StartUp Health Magazine_Issue 03 (2019) by StartUp Health

ACCESS FOR ALL Health innovation for the underserved

JANE METCALFE The neobiological revolution is at hand

HEAVYWEIGHTS Can a pharma giant think like a startup?

JOIN THE MOVEMENT Connect today at startuphealth.com

2019 ISSUE 03

THE HEALTH MOONSHOT ISSUE FEATURING The health policy pro helping black men live longer The finance guru speeding up drug development The fintech founder making healthcare more affordable The media exec who created a social network that brings healing

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startuphealth.com startuphealth.com $5.99 $5.99

Plus A global army of entrepreneurs transforming health

The Addiction Moonshot Join us as we launch an urgent moonshot to end addiction and the opioid epidemic. Page 62

“WE CHOOSE TO GO TO THE MOON” Decades later, JFK’s words hold the key to overcoming the great health challenges of our time.

The Health Moonshot Vision

HEALTH TRANSFORMERS

OF THE WORLD

UNITE.

WITH THE RIGHT MINDSET, A MOONSHOT VISION

AND THE SPIRIT OF AN ENTREPRENEUR,

ANYTHING P U R P O S E IS POSSIBLE.

SOMETHING MAGICAL HAPPENS WHEN PEOPLE WITH PA S S I O N AND COLLABORATE TO ACHIEVE EXTRAORDINARY GOALS.

WHY SHOULDN’T EVERYONE HAVE ACCESS TO QUALITY CARE?

WE MUST STRIVE TO END CANCER AND DISEASE. LET’S PRIORITIZE WOMEN’S AND CHILDREN’S HEALTH AROUND THE WORLD.

HOW DO WE BRING THE COST TO ZERO? IT’S TIME TO ALIGN MIND, BODY AND SPIRIT. WHAT HAPPENS WHEN WE RETHINK HEALTHY FOOD, WATER, NUTRITION AND FITNESS AS A

HUMAN RIGHT?

TOGETHER WE WILL IMPROVE MOONSHOT T H E H E A L T H THINKING MATTERS. IMAGINE WHEN WE UNLOCK THE MYSTERIES O F T H E B R A I N T O I M P R OV E H E A L T H .

LIVE HAPPIER, HEALTHIER, LONGER.

OR DO NOT, THERE IS NO TRY. AND WELLBEING DO JOIN US IN SUPPORTING HEALTH

OF EVERYONE TOGETHER WE WILL IN THE WORLD. ACHIEVE THE IMPOSSIBLE. TRANSFORMERS EVERYWHERE.

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Founders’ Letter

We Choose to Go to the Moon

n May 25, 1961, President John F. Kennedy announced before a special joint session of Congress a seemingly impossible goal – to send an American safely to the moon and back before the end of the decade. The space race was on, and a bold new moonshot vision was born. Looking back through the lens of history it’s inspiring to trace the impact of Kennedy’s call to action – he sparked a global sense of urgency, commitment and collaboration, pushing the world toward progress. The result was one giant leap for humankind. Bold dreams have the power to unite and inspire, especially when they push the boundaries of what’s possible and move us forward with purpose. That’s why we created StartUp Health. In 2011 we mapped our own impossible dream – a 25-year plan to improve the health and wellbeing of everyone in the world by investing in a new generation of entrepreneurs focused on transforming health. For the last eight years we’ve organized a global army of Health Transformers committed to achieving 10 health moonshots, each of which can impact at least a billion people. And this year, at the 7th annual StartUp Health Festival, we announced an urgent health moonshot – The Addiction Moonshot – to focus on ending addiction and the opioid epidemic. Thank you President Kennedy for inspiring generations of progress and unleashing the pioneer’s spirit in us all – whether we are racing to the moon, to Mars, or toward the future of health. We, too, choose to go to the moon by uniting Health Transformers everywhere, and supporting their spirit of invention, ingenuity and creation toward achieving health moonshots. Join us at startuphealth.com.

Unity Stoakes President & Co-founder

THE HEALTH MOONSHOTS CHANGING THE WORLD Access to Care Moonshot Together we can deliver quality care to everyone, regardless of location or income Cost to Zero Moonshot Together we can reduce the cost of care to “zero” Cure Disease Moonshot Together we can rid the world of disease Cancer Moonshot Together we can end cancer as we know it Women’s Health Moonshot Together we can improve the health of every woman, closing the gender gap Children’s Health Moonshot Together we can ensure that every child has access to quality care Nutrition & Fitness Moonshot Together we can ensure access to food, water and a healthy lifestyle Brain Health Moonshot Together we can unlock the mysteries of the brain to improve health and wellness Mental Health & Happiness Moonshot Together we can connect mind, body and spirit in the pursuit of wellbeing Addiction Moonshot Together we can end addiction and the opioid epidemic Longevity Moonshot Together we can add 50 healthy years to every human life

Steven Krein CEO & Co-founder 3

Transforming patient health with digital solutions www.sanofi.com

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At Sanofi, we are using digital technologies to generate new insights into disease and offer new, customer-focused solutions.

In This Issue

23 03

Founders’ Letter

Masterclass

Editor’s Letter

Polina Hanin: Ditch the Pitch

Bari Krein: The Moonshot

Wisdom

Foundation

Esther Dyson

Beth Comstock

Unity Stoakes

Jane Metcalfe

the World

Jerry Levin

Access to Care / Hoy Health

Cure Disease / Sanguine

Women’s Health / BabyMed

End Cancer / Savor Health

Children’s Health / Pathfinder

Cost to Zero / emPower

Mental Health & Happiness /

Meet the Health Transformers 20

Shameet Luhar / Vheda Health

Lynda Brown-Ganzert / Curatio

Aubrey Jenkins / inHealth Medical Services

Dr. Alexandra Greenhill / Careteam

Greg Guettler & John Dykstra / MetaLogics

Karen Drexler / Sandstone Diagnostics

The Health Moonshots Changing

LifeDojo 54

Brain Health / Life Recovery Systems

Nutrition & Fitness / FitBliss

Longevity / Zeel

End Addiction

Features 62 66 71 74 78 82 86

Recovery Rebooted Weight of the World Building a Health Record that Tells the Whole Story More Trial, Less Error Data Mine When Forgetting a Dose Isn’t An Option Leapfrog Innovation in South America

Industry Influencers 92

Katya Hancock / StartUp Health

Bertrand Bodson / Novartis

Giacomo Chiesi / Chiesi

Dr. William Carson / Otsuka

102

Terry Stone / Oliver Wyman

104

StartUp Health Around the World

106

The Global Army: An Index of Health Transformers

131

StartUp Health’s Year in Review

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Editor’s Letter

The Health Moonshot Issue

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

hile gathering stories for this issue I had the chance to visit the folks at Vheda Health. Tucked away in a no-frills business park in Columbia, Maryland, this startup is doing the seemingly impossible. Founders Shameet Luhar and Philip Rub have found a way to dramatically increase care quality for chronically ill Medicaid populations while simultaneously slashing costs for insurers. It’s a high-tech, high-touch approach that flips the economics for one of the most challenging and expensive populations in health (read how they do it on page 20). In Minneapolis, Minnesota, there’s a small team bringing a new wearable to market that has the potential to finally address the world’s obesity epidemic, saving millions of lives. The Lume armband by MetaLogics measures how individuals process calories and transmits clinically actionable data to physicians so that they can prescribe and monitor personalized weight loss regimens. This metabolic data, which used to cost hundreds of thousands of dollars – and multiple days – to obtain, will now be available to consumers for the price of a wristwatch. (learn how the Lume came to be on page 30). Can you increase quality, expand access and lower healthcare costs at the same time? Vheda Health is doing it. Can you solve one of the world’s most deadly and intractable health problems in a way that pays for itself ? MetaLogics says yes, and they’re doing it by working with employers and identifying the economic benefits of weight loss. If you’ve been around StartUp Health for any length of time, you’ll know that health moonshots matter to us. We’ve dedicated this issue to these

audacious health goals that can only be reached through radical collaboration, creative re-engineering and strategic investment. Vheda Health and MetaLogics are just two out of literally hundreds of startups that are flipping business models, re-engineering medical devices and building a smarter healthcare world Health moonshots require the for the next generation. breaking down of silos and the Not to mention industry crossing of borders. That’s one reason we were thrilled to take part heavyweights like Novarin Novartis’s Innovation Week in tis, Otsuka and Chiesi Buenos Aires, an event where legacy that are using their influpharma met startup ingenuity in a ence as legacy pharmamulti-lingual conversation. Read ceutical giants to expand an essay on the subject by Unity Stoakes, pictured, on page 14. digital health (read more from our industry influencers on page 91). As you flip through these pages and read about the hundreds of people and companies transforming health, I want you to be inspired, but don’t stop there. Through our digital platform, StartUp Health HQ, we’ve made it easy to connect with every entrepreneur in this magazine, as well as the broader world of health innovators. Log on, ask questions, send a high five to someone you admire, or meet your next business partner. Because every great journey – even a journey to the moon – starts with a single step. Let’s get going.

Logan Plaster Editor-in-Chief

My family, who has always been and will be my #1 priority and support system.

PUBLISHERS Unity Stoakes / Steven Krein

#moonshot

who has inspired you to keep a moonshot vision?

Bob Dylan, who has inspired so many other creators to think differently.

EDITOR-IN-CHIEF Logan Plaster

CONTRIBUTING EDITOR Jeremy Lehrer PHOTO EDITOR Paul Newson SENIOR WRITER Nicole Clark

My mother, for giving 30+ years of her life to the US public school system as an educator and change agent.

My mother, who enrolled in undergrad at age 40 and never stops learning.

DEPUTY EDITOR Jennifer Hankin

My grandfather, who is 94 years old and living independently, and worked as an optometrist well into his 80s.

CONTRIBUTING WRITERS Michael Yockel / Christine Grillo / Cole Stryker Patrick McGuire / Sonya Swink / Newt Bugbee ASSISTANT EDITOR Deena Metz

STARTUP HEALTH Steven Krein CEO & Co-founder

Unity Stoakes President & Co-founder

Jerry Levin Executive Chairman

Bari Krein Chief Strategy Officer

Howard Krein, MD, PhD Chief Medical Officer

Jennifer Hankin Chief of Staff

Katya Hancock Investor Relations Director

Muhammad Ali is proof that if you believe in and stay true to yourself, impossible really is nothing.

Piper Leonard Senior Controller Maxim Owen Academy Manager Max Weiss Counsel

Logan Plaster Polina Hanin My Academy Director commander Media Director in the Israeli Lauren Doolan Mark Liber Special Academy Manager Academy Manager Forces, who smiled no Nicole Clark Callie Fisher matter the Senior Writer Events Manager situation or Liz Austin Nicole Kinsey challenge. Media Manager Media Manager

Michael Karelis Head of Video Production

Anne Dordai Academy Lead

Andrew Solomon Academy Lead

Liz Tucci Data Lead

Tara Salamone Media Lead

Andrew Isaacs Ventures Advisor

Aki Koivistoinen Ambassador, Europe

Deena Metz Fellow

Pear Poolvaraluk Fellow

Bianca Sanabria Fellow

Amanda Spence Fellow

My great uncle, who founded several organizations to improve the lives of underprivileged youth in South Africa.

StartUp Health Magazine is published by StartUp Health Holdings, Inc. Copyright 2019. All rights reserved. StartUp Health and Health Transformer are registered trademarks. Disclosure: StartUp Health is an investor in more than 260 companies, many of which are featured in StartUp Health magazine. For a complete list of our active companies, visit the index which begins on page 106.

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My dad, who always encouraged me to focus on the two things I can control: my attitude and my effort.

People and ideas for innovation in healthcare

www.chiesi.com

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Wisdom

sion-driven. Why did you bother to create yours? So you could become a CEO? Not a very good purpose, in my opinion, but that happens. Or perhaps you want to cure the kind of cancer that killed your uncle. Or perhaps you want to show a parent or an ex that you are not a loser. Again, not the kind of motivation that’s likely to get you through tough times, but it happens. That kind of motivation is unlikely to attract the best employees, because it’s not a unifying vision. The best you can offer employees at a company built around the founder’s needs is usually the opportunity to get rich, which ultimately tends to create a toxic culture. You might call it “mission slide.” You begin your company with a strong purpose. The extreme case there is Theranos. I don’t think Elizabeth Holmes started out wanting to lie and cheat. She had an admirable initial purpose – to make blood draws painless. But one way or another, she couldn’t face the challenge to her own perceived identity as a winner and ended up creating a corporate identity of self-delusion and lies.

The Epigenetics of a Startup: From DNA to a New Identity Esther Dyson

photo by Paul Newson

Executive Founder of Way to Wellville

When you start your business, it generally has a single, clear identity – yours. Its mission and culture reflect yours; it has your DNA. But consider how that changes over time: how your DNA will mix with that of your employees. And ultimately, the company’s identity will be influenced by the business equivalent not just of DNA, but of metabolism (energy/money flows) and what evolutionary biologists call the fitness landscape (the environment in which organisms prosper and adapt, or ultimately die out). There is no single “right” identity, though I would argue that long-term purpose always beats short-term tactics. Whether you are a founder (the focus here) or a job candidate, an investor or a partner, or even a regulator, it’s useful to understand how a company’s identity can change over time. If you’re the founder, start by thinking about the future and asking a few hard questions. What is the mission? In order to accomplish the mission, should the founder move from CEO to Chief Medical Officer and bring in a new CEO? In the health space in particular, startups are often mis"

Building the Team

The first big change in DNA comes when you create a team, usually and ideally starting with a co-founder who shares the mission but has complementary skills and personality. The way this team interacts will set the culture of the company: open or closed, tight or loose and other more specific things around work style, language, politics and more. Culture and mission interact, but they are not the same thing. As a company grows, its identity changes from that of a few founders to a group culture, usually shifting from the product or service to sales. Bill Gates used to talk about the corporate nervous system. It was a hierarchical system with the brain (i.e. Bill’s brain) at the top. But a good company culture is more like an immune system. It’s everywhere and decentralized. Each piece of the body knows its identity, and recognizes and rejects foreign objects. Yet sometimes you want to embrace foreign influences. Take the case of WeWork and Meetup, on whose board I sat on until it was acquired by WeWork. Yes, Meetup made a profit, but mostly so it could grow and achieve its mission of helping people to meet in real life around common interests. WeWork bought Meetup in part so that the real-estate unicorn could absorb some of Meetup’s community-centered identity, while Meetup can now benefit from WeWork’s growth-oriented culture and its abundance of venues. While acquisition is one way to change your company’s DNA, it doesn’t always work, just as transplants can sometimes be rejected by the immune system.

Wisdom / Esther Dyson

“...You can choose to sell to high-end hospitals near spas, or you can choose hospitals focused on Medicaid ... there’s no divorcing the company’s identity from the forces that feed it.” Now for the Money

Many health and tech companies start with a strong purpose determined by the founders, whether it’s Google bringing information to all, or Meetup creating community. But like a person, a company has to eat, whether it’s seed funding from investors or revenues from customers. The thing that keeps a company alive and lets it grow – its food – is money. The money, because it’s so vital to the company’s existence, comes with great influence. Be careful whom you pick as investors. Their mission is typically to make money, but there’s a big difference between making money short-term and making money long-term. Moreover, if you the founder have a strong sense of purpose, pick investors who share it, because once you take their money, they have a say in how the company is run. That’s especially true if you are not profitable and need to keep raising money. If you aren’t mindful, you’ll wake up one morning and find that your company’s purpose has changed from saving the world to feeding investors. I’ve watched as CEOs go after the highest valuation rather than investors who will help them build a company long term. I’ve seen entrepreneurs who cater to the payers over the patients, and create profitable companies that literally harm patients. I’ve known venture capitalists (VCs) who invest in two companies with the purpose of selling one to the other - a clear conflict of interest. On occasion, VCs even downplay the value of a company to other investors so that they can buy in cheaper themselves. Saying No to the Money

It’s one thing to write a mission statement and declare your purpose to the world. It’s another to turn down funding because the VC isn’t aligned with your mission. What I tell entrepreneurs in this situation is, “Look, the chances that you’re going to have a problem in the next two to three years are high. That’s the nature of startups. Do you think these people are going to have your back? Or are they going to kick you out in favor of someone who will tell them what they want to hear?” The VC might offer you a high valuation, but that means they’re going to want to double it in three years. Can you actually do that in a way that will make you proud? Know Your Metabolism

Likewise, customers are another key to the long-term identity of the company; they provide the day-to-day energy and their desires and preferences ultimately de12

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termine what it is that your company offers. Customers are the entities that pay; they may not be the users of the product. Both Facebook and Google are noticeable examples: they sell their users’ attention – and (use of ) their data! – to their actual customers, advertisers. Just as you can choose investors, you can choose the customers who influence your identity. You can choose to sell to high-end hospitals near spas, or you can choose hospitals focused on Medicaid. You can deal with chronic health conditions or rare cancers, with cosmetic surgery or bariatric surgery. But there’s no divorcing the company’s identity from the forces that feed it and allow it to exist.

STARTUP HEALTH

HQ 6

Start a conversation with Esther Dyson on StartUp Health HQ 6 startuphealth.com

The Fitness Landscape

Then there are the influences that you cannot really choose (except perhaps by moving to a different country or marketplace). That’s the fitness landscape. It comprises both government regulations and cultural norms, and also the competition. The government and its rules and regulations (often specific to a particular market or product, though also more generally around business practices), are an important part of the environment that can constrain your company’s identity, whether through learning/adaptation (when you change in response) or evolution (when you can’t adapt and die, while other companies prosper). When the healthcare regulatory environment changes from fee-for-service to value-based payments, for example, you need to change your identity – the rules that run your business and what you reward your employees for – or some other company will take your place. And then there’s the competition – the companies competing for the same dollars, though not always with the same identity. Having a purpose that’s genuine and that attracts good customers can help you compete with money-hungry companies that offer low prices and little more – but not entirely. It’s much easier to compete in a clean market than in one where a larger, well-funded predator can wait you out using their investors’ money. The Bottom Line

Know how company identity works, and how it can change. If you’re purpose-driven, make sure your collaborators are similarly minded. If you want to satisfy customers and improve the world, make sure you have investors who share your mission. And then go and do it.

Disclosure: Some of the companies mentioned here are in the StartUp Health Academy or in my portfolio of angel investments, or both. In other words, I believe my own advice!

Wisdom

Beth Comstock Former Vice Chair of GE

photo courtesy of Beth Comstock

The Call for Discovery " By the end of Jeff ’s first week in the corner office, GE shares had plunged 20 percent, cutting the company’s value by almost $80 billion. There was a palpable sense that the ground was shifting under our feet, and it extended well beyond the change in leadership at GE or the 9/11 attacks. There were forces at work that were beyond our control, beginning with the bursting of the dot-com bubble. The collapse affected new technology businesses (good-bye Pets.com) and established ones alike (Cisco’s stock declined by as much as 87 percent). And then there was the giant energy conglomerate, Enron, which declared bankruptcy at the end of 2001 in a maelstrom of scandal, followed by the dissolution of one of the world’s leading accounting firms, Arthur Andersen. All these failures combined to create a general sense that big corporations were secretive institutions that couldn’t be trusted. It was around this time that the word “transparency” started cropping up in conversations about corporate America, and not in a good way. At the time Jeff Immelt took over, GE was a disparate and complex conglomerate that included a giant television and movie company; America’s seventh largest bank; a large insurance business (for humans and pets); portfolios in transportation, health care, and energy; and traditional industrial components like appliances and plastics. Growth at GE had slowed; doubts were being raised about the long-term viability of the insurance business and the dominance of GE Capital. Some economists questioned how GE had so consistently generated double-digit profit growth for nearly a decade.

Excerpt taken from Imagine It Forward: Courage, Creativity, and the Power of Change (Currency 2018)

Jeff believed GE had relied too much on buying other companies to support top- and bottom-line growth. His mandate was to grow from our base of technical strength. Jeff sought what investors call organic growth, meaning you don’t buy your revenues, you grow them. He wanted to put the company on a course to invest record amounts in technology but also to be more connected to the world’s global markets, especially those in developing countries where suddenly much of the world’s entrepreneurial energy (and growth) was being generated. That would require a new kind of leadership, one that expects judgment calls to be made in the face of incomplete data, that encourages original thinking, that values speed over perfection, that embraces change. That this would take over a decade to seed wasn’t clear at the time. We knew we had to expand on the “all-in” zero- defects managerial doctrine of Six Sigma. There is a lot of good in Six Sigma, because it focuses people on quality and reduced distraction. But Six Sigma created a culture that venerated process, and along the way, our people lost some of their capacity to take smart risks and use personal judgment when making decisions. The new GE would have to be as much about opportunity as efficiency. The task was monumental: maintain all the expertise that made us who we are and at the same time learn how to think and act differently to ensure we are able to grow into something new. But how do you teach a company imagination that looks to create a future few can see? I describe it as “optimize today and build tomorrow.” Companies have to learn how to do both if they expect to be around for future generations. Good leaders know it is their job to manage the tension from this hard balancing act. To become an ambidextrous organization, we needed to become better explorers. We needed to engage the world as a classroom from which we could learn and extract the ideas that would create our future. It was something that I would eventually codify in our work- flow and come to call discovery. It’s hard to convey just how absurd, and even threatening, these ideas sounded to so many of GE’s leaders at the time. The story we told of ourselves and celebrated then was almost exclusively a story of optimizers – our language centered on efficiency, defect removal, and process rigor, while our Six Sigma “black belts” were GE’s ninja forces, guiding teams forward through continuous process improvement. How many times had I heard, “That’s not who GE is.” I knew the primary source of resistance to the changes we were seeking would be our own identity.

Wisdom

The Health Innovation Paradox: Leaping Forward, Inch by Inch Unity Stoakes President & Co-founder, StartUp Health

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In traveling the globe on StartUp Health’s World Tour (we now have Health Transformers in 22 countries on six continents) we’ve had the opportunity to spend time with thousands of entrepreneurs, doctors, investors, patients and caregivers. A confusing pattern keeps standing out – I call it the health innovation paradox. Whether in Beijing, Berlin, Berkeley or Buenos Aires, health innovation today is progressing slower than we think and faster than we ever dreamed possible – at the same time. One path is incremental, linear innovation that frustrates us with its slowness and fails to keep pace with consumer expectations. These are the innovators building on top of a broken system. Like workers filling in the potholes on a busted road, they’re building point solutions and features rather than leaping over the outdated foundation to start fresh. Some of that is out of necessity, because that’s what customers are buying and what a lot of investors are funding. But it’s also based on the fact that there is a broken legacy infrastructure that dominates our world and tries to govern what’s possible. The system defaults to incremental progress by its very nature. The other parallel path, however, is leapfrog innovation that blows our minds. Diseases are being transformed, gene editing is being unleashed, organs and prosthetics are being “printed,” brains are being rewired, robots are "

StartUp Health Magazine

becoming surgeons, services are being exchanged for data and digital therapeutics are being prescribed. This exponential innovation is accelerating in part because of the global opportunity and increasing demand for new solutions – and also because we are in a golden age of entrepreneurship and the tech world has finally discovered new meaning in the world’s most universal industry: health. New technologies, new platforms and new entrants into the market are changing entire paradigms. These companies are rethinking, reimagining, reinventing and starting with a blank slate. They’re not trying to build on top of the legacy infrastructure. They’re leaping over it. Make no mistake, incremental innovation is essential. Sometimes a road – or an electronic health record – just needs fixing. And sometimes it’s in that seemingly mundane repair work that breakthroughs emerge, when new discoveries happen. But the opportunity for leapfrog innovation in health has never been greater than it is today, thanks to five key market forces. 1. New Platforms to Build On: Instant Scale

Apple, Amazon, Ping An’s Good Doctor and Tencent are a few leading examples. These technology platforms are creating a new baseline from which innovators can build on to quickly scale. They already have billions of users and they are integrated into people’s day-to-day lives. Health companies that are smart will ask themselves how they can leverage these platforms and tap into the billions of people (consumers and caregivers) who are using them every day. 2. New Consumer Behaviors: Design Into the Fabric of Life

Ubiquitous smartphones, devices and health tracking sensors are opening the door to new consumer behaviors. Devices enable us to engage with products and companies wherever we are, from home to our cars. This opens up new opportunities to leverage consumer behavior for health. Figure out how to make your solution invisible and automatic so that it’s designed into the fabric of our lives. 3. Unique Collaborations: Mix, Match, Fuse

When Amazon, Berkshire Hathaway and JP Morgan announced they’d be collaborating on a health initiative, the industry took note. There’s an opportunity to get even more creative with the types of partnerships that are formed in order to break through to what’s possible in health. What if Kaiser Permanente teamed up with Tesla to turn your ride to work into a daily health checkup? What if a preventative health company like KingFit partnered with United Airlines to turn your next transcontinental flight into a health retreat instead of leaving

you tired and dehydrated? What about TD Bank collaborating with LifeDojo to join financial and personal health coaches into one modern consumer experience? Collaboration doesn’t just happen at the enterprise level, between industry titans like Amazon and JP Morgan. When the Wright brothers took flight, their ragtag band of dreamers and doers beat out the well-funded industry. It was scrappy upstarts with little experience and less money who thought about the problem in a new way and ultimately succeeded. They were unencumbered and unconstrained by legacy challenges. So if you’re one of these big players in the industry, there’s new opportunity to lean in and support the entrepreneurs reimagining the future. 4. New Business Models: Transform Health Costs Into Investments

Perhaps the biggest opportunity for innovation in health is around rethinking business models. The time is now to completely rethink who pays, how money flows, how pricing is structured and market expansion. Consider how business models have changed in other industries like banking, media, communications, travel and entertainment. By shifting from a cost mindset to a longer-term investment mindset, there are ways to radically reduce costs (by cutting out layers of bureaucracy, leveraging technology, changing incentive structures, considering the value of data, etc.) and shift to a growth paradigm measured by wellbeing, happiness, productivity and innovation. 5. New Global Opportunities: Build for the Rising Billions

Yes health is regional, but it’s also universal. There’s a unique opportunity today to create global solutions – ones that work in the most underserved areas and for everyone else, too. We tend to think about health solutions for only a few people at a time. But, when we reframe with a global lens, and design for the seven and a half billion people who need care, we need to bring a fresh mindset to every solution. When you think at that scale, you have to build from a clean slate. You’ve got to rethink pricing, business models, distribution, regulation and marketing. Because health is important and essential to every human on earth, it can cross borders and connect disparate people. ******* We’re living in the most exciting time in history for transforming health – but there is still too little imagination being unleashed on our greatest health challenges. Together we need to choose to go to the moon again. The time is now to stop inching forward and start racing past the health innovation paradox.

The Neobiological Revolution is at Hand " How many of you use a neuro-prosthetic Jane device for cognitive enhancement? Most, I’m guessing. Metcalfe It’s more frequently referred to as a smartphone, and consumers bought 1.5 billion of them last year. Founder of Neo.Life; Or maybe you’re one of the millions of people who Co-founder use a fitness tracker, and who contributed to $2.5 bilof WIRED lion in sales last year. If you’re reading this magazine, chances are you’re one of the 15 million Americans who have sequenced your DNA, perhaps discovering family or medical issues that affect you or people you love. You might even have sought an extra measure of control over your own reproduction by freezing eggs or embryos. All these trends are signs of an enormous change that’s transforming our brains, bodies, families, lifestyles and the very definition of what it means to be human. I call it the Neobiological Revolution. Twenty-five years ago, I started WIRED magazine with my partner, Louis Rossetto, who coined the term “Digital Revolution.” WIRED covered the most important story of our modern era: how digital technology was changing work, business, education, entertainment, politics and culture. There is a new revolution underway that allows us to alter our DNA, map our brains, command existing organisms to do our bidding, and create new ones never seen before. Homo sapiens is seizing control of its own evolution.

Innovation in genetic sequencing has driven down the cost of decoding a human genome from $100 million in the year 2000 to less than $1,000 today. 15

Wisdom / Jane Metcalfe

What’s fueling this transformation?

u Innovation in genetic se-

quencing has driven down the cost of decoding a human genome from $100 million in the year 2000 to less than $1,000 today.

u Advances in imaging are lay-

ing bare biological circuits and systems that we can harness for other uses.

u A profusion of sensors is re-

cording, measuring and tracking events both inside and outside our bodies.

uMassive amounts of data

from sensors, imaging and other sources are feeding machinelearning software that spots patterns and makes decisions, generating fresh insights that we can put to use.

We’re already exploring the breadth and depth of our new powers. Entrepreneurs Mark Zuckerberg, Elon Musk and Bryan Johnson are investing heavily in neural implants. Companies like Halo Neuroscience and Humm are working on noninvasive brain stimulators designed to boost performance in athletes and electronic gamers. Koniku is melding silicon and disembodied neurons in devices that can sense chemicals in the air. Meanwhile, insights gleaned from reading DNA are revolutionizing medicine, thanks to some 75,000 available gene tests, and genomic data is driving treatment and drug discovery. Patients like Onno Faber, a tech entrepreneur who is fighting a rare disease, are getting their own genomes sequenced to discover and develop the treatments they need. Companies including Nebula Genomics, hu-manity.co and Seqster are building systems that allow individuals to take control of their own health data, so they can realize not only health benefits but also profits by licensing their records to researchers. The Neobiological Revolution isn’t quite a household word–yet. But it already permeates our collective unconscious through films, TV shows, and books like Altered Carbon, Autonomous, Black Mirror, The Nexus Trilogy, Orphan Black, Seveneves, Westworld, and many others. Most of these stories feature rogue biohackers, synthetic humans in revolt, and clones manipulated by evil corporations. But that’s not actually how I think the 16

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“...we need experts in a particular field who are willing to become novices in another, because this revolution demands collaboration and cross-fertilization across disparate fields of science, technology, and philosophy. Neobiological Revolution will play out. For one thing, the vast majority of scientists are highly principled people who hold human advancement as their highest goal. For another, their innovations are laying the groundwork for better and more equitable healthcare, more productive agriculture, cleaner energy, and more. I believe we will work through the challenges because the benefits on the other side are so compelling. It’s true, we’re building tools to manipulate things we don’t yet fully understand. Technology is getting ahead of science, and business is getting ahead of technology. That calls for us to proceed with caution and humility. We have to be clear about what we do and don’t know. We need to re-think what we consider “natural.” And we need experts in a particular field who are willing to become novices in another, because this revolution demands collaboration and cross-fertilization across disparate fields of science, technology and philosophy. The Neobiological Revolution is already bringing immense social change. In-vitro fertilization was hugely controversial 40 years ago, but now it’s considered every couple’s right. Genetically modifying embryos to prevent inherited diseases seems like a human right to me. What may strike you as outrageous today may seem like business as usual to your children in 20 years. We are alive at an extraordinary moment in the history of our species. We can make tremendous advances—and enormous mistakes. So we need to bring all our humanity, intellect and wisdom to bear in deploying these powerful tools. What do we want our future to look like? I can’t wait to find out.

Curious minds can peer inside Jane Metcalfe’s head any day of the week, thanks to her latest venture, Neo.Life, a newsletter and online magazine focused on “the people, companies, and technologies that are improving, repairing, and extending life.” 4 neo.life

Wisdom

Dear Freshmen Politicians: Think Like a Startup 2

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

" I have that stirring feeling of confident opBe an army for good. At StartUp Health, we’re ortimism again with the advent of 100 women elected to ganizing a global army of like-minded Health TransCongress from every background, age and skill set, with a formers around audacious health moonshots. At times, values orientation to take on the old boy legacy network competitors are marching shoulder to shoulder in pursuit accustomed opportunistically to “kicking every can down of a greater good, like access to care for everyone. These the road.” They want to improve our society by transformmoonshots require radical collaboration; and in governing our wellbeing with real solutions and deliver on the ment, success can only be achieved through collaborative Declaration’s guarantee of the pursuit of happiness. progress on complex problems. My initial vote was cast in 1960 for a new generation of articulate leadership in the person of Jack Kennedy, age Think through the next quarter century. We chal43, and the first Catholic President. After eight years of lenge entrepreneurs to look beyond the immediate stolid, unimaginative governance from an Eisenhowerurgency and think instead in terms of 25-year goals. Nixon Administration, it was time for fresh In government, the only avenue for achieving perspectives. The determinative event was something transformational — a moonshot Take the the very first televised live presidential — is to look beyond where the current long view debate. Even though we were still in political winds are blowing. For examIn government, the early stages of colorless black and ple, the ultimate fate and mechanism the only avenue for white TV, the difference in the candiof “entitlement programs” cannot achieving something dates was energetically obvious: Kenbe dealt with short-term or you will transformational is to nedy was poised, knowledgeable and continue to come up with the wrong look beyond where extremely personable while Nixon was answer. the current political pale and famously sweating under the winds are blowing. bright lighting. Interpolating from the Be mission driven. For our Health future back to that moment, Nixon apTransformers, there is one master peared cunning and corrupt! mission to improve the health and wellbeing And now today, the do-nothing Congress has beof everyone in the world. Investors and team memcome an intractable reality. Change came briefly with the bers must be aligned with this focus. Similarly, this new passage of the Patient Protection and Affordable Care Act cadre of political entrepreneurs can transform our staid in 2010. But 45 years had already passed since Lyndon government into a new-age mission-driven government Johnson signed the act enabling Medicare and Medicaid with this insight. Politics for its own sake runs counter to as amendments to Roosevelt’s Social Security Act. I am this mission. struck by the parallels between what this new cohort of Congresswomen can achieve and the importance of the Be guided by the impossible. It was on September model of the Health Transformer Mindset! 12, 1962 in Houston that President Kennedy challenged the existing science and space communities to Here are five entrepreneurial prescriptions for work relentlessly to put a man on the moon by the end of freshmen politicians: the decade, “not because it is easy but because it is hard.” It seemed a reach too far, and yet, Neil Armstrong made it Deploy big data for sources of innovation. Take a reality only seven years later! immigration for example. As a policy matter and culThe lesson is clear: declare the dream and believe in it tural influence, we have waffled between letting people in through radical collaboration and determination and set and keeping them out. Query the database and find out the course of history. At StartUp Health every day we what worked and what didn’t, what was integral to our declare audacious health moonshots. And so our newly value system and what was an aberration. elected entrepreneurs can confront a broken, insurmountable political system by setting new moonshots, with a new declaration that the impossible is indeed possible!

Issue 3

StartUp Health Magazine

StartUp Health Insights s

Health Moonshot Funding CURE DISEASE

171

TOTAL DEALS

TOP DEALS -Helix: $200M San Carlos, CA, USA Medlinker: $147M Beijing, China Benevolent AI: $115M London, England

CURING DISEASE StartUp Health breaks down funding analysis in health innovation to see how much is being invested in specific health moonshots. Here’s a glimpse of the funding being put towards curing disease this year.*

$3.4B TOTAL RAISED

$19.7M AVERAGE DEAL SIZE

SPOTLIGHT: ORATEL DIAGNOSTICS -Oratel Diagnostics is transforming diagnosis for pelvic pain in women, starting with endometriosis Learn more on StartUp Health HQ www.startuphealth.com

*Data from January 1, 2018 – November 15, 2018 Download the StartUp Health Insights report at startuphealth.com/insights

Health Transformers

Shameet (L) met his Vheda Health co-founder Philip Rub while the two worked at Resolution Health.

Shameet Luhar & Philip Rub vheda health

They Worked for Insurers, Then They Built a Way to Save Them Millions, Through High Tech, High Touch Care "

AS EARLY AS HIGH SCHOOL, Shameet Luhar knew

he was headed towards a career in healthcare. But the pieces didn’t fully gel until one weekend when he was 29. Shameet and his co-worker (and co-founder) Philip Rub took the seed of an idea Shameet had been developing in grad school and in two caffeine-fueled days drafted a business plan for a pitch contest. That plan – which got them to the contest’s quarterfinals – was the beginning of Vheda Health. The idea was for Shameet and Phil to take their experience as health insurance consultants after their previous company, Resolution Health, got purchased by WellPoint (now Anthem), to create a better kind of compliance company. And that’s what they did. Now, when they walk in the door to talk to a new health plan, it’s with the knowledge that they can save that plan more than $17K per member per year, on av-

Issue 3

StartUp Health Magazine

erage. They do it through a combination of high-touch hardware, software and services such as member identification, remote monitoring and live health coaching/outreach that drives behavior change, saving health plans money. But the secret sauce? Data. Vheda Health can look at massive population health data sets and identify the right populations that yield at least a 3:1 ROI for Vheda Health’s specific intervention programs, such as heart failure, diabetes, hypertension, COPD, behavioral health and more. Shameet, a Maryland-native who returned to his home state to set up shop, is just getting started. Good enough to lock in the second largest health insurer in the US and a former employer. StartUp Health sat down with Shameet and talked about his entrepreneurial motivations, the uniqueness of his product, and his “aha!” moment.

STARTUP HEALTH

HQ 6

Meet Shameet and Philip on StartUp Health HQ. 6 startuphealth.com

Dossier Vheda Health vheda.com @vhedahealth HQ: Maryland

Shameet Luhar, CEO

What was your journey to becoming a health entrepreneur?

What gave you the confidence to step away from a secure job into the tumult of health entrepreneurship?

When you’re working on projects for a Fortune 50 company, the work can become repetitive, and so your mind has a natural tendency

What stats do you lead with?

Vheda Health is a member compliance company saving health insurers an average $17,175 per member per year. And how do you do that?

As a member compliance platform, we are bringing disparate data sources into a singular solution. This means we combine hardware, software and services that decrease emergency room overuse, inpatient admissions "

I got my first taste of the health IT field when I joined Deloitte right out of college, which led to consulting for health insurance companies. It was there that I really started understanding the inner workings of how a health insurance company operates. I learned how health plans work in terms of interacting with members, about the various programs offered to members that have chronic conditions, how plans increase revenues and lower their costs. That paved the path for my work in 2010 at Resolution Health, a data-analytics company, purchased by Anthem. There we developed a clinical rules engine built to analyze claims and send members messages to elicit behavior changes on identified care gaps. The problem was that the whole system at Resolution Health (and Anthem) was paperbased, so the data was too old to be useful, ultimately costing the insurer money. Around this time, in 2013, we saw the beginnings of a generational shift in healthcare, triggered by three key events: smartphone adoption was increasing, access to remote monitoring was coming of age and the ACA passed. We realized that to drive change, and save insurers money, health plans are going to need access to real-time data, and so the seeds of Vheda Health were planted.

go. And that’s why every time we go into a meeting, we always hit them up with our results first. Results are what get their attention.

“...each member is being tracked by various remote monitoring devices, and if one or more of their values is out of range, they receive a phone call from one of our triage call center support reps to help them normalize that value before it turns into a high cost event.” "

Q&A

to wander. Phil and I were working on the same enterprise projects. I came to him with this idea and he and I started talking and we said that there might be some legs to this. Phil’s wife is a type 1 diabetic, so he’d seen a lot of the struggles that she has had with access to care. We happened to land on an opportunity for a business plan competition. Phil and I looked at each other and said, you know what? We might as well throw our hats in the ring and see what happens. Over a weekend, we wrote our first business plan for the company and we made it to the quarterfinal round.

You’ve got a pretty young team. What are the opportunities and challenges of being a team in its 30s?

When we are meeting with leaders of a health insurance company and describing our philosophy and value proposition, Phil and I are the youngest people in the room. Sometimes there is a stigma against younger entrepreneurs, but it comes down to how you communicate the value. There’s always going to be skeptics because health insurance is a very risk-averse industry. So you have to hit them with the hard financial impact that you can provide to them in a short amount of time. If you’re able to communicate the value in a very effective and simple way, everybody sits up in their chair, their ears perk up and you’re ready to

and inpatient days. Vheda Health focuses on under-resourced (Medicaid) and elderly (Medicare) populations, providing the hardware and software they need to improve their health, but then we also layer on human touch. This human touch is key because it drives behavior change and results. We assign every member enrolled in one of our chronic condition programs access to a health coach that they meet with through live video and text message through Vheda Health’s mobile app. Additionally, they receive “human touch” support from our tech team who can help them resolve any technical issues with their hardware or the app itself. They also receive support from our triage support. So each member is being tracked by various remote monitoring devices, and if

Stat Deck

100 Approximate number of times Vheda Health touches each member per month

$17,175 Average amount Vheda Health has saved clients per member per year.

Health Transformers

one or more of their values is out of range, they receive a phone call from one of our triage call center support reps to help them normalize that value before it turns into a high cost event. The combination of those three things enables us to touch our members over 100 times per month. That’s an industry-leading number! What hardware do you deploy?

That seems like a pretty unique value prop in this space.

I don’t know of a single company offering a full end-to-end solution. A key differentiator for us is our value on simplicity for the members at the health plan. We’re focused on removing as many obstacles to compliance as we can. That’s why we pair all the devices ahead of time and make sure each device has a year battery life. What was one moment when you realized that this wasn’t just a good business idea, but you were actually helping people?

For me, it was when we started to analyze the results of our first client, a 22

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Medicaid Health Plan in South Carolina. When we analyzed those results, Phil and I looked at each other, like, holy shit, this is really working. Because not only were we saving the health plan money, but the average number of hospitalizations went down, average hemoglobin A1Cs went down, average member weight went down, and members were actively complying with the program. When we did our exit assessment, a number of members said they would probably be dead if it wasn’t for our program. You talk about saving health plans $17,175 per member per year. Where do those savings come from?

We bucket it into three categories. The first is in decreasing emergency room overuse. The second is reducing inpatient admissions. The third is reducing inpatient days. We ingest and analyze medical and pharmacy claims sets. With access to this data, we can analyze the health plan’s entire population and provide an analysis of focused opportunities. In other words, after deploying Vheda

StartUp Health Magazine

We combine the best hardware currently available. Every member that’s enrolled in one of our programs receives a care package in the mail that includes an iPhone with unlimited talk, text and data. It’s preloaded with the Vheda Health mobile app, the health plan’s mobile app, along with hotkeys with quick access to all the health plan services, such as the member’s care manager, their nurse access line, their member services line, transportation and our tech support number. And then we include various biometric remote monitoring tools, based on the person’s condition. A member enrolled in Vheda Health’s heart failure program, for example, will receive a blood pressure cuff, weight scale and a pulse oximeter in their care package.

Every member that’s enrolled in one of Vheda Health’s programs receives a care package in the mail that includes an iPhone with unlimited talk, text and data. It comes charged and preloaded with the Vheda Health mobile app, the health plan’s mobile app, along with hotkeys with quick access to all health plan services.

Health’s programs in these chronic condition areas, here is the projected cost savings and ROI. What’s next for Vheda? Do you have a dream client you’re going after?

The dream client piece has already been answered. Our former employer is a customer. We have a really aggressive push over the next 12 to 18 months on sales and marketing. It’s time to get our name out there and to educate the rest of the health insurance world about our results. Our ultimate goal is to become the preeminent leader in member compliance among Medicaid and Medicare health plans.

Lynda Brown-Ganzert curatio

From Gaming to Health Tech, She Created a Social Network That Can Heal LYNDA BROWN-GANZERT HAS

" always been a bit ahead of her time. She started a ballet school at the age of 14, created a social messaging app before WhatsApp hit the scene and designed a multiplayer mobile video game more than a decade before Fortnight was conceived. Now, with Curatio, the serial entrepreneur is gazing into the future of healthcare, predicting how social networks can play a role in care coordination. Dossier Her platform, Curatio which provides CEO / Founder AI-driven and curatio.me peer-supported @curatiome care navigation, HQ: Vancouver is being used in 70 countries. In clinical results, Brown-Ganzert and team have shown that private peer groups created around health conditions and goals can not only meaningfully improve outcomes, but also provide a more valuable way to address patient acquisition and retention. What’s more, they create much-needed community, helping patients feel less alone.

Q&A You started your first business at age 14. What was that experience like and how did it shape you?

When I was 14, I moved with my family to Haida Gwaii, a remote northern region of Canada. It was a remarkable place at the end of the world. I’d moved from Vancouver, in the city, where I’d studied ballet

Track Record In 2017, Brown-Ganzert received the Entrepreneur of the Year Award from Startup Canada.

since I was five. Haida Gwaii, where my father was working for a telecommunications company, was a logging and fishing town of about 1500 people, and there was obviously no dance school. So I started my own. We were profitable the first year. I had about 60 students, and put on recitals that sold out. I taught, I took care of admin, I swept the floors. So the lack of resources become the mother of invention.

I think that’s a unifying personality trait for all entrepreneurs. We look at something and think, how can I fix this? It’s so empowering to get to do that at a young age. It becomes quite addicting in a way. Growing up in remote Canada, you must have a better appreciation than most of the value of telemedicine.

Gosh, yes. I remember we had to fly out for dentist appointments. As a kid I had to take two days out of school and fly down to Vancouver

We talked to Lynda about how her entrepreneurial roots shaped her as a Health Transformer, and why we need to think differently about “gamifying” healthcare.

Health Transformers

to go to the dentist. Tragically, about two years ago an old high-school friend who was still living in Haida Gwaii died of a heart attack because they didn’t have the first responder resources. We don’t think about it, being in large centers, but that access to care can mean the difference between life and death. So the dance studio lit a fire. What was next on your path to founding Curatio?

Curatio is my third mobile startup. Before Curatio was a company called zuluMe which was based around private social networks. It was beautifully designed, but it was a little ahead of its time - we launched before WhatsApp and saw that wave coming. Before zuluMe, I started GoBe media, a massive multiplayer online game for kids with a strong mobile component. That was super cool, but again, we were way too early for the market. But we could see what was happening in Asia and Europe, the penetration of mobile devices and the increasing way that people were using them for information, education and entertainment.

cation is incredibly complex. It takes a very diverse and multi-talented team to pull that together and at the heart of game theory is behavioral science and psychology. I find that the “gamification of health” comes from a very external perspective. How do we get the patient to do more of what we want them to do, as opposed to what does a patient need to do, or what does a patient want to do and how do we empower them. Those are very different approaches. Curatio is used in over 70 countries. Give us a snapshot of what it’s like to have such a global focus?

One of the great benefits of building a business in Canada is the diversity of the country itself. Even on our team, we have diversity of culture, gender, language and orientation. Secondly, we invest as a country heavily in R&D and we invest and support emerging companies. In some cases it’s unprecedented how the government rallies around researchers and entrepreneurs and supports their work, especially work that is solving really big problems.

How did your experience in the gaming industry at Entertainment Arts (EA) translate to health innovation?

Why has it been so important to grow as a global company versus having a focus on North America?

There are similarities in how to think about engagement, the narrative and the immersive story experience. To replicate the success from the gaming world in healthcare would be extremely powerful. We’re very focused on that at Curatio. A lot of people who feel isolated or stigmatized find empowerment through games. How can we inject that empowerment into the patient experience using some of those same game theories and immersive experiences?

Access to care is a global problem. That’s why being part of StartUp Health is so important, because we’re all working on this together and we can fast track making linkages between countries.

What’s your take on the “gamification of healthcare” as a buzzword or trending concept?

Generally, I think it is naive. Gamifi24

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Curatio is a multi-faceted product. You combine social network theory with daily disease management tools to aid patient retention and care navigation. You also license a SaaS platform to pharmaceutical companies, payers and providers. What element of the product gets you the most excited right now?

StartUp Health Magazine

Telling Your Story Brown-Ganzert pitched Curatio on Dragons’ Den, a Shark Tank-style show that airs on Canadian TV. She gained a few new investors, and these valuable lessons:

1 Know your audience and customize and articulate for them.

2 Know your numbers. Financials, user rates, costs, clinical evidence, everything.

3 Know yourself. Pitching is stressful, so know your pressure points and how to push through them.

I’m really proud that we are in 70 countries and four languages and growing. We’ve got community managers now in Egypt, Italy, Greece and India. Just the other day I saw that we have a super-user in Macedonia! We’re using AI to provide a kind of health buddy who navigates patients and their families through every stage. It’s not just about adherence and care plan management, but about prevention and wellness all the way through the care continuum. We’re also starting to fill a big gap in patient acquisition. Providers may have a patient in their system, but not know where they go for support and what they consider “home base” when they have a tough day. We help provide that kind of home base, helping with patient retention and creating robust patient groups. Describe for us a lightbulb moment when you saw that Curatio was more than a good business idea – it was helping people in tangible ways.

Early on we did a closed beta for young adult survivors of cancer. We had a couple hundred users from around the world including a young fellow who had a rare form of cancer. He was in his early twenties and he’d never met anyone else with the same form of cancer. On our platform, he met his match, another young person with the same type of cancer in the US. Talking to him about the elation and the sense of not being alone in the world was so powerful. A second example was a group of women that had heart disease. They were spending 45 minutes a day on the platform, visiting up to 10 times a day. We saw statistically significant improvements in their health outcomes, adherence and self management. That’s when the lightbulb really turns on and you realize you’re making a valuable difference to actual health outcomes, their ability to self manage and their ability to navigate.

Aubrey Jenkins inhealth medical services

Weight Loss Coach Goes Virtual to Scale Up, While Keeping a Personal Touch

AMERICA’S WEIGHT PROBLEM

is massive, and its effects are rippling through society and the economy. The US spends $190 billion a year on obesity-related health issues, yet no intervention seems to make a dent. Now, employers are getting in on the conversation as they see weight problems negatively affect the bottom line through lost productivity and increased health insurance claims. For Aubrey Dossier Jenkins, helping inHealth Medical people reclaim Services their lives by losCEO / Co-founder ing weight isn’t inhealthonline.com about these data @inhealthonline points so much as it’s about actual people. Jenkins co-founded inHealth Medical Services after watching her own mother’s struggle with obesity, followed by her difficult recovery from bariatric surgery. They initially launched as a brick and mortar obesity medicine coaching program, but their clinically-validated results were so positive, and the response from physicians so strong, that they expanded into a scalable digital platform. With partners like American Well, one the largest telemedicine platforms in the world, inHealth is ready to combine high touch with high tech and take their technique global.

We chatted with Aubrey about her recent funding round (led entirely by physicians), the “inHealth Diet” and the aha moment when she knew she was transforming health, one person at a time.

Q&A You recently had an interesting funding round led by physicians. Tell us about that.

It started out when a doctor came to us and asked us if he could invest, and that sparked the idea of having other doctors invest. In our seed round we raised $600,000 and it was all from doctors who use

our program. It’s added credibility to us to know that the people using our programs like what we’re doing so much that they would put their hard-earned money into the company. We’ve since closed on our series A funding round where we raised $3.25M from an Australian, publicly traded company called CardieX. 25

Health Transformers

Telemedicine and tele-coaching have been around a long time. What’s the secret sauce that makes inHealth unique?

We’ve been in the business for a long time. We started in obesity medicine back in 2008 as brick and mortar offices in Arizona and California. It was family-owned, which gave us a very unique perspective. Every one of the founders have been bootson-the-ground in an office being a health coach and we were able to see firsthand the impact that health coaching can have. My mom is a national speaker in obesity medicine. The other thing that differentiates us is that we do research and prove out our methods. You partnered with American Well about five years ago. How did that help you strategically?

We were one of American Well’s very first, if not their first, private practice customer. After we met their sales rep I looked at my co-founder and we said: this is how we’re going to scale this business and go nationwide, or worldwide. They gave us a platform for free and donated resources for our very first clinical trial and we’ve been with them ever since. How did that partnership scale your business in the end?

It’s just now starting to take shape. American Well recently launched their population health initiative, which is what we’re part of. InHealth covers their diabetes program, hypertension program and their weight loss program, and soon we’re going to be covering their smoking cessation programs. They’re marketing these services to their 2,000+ employer groups they have contracts with.

Issue 3

At one end of the spectrum, you’ve got your AI chat bot that’s working you through a coaching algorithm, and on the other end of the spectrum you’ve got high touch care that is hard to scale. Where do you see yourself heading?

There’s a happy medium. In terms of scaling, it has to move to more technology to manage the amount of people that need this service: 70% of the United States is overweight or obese. That’s a lot of need. We’ve got a clinical trial coming where we’ve partnered with Kaiser and California State Long Beach to study the many effects of weight reduction in 500 patients. One of the things that we look at is the frequency of visits, so that we can better understand the move from high touch care to a more technologybased program. In other words, as the patient moves through the program, at what point do you bring the high touch back in, or at what point can you titrate them off of the high touch care? There’s no literature out that talks about frequency of visits and what it actually takes for longterm success. What kind of power does this remote coaching program have to save lives or extend life?

In hypertension alone we’ve seen people come to us on very high doses of medication and within two to four weeks, they’ve significantly lowered their medication, which means we’ve completely reversed their hypertension that essentially could have killed them within a number of years.

StartUp Health Magazine

Using that hypertension patient as an example, paint a picture of your coaching regimen.

Lightbulb Moment “I can remember a man who was obese, had pulmonary issues and hypertension. Because of his health issues and weight on his knees, he couldn’t walk. He was getting ready to go on disability because he wasn’t able to do his job anymore. He was young, probably late 40s. We put him on our program and within two months he was walking, able to stay at his job, no disability. He even came off the majority of his meds.”

We’re going to completely change their diet, for starters. We’re going to get them moving. A lot of behavior change, like parking farther away from the grocery store or using the stairs versus the escalator. Changing unhealthy environments at work or at home. Immediately stopping eating fast food. It’s an intensive behavioral therapy program. Our patients are dropping weight very quickly. In our most recent clinical trials our patients lost 7.7% of their body weight in only 12 weeks. What does that inHealth diet look like?

Generally, it’s going to be low carbohydrates, moderate protein. It’s going to be a lot of fruits and vegetables. It also depends on the patient’s conditions and what meal plan works for them. Definitely portion control and a lot of water. Water is one of the most important things that we introduce into people’s lives. We have our patients drinking 80 to 100 ounces of water a day. Sleep is another big shift as it’s an issue for many people. A lot of our patients have obstructive sleep apnea, which contributes to their chronic health problems as well. The reason we started inHealth is because of my mom’s experience after having bariatric surgery. She had no support afterwards and we realized that for her to maintain her weight loss and a healthy lifestyle she was going to have to have a person helping her.

Health Transformers

Alexandra Greenhill, MD careteam

Connecting the Dots Between Providers and the Village of Caregivers "

ALEXANDRA GREENHILL, MD,

learned at an early age that when it comes to navigating a complex healthcare system as a patient or caregiver, it’s about the experience of care, not just the outcome. At 11 months old, she suffered a broken arm that led to a series of complications and more than 25 surgeries by the time she was 12 years old. Alexandra remembers how taxing her road to recovery was on both her and her mother, requiring a stubborn tenacity on her mother’s part to ensure Alexandra received the care she needed. Later, as an emergency room doctor, she watched patients with chronic conditions become consumed with managing the logistics of their care, struggling to maintain their health because of lack of clear instructions or the inability to follow them due to lack of coordination with caregivers. She saw providers burning out in part because of the administrative burden to input the same data into an outdated EMR. For Alexandra, Careteam Technologies was the logical next step in a life spent within a fragmented healthcare system. With Careteam, she is connecting patients, families, providers and hidden caregivers in a horizontal digital support structure, giving patients the opportunity to be active agents in their care. Patients are able to organize the help they need, when they need it – even if it’s just an Uber ride to the doctor’s office – and doctors get essential data on compliance, so they can offer personalized care for patients with the most complex and chronic conditions. We caught up with Alexandra to get under the hood on her latest software offering and talked about how she became a Health Transformer.

ies. Kudos to my mom who did not take no for an answer, and went out and found the best surgeon and the best antibiotic specialists she could. Along the way some people took the time to make the experience humane for a little kid who was really scared and some people didn’t. I learned first hand that it’s the little things that make the big difference in healthcare. Sometimes the surgery can be a success but the experience for the patient and the family could be a mess. And so that’s what drives me. How did that experience inform Careteam more specifically?

Dossier CEO, CMO, Co-founder Careteam Careteam.tech @getcareteam

Q&A

HQ: Vancouver

What gave you the drive towards health innovation and entrepreneurship?

I was a patient for the first 12 years of my life. Everyone that I see in the health system is like a relative, and I treat people as if they are my mom, sister or cousin. Some people say, “We’ve tried it three different ways, it didn’t work.” But you don’t stop if the goal is to improve the care of your loved ones. Nothing’s ever good enough and things can always be better. How did your first 12 years as a patient shape you?

I was 11 months old when I broke my arm and it led to a series of complications, infections and 27 surger-

The average patient, when you ask them about their experience in healthcare, they use words like lonely, confusing, scary and overwhelming. What we want to do is the opposite. Our goal is to enable families at any point of this very scary journey to spend time with one another instead of worrying about when is the next appointment and am I following the doctor’s instructions? To me, patient engagement is not about getting patients to worry about their medical conditions 24/7. It’s about letting people live their lives, and having the information they need to live their healthiest life magically appear when they need it. Then I can continue working, living, enjoying time with my loved ones. That will be the definition of success. So Careteam is really about the experience of care, and not simply about outcomes.

Yes. The biggest challenge for the patient begins after they leave the doctor’s office or hospital. The diagnosis of stroke implies a number of things that need to happen. It literally broke my heart to see patients with fairly similar diagnoses have completely different outcomes. In one case, family stepped in and organized a binder and project-managed the illness, with other family members stepping in to support. Someone else with the same diagnosis, without that village 27

Careteam extends so far beyond the EMR that it can include the driver – organizing help to get to and from an appointment. How does that organizing of tertiary helpers work?

We started with 200 patients that we followed in real life in order to understand the ups and downs and the inevitable last minute changes that occur in healthcare. One case was an older patient who needed an injection for her arthritis three times a week. The hospital had set up a system to teach patients how to inject themselves, but because she had arthritis, she couldn’t handle the needles. The hospital offered to train her husband, but unfortunately, he had Alzheimer’s. She needed to find a neighbor to drive her to her appointments three times a week, and then another neighbor to sit with her husband during that time. Before we stepped in, her only option seemed to be to hire help to watch for her husband and then take the bus. Which she literally couldn’t do, so her condition was deteriorating without the treatment that could easy help her. How did you apply Careteam to her scenario?

In our system, a patient like her would get her appointments lined up digitally. She would then have access to a series of people in her community that she has set up as potential helpers. Our software gives you access to a series of people who are very involved in the care or the backup list of people who then can step in as needed. It allows real time 28

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We treated a single mother with a two-year-old with no living relatives who needed an abdominal surgery. She asked neighbors in her building and parents at the daycare. Instead of relying on text messages and WhatsApp, she could send off an appointment request and ask somebody to watch her child during an appointment. "

of support, ends up with a complication and has a completely different trajectory in life. One analogy would be to think of the different spaces designed for healthcare, from clinics to hospital lounges to family rooms. Each has a different purpose. We have created digital versions of that in our software.

adjustments so that you can have always have someone ready to step in. One of our cases, an 82-year-old with cancer, had 26 relatives willing to support him. And so our software helps identify who needs to do what, who has a car and it organizes them. We treated a single mother with a two-year-old with no living relatives who needed an abdominal surgery. In her case she asked neighbors in the building and parents at the daycare. Instead of relying on text messages and WhatsApp, she could send off an appointment request and ask somebody to watch her child during an appointment. It’s the practicality of daily life, making sure that all of the related things that need to be handled are handled so that the healthcare actually happens. Our software was “built for humans and for health care” – it has all the ease and intuitive design of a consumer software, as well as the strict requirements for healthcare grade software. You’re painting a beautiful picture of connectedness and mutual communal support. What’s your bigger moonshot vision? What does this look like if it’s really embraced in terms of global connectivity and care?

Everyone talks about personalized medicine, specifically our ability to check your genome and identify a treatment that’s perfect for the condition that you have. The vision that we have is more about a personalized healthcare system. Everything about every patient is absolutely unique. They have different conditions, life

StartUp Health Magazine

circumstances, providers and community support. Our software allows you to manifest that complex universe in a simple-to-use system. How do you manage the handoff between the provider and, for example, the neighbor helping out.

At the end of a doctor’s visit, the doctor might say, “do lab tests and see me again in six weeks.” That’s often not specific enough for patients to actually take action. In our software, they’d know which lab tests they need and have the ability right there to set up someone to drive them to that test if necessary. The important part is that the physicians can then track and see whether it’s happening or not. This gets to the issue of noncompliance. A good example is that in 2006, the Institute of Medicine said that “survivorship plans” make a huge difference for cancer survivors, in order to catch a recurrence quickly. In 2016 they published a study showing that 10 years later, even though every patient needed a “survivorship plan,” only 10% had one. Patients with dementia who get a hearing and a vision test don’t deteriorate as fast, yet only 8% of patients actually get those two simple tests on a yearly basis. It’s because there’s no project management checklist allowing physicians to see that the patient has followed up. We see Careteam as the horizontal integrator in a space where more and more talented people are inventing amazing tools that are vertical. We connect the EMR but also the wearables and apps.

Self Aware Dr. Alexandra Greenhill on the importance of listening to unhappy clients --If somebody doesn’t like something you’re doing, respect the fact that they took the time to say something. Hearing them out allows you to discover something that needs to be solved. If a user takes the time to explain their frustration, I’m grateful, because we usually arrive at an understanding that makes the product much better overall.

kp.org

CALL IN. CLICK IN. OR COME IN.

CARE, THE WAY YOU WANT IT.

Health Transformers

Greg Guettler & John Dykstra metalogics

First Wearable Direct Calorimeter Gives MDs the Data They Need to Prescribe Weight Loss OBESITY HAS BECOME ONE OF the world’s great killers. In 2016, 650 mil" lion people worldwide were obese, a number that has nearly tripled since 1975. Obesity is a major risk factor for heart disease, diabetes, osteoarthritis and even some cancers. At the root of weight gain is a data problem – under controlled clinical trials have shown that people underestimate what they eat by 50% or more. Enter Greg Guettler, John Dykstra and the team at MetaLogics. After years working with cardiologists on medical devices, Guettler decided to take on the problem of weight loss as an endcap to his career, which has already included starting and leading three companies, two of which went public and were later sold. He teamed up with Dykstra to bring to market a device that would finally accurately measure calories in and calories out, giving clinicians the real-time metabolic data they needed to create and manage a personalized weight loss program, monitor adherence, and measure success. The device, called Lume™, is the first consumer device of its kind and is built on a body of research – the team conducted multi-year clinical trials Dossier before coming to market. MetaLogics StartUp Health talked with Greg Guettler and John Dykstra metalogicscorp.com about how Lume works, how they’ll take it to market and why HQ: Minneapolis their first two investors were practicing cardiologists.

Q&A On the Birth of MetaLogics: Framing the Problem

Greg Guettler: In my last startup we developed a technology to detect and treat cardiovascular disease, so I’ve spent a lot of time with cardiologists. Throughout that experience as we were trying to diagnose and treat disease, these cardiologists would frequently turn me around, point to their exam room and say, “There’s the problem.” The room would be full of overweight people 30

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with hypertension, high cholesterol, heart disease and diabetes. We can fix most of the plumbing problems, they’d say, but what we can’t fix is that underlying cause. I heard this often enough that it struck me. What is so hard about weight loss? I would sometimes challenge the cardiologists and say: What are you doing about it? They’d say they’d tried everything. They’d sent patients to obesity clinics, Weight Watchers, encouraged them to use Fitbits. Nothing worked. It finally hit me just how big this problem. I went and talked with employers and they said their big problem is excess weight among employ-

StartUp Health Magazine

The Lume wearable calorimeter pairs with a bluetooth scale to accurately measure calories in and calories burned. Providers can use that data to safely guide a personalized weight loss regimen.

ees. Weight drives their healthcare costs and problems with employee productivity. In healthcare, we’re constantly late to the game. We’re pulling people out of the river instead of asking how they got there in the first place. And obesity isn’t just an American problem – it’s doubled in 73 countries since 1980 and not one country has been able to reduce the rate. This is driving an avalanche of chronic disease in every country. In the US alone $250 billion a year of our healthcare spend goes into chronic diseases generated by weight. So I started to do some work with

clinicians to find out why weight loss is such a challenge. The story that came back was the same again and again: A patient comes in to the doctor because they’re motivated by a life event like a heart attack. They need to reduce weight so the doctor tells them to move more and eat less. They send the patient home, then they come back, claim to be following the instructions, but are still gaining weight. What can the doctor do, not knowing what they’re really eating, not knowing what activity they are engaging in and not knowing anything about their personal metabolism? On Building a Solution, and a Team

Guettler: The problem is a lack of data, so I set out to find solutions that solved the data problem. I teamed up with John Dykstra and Dr. Jim Hill of the University of Colorado, who were both working on the problem of measuring calories. But there is no way to measure consumption other than to log your calories, and scientists say that even under controlled clinical trial operations, most people underestimate what they eat by 50% or more. People are probably underestimating what they eat by 75–100%. Even today’s best fitness trackers were off by 27–93% in terms of overestimating calories we burn. Therein lies the problem. If you can’t manage your daily calorie expenditure within roughly 500 calories, you can’t achieve your goal. Under the Hood: How the Tech Works

John Dykstra: We were focused on getting a tool that a health professional could rely upon. We knew that it had to be driven by clinical data. Clinicians said they wanted to be able prescribe a weight loss plan – eat X calories, and burn Y calories – and then monitor for compliance. But they had no tools to do this. We identified the technology that

h “If you can reduce someone’s weight by five percent, you can reduce their risk of diabetes by 58%. Small weight reduction, huge benefit.” -Greg Guettler

measured physiologic calorie, which is called direct calorimetry (which measures the amount of heat produced or expended by a subject) and it’s the most accurate measurement of calorie expenditure. We found the patent and began talking to the inventor. I formed MetaLogics and then we began raising capital to take the idea and turn it into a product. We started to do clinical trials at the University of Colorado, then we got the NIH involved and received a grant from them which funded the early development program. Once we had the technology in hand, we then turned to solving for calorie intake. We came across a technique to do this and licensed technology that came out of NIH. We married these two technologies together, taking research grade technology and developing it into a consumer-friendly product with clinical data that clinicians can rely upon. On the Importance of Accuracy

h “We can accurately predict or measure calorie intake within 40 calories per day – about 2% of the calories consumed for the average person.” -John Dykstra

Dykstra: Our approaches to measuring calories consumed and calories burned have been validated in clinical studies. We can accurately predict or measure calorie intake within 40 calories per day – about 2% of the calories consumed for the average person. Our calorie expenditure wearable monitor was tested at the University of Colorado and was found to measure within 92 calories per day, or 4.6%. We can now share with the clinician what calories the patient is consuming and burning, and more importantly, the relationship between these two items. We did a small study at Kaiser Permanente and everyone in the study group lost on average one pound per week, which is ideal. No one gained weight and the users rated us a nine out of 10 because they said it helped them better understand themselves, stay motivated toward their goals and make adjustments in their behavior to support their objective

Now, for the first time, the weight loss professional has metabolic processing data and they can start to look at how they can create and manage a weight loss plan that allows people to successfully lose weight over time without putting their body into a fight back mechanism. On Lume’s Form Factor: Access for All

Guettler: The device we use is a sensor technology worn on the upper arm, coupled with a digital bathroom weight scale. I fully expect that within the next year or two that the price point in wearable, washable sensors in clothing will drop to the point where we can turn this into a piece of wearable clothing. To put this in perspective, the competing technology for measuring calories is a million dollar room calorimeter in a research laboratory. If you want to measure metabolism, you have to put somebody in a sealed chamber for three days. To take this from a million dollar piece of technology to a $200 piece of technology is where we’re at. Making it accessible to millions. On the Importance of the Database

Guettler: Getting users into the product creates a valuable database that allows us to aggregate data. What are the best techniques for helping a 45-year-old man lose 10 pounds? What about 20 pounds? We can also provide more information on best practices in the realm of disease management. The data becomes very important in identifying those techniques that work the best for a particular group.

Health Transformers

Karen Drexler

KAREN DREXLER HAS BEEN an entrepreneur since

before she could drive a car. The serial CEO spent her high school days designing and selling custom kids clothes, then used the savings to pay her way through Princeton. After her father died of complications of diabetes, Drexler dedicated her professional life to creating companies and products that heal. Early in her career she helped to grow LifeScan from a company of 30 employees to a billion dollar corporation that was acquired by Johnson & Johnson. In her latest venture, Sandstone Diagnostics, Drexler helps people in a brand new way. Sandstone’s Trak® Fertility product is a consumer sperm test that employs a patented centrifugal technology to allow men to track their fertility easily from home. As that has gained momentum, another application for Sandstone’s centrifugal technology has taken shape. Now, under the name ZD – for ZeroDelay™ – Sandstone is building a simple-to-use centrifugal system that stabilizes blood samples at the point of blood collection. The ZD tech will bolster access to diagnostic testing and facilitate the growth of point-of-care testing (home and doctors’ offices) plus enable expansion in exciting areas such Dossier as cell-free DNA testing. Sandstone Diagnostics We caught up with Karen to learn CEO & Co-founder more about her path to entrepresandstonedx.com neurship, her lightbulb moment with @TrakFertility Sandstone and the hurdles she’s faced HQ: California as a female founder.

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Sandstone’s patented point-of-care centrifuge.

sandstone diagnostics

StartUp Health Magazine

Portable Centrifuge Tech Opens New Opportunities in Personalized Medicine Q&A How long have you been an entrepreneur?

I started my first company when I was in middle school. It was a children’s clothing design firm. I had designed a bunch of apparel for babies and toddlers. What inspired you at that age?

I had been kind of sickly as a kid and I was always very petite. It was hard for me to get age-appropriate clothing that fit. My grandmother taught me to sew and I made a lot of my own clothes. I came up with a bunch

of patterns and ideas and decided that if people were interested I could potentially sell more than what I could make. I also knew from frank discussions with my parents that getting funding for college was going to be pretty challenging. So once I was in middle school and had a more flexible schedule, I made up some sample patterns and then my mom drove me around to a couple of local stores, including a local department store. I walked in cold as this little kid with samples. And they really liked it and basically said they were willing to feature the products in the store. I ended up going to Princeton and left school with only 50 or 60K in debt. It pretty much covered me for college.

How did your time at Princeton prepare you for your life as an entrepreneur? What did you study?

I studied chemical engineering because I always really liked science and math. My father worked for Exxon as an electrical engineer, and remarkably, he had a female boss. This was the 1960s – there could not have been many female senior engineering managers. He thought she was fantastic and I grew up having no inkling that that was unique. What did your path from Princeton engineer to health transformer look like?

Right after I graduated with the engineering degree I went to work for Boston Consulting Group which ex" "

“We had one couple who told us that they’d been trying to conceive for 15 years. It never occurred to them before seeing our material that it might be a problem on the husband’s side.”

posed me to a lot of different industries. I then came out to California to go to Stanford Business School. At this point I was absolutely convinced I had to get back to being an entrepreneur. Unfortunately, during that time frame my father died of complications of diabetes. So that’s when I decided that impacting people in human health was what I had to do. I went looking for places where I could make an impact – in diabetes in particular – and I was very fortunate to be introduced early on to the team at LifeScan. I did some projects during business school with LifeScan and ended up getting an offer from them to go to work for the summer. I stayed with

LifeScan a total of 11 years, in all different functions, from a company of 30 employees to growing to a billion dollar revenue company. I worked in marketing, sales, product development, some finance; my longest stint was actually running manufacturing which I loved. It gave me a view of all the functions of the company, really empowered me to go out and start companies as a founder. When I left there I started another company in the diabetes space, which I ran for six years before selling to Roche. Your current enterprise, Sandstone, gives men the opportunity to take control of their own fertility through

at-home testing. How have you seen that tech impact people’s lives?

We had one couple who told us that they’d been trying to conceive for 15 years. It never occurred to them before seeing our material that it might be a problem on the husband’s side. There’s so much in the press about women and their eggs aging with them, women over 35, it’s just kind of assumed. And so in this case we got a really lovely write-up from this couple just recognizing that it takes two to tango. He originally tested at the lower end of the moderate range, and after following recommendations and retesting he saw improvement over the course of a few months, and then eventually got pregnant. It was pretty amazing to hear from people who have been trying for 15 years and not trying anything different, because they never heard there was something different to try. It’s such a gift for people.

h Sandstone’s portable, patented centrifugal technology stabilizes blood samples at the point of care, allowing primary care offices to offer a greater breadth of on-site tests.

Karen Drexler on Female Leadership in Health Innovation You’ve been an advocate for women in business for years. When did it hit home for you that being a woman was going to bring an extra set of challenges as you advanced your career?

The first day I got to college. When I started, Princeton had only been coed for a few years and the engineering school was heavily maledominated. And there were professors who very openly said that having women there had ruined the school. That made me want to prove that we were better than everybody else. I graduated near the top of the class. It was like, I’m going to show you we belong here. Fast forward to the present, how has having to overcome that hurdle impacted your work in healthcare?

In general it helps build confidence when you just realize the strength has to come from within you. In the healthcare startup world, the CEOs are still dominantly men. Early on I definitely had investors who very bluntly said I don’t invest in CEOs that look like you. Or, you don’t belong in this world. We certainly hear plenty of stories of investors behaving badly. When I started my first medical device company, I could hardly get people to take a meeting until I went out and recruited a very experienced guy as chairman. They would open up the meetings to him, basically, and then he would hand off to me.

Track Record Karen Drexler was President and CEO of Amira Medical, a glucose monitoring company that was sold to Roche in 2001. --Drexler received the Female Entrepreneur of the Year by the Stevie Awards and Entrepreneurial Woman of the Year by Silicon Valley Women’s Fund.

Given your experience over multiple decades dealing with gender discrimination in business, how do you think the health innovation sector is doing today?

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StartUp Health Magazine

“The only way to get these exceptionally qualified women and their inventions to the market is to be more creative about funding sources, because still only about 3% of funding goes to female entrepreneurs.”

I’m seeing a tremendous amount of innovation coming from women in the healthcare field, however, we continue to have a harder time getting funded, which is part of the reason that I’m so active with Astia, a global nonprofit that supports female entrepreneurs. The only way to get these exceptionally qualified women and their inventions to the market is to be more creative about funding sources, because still only about 3% of funding goes to female entrepreneurs. On the positive side, I could reel off more than a dozen groups that now focus on female founders and we’re seeing more money coming into the space. Are we reaching a tipping point when it comes to recognizing the role of women in health innovation and funding projects equitably, or are we still just scratching the surface?

I honestly still feel we are at the beginning. There is some movement on diversity on corporate boards, but it’s slow. California just passed a law that corporate boards need to include female representation. If you look around Silicon Valley you don’t see a lot of diversity. It’s not quite as bad in the public sector, but private

venture-backed companies often have all male boards - and management teams as well. Since you’ve been a mentor for a long time, what tips and strategies do you give to younger female entrepreneurs either in general or specifically when they are going into pitch for funding?

I encourage people to form a relationship first with someone who can act as a champion. There’s so much data around people investing in people they’re comfortable with. Try to find somebody who’s going to be in the room with you who can break the ice. It adds credibility that you’re not a random person walking in the room who doesn’t look like any of them. Then, really try to identify who the decision makers in the room are and make sure that you connect with that person on a more personal level. Although this might be controversial, I do advise women to dress conservatively. I have had some female founders who get really dolled up to go in for a pitch and I honestly don’t think it helps. It draws attention away from the fact that you’re an intelligent, innovative person. You want the focus to be on your ideas and on your business. On the flip side, what message would you send to a male audience about changing their thinking or reconsidering the status quo?

With male investors, I go with data. There’s plenty of it now which shows that more diverse teams produce better results. The other thing is that I tell male investors is that there’s less competition for female-led teams. Investors may be able to get in at a lower price. Personally, as an investor in female-led companies, I feel like I can get into these deals at a reasonable valuation, which is just smart, to get in where the whole market isn’t necessarily focused.

The New Gateway to Employer Health Benefits platforms and portals are not the right starting place for employee health. What is?

LifeDojo: the Health Engagement Gateway LifeDojo is trusted by companies like Adobe, Berkshire Hathaway, Airbnb and Goodyear Tire to engage employees in healthcare and health improvement by starting in a radically diďŹ&#x20AC;erent place: employee-designed wellbeing. By engaging over 50% of employer populations in creating their own self-

improvement journey, and matching every employee with a personal health coach of their choice, LifeDojo ties health analytics, prevention and disease management together into one revolutionary platform. Ready to co-create a culture of health with your employees? Learn more today:

lifedojo.com/gateway 35

Masterclass

Polina Hanin Academy Director, StartUp Health

Ditch the Pitch: Ask These 4 Q’s At Your Next Sales Meeting

any years ago

STARTUP HEALTH

HQ 6

Polina offers online Office Hours to Academy members, addressing startup challenges. 6 startuphealth.com

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I started my first B2B sales job at a consulting firm. We were brand new and the only track record we had was the caliber of our team. During our first major conference, we set out to hold 21 meetings in the span of 48 hours. Of course I created a customized pitch deck for each meeting. Of course I printed a spiral-bound copy for each one. Of course I brought every single one of those presentations back home. The reason why I brought each presentation home is not because our potential clients didn’t want them, but rather that after the first few presentations we ditched the deck altogether - they were flat out wrong. There was no way that we could have possibly guessed what the customers were looking for without ever speaking to them. StartUp Health Magazine

For entrepreneurs for whom sales is not their comfort zone, it’s OK. Just think of it as a simple conversation, where both people are on equal footing, both seeking to create value together. And the good news is that there are only a few questions you need to know the answers to to evaluate if an opportunity exists, and how a partnership could potentially work.

Three years from today, what needs to happen for you to feel happy or proud with your success or progress?

This question will change the game in how you run your meetings. It is this question that will give you the qualitative, and more importantly, the quantitative information from a prospective partner that you will need in order to assess whether your interests align, and how you can structure a contract going forward. Let’s break this question down: • “Three years from today” – You are thinking long-term and encouraging the partner to think long-term too. Also, you’re a partner from “today” – day 1. • “What needs to happen” – You are forcing the partner to be specific and talk about activities and results. • “Feel happy or proud” – Success is also felt intrinsically. You’re tapping into the partner’s sense of purpose • “Your success or progress” – The success will be theirs and they will have moved the dial. You’re getting them to think critically about the future and quantify it. Most of the time, the response to the question will be “Hmm. No one has ever asked me that before….” and then they’ll look out into space. Revel in that silence. Because it is within that pause that the true answer is being formulated. It is within that pause that the person at the other end of the table is evaluating how they judge

their success, but sometimes even more importantly, how their success is judged by someone else. When you finally get the answer, make sure that it can be measured. Pro tip: the answer to this question will be the success metric that you and your prospective partner will try to hit when you structure your formal relationship. It is that answer that will set up an alignment of interests for the relationship going forward.

What are your challenges to getting there?

With this question, you’ll know exactly what obstacles the partner is facing in order to meet their intended success three years from today. When you get an answer to this question, again, make sure that the challenges are measurable and quantifiable. More importantly, make sure that they are not macro and are specific to the organization. Pro tip: the answer that you get to this question will effectively be the “top customer challenges” portion of your presentation. You will spoonfeed them back to your partner. They will be the cornerstone of the value that you deliver. They will be the three top features that you showcase during your product demo. All with literally zero guesswork.

What are your biggest opportunities or what are you most excited about?

The question about opportunities is centered around what are they most excited about. This allows you to see if there’s something that your partnership can leverage. For instance, if your potential partner is excited about the launch of a new initiative, you can ascertain if this is something that could either help the partnership because you can piggyback on it, or possibly hurt your timing because their focus will be elsewhere. Or they are excited about a new regulatory initiative that gives

you wind for your sails. Or maybe they are excited about a conference that they are hosting, so maybe you can announce your partnership there!

What are your biggest strengths, or what are you most confident about?

This is a feel-good question that allows the potential partner to brag. They can talk about the strength of their team, their brand, or their procurement process, literally anything. Ending your discovery questions on this note allows you to see your partner for who they truly are – it’s not just about the obstacles and the challenges. But rather about making your partner feel great about where they are today and how much more you can do together. Lasting Impact

Though there is a lot of skill involved in the sales process, in healthcare, particularly when you are just starting out, you’re building heroes, champions and partners. Remember that you are on equal footing and therefore have a choice in who you partner with. You have the freedom to decide if the relationship will get you closer to your health moonshot. The questions above make up a tool we call the Value Creation Discovery Filter™, which allows you to be seen as a leader and a partner to anyone you do business with. As an added bonus, because of the alignment, you will be transforming your potential partners into heroes within their own organization. If you approach your conversations from a Value Creator Mindset, you’ll be able to generate relationships that might not sign with you tomorrow, but when they close, they will stick because you’re aligned with the strategic goals of the partner and you created champions along the way. They will grow with you, and together, you can collectively achieve your health moonshot.

The Moonshot Foundation: An Agreement Between Founders

while ago, my colleagues

and I were working with a company and discovered that the business had a co-founder we hadn’t known about. My spidey sense started tingling; I’d seen this before. An absent founder—that presages a legal imbroglio if their departure hadn’t been handled properly. We learned that a year prior, the co-founder began having problems executing her responsibilities. The issues became so severe that the existing leadership removed her from the management team. Since she had a significant amount of company stock, her former colleagues issued more shares to themselves to dilute her ownership. The kicker: they didn’t have the legal authority to do that. Outraged, she sued, leading to litigation that lasted months. That stagnated the company’s ability to raise capital when it was ready to grow. At StartUp Health we coach entrepreneurs on the mindsets of the long-term commitment and supportive relationships necessary to achieve health moonshots. Supporting these mindsets are the smart foundational structures that keep things running smoothly. And that starts with the founders’ agreement (FA). The FA is part prenuptial agreement, part incentive plan. To create one, you delve into conversations with your co-founder(s) about what you want from the company and the relationship. You ask fundamental questions: Does one co-founder contribute funds and the other, time? Who’s president and who’s CEO? Who has the key decision-making power? Examining these concerns minimizes the likelihood of surprises and conflict when thorny situations arise. If they do, you have a mutually

agreed strategy in place to iron them out efficiently. No investor worth their salt will invest in your company if they think you have open disputes or legal quagmires. Bari Krein, An FA defines the JD, LLM company’s mission and Chief Strategy goals. It creates incentives Officer, StartUp Health for co-founders to be committed to the business, and specifies that intellectual property and company know-how is the business’s property. The FA creates protocols for numerous conundrums, like when a co-founder stops contributing to a company to focus on another project. If a co-founder gets divorced, an FA can prevent the ex from getting ownership of company stock. FAs define the details of company roles and responsibilities in greater detail than the company’s bylaws or operating agreement: how much time everyone has to work to stay vested, who’s contributing to what. The agreement fleshes out the expectations of each owner and if they retain ownership in certain conditions, what compensation they’ll receive, and how that changes over time. It provides an open and honest documentation of aspirations and expectations of each individual for themselves and the company, often dealing with sensitive issues such as how founders exit the business when it’s not a mutual decision. Investors want to know that a company’s leaders are properly incentivized to have skin in the game and that they’re going to stay for the long haul. Investors also want to know that the company is prepared for all potential contingencies or problems it may face. The FA’s mechanisms accomplish this, while ensuring that everyone’s equity percentage and ownership is aligned with their contributions. With that done, you can focus on your moonshot. 37

Moonshot Report --

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DESIGN BY JONATHAN LINDSAY

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StartUp Health Magazine

ACCESS TO CARE CURE DISEASE MENTAL HEALTH & HAPPINESS BRAIN HEALTH

THE HEALTH MOONSHOTS CHANGING THE WORLD The space race of the 1960s declaredHEALTH to the WOMEN’S world that the impossible was attainable. CHILDREN’S HEALTH It is time to face the great health challenges of our era with a moonshot vision. Together, CANCER with global collaboration END and leapfrog technologies, we have the opportunity – even NUTRITION & FITNESS the obligation – to completely rethink health and wellbeing and achieve health COST TOgoals ZERO previous generations thought impossible. In the pages ahead we write about these health ADDICTION moonshots, and profile a few of the innovative LONGEVITY companies moving the needle in each. ILLUSTRATIONS BY LEONARD PENG

The Access to Care Moonshot

TOGETHER WE CAN DELIVER QUALITY CARE TO EVERYONE, REGARDLESS OF LOCATION OR INCOME

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StartUp Health Magazine

PREFACE Today, healthcare is for the few, for those who live near more developed cities or towns, and for those with money. We call it a problem of access, and it’s an issue that’s attracted plenty of attention. For years the world has had “increased access to health” as a target. For the World Health Organization, global access to care is the underpinning to every other health goal. Yet we still fall short. Our objectives are too incremental, based on expectations from the past. When we talk about access to care, we often talk about people who lack insurance. But the lack of access to quality healthcare is so much bigger than that. It’s a problem affecting billions of people across diverse economies in every corner of the globe. Access to care is about geography – is it a fourhour drive to the nearest hospital? Is there a hospital at all? But it’s also about being able to afford the care once you arrive. And it’s impacted by problems upstream, like the health of our provider community. If we are going to truly solve the access problem and open up quality healthcare to more than seven billion people, we will need radical new solutions that address delivery, cost, geography and technology. We will need to leapfrog legacy systems and dream up brand new ways of doing business. This moonshot isn’t about “a little more access than we used to have.” Nor is it about “access for a few more people.” Together, through global collaboration, innovative technology and massive investment, we can make quality healthcare available to every single person in the world, regardless of location or income. Without moonshot thinking, this question is a fantasy, even naive. But with moonshot thinking, this dream of global access is not only possible, it’s essential.

Companies to Watch HOY HEALTH

Rethinking How We Pay for Meds... and How We Send Them to Mom Hoy Health is leveraging decades of health industry knowledge to open up access to care, starting with Spanishspeaking communities. They’re doing it through an interconnected suite of cashpay products, discounted medications and a unique system for sending medications across the border.

Leadership Profile CEO & co-founder Mario Anglada has 20+ years of healthcare sales and marketing experience with Procter & Gamble, Johnson & Johnson, Nestle Health Science and Univision Communications. He developed the first Hispanic medication discount program, pediatric vitamin line, telemedicine line, and diabetes peer mentoring program. Josh Neumann, CFO and co-founder, has 20 years of finance, VC and capital markets experience at HSBC, Pacific Capital Group and PWC. Target Audience By focusing on the US Hispanic market, Hoy Health was able to quickly establish a large market potential for its offerings. A recent National Health Interview Survey indicates that one in six people liv-

ing in the US is Hispanic, and that number is projected to grow to one in four over the next 20 years. Following the “population feeder patterns” for this growth, Hoy Health has developed delivery structures in all 50 states, Puerto Rico and parts of Central America. How it Works Hoy Health has created a unique set of interconnected cash-pay products – HoyRX, HoyMEDS, HoyCCM and HoyDOC that are designed for the Hispanic and medically underserved markets and are all digitally accessible, bilingual and culturally relevant. Their HoyMEDS program is a free medication discount program that allows any consumer to have access to FDA-approved medications at a significant discount. Hoy Health currently partners with more than 62,000 pharmacies. HoyMEDS has saved patients up to 80% on prescription medications with an average savings of 54%. The HoyRX program puts a new spin on caring for family, allowing users to safely and efficiently “gift” medications to loved ones within the system. This can allow a son or a daughter who lives far from a parent to purchase their medication and provide their loved ones with the ability to pick up their medications at their pharmacy of choice. Another avenue that attracts people into the Hoy Health system is its telehealth services. For health consumers who have traditionally not been able to get quality care in their language of choice, HoyDOC’s network of US-based bilingual providers ensures care that is both culturally and linguistically appropriate for their needs. In doing so, HoyDOC addresses this population’s main reasons for not always receiving the medical attention they require, that being the need to select the time and location of a doctor’s appointment.

While their passion for the Spanishspeaking world is evident, Hoy Health plans to reach Africa and Asia by 2020.

Partnerships Rather than end-run pharmacist incumbents in the industry, Hoy Health works with them to optimize and develop new ways of providing care. They view the patient-pharmacist interaction as a critical milestone in the healthcare journey. Hoy Health’s programs are deployed through Medimpact, one of the largest privately-held pharmaceutical benefits manager (PBM) networks in the US. When looking for strategic partnerships, Hoy Health values two elements: a nimble partner and a partner that shares the Hoy Health vision for increasing access to care for underserved populations. Hoy Health recently announced new channel partners and resellers including benefitsFIRST, Dallas Medical Center, TKARGO and United Retailers Association of Puerto Rico. Global Goals While their passion for the Spanish-speaking world is evident, Hoy Health’s method for expanding access to care isn’t region dependent, and they have plans to go global, reaching Africa and Asia by 2020.

The Cure Disease Moonshot

TOGETHER WE CAN RID THE WORLD OF DISEASE PREFACE Heart disease. Cancer. Stroke. Obesity. Diabetes. Respiratory infections. There’s a sad irony about the the world’s biggest killers. These diseases, which accounted for tens of millions of deaths in 2016, are already within our power to treat, or cure. Thanks to a revolution in medicine, data and technology, we have the ability to close that gap. Imagine a world where we deploy groundbreaking technology to exponentially expand the use of treatments that have already been proven? Applications of telemedicine are beginning to address the problems of access and cost by making complex therapies available where there are no specialists. But it’s just the beginning. By implementing the treatments and cures that we already know, we can significantly bend the curve on chronic disease. Through basic mobile apps run on ubiquitous smartphones, billions of

people can follow healthy diets, track their exercise routines and plan their next recommended screenings, whether it be mammograms or colonoscopies. Along the way, smart pill bottles keep us healthy by reminding us to take our meds on time. The bottom line: If a cure exists, it should exist for all, and digital health has the potential to be that democratizing ingredient. A moonshot to cure disease is about access, but it’s also about discovery. Groundbreaking advances in machine learning and exponential growth in computation power are increasing our capacity to understand the drugs we’re making, and how they will affect our bodies. This, in turn, is opening the door to faster cures, and targeted medicines for rare diseases. Together, thanks to a wave of innovative entrepreneurs and leapfrog technologies, we can share known cures with new populations, and redefine what’s curable for every human being.

Companies to Watch / SANGUINE

Tech-Enabled Clinical Trials Mean Faster Cures Sanguine’s mission is to help patients focus on resilience and being ‘sanguine’ by empowering them to accelerate research for the disease from which they are suffering. The company’s technology platform enables patients to simply donate their data and in turn receive updates on how they are impacting research for their condition.

Issue 3

StartUp Health Magazine

Leadership Profile Brian Neman, CEO, an adjunct professor of digital health at USC, cofounded Sanguine in 2010 out of his graduate program in healthcare administration. Gerald Lee is a former cancer researcher from Stanford. How it Works Sanguine helps patients accelerate research for their condition by ‘packaging’ their data in the most convenient and patient-centric way possible. Patients provide e-consent to Sanguine to draw their blood from the comfort of their own

home, and to retrieve medical records from their doctor, on their behalf. Once in possession of the samples and data, Sanguine anonymizes and structures the information into a searchable form for researchers to identify potential candidates for clinical trials, optimize the design of clinical trials and perform deeper data analytics. Core Commitments Neman says, “By empowering patients with their data, and the knowledge of how that data is being used to accelerate research for their

condition, we have the potential for a paradigm shift in how we design clinical trials and how (and how much) we develop new therapies and diagnostics.” “Transparency about data contribution and use is at the heart of everything we do,” says Neman. “For each research study request, we require that the researcher provide us with how the samples are being used (assay, test), why the research is being conducted, and their general research objectives and plans. Soon, we will launch an initiative where patients will receive updates on the progress of the research, and how their data has made an impact. We want to bring that ‘sanguine’ feeling back to patients’ lives.” Case Study Sanguine has accelerated medical research in over 400+ projects/studies and has helped over 200 biomedical researchers at academic, biotechnology and pharmaceutical companies. In 2017, Sanguine became the #1 patient recruitment leader (by 200%+) for the international Genetic, Environmental and Microbial (GEM) study of 5,000+ patients, after only six months of service (study was open for 5+ years). The sponsor of the project, the Crohn’s and Colitis Foundation of Canada, recognized Sanguine as the top partner for the program. Sanguine currently works with Pfizer, Abbvie, Gilead, Sanofi, Takeda and many top 40 global pharmaceutical companies, with an overall 15% reduction in total clinical trial time. Market Differentiator Unlike platforms that aggregate patient data from hospitals and do not have any direct link to patients or any additional operational services, Sanguine works directly with patients, and assists them in the logistics and operations process, which ultimately yields faster research studies and bet-

Sanguine CEO Brian Neman takes to the whiteboard during a team meeting

ter data collection.

Track Record Sanguine currently works with Pfizer, Abbvie, Gilead, Sanofi, Takeda and many top 40 global pharmaceutical companies, with an overall 15% reduction in total clinical trial time.

Target Audience Sanguine is specifically designed for those individuals who want to make a positive impact in medical research for their condition, and want to improve care for the next generation of individuals afflicted with that condition. Translational, clinical, genomics and epidemiology research leaders can experience at least a 15% time savings on their studies, while getting richer data sets. Moonshot Progress Sanguine has a big moonshot: Put patients in charge of their health data, accelerate medical research and make precision medicine the standard-of-care. To do so it has partnered with over 200 researchers to build out data research studies on the platform. Most recently, Sanguine reported that it has teamed up with BGI Genomics of Shenzhen, China, a world-leading, DNA sequencing and bioinformatics research and development firm, to develop a da-

tabase that combines genomic and clinical patient data in order to improve enrollment in precision clinical trials. Specifically, Sanguine and BGI plan to make searchable wholegenome data and electronic medical records from more than 1,000 rheumatoid arthritis patients accessible to trial designers and translational researchers. Doing so will allow drug developers to make their trial cohorts more homogeneous, to reduce their risk and cost and increase their likelihood of success. Sanguine has also secured a partnership with Intel, with the goal to co-develop algorithms that will be used to match patients’ medical records against clinical trial enrollment criteria. Sanguine has partnered with patient advocacy groups across 70+ conditions including Duchenne’s Muscular Dystrophy and Sickle Cell Disease.

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Issue 3

StartUp Health Magazine

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The Women’s Health Moonshot

TOGETHER WE CAN IMPROVE THE HEALTH OF EVERY WOMAN Companies to Watch BABYMED

PREFACE Being born a woman shouldn’t be a health risk factor. But in much of the world, it is. For too long, women have suffered under an unequal power paradigm, and it has compromised the quality of healthcare they receive. A staggering one-third of women are likely to experience physical and/or sexual violence in their lifetime. Depression is more common among women than men. Women are prescribed less pain medication than men, even though women report more frequent and severe pain levels. According to the WHO, self-harm, including suicide, was the second leading cause of death globally among females, aged 15–29, in 2015. Building a global women’s health moonshot means widening the aperture on the definition of women’s health, focusing on issues that move beyond the current litmus test—sexual and reproductive health—to a standard of living well. This includes a women’s right to physical and mental health and well-being. It means creating a world where individual women no longer have to shoulder the burden of advocating for themselves in order to get proper medical care, a world where they can rely on the medical system. It means that moving forward, there will be no country where women fear for their health and safety simply because of their gender.

Kenyan App Brings Prenatal Education to At-Risk Moms While many women in Kenya lack access to medical professionals or prenatal education, most own a mobile phone. BabyMed is on a mission to save the lives of hundreds of women dying daily in East Africa due to preventable pregnancy or childbirth complications through its information-alert app. BabyMed steps in by providing educational, supportive text messages or voice memos at every stage of pregnancy. The technology supports simple health interventions that have been proven to reduce maternal and child deaths. Currently Kenya is among the ten most dangerous countries for pregnant women with a mortality rate of 300-488 deaths per 100,000 live births. BabyMed’s moonshot is to cut that number by more than 50%.

Leadership Profile Bryan Okello, CEO and co-founder of BabyMed, has experience in web and app design. He is also the founder of Jabotech Creative Media, which is the digital services company that created the app. How it Works When a pregnant woman visits a BabyMed-partnered obstetrician or midwife, she is signed up for the free app in-office. Immediately, free educational text messages, voice messages and e-learning courses are available to her in both English and Swahili depending on her stage of pregnancy. From weeks five to 42 she receives simple text or voice messages on nutrition and preparing for the baby’s arrival. When she gives birth, she then receives messages on breastfeeding, hand washing, use of bed nets to prevent malaria and prevention of the transmission of HIV/ AIDS, especially if she is already diagnosed. She receives educational messages on post-partum planning in the weeks that follow. A sample message a mother receives on her phone is, “Your breastmilk is making your baby strong. Feed him 8-10 times a day, with nighttime feeds too. Don’t give him water or anything else.” The app preps mom in bite-size chunks for the process of birth and raising an infant.

The Cancer Moonshot

TOGETHER WE CAN END CANCER AS WE KNOW IT Companies to Watch / SAVOR HEALTH

This Entrepreneur is Helping Cancer Survivors Beat the Odds Through Personalized Nutrition PREFACE Cancer has caused so much devastation that the word itself has become a potent metaphor for that which consumes as it grows. It claims the lives of millions, shattering families across every bracket of age, geography and economic status. By 2030, the number of new cancer cases per year is expected to top 23 million. Chances are, you know someone personally who has battled cancer. And if you don’t, you unfortunately most likely will. Ending cancer as we know it is going to take true moonshot thinking. A global cancer moonshot is built on a level of collaboration we’ve never seen before. It’s going to require breaking down data silos between academic institutions, reaching across political aisles, and even sacrificing personal egos. Moonshot thinking also means seeing the problem in completely new ways. “When it comes to the cancer moonshot, everyone always asks about the lab,” says Howard Krein, MD, PhD, a member of the Biden Cancer Initiative board of directors. “Will immunotherapies work? But if you want to cure cancer, there are some very simple things that you can do. Like making sure that colonoscopies are readily available to everyone across the globe.” To defeat cancer once and for all, we are rallying under a global Cancer Moonshot that will break down silos, weave new partnerships and rethink the very problem before us.

Issue 3

StartUp Health Magazine

At the time of diagnosis, 90 percent of cancer patients experience addressable nutritional issues that result in poor clinical outcomes (mortality and morbidity), high symptom burden resulting in poor quality of life, and increased spending. Savor Health addresses these nutritional issues through its personalized technology platform and Intelligent Nutrition Assistant (Ina™) chat bot which relies on evidence-based protocols, clinical best practices and a patient’s own unique data. Ina’s personalized and clinically-appropriate nutrition recommendations support patients from diagnosis into survivorship. The Savor Health technology is licensed by healthcare enterprises (primarily pharma today), through a SaaS model, and is offered for free to patients.

Leadership Profile Susan Bratton, CEO and founder, started Savor Health after losing a friend to terminal cancer. She identified a significant unmet need in oncology that had meaningful clinical, quality of life and cost implications for all healthcare stakeholders. Recognizing the positive impact she could have on people like her friend Eric and his family, she quit her investment banking job to start Savor Health. Jessica Iannotta, COO, is an oncology-credentialed Registered Dietitian who has worked in the Northwell Health System for more than 15 years. Cary Jardin, CTO, a successful serial entrepreneur, who sold IPivot to Intel in 1999 for $500 million, rounds out the team. His research created a breakthrough in parallel data processing which led to a $275 million technology acquisition by Microsoft. How it Works Nearly everyone undergoing treatment for cancer experiences trouble eating, from physical swallowing difficulties to getting the right nutrients that keep your body strong before, during and after chemotherapy. Yet only 20% of patients

ever speak to a nutritionist. Because of the shortage of specialized dieticians, patients who aren’t seriously ill often face three week long waiting lists. Savor Health has stepped into this gap in oncology treatment and created a sophisticated deep learning system that leverages its oncologycredentialed medical team’s clinical experience and the latest in peer reviewed journals. This expertise is used to develop expert rules and proprietary content that is delivered to patients based on their unique needs. Through two-way dialogues with the chat bot named Ina, the patient provides information that is then evaluated by the deep learning system to identify nutritional areas of need, followed by support and advice specifically for the patient. Case Study Savor Health works closely with pharmaceutical companies on new oncology brand launches. Patients visit the brand’s patient support website, opt-in for nutrition support, provide their phone number and begin texting with Ina for support and advice by answering questions about their diagnoses and side effects.

Lightbulb Moment CEO Susan Bratton lost a close friend, Eric, to cancer in five short months. After watching his struggle, Susan quit her Wall Street job and spent two years researching the area of nutrition and cancer. Armed with the results, she started Savor Health.

As a physician and entrepreneur, I’ve seen the myriad of ways in which pessimism obstructs progress. The purpose of any moonshot initiative is to galvanize different groups to work together and achieve decades of progress in a shorter amount of time. HOWARD KREIN, MD, PHD BIDEN CANCER INITIATIVE BOARD OF DIRECTORS CMO, STARTUP HEALTH

has clinical research support behind its nutrition system. The company has a deep core competency working closely with pharmaceutical company brand teams and their legal, medical and regulatory professionals to configure unique solutions that meet their clinical needs and risk tolerance. This has resulted in multiyear assignments with pharma leaders including Celgene, Merck and Pfizer.

Market Differentiation Savor Health is exclusively focused on oncology, is evidence-based and

3 Savor’s AIdriven chatbot, called Ina, interacts with users and learns their personal nutrition needs.

lower treatment toxicity, side effect and complications. Savor Health is not meant to replace a qualified nutritionist, but to offer 24/7 support from diagnosis to hopefully survivorship. It is meant to fill in the gap in the industry where right now there is a shortage of qualified oncology nutrition professionals.”

Target Audience Savor Health reaches patients through pharmaceutical companies who want to support patients holistically by improving adherence, compliance and patient outcomes. Bratton says, “Strong evidence-based research shows that when patients are well nourished and maintain a healthy weight, they have higher adherence, better survival rates and 47

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THIS PLAN IS NOT INSURANCE, and is not intended as a substitute for insurance. This plan is not a Medicare prescription drug plan, and is not a Qualiﬁed Health Plan under the Affordable Care Act. This plan does not meet the minimum creditable coverage requirements under federal or state law. By using this plan, you agree to pay the entire prescription cost less any applicable discount. You are obligated to pay for all prescriptions but may receive a discount from those pharmacies that have contracted with the plan. Discounts are only available at participating pharmacies. Savings will vary by drug and by pharmacy. The discount prescription drug plan o rganization may obtain and retain fees or rebates from manufacturers and/or pharmacy beneﬁt managers based on your prescription drug purchases. You may access a list of participating pharmacies at: www.hoyrx.com. Upon request the plan will make available a written list of participating pharmacies. Prescription claims through this plan will not be eligible for reimbursement through Medicaid, Medicare, or any other government program. 48 Issue 3 StartUp Health Magazinedrug plan organization is Hoy Health, LLC, 45 South Park Place #228 Morristown, NJ 07960. The discount prescription Toll-free number: 1-866-504-5032. Email address: info@hoyhealth.com.

The Children’s Health Moonshot

TOGETHER WE CAN ENSURE THAT EVERY CHILD HAS ACCESS TO QUALITY CARE PREFACE For Nelson Mandela, there was “no keener revelation of a society’s soul than the way in which it treats its children.” So how is that soul looking? On one hand, we have cause to celebrate. The infant mortality rate has been going down steadily around the globe, from an estimated 65 deaths per 1000 live births in 1990 to 29 deaths per 1000 in 2017. Global annual infant deaths have been cut in half between 1990 and 2017. At the same time, we see massive opportunity for improvement. Every year more than 1.4 million children under five die of preventable environmental hazards like air pollution, hazardous chemicals, inadequate water, sanitation and hygiene. Likewise, nearly 100,000 kids under 15 die of cancer even though the vast majority of childhood cancers are potentially curable with existing treatments. We love our children. That’s not in question. But if we do, how can we accept these preventable deaths? What we need is a bigger vision for what’s possible, and the determination to accept nothing less. Imagine a world where every child, regardless of where they were born or the amount in their parents’ bank account, had equal access to a safe and healthy environment in order to grow and thrive. In Japan, infant mortality is the lowest in the world, around two deaths per 1000 live births. That’s admirable, but let’s cut that number in half, and then make it the norm for every nation on every continent. Let’s make sure that every single child who can survive cancer actually does, receiving the world’s most advanced and effective treatments, regardless of location. With a true Children’s Health Moonshot, we have an opportunity to put the next generation on higher ground, allowing them to set new audacious goals we can’t even dream of.

Companies to Watch // PATHFINDER HEALTH INNOVATIONS

Caring for Autistic Youth Just Got Easier Professionals helping in the care of autistic patients handle a lot of logistics, from managing bills and scheduling to filling out insurance

forms and keeping stock of patient signatures. It can be daunting for any practice and downright overwhelming for smaller offices. Pathfinder Health Innovations (PHI) helps practice owners, educators, billing administrators and therapists achieve their main goal - assisting autistic patients - by streamlining all-in-one software for both practice management and data collection.

Leadership Profile Before heading up PHI, CEO Tina Youngblood was a C-suite exec at Zurich Insurance. Spencer Re. Ann Monahan, COO, is board member of the Arizona Governor’s Autism Spectrum Disorder Committee. Almost 90 percent of PHI’s team is 49

The Cost to Zero Moonshot

Companies to Watch PATHFINDER personally connected with the special needs field and many are related to someone on the autism spectrum. How it Works The experience of PHI fades into the background as it streamlines practice management, improving everything from billing to patient goals. At its core PHI is about logistics and data within a medical practice environment. A practice can get invoicing, claims, billing and scheduling all streamlined within the system. Insurance claims are filed with a single click, and then PHI’s clearinghouse partner, Optum, electronically submits claims on an hourly basis to the appropriate payer, ensuring that claims get submitted on time, every time. These automated processes are designed to help reduce or eliminate errors, but they also serve to give control back to the medical practice by providing the data they need to track and graph patient progress. Practices use this new data – which is available online and off – to modify patient goals in real time.

TOGETHER WE CAN REDUCE THE COST OF CARE TO “ZERO”

Company Vitals PHI is working with more than 140 therapy centers. Extra Credit Most new practices lack the training and resources to organize their office. Pathfinder decided to create The Therapy Practice Handbook to help their clients. It includes best practices, forms, resources and workflows to help start and maintain a therapy practice. Key Partnerships KC Behavioral Health, KU Med, BioNovus, FCA Venture Partners are all supporters and partners in the PHI mission of medical info systemization.

Issue 3

StartUp Health Magazine

PREFACE Much ink has been spilled over the high cost of healthcare in most of the world. About 800 million people spend at least 10 percent of their household budgets on medical expenses, according to a 2017 report by the World Bank and the World Health Organization. That’s expensive enough to send 100 million people into extreme poverty, according to the study. All of that debilitating, life-shattering expense for services that most people can agree are fundamental to the fabric of society. Pediatric appointments for a newborn. A tooth extraction for a person in pain. Emergency care for the victim of a car accident. Compassionate elder care for one’s mother or father. These aren’t extravagances, but basic markers of a humane world, a world where we take care of each other. Imagine a world where we did more than stop the upward curve of healthcare costs. Imagine a moonshot mission to take healthcare costs from poverty-inducing all the way to zero. Yes, zero! The only way that is going to be possible is for us to dismantle our understanding of health and rebuild the machine from the ground-up, using innovative new technologies, distribution and delivery systems and business models that leap us forward. There’s hope on the horizon. We have an opportunity to reposition health as an investment, a value creator and marker of productivity. Mobile technology and far-reaching internet connectivity are flipping the cost of care paradigm. Telemedicine has dramatically lowered provider overhead. New population health startups are upgrading the way patients battle chronic illnesses, slashing the cost of diseases like diabetes and hypertension. Personalized medicine is reimagining how we treat disease to control cost by determining whether a treatment will be successful based on individuals genomics and not general recommendations. Together, we can reverse the cost trend that’s crippling the world, and bring affordable, life-changing care to every person on earth.

Companies to Watch / EMPOWER

FinTech Health Startup Creates a Smarter Way to Afford High Deductible Health Plans As anyone who has had a health event knows, not all health insurance is created equal. In the US, more than 43% of adults under 65 have what are called high deductible health plans. That number, according to recent studies, is up from 39% just a year prior. For most of these people, when a costly health event occurs, the options are to rely on unsecured consumer credit, predatory financial services or go into bankruptcy. Or worse, some people avoid the care they need. Fintech-meets-healthtech company emPower is taking on this mammoth problem in a completely unique way. They’re creating the next generation health plan, one that seamlessly integrates financial products and services into the plan design, simplifying the payment and management of healthcare expenses and ensuring that each member has the financial means to fund their outof-pocket expenses. It’s a whole new way of thinking about insurance, and if they’re successful, it could make healthcare more affordable for millions.

Leadership Profile The team at emPower is made up of leaders from the healthcare, financial services and technology sectors. Its founder Ron Weidner has been a co-founder and managing partner at several public and privately-held investment firms, including expanding a $30 billion real estate investment platform as global chief investment officer at Allianz. Jason Pyle was a co-

founder and CEO of Base Health, a comprehensive predictive analytics company for population health management. Emin Martinian was the senior architect for Base Health where he helped the company combine their evidence-based medical risk engine with machine learning tools to predict future health risks and outcomes for patients. James Lambright served as the Chairman and CEO of the U.S. Export-Import Bank and as the chief investment officer of the U.S. Treasury Department’s $700 billion Troubled Asset Relief Program at the request of Henry Paulson and Timothy Geithner. Advisor Dr. Kent Bradley was the former President of Safeway Health and is on the board of Dignity health. How it Works It’s all about integration and simplification, i.e. one plan, one premium, one card and one app. EmPower wants to be as simple as a regular banking app on a person’s phone and as easy to use as a fitness tracker. The company partners with self insured employers to integrate its mobile banking solution with the employer’s high deductible health plan (HDHP). Employees then benefit from having easy access to their HSA account and advances at 0% interest rates and additional features that help them ensure tax optimization and budgeting for future healthcare expenses, right from their phone. Still confused? Think of it as

a 401k meets a home equity line of credit. Target Audience Over 180 million adults receive health insurance through an employer sponsored plan. Given the exponential rise in healthcare costs, HDHPs are becoming the new normal. Consequently, out of pocket medical expenses have become the leading source of financial stress and instability for employed, workingclass families.

Moonshot Vision -“There are over 180 million covered workers insured through employer sponsored health plans, of which 70 million are enrolled in a high deductible health plan. We envision that our plan design will become the standard for all high deductible health plans.” -Ron Weidner, Founder, emPower

Market Differentiator EmPower’s platform helps insurers and members together plan for unexpected medical expenses. By helping employees preempt high medical expenses, employers can keep costs down, and employees can rest easy knowing they have an accessible account for emergencies. This allows employers to help make sure employees don’t fall into bad debt due to unforeseen health expenses. Weidner says, “The cost of the program is not additive to the employer and employee; to the contrary, we reduce the costs of financial services by bundling and integrating them into the health plan. It is an innovative and novel approach to financing healthcare that doesn’t exist in the market and it’s a win-win for all stakeholders.” Extra Credit A special feature of the tech company is the LifeScore application. The app enables members to track their own key lifestyle behaviors. As healthcare moves from fee-forservice to an outcome-based model, this data becomes more and more essential to population health management.

The Mental Health & Happiness Moonshot

TOGETHER WE CAN CONNECT MIND, BODY & SPIRIT IN THE PURSUIT OF WELLBEING PREFACE The Diagnostic and Statistical Manual of Mental Disorders (the DSM-5) tells us that there are approximately 300 mental disorders. In 1952, when this tome was first introduced, that number was a quaint 106. Of course, society isn’t three times sicker than it was in the 50s. Rather, advances in mental health research have shown us deeper and more nuanced ways of understanding how our chemistry and environments affect our brains, and our behavior. A lot of good has come from that increase in knowledge. Like the breaking down of stigmas around depression and anxiety. We’ve also developed game changing drugs to allow people with debilitating mental illnesses to reclaim their lives. But we’ve only scratched the surface. We still live in a world where 600 million people suffer from depression and an epidemic of loneliness threatens our elderly population. Let’s embrace a Mental Health and Happiness Moonshot that finally reimagines what it means to thrive, feeling whole inside and out. It means using telemedicine and smartphones to expand the reach of mental health services. It means gamifying healthy habits in a community of peers. And it means expanding our definition of happiness in ways that we can’t even fathom yet.

Issue 3

Companies to Watch / LIFEDOJO

This Wellness App Is Introducing a New Way to Access an Ecosystem of Digital Healthcare

StartUp Health Magazine

It’s much simpler to eat an apple a day than to go to a doctor for a diabetes test. Yet the first time most people begin to address their health or a major illness is when a crisis hits. Studies show people can prevent a number of illnesses with regular guidance in forming habits, something hospitals can’t provide. LifeDojo is filling this giant gap in preventative care – and creating a

new ecosystem for digital therapeutics – through the gateway of employer wellbeing programs.

Leadership Profile Helmed by public health leader turned tech entrepreneur Chris Cutter, CEO and co-founder (pictured, at whiteboard), and CTO / co-founder Patricia Bedard. Bedard, who has 15 years of experience architecting technology systems. How it Works We know healthy habits build towards a healthy life, but actually maintaining healthy habits? There’s the rub. It turns out we need proper motivation and accountability to change habits. LifeDojo’s app-based coaching system is made for users to set personal wellbeing goals and get on a path to achieving them through habit formation with a live coach of their choice. Evidence-based programs, personalized to every employee or user, are designed to address physical, financial or mental health goals. There are 32 different habits to choose from within LifeDojo’s themes of Resilience, Stress Management, Healthy Eating and Fit for Life programs. Users select one easy habit to start with within one of the four programs. They then select their own coach and can focus on building a new habit every 12 weeks or continue to build on an existing habit throughout the year. With LifeDojo’s growing digital therapeutics ecosystem, the care does not stop at habits. LifeDojo commands over 50% enrollment at its average customer and with this attention, they are in the best position to guide employees to the right care, at the right time, whether for diabetes, obesity or deeper mental health counseling. By linking health analytics to preventive health and LifeDojo’s disease management ecosystem, LifeDojo is the first platform to be a one-stop employer behavior change solution.

Stat Deck

45% of users create new healthy habits that stick for more than six months.

31% of users reported stress reduction in four months.

Target Audience LifeDojo works with corporations looking to reduce healthcare costs, improve productivity and drive employee engagement all through one vendor instead of a dozen. It promises to reach between a 4x to 7x ROI depending on an employer’s goals. Unlike employer benefits portals or single point solutions, LifeDojo leverages the consumer’s desire to focus on the life improvement goal of their choice, allowing them to double or triple utilization of existing disease management solutions that employers already offer (think employee assistance or health center weight loss programs). As the first point of health engagement for employees and eligible dependents, LifeDojo is positioned as the central platform to tie all employee health improvement together. Case Study An employee downloads the app, picks a simple habit, such as trading daily soda intake with water. They work with a live coach over 12 weeks to stick to that program. The coach is available 24/7 and tracks

the employee’s progress on a chart. Success with one habit then leads to the building of another until an employee has a year’s worth (or more) of wellbeing habits formed. While working on this habit, the app and the coach let the user know that more intensive programs are available to help them accelerate reaching their goals, and the data from those solutions flows back to LifeDojo to keep track across solutions. These habits and deeper interventions lead to cost reductions in health expenses for individuals and corporations alike. With LifeDojo, 45% of employees on the program create new healthy habits that stick for more than six months. Moonshot Progress For high tech companies, LifeDojo has consistently reduced reported stress of participating end users by 31% within four months. In addition, LifeDojo reduced at least 2% of body weight for one in three participants within its healthy eating habit pathways. On the business side, employees using LifeDojo report job satisfaction improving by 17% 53

Companies to Watch

The Brain Health Moonshot

LIFEDOJO

within four months. Absenteeism was reduced by 9% and employee engagement improved by 23% over the same period. Cutter says, “Our model is the first point of contact for healthcare should be wellbeing. We get the highest enrollment rates of any type of platform, because people want to work on these non-threatening habits. And they want their own personal coach to work on whatever they want to.” The company has partnerships with Fortune 500 companies and high-tech, high-growth companies, alike including Goodyear Tire, Berkshire Hathaway, Adobe and Airbnb. Organizations like Komoto Healthcare see the impact of LifeDojo, where Julie Anderson, department head, said, “When LifeDojo started, suddenly you saw gallons of water on people’s desks and health became a regular topic of conversation. People were taking it seriously and making real changes.” LifeDojo’s goal is to get millions of employees on the platform to become healthier, more resilient and to get the clinical-grade care they need at the time they most need it. “We are currently the best in class wellbeing platform on the market,” says Cutter. “But that’s not what we’re after, ultimately. We see wellbeing as the first point of contact for all health, for all people.” Cutter is working towards a world where instead of leaning heavily on primary care providers, the first point of contact with the health industry would be a primary prevention coach.

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StartUp Health Magazine

TOGETHER WE CAN UNLOCK THE MYSTERIES OF THE BRAIN TO IMPROVE HEALTH AND WELLNESS PREFACE Aristotle believed that thinking happened in the heart, and the brain was merely like a car radiator, cooling the blood. With every new age has come startling, beautiful revelations about the human brain. How, like an intricate map, sections of the three pound mass can be tied to everything from speech to memory to personality. How it physically changes based on how we behave. Yet the more we understand it, the less it appears like a map, and the more it opens up like an unexplored galaxy, full of mysteries and new frontiers. Our Brain Health Moonshot means dismantling the old, siloed notions about basic neurology and searching its great depths to unlock its mysteries. No longer will we merely treat health challenges without connecting the brain to the solution. We will master the mechanisms of the brain in ways that will create new opportunities for health and wellness, and then share them with the world.

Companies to Watch LIFE RECOVERY SYSTEMS

be cooled before transferring them from the emergency department.” says Carolyn Gattuso, RN, of Virtua Health System in New Jersey.

Saving Lives Through Rapid, Precision Body Cooling

Milestone Partners Life Recovery Systems first large backers were leaders at the National Institutes of Health (NIH) who supported efforts with grants to develop the ThermoSuit product from concept to clinical application. Schock says, “They saw very early the po-

“We believe that our research will demonstrate a tremendous improvement in the chances of recovery of stroke patients, and that this will ultimately lead to our adoption in thousands of hospitals.” "

Leadership Profile Robert Schock, vice president of R&D and co-founder, is the coinventor of the ThermoSuit System and received a PhD in Biomedical Engineering from Rensselaer Polytechnic Institute. Dr. Schock has over 20 years of experience leading R&D groups in cardiac assist, critical care and anesthesia and holds over 20 patents in the space. Robert Freedman MD, chief medical and strategy officer and co-founder, has practiced Interventional Cardiology for more than 30 years and holds an assistant clinical professorship at Tulane.

Rapidly cooling a patient suffering from a stroke, cardiac arrest or a heart attack can mean the difference between permanent brain damage and walking away healthy. But the old method – throwing ice packs on a patient – is an inexact science. Life Recovery Systems (LRS), with their ThermoSuit, is leading a trend towards rapid, controlled cooling and discovering new use cases for therapeutic hypothermia along the way.

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tential of our ideas to dramatically improve the prospects of recovery for millions of patients.” Therapeutic hypothermia induction became a new field of business and science opportunity in the early 2000s that LRS seized upon and investors supported. How it Works The ThermoSuit uses liquid convection cooling to rapidly cool down the patient with direct water on skin contact. The water flows over the patient and is returned to the pump. A continuous flow of water is cycled through – drawing heat off the body in a much more rapid process than either gel pads or cooling blankets. A treatment period of about 30 minutes is usually sufficient to cause a body core temperature reduction of three degrees celsius. The suit is portable and is used on a conventional stretcher. As the patient reaches the target temperature the water is drawn off the patient and the ThermoSuit is rolled up and discarded. The patient will stay cool for hours after removal from the ThermoSuit. Case Study “The ThermoSuit System enables our ER nurses to cool patients to target temperatures safely and accurately. After initial cooling induction, patients are removed from the suit and target temperatures are easily maintained using standard cooling blankets or wraps. Clinical results have been outstanding – our critical care nurses are demanding that patients requiring therapeutic hypothermia

Target Audience Outside of the hospital, the ThermoSuit has potential for treating heat stroke at places like sporting events and concerts. Schock says “We see a tremendous opportunity to treat patients in the field with our rapid cooling approach.” Although this is a goal audience not yet reached, Schock does believe it is achievable. “Out-of-hospital use of our technology will require the development of our next-generation device, which will be more compact, lightweight and tolerant of field conditions.” Moonshot Progress While only being used in a small number of hospitals so far, customers have cooled over 2,000 patients to date with the ThermoSuit. Life Recovery Systems’ primary goal at this time is the completion of clinical research into the use of the product for new indications to expand their market and demonstrate our unique advantages. Their initial phase of ischemic stroke research has had positive results. “This is an indication for which other cooling devices have yielded disappointing results” says Schock. “We believe that our research will demonstrate a tremendous improvement in the chances of recovery of stroke patients, and that this will ultimately lead to our adoption in thousands of hospitals. The 795,000 stroke patients per year in the US alone represent a $1.2 billion market. The indications of cardiac arrest and heart attack represent a similar market opportunity.”

The Nutrition & Fitness Moonshot

TOGETHER WE CAN ENSURE ACCESS TO FOOD, WATER AND A HEALTHY LIFESTYLE PREFACE If we are what we eat, we’re a world of extremes, desperate for a healthy middle. On one end of the global stage is hunger. According to UNICEF, in 2017 approximately 200 million children under the age of five suffered the ill effects of malnutrition. Malnutrition makes it harder to fight sickness and infection, and creates a cascade of problems from impaired cognitive ability to reduced school and work performance. Where malnutrition has been abolished, we’ve overcorrected and created an epidemic of excess and poison. Obesity is now a primary cause of some of the world’s biggest killers, like heart disease, stroke and diabetes. Literally billions of people the world over are overweight, and 650 million are obese. We need to fundamentally change how we think about nutrition and fitness and find balance. We need a Nutrition and Fitness Moonshot. Together we can create a world where all people have access to the foods they need to thrive, prevent disease, and stay healthy regardless of where they live. We also can build communities of support to help people control their weight and live healthy lifestyles. We can collect, analyze and share the complex data that patients and doctors need to make healthy, personalized food choices. These objectives would change the world, and they’re within our grasp.

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Companies to Watch / FITBLISS

Connecting Employee Wellness to the Bottom Line, So Everyone Wins STARTUP HEALTH

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StartUp Health Magazine

FitBliss is redefining corporate wellness by creating a new industry they’re calling Health Productivity, optimizing employee job performance by connecting consumer health data with work productivity. As a B2B SaaS application built on the Salesforce platform, FitBliss focuses on driving performance through better health of sales and service teams globally.

How it Works The digital health productivity platform is designed to motivate sales and service teams by proactively

demonstrating how their wellbeing directly influences their daily interactions with customers. FitBliss provides employees with personalized health productivity goals that directly align with their sales and service performance goals. With FitBliss’s AI health education technology delivered inside Salesforce, employees receive real-time health interventions to mitigate stress-burnout and optimize performance outcomes for both their health and productivity. All of this information is parsed into aggregated insights that help the employer maximize top-line revenue

and overall company wellbeing. Provided by employers, employees log into the FitBliss platform to access the personalized, social and integrated health productivity experience. With an industry standard of 40% of employees reporting burnout each year, FitBliss users report an 83% improvement in health and over 90% report better productivity. FitBliss provides an integration suite with over 100+ wearables and fitness apps such as Fitbit and Apple Health to gamify their health and simplify tracking all aspects of their wellbeing, as well as provide them with FitBliss’s proprietary databases of 1,000+ health education tips and videos focused on exercise, mindfulness, nutrition, sleep and stress. Built on Salesforce, FitBliss gets over 90% engagement by streamlining their application into the customer’s day-to-day. Eric Bicknese, CEO at Vertical Limit says “FitBliss allows us one integrated platform with a consistent mobile first user interface to all our core business applications. It drives motivation, and helps with productivity.” Leadership Profile FitBliss CEO & founder, Navid Rastegar was a Top 1% Sales Performer during his tenure at Salesforce and is certified in meditation with over five years of education at the School of Practical Philosophy. FitBliss recently added Rajani Ramanathan, former Salesforce COO and executive vice president of technology, to their team of advisors. Also joining the team is Vasant Kumar, who previously led product development and engineering at Oracle, and is now COO and board member at Vayu Technology Corp. FitBliss also added advisor Virginia Long, PhD from UCLA, who is the head of clinical health data science at Marin General Hospital.

FitBliss is carving out a new category, moving from corporate wellness to “health productivity”

$$$$ The high cost of employee stress ---

$500B

Amount employee stress costs US employers each year ---

73%

Nearly threequarters report significantly high stress in sales ---

1.5-2x

Replacing employees who have burned out from stress can cost upwards of twice their salary

Milestones In 2018, FitBliss was selected to participate in Salesforce Accelerate Cohort #3, focusing on tackling the $43B market in workplace wellness. FitBliss was also selected to participate in the MetLife Digital Accelerator powered by Techstars. Market Differentiator Rather than competing for new attention, FitBliss capitalizes on places the employee already has attention parked, and then reformats it to be competitive, fun and meaningful. FitBliss delivers cross ERP and CRM analytics on how employee wellbeing and employee performance are highly dependent. FitBliss is not only getting superior engagement rates as high as 90% among employee groups, but they’re doing it alongside measurable productivity KPIs such as sales and service, and using intelligent interventions to maximize productivity output. Target Audience Organizations who have a large sales and service arm, looking for a way to boost customer experience, maximize employee health and lower costs of insurance. Moonshot Progress FitBliss has customers in six conti-

nents and includes companies like Salesforce, MedeAnalytics, Vertical Limit and Westcore Properties. “Employers are telling us use cases similar to for instance, ‘because our inside sales teams are getting on average seven hours of sleep a night, we’re predicting a 15% increase in lead generation by Q4,” said Rastegar. “We’ll actually be able to tell employees, ‘You need to average x number of hours of sleep to overachieve on your quota.’” Company Vitals FitBliss has a 5-Star Rating on the Salesforce AppExchange as the #1 rated wellbeing application. FitBliss has also been ranked #1 health startup by Startup Grind. Wildcard In an effort to practice what it preaches, FitBliss asks its own employees to complete a V2MOM (Vision, Values, Methods, Obstacles and Measures) inspired by Salesforce co-CEO and co-Founder, Marc Benioff. As part of the Measures, every employee shares their wellbeing goals for the year such as cooking at home three times a week, getting at least 30 minutes of exercise daily or meditating 20 minutes a day.

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WEARABLE TECH + DIGITAL HEALTH + NEUROT EC H SILICON VALLEY

STANFORD UNIVERSITY FEBRUARY 21-22, 2019 StartUp Health members receive a 20% discount with the code SUH19

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StartUp Health Magazine

Presented by

The Longevity Moonshot

TOGETHER WE CAN ADD 50 HEALTHY YEARS TO EVERY HUMAN LIFE Companies to Watch / ZEEL

Life-Giving Massage, At the Tap of a Button Named one of the “Best Entrepreneurial Companies in America” by Entrepreneur and one of the fastestgrowing companies in the country by Inc., Zeel is the first, leading and largest on-demand massage provider with over 11,000 licensed massage therapists delivering massages across the country.

PREFACE Jeanne Louise Calment is the oldest person to ever live: She died in 1997 at the age of 122, and 164 days. Scientists and physicians alike have studied her lifestyle, searching for clues to understand her secret to becoming a supercentenarian. We know she came from a long-living family, played tennis, enjoyed braised beef and used olive oil as face moisturizer. Clement’s daily habits join a long list of eccentric conjectures that promise a long life. Fortunately, medical advancements and thorough research into the field of human longevity have taught us that there is more to our endurance than olive oil and braised beef. For example, we know that where you live greatly impacts how long you live. What public health experts refer to as social determinants of health — think housing quality, access to fresh food, water and air quality — are thought to be among the most powerful influences on a person’s health. We also know that by organizing the world’s genomic data in a more efficient manner we will eventually be able to develop highly effective diagnostic tools to better understand the health needs of people based on their genetic-makeup, and in turn, design more powerful treatments. Together, let’s add 50 healthy years to every human life. This moonshot is just as personal as it is technical. As more people live longer, we need the ability to scale senior care in a way that addresses both medical and mental health needs in this older population. We need smart solutions to improve injury recovery. We need support and accountability to adapt a preventative mindset when it comes to our health in order to detect diseases earlier.

Leadership Profile CEO Samer Hamadeh received an MS and BS from Stanford University and describes himself as a lifelong entrepreneur. Starting with a candy reselling company in middle school, he has worked with more than a dozen startups as an advisor, investor and board member. He is a co-founder and former CEO of Vault.com, the career information company. From Spa to Health Clinic According to Hamadeh, “Zeel’s rise parallels the more general acceptance of massage therapy as part of complementary and integrative medicine. Today, massage is offered along with standard treatment for a wide range of medical conditions and situations. You’ll see massage therapy offered in businesses, clinics, hospitals, hotels and even airports.” He’s right. The American Massage Therapy Association (AMTA) reports that “from 2012 to 2017, revenue from alternative or complementary healthcare providers, which includes massage therapists, increased four percent, and employment increased 3.3 percent. Revenue growth is projected to continue at an average rate of four percent per year through 2022. Between July 2016 and July 2017, AMTA 59

CEO Samer Hamadeh has been an entrepreneur since he started a candy business in middle school. Since then he has worked with more than a dozen startups as an advisor, investor and board member.

surveys indicate that roughly 47-60 million adult Americans (19-24%) had a massage at least once. The atmamassage.org website lists links in 11 health categories where massage therapy is considered as a viable integrated treatment. These include arthritis, cardiovascular health, pain management, exercise performance and recovery, fibromyalgia, headaches/migraines, low back pain, senior therapy, mental health, stress and wellness. Market Differentiator One element that sets Zeel apart is the added layer of business/customer experience thinking Hamadeh and his team of entrepreneurs bring that create best-in-class security protocols. They recruit top massage therapists and go the extra mile by requiring all client customers to verify their identity through Zeel tech partners. The protocols give the massage industry a level of transparency and acceptance it never really had before, along with an “Uber60

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Zeel Gives Back is a monthly donation initiative to help non-profit organizations. Each month, Zeel sponsors chair massages for the staff of service programs helping people in need. “At Zeel, bringing wellness relief to people in need is essential to our core mission,” says Zeel founder and CEO Samer Hamadeh (pictured). “We want to help the helpers.”

StartUp Health Magazine

like” social component that allows for community self-regulation. That transparency helps users know that their in-home massage experience will be wholesome and healing. Satisfaction levels on both sides of the massage transaction remain high, giving Zeel confidence to expand its model to more than 90 cities across the US. An Expanding Offering Zeel offers on-demand, at-home massages in as little as an hour, 365 days a year, with start times as early

as 8 am and as late as 10:30 pm. Zeel is also home to Zeel Spa, the on-demand staffing solution for spas; Zeel Concierge, which enables hotels to provide in-room massage bookings for guests; and Zeel@Work, which brings chair massages to companies, events and workplaces. Hamadeh says “People recognize the Zeel brand as the most trusted name in massage. A Zeel membership is part of their wellness routine, the same as a gym membership. It’s our mission to make the health, wellness and stress-relief benefits of massage attainable, easy and convenient.” Options on the Table Customers choose from Swedish, deep tissue, sports, prenatal, couples massage and a custom sleep massage specially-designed to treat insomnia and sleep insufficiency. Massages are booked on the Zeel app for iPhone or Android and on zeel.com.

StartUp Health Insights s

Funding Breakdown

Diagnostics/Screening

SPOTLIGHT: OXITONE MEDICAL -Oxitone is on a mission to keep people healthier at home by next-generation, hospital grade digital continuous care.

Diagnostics/ Screening Every day StartUp Health monitors the market and breaks down funding by business segment. Here’s a look at the funding being put towards diagnostic/screening solutions this year.

$32.5M

TOP DEALS -Grail: $300M San Francisco, CA

AVERAGE DEAL SIZE

23andMe: $300M San Francisco, CA LinkDoc Technology: $149.4M Beijing, China Allcure Medical Technology: $102.7M Beijing, China Personal Genome Diagnostics: $75M Baltimore, MD

$2B

TOTAL RAISED

TOTAL DEALS

*Data from January 1, 2018 – November 15, 2018 Download the StartUp Health Insights report at startuphealth.com/insights

The Addiction Moonshot

TOGETHER WE CAN END ADDICTION AND THE OPIOID EPIDEMIC PREFACE Addiction manifests itself in many ways, from drugs to alcohol abuse to technology and screen time. What’s clear is addiction is no longer anonymous, like the sign on the front of the church suggests. Its cords are reaching into families everywhere, ripping at the fabric of our communities. It’s been called a war, and it’s been called an epidemic, but whatever you call it, we seem to be losing. More than 70,000 Americans died from opioid overdoses in 2017 – more than were killed in the entirety of the Vietnam War. Globally, around 31 million people have drug use disorders, according to the WHO. Addiction and opioid abuse are one of – if not THE – great health crises of our time. The time is now to fight back, to radically alter our thinking about treating addiction and ending the opioid epidemic. It starts by rethinking what’s possible. Together, with a unified will, global collaboration and innovative health treatments, we can create a world where addiction is a crisis of the past. It feels utterly impossible now, but we must succeed. It’s a global imperative.

Issue 3

Recovery, Rebooted At the 7th annual StartUp Health Festival, the Addiction Moonshot was announced, followed by a fireside chat with Dr. Sanjay Gupta who has covered this topic extensively in his reporting for CNN.

StartUp Health Magazine

Startups are using all of the tools in the digital health toolbelt to reimagine how we fight drug abuse and aid addiction recovery. by Michael Yockel

Before launching his addiction treatment app, inRecovery, in April 2017, David Sarabia learned the ins and outs of rehab from the most personal perspective possible: as an addict himself. By age 27, Sarabia already had established himself as a successful serial entrepreneur, helping to found – and then sell – the online printing company UPrinting and the mobile commerce platform eMobileCart. Flush with money and time, he moved to New York City, and, as he terms it, “that’s when things went a little bit sideways.” Although he had previously never used drugs, he became hooked on cocaine. “That was the start of the end of my success,” he confesses. Ultimately, he graduated to heroin, and by the time he turned 30, found himself

nearly homeless, sometimes sleeping on park benches and subway trains. After several months in this perpetual downward spiral, he reversed course, at least to a degree, starting a consulting business while working as a “functional cocaine addict.” Then a there-but-for-the-grace-ofGod-go-I event interceded: a close friend and mentor – a prominent tech investor – died in early 2016 at age 51 in his condo after a night of partying that included cocaine and Xanax. “That was the turning point for me,” Sarabia, now 35, recalls. “And I realized, ‘I’m next.’” Shortly thereafter, he entered a rehab clinic. There, residents received attentive care during their first week of treatment, but as successive waves of new addicts arrived, that level of care sig-

nificantly dropped off, a situation exacerbated by what Sarabia considered the clinic’s underperforming technology. His entrepreneurial mindset undiminished by his addiction, Sarabia, of his own volition, built an app for the treatment center, one that would “help its clinicians engage their patients more,” he explains. “A lot of disconnect starts happening,” he says. “A clinician can only meet with you every so often, and if you’re not very committed to your recovery, then you’re at high risk of relapse.” With his app, the center’s staff could keep in constant touch with a patient, covering the gaps between face-to-face visits. Discharged in January 2017 – and clean – Sarabia dived into research about the rehab industry, discovering that the problems that plagued his treatment center were endemic throughout. And at that moment, he says, “I knew I had found my purpose: I thought, ‘This is it. I have to do this. I have the right business

background, the right knowledge background and I’ve been an addict. I really get it.’” Three months after walking out of his clinic, he founded inRecovery, assembled a team and setup operations in San Diego. He now serves as its CEO. InRecovery joins a host of digital health companies addressing the national substance abuse problem, fueled in recent years by an explosion in the use of opioids – prescription painkillers such as OxyContin, illegal drugs like heroin and the potent synthetic fentanyl – which in 2017 accounted for more than 49,000 of 72,000 overall overdose deaths. Widespread substance abuse, particularly of opioids, has shattered the lives of millions of Americans who cope with addiction daily, as well as creating a ripple effect that has engulfed their families and friends and dramatically increased healthcare costs while decreasing workplace productivity. No state has gone unscathed by the crisis, with West Virginia, Ohio and New Hampshire

suffering alarmingly high rates of overdose deaths. Federal, state and local governments, as well as the private sector, have scrambled to deal with this dramatic increase in opioid use. In 2017, President Donald Trump officially declared a “public health emergency”; this past spring, the U.S. surgeon general issued a public health advisory – the first in 13 years – urging addicts and those close to them to arm themselves with naloxone, more commonly known as Narcan, a narcotic that can reverse the effects of an opioid overdose. And, in October, Congress overwhelmingly passed – and president signed into law – legislation that pumps $6 billion into confronting the opioid scourge by expanding recovery facilities, stifling drug shipments into the country, easing restrictions on the use of withdrawal medications like Buprenorphine, allowing the National Institutes of Health to more aggressively pursue research into non-addictive pain drugs and 63

The Addiction Moonshot: Recovery Rebooted

boosting Medicaid coverage for opioid treatment. Phrases like “opioid crisis,” “opioid epidemic” and “opioid emergency” now permeate the public conversation via countless magazine and newspaper articles, scholarly nonfiction books, and personal memoirs, not to mention a welter of online blogs, TV broadcasts (the HBO documentary Warning: This Drug Will Kill You and the three-part PBS series Do No Harm – even Netflix’s animated comedy-drama BoJack Horseman) and narrative films (the most recent example: Ben is Back). This heightened awareness has coincided with digital health’s burgeoning role in grappling with opioid addiction, a complex issue – often rooted in an associated mental-health problem – that runs the gamut from traditional recreational abuse to people in chronic physical pain who self-medicate because they lack the financial means or insurance coverage to seek treatment. Or, like street addicts, who in addition to lacking the necessary monetary resources, also might simply fail to recognize the seriousness of their disease or feel sufficiently motivated to confront it. (Treatment for lowincome adults is offered through expanded Medicaid coverage under the Affordable Care Act in all but 14 states.) In truth, no single solution exists for dealing with opioid addiction; rather, it requires a holistic approach, one that spans the broad medical/ social spectrum, from identifying who is at risk to shepherding addicts to appropriate treatment once they have been diagnosed. Vancouver, British Columbiabased Curatio, for example, has developed a digital app that uses social media to gather people around a common chronic condition, including for addiction, while also collecting realworld insights on patient adherence and case-by-case effectiveness. 64

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“Stigma and isolation are serious barriers to seeking addiction recovery support,” Curatio CEO Lynda Brown-Ganzert, points out. “Employees who disclose addiction to their employer may be taken off the job, asked to take leave or even dismissed. The issue of privacy is paramount in empowering patients to get the help and support required for overcoming an addiction. The Curatio platform uses private, highly personalized, closed social networks to empower, educate and engage patients. This approach enables individuals to overcome the challenges of being isolated in gaining support and help. It also gives providers a private, de-identified, education and engagement solution that can address a variety of patient segments. But before a person can even think about their recovery, as a society, we need to recognize that sometimes the very people that require help don’t always receive it. Cloud9, operating out of Austin, has extended its original mission of connecting mental health teams to patient populations to now encompass first responders such as police, fire and EMS for support at the scene of a substance-abuse crisis. “Substance use disorders typically are a co-occurring issue with a mental health disorder,” explains Cloud9 CEO and founder J.C. Adams. “Many people are self-medicating for a variety of mental health diagnoses. In order to best treat a substance-abuse issue like an opioid addiction, we need to address both.” Cloud9 first deployed this approach by partnering with the Harris County Sheriff ’s Office, whose jurisdiction includes Houston, giving its deputies an app that directly connects with mental health clinicians and substance-abuse specialists. “With the opioid crisis,” says Adams, “first responders are out there on the front lines dealing with overdose-related issues and can actually help at

StartUp Health Magazine

that intercept point to intervene to prevent harm and prevent overdose deaths.” And in an effort to tackle opioid addiction as early as possible, Palo Alto-headquartered PSYCHeANALYTICS (pronounced “psych-eeeanalytics”) offers a tool to screen for addiction, opioids and otherwise, in a primary care setting. Upon arriving at a doctor’s office, a patient, using a tablet, completes a questionnaire that thoroughly probes his or her psychological and psychosocial medical history, including substance abuse. After finishing – the process takes about 15 minutes – the patient clicks through that data to PSYCHeANALYTICS, whose AIdriven support quickly generates a report that is entered into an electronic health record and perused by the physician before he or she sees the patient. PSYCHeANALYTICS’ CEO David Haddick considers this a vast improvement over the paper-oriented PHQ-9 (Patient Health Questionnaire), the existing standard screening evaluation that, based on responses to nine questions, assigns a patient a score (low score, good; high score, concerning). According to Haddick, the PHQ-9 fails to provide doctors with essential factors that can lead to an accurate patient portrait. By contrast, PSYCHeANALYTICS’ report, Haddick says, efficiently communicates to the physician if the patient has indications of depression, and, if so, some sense of its exact condition, its causes and any associated co-morbidities such as opioid addiction. “People take drugs to reduce pain in their lives,” Haddick notes, “and if you don’t figure that out, it can go on for years.” PSYCHeANALYTICS’ more precise psychosocial information also proposes a menu of appropriate coordinated-care patient treatment plans that call in the services of a consulting psychiatrist,

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therapist, social worker, case manager, et al. The company has rolled out its program in Northern California’s Solano County, which comprises 435,000 residents. “The theory behind what we’re doing,” explains Haddick, “is that patients are far more likely to answer questions honestly talking to a computer than to a person. People self-censor themselves all of the time. They will say, ‘Oh, I don’t want to bother the doctor with my little worries’ – and, as a result, physicians don’t help them.

“Patients are far more likely to answer questions honestly talking to a computer than to a person. People self-censor themselves all of the time.” “These questions are educational in nature. But when you put them all together, it indicates the interest the doctor has in you as a person. The opportunity to give this information to the physician in a concise format becomes very life-affirming, and it leads to a much better relationship.” Other digital health platforms are queuing up to enter the treatment pipeline. For example, Seattle-based WEconnect, which has devised an addiction recovery app, recently raised $6.05 million in an initial round of venture capital investment. Some, such as SmartTab, sound more akin to science fiction than

science, not uncommon with past technologies that became reality. Developed by Denver-based Veloce Digital, SmartTab is a wireless medication delivery system whereby a patient ingests a trackable smart pill that allows him or her to trigger its release – via smartphone, smart watch or computer in a clinical setting – at a chosen time and at a spot in his/her body where it will be most effective. This way, doctors can monitor a patient’s compliance with his or her drug regimen, an imperative factor in treating opioid addiction. And consider the growing interest in mood forecasting, an even more futuristic-sounding concept: Doctors constantly recording data from a person wearing a sensor that communicates with a mobile device, information that could uncover possible mental illness, particularly depression, which is often associated with substance abuse. These kinds of technologies will be necessary to meaningfully reign in the nation’s appalling number of opioid casualties, whose rate of annual increase, according to preliminary data from the Centers for Disease Control, showed signs of declining in late 2017 and early 2018, attributable to apparent decreases in overdose deaths from heroin and prescription painkillers (but not synthetics). For his part, inRecovery’s David Sarabia has already begun to gaze into the near future, fashioning a five-year plan that not only will steer an addict onto the path that best addresses his or her specific problem, but also dramatically lower costs. Opioid treatment, he points out, now comes with an exorbitant price tag – anywhere from $30,000 to $60,000 per month. “It’s not a right,” he contends, “it’s more of a privilege.” If you don’t have a high-paying job or comprehensive insurance or a pocketful of discretionary cash, he adds, “you’re pretty much screwed.”

To decrease costs, Sarabia envisions inRecovery working with other treatment providers to gather all existing data to create the strongest intelligence possible to understand what works and what doesn’t for each individual. And he wants inRecovery to lead the way in establishing a more scientific approach to assessing levels of addiction risk. As part of that effort, the company has partnered with Boulder-based SomaLogic to conduct a clinical study to discover the protein signatures – the biological markers – of addiction risk. At the present time, a person’s propensity for addiction is determined through a psychosocial evaluation – a conversation with a clinician – without a biological component. Addiction treatment, he hopes, will begin at the retail pharmacy level, where a person undergoes a scan to ascertain his or her level of risk. A low-risk client would qualify for remote treatment via telemedicine, costing a nominal amount. For highrisk clients, he explains, “inRecovery will have worked with so many treatment providers that it can guide you in the right direction: Say, ‘This is the best treatment for you, based on thousands of patients who have similar profiles.’” By intervening early, he adds, “We can save a patient’s life.”

Kevin Dedner, founder of Henry Health, is on a mission to increase the life span of Black men, in part by opening up access to mental health services.

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Weight of the World Some Health Transformers choose the hard road, knuckling down to bring the best in digital health to underserved communities. Whether itâ&#x20AC;&#x2122;s working to improve the life spans of Black men, or expanding access to culturally relevant care for Hispanic Americans, these entrepreneurs wear the world on their shoulders, and are using technology to give voice to the voiceless. words by Nicole Clark photos by Paul Newson

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Kevin Dedner scrubs a sticky coffee table in the common area of D.C.’s 1776, a brick and mortar hub for incubators and startups just blocks from the US Capitol. It’s a chilly October morning, and Dedner has yet to warm up with a hot cup of coffee, but he radiates hospitality. The public health professional-turned entrepreneur can’t help but improve his surroundings, even if it’s mopping

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up someone else’s coffee stain. “I feel like I’ve invited you to my home. I wouldn’t want you sitting at a dirty table in my home,” Dedner says. He finishes the clean-up, disposes of the disinfectant wipe he was using, and returns to the now sparkling table. “Do you know what today is?” he asks. “A year ago today, I had the life-changing meeting that sparked the start of Henry Health.” Dedner, CEO and founder of Henry Health, is referring to his fortuitous meeting with Oliver Simms III, Henry Health’s COO, in which the two first discussed the concept for what is now the company’s digital mental health platform. Since that meeting, Dedner has been laying the groundwork for his startup with a moonshot mission so powerful, he says “it takes up space in the room.”

He and his team at Henry Health are dedicated to increasing the life expectancy of Black men in America in the next 25 years. Launched at the start of 2018, the company provides culturally sensitive self-care support and mental health services to Black men in the US, connecting patients with Henry Health therapists in a secure and confidential online environment. Untreated mental health disorders and unmanaged stress are silent killers of Black men. Henry Health is amplifying that narrative and it is resonating with people. “It’s something people have seen firsthand in their family, but they have never heard it articulated,” Dedner said. Five years ago, Dedner posed a question to a close circle of peers, many of whom are now the backbone of his startup: Could being a Black man in this world make you sick? At the time, George Zimmerman had just been acquitted. “It literally made me sick. I was getting headaches everyday,” Dedner says, referring to the 2013 Florida case in which Zimmerman, a neighborhood

Though he tried to make adjustments in his life to manage the stress, he couldn’t make them fast enough and soon found himself in the throes of a debilitating depression. “I had become the subject of my own research,” says Dedner. watch coordinator, was charged with the murder of an unarmed 17-yearold Black high school student. The shooting incident was reviewed by the Department of Justice for civil rights violations, but no additional charges were filed. “Once the headaches stopped, I took a step back and from a place of intellect I found myself wanting to understand what this kind of stress does to Black men,” Dedner said. Dedner delved into studies about mental health in the Black community, particularly the 1980s research of Sherman James. In addition to laying out staggering statistics of health disparities between Blacks and Whites in America (e.g. Blacks in the US are 2-4 times more likely than Whites to develop hypertension by age 50 and 3-4 times more likely than Whites to suffer a stroke), James’ coined the term “John Henryism.” His thesis was this: that when resilient people work hard within a system that has not afforded them the same opportunities as others, their physical health deteriorates. Sherman named this behavioral and health predisposition after the folk legend of John Henry, an African-American slave who transitioned to freedom but died from exhaustion after beating a mechanical steam drill in a steel-driving contest. Henry Health takes its name from this folk legend. At the time of Dedner’s research, life was becoming increasingly stressful for him. He was working to grow his government consulting firm, rehabbing his home, had a new

baby on the way and was searching for philanthropists to help turn his informal probe into a national survey called “What’s Killing Black Men?” Though he tried to make adjustments in his life to manage the stress, he says he couldn’t make them fast enough and soon found himself in the throes of a debilitating depression. “I had become the subject of my own research,” says Dedner. Dedner openly shares his personal journey with depression because it is entwined with the mission and story of Henry Health. The therapist that ultimately helped Dedner find his way out of depression – Rufus Tony Span, PhD – now serves as the company’s Chief Clinical Officer. While Dedner’s health moonshot is framed with the phraseology of increased longevity, his work to uplift a historically underserved population requires a systems approach, one that dismantles structural racism and entrenched stigmas. That is why Dedner’s vision is multidimensional, one in which several moonshots are achieved – increased longevity for Black men, yes; by way of bridged access gaps experienced by Black men, and the destigmization of mental health. Equity AND Equality in Healthcare At the turn of the millennium, when the US Department of Health and Human Services’ Healthy People 2010 goals were being finalized, an explicit goal was added to ensure

that the health information benefits of the Internet be expanded equally to all communities within the US. Over the years, as the Healthy People community began broadening its focus to include an emphasis on social determinants of health and on reducing the persistence of health disparities, the topic area expanded to include the equitable use of health information technologies to improve personal health. This is what digital health entrepreneurs like Dedner are working to create – a more level playing field when it comes to access to culturally relevant care. His work is not for the faint of heart. Low-income and minority groups suffer higher rates of obesity and increased co-morbid conditions like cardiovascular and pulmonary disease. Coupled with poor quality of life, the ladder to happiness and health is widely spaced, with greased rungs for underserved populations, resulting in low compliance and high treatment failure rates. Health Transformers, like Dedner who are drawn to working with traditionally underserved populations, are aware of the immoral connection between social injustices and health disparities. And they are making it their life’s work to help others understand what it takes to provide quality care to those that needed it most. “I often say to investors, ‘We start with Black men, but this is really about providing culturally competent therapy.’ As we embrace the need for broader mental health services, only through technology can we meet that need,” Dedner says. 69

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A New Way to Care for Hispanic Communities For Mario Anglada, CEO and co-founder of Hoy Health, helping underserved populations starts with letting go of false stereotypes. In his work with Hispanic communities worldwide, Anglada says he’s noticed an ubiquity of blanket assessments made about low-income or underserved consumers. “One of the assessments is that these health consumers are digitally unsavvy and another is that they are uneducated. We found that to be quite the opposite,” Anglada said in a recent interview with StartUp Health. “Once you understand that they have the digital and educational capability to engage with your health service offerings, the next thing you do is engage them with opportunities that are inclusive.” The ability of providers and health organizations to effectively deliver care services that meet the social, cultural and linguistic needs of patients is paramount to access. That’s precisely why Anglada and his team have studied the intercontinental connectivities of their Hispanic

Below, a man stands in front of a pharmacy in Nuevo Progreso, Mexico. 6

customer base, and have used their cultural understanding of this population to negotiate affordable care on a global scale, creating a cash-pay business model for medication and patient engagement services. Hoy Health has created a unique set of interconnected products – HoyRX, HoyMEDS, HoyCCM and HoyDOC – that are designed specifically for the Hispanic and medically underserved markets and are all digitally accessible, bilingual and culturally relevant. Their prescription medication voucher program, HoyRX, is the first-of-its-kind medication gifting system and puts a new spin on caring for family, allowing users to safely and efficiently “gift” medications to loved ones within the system. This can allow a son or a daughter who lives far from a parent to purchase their medication and provide their loved ones with the ability to pick up their medications at their pharmacy of choice. Another avenue that attracts people into the Hoy Health system is its telehealth services. For health consumers who have traditionally

not been able to get quality care in their language of choice, HoyDOC’s network of US based bilingual providers ensures care that is both culturally and linguistically appropriate for their needs. “When working with consumers at the lower end of the economic scale, technology helps them engage with health services,” Anglada says. In the US, a certain political will is needed to ensure the Healthy People technology and health communication goals are met, particularly if underserved populations are at risk of losing health insurance coverage and related benefits in the tug of war over the Affordable Care Act and coverage of preexisting conditions. Whether in the short or long term, both Dedner and Anglada agree it is more important than ever to leverage digital tools to maximize scarce healthcare resources. “Technology is here,” says Dedner. “It’s no longer a choice, but a question of how we integrate it in our lives and use it to improve access to care for underserved populations.”

Hoy Health’s prescription medication voucher program, HoyRX, is the first-ofits-kind medication gifting system. A child who lives far from an elderly parent can purchase their medication and provide their loved ones with the ability to pick up their medications at their pharmacy of choice, even one across the border. 70

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Building a Health Record That Tells the Whole Story Thanks to federal programs like HITECH, electronic health records are becoming the norm, but they are often so siloed that doctors only have a piece of the patient profile. iShare Medical has created an awardwinning platform that helps EHRs communicate smoothly, and gives patients a single source of health information that they can carry throughout their life. by Patrick McGuire

p iShare Medical has set about solving one of the great puzzles of modern medical administration: EHR interoperability.

After a couple of months spent duking it out with insomnia, I finally listened to my girlfriend and went to a doctor for help. We’d just moved to a new state, so the physician assigned to me through my new insurance plan didn’t know me. In the sunlit waiting room, I rubbed my eyes over and over again as if the futile action would replace some of the sleep I’d lost the night before. When the doctor asked me about my health background, my mind blanked after giving her a rough outline of my sleep issues and medical history: Non-smoker. Moderate drinker. I exercise frequently but not as much as I should. It wasn’t until I was halfway out the door of the examination room that I remembered to share a few major pieces in the puzzle of my health. “Oh, I almost forgot,” I said to her, standing at the threshold. “My dad had a major heart attack a couple of years ago. Also, I was in a nasty bike accident in 2016 and had to have two surgeries.” The doctor waved me back in and asked for more details. Like all bodies, mine tells a nuanced and complex story. Having omitted key information, I was an unreliable narrator in the first-person account of my own life. My bike accident and father’s heart attack were massive, life-altering events that occurred just in the past few years, but between my forgetfulness and the fact that I’d already mentioned them to multiple physicians, I initially forgot to bring them up. If I can’t tell the whole story behind my health, how can I expect my health71

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care providers to understand what’s going on, much less to address my issues accordingly? iShare Medical, a Kansas City– based startup, aims to capture the story behind each individual’s health and dramatically improve the healthcare system in the process. The burgeoning company is one of only five nationally accredited government trust anchors. This puts them in the position of punching way above their weight, facilitating medical record exchange with 23 Federal agencies including Medicare, Medicaid, Indian Health Services and the Veterans Administration. “We want to build the first cradle-to-grave lifetime medical record,” explains Linda Van Horn, CEO and founder of iShare Medical. A 2018 Pipeline Entrepreneurial Fellow, Van Horn brings decades of healthcare industry leadership and consulting experience to iShare. The company has already won top prizes at the 2017 LaunchKC contest and 2016 SBA InnovateHER Kansas City Business Challenge. “Patients are not good health historians. And when they forget vital information about their health, it’s not just inefficient but also dangerous. At the moment, complete health records for individuals don’t exist. Because physicians don’t have access to this information, so much goes wrong in the healthcare industry. And as a patient, when things go wrong, it can cost you your health, wealth or even your life.” Effectively, iShare is an EHR (electronic healthcare record) translation engine. If a surgeon performs a knee replacement and a physical therapist does the follow-up therapy, iShare allows both practitioners to view, edit and add to the medical records no matter what EHR system is used. Everything is on one platform; crucial details don’t get lost. The healthcare industry is start72

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p The team at iShare Medical has won top prizes at the 2017 LaunchKC contest and 2016 SBA InnovateHER Kansas City Business Challenge.

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ing to take notice. iShare recently partnered with the Veterans Choice Program, which helps over 200,000 providers in 28 states coordinate care for vets. The comprehensive picture of patients’ health isn’t confined to their recent health problems or even the span of their own lifetimes. It stretches back decades to incorporate the health history of their relatives, how they grew up and, in many cases, what part of the world they’re from. It’s a story too vast in scope for patients to accurately convey to physicians. iShare solves this problem by taking the medical storytelling responsibility aspect of healthcare out of the hands of patients and leaving it to the providers no matter the context of care. The relevance of iShare’s approach is implicit in a 2016 study conducted by Johns Hopkins University School of Medicine, which concluded that preventable medical errors were the third leading cause of death in the US, behind heart disease and cancer. “People don’t just die from heart attacks and bacteria,” says Dr. Martin Makary, professor

of surgery at Johns Hopkins, “they die from system-wide failings and poorly coordinated care.” And while incomplete medical records can’t shoulder the entire blame for this issue, they are a preventable part of the problem that has yet to be fully addressed. iShare also seeks to address woeful deficiencies in the healthcare industry’s information systems. While we expect the US healthcare system to be driven by cutting-edge technology and information systems, physicians currently share medical records using an antiquated faxing system that originated in the 1980s. According to the Council for Affordable Quality Healthcare, somewhere in the range of nine billion faxes are exchanged in the American healthcare system each year, 94% of which are sent manually. At about seven dollars per transaction for things like verifying that a patient’s insurance or obtaining authorization for a procedure, it doesn’t take long to realize the scope of the problem. Compounding the quandary is the problem of interoperability, a

The Interoperability Dilemma ---

38%

of hospitals claimed that they could use or integrate data from another hospital into their own electronic records system.

53%

of physicians say that even when they do receive outside EHR information, they don’t use it—because it isn’t viewable in their own systems.

term that describes whether or not one EHR system can communicate with others. For the most part, they don’t, and health histories are lost when patients move from one doctor to another. Though President Obama sought to modernize medical record keeping through his 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, the administration prioritized basic records digitization and left interoperability in the wings. There are currently several competing formats—Epic has the largest percentage—and shifting from one platform to another is an

IT nightmare. As of 2015, a meager 38% of hospitals claimed that they could use or integrate data from another hospital into their own electronic records system, and 53% of physicians say that even when they do receive outside EHR information, they don’t use it—because it isn’t viewable in their own systems. iShare Medical is poised to solve the interoperability issue. Van Horn likens the way her company addresses interoperability to how cell phone providers allow different brands of phones to connect and communicate. Even if the EHR system at one hospital is completely different from another’s, the platform allows a doctor to view both. When physicians want to transfer records from their EHR to another care provider, they use iShare’s flagship product, iShare Medical Messaging, a HIPAA-compliant encrypted data transfer system. Since the system eliminates faxing, it cuts costs significantly while streamlining accuracy and communication. But the biggest benefit the product offers is a solution to the healthcare industry’s nasty interoperability problem, a challenge no company has been able to address previously. The platform is designed to look and operate like conventional email while adding layers of security. Messages sent through the system can never be spammed or spoofed because the identity of both the sender and receiver is always authenticated before each transaction. The system also comes with one of the industry’s largest direct addresses for healthcare providers available. Rather than relying on internet searches and phonebooks to look up industry contact information, this saves providers, patients and payers time. iShare also benefits from its own efforts in the verification realm; it is one of only five accredited governmental trust anchors qualified to exchange with federal agencies. The

company prides itself on operating at the highest levels of trust and security in the healthcare industry. Van Horn’s clients have seen improved efficiencies as well as cost savings. “We just got some great feedback from a large physical therapy office we work with,” she says. “They’ve seen a big jump in patient referrals and a decrease in toner ink usage because they’re not faxing nearly as much as they used to.” The cost of toner ink is a smaller item in much more extensive ledger that includes wasted staff time, longer hospital stays and incorrect treatment plans as a result of inaccurate diagnoses, and the inefficiencies caused by medical errors: iShare estimates that the American healthcare system can save $2.2 billion dollars annually by using its product. My sleep issues persist, but things are slowly improving. After looking through my blood tests, my doctor surmised that my condition resulted from anxiety brought on by recent stresses. It was nothing physical. I doubt I’ll ever forget this long period of restlessness, but I know how evanescent memory can be, a fragility that undermines our physicians’ efforts to understand our health. As iShare becomes more widely adopted, the full portrait of our medical histories will be preserved for OR be accessible to us and to our physicians: our stories will not be lost. If our stories are not lost, then our doctors are far more likely to treat us effectively.

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More Trial breast neoplasm DHFR

TNF

inflammation

Ligand Express’s “Network Graph” shows where the drug methotrexate interacts with proteins associated with more than one diagnosis: breast neoplasms, arthritis and inflammation. (Artist rendering)

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Less Error Cyclica’s revolutionary approach to pharmaceutical research can accelerate the drug development process and help scientists understand the critical nuances of drug side effects and drug interactions. By Jeremy Lehrer

arthritis

For Naheed Kurji, the need to get drugs to market more quickly isn’t a theoretical problem. Members of his family have suffered from cancer, cardiovascular issues and autoimmune disorders for generations. Pharmaceutical research could hold the keys to reducing suffering or even saving a family member’s life. In the pharmaceutical industry, the cold fact is that developing new drugs can take 10–12 years, with seven of those years spent in pre-clinical trials. The pricetag? Upwards of $2.6 billion. And the process can be painstakingly inefficient. Drugs that seem promising in laboratory trials can prove to have disastrous side effects in clinical testing, effectively wiping out years of effort and investment. That’s because of the way research has traditionally been structured. Typically, pharmaceutical companies have researched drugs by targeting one particular protein: to create a key that would open that particular “lock.” This approach to research, known as target-based drug design, didn’t account for all the difficult-to-predict “off-target” interactions that lead to side effects, which meant that the drug hit its bullseye but the “off-target” reaction was sometimes so extreme that the medication was ruled out. At Toronto-based Cyclica, where Kurji is CEO, scientists are aiming to help pharmaceutical companies shorten the pre-clinical discovery process from seven years to two or three. The company does this by empowering pharmaceutical researchers with integrated cloud-based and

AI-augmented platforms that enhance how scientists design, screen and personalize medicines. Instead of looking at one lock, Cyclica’s strategy is to examine all the possible locks that interact with one key; in other words, its technology analyzes the molecule under investigation and identifies all the proteins in the human body where the molecule might bind. If a medicine is targeted for the kidney but also has a strong possibility of interacting with proteins in the pancreas, that could be a cause for further examination and reevaluation. “We bring artificial intelligence to augment computational biophysics,” explains Kurji. “That’s a philosophy that underpins all of our technologies.” The technologies reduce upfront risk as well as trial and error inefficiencies. Ligand Express, one of the company’s platforms, is incredibly sophisticated. It integrates computational biophysics, AI and advanced algorithmic analysis to uncover on- and off-target protein interactions (called “polypharmacology”) and pharmacokinetic properties. Pharmaceutical companies like Bayer, China’s WuXi, Brazil’s Eurofarma and Germany’s Merck KGaA use it to reveal the biological targets that potential medicines might interact with, both intended and unintended, and from that gain understanding on medicine effectiveness and safety. Here’s how it works. After accessing Ligand Express through the web, scientists enter in the alphabetical shorthand for a drug’s small molecule, and the platform generates a wealth of information—it tells them where the compound’s interactions, both desired and unintended, may occur on protein surfaces and creates a 3D representation of the compound in the predicted site of interaction. To hone in on potential impacts, Ligand Express allows us75

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ers to filter the analysis according to functional biology, disease biochemistry or protein abundance, which refers to the amount of protein within a specific cell or tissue type, helping scientists to understand the impact of an off-target reaction. The platform provides links to existing research on the mechanism of known interactions. It presents data in artfully interactive infographics—the company calls them “Network Graphs”—that illuminate predicted protein targets of interest in addition to providing links to related data and papers on known drug targets, diseases, ADMET properties (absorption, distribution, metabolism, excretion and toxicity) and subcellular localization. The information and bioinformatics are based on a hard-core computation that takes three days to complete. If you tried to run the same analysis on your home computer, the calculation would last 480 days. In January 2018, Cyclica debuted the commercial version of Ligand Express, the culmination of a relatively stealth, three-year effort to achieve a biocomputational milestone that no one else had before. The goal of the effort, which involved a team of scientists, developers and interface designers, was, “How can you take a given drug and screen it across the entire surface of all proteins?” explains Kurji. “And then how can you do that across all possible proteins in a computationally efficient way?” The effort, known in the field as “a highly non-trivial problem” computationally, is the coding equivalent of summiting Everest. Or of Google’s algorithmic indexing of the web. Essentially, Cyclica’s scientists and developers transformed the known structurally characterized proteins— at the time, all 130,000 complex macromolecules available in the Protein Data Bank (PDB)—into surface data that could be readily used and indexed for analysis. 76

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AI is integral to the company’s emerging suite of biophysical and biocomputational analyses, yet Kurji recognizes its limitations. “We undeniably believe that artificial intelligence will play an important role in how the medicines are discovered and brought to market,” he says. “But artificial intelligence by itself cannot be the silver bullet. It’s one piece of a much bigger puzzle.” The ingenuity of Ligand Express’s algorithmic back-end is complemented by the elegance of its frontfacing user interface. Many user interfaces in the medical field are wonky and poorly designed—seen an EHR lately? They take little account for user interaction and the way that an interface can enhance a platform’s efficacy. Meanwhile, users’ design savvy, and their ability to recognize bad design, is continually increasing as UX-centric apps become more and more pervasive on phones, tablets and other devices. “What’s unique about the way we’ve designed Ligand Express is that it’s not accessible just to the computational scientists but to a broader audience. That’s why we are employing good design principles that you might see in your day-to-day consumer apps,” says Vijay Shahani, Cyclica’s head of design and product ambassador. “We allow users to quickly analyze the results presented by our platforms. We’re building out the ability to interrogate the data but not overwhelm. Allowing you to query that data readily, see it in multiple forms—in a graph or table, in a molecular viewer—and figuring out ways to tie these together in a seamless way.” Ligand Express may be a gamechanging platform, but the company’s leadership came to realize that the “software as a service” (SaaS) model for it and other technologies had inherent limitations. Providing the research capabilities to pharma companies would generate income,

sure, but it didn’t give Cyclica a stake in the outcome of the research: the drug. So Cyclica took the process a step further, with what Kurji terms “differential drug design” (DDD), which means that the company is now helping to design molecules that have the right properties to interact with specific targets while also avoiding unintended sites. To generate these molecules that have desirable pharmacokinetic qualities (i.e. drug-like properties), the company uses a “selective pressure” methodology, which means that certain criteria are defined at the beginning of the analysis: for instance, molecules likely to pass the blood-brain barrier, or be readily absorbed in the intestine. “What DDD has allowed us to do is get into the game of designing molecules and having a stake in the molecule game,” says Kurji. “Once we design molecules that have the right polypharmacology in mind, those molecules can then be run through Ligand Express to uncover unanticipated off-target interaction. They work together.” As remarkable as Ligand Express is—as a confluence of technology, processing power, algorithmic evolution and biological data analytics—Kurji is careful to emphasize that it is not the full story of Cyclica. The company’s DNA is built on an approach, not a specific technology or algorithm. Ligand Express, Kurji says, is “a philosophy exemplified in one technology.” And what Cyclica offers is an integrated set of technologies to enhance how pharmaceutical scientists design, screen and personalize medicines. “That’s what makes us, today, a highly differentiated and demonstrably valuable company,” he says. Indeed, in December 2018, the consultancy Deep Knowledge Analytics identified Cyclica as one of the top 20 AI companies in the pharma space. Cyclica’s next initiative—which

t A structural model of an enzyme involved in cancer proliferation, and how it binds to a drug used to treat breast cancer.

Kurji asserts no other company is even close to tackling—is to take genomic data, map corresponding genetic variations onto the entirety of the known human proteome, and layer that into its analysis platform to account for the fact that certain proteins within the body vary according to an individual’s genetic background—the reason why one person will respond to an antidepressant while another person won’t. The new platform, built entirely on Cyclica intellectual property and leveraging highly refined public data, would allow researchers to examine how drug interactions would vary based on genetic mutations or genetic variants. The platform could anticipate if a medication might be ineffective or, worse, life-threatening, as it might be for someone with

genetic variant that causes a G6PD deficiency, for example. The genomic-analysis technology emphasizes the notion that predictions can only be as good as the model that generates them. Think of the computational models used to predict weather: the algorithms are becoming increasingly complex and accurate as scientists calculate in different factors and influences, but there’s room for error because of the systems’ complexities, variations and chaotic processes that affect outcomes—meaning that instead of a predicted dusting of snow, New York City gets six inches. Human biology and variation is, of course, equally and mind-bendingly complex, so even when scientists know a molecule will bond at a certain site, they don’t necessarily understand the full story.

Kurji says that the goal is not to predict everything that can happen, but to reduce discovery time and to develop medicines with a greater degree of intention and precision. “Our view is to get scientists to the best starting point possible by reducing risk and minimizing as much upfront trial and error as we can,” says Kurji. “But we aren’t saying that by clicking a button, we will put a drug into the market to cure ovarian cancer. What we can do is augment how scientists generate and test hypotheses faster and let them do so with higher quality. We believe that if we can make the lives of scientists easier, they can then in turn improve the lives of patients.”

j Interim CEO Dr. David Karow took the helm at HLI in 2018 after developing the companyâ&#x20AC;&#x2122;s radio genomics section

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Data Mine Today’s diagnostic approaches are ridiculously primitive, so Human Longevity is bringing preventive care into the 21st century. By Cole Stryker Photos by Parker Simpson

Our human bodies have no scales or fangs to protect us from danger. We can’t run down our prey like cheetahs or pound adversaries into submission like gorillas. Over the millennia, we’ve traded in all these physical attributes for our big smart brains. In the end, the trade-off was worth it—our brains came up with kevlar, agriculture and nuclear fission to make up for our frailty. Now all sentient life must bow before puny, weak Homo sapiens. And yet, even the smartest and the most successful among us are still profoundly vulnerable. Invisible bacteria lay us low, viruses and tumors we haven’t begun to understand burrow into our organs, tearing our fragile bodies apart from within. Pioneers of the medical field developed treatments to cope with such ailments, whether a vaccine for polio, or antiretrovirals for HIV, and even the ingenious immunotherapy treat-

ments that help the body’s defenses target cancer. Our methods have advanced considerably from their primitive origins. But the way we approach illness is still clumsy, because preventive medicine is expensive and not especially precise. Apart from routine physicals—the old faithful tongue depressor, reflex hammer and stethoscope—and a handful of suggested checkups for certain age milestones, we don’t know we are sick until we feel bad, and that’s sometimes months or years too late. For the team at Human Longevity Inc. (HLI), that diagnostic approach—and the philosophy of waiting until something is wrong—is ludicrously passive, not to mention outdated. Using highly advanced diagnostic tools and genetic analyses, the company seeks to detect diseases, problems and proclivities long before they evolve into minor or more serious health problems. The company’s researchers are focused not so much on lifespan as “healthspan.” HLI’s goal is not to produce a 160-year-old ubermensch; rather, it is to ensure that everyone lives to a ripe old age of 90 or 100, instead of being felled by illnesses that could have easily been prevented if they were caught in time. HLI intends to ward off early mortality culprits like numerous cancers as well as neurodegenerative, neurovascular, metabolic and cardiac diseases. Three men co-founded HLI in 2013. The first, J. Craig Venter, PhD, attained legendary status in the medical community when his team of researchers became the first to sequence the human genome. Peter Diamandis, MD is the founder and

executive chairman of the XPRIZE Foundation, and Robert Hariri, MD, PhD, is a surgeon, biomedical scientist and serial entrepreneur. The trio launched HLI with the goal of building the world’s most comprehensive database of human genotypes and phenotypes. In 2015, the company established the Health Nucleus, a posh clinical research and discovery center in La Jolla, California, where clients undergo a comprehensive health analysis regimen unlike anywhere else. The results of their tests are used to make health recommendations and are then added to HLI’s collection of genomic, phenotypic and medical image databases to better understand, inform and impact individual and population health. The researchers at Health Nucleus began with an initial test run of 50 control subjects in fall 2015. After a rigorous series of MRI body scans and genetic analysis, they found that roughly 40 percent of them were, in fact, not so healthy, and had what HLI termed a “clinically-significant finding,” such as an inherited risk factor that doesn’t require immediate medical attention but rather long-term monitoring. About 15 percent of the initial test group had an “actionable finding” requiring immediate or near-term follow-up and intervention, including a tumor, aneurysm and a rare genetic mutation that hadn’t been previously detected. David Karow, MD, PhD, HLI’s interim CEO, says that among the several thousand patients that have passed through the Health Nucleus, 25 percent have a new rare genetic mutation that hadn’t been previ79

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Human Longevity Inc.

ously identified, like a BRCA mutation, which indicates risk of breast, prostate or ovarian cancers, or a LDL receptor mutation; 3.5 percent have new atrial fibrillation or severe ABblock conduction abnormalities; and two percent have a undiscovered aortic or brain aneurysm. The list goes on and on. Karow began his medical career with a combined MD-PhD program at the University of Michigan Medical School. He got his start in interventional radiology at UCLA using minimally invasive techniques for cancer treatment using cryotherapy, thermal therapy and radiofrequency ablation. Then he ran a research lab at UC San Diego focused on generating imaging and genomic biomarkers of chronic age-related disease. He joined HLI in 2017, as the company was becoming more focused on integrating genotype data with phenotype data. For his first year, Karow developed the company’s radio genomics section. When HLI’s founder and CEO Craig Venter announced his retirement from the 80

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company in May 2018, Karow was brought in to lead the company. The Health Nucleus applies a two-pronged approach. One prong is a whole body MRI, the most advanced and comprehensive version of the scan available, according to the company. The second component consists of a whole genome sequencing, followed by an analysis of the patient’s DNA, which provides insights into genetic predisposition for various diseases. Karow opines that these tools are essential in creating the most effective diagnosis possible. “As we think about what a data-driven precision health platform or assessment looks like, our view is that the code should be assessed with whole genome sequencing of all six billion base pairs, not just someone’s verbal family history,” he says. “The core shouldn’t be some superficial exam with a reflex hammer, but should be an actual full body MRI of your core. Because there’s just so many data points that come from that, and increasingly it’s [a result of integrating] machine learning and AI.”

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Scan data is cross-referenced to the patient’s whole genome sequence and both are analyzed with machine learning technology to look for irregularities and patterns that could indicate the presence of a disease, even those in early stages that would be otherwise undetectable. The analysis allows HLI’s specialists to make health recommendations to patients; the company’s long-term goal is to build a trove of patient data that can be continually consulted to make new discoveries about how diseases operate, and how to predict, prevent and treat them more effectively. Until recently, the price of this premium assessment at the Health Nucleus was $25,000—out of reach for most Americans. Health Nucleus is currently rolling out a standard version of the service for $5,500 called the HN Core. This program takes just two and a half hours, and patients can use health savings plans toward payment. Still expensive as far as preventive medicine goes, but quite a bit cheaper than late-stage cancer treatment.

p The Health Nucleus applies a two-pronged approach. One prong is a whole body MRI, the most advanced and comprehensive version of the scan available, according to the company.

With that price drop, the Health Nucleus evaluation is now reaching a wider population—over 3,000 people to date—and building out its database of patient data, comprised of tens of thousands of sequenced genomes. Every patient who undergoes testing helps the algorithms become smarter. Of the men over 59 who did the diagnostic, 2.5 percent had highgrade prostate cancer and didn’t know it. “I can only surmise that we’re extending the lives of those individuals,” says Karow, ”but I can’t yet prove it.” To do that, HLI needs longitudinal data that shows health outcomes over time. With that, Krakow explains, “I’ll be able to then say to you, we have 10 years worth of data, and in those men where we identified high-grade prostate cancer, they live significantly longer, statistically, then men who didn’t go through our platform.” The company is now partnering with existing clinical imaging facilities in order to replicate its analysis model across the country, and beyond. Karow estimates that Health Nucleus will expand to 10 locations in 2019 and to over 300 by 2022. The price of standard treatment will be sliced in half over the next couple of years, he says, and will continue to plummet as the company scales, the technology develops and demand for the product expands. HLI’s push toward data-driven preventive medicine dovetails with the popularity of wearables like the Fitbit or Apple Watch, whose everincreasing suite of biostatistics reveal a public eager to consume more information. “The current healthcare system isn’t giving them the data that they need,” says Karow. Such gadgetry has built consumer interest in a data-driven approach, but the devices are not going to reveal a lurking tumor. Or Alzheimer’s. Current Alzheimer’s prediction methods are largely qualitative and subjective,

“As we think about what a data-driven precision health platform or assessment looks like, our view is that the code should be assessed with whole genome sequencing of all six billion base pairs, not just someone’s verbal family history.” Dr. David Karow, Interim CEO

based on a physician’s assessment of a patient’s symptoms and family history. But with machine learning algorithms and other clinical biomarkers, Karow claims HLI can identify Alzheimer’s 10 years before onset. Having access to that information might prolong a patient’s life considerably, because, according to the latest research, one in three cases are preventable through lifestyle changes like exercise and quitting smoking. It’s not always easy to tell a patient to do these things because they might get sick at some point in the future. Being able to tell that patient with a precise degree of certainty based on specific genomic and biometric data can be a more powerful motivator. When Karow explains the process, his speech accelerates with excitement, and the words spill out of him in quick succession. “We take quantitative estimates of your regional brain atrophy from MRI,” he says, “we take your rare and common variants from whole genome sequencing, we take your bloodborne biomarker, including inflammatory biomarkers and cholesterol, and integrate that all together so that we can tell your family member, what is that person’s risk. In the next year and the next five years? Over their lifetime?” Karow envisions a near future, within the next few years, where patients of all income levels are able to access the technology offered by HLI, including whole genome sequencing as a birthright, whole-body MRI performed annually (the scanners used at the Health Nucleus do not involve radiation, so annual exposure is not a concern), and extensive blood work that encompasses a range of tests that are typically not conducted on a pre-symptomatic basis. Eventually, says Karow, insurance companies will cover these tests. Life insurance companies are already on board. Every extra year a patient lives to pay their premium is a good thing

for them. Soon the public is going to demand coverage, and politicians will pressure the broader health insurance industry to adapt to the new preventive care paradigm. “Despite the $3 trillion that we spend in the US on our current healthcare system—17 percent of GDP—it’s still a fact in this country that if you live to the age of 50, you have a one in three chance of not making it to the age of 75 due to morbidity and mortality from chronic age-related disease. And that crosses all economic groups. Not to be too hyperbolic about it, but I think in a way consumers—our clients anyway—get a sense that with the current healthcare system, they maybe got ripped off.” Karow believes that as the company scales, the technology will be democratized, and there will be a positive feedback loop where consumers tell their friends about the unexpected things they’ve discovered about their bodies, and those friends will tell their friends, until eventually everyone expects this level of preventive analysis as a baseline standard in healthcare. The quest for longevity and even immortality has captured the human imagination for millennia, from the Greeks’ Elysium, to the fountain of youth, to Shangri-La. Scads of “antiaging” startups in California have followed in the footsteps of these dreamers. HLI, in contrast, offers a chance at a better quality of life within the average human lifespan, through a revolutionary new preventative care model. And if Homo sapiens from all walks of life can stay healthy throughout our short time on earth, such an advance would be well worth celebrating.

MESSAGE IN A BOTTLE AdhereTech’s smart bottle, received the GOOD DESIGN award, and was featured in “Access+Ability,” an exhibition of health technology exhibit at Cooper Hewitt, Smithsonian Design Museum in New York City. 82

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When Forgetting a Dose Isn’t An Option Medication adherence is one of the Holy Grails of health innovation. Getting patients to take the right pills at the right time, for the right duration, saves lives, saves the health system money on bouncebacks, and increases revenue for drug makers. AdhereTech has combined the Internet of Things with awardwinning design to create a device that may finally crack the code on adherence.

PHOTOS BY PAUL NEWSON

by Scott Jung You could say Josh Stein is following in his parents’ footsteps, but that would only be telling a fraction of this Health Transformer’s story. Once a fresh-faced MBA student at the University of Pennsylvania’s Wharton School of Business, Stein says he hoped that the company he would start would be in the same industry as his parents – healthcare. Now CEO and co-founder of AdhereTech, Stein kept his word, but is more than an adjacent player in the space. He is creating head-turning digital disruption, using smart pill bottles to address gaps in healthcare, especially in the area of speciality medication adherence. Stein came up with the basic idea of a smart pill bottle in 2008. While at Wharton, he incubated the idea, refined it with the help of his pro-

fessors and classmates and formally launched AdhereTech in 2011. The company targets patient consumers and providers of speciality drugs. And for good reason. While no strict definition of specialty drugs exists, they are commonly thought to require: prescription by a specialist; special handling; intravenous administration; and a high degree of patient management to ensure compliance and safety. The current statistics for speciality medication add up to a dismal reality. Express Scripts, one of the nation’s largest pharmacy benefits managers projects reported that almost 40% of drug spending was represented by specialty medications, with that number predicted to to hit $1.7 trillion by 2030. The impact on a patient’s health for missed doses of speciality drugs can also be a matter of life and death. The Centers for Medicare & Medicaid Services (CMS) reports that nonadherence causes ~30% to 50% of treatment failures and 125,000 deaths annually. Missing a dose of any doctor prescribed medicine is an area of great concern amongst the health community, but missed doses of speciality medication is not only bad for health, costs quickly add up. A Product that Is So, So Simple

AdhereTech’s technology aims to track and improve medication adherence in real-time, and to address the complexities of medication nonadherence while making the user experience as seamless as possible. “One of our core philosophies,” says Stein, “is that a product has to be so, so simple in order for someone to use it.” The bottle itself is subdued and minimalistic: a seemingly ordinary, plastic white pill bottle with an LED ring encircling it, topped with a standard child-resistant cap. There are no extra costs or setup involved; 83

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the bottles are paid for by drug companies and given to the patients prefilled with the medication and also come fully-charged with more than six months of battery life. Hidden in the bottle is a sensor that can determine when it was opened or closed. A cellular chip sends and receives data to and from AdhereTech’s secure cloud platform in real-time to analyze it, delivering necessary reminders to the bottle using lights and chimes or to the patient and/or caregiver using text messages or phone calls. AdhereTech can also give detailed feedback to pharmaceutical companies on how their drugs are being used by patients, and why patients stop using them, an incentive for drug companies to pay for the smart pill bottles. That means, in addition to curbing medication nonadherence for the patient, the company’s competitive edge is sharpened by its proprietary database and the ability to offer insights from its patient adherence data. 84

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Medication Non-Adherence: Poorer Health for Everyone

Just how big of an issue is medication adherence? According to one of the most cited articles on medical adherence published in 2005 by Lars Osterberg, MD, and Terrence Blaschke, MD in the New England Journal of Medicine, medication non-adherence is responsible for 125,000 premature deaths in the US every year. More recently, the Oman Medical Journal released a study in 2011 that found that the risk of hospitalization is twice as high in chronically ill people who do not follow a prescribed medication plan, compared to chronically ill people who do. When patients miss their medications, they have poorer health outcomes, and that has a negative impact on the economy. In July 2018, The Permanente Journal reported that the financial impact of people skipping their medications is an estimated $300 billion in increased medical costs and $100 billion in

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lost revenue annually. These challenges have shaped Stein’s strategic vision for AdhereTech. Since its launch, the company has evolved from “just a smart pill bottle developer,” to an adherence platform that weaves in behavioral change strategies. These days, Stein says he considers AdhereTech as more of a software and services company that is driven by its smart pill bottles. “We like to think about our offering as less about the physical pill bottle and more about providing patient support programs,” Stein said in a recent interview with health technology blog Medgadget. A Moonshot Vision For A Specialty Market

Stein’s strategic vision for AdhereTech has kept the Health Transformer and his company agile in an ever-evolving and complex healthcare industry. In a 2018 interview with Unity Stoakes, StartUp

5 Stein came up with the basic idea of a smart pill bottle in 2008. While at Wharton, he incubated the idea, refined it with the help of his professors and classmates, then formally launched AdhereTech in 2011.

According to one of the most cited articles on medical adherence published in 2005 in the New England Journal of Medicine, medication nonadherence is responsible for 125,000 premature deaths in the US every year. Health’s co-founder and president, Stein took note of potential obstacles: “In any entrepreneurial journey there will be speed bumps that you have to overcome,” he said, and then summarized his approach: “Keep your head down and work through it.” At the beginning of November 2018, Stein’s perseverance paid off when Argentum—a growth equity firm that provides capital and strategic guidance to high-growth companies that focus on software, technology-enabled services and healthcare-solutions—invested in AdhereTech’s latest round of fundraising, with follow-on capital from StartUp Health’s Fund II. The investment will be used to expand smart pill bottle technology into additional healthcare verticals and further enhance data analysis and engineering applications. That said, Stein isn’t going after the major pharmacy chains—yet. Instead, he’s aimed to build partnerships with specialty pharmacies, who he felt would benefit from a more rigorous drug “verification” system. These pharmacies carry less common medications that are often used to treat rare diseases, and, as a result, are often more expensive. Both patients

and pharmacies alike benefit from the patient reminders and additional data generated by the platform. AdhereTech’s bottles are also used by academic researchers and drug manufacturers sponsoring clinical trials. In clinical research, it is critical that study subjects strictly follow the schedule for taking an investigational drug or placebo, and the AdhereTech platform can help ensure that the clinical data isn’t affected by a subject’s failure to take a scheduled dose. Academic researchers can likewise use the data generated from the AdhereTech platform to quantify whether its behavioral experiments are making any headway in solving the difficult and complex issue of medication non-adherence. The company’s current clients include the NIH, Verily Life Sciences, the US Department of Veterans Affairs, St. Jude and other leading children’s hospitals, as well as several Ivy League universities. Milestones

Since 2011, AdhereTech has been able to partner with nearly all of the top specialty pharmacies in the US. One of them, Avella, an American specialty pharmacy company that serves patients in all 50 states, released data earlier this year showing that AdhereTech pill bottles have improved duration on therapy by 26%, fill rates by 9% and dose-level adherence by 15%. On average, the AdhereTech program generates one to two additional fills of specialty medications, per patient per year. With estimates like the World Health Organization’s predication that by 2020 about 157 million Americans will have at least one chronic condition requiring medication therapy, generating refills of medications per patient is a hefty and healthy win. The smart bottle, which has garnered accolades like the GOOD DESIGN award, was featured in

“Access+Ability,” an exhibition of health technology exhibit at Cooper Hewitt, Smithsonian Design Museum in New York City. A central component of the AdhereTech platform is the real-time collection and analysis of data, not just from the pill bottle, but also from patient reminders sent out and from the pharmacies themselves. “AdhereTech is collecting real-world data about how patients take their meds, which has never been collected before in human history at this scale,” Stein says. AdhereTech overlays this data with additional inputs that its platform collects, such as reasons for missed doses, adverse events and other data input by both patients and pharmacists. The resulting analysis allows for a more granular understanding of the patient journey, which AdhereTech uses to deliver customized support to patients based on their specific needs. The information also provides insights into the behavioral shifts necessary to promote medication adherence. Behavioral change is the linchpin in the quest for medication adherence. The desired outcome, of course, is that a patient will take her medication in the right dose at the right time. As AdhereTech continues to evolve its approach and technology, missed doses may become as obsolete as the pills bottles of yesteryear.

Leapfrog Innovation in Latin America Instead of re-inventing the healthcare wheel, or borrowing wholesale from more digitally-advanced systems, these entrepreneurs are curating the best solutions and adapting them to their unique environment. by Christine Grillo 86

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When Argentinian engineer Matías Spanier was diagnosed with a chronic disease, he made the typical rounds to a series of doctors from various specialties. During this process, Spanier realized that some of the doctors requested the exact same diagnostic tests, but almost invariably, the results were stored on paper charts, making it nearly impossible to share with other members of the medical team. That was when he started thinking about how to build a digital health solution that would integrate all the existing information about a patient into one electronic record so that medical teams anywhere could use it. ~ Within the world of health technology, Spanier’s story isn’t particularly unique. Across the globe, from Boston to Beijing, this frustration at a lack of digital health connectedness has led to a health data revolution. But South America, where Spanier is focusing his company’s attention, is at a crossroads, and offers digital health innovators a unique set of challenges and opportunities. The southern continent wears many of its health challenges on its sleeve. Despite moves towards universal healthcare, ac-

cess continues to be a challenges. According to the World Economic Forum, approximately 30% of the population in Latin America lack access to health care for financial reasons while 21% face geographical barriers. Few countries in the region meet international standards for the number of available doctors or hospital beds, and when they are available, they’re often concentrated in urban centers. Those who seek to address South America’s healthcare challenges are faced with economic instability – massive inflation and rapid currency devaluation are not easy on a company’s growth. It’s within this environment that entrepreneurs like Spanier have made their mark. The result has been an ecosystem of startups that have learned to be hyper-adaptable to changing conditions. “You have to develop a special set of skills in order to survive the turmoil,” he says. “In the US you might have an economic crisis every 70 years or so, while in Argentina it seems like it happens every five to 10 years.” Political instability poses other challenges, as well, such as the exodus of experienced medical professionals, which results in “brain drain.” But brain drain turns out to be one of the challenges that makes healthcare tech innovations more valuable: the technology can fill gaps and provide more standardized health care when resources are strained. Innovators in Latin America are also taking advantage of the huge technology gaps between the US and their countries. Currently, Latin America’s digital healthcare infrastructure is rudimentary in comparison, often limited to scheduling appointments and online bill paying. By learning from what has worked in more technologically advanced nations, innovators identify how to fine-tune advancement

for Latin America. Instead of reinventing the wheel, they adapt and improve for relevance. Electronic health records (EHRs) is one example: the US market has a multitude of choice, but Latin America healthcare systems are hungry for a breakthrough platform. Furthermore, for these entrepreneurs, the market is wide open, because Latin America has so far been largely ignored by Europe, Asia and North America—and yet its proximity to North America (and convenient sharing of time zones!) make it easy to learn and collaborate. Emphasis on Interface at Omnia Salud

Based in Argentina, Omnia Salud was co-founded by Spanier, software engineer Alejandro Bologna and physician Maura García Aurelio. The trio developed their eponymous product in constant collaboration with a team of ten people. Trained in cardiology and medical informatics, García found the existing Argentinian systems clunky. “The current systems are not modern or cloud-based,” says García. “They’re systems from the 1980s.” Omnia Salud provides a way for all members of a patient’s medical team to connect digitally, to have access to the same records and to collaborate. Omnia Salud is cloud-based and can be accessed from any computer with an internet connection—which means that clinics and hospitals save money since they don’t have to build special servers. Argentina’s major cities have excellent connectivity, but even in small towns Omnia Salud is having success with the product. They’re doing trials in small towns all the time, and the country’s internet connectivity is improving steadily. But the real beauty of the product, says García, is its user interface and user experience. The team refers to the platform as being “physiciancentric,” because it was designed first and foremost to assist medical teams.

“The main idea is to add real value,” explains Garcia. “Because data until this moment has not been useful for doctors. Our idea was to create data that’s useful.” To determine what would be, the founders surveyed medical professionals—doctors, nurses, pharmacists, psychologists, physical therapists—and asked them what kind of electronic system they would like to use, and how they’d like to use it. The result is that Omnia Salud has a user interface tailor-made for each type of professional. So, for example, when a nurse opens Patient X’s record, he sees something different than when Patient X’s physical therapist opens the record. All the patient’s data is in the record—but it’s presented differently according to who’s looking at it. The data available in every patient record includes everything that would be part of what Omnia Salud calls a patient’s “program,” that is, their procedures, challenges, lab results, notes, X-rays, images and other records of their condition, diagnosis and treatment. The founders are continually making the platform ever more robust by adding new sections to it, such as mental health and gastroenterology. The team is now building a section on fertility, and soon hope to implement a pharmacy module that simplifies prescriptions for the doctors and the patients. A patient portal is in the works for next year. Omnia Salud charges providers a monthly subscription fee to use the product, the fee determined by the size of the setting. So far the feedback has been very good, and Omnia Salud is being used in more than 80 clinics with 100,000 patient records. “We’re planning to expand to other countries,” says García, “Chile, Peru, even Mexico.” Standardizing Care with OTAWA

OTAWAhealth is the brainchild of three brothers, Cid, Sergio and Paulo Gusmão, who run Centro de Com87

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bate ao Câncer (CCC), one of the top cancer clinics in Brazil. Cid is the doctor, Paulo is the IT guy and chief information officer and Sergio is the finance expert and chief executive officer. Like García in Argentina, they were also inspired to build a digital platform to improve their healthcare system—and they knew that the product needed to start with the physicians instead of with the billing and scheduling components, which is what the previous generation of portals focused on. Their insight led to two products, OTAWAonco, which focuses on cancer care, and OTAWAcare, which facilitates collaboration among all parties involved in the health care delivery of a patient. The brothers chose oncology to start building their app, because cancer care is well standardized around the world. Regardless of which country they’re in, oncologists use the international classification of diseases (ICD) to identify the type of cancer. A breast cancer patient will have the same code whether she’s in Brazil, the US or China; lung cancer has a different code, as does liver cancer, and so on. Paired with that is another globally recognized standard for classifying cancer, the TNM classification of malignant tumors. “T” describes the tumor, “N” indicates the nearby lymph nodes and “M” refers to malignancy. As with the ICD, each tumor gets assigned a specific code composed of letters and numbers. The physician enters the ICD and the TNM, or staging, of the cancer for each patient into OTAWAonco, where those codes determine the treatment protocol for the patient. From that point on, any attending medical team can easily tap into the global body of knowledge about the best ways to treat that particular combination of ICD and TNM. “It’s important to do this,” says Sergio Gusmão, “because a new doctor who’s just graduated will use our sys88

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tem and will be able to treat patients using the knowledge of more sophisticated doctors. Once a protocol is determined, only that protocol can be used.” So that doctor, whether a rookie or a seasoned professional, is only able to see information about the globally accepted best treatment for the patient. This is critical, Gusmão explains, because one protocol for one stage of cancer could benefit the patient, while the same protocol might harm a patient at a different stage. “This product prevents human error,” he says. Like Omnia Salud, OTAWAonco and OTAWAcare were born with the goal to make care more effective. “We started with the real client: the doctor, the nurse, the nutritionist, the pharmacist. They tell us what they need,” says Gusmão. The product is so helpful that, five years ago, a psychologist at CCC approached the team and asked to have a psychology section added to the product. “She told us it transforms the way she works,” says Gusmão. The brothers added a psychology section. Since 2010, the mobile app, OTAWAcare, has been used in the treatment of more than 6,000 patients, and OTAWAonco is used at the CCC to manage all aspects of care delivery. Expanding Services and Breadth

Although they are some of the largest solutions, by no means are OTAWAhealth and Omnia Salud the only physician-centered health tech products in Latin America. The trend seems widespread: expanding beyond—way beyond—the traditional patient portal that assists with appointments and billing, and offer health care value to both the medical team and the patient. MedCloud, headquartered in Brazil, is a digital solution that offers support in the field of radiology by storing images, test results and other data. It even offers support to patients by allowing

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Innovators in Latin America are taking advantage of the technology gaps between the US and their countries. By learning from what has worked elsewhere, innovators identify how to fine-tune advancement for Latin America. Instead of reinventing the wheel, they