take responsibility for leading our late stage drug development and diagnostic development for Alzheimer's disease, which were both therapeutics and imaging agents at the time. It was a real change in my career, a pivot from commercial and marketing and selling to really thinking about how we were going to get these drugs through

the development pathway. But the really interesting part of this story is that about six months after I was asked to take on that role, my father was diagnosed with Alzheimer's disease. So I spent the second half of my career at Lilly really fighting both a personal and a professional journey. How did the experience with your father shape your perspective on the disease and your work?

Ferrell: It meant the job was not a job. You got up every day knowing that the fight was for your own family. But I think what really it shaped for me, and one of the reasons why I'm so excited about StartUp Health's Alzheimer's Moonshot is that there were so many things broken startuphealth.com 21

ALZHEIMER'S MOONSHOT // IMPACT BOARD

outside of the science. I recall someone coming and telling me we enrolled a study as fast as it's ever been enrolled – a thousand patients in the US in just 18 months. It took us 18 months to find a thousand people with Alzheimer's disease in the United States? I realized we were really sitting on top of a very broken healthcare system where people with Alzheimer's disease were in hiding. They weren't talking to their doctors, they weren't getting diagnosed in a timely or an accurate way, and as a result, they weren't ever being offered a clinical trial. But then of course, with a commercial background, a light bulb went on and said, gosh, what's going to happen when we actually are successful in the science, which we're starting to be right now, and the people who really need these drugs aren't going to be able to get them because the whole ecosystem wasn't working together. You're coming from this institutional understanding of bringing drugs to market, and now you are liaising with a community of startups. What do you see as something that's really essential and important about working with people in those early stages of innovation?

Ferrell: What I love about startups and founders is that they see a need, they see an opportunity, and they jump in with both feet. The way I looked at it is, we're now successful with these first therapies coming out of the regulatory process. We need to go make sure that all these startups, all this ecosystem around these

I'm really excited to increase the number of people that decide to raise their hand, take the pledge and say they want to be part of this because that's really how we're going to make a big difference in this disease.

therapeutics are available too. And that could be startups that support caregivers and families. It could be startups that help support care workers or B2B in a health system situation. It could be new diagnostics, new therapeutics. So for me, it's really exciting to be around people who said, I have an idea. I'm willing to jump in. I'm going to be a part of this battle. And that's really what it's going to take. There's not one sector that can do this by themselves. Is the breadth of innovation something that's important to you?

Ferrell: Well, it's one of the reasons that I decided to make the change and

22 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

leave a very successful and long career in pharmaceuticals. Any big pharmaceutical company will agree the drug is not the silver bullet. There has to be an ecosystem around these therapeutics. You see it in diabetes and oncology, but we haven't had it in Alzheimer's disease. People have been sitting alone, undiagnosed, hiding, losing their social networks. We can do better than this. And so I think that breadth of innovation is actually the only thing that's going to make us successful. With the Alzheimer's Moonshot we're creating a platform for a new kind of collaboration. Talk to me about why the sharing of data, the sharing of information is important in Alzheimer's in particular.

Ferrell: It's not just sharing the data of the studies, but it’s sharing what you learned about doing the clinical research. It’s sharing what you learned about physician behaviors and insights. When you talk about putting together a community of champions, it's going to be people who raise their hand and say, I want to participate in something that's bigger than myself. So now we've got a collective group of people in this moonshot that are sharing with each other how that change is happening, what they're learning as they're interfacing. And I think we're going to actually see some organic collaboration come between those moonshot champions. So I'm really excited to increase the number of people that decide to raise their hand, take the pledge and say they want to be part of this because that's really how we're going to make a big

4 0 E S T. 2

ALZHEIM T, D

T HO& C U R E

’S MOON ERO S E , M A N A G S

TUP H

difference in this disease. I know we're just in the early days of the Alzheimer's Moonshot, but have you received any feedback?

Ferrell: I've been in this community now for 15 years. And the thing about the Alzheimer's community, it's really tight knit. When they saw the moonshot announcement there was tons of inbounds. How can I help? How can I be involved? What can we do? This is great. We've needed this for a long time. And that's really validating and reinforcing. I know we have a hard road ahead of us, but I do know it makes it a lot easier if you're not doing it alone. Talk to us about the caregiver side of Alzheimer's. Obviously it's important to talk about drug development but there are innovations that can lift up those who provide care as well.

Ferrell: We often say that in Alzheimer's disease, you don't just have a patient, it affects the whole family. So I'm excited for families to not have to do it alone anymore. I'm especially excited for women. This disease disproportionately impacts women. It disproportionately impacts women as patients, both because we live longer, but also for some other reasons that we haven't completely understood yet. Caregivers are four to one more likely to be a woman. And paid caregivers, like CNAs – who are angels on earth – are more likely to be women. We see women dropping out of the workforce because they're honored to take care of their famstartuphealth.com 23

I didn't make it in time for my daddy. We lost him in 2017. I promised him we wouldn't give up. But I'll tell you what, we're going to make it for somebody else's daddy, and we're sure as heck going to make it for my kids.

ily members, but that shouldn't be the way things have to be. So I'm excited for caregivers to have more support. I'm excited for families to be able to talk about this disease. I'm excited for neighbors and communities to say, I know how to help now.

Alzheimer's research even before it was sexy to do so.

The moonshot is supported by two initial "Health Moonshot Champions," – ADDF and Gates Ventures. What does it mean just for the energy of an operation like this to have those two particular supporters?

Ferrell: There isn't one single innovation we are looking for. In terms of what kind of culture, what kind of founder, what kind of company we want, I want one that's gonna roll up their sleeves and say, I want to be part of something bigger. I want to come in and say that I'm going to share, collaborate, help pick up other founders. This is a hard and emotional thing to do. So how do you pick each other up? How do you keep each other going?

Ferrell: We were thrilled when Gates Ventures and the Alzheimer's Drug Discovery Foundation decided to come in and really catalyze this. I have to tell you though, I wasn't surprised. These two organizations have been funding

Is there a particular innovation that you're looking for or a type of company that you would love to see apply to the Alzheimer's Moonshot?

24 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

What I'm hearing from you is a message of hope for folks who have been told for decades that there's really nothing that you can do about Alzheimer's Disease.

Ferrell: If you looked in the lay press, all you'd hear was failure after failure in Alzheimer's drug discovery. But what people don't realize is negative studies to scientists are not failures. The only failure is when you don't learn. And so these scientists were building on each one of those negative studies and increasing exponentially our understanding of the underlying pathology and biology of this disease. Now we know how to target some of the underlying pathology, and we know how to study the drugs. We used to not be able to see the pathology in the brain until someone had passed away. We now know that pathology starts 10 to 20 years before symptoms. We know that these therapies are going to work better the earlier they are used. When I think of the inflection point, the science is coming, the biology is moving. The fact now that we have successes means we have investment coming in. People who were kind of gun shy and holding back are now jumping in. And we've learned so much over the last decade that now we at least have some of the first steps. Is it the end? Heavens no. But gosh, it's the beginning of the end. And that's a really exciting thing for someone like me who's had this disease impact my own family. I don't think there's a better time to be coming into this field. Now, do you have to have thick skin? Do you have to

4 0 E S T. 2

ALZHEIM T, D

T HO& C U R E

’S MOON ERO S E , M A N A G S

TUP H

be resilient? Do you have to be willing to roll up your sleeves and get in the trenches and work through some tough details? Absolutely. But there's never been a better time to be part of an Alzheimer's Moonshot and Alzheimer's research or startup community than right now, because we're at the beginning of something really, really fun and special. What are you looking forward to most in 2024?

Ferrell: I'm looking forward to some uptake in these therapeutics, because I think it's going to drive health systems, providers, practitioners, families, to realize that there is something there for them. And I think that in turn is going to fall right back to the funding for these startups. When we finish 2024, I really think this world's going to look a lot different for Alzheimer's patients than it did in December of 2023. And that's something that's really exciting for me. I didn't make it in time for my daddy. We lost him in 2017. I promised him we wouldn't give up, but I'll tell you what, we're going to make it for somebody else's daddy and we're sure as heck going to make it for my kids. Learn more about StartUp Health's Alzheimer's Moonshot at startuphealth.com/alz

startuphealth.com 25

T1D MOONSHOT CASE STUDY

The T1D Moonshot Looking Back on a Year of Growth and Connection

In 2023 StartUp Health launched a program designed to help Type 1 diabetes innovators achieve their health moonshot. The program, anchored by a program-related investment from The Helmsley Charitable Trust, has had an exciting first year. On the following pages we'll give an overview of how the Health Moonshot Community has evolved, then we'll share substantive progress updates from our founder community. Learn more at startuphealth.com/t1d

26 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

PRE

journey, like a story, is not about diabetic retinopathy, kidney failure, neuthe destination. It is really about ropathy, and gum disease. Access to insuthe people. How they grow. How lin and medical devices that deliver insulin they face challenges. How they change the and monitor sugar levels is expensive and course of their lives and the lives of others. not available consistently across socio-ecoOur approach at StartUp Health has nomic and geographic groups. A shortage always been grounded in people. We help of endocrinologists and diabetes specialdreamers and big thinkers achieve the ists compounds these challenges. Those seeking solutions and impossible by providing hands-on O N O a cure face their own chaleducation, emotional support, MM A N A G ESH D , lenges. & T and a network to leverage. When we look across Our secret: we create comthe verticals of academmunity. ics, industry, government, Since 2011, we’ve united foundations, and invesand empowered foundES T. 2 0 2 3 R tors, we see isolated efforts ers and funders aiming to A TU E H P and slow, siloed progress. achieve health moonshots. InIt’s time for a different model, spired by the original moonshot one that goes deep on impact by creatin the 1960s, where 400,000 people from ing a uniquely collaborative environment. 20,000 organizations collaborated to land We need to complement the extraordia man on the moon and return him safely, nary R&D efforts taking place with a we’ve honed our strategy for multifacfocus on entrepreneurial innovation that eted, long-term collaboration in service of brings new solutions to market and opens a world-changing outcome. In early 2023, the T1D Moonshot took up global access to care. flight, fueled by a significant program-related investment (PRI) from The Helms- ROLLING OUT A T1D HEALTH MOONSHOT COMMUNITY ley Charitable Trust. The initiative’s Our first step was assembling an elite primary aim is to streamline the developT1D Moonshot Impact Board comprisment and delivery of solutions for Type 1 ing visionary leaders, personally impacted diabetes. by Type 1 diabetes, spanning philanthropy, venture capital, industry, business, and WHY TYPE 1 DIABETES? Globally, more than 18 million people academia. Next, we set out to define a process have Type 1 diabetes (T1D). But the real for identifying, assessing, and measuring impact goes beyond the disease itself. companies to enroll in the T1D track of More than 70% of people living with T1D Health Transformer University (HTU), do not have their blood glucose under our education program for healthcare control, which can increase their risk of diabetic complications like cardiac disease, innovators. This led to the design of our

startuphealth.com 27

T1D MOONSHOT BY THE NUMBERS

T1D MOONSHOT COMPANIES

T1D RESEARCH TEAMS

COUNTRIES REPRESENTED

T1D HEALTH TRANSFORMERS

230+ T1D APPLICATIONS RECEIVED

28 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

<< Singer and T1D ambassador Nick Jonas met with members of the T1D Moonshot Community at a HLTH reception organized by Beyond Type 1.

novel T1D Moonshot Scorecard. In addition to providing a framework for vetting potential health moonshot partners, the scorecard would serve as a data-driven tool to gauge our momentum and chart the trajectory of our progress. During the first year, using our rigorous admissions process, our team reviewed hundreds of applications, many of which were referred by members of our T1D Moonshot Impact Board and T1D Moonshot Network. From this extensive pool, we have handpicked 30 standout, early-stage startups and research teams, representing a diverse selection of innovators, ideas, and products. Our inaugural T1D Fellows are now deeply engaged in HTU, harnessing the power of our expert coaching, global community, and robust brand presence. Like us, they are mission-driven, mindset-obsessed, communitypowered, and batteries-included. The T1D Moonshot 10-year vision isn’t to declare a cure. We’ve seen enough over-promising in the cure department. Instead, we want the result of the collective efforts of our global community to ensure that everyone with T1D has the tools and resources necessary to thrive. We want to create the tools so that we can prevent and delay the onset of the disease. These goals are audacious in their own right and will demand a level of collaboration and funding previously unseen in this sector. Just as the original moonshot required, our community must embrace learning and innovation, forging new solutions along the way. Every day, the impossible looks more possible. Our journey is far from finished. But if our goal is the moon, we’ve already put a rocket in orbit. The best is yet to come.

startuphealth.com 29

T1D MOONSHOT CASE STUDY

T1D Health Moonshot Community Building It's a been a fast-paced twelve months in the formation and development of the T1D Moonshot Community, which is a model for future health moonshots. Here are a few highlights.

SECURED T1D CHAMPION Helmsley Charitable Trust (HCT) became the inaugural T1D Moonshot Champion through a programrelated investment.

FORMED T1D IMPACT BOARD Assembled a 10-member Impact Board, convening quarterly, featuring top stakeholders from the T1D ecosystem.

30 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

CREATED T1D SCORECARD StartUp Health and the Impact Board set precise success criteria for selecting T1D companies and ongoing growth assessment.

Hosted

T1D Office Hours

WELCOMED T1D INNOVATORS StartUp Health selected 27 companies and 3 research teams from nine countries, out of more than 230 applications.

HOSTED VISITING FACULTY T1D founders learned from leading minds in the T1D ecosystem, like Glen Tullman and Mike Mason, during Office Hours and Masterclasses.

SPARKED COLLABORATION THROUGH IMPACT BOARD AND IRL StartUp Health united founders with the Impact Board during quarterly meetings and in person at HLTH in Las Vegas.

startuphealth.com 31

T1D MOONSHOT CASE STUDY

T1D Moonshot Impact Board Collaboration Sessions Each quarter StartUp Health prepares Health Transformers to present their work to the multi-disciplinary Impact Board, in order to get direct feedback and facilitate growth. After a recent session we asked Impact Board members to share their greatest insights. Here's what they said.

"I never imagined there would be so much innovation. We're onto something. Keep it coming!" Robert Oringer Chairman & Board Director, AMG Medical

"I've noticed an elevation of activism on the impact board. I love how many people are offering to make introductions and to help these early-stage companies. Let's keep it going!" David Weingard Executive Chair & Founder, Cecilia Health CSO & Founding Team, Valendo Health

32 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

"It gives me hope for my daughter and everyone else living with Type 1 diabetes. I'm really enjoying being a part of this." "It just gets me excited because so many [startups] don't make it far enough. I'm grateful for this opportunity to see these people bridge to the next steps." Jennifer Sherr, MD, PhD Professor in Pediatric Endocrinology, Yale School of Medicine

Norma S. Kenyon, PhD Deputy Director, Diabetes Research Institute; CIO, U of Miami School of Medicine

"Meeting [these startups on the Impact Board meeting] was a good reminder that StartUp Health has helped a lot of talented people." Mike Mason Former SVP and President, Lilly Diabetes, Eli Lilly

startuphealth.com 33

T1D MOONSHOT CASE STUDY

T1D Moonshot Progress Each issue we'll share a curated list of recent advances made by members of each Health Moonshot Community. Get weekly updates by subscribing to our newsletter at startuphealth.com/insider

Abvance Abvance Therapeutics developed a metabolic disease treatment, ABV100, a product combining insulin and glucagon effective in managing diabetesrelated hypoglycemia. Collaborating with some of the biggest diabetes organizations in the world (TBA) to round out a $15M seed raise

Diatech Diabetes Diatech Diabetes offers SmartFusion, an AI-powered app and algorithm for detecting infusion set failures, enhancing the safety and reliability of insulin therapy in diabetes management. Received JDRF Award to Advance Novel Software Platform for Monitoring Insulin Pump Infusion Set Failure

34 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

Hibiscus Health Hibiscus Health integrates holistic care with a diabetes-specific risk score and facial scan technology to detect glucose fluctuations, offering personalized treatment plans, education, and clinical support. Saw a 373% growth in MoM revenue in December ---Now officially in-network with United Health Care as a provider ---New patients being acquired through ZocDoc and physician offices

PRE

T. 2 0 2 3

Launched their platform nationwide, available in all 50 states ---Won a partnership at 2023 NXTSTAGE Community Health & Vibrancy Pilot Competition

Eddii Eddii is a gamified, softwaredriven personal health companion that offers real-time glucose monitoring and personalized clinical interventions for engaging diabetes management.

MANAGE

MOONSH C

In October, 2023, members of T1D Moonshot Community met in person at HLTH in Las Vegas, sparking new collaborations.

UP HEA

In-Range Animation In-Range Animation simplifies diabetes education with captivating microlearning animations, empowering patients to effectively manage their health. Began leading a team of diabetes educators, pharmacists, and clinicians to create “urgent case” diabetes training for pharmacies and community centers.

Journey Biosciences Journey Biosciences, have pioneered a groundbreaking predictive test, the NaviDKD, which assesses the risk of developing kidney complications associated with diabetes. Awarded CPT (0384U) from the American Medical Association (AMA) and a CPT awarded fee schedule by Centers of Medicare and Medicaid Services (CMS) for 2024 and beyond. This create a pathway to provide reimbursement for NaviDKD to millions of people living with diabetes in the U.S.

startuphealth.com 35

T1D MOONSHOT CASE STUDY

Quarterfinalist in UCSF Digital Health Hub Foundations Digital Health Awards 2023 ---Successfully completed ‘ProductMarket Fit’ pilot generating their first $35K in a 90-day window ---Built a Commercial CLIA Laboratory for high-complexity testing in Cleveland, Ohio ---Developed and deployed Compass digital platform that is AI-driven to produce risk assessments, engagement with healthcare professionals (HCPs) and is the primary user interface for patients and partners

NICH Novel Interventions in Children’s Healthcare (NICH) is a transformative program offering specialized, support for youth with chronic conditions like Type 1 diabetes, focusing on tailored interventions, and addressing social determinants of health. Partnered with Medicaid MCOs to offer unique services to the most vulnerable, high-risk youth with T1D

Secured funding from The Helmsley Charitable Trust for sustainability at Stanford and UCSF ---Renewed contracts with Oregon MCOs and received a substantial donation from Charter Mechanical to provide essential resources and basic needs for youth and families managing T1D

Pramana Pramana Pharmaceuticals is developing a new class of small molecules specifically targeting diabetes and metabolic disorders. Pramana's lead oral candidate for T1D, PRM A, demonstrated compelling results in recent data analysis, particularly in the statistical significance of activating glucagon on alpha cells. The data was presented at the 2023 ADA conference, introducing a

36 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

MANAGE

new therapeutic approach for Latent Autoimmune Diabetes in Adults (LADA) ---Phillip Crooker, former staff counsel at the FDA and head of New Drug Research and Evaluation, joined Pramana to assist in navigating fasttrack opportunities and orphan drug status. Mark Heiman, PhD, ex-Chief Scientific Officer of Obesity for Eli Lilly and current adjunct professor at NIH partnered Pennington Biomedical Research Centre, joined Pramana to lead their Obesity and Cardio Metabolic Disease program. Rob Jones, PhD, the lead inventor of Velsiptiy (acquired by Pfizer for $6.7B), joined Pramana to spearhead the LADA program

Smart Start Health SmartStart Health offers a patient education app personalized for individuals with diabetes using CGMs, providing tailored content based on factors like age and treatment approach, accessible via handheld devices. Completed proof of concept study for SmartStart CGM ---Kicked off a pilot for SmartStart CGM with Gary Scheiner at

H ES

T. 2 0 2 3

PRE

MOONSH

UP HEA

Integrated Diabetes Services, a global leader in one-on-one and remote consulting for people who use insulin ---Presented interim data from the proof of concept study at the 2023 Diabetes Technology Meeting and accepted to present at the 2024 ATTD Conference

Undermyfork Undermyfork is a food diary mobile app catered to individuals with diabetes, using data from CGM sensors. Published a pilot study on the company's diabetes app in the Journal of the European Society of Medicine

Xplosion Tech Xplosion Tech has created, Greens, a mobile app utilizing photo vision analysis to assist kids in managing their glucose levels. Received investments from 450 Ventures, the venture arm of BCBS Alabama ---Secured investment from Techstars and Innovate Alabama

startuphealth.com 37

T1D MOONSHOT CASE STUDY

38 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

MANAGE

PRE

T. 2 0 2 3

MOONSH

UP HEA

Are You Ready to Transform T1D with Us? For 13 years, StartUp Health has been more than a company. We’re architects of a global ecosystem aimed at conquering the biggest health challenges of our time. We blend creativity, efficiency, and compassion in an unprecedented approach to healthcare. Now, harnessing all we’ve learned, we have created a unique opportunity for passionate funders and families to champion specific global health moonshots, bringing an audacious dream from initial development to exponential progress. Our T1D Moonshot is just the tip of the iceberg. Under the guidance of an expert board and powered by mission-aligned families and organizations, we’re employing a double bottom line strategy— simultaneously generating profit and impact. Our 25-year vision for the T1D Moonshot is laser-focused: prevent, manage, cure. The stakes are monumental, but our collective potential for change is even greater. For the loved ones we’ve all lost, for those we can still save, now is the time to come together to meet our biggest health challenges. You can be a part of changing the world. If you’re driven to make a difference and want to be surrounded by similarly ambitious individuals and organizations, then we want you at the table. Together, we’ll turn each day into a monumental stride, not just advancing medicine but elevating the health and well-being of humanity.

Let’s bring healing and hope to people suffering from Type 1 diabetes. Contact us to learn how you can become part of the T1D Moonshot Community. CHAMPIONS: Contact our team at t1d@startuphealth.com FOUNDERS AND RESEARCH TEAMS: Learn more and apply at startuphealth.com/t1d

startuphealth.com 39

MEET THE NEWEST HEALTH TRANSFORMERS Each issue we introduce you to the inspiring founders we invested in recently. Their work addresses a range of health moonshots and themes. Are you a passionate funder of health innovation? Learn how you can support the next generation of Health Transformers at startuphealth.com

DATOSX BODIMETRICS SMARTSTART MINDR TRIBETIC IN-RANGE ANIMATION HIREME HEALTHCARE PREDICTIVE HEALTH LEVICURE HIBISCUS HEALTH ZINACARE QULAB MEDCOSHARE INSULLOC AMBROSIA SYSTEMS BULSAI startuphealth.com 41

DatosX Accelerates Innovation by Validating Digital Health Technologies DatosX partners with companies across the health tech ecosystem to generate the data needed to validate digital health tech without the high costs and extensive timelines of clinical trials.

When Robin Roberts worked at the global pharma giant Novartis, he would often participate in a recurring conversation with his colleagues. “We were having a very difficult time understanding how well a digital health technology would work in a specific use case,” he says. “I’d be sitting in conference rooms over and over again trying to solve the same problem.” The options presented to Roberts and

42 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

his colleagues were unsatisfying. They could either test a new digital health technology in conjunction with an extremely expensive and time consuming clinical study or they could make a guess. But the stakes in this guessing game were high. Some of the projects they were considering leaning into could cost the company millions of dollars in investment. “Often we choose wrong,” says Roberts. “We needed to develop a way to be able to test things in a time-efficient and cost-efficient manner.” Roberts was frustrated by the inefficiency of the system and by the lack of hard data. “In an industry of scientists and rigorous clinical trials, it struck me as unacceptable that we didn’t have the ability to collect data on digital health tech in a systematic and efficient way in order for us to bring something useful to patients or healthcare providers.” ORIGIN STORY

Roberts began tackling this problem in 2018 after launching The Novartis Biome in San Francisco, an innovation lab exploring ways technology can address big health challenges. Working at the intersection of health, data, and technology, Roberts quickly became aware that vetting healthcare technologies wasn’t just an issue faced by big pharma but also healthcare systems, startups, and VCs looking for data to support investment decisions. He then made tackling this gap his main priority. In 2023 Roberts left Novartis to co-found datosX Digital Health Labs — uniquely dedicated to systematically testing digital health

technologies. In order to build a successful system to test digital health technologies, Roberts relied upon leadership skills he developed while serving in Naval Special Warfare. Roberts thought his career at Novartis was over when he left the company 14 years ago to become a Navy SEAL. However, his career in the military was cut short after an injury. He returned to his previous job at Novartis as a global trial leader but with new potential. “I came back with a new set of skills, primarily around leadership,” says Roberts. (Other newly acquired skills, such as deploying explosives, were less transferable). “One of the things you learn very quickly in the military is how to lead on things that you may not be an expert in, but you need to become one very quickly,” he says. A mentor soon pushed him to take on the challenge of separating the financial and scientific management of trials. It was a problem he had flagged to his mentor, but not one he expected to solve himself. Yet he learned quickly, becoming an expert and leading a team in the first organization he developed and ran, the Global Trial Budget Management Organization. To address the unchartered territory of testing health technologies in a costand time-effective manner, Roberts and his team began by considering the biggest challenge. “We didn’t have access to the end users, whether they were patients or healthcare providers,” says Roberts. However, they realized that healthcare systems had the access they needed. “We went on this journey to start talking to health-

startuphealth.com 43

MEET THE HEALTH TRANSFORMERS / DATOSX

care systems and figuring out whether they wanted to be a part of this solution,” says Roberts. Although they found that healthcare systems were interested, the organizations needed to have more incentive to give their time and resources toward the effort of testing technologies. “The value proposition needed to be refined for all parties so that executing the study helped them achieve their objectives along with collecting this important data.” WHAT THEY BUILT

Roberts and his team realized that the monetary piece of the equation wasn’t of primary importance to healthcare providers. They were more interested in understanding the data on how effective the

solution is and solving relevant problems in their organizations. Hence datosX designed a value proposition that covered the expenses for the healthcare system in executing trials, allowed them access to the data, and aligned with problems they were already focused on solving. “For them, it becomes a risk-free opportunity to test the solution that they would have wanted to test anyway and understand how well it works in their specific system,” says Roberts. DatosX has since built a consortium of leading US healthcare systems that they consider as partners in testing digital technologies. A large part of their process involves matching the right healthcare systems — their study partners — with their

44 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

clients, which they call Study Sponsors. Their sponsors are diverse: it could be a digital health tech company collecting data for regulatory submissions or new claims, or a pharmaceutical company testing an internal incubator or weighing whether or not to develop a partnership with a digital health company. Once a match is made, datosX works with the study partner to develop the protocol and timeline for the study before it is executed and then analyzed. The end result is a decision point that provides sponsors with data-driven information to refine a solution or pivot to an alternative. Recently, datosX partnered with Banner Health, a large healthcare company, to test a wearable device. Although it had been used successfully in a particular context, the company needed information to see how it would work in a different space, with oncology patients. Like many other products in the digital health field, a full clinical trial was not needed to test this wearable. “What was needed was a simple test to see how well it works,” says Roberts. DatosX and Banner Health ran a study with several dozen patients. “We better understood how patients and healthcare providers react to that particular wearable,” says Roberts. “That’s the kind of information that an organization needs,” he adds. Although datosX’s first projects were executed under the umbrella of Novartis, they have been functioning as an independent company since October 2023. The benefit of scaling a tried-and-tested concept into a new venture is that “we’re

not a new organization that hopes they can fit in the marketplace and hope that it works,” says Roberts. “We’ve gone through the process of figuring out how it is going to work best for healthcare systems, life science companies, and digital health tech companies,” he says. Currently, datosX has over a dozen healthcare systems on board. “We’re constantly growing that list,” says Roberts. TAKE AWAY

DatosX helps make the health technology field more agile and efficient and it’s a service that has the potential to impact the overall wellbeing of the health technology field. DatosX has solved an industry-wide problem and in doing so has removed the problematic choice many companies face: take a wild guess or spend huge amounts of money and time testing a digital health technology. With datosX’s expertise, connections, and partnerships across the ecosystem, “Now this is a problem that you can solve,” says Roberts. CONTACT DATOSX@STARTUPHEALTH.COM

startuphealth.com 45

BodiMetrics Introduces the First FDA-Cleared Pulse Ox Wearable That Works with Darker Skin Pigmentation Traditional blood oxygen devices have a serious flaw: they aren’t as accurate for people with darker skin tones. Co-founders Neil Friedman and Mark Goettling have solved this health equity dilemma with their circul+ Smart Ring, which has a unique, patented design that takes readings from the underside of the hand.

“For decades, there was a known problem, and people swept it under the carpet. Covid just laid bare the long standing issue and related deaths in darker skinned individuals.” Neil Friedman is not a man to pull his punches, especially when it comes to healthcare inequity or injustice. Today he’s talking about what the New England Journal of Medicine called “the non-intended racial discrimination” of blood ox-

46 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

ygen measurements using a pulse oximeter on people with darker skin tones. Pulse oximeters gauge blood oxygenation numbers by measuring the amount of oxygen in red blood cells using lights shined into the skin of the finger, so it makes sense that for over 40 years, doctors and researchers knew or should have known that fingertip pulse oximeters placed on darker pigmented skin may provide inaccurate readings. Based on pulse oximeter readings, doctors can diagnose various pulmonary diseases and determine treatments including whether a patient needs supplemental oxygen. Inaccurate blood oxygenation readings could mean patients aren’t maintaining the oxygen levels in their system to sustain their health and may not get the oxygen they need. A 2022 Harvard Medical School study determined that Black, Hispanic, and Asian patients in intensive care units received less supplemental oxygen than Caucasian patients because of inaccurate pulse ox readings. With blood oxygen being one of the key metrics for triaging and treating patients with Covid, it’s little wonder that people of color suffered disproportionately poor outcomes — including death — during the pandemic. “During Covid, everyone ran to buy fingertip pulse oximeters or, here in NYC, minority populations were handed them by their doctors. The readings weren’t accurate,” says Friedman. “The healthcare community knew about the problem for years and didn’t do anything about it.”

THERE’S GOT TO BE ANOTHER WAY

Friedman and his business partner Mark Goettling knew that patient monitoring, particularly when it came to blood oxygen, could be better, much better. When their company, BodiMetrics, looked to enter the remote patient monitoring (RPM) space, they took their time testing and validating the device they built to see if it could accurately monitor patient blood oxygen without a pigmentation problem. After years of experimentation and different mods, they figured out a solution that met their exacting standards and introduced CIRCUL Ring in 2019 and second-generation circul+ Smart Ring in 2021. The key, or what Friedman calls the “secret sauce,” lies in the patented form factor of the circul+ design. Worn on the finger like a ring, the device has spring loaded expandable sides to maintain a snug fit. This stabilizes the sensor because it can expand and contract with the patient’s movements and gives it the ability to provide medically accurate and actionable metrics. This stability and the fact that the light sensors lie on the palm side of the patient’s hand solves the issue of skin color, as the inside of the finger is lighter than the outside. “It’s a hospital on your finger, providing clinically valid data continuously every second via our patented form factor. This gives clinicians and patients alike the information needed to monitor and manage their chronic conditions and general wellbeing,” emphasizes Goettling. The BodiMetrics circul™ pro Ring received FDA 510(k) Clearance in Fall 2023 and the Mayo Clinic released a

startuphealth.com 47

MEET THE HEALTH TRANSFORMERS / BODIMETRICS

peer-reviewed study in Summer 2023 proving that the ring provides accurate blood oxygen measurements in all tones. This is a huge boon for the company, with Friedman describing the study as an earthquake in the industry. “Once that message is out there, every CEO of a healthcare system, an insurance company, etc. can’t hide from the fact that other measurement devices have a pigmentation problem that our device is clinically validated to solve.” COMPETITIVE LANDSCAPE

Besides its proven effectiveness across different skin tones, the circul+ Ring runs, well, circles around its competitors in terms of providing clinically relevant, actionable data. While other wearables take periodic measurements of blood oxygen levels during sleep (the Oura Ring, for instance, measures every 15 minutes), only the circul+ provides measurements every second, making it the most accurate on the market. As sleep expert Meir Kryger from the Yale School of Medicine put it, “this is the only consumer device measuring and storing oxygen level heartbeat by heartbeat.” And sleep is a big deal when it comes to overall health. Just last year the American Heart Association added sleep to their checklist of essential components for optimal cardiovascular health. Poor quality of sleep contributes to problems with blood pressure and increases the risk of heart disease, stroke, and diabetes. The circul+ ring quantifies its users sleep quality using multiple key performance indicators, like

heart rate variability, temperature, oxygen desaturation, and sleep stages. BodiMetrics has a multi-year head start on their competitors in terms of crossing over from the fitness-focused wearables market to the medical world. They have three-year partnerships with both Kaiser Permanente and the United States Department of Veterans Affairs (VA). In addition, they just signed an agreement with Carahsoft, a huge player in government and public sector and holder of government contracts. As a health solution, their target market is the chronically ill, those who are aging in place, rural communities, and anyone who is medically or geographically underserved. “Our device accurately measures more data than any other, and our mobile and cloud-based applications use AI and machine learning to contextualize that data for both the clinician and the patient to manage exercise, stress, sleep, and other important factors for health.” ONWARD AND UPWARD

Besides their partnerships with providers like Kaiser and the VA, BodiMetrics sells products to consumers through wholesalers and retailers like Walmart and McKesson and directly to consumers via ecommerce from their own website, Amazon, and Sharper Image, and they have more retailers lined up. Although their eye is on the healthcare market, their product also appeals to the health conscious consumer who wants to accurately track their sleep and fitness metrics, a market that is expected to reach $612B

48 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

by 2024. What the two founders love hearing the most, however, are the stories of real patients who received better care because of accurate readings. Just the other day, Friedman received a phone call from a physician in an ICU unit about a Black patient from whom they couldn’t get a good blood oxygen read. Then they used the circul+ Ring, and it got the reading perfectly.

both the healthcare and consumer wearables market. As Friedman put it, “we are a great team.” Together they combine backgrounds as serial entrepreneurs in technology, healthcare, manufacturing, and distribution. The duo are backed by some of the most distinguished doctors in the sleep and pulmonary space as business advisors. We can’t wait to see how far they can go in the journey to provide next-level health metrics to patients and consumers.

OUR TAKE

CONTACT BODIMETRICS@STARTUPHEALTH.COM

Thanks to the tireless work of managing co-founders Neil Friedman and Mark Goettling, BodiMetrics’ real-time monitoring solution, circul+ Smart Ring and app, is extremely well-positioned in

startuphealth.com 49

50 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

MEET THE HEALTH TRANSFORMERS

SmartStart Bridges the Knowledge Gap for People with Type 1 Diabetes the achievement of key targets for diabetes management, and we’re not there yet,” says Holloway. She points to an international consensus stating that most people with diabetes should aim to spend 70% of the time in the target range for blood sugar levMelissa Holloway, CEO & els (70–180 mg/dL) and no more than 4% Founder of SmartStart, says of the time below the target range. “The there’s too much smiling and familiar figure seems to be about 30–50% nodding in healthcare. of people reaching both goals, even O N MO SH “It’s a big problem in commuwith automated insulin delivery D nication,” says Holloway. It’s a technologies,” says Holloway. situation we’re all familiar with, She has observed this firsthand, whether we’ve experienced it including in patients receiving RT UP HEA with a doctor or some other exquality care from enthusiastic and pert, like a teacher or car mechanic. knowledgeable healthcare profesWe smile, we nod, and later on we struggle sionals. to recall something important. Holloway, Holloway spends a lot of time in who has Type 1 diabetes, was particularly Facebook groups where people with T1D concerned about people using continu- ask questions about using diabetes techous glucose monitoring (CGM) missing nology. She finds herself sharing knowlout on or misunderstanding information edge and tips — a role she has adopted on about diabetes self-management. As a solu- an ad-hoc basis since her days as a gradution, she developed SmartStart CGM. The ate student, when she established a supmobile-first platform streamlines the pro- port group for other students with T1D. cess of patient education through interac- Discussions on social media opened her tive learning tools easily accessible on one’s eyes to the ways that people struggle to phone. reach diabetes management goals. “A lot of it has to do with the way that people THE CHALLENGE make diabetes decisions using their data,” “There’s all this great technology, but says Holloway. Many people aren’t able to then you look at the outcomes data around accurately interpret or proactively use data Melissa Holloway built a mobilefirst, interactive educational platform for people on intensive insulin therapy.

MANAGE

T. 2 0 2 3

PRE

startuphealth.com 51

MEET THE HEALTH TRANSFORMERS / SMARTSTART

from their CGM. Many also don’t heed the advice of the healthcare providers, whether intentionally or unintentionally. They might have been nodding and smiling in their doctor’s office, but they’re not necessarily able to put principles into practice. Holloway’s intention is not to shame people. Inspired by experience, SmartStart CGM even includes an interactive case study about someone out drinking with friends who doesn’t want to interrupt the moment to correct a high glucose level. “People make tradeoffs,” she says. She also finds that healthcare providers tend to make assumptions about how much people living with T1D know about treatments and technologies. “You don’t know what they know unless you actually ask,” says Holloway. “And it’s very difficult for healthcare providers to assess knowledge in

routine care. We don’t have great validated tools and there’s never enough facetime,” she says. WHAT THEY BUILT

SmartStart CGM is designed to help the intensive-insulin-using population use CGM. Its content modules orientate users to the technology, developing their understanding of the numbers, trends, and graphs that provide insight into glucose levels. SmartStart CGM fosters engagement through games, stories, and interactive case studies about interpreting CGM data in realistic hypothetical scenarios. Holloway hopes learning experiences in SmartStart CGM will translate into more informed self-management in real life. So far, those ambitions are looking attainable. In the proof of concept study, participants’

52 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

average CGM knowledge scores doubled from baseline to completion. Furthermore, the proportion of participants reaching both the clinical goals for time in range and time below range increased from 29% to 65%. ORIGIN STORY

Holloway’s passion for healthcare communication grew out of her experience supporting other students with T1D while she was studying for a doctorate in Reformation-era British history. She left graduate school to pursue a career in the healthcare industry. An invitation to write an expert patient column for Medscape. com led to a job with Close Concerns, a leading consulting company focused on the business of diabetes and obesity. Then, after two years with Abbott Diabetes Care, she moved to London as a healthcare consultant and turned to medical copywriting in healthcare advertising. From 2013 to 2018, she also ran a small charity promoting access to diabetes technology and education within the UK National Health Service (NHS). As a frequent attendee of diabetes conferences, she had a front-row seat to developments in diabetes care. In 2017, the SPECTRUM patient education program on CGM caught her attention. She wondered if it could be delivered digitally. Like many other diabetes education programs, it required in-person attendance, which isn’t always practical for people with diabetes or for healthcare providers. When COVID happened, she heard about people having NHS funding for

CGM withheld because they were required to attend in-person training, but those in-person training sessions were indefinitely postponed. “Finally, we’re going to have an honest conversation about how in-person diabetes education classes aren’t meeting everyone’s needs,” she thought. Sensing that the timing was right, Holloway got to work developing SmartStart CGM. The Diabetes Center Berne Innovation Challenge in 2021 further focused her efforts and provided necessary funding to realize the project. TAKE AWAY

People using intensive insulin therapy can benefit greatly from CGM. However, the right knowledge goes a long way in improving outcomes. With far too few diabetes specialists on the ground — and evidence of gaps in communication between healthcare providers and patients — SmartStart delivers relevant and relatable information about CGM effectively. This tool helps to leverage CGM’s potential and improve health outcomes for its users. SmartStart’s value also extends to the space within a clinic, promising to enrich conversations between healthcare professionals and their patients. “We’re going to be able to personalize the learning journey,” says Holloway, who has designed the platform to help focus conversations with providers — and hopefully cut through some that nodding and smiling. CONTACT SMARTSTART@STARTUPHEALTH.COM

startuphealth.com 53

MEET THE HEALTH TRANSFORMERS

MINDR, a Digital Diagnosis and Prevention Platform, Humanizes Dementia Care at Scale Co-founders Dr. Inna Marquard and Adam Shultz (above) are leading a team digitizing and streamlining the seminal FINGER study, which proved that if people target five areas of their health — train their brains, move their bodies, manage vascular health, eat better, and engage in social activities — they can decrease the risk of dementia and slow the progression of cognitive impairment disorders by up to 40%.

By the time patients come to me, it’s already an established problem. They are too scared to bring it up earlier because they don’t think there’s anything they can do.” Inna Marquard, MD, is talking about patient attitudes towards cognitive decline and dementia. Over her years as a practicing physician focused on geriatric care and rehabilitation, she saw the same thing again and again — patients unwilling to mention some of their early signs of reduced cognitive functioning because

54 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

they thought there was nothing they could do. And that was terrifying. These fears aren’t unfounded. There is no cure for Alzheimer’s disease or other dementias. It is the sixth most deadly disease in the United States, and since the number of people in the US over 65 is set to double over the next 40 years, cases will only grow. Despite its prevalence, however, 40% of US physicians don’t feel comfortable diagnosing dementia, and 55% percent felt like there are not enough dementia care specialists in their communities to meet demand. Between the patients’ hesitancy to share indicators and the physicians’ uncertainty in diagnosis, it’s little wonder that a dementia diagnosis typically comes a full 18 years after symptoms start to appear. 18 years of possible intervention time lost. 18 years living in fear and worry. 18 years that could have been used to slow or even stop the progression of cognitive decline. ORIGIN STORY

“With every other disease, it’s screen, screen, screen, prevent, prevent, prevent, but that story isn’t happening with Alzheimer’s and dementia, even though we now know there are things you can do. Dementia is not a wait and be helpless situation.” That’s Adam Schultz talking, co-founder of MINDR with Dr. Marquard and Tim Ottenbreit. He joined the MINDR team to help its users implement the findings of the FINGER Trial, a landmark study out of Finland in 2013, that proved

the effectiveness of a multi-pronged intervention to prevent cognitive decline. Specifically, the study showed that if people do these five things as they age — train their brains, move their bodies, manage vascular health, eat better, and engage in social activities — they can decrease the risk of dementia and slow the progression of cognitive impairment disorders. The Lancet estimates that this could be true for up to 40% of cases. 40% is a huge number. If this was a study that found a 40% reduction in breast cancer or diabetes cases, it would be shouted from the rooftops. Instead, ten years after the initial findings of the study, which have been corroborated in ongoing trials, few physicians either know about it or bring it up with their patients. Part of the problem is the results didn’t feel actionable. There simply aren’t enough specialists to meet the demand, and the comprehensive lifestyle program as recommended by the study is believed to be an enormous (and expensive) undertaking. UNDER THE HOOD

Enter MINDR, a digital diagnosis and prevention platform for people at risk of Alzheimer’s disease and other dementias. What the MINDR team did was digitize the interventions proven in the FINGER study so that they became scalable and accessible, available affordably to as many people as possible. Their mission is to democratize access to screening, diagnosis, and these proven treatments. The key to their program is delivering digital coaching and accountability in a

startuphealth.com 55

MEET THE HEALTH TRANSFORMERS / MINDR

way that helps people actually reach their goals. It’s not easy for anyone to shift exercise, diet, and social habits, let alone an older adult for whom these patterns are more ingrained. That’s where Schultz’s experience comes in. Before MINDR, he created another app for teaching corporate skills — different clients, but same focus on learning and practicing new ways of being. “You need to tap into people’s intrinsic motivation to change. Figure out why making a shift is important to them and you can access that motivation and remind them of it when things get hard.” How does this look practically in the MINDR app? The user experience starts with a digital assessment, covering their user’s cognitive and physical health, interests, relevant family information, plus a motivational interview to find out their concerns, goals, and reasons for using the platform. An important part of this process is asking them to sign a contract and make a commitment to an actual human, a certified health coach who walks them through making small changes along the way that lead to bigger lifestyle change. “The human part is important. The program is 95% digitized, making it very scalable, but the 5% that’s human makes the impact, so that it’s both wildly scalable and widely effective.” A 90-day pilot study proved that effectiveness. 71% of participants saw an improvement in their memory, with a 50% uptick in remembering recent conversations and 43% reporting fewer lost objects. The number of days of limited

THE FINGER TRIAL MINDR is grounded in data from The FINGER Trial, an ongoing, multi-center, randomized, controlled trial proving the effect of a multidomain intervention in preventing cognitive impairment and disability in older people at increased risk for dementia. --According to the FINGER trial, if people do these five things as they age they can decrease the risk of dementia or slow the progression of cognitive impairment disorders by up to 40% of cases. 1. Train their Brains 2. Move their Bodies 3. Manage the Medical 4. Eat Better 5. Get Social

activity decreased from 10 monthly to 3.5 at day 90. Even in its pilot form, MINDR was able to do what it set out to do — take the findings of the FINGER Trial and make them accessible and actionable to anyone, anywhere.

56 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

WHERE DO THEY GO FROM HERE

The MINDR team is currently focused on building and testing their platform before their public launch. That includes establishing a comprehensive network of providers in all 50 states for telemedicine visits and physician-led testing and diagnosis, already well on its way thanks to a strategic partnership with MD Integrations, a white-label telemedicine platform. They’ve additionally partnered with Cytox for genetic risk assessment and Labcorp for further patient testing and monitoring. If you believe MINDR would be a good fit for you or someone you love, you can sign up for the beta program at Mindr.us. With between 60–80 million Americans in their target market — anyone with risk factors for cognitive impairment, including family members with dementia or experiencing early symptoms — and that number projected to rise 37% over just the next seven years, there is a giant opportunity for growth, especially given the lack of currently available scalable solutions. As they go to market, MINDR has its eye on VBID (Value Based Insurance Design) contracts since their product can deliver results at a fraction of the cost of the memory clinic model, which they feel would be particularly interesting to Medicare Advantage plans. It’s that opportunity for impact driving the team forward, and not just for the impact they can have on their users’ quality of life. Dementia, Alzheimer’s, and other cognitive performance issues affect

the lives of entire families, as adult children, partners, and spouses work to care for their loved one. For instance, just a year into getting involved with MINDR, Schultz’s mother experienced temporary cognitive impairment related to high blood pressure. “I knew she was aging, and I knew that what we were building might matter to me someday, but my work with MINDR helped me see exactly what I needed to do for her and what tools she needed to stay healthy, even while I managed her care from three states away.” OUR TAKE

MINDR takes on a huge potential market experiencing significant pain points and provides a scalable option that is still deeply human. We think the health coach aspect of their platform is key to keeping users motivated; it’s the right amount of connection with an actual person to achieve results. And with an experienced team and a detailed goto-market strategy, we see MINDR as a company able to hit the ground running once they have their funding in place. We are thrilled to welcome them to StartUp Health and have a front row seat as they tackle dementia diagnosis and treatment. CONTACT MINDR@STARTUPHEALTH.COM

startuphealth.com 57

58 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

MEET THE HEALTH TRANSFORMERS

TRIBETIC Is Transforming Type 1 Diabetes Management Through Personalization, Integration, and Interpretation but leave out essential elements like nutrition, sleep, and physical activity. It’s as if you are handed a recipe with only half the ingredients, you’re left with something incomplete and unsatisfying. Enter TRIBETIC, a platform that takes a new approach to T1D management. Instead of just collecting data, it’s designed to interpret, integrate, and personalize it, making it more meaningful and actionable, improving quality of life.

Co-founders Dan Donlevie and Suzanne Stites (left) are leveraging their experience in elite athletics and business creation to build a new kind of T1D management platform, one that seamlessly integrates critical data and makes care guided and highly personalized.

Imagine being handed a thousand jigsaw pieces ORIGIN STORY but no picture on the box Dan Donlevie, an Ironman athlete, got to show you how they fit his first taste of the struggles of diabetes together. For folks with Type 1 diabetes management when he found himself mys(T1D), this is an everyday reality. They teriously falling ill during the Ironman have access to a wealth of data about Lake Placid in his late 30s. “I wasn’t feeltheir blood sugar levels but no ining great. I remember completing O N MO SH formation on how to interpret it the 112 mile bike but on mile D or take actions to manage their two of the run something was condition better. It is like havjust not clicking. After throwing ing a toolbox full of tools but up, I was thinking, ‘how am I RT UP HEA no instructions on how to build going to run the rest of this maraanything. thon?’ I knew it wasn’t lack of trainNow, to make matters even more puz- ing or preparation, but I also didn’t know zling, imagine some of those jigsaw pieces what was going on?” being missing. Existing solutions for T1D It turned out that Dan’s body wasn’t abmanagement often focus on just a few sorbing carbohydrates the way it should, pieces of the diabetes puzzle. They might and a little later, he was diagnosed with give you a glimpse of the bigger picture T1D, a revelation that rocked his world. MANAGE

T. 2 0 2 3

PRE

startuphealth.com 59

MEET THE HEALTH TRANSFORMERS / TRIBETIC

Being a healthcare professional with a background in athletic training, physical therapy, and nutrition, Dan thought he was prepared. But despite his expertise, he found himself facing an entirely new challenge. Dan vividly recalls the early days of learning to manage the condition, testing different foods, and constantly monitoring his blood sugar levels. He had to become his own lab rat because there weren’t many resources available. Dan realized that the best insights into his body came during intense physical stress. “Your body adapts in terms of the way it handles things so you can go through your day as a person with diabetes. If you’re fairly inactive or sedentary, you are experiencing the same things on a much smaller scale. But when you start to stress your body, those adaptations start to surface much more readily.” Over the years, Dan’s diabetes management evolved from manual injections and finger pricks to continuous glucose monitors (CGMs) and insulin pumps. He also began exploring wearable health devices like the Oura Ring and Whoop Straps. What struck him was the wealth of data available for athletes but the absence of integrated solutions catered toward people with diabetes. So Dan took matters into his own hands and started creating spreadsheets to understand the intricate relationship between exercise, nutrition, and blood sugar levels. In doing so, he discovered the highly personalized nature of diabetes management, understanding that

CONTACT TRIBETIC@STARTUPHEALTH.COM

what works for one person might not work for another. He also noticed a gap in the market–companies invested millions in creating software solutions for diabetes management but offered little or no guidance on how to interpret it. These apps showed what was going well and what was going wrong but didn’t provide instructions on how to manage the condition better. Furthermore, most diabetes management apps focused on just one biomarker–blood sugar levels–when there were many more elements that influenced metabolism and affected the blood sugar levels. However, it was challenging to break them down, but it is exactly what Dan wanted to do. Dan’s idea was simple: making T1D management highly personalized by integrating critical data about all aspects of

60 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

metabolism–nutrition, physical activity, blood glucose levels, and more–helping people understand it and then creating individualized plans. Things started falling into place when Dan spoke to Suzanne Stites, an accomplished triathlete with whom he had shared a decade-long friendship. Suzanne had faced her own challenges: an equestrian accident from which she needed significant rehab. A few years after the accident Dan started to work with her to address her physical and metabolic challenges. She too is now doing Ironman triathlons. Suzanne also had a career creating health and wellness businesses. She has run and created multi-million dollar businesses. Her core drive was to make a difference in people’s lives. So, when she saw what Dan was building, she couldn’t help but be drawn to it. Together, they formed TRIBETIC in 2019, a name that resonates with their athletic spirit; the three metabolic levers of nutrition, exercise, and sleep; and a commitment to helping people with T1D. The duo believed they could revolutionize healthcare by optimizing the metabolic health of people with Type 1 diabetes, and the good people surrounding them are proof that they will. TRIBETIC’s advisory boards comprised accomplished endurance athletes and nutritional, genetic, behavioral, physiological, and metabolic experts who understand the intricacies of how the human body works. Currently, TRIBETIC is in the midst

of a feasibility trial to refine their system and fundraising to develop the MVP. Ultimately, their goal is to make T1D management integrated, highly personalized, and accessible to all. UNDER THE HOOD

TRIBETIC is a B2C platform whose approach to T1D management is rooted in personalization, integration, and interpretation. Personalization is at every step of a user’s journey with the app and live coaching. As soon as a user signs up, they will be asked to answer a few questions and engage in a brief discussion with an onboarding expert. This initial conversation is used to determine the best plans based on individual biology and lifestyle preferences. The next step is to connect daily activity trackers or CGMs with the app. TRIBETIC then gives users a personalized daily map. The map includes new plans for exercise, nutrition, and sleep every week and is adjustable based on the body’s response and schedule. All are supported by weekly calls encouraging compliance and persistence. TRIBETIC doesn’t just look at blood sugar levels but all aspects of metabolic health, including nutrition, sleep, exercise, and heart rate variability (HRV).

Scan to read the full story or go to healthtransformer.co

startuphealth.com 61

MOONSH T,

MANAGE

T. 2 0 2 3

PRE

MEET THE HEALTH TRANSFORMERS

UP HEA

In-Range Animation Uses Illustrated Micro-Learning to Improve Diabetes Education Neil and Suzie Israel are on a mission to make diabetes education more effective. They are helping young adults take control of their health and live the best lives without feeling restricted, one animated video at a time.

Have you ever been in a class with a super smart teacher who knows the subject inside out but explains things in a way that leaves you scratching your head? Well, that’s how some people with diabetes feel when they visit endocrinologists.

62 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

Endocrinologists are extremely knowledgeable in their field. But they are busy and use medical shorthand that confuses and intimidates an average human. The conversation can also be quite inquisitive. It’s like getting called to the principal’s office for something you didn’t do. The air becomes heavy, and their questions can make you feel like you’re on trial for your life decisions. “Why did your blood sugar spike that day three weeks ago?” they might ask. Think about it — remembering every detail of what you ate three weeks ago or the exact sequence of events leading to a blood sugar spike is as challenging as recalling the weather on a random day months ago. Now, imagine being in this scenario in high school or college. When everyone else seems carefree about what they eat and drink, you are making strategic decisions about every morsel of food and every drop of drink you consume, only to have your blood sugar levels rise or fall unexpectedly and find yourself at the endocrinologist’s office. This is where In-Range Animation steps onto the stage. They act as guides on the T1D journey, creating short, fun, animated videos that transform complicated diabetes management into easy-to-understand nuggets. With In-Range Animation, you no longer feel like sitting through a boring lecture but more like chatting with a friend who knows what you’re going through.

ORIGIN STORY

The story of In-Range Animation began with two individuals driven by their unique experiences, empathy, and a strong desire for change. Neil Israel, one of the co-founders of In-Range Animation and a seasoned educator, had been working at a nonprofit, writing grants to fight poverty and tackle various pressing issues. One day, while going through a grant proposal filled with dry, boring text, Neil had a moment of realization. He thought, “This is so boring. If I find it dull, anyone reading it will definitely lose interest.” Neil, together with his wife, Suzie Israel, a fine artist and seasoned software developer, approached his bosses and suggested creating a video that explained things in a fun way so that more people would pay attention. The response to the video they created was overwhelmingly positive, which got Neil thinking about how he could use his skills to help people in other ways. And in 2019, In-Range Animation was officially born. However, what truly shaped In-Range Animation into what it is today was Neil’s personal journey with Type 1 diabetes for 43 years, plus his deep appreciation for individuality and the understanding of sensitive conversations he gained while working as a trainer at the Anti-Defamation League. Neil had always believed that access to non-judgemental information during his early years with diabetes could have made a significant difference in his life. His belief was further solidified by numerous

startuphealth.com 63

MEET THE HEALTH TRANSFORMERS / IN-RANGE ANIMATION

studies that found young adulthood to be a crucial phase in life when complications manifested. Neil was also alarmed by a prevalent issue within the diabetes community: Despite remarkable advancements in healthcare, blood sugar management wasn’t showing corresponding improvements. His initial inquiry shed light on two critical factors. First was the often adversarial relationship between young people with diabetes and healthcare professionals. Doctors, while well-intentioned, often assumed the role of investigators, probing patients about past actions and decisions. This resulted in people with Type 1 diabetes often resorting to fear-based management of the disease, focusing on avoiding unexpected high or low blood sugar levels rather than planning for better outcomes. Second, Neil and Suzie saw that the existing educational resources were fragmented, lacked engagement, and failed to provide the kind of holistic support that individuals with diabetes desperately required. “The most effective diabetes education that exists is classes by live diabetes educators where you can get immediate answers to your questions. While there are a lot of great YouTube videos, the information is so vast that it becomes hard to find what you need. Plus, young people often have shorter attention spans. So, any educational solution has to be not just authentic but also engaging and something that doesn’t make people feel like they are being talked down to,” said Neil. The pressing need for innovative edu-

cational tools in the diabetes space made Neil and Suzie begin their search for new ways to teach young adults about diabetes. They decided to merge micro-learning and animation, a combination that would allow them to tap into the cultural moment, simplify complex information into quick, impactful lessons, and make it more accessible to a broad audience in an entertaining, informative, and memorable way. Innovative checks for understanding — developed by award-winning diabetes educators — aid in understanding and retention. Around 2022, they decided to make In-Range Animation proactively focus on diabetes education. Their journey was marked by milestones such as creating educational videos for JDRF in Texas and producing a short explainer training video for a continuous glucose monitor (CGM) reseller. The latter experience solidified their belief in the power of animation to explain complex ideas effectively. Today, In-Range Animation is on a mission to change how people learn about diabetes. They are creating content that empowers individuals to take control of their lives by moving away from fear-based education to proactive self-management. UNDER THE HOOD

In-Range Animation takes a twopronged approach to diabetes education. First, they are developing an app that integrates educational videos and interactive features. The app serves as a user-friendly platform for individuals with diabetes to access valuable information seamlessly.

64 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

The curriculum within the app is designed to be flexible. While there are structured educational tracks, users can also explore content based on their specific questions or needs. This approach ensures that education isn’t a linear journey but a personalized one. The second aspect of their product is a series of 30+ educational videos. These videos are designed based on insights gained from diabetic educators. They cover essential topics for diabetes management, making them accessible and easy to understand. Neil and Suzie are also interested in the potential of AI to enhance the effectiveness of micro-learning. The duo is considering the integration of smart search that will interpret users’ questions and provide precise video clips that answer those questions directly. This feature will enable users to engage with the app in natural language, making it an intuitive tool for managing their condition. The two-pronged approach enables InRange Animation to envision both B2B and B2C models for its offerings. They position themselves as partners to those

at the front lines of diabetes education. They plan to engage clinics, hospitals, and insurers as their primary customers, with the potential for white-labeling the basic content to align with their branding. At the same time, they also foresee offering a freemium version to ensure accessibility for individuals with Type 1 diabetes. LAST WORDS

In-Range Animation is an exciting venture that is set to make a substantial impact on diabetes education. Besides their blend of educational expertise and a genuine understanding of the unique needs of individuals living with diabetes, what truly sets them apart is that they are not just providing information but fostering empowerment. By emphasizing self-management and autonomy, they aim to shift the narrative from patients feeling like victims relying solely on medical professionals to individuals who take control of their lives and health. This change in mindset, from passive recipients of care to active participants in their wellbeing, can have a tremendous impact on improving health outcomes and overall quality of life for those dealing with Type 1 diabetes. CONTACT INRANGEANIMATION @STARTUPHEALTH.COM

startuphealth.com 65

66 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

MEET THE HEALTH TRANSFORMERS

HireMe Healthcare Is Fighting the Nursing Shortage with a Better Matchmaking Experience Co-founders Trey Ennis and Ryan Lee (left) are working to make the job search more efficient, personable, and pleasant for both nurses and their would-be employers.

HireMe Healthcare would like the hiring process for nurses to feel a lot more like online dating. Ryan Lee, CEO & Co-founder, is full of romantic analogies for a process that many associate with drudgery. He describes the company as if Match.com and ZipRecruiter had a baby and he hopes the candidates using the site feel some reciprocity. “They control where the conversation goes,” Lee says, likening the process to the way Tinder pairs people and then opens a door for conversation. Here, chatting with a hiring manager is as easy as swiping left or right.

THE CHALLENGE

HireMe Healthcare (HMH) grew out of a frustration with inefficiencies in healthcare hiring. Trey Ennis, Chairman & Co-founder, designed HMH after working in an operational role for a major healthcare system. He watched highly qualified candidates apply for positions

and go nowhere because of staffing software with flawed algorithms that disqualified candidates for minor reasons, like not having the right keywords in their resumes. Meanwhile, the hiring managers working with Ennis were desperate to find employees as nurse-to-patient ratios began declining to dangerous levels. The nurse staffing crisis is a national problem. HireMe Healthcare points to a 17% national RN vacancy rate in 2022; 81% of hospitals are struggling with RN vacancy rates of 10% or higher. According to their numbers, Covid exacerbated the nursing shortage — a period in which agencies dramatically increased the hourly rate for travel nurses. “It has really thrown this industry into a bit of a tailspin,” says Lee. Hospitals were often forced to pay inflated rates for travel nurses, adding to their existing financial woes from staffing vacancies and high turnover rates among nurses. Presently, 83% of hospitals are now operating in negative margins. “We’re watching critical access hospitals shut down,” says Lee. Lee thinks that the solutions to these staffing problems are inadequate. “It’s a fulltime job just applying to these jobs,” says Lee. Applicants are required to input their resume into a different system each time they apply to a job. “It’s utter madness,”

startuphealth.com 67

MEET THE HEALTH TRANSFORMERS / HIREME HEALTHCARE

Co-founders Kaitlyn Rice and Trey Ennis

he says, adding that “there currently isn’t a space for the human aspect of the process.” He hopes that HireMe Healthcare will function like a one-stop shop for nurses seeking employment and a more trustworthy, efficient resource for employers trying to fill vacancies. And he wants the process to feel good for all parties, even if sparks aren’t flying at the same velocity as they may on Tinder or Match.com. THE ORIGIN STORY

After Ennis’s first-hand observations of staffing inefficiencies, he began building HireMe Healthcare by creating a beta app, testing the concept, and conducting market research. He soon started gathering a team to help realize his vision. One of Ennis’s first phone calls was to Lee, a childhood friend from Charlotte, North Carolina. “I went to an investor meeting with him and I walked away as a co-founder,” says Lee, who has a back-

ground practicing entrepreneurial law and a master’s degree in human rights. Lee was enthusiastic about the viability of the business from a logistics standpoint. “Anyone can have a good idea and Trey has brilliant ideas but this could be carried out logistically,” says Lee. Ennis, like Lee, felt an affinity with the healthcare industry as many of his family and friends work in the field and he saw the opportunity as a pathway toward his lifelong dream of creating a startup in the humanitarian space. “Figuring out how to improve access to healthcare in my own homeland, beforehand, was an opportunity I wanted to be a part of,” says Lee. THE PRODUCT

The platform is an online marketplace and career development resource, designed to supply healthcare providers with nurses that are high-quality, local, and permanent. The intake process for nurses is “quick and

68 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

one time.” Once in the system, nurses are able to search for jobs in an interface that looks a lot like Zillow, with jobs displayed geographically. Hiring managers are encouraged to bolster their jobs with tailored descriptions about their workplaces and if a match looks enticing, HMH’s app and messaging function allows for easy communication between hiring managers and job seekers. HireMe Healthcare boasts of their proprietary technology — a precision staffing algorithm which allows for better results than the blunt software tools Ennis encountered while working in the healthcare industry. “Our algorithm scores candidates based on job descriptions with every aspect of the description bifurcated into whether it’s required or desired,” says Lee. Candidates are then ranked for best fit according to listed positions. Once a candidate is placed, HMH earns a placement fee or larger facilities can choose to pay for the service through a monthly subscriptionbased fee. In order to build candidate profiles, HMH doesn’t merely rely on data from one’s resume, which Lee describes as “an outdated document.” “We’re working to make the hiring process a human experience by considering factors beyond what the resume holds,” says Lee. These factors — the qualitative, intangible qualities of a person — can make the difference between a decent fit and a great fit and identify candidates that might best complement the culture of a hospital or community. Lee and his colleagues at HMH are experimenting with pickup lines to ask can-

didates. Lee has a favorite: What are you most passionate about in life? “You can gain a lot from a person by asking them this,” he says. He hopes that answers to questions like these put a more human face to their candidates. OUR TAKE

While speaking with healthcare professionals about HireMe Healthcare, Lee encountered an orthopedic surgeon who said if he had access to this technology and could keep up with staff needs, he would be able to nearly double his output and complete up to 15 surgeries a day. A hospital fully staffed with capable nurses results in a workplace where other staff — like the orthopedic surgeon — can work to their potential. It’s also a win for patient care and the financial health of hospitals. For nurses seeking the right placement, HMH simplifies an arcane and frustrating process. With the staffing needs of healthcare facilities in crisis mode, we are enthusiastic about standing behind HireMe Healthcare. It’s a smart platform to make things easier and more efficient for job seekers and employers alike. We’re looking forward to seeing some of their matches yield long-term commitments — and transforming healthcare hiring along the way. CONTACT HIREMEHEALTHCARE @STARTUPHEALTH.COM

startuphealth.com 69

MEET THE HEALTH TRANSFORMERS

Predictive Healthcare Helps Anticipate and Prevent Surgical Site Infections While doing volunteer work, serial entrepreneur and software engineer Talal Ali Ahmad witnessed the challenges faced by surgeons and patients, particularly in monitoring surgical site infections. Drawing on his prior experience co-founding a medical device company, he set out to create a groundbreaking AI-based platform, MyHealthPal, to predict these infections remotely — improving patient outcomes and reducing healthcare costs.

When a friend talked Talal Ali Ahmad, a software engineer who worked in telecom infrastructure, into volunteering his skills to the Global Smile Foundation (GSF), Ali Ahmad had no idea he’d end up a medtech entrepreneur. It was 2012, and he was taking the year off after his company, Centrix, was acquired. Soon Ali Ahmad was traveling extensively on medical missions to help provide IT infrastructure and tech support to the Global Smile surgeons as they performed corrective procedures for people with cleft lips and cleft palates. “This really started my exposure to the

medical field,” says Ali Ahmad. “I quickly started to identify some problems we could use tech to help solve.” One such problem was monitoring patients for surgical site infections following the procedures. When the GSF surgeons arrived, there’d immediately be a queue stretched down the block. They’d treat as many patients as they could and discharge the patients and provide instructions on how to take care of their wounds. The majority of the patients lived far and it was difficult for them to return for a followup appointment with the local surgeon. As one surgeon put it, “the patients go home and we don’t hear from them or see them unless they end up in the emergency room.” Ali Ahmad dug into it and soon realized

70 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

that this wasn’t just an issue in countries with limited access to medical resources. The reported infection rate of open incision surgeries is between 10–30%. These infections lead to major complications, increasing the risk of sepsis, major organ failure, and even death. It’s a costly problem as well, to the tune of more than $3.3B spent because of surgical site infections in the US annually. ORIGIN STORY

Before he began tackling the issue of remote incision site monitoring, Ali Ahmad co-founded a different medical device company in 2014 — Proximie, a virtual operating room which allowed surgeons to “scrub in” on a surgery from a distance. It started as a way to address the need to train local doctors on how to address cleft palates, but it quickly transitioned to a resource the US doctors who work for GSF

wanted to bring back to the states. All that to say, by the time he set his sights on infection sites, Ali Ahmad was well-versed in the way physicians, particularly surgeons, think. He knew their time was both limited and expensive and that you don’t want to be the one wasting it. He also knew physicians were tired of having to download and utilize new apps and wanted all relevant patient information to be on their EMRs. Ali Ahmad set out to create a way to virtually monitor surgical sites that seamlessly integrated into the normal workflow of the clinicians. The key to its success rested in the accuracy and actionability of its data: how well can the AI in the digital platform detect early signs of surgical site infection (SSI) and prevent readmission? He and his team of engineers and programmers set to work, creating a system to analyze wound photos and up to 30 other

startuphealth.com 71

MEET THE HEALTH TRANSFORMERS / PREDICTIVE HEALTHCARE

key performance indicators, such as the patient’s temperature, pain levels, medication adherence, and wound temperature When they had a beta version ready, they found willing trial partners in the Global Smile Foundation, who set up 300 patients and their families to use the tool to monitor their postoperative surgical sites. This early trial was a success, with an 85% patient compliance rate and an 80% prediction accuracy rate — numbers high enough to prove the usefulness of the tool and push the team forward to train the AI towards even greater precision. UNDER THE HOOD

Predictive Healthcare’s first offering, MyHealthPal, is an AI-based digital platform that predicts surgical site infections remotely, detecting early signs of trouble and preventing readmission and other post-surgical health complications. It’s a HIPAA-compliant solution that integrates seamlessly into a patient’s EMR, alerting physicians to infection risk and providing a comprehensive overview of the wound status and patient entered data to allow the care team to make quick decisions. In the typical day-to-day of surgery, a patient heads home with a stack of information on how to take care of their wound and little to no follow up from the health-

care team. The hospital workflow doesn’t offer an existing procedure on wound followup and healthcare providers often only hear from a patient when something’s gone wrong. MyHealthPal helps the patient track their healing progress, guiding them through taking clear pictures at the right angle, keeping track of changes and symptoms, which lets healthcare providers catch early signs of surgical site infections (SSIs) while antibiotics will still be effective. For abdominal and open incision surgeries–things like C-sections, colectomies, liver and pancreas surgeries, hernia surgeries, abdominal hysterectomies, and the like–this type of close monitoring is especially important because these procedures have double digit SSI rates. Not only does this represent an enormous amount of money spent on readmission costs, but it also hits hospitals on their CMS rating. Then there are surgeries involving an implantable device, like a knee or hip replacement or putting in a pacemaker–if an SSI arises after the procedure, it often means a complete redo where the entire apparatus is removed and replaced with a clean device. The hospital loses financially, the physician loses time, and the patient faces a longer recovery, additional missed work, and insurance issues.

CONTACT PREDICTIVEHEALTHCARE @STARTUPHEALTH.COM

72 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

Scan to read the full story or go to healthtransformer.co

MEET THE HEALTH TRANSFORMERS

MOONSH T,

MANAGE

T. 2 0 2 3

PRE

It’s been a hundred years since researchers discovered insulin, forever changing the lives of people living with Type 1 diabetes (T1D). Since then, there’s been a steady flow of innovations in the diabetes space, refining the process of insulin monitoring and delivery modes so that patients get the insulin their bodies need. With insulin, the prognosis of T1D changed from an early death to a manageable chronic disease. At the end of the day, though, insulin is just that–something to manage the disease, not a cure. 100 years later, researchers are

Shmuel Levit, MD, PhD (pictured on page 74) has developed a therapy for Type 1 diabetes (T1D) that could revolutionize diabetes treatment. Combining proven and safe drug components, Levicure offers the possibility of remission and improved quality of life for people with T1D. Driven by the remarkable results observed in early patient trials and backed by rigorous research and with a focus on scalability, safety, and affordability, Levicure aims to bring relief to millions of people living with T1D.

Levicure Is Developing a Breakthrough Triple Therapy for Type 1 Diabetes

UP HEA

still looking for that magic bullet that will actually halt or reverse diabetes, with investors and pharmaceutical companies throwing massive amounts of money behind novel molecular and cell-based interventions. However, diabetes, like other autoimmune disorders, is incredibly complex, involving multiple pathological processes

startuphealth.com 73

MEET THE HEALTH TRANSFORMERS / LEVICURE

within the body. The likelihood a single molecule addresses the many systems at play is slim. That’s why diabetes researchers like Alex Rabinovitch, MD, PhD, have spent decades looking into compound drugs that tackle different disease mechanisms simultaneously. Dr. Rabinovitch specifically found that a combination of proton-pump inhibitors (PPIs) and an enzyme inhibitor known as DPP-4i proved effective at restoring pancreatic beta cells, the cells that synthesize, store, and release insulin, which were safely and effectively used in the market for other indications. These results are a big deal, especially considering both drugs have well-established safety records, making the combination low risk. Unfortunately, the combination of the two drugs together was not enough to show significant improvement in a clinical trial. NO ONE BELIEVED HIM

Shmuel Levit, MD, PhD (pictured) Head of Endocrinology and the Diabetes & Metabolism Institute at Assuta Medical Centers in Israel, knew all about Dr. Rabinovitch’s research into combination therapies. He was a big believer in their efficacy. Dr. Levit also closely followed the research around the efficacy of GABA, a neurotransmitter widely available as an over-the-counter supplement. In studies, GABA improved function of islet cells involved in producing insulin, delaying diabetes onset and helping restore normal blood glucose levels in animal models. Because of the established safety of PPI, DPP-4i, and GABA, Dr. Levit felt

emboldened to take action: he suggested a course of treatment to his patients with T1D that combined all three elements. He expected this plan would reduce insulin demand. What he didn’t foresee or imagine was that some of his patients would get off insulin completely. Dr. Levit was flabbergasted. The triple combination promoted full remission for 70% of his patients that were newly diagnosed with T1D and significantly reduced insulin needs for his patients who’d lived with the disease for years. Ironically, without animal model studies and scientific peer-reviewed publications to back up what Dr. Levit saw with his patients, no one believed him. No one, that is, except Daniil Koshelev and Lucy Kosheleva, a husband and wife team with combined legal, research, and execu-

74 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

tive experience in the biotech space. They knew Dr. Levit through a personal connection–he treated and cured a close relative with a severe endocrine disorder–and they trusted his experience. Moreover, Dr. Levit’s discovery offered exactly what the Koshelevs were looking for–the chance to work on something big, something that could make a tremendous difference in patients’ lives around the world. Dr. Levit and the Koshelevs embarked on an unusual journey to prove the results Levit observed in his patients, working backwards from the typical cells-to-animal-to-patients model of new drug testing. With the support of Professor Helgi Schioth from Uppsala University and Dr. Rabinovitch, who came on board as a scientific advisor, a large study on NOD mice was conducted and published. This research confirmed that the synergistic effect of the triple combination was significantly superior to all double-combination results in a comprehensive animal model of T1D. This study was fundamental for successfully obtaining US and European patents. To solidify Dr. Levit’s findings in his patients with T1D, the team together with Assuta Medical Centers received Helsinki’s approval to review existing medical records of treated individuals. It was important to unequivocally establish that patients had T1D and to carefully analyze all available data to establish the concrete therapeutic effect of the triple combination. The study was successfully published in a peer-reviewed journal and uncovered that 70% of people with T1D that were treated within 12 months of diagnosis experienced

full insulin independence and a staggering C-peptide growth of 145%. While patients with long-term Type 1 diabetes also experienced improvement in glycemic control and decrease in exogenous insulin demand, it was really the early diagnosed group that showed such an unexpected result. The fact that all three components are considered extremely safe can substantially speed up the development process of bringing the novel combination to market. Just three years after hearing about Dr. Levit’s very promising patient results, the team has recently received positive and helpful feedback from the FDA and is ready to proceed directly to phase 2a clinical trials without needing to do any prior human or even animal safety studies. MEET LEVICURE

Levicure’s triple therapy is a proprietary combination drug entering phase 2 clinical development that will provide people with T1D a single tablet to facilitate remission, avoid T1D complications, and significantly improve their quality of life. Levicure combines safe and readily available drug components to create a scalable and affordable solution for the millions of people worldwide living with T1D. They have already successfully proved the concept with patients and received patents for their triple combination in US and Europe with additional IP protection in the form of exclusivities. “We see ourselves as taking the first step on the moon because so far there is no product for people diagnosed with T1D that can offer sustainable remission. This

startuphealth.com 75

MEET THE HEALTH TRANSFORMERS / LEVICURE

combination could be the first step on the long way towards curing the disease, which will also change the way others look at combination therapies for complex diseases,” Koshelev says. Besides the evidence that the Levicure triple combo therapy promotes full remission in adults recently diagnosed with T1D, its scalability and safety make the case for the product’s ability to penetrate the large diabetes market. Other diabetes solutions like cell therapies, transplants, stem cells, and immunotherapy come with high price tags, risks, scalability challenges, and high demands on a patient’s time and energy. Levicure aims to deliver a single tablet, taken once a day, to optimize compliance and adherence. Levicure is fundraising to finalize their phase 2 program and develop the final version of the triple combination drug. Assuming all goes well, they hope to bring their product to market as soon as 2029. To that end, they’ve assembled a stellar management team to guide them through the process, including Mike Teiler as their Chief Pharmaceutical Officer; Dr. Yafit Stark as their Head of Clinical Development; and Dr. Alexander Fleming, formerly responsible for diabetes therapies at FDA, T1D expert, and founder of Kinexum, serving as a regulatory advisor. It’s a difficult process, but the co-founders find overcoming the challenges part of the joy of their work. “This is the most challenging thing I’ve ever encountered. No one has ever conquered it,” Daniil says with the enthusiasm of a mountain climber. “Seeing Dr. Levit

actually help his patients was the push moment for me,” adds Lucy. “He was brave enough not to stick to the book and bring this solution to people, and we want to get it out there for everyone else.” OUR TAKE

Levicure offers impressive results in a safe, scalable package, making it a diabetes intervention to watch. Because they repurpose and reformulate existing drugs to achieve these results, they can come to market much faster than novel molecules in development. With passionate founders at the helm, we see Levicure as having the grit and resources to shepherd their product to market, offering a viable path to remission for many people with diabetes. CONTACT LEVICURE@STARTUPHEALTH.COM

76 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

MOONSH T,

MANAGE

T. 2 0 2 3

PRE

MEET THE HEALTH TRANSFORMERS

UP HEA

Hibiscus Health is Combining the Latest Tech Tools to Transform Diabetes Health Frustrated by a lack of effective technology to detect and reverse his own prediabetes, serial entrepreneur and two-time Health Transformer Kavi Misri decided to build the solution himself.

By the time Kavi was three years old, he had already had two open-heart surgeries for a congenital heart defect. Because of that, he’s at an increased risk for other health conditions. When Kavi Misri was working on his first healthcare startup, Rose Health, he thought he was taking care of himself. After the acquisition of Rose Health, a digital platform for mental

startuphealth.com 77

MEET THE HEALTH TRANSFORMERS / HIBISCUS HEALTH

CONTACT: HIBISCUS@STARTUPHEALTH.COM

health, he finally took the chance to see his doctor for a physical. At Misri’s physical exam, he found out that he was pre-diabetic. “I had no idea what pre-diabetes was,” he says. His grandfather had passed away from Type 2 diabetes, and the diagnosis “was a bit alarming and an awakening moment,” says Misri. The exam results led him on a journey of self-care and eventually a new business venture – Hibiscus Health – a comprehensive digital and clinical care platform that leverages cutting-edge technology for the early detection, prevention, and management of metabolic conditions, including diabetes, hypertension, and obesity. “Almost 40 million American adults currently have diabetes. But 96 million have prediabetes, and 8 in 10 of those don’t even know they have it,” said Misri, just like

he didn’t. “Pre-diabetes has no symptoms and lurks silently. If untreated, 70% of those will go on to develop type 2 diabetes,” said Misri. He was baffled by the fact that he had visited his primary care doctor more than 15 times in that same five-year period for one-off conditions like a cough or a vaccine, and yet his pre-diabetes was not detected. “I learned that pre-diabetes posed no major symptoms, and its only form of detection was through a metabolic blood test panel, which is traditionally done during a routine physical exam. He thought there had to be a better way to identify symptoms early, so he built a team and got to work. He was able to combine digital health with clinical care to identify patients at risk using facial blood flow, thereby completely removing the

78 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

barriers that exist with getting one’s metabolic blood panel completed, which would typically be scheduling a physical with a primary care doctor (which sometimes takes months) and then fasting and going to a lab diagnostic service like LabCorp or Quest to get blood drawn (which many people do not complete because of their busy schedules and the inconvenience). He also built a dedicated clinical care team supported by AI that reaches out to individuals flagged for metabolic conditions and crafts personalized care plans for each patient. A digital dashboard aggregates data from patient inputs, enabling Hibiscus’ clinicians to offer tailored guidance and support. With a wealth of educational content, Hibiscus Health empowers patients to understand their health better and make more informed decisions about their eating habits and lifestyles. THE CHALLENGE

Before Hibiscus Health, Misri was managing his pre-diabetes through a regime that involved nutritionists, meal tracking, lifestyle changes, and fitness. This was a challenging task. “It was difficult to navigate the entire ecosystem to get the quality care I needed,” says Misri. Finding a nutritionist who accepted his insurance, identifying the right guidance for lifestyle changes, being held accountable for his changes, and juggling different apps left him frustrated. “I realized there should be less friction in managing my care and more technology to augment the process,” says Misri. “I lived the experience, and I decided I needed to make this happen and build

a company that brought in a comprehensive solution of care with a focus on patient engagement and empowerment for a seamless care journey,” says Misri. WHAT THEY BUILT: A DIABETES REVOLUTION

Misri’s solution is a comprehensive digital and clinical care healthcare platform that functions like a one-stop shop for detecting and managing metabolic conditions. It’s forward-looking - to the point of feeling futuristic - with its seamless integration of the latest technological developments. One novel feature is a 30-second facial scan done through one’s phone or webcam that detects about 35 different vitals. It can calculate blood pressure, determine cholesterol levels, and assess cardiovascular and stroke risks, eliminating the need for a doctor’s visit to determine one’s A1C score, the metric used to diagnose prediabetes and diabetes. “I wanted to lower the barriers for screening of metabolic conditions,” says Misri. “Existing solutions start at the state of diagnosis or later in the process. We’re able to catch it earlier on by doing this screening.” If a patient is flagged for prediabetes or diabetes, a clinical care team will reach out to the individual. “We provide comprehensive care, which is the digital solution in addition to clinical care,” says Misri. The team includes Registered Dieticians and Primary Care Physicians whom AI supports. Using AI, the team runs about 1,000 simulations on the patient to identify an appropriate care plan based on demographics, lifestyle, activity, food

startuphealth.com 79

MEET THE HEALTH TRANSFORMERS / HIBISCUS HEALTH

sensitivities, motivations, etc. As part of this process, a digital twin of the patient is created. “It’s a gamification feature and a clinical assessment tool,” says Misri. “The digital twin is a benchmark and shows the progress of care. We want to see the patient and the digital twin moving in parallel, and if they’re not, our clinical team intervenes and reassess the patient’s care plan.” Since adjusting one’s diet is usually a critical component of metabolic care, Hibiscus Health has innovative dietary features to make it easier to track one’s food consumption and make necessary changes. When Misri used a food app to monitor his pre-diabetes, he was frustrated by the lack of diversity in the meal suggestions. To solve this problem, Hibiscus Health purchased about four million recipes from leading nutrition sources. “Now we’re able to serve different populations,” says Misri. Users can find recipes from Chinese to Mexican food, and there’s even a feature where AI can identify macronutrients that one is eating from an actual photo of their meal. A ChatGPT feature can populate an Instacart with the necessary ingredients for one’s meal plans. “We’re providing customized care plans at scale,” says Misri, who boasts that his team at Hibiscus Health – composed entirely of people of color or women – caters to the considerations of patients from various cultures and viewpoints. A digital dashboard compiles all of the data collected from each patient, including what one’s eating, health metrics, and answers to surveys about one’s mood and level of motivation. “Two minutes before a

patient is seen, a clinician can go through the dashboard to see months’ worth of data,” says Misri. Providers can offer guidance and problem-solve barriers to achieving healthcare goals in discussion with the patient. In addition, a patient portal provides over 1,000 pieces of content in articles, audio recordings, and videos that educate patients about various topics ranging from how sugar or gluten works in the body to entire modules on diabetes prevention. WHERE THEY ARE IN THE PROCESS: A COLLABORATIVE COMMITMENT

To bring Hibiscus Health to patients, the company is targeting self-funded employers and payors who would purchase Hibiscus Health as an employee benefit or member benefit. Misri believes if a company invests in a service that provides early detection of metabolic conditions, they will save money in the long run. To prove his point, Misri points to a statistic: healthcare costs for a healthy employee average $7,000 per year, whereas the cost of a diabetic employee averages $20,000 per year. “If we're able to identify a patient at the prediabetes stage or as the disease progresses and get them to adopt the right lifestyle choices and engage with the platform, we're preventing that overall decompensation that happens down the line,” says Misri.

80 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

Scan to read the full story or go to healthtransformer.co

MEET THE HEALTH TRANSFORMERS

Zinacare Makes Healthcare More Accessible in Africa Through At-Home Testing Services Philip Mngadi forged relationships with South African laboratories while working on Covid tests. His company leveraged those connections to create lab-based tests for other health conditions — including HIV and STDs — which can be used by customers in the privacy of their homes.

When Philip Mngadi left his native South Africa to study in Ireland, he found many similarities between the two countries. These include the English language, nightlife, a mutual love for soccer, and — surprisingly — the food. “Ireland is a country where I can go out and get a curry and rice,” says Mngadi. However, upon returning to South Africa after studying law at University College Cork, Mngadi

startuphealth.com 81

MEET THE HEALTH TRANSFORMERS / ZINACARE

was struck by the absence of one service he encountered in Ireland: at-home, labbased health tests. South Africa has one of the largest HIV epidemics in the world, infecting 5.7 million citizens. “As a consequence of the HIV numbers we also have a lot of STD cases,” says Mngadi. Mngadi points to the troubled South African healthcare system as a barrier to widespread testing. The majority of the population relies upon a strained public health system or pays out-of-pocket for healthcare. While in Ireland, Mngadi learned about Let’s Get Tested, a service that makes testing easy for HIV, STDs, and other health conditions through self-administered, at-home tests. However, despite South Africa’s other advances, this solution for empowering individuals with knowledge about their health was absent from the market. Zinacare, which Mngadi launched with Lillian Keetse in 2020, is an at-home health testing service that prioritizes confidentiality, convenience, and affordability. The concept for the company is not novel, but its adaptation to Africa sets it apart. “We are prioritizing tests that are relevant to the African market,” says Mngadi, who plans to expand beyond South Africa to four other sub-Saharan countries. And unlike African competitors that only sell rapid tests created by international manufacturers, Zinacare establishes relationships with local laboratories to develop and process tests and identify testing needs specific to their country.

ORIGIN STORY

Zinacare started out in 2020 selling rapid tests, but Mngadi had his eye on something more ambitious. “I was trying to figure out how to do lab-based home testing,” he says. “While we were researching molecular testing methodologies and PCR tests, Covid happened.” The pandemic provided Zinacare an opportunity to shift their focus. They stopped selling rapid tests and established 18 physical pop-up testing stations across the country. “At that point, we were working with the leading laboratory in South Africa,” says Mngadi. Mngadi knew that if he was going to expand beyond the territory of selling rapid tests he had to build connections with local pathologists, biologists, and laboratories. “No one was doing that, and that’s when I became more obsessed with the opportunity,” says Mngadi. Working on Covid tests provided Zinacare the introductions necessary for their next step. “Labs that we normally wouldn’t get a chance to work with before Covid were now saying ‘bring your work to us,’” says Mngadi. And that’s what they did. Their first lab-based test kit was for Covid, and soon they started expanding their menu. Currently, they offer tests for HIV, HPV, bacterial vaginosis, colon cancer, herpes, and Covid-19, with plans to expand their menu within the areas of sexual health, men’s health, women’s health, and general wellness. They also provide a mobile nurse service in which a nurse visits one’s home or workplace to conduct tests from a more expansive list, ranging from drug tests to liver tests.

82 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

The customer experience is at the heart of the Zinacare service. While developing their company, Zinacare put a pause on building their menu in order to streamline the communication process with their clients. Currently, their relationship with a client begins on their website when a test is ordered. After acknowledging the order, their system helps a customer track the package;aonce it arrives, a pamphlet provides step-by-step instructions for self collecting so that the integrity of the sample is not compromised. A bar code in the pamphlet also directs customers to a video where customers can watch instructions on how to collect a sample from their body in the privacy of their homes. Customers are then instructed on how to coordinate pickup with UPS and track their package to the lab where it is processed. If a customer receives a negative test result, the notification is sent by email. For a positive test result, the chat team sets up a consultation with a Zinacare doctor at no additional cost. The doctor delivers the results before furnishing a copy of the medical report with further explanation.

lishing their presence in South Africa, they are preparing to launch in other African countries. “What’s unique about us is that we are the first to do at-home lab testing on the African continent, and currently we are probably the only ones with noteworthy traction,” says Mngadi. The company has targeted four of the biggest economies in Africa for their next stage of development: Kenya, Ghana, Nigeria, and Tanzania. “The healthcare markets are very similar,” says Mngadi, who has people on his team with experience working with these countries. Soon they plan to introduce their service to Kenya, where they’ve already established a partnership with a lab and ironed out logistics. In addition to expanding their menu of tests, Zinacare also hopes to create a subscription model where customers pay a modest fee — around $14 a month — in exchange for a different test each month. “We see it as sort of an insurance,” says Mngadi, who also hopes that a subscription service could yield more consistent income and improve customer retention.

MOVING FORWARD

OUR TAKE

In the past 36 months, Zinacare has done 20,000 tests, averaging around 6,000 per year. As they continue estab-

Zinacare is poised to make an impact on healthcare accessibility in developing African markets.

CUSTOMER EXPERIENCE

CONTACT ZINACARE@STARTUPHEALTH.COM

Scan to read the full story or go to healthtransformer.co

startuphealth.com 83

MOONSH T,

MANAGE

T. 2 0 2 3

PRE

MEET THE HEALTH TRANSFORMERS

UP HEA

QuLab’s Nanotechnology Monitors Multiple Metabolites on One Minimally-Invasive Patch CEO Idan Tamir (pictured second from left) and his team in Israel are developing a novel device that goes beyond the continuous glucose monitor (CGM) to provide people with diabetes with a fuller picture of their health.

To monitor a complex condition like diabetes many health professionals understand that glucose is just one part of the metabolic picture. Other important, informative metabolites include ketone bodies and lactate. Idan Tamir, CEO of QuLab, gives glucose and ketone bodies as an example: “One is a carbohydrate, and the other is a breakdown product of fat. They are our two main sources of energy. Kind of like a hybrid car. You

84 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

want to use them both in a coordinated way to make sure your metabolism is balanced.” However, typical monitoring devices are only focused on glucose. “It becomes a problem of real estate,” says Tamir. “There is just so much space on a sensor, on a filament, that one can occupy with different sensing technologies,” he adds. QuLab solved this real estate problem with innovative nanotechnology. Tamir likens the current CGM products on the market to black and white televisions, only delivering part of the picture. But with more sensors and data fusion, a full-color health picture comes into view. They tackled the dual challenges of building a business and building the product and are now on their way to testing it in humans. They anticipate their patch will be ready for the market within two years. ORIGIN STORY

QuLab has its origins at Tel Aviv University where Sharon Lefler developed technology focused on monitoring glucose. Tamir, who had previously worked for other companies on point-ofcare diagnostics, was brought on to develop the business and commercialize the technology. “A company run out of a university lab is kind of an oxymoron,” says Tamir. “It doesn’t work.” In 2018, two years after the founding of the company, they became independent and moved from the university to their current offices in Herzliya, a tech hub bordering Tel Aviv. “We took some science from the university and

then started playing with it and making modifications to further develop and commercialize it,” says Tamir. The device they wanted to create was complex and ambitious. It incorporated enzymes along with hardware and software components and would eventually need to be fabricated at a large scale and pass regulatory approvals to be used as a medical device. In order to start achieving this goal, they assembled a versatile team heavy with PhDs. “We found people across multiple disciplines and technologies,” says Tamir. “We made sure to have some sort of overlap and complementarity in capabilities,” he adds. Consequently, their team blends the deep expertise of an academic lab with the nimble energy of a startup where employees wear multiple hats. WHAT THEY BUILT

QuLab’s ambition was to create a patch to electronically monitor multiple metabolites continuously and in parallel. Other microprobe-based products that monitor glucose rely on a sensor array that penetrates the skin. “The reason for the array is that each microprobe provides a certain current and then it all adds up to a significant signal. That means you have to introduce 10 or 20 microprobes into the skin,” says Tamir. QuLab wanted something less invasive. In order to achieve this, they developed tunable microprobe sensors. In typical sensors, the amplification of a signal comes with the amplification of noise. In order to avoid that, QuLab sensors amplify changes in electrochemical potential using a special transistor. “A

startuphealth.com 85

MEET THE HEALTH TRANSFORMERS / QULAB

transistor amplifies the core signal and we can tune it. We can amplify it more or less depending on which analyte concentration range we want to target,” says Tamir. The amplification component allows the probes to get a reliable and robust signal using only one probe per metabolite. The final product will feature a single patch harboring a few probes that monitor several different metabolites in parallel. Taken together, this data presents a holistic image — like color television. “If we’re monitoring glucose, we can also monitor its breakdown product like lactate and also ketone bodies,” says Tamir. “This makes a big difference.” Minimally-invasive probes are another innovation of QuLab’s sensors. The filaments — a little bit thicker than a hair — are relatively painless when inserted in the skin. For Tamir, he observed how painful traditional CGM devices could be when his daughter, who was pregnant and at risk for gestational diabetes, rejected two different patches because they were painful and caused bleeding. “That made me understand that it’s really important to minimize the pain and the invasiveness of the device,” says Tamir. The probes — which only penetrate one and half millimeters into the skin — are also solid, unlike the flexible filaments in many other sensors. “There are all kinds of artifacts that appear in other sensor systems because the sensors are placed on a flexible filament,” says Tamir. QuLab sensors sit on solid probes that don’t move in the skin, a feat they accomplished through developing a metallic support that can

bend without breaking. WHERE THEY ARE IN THE PROCESS

As they developed their product, scalability and reproducibility were critical considerations. “We had to think about this as a medical device that can be manufactured at a large scale and at a low cost,” says Tamir. “All these challenges were there from the beginning.” While developing a scalable product, QuLab worked with nanotechnology centers at different universities and then larger nanotechnology centers where they were able to complete multiple fabrication steps. At present, they are working on the realization of their product with IMEC in Belgium and Tower Semiconductor in Israel. In the mechanical production of the product, QuLab continues to innovate. Whereas many current sensors on the market screenprint their sensors, QuLab nanoprints their sensors using an inkjet technology. “We have an inkjet that points where the sensor is and prints the specific enzyme,” says Tamir. In December, QuLab plans to conduct studies in a hospital in Israel on healthy volunteers to ensure that the devices penetrate the skin without breaking and that the mechanics work properly. Previously, these studies were done on pigs. Their main project at the moment is focused on lactate monitoring, a field that’s much less competitive than glucose monitoring. “Lactate is a distress signal of the body,” says Tamir, who explains that rising lactate levels often indicate the development of severe infection (e.g., that may lead to

86 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

sepsis), organ failure, or extreme muscle fatigue. In this project, they’re focused on monitoring patients in hospitals who have infections or are recovering from transplantation. Currently, there are no marketed devices that allow for continuous lactate monitoring. “Rising lactate has to do with other vital signs and the overall situation of the patient,” says Tamir. And here, QuLab’s holistic aims come into view: “It’s all about the larger picture,” says Tamir, “not just monitoring one thing out of context. It has to be in context.” OUR TAKE

QuLab’s innovative technology sets it apart from other products in the field. The company points a way forward by expanding continuous glucose monitoring to include other metabolites. In doing so,

this promises to address diabetes management more holistically by utilizing a wider range of data that can be analyzed by patients, healthcare providers, and AI to more accurately inform the management and treatment of one’s condition. And its application is not limited to diabetes. Their work with lactate monitoring shows how it can be used in a hospital setting to provide a new service for patients in distress. It’s an original tool for extracting health metrics from the body and the sky’s the limit in terms of how those metrics can be leveraged in the management of one’s health. Color television is here. CONTACT QULAB@STARTUPHEALTH.COM

startuphealth.com 87

MEET THE HEALTH TRANSFORMERS

MedCoShare Is Revitalizing Independent Healthcare Practices Through Medical Co-Working Spaces Dr. Greg Goldmacher, Amit Mundade, Ronak Vyas, and Anthony Khan (pictured L-R) are creating medical co-working spaces that empower independent healthcare providers with the flexibility to practice on their terms. This new approach will help healthcare professionals break free from the constraints of traditional healthcare settings, redefine the future of healthcare, and improve patient access to quality care.

88 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

Imagine this: you’re a healthcare provider, dedicated to treating the sick and keeping people healthy. Your passion and expertise know no bounds, but the practice environment keeps getting harder. If you work for a hospital or a large group practice, you spend an enormous amount of time on paperwork and navigating the complexities of the system rather than taking care of patients. Like many of your colleagues, you would love to have more flexibility in your practice. Maybe you’d like to start your own practice and run it your way. Or, perhaps you have a practice, but you would like the flexibility to work part-time due to family obligations. Maybe you would like to reach patients in different areas, to expand both your practice and access to quality care for patients. If you want any of these things, there is a challenge that sets you apart from professionals in other fields. Traditional medical office space does not allow experimentation, flexibility, or significant degrees of freedom for healthcare providers, so you cannot practice the way you would like to. Imagine how frustrating and demoralizing it would be if architects couldn’t design the buildings they wanted or artists had to paint within prescribed lines, just because they couldn’t find a space to let their creativity shine. This is the challenge many healthcare providers face in their career. The upfront cost and risk of opening a practice keep them from striking out on their own, and

the restrictions of traditional medical office leases make trying novel models, such as hybrid telemedicine/face-to-face practices, impossible for an independent provider. If you are frustrated, and have no way to try another way to practice, you might give up and leave healthcare practice entirely, as many have done in recent years. But, before giving up and going into a different career, you find MedCoShare: a revolutionary concept for co-working spaces for healthcare providers, which offers a flexible workspace and a supportive community where you can thrive. ORIGIN STORY

Ronak Vyas, an expert in commercial real estate, had no direct healthcare experience other than being a patient, but he dealt with many healthcare clients and noticed a gap between what healthcare providers wanted and what landlords were willing to offer them. Landlords seek credit-worthy, longterm tenants who can support their financing needs. Tenants must sign long leases and then spend tremendous time and effort to fit out and set up their space. Medical tenants, on the other hand, need short-term commitments and minimal upfront costs, if they want to grow a new practice or if they want to seek work-life balance by seeing patients part-time. Ronak had seen co-working growing in other industries and realized that medical co-working could bridge this gap. However, he was still dubious about the idea because when he researched the

startuphealth.com 89

MEET THE HEALTH TRANSFORMERS / MEDCOSHARE

concept, he found very few companies in the country exploring this idea and none in Philadelphia, a city of millions. Ronak wanted someone to provide him with honest feedback, and he knew exactly who he should turn to — Greg Goldmacher, MD, PhD. Greg was a physician who had gone into clinical research but was still deeply immersed in the healthcare community. Ronak knew Greg from his time at Temple University, where they attended many of the same classes and even collaborated on the capstone project for an MBA program — developing a business plan for a heart and vascular center. Ronak valued Greg’s frank and realistic feedback and thought that if anyone could poke holes in this business idea, that was Greg. Much to his delight, Greg saw great potential in Ronak’s idea and thought the challenges of such a novel approach could be overcome through strong execution. This reassurance motivated Ronak to move forward with the plan. To bolster their team, Ronak and Greg brought in two more partners — Amit Mundade and Anthony Khan — an engineer turned real estate entrepreneur and an expert project manager with a healthcare background. In late 2019, they launched their medical coworking venture. Unfortunately, just as they found their first space and signed the lease in January 2020, the pandemic struck. This made refitting and preparing the space difficult and expensive (just getting a construction permit took months), but they were committed and believed in the strength of the

concept, so they pushed forward. In the uncertainty of the pandemic, it was harder to launch a major new undertaking, but paradoxically this could be a selling point for healthcare providers who wanted to try something new with little risk. As vaccination rates increased and the world adapted to the new normal, the demand for their medical co-working space grew. The key driver behind this demand was the dissatisfaction of many doctors and medical professionals with their employment status. They sought more autonomy, flexibility, and independence, which were challenging to achieve within traditional institutional structures. In addition, many doctors — especially those concerned with elective procedures, such as plastic surgery — were furloughed during the pandemic. Ronak and Greg’s medical co-working model offered such doctors a short-term, affordable space to practice on their terms. This could be a part-time practice for a new provider or one moving towards retirement, part-time use of a physical office for hybrid telemedicine practices, shortterm exploration of satellite locations for an existing practice, and many other uses. By eliminating the need for long-term commitments and high upfront costs, doctors could explore new practice models without financial burdens. Another crucial aspect that has contributed to MedCoShare’s success is the suite of services that the company is developing to support providers within their coworking spaces. Real estate and payroll are the two biggest costs associated with

90 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

The reception area of a medcoshare space in philadelphia CONTACT: MEDCOSHARE@STARTUPHEALTH.COM

starting a private practice. MedCoShare addressed the real estate component by offering flexible and less-risky solutions. To tackle staffing issues, it enabled doctors to contract medical assistants on an hourly basis. A third pain point they addressed was marketing. Many private practices struggle to navigate the complexities of marketing their services effectively. Ronak and Greg established an in-house marketing division to help doctors build their brands, establish a social media presence, and create professional websites.

Since signing its first lease in January 2020, MedCoShare has made remarkable progress. Despite the initial challenges caused by the pandemic, the team secured early investors, raising essential funds to start their venture. The break-even point for their first office in Philadelphia took nearly 14 months.

Scan to read the full story or go to healthtransformer.co

startuphealth.com 91

MEET THE HEALTH TRANSFORMERS

Insulloc Is Combining AI and Computer Vision to Identify Safe Injection Sites for Insulin Dr. Bogdan Oancea and Emilia Breban aim to help diabetes patients manage their insulin regimen effectively using just a smartphone and their innovative app. They have their sights set on a goal of zero lipohypertrophy for people with diabetes, but their technology could have even further-reaching implications.

Sixty-four percent. That’s the percentage of insulin users who end up bearing serious complications of lipohyper-

trophy. Lipohypertrophy is a condition that has long haunted the diabetes community. It is when lumps of fatty tissue form under the skin due to repeated injections in the same place. The result is disrupted insulin absorption and compromised effectiveness of diabetes treatment.

92 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

T. 2 0 2 3

PRE

MANAGE

Let’s put that number into perspective. istering insulin for three months showed Imagine a room filled with 100 insulin promising patient outcomes, Dr. Oancea users, all sharing the same hope for better knew that having a nurse administer insuhealth and fighting the same battle. lin multiple times a day was impracMOONSH Among them, only 36 users have tical. This prompted the idea of D mastered the art of correctly roAI-powered virtual nurses that tating their injection sites find would tell the patients when, themselves in the elite club, narwhere, and how to do safe and RT rowly evading the clutches of liproper insulin injections. UP HEA pohypertrophy. When Dr. Oancea explained On the other hand, there is an overthis problem to his acquaintance whelming majority of 64 users who, either Emilia Breban, she knew she had to join due to carelessness or lack of knowledge, the team because, despite efforts to edufind themselves entangled in the web of cate patients on proper insulin adminlipohypertrophy. This group of people is istration, this problem had managed to who InsulLoc aims to cater to, and this is persist for over a century. They found that the challenge they seek to confront head- one reason why it was so was that diabetes on. affects many organs and aspects of an individual’s life. There is a decline of cognitive ORIGIN STORY senses, and the patient starts losing vision A medical professional specializing in and experiencing tremors. It also takes a preventive medicine, diabetology, nutri- toll on mental health. tion, and phytotherapy, Bogdan Oancea, It became apparent to Dr. Oancea and MD, says he has always been drawn to Breban that patients needed further handthe challenges of life. He began his career holding. And a core part of the solution teaching nutritional hygiene and medi- they came up with involved using comcine at a Romanian medical university and puter vision to guide patients on how to then later quit his job to work at a govern- find a safe injection site. ment hospital. This was when he started Dr. Oancea explains computer vision noticing a concerning pattern among pa- as something similar to the technology tients with diabetes. leveraged by an apple sorting and gradDr. Oancea saw that most of the pa- ing machine in apple packing facilities. tients on insulin treatment ended up in The machine automatically sorts apples the hospital due to insulin misapplica- based on their quality, size, and ripeness tion. On initial investigation, he learned and forwards them to the right containthat two-thirds of these patients were in- ers. Similarly, the computer vision in their correctly injecting insulin, leading to the platform would map the safest insulin indevelopment of lipohypertrophy. While jection site based on what’s visible on the clinical trials involving real nurses admin- outside.

startuphealth.com 93

MEET THE HEALTH TRANSFORMERS / INSULLOC

With that, Dr. Oancea, Breban, and a third co-founder who is also an AI engineer began their journey toward creating InsulLoc, a revolutionary app that harnesses the power of AI and computer vision to guide patients in administering insulin accurately. Currently, team InsulLoc is working with a software company in Romania to create the minimum viable product (MVP). Once the app is ready, their immediate plans include conducting three months of trials and studies with patients to understand and gather clinical data. The team hopes that these results will yield promising and accurate results. If successful, the next step would be introducing the solution to a broader user base and taking it to the market, which, if all goes according to plan, will happen within the next four to five months. UNDER THE HOOD

InsulLoc’s platform is designed to support individuals with diabetes in managing their insulin treatment effectively. The system includes several features and capabilities to provide comprehensive care. To begin with, the app sends out up to four daily reminders (depending on their insulin chart) to help patients stay on top of their insulin regimen. Plus, the system checks the insulin dosage to en-

sure it aligns with the prescribed dosage. However, the most important feature is InsulLoc’s ability to employ artificial intelligence (AI) and computer vision to assess the suitability of an injection site on the patient’s abdomen. All that the user has to do is open the InsulLoc app on their phone and move the insulin pen around their abdomen in its view. The platform then scans the user’s abdomen and suggests how good a site is for insulin injection. Once an ideal injection site is identified and the user administers the insulin, the system records the injection sites and insulin dosage used by the patient. This information is logged for future reference and can be shared with healthcare professionals if the patient wishes to do so. InsulLoc also allows for communication between the patient and their healthcare provider. The platform can connect to a continuous glucose monitor (CGM) via Bluetooth, gathering real-time glucose data for better monitoring. Doctors have the option to receive data and alerts from the platform, enabling them to monitor the patient’s progress and intervene when necessary. This functionality is optional, and the extent of data sharing is determined by the patient’s preferences and the healthcare provider’s interest.

CONTACT INSULLOC@STARTUPHEALTH.COM

94 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

Scan to read the full story or go to healthtransformer.co

MEET THE HEALTH TRANSFORMERS

Ambrosia Systems Is Designing an Affordable Non-Invasive CGM for Low-Resource Settings Founder Piyush Gupta (pictured on page 97) is building on his medical device experience at Abbott to design a continuous glucose monitor (CGM) that’s financially accessible for all people with diabetes. They’ve gotten their real-time CGM below $1000 per year and have an ambitious long-term goal of getting that price down to $100.

T. 2 0 2 3

PRE

MANAGE

“People with diabetes are uct universally accessible is reliant upon everywhere,” says Piyush cost. “Whoever has diabetes and whoever Gupta, CEO & Founder needs this product, should be able to afof Ambrosia Systems. Yet, ford it,” says Gupta. “That’s our aim.” To as he points out, companies providing date, they have managed to bring down products for people with diabetes the costs of real-time CGM below MOONSH focus on only 50 or 60 countries. $1,000 per year, per patient. D With his eye on the global situBut they have more ambitious ation, Gupta is taking steps for goals: “Our aim is to build a his company’s product to reach real-time CGM for less than RT all 192 countries. $100 per year, per patient,” says UP HEA Ambrosia is a platform for Gupta. diabetes, metabolic health, and fitness management that connects a continu- ORIGIN STORY ous glucose monitoring device (CGM) When Gupta’s wife became pregnant to a smart watch or phone, allowing for and developed gestational diabetes, he real-time reading updates, alarms, re- became acutely aware of the challenges mote monitoring, and food insights. The of monitoring one’s diabetes through company knows that making the prod- conventional means. “Every time you eat

startuphealth.com 95

MEET THE HEALTH TRANSFORMERS / AMBROSIA SYSTEMS

something, you need to poke your finger to draw your blood,” says Gupta. “When somebody is pregnant, their skin is very sensitive. It was a very painful experience for my wife. She was crying and pregnant and I was not able to do anything,” says Gupta. Although he couldn’t do anything at that moment, he soon began formulating a plan for a more user-friendly and widely-accessible CGM device. At the time he was working for Abbot, a medical device company active in developing products for diabetes care. There another problem had come to his attention: parents reaching out looking for products to help monitor their children’s diabetes. Although CGM products were on the market, their cost was prohibitive to many. Additionally, the technology that took readings from a patch on one’s body only provided real-time reporting on smartphones. This solution didn’t work for children. “For five- or six-year-old kids with Type 1 diabetes, carrying a phone to school or the playground is not possible,” says Gupta. In 2016 Gupta quit his job and started Ambrosia. He wanted to remove smart phones from the equation and transmit data from the CGM device to smart watches, which could be worn by people — young and old — who couldn’t always be tethered to phones. It was a challenge that previous co-workers he had worked with deemed impossible. “Building NFC Bluetooth in such a small space was not possible at that time,” says Gupta.

HOW IT WORKS

Ambrosia created BluCon, which allowed for the transmission of real-time glucose readings to watches without the requirement of a phone (although their mobile app can also be read on a phone or computer). “What we are doing with our real-time CGM technology is using a third party, like Abbott FreeStyle Libre sensors, as our input device, and then we have our own BluCon electronic device which picks the data from the sensor and transmits it over to a smartwatch and phone,” says Gupta. BluCon, their flagship product, sets them apart from other companies, which are not able to transmit directly to watches. “Our product is more advanced than Dexcom or Abbott for that reason,” says Gupta. “They have to have the phone in between.” So far, their product has proven useful for patients. “It is very convenient for kids to wear an Apple watch or Android watch and their parents can monitor their glucose levels remotely,” says Gupta. It’s also proven useful for elderly people, hearing impaired patients, and others looking for a simple product. “Once we started, everybody started using it because the whole user experience is so easy. The setup is so easy, and it’s so useful,” says Gupta. The product — which is appropriate for people with pre-diabetes, Type 1, Type 2, and gestational diabetes — allows users to see changes in glucose in real time, receive alarms, and observe how different foods are impacting their glucose levels. Its integration with other health apps also allows

96 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

users to see how glucose is impacting their heartbeat and oxygen levels. Additionally, a web platform allows healthcare providers to observe this wide range of data from their patients. WHERE THEY ARE IN THE PROCESS

Their product is currently being used around the world thanks to their innovative technology and relatively low price point. But they have bigger aims. “Our aim today is to build a real-time non-invasive CGM for less than $100 per year, per patient,” says Gupta. They hope to support more glucose sensors which will develop in the future and establish affordable and efficient distribution partners around the world to make this goal a reality. “We were able to bring down the cost from $6000 to $2000 and now, less than $1000. I’m sure in the near future we will be able to build something below $100.”

diabetes a lot better,” says Gupta. “When people use these products and then see how the foods they are eating are impacting their glucose levels in real time, they automatically cut down on that food. Nobody needs to tell them.” This observation isn’t groundbreaking. The effectiveness of CGM devices is well known and well documented. What’s encouraging about Ambrosia is how they are taking existing CGM technology — and all the benefits that go along with it — and extending it to a wider range of people through their direct-to-watch technology and affordable price point. Younger people, older people, and the hearing impaired are all benefiting from their BluCon technology, which transmits straight to smart watches. Their price point promises to further expand CGM to people around the world for whom the service may have been previously out of reach. “Making expensive products is easy, making a product which people can afford is tough,” says Gupta. It’s this commitment to all people living with diabetes, in all countries, that sets Ambrosia apart and makes us excited to partner with them. CONTACT AMBROSIASYSTEMS @STARTUPHEALTH.COM

OUR TAKE

“We noticed people who are using real-time CGM are able to manage their

startuphealth.com 97

MEET THE HEALTH TRANSFORMERS

Bulsai Will Use Portable Ultrasound to Improve Insulin Delivery When Bill Ervin faced a diabetes management challenge it led to a groundbreaking idea that could transform insulin injections for millions of people with diabetes. Like a stud finder in construction, Bulsai’s device will use ultrasound technology to locate optimal areas on the body to inject insulin, preventing under- or over-dosing.

On Thanksgiving day 2021, Bill Ervin did what many of out just didn’t work. So while the rest of us do: drove to a relative’s his family sat down to enjoy the spread, home to share a family he drove home to deal with his pump meal. However, eating that Thanksgiving failure, missing both rare time with reladinner was a little more complicated tives and the entire meal. He’d had thanks to his Type 1 diabetes. enough. MOONSH D He needed to make sure he Five years earlier, he told his got enough insulin to process endocrinologist that one of his the sugars from the meal but biggest frustrations with his diRT not so much that he had a hyabetes care was locating healthy A UP HE poglycemic event. After 37 years tissue to inject his infusion set. living with Type 1, Bill was a veteran Past injections had led to a buildup at administering the insulin needed and of scar tissue, cysts, and fatty tissue, a didn’t anticipate any problems. condition known as lipohypertrophy or But on this Thanksgiving day, when LH, preventing proper absorption of inhe changed his insulin pump before the sulin and causing high blood sugar (hymeal, he couldn’t find a good site. It flat perglycemia). MANAGE

T. 2 0 2 3

PRE

98 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

“I asked my doctor if there was some way to scan my abdomen to find a good injection site. When she said she didn’t know of anything, it really got my wheels turning.” Bill imagined a tool that used the advancements in portable ultrasound technology and artificial intelligence to locate healthy tissue for injection sites. Like a builder uses a stud finder in construction, such a device would locate optimal areas on the body to inject into when inserting a pump, using a syringe or insulin pen. Together with a cousin who holds a PhD in mechanical engineering, Ervin wrote a provisional patent for his idea, but wasn’t sure if he was ready to launch himself into the medical device field. That is until he missed Thanksgiving dinner and decided that enough’s enough and launched his new company Bulsai™. THE RIGHT IDEA AT THE RIGHT TIME

Once he decided to run with his idea, he knew just where to turn. He had a connection at Genesis Innovation Group, which specializes in medical device development and commercialization. They invest in early-stage companies, turning ideas into innovations and those innovations into assets. Genesis vets around 300 ideas a year and chooses only a handful to work with. Bulsai made the cut. Matt Miller, Genesis Innovation Group’s Senior Director of Technology and Software Development, as well as Bulsai’s interim CTO stated, “His idea addressed a totally unmet need. As we

worked through the market research, we recognized the problem and the size of the market. It was also an opportunity to get in early on a unique solution.” After years developing software in the automotive and consumer electronics industry, Miller welcomed the chance to move into the healthcare space and create a device with meaningful impact for people living with diabetes. The timing was also right for taking advantage of the innovations in ultrasound technology to create a very specific application. Miller, Ervin, and the Genesis team conceptualized a handheld, portable device about the size of a large magic marker, with the singular purpose of scanning the body to locate healthy tissue for injection sites. The focus for the Bulsai device is on ease of use, incorporating a red light/green light indicator marking the good area with either an erasable ink stamp or some sort of small imprint. They’ve patented this concept along with secondary uses for the device such as using it as a depth finder to locate muscle on leaner patients, to scan the injection site after a dose to know if insulin has been successfully absorbed, or using ultrasound frequencies to help the insulin absorb. Early market research has shown great promise. “People with diabetes get it — if you have a good injection site, you’re fine, and if you don’t, you’re not.” explains Ervin. “We’ve seen all of these incredible ideas and new technologies in the diabetes space come along including insulin pumps, wearables, smart pens,

startuphealth.com 99

MEET THE HEALTH TRANSFORMERS / BULSAI

and CGMs, but at the end of the day, a CGM won’t work if it’s in a bad site. You won’t get the insulin you need if the pump isn’t in healthy tissue.” THE ROAD AHEAD

With 8.3 million insulin dependent diabetics living in the US, and over 16 million ER visits by people with diabetes a year, the Bulsai team is pushing forward to get their tool into patients’ hands as quickly as they can. To that end, they are working towards a prototype in the next six to nine months and seeking to partner with universities or other research institutions to accelerate clinical trials and testing.

100 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

Besides their collaboration with Genesis, they’re also expediting their commercialization process through partnerships with a highly experienced global electronics manufacturing company that specializes in prototype design and commercialization and with A Wright Path, industry experts in FDA regulatory processes and devices, including biocompatibility, artificial intelligence, and machine learning. Although the market is stronger for people between 40 to 70 — those who have been living with diabetes for years and have developed scar tissue or lipohypertrophy from repeated trauma to the same injection sites, younger patients with diabetes are leaner and inject into muscle which is painful and doesn’t absorb insulin very well. With a tool like Bulsai in their hands from the start, they can prevent injection-related complications from occurring and decrease the risk of hospitalizations because the body absorbed too little insulin at a site or unintentional overdoses because of insulin pooling in the body. “I really wanted this for myself, and I know it will help the many people who deal with the frustrations I experience on a daily basis,” says Ervin.

no known competitors in the market. And it’s easy for patients to add to their existing routine, providing peace of mind and preventing over- and under-dosing insulin and injection site complications. 37.3 million Americans have diabetes, which is projected to grow to 54.9 million by the year 2030. The Mayo Clinic estimates that 70% of insulin-dependent patients inject into LH daily or weekly, with 61% of them doing so out of habit or because they simply don’t know. Injecting into LH reduces absorption, raises glucose, and greatly increases insulin uptake variability — if insulin isn’t absorbing fast enough, a patient might inject a second dose, only to have the first dose finally kick in. Bulsai takes the mystery out of dosing and through proper placement ensures patients that their insulin will work for them when they need it. CONTACT BULSAI@STARTUPHEALTH.COM

OUR TAKE

It’s a golden era for portable ultrasound technology and Bulsai taps into these advancements with a specific, user-friendly application for people with insulin-dependent diabetes. The concept is clear, simple, and unique — there are

startuphealth.com 101

HEALTH TRANSFORMERS IN THE NEWS RECENT HEADLINES, AT A GLANCE

For daily health moonshot news, follow StartUp Health on social media @startuphealth and subscribe to the StartUp Health Insider newsletter startuphealth.com/insider

HireMe Healthcare Launches Its Platform to Connect Nursing Professionals to Healthcare Organizations

Joydays Picked as One of the Best Back-to-School Snacks on the TODAY Show

Women Who Lead in Transportation: Erica Plybeah Hemphill of MedHaul

Quick'rCare & Arrive Health Named to 2023 Inc. 5000 List of Fastest-Growing Private Companies

BUSINESS INSIDER 6/26/23

MEMPHIS BUSINESS JOURNAL 8/1/23

TODAY 8/8/23

INC

8/15/23

102 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

Women Who Lead in Transportation: Erica Plybeah Hemphill of MedHaul -Memphis Business Journal

The Best Medical Alert Systems: UnaliWear Kanega Watch Is Our Favorite Wearable System THE NEW YORK TIMES WIRECUTTER 8/22/23

IndyGeneUS AI Is Examining Health Equity at the Genomic Level KPMG 8/30/23

Cityblock Health CEO & Co-founder Toyin Ajayi, MD, Named to 2023 TIME100 NEXT List

Wireless Treatment: Lazurite's No-Cord Cameras Help Hospital Staff Quicken Surgery Process PACIFIC COAST BUSINESS TIMES 9/14/23

In-Hospital Strokes Like Charlie Manuel’s Are Common - Neuralert Is Designed to Identify Strokes Faster THE PHILADELPHIA INQUIRER 9/18/23

TIME 9/13/23

startuphealth.com 103

HEALTH TRANSFORMER NEWS // AT A GLANCE

Discover the Next-Gen Platform for Integrated Collaborative Care: Careteam MEDCITY NEWS 9/20/23

And the Winner of Startup Battlefield at Disrupt 2023 Is… BioticsAI TECHCRUNCH 9/21/23

Fierce 50: Health Equity Honorees: Kameron Matthews, MD, Cityblock Health FIERCE PHARMA 10/2/23

Fierce 50: Innovation Honorees: Kaitlin Christine, Gabbi FIERCE PHARMA 10/2/23

Keep Labs' Smart Storage Redefines Medication Management TECHCRUNCH 10/4/23

Avanlee Care and Mark Cuban's Cost Plus Drug Company Team Up MOBIHEALTHNEWS 10/5/23

Sanitas Health Selected for UCLA Health’s TechQuity Accelerator Focused on Equity-Driven Innovation UCLA HEALTH 10/9/23

Novartis Expats Detail Their Health-Tech Spinoff DatosX MM&M 10/11/23

Savor Health Awarded the 2023 C2 Award for Innovation in Cancer Care by AstraZeneca and Scientific American ASTRAZENECA 10/13/23

104 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

BioticsAI wins Startup Battlefield at Disrupt 2023.

HealthBook+ CEO Shares Vision for How People Can Own Their Health by Leveraging Data and AI

Image source: TechCrunch

Particle Health, Hona Integrate to Deliver Longitudinal Data for Informed Clinical Decisions

MEDCITY NEWS 10/25/23

HIT CONSULTANT 11/7/23

How An EvidenceBased Culture Can Drive Performance: A Look at Virta Health

Healthcare Payments Platform PayGround Raises $19.7M

FORBES 11/2/23

BECKER'S HOSPITAL REVIEW 11/28/23

startuphealth.com 105

HEALTH TRANSFORMER NEWS // AT A GLANCE

Devoted Health Closes Out 2023 with $175M Series E Funding Round

106 StartUp Health Magazine / ALZHEIMER'S MOONSHOT

9amHealth Executives Talk Their Mission, Telemedicine, Medicare, More in Interview FORBES 11/29/23

Virtuleap Scores AI and $2.5 Million in Commercialization Push XRAY TODAY 12/7/23

Presenting Empire BlueCross BlueShield’s 2023 Whole Health Heroes: Richard Bennett, Epicured

Snack Your Way to Weight Loss Success: Joydays' Tasty Cookies Work Like Ozempic to Help You Shed the Pounds Fast

Virta Is Corporate America’s Secret Weapon Against Ozempic

Devoted Health Closes Out 2023 with $175M Series E Funding Round

CRAIN'S NEW YORK BUSINESS 12/1/23

FAST COMPANY 12/3/23

AvoMD and Particle Health Selected for The 2023 Digital Health 50 CB INSIGHTS 12/5/23

DAILY MAIL 12/7/23

FIERCE HEALTHCARE 12/29/23

Cala Health Is a Notable Example of Effective Wearable Devices FORBES 12/29/23

startuphealth.com 107

When Geri Taylor found out she had Alzheimer’s disease, she and her husband Jim became fierce advocates for clinical trial participation and patient access to new innovation. Recently they launched the lobbying organization Voices of Alzheimer's.

Dream Impossible We solve big health challenges by collaborating with mission-aligned organizations to transform once-siloed projects into powerful health moonshot communities. Learn more at startuphealth.com 108 StartUp Health Magazine / ALZHEIMER'S MOONSHOT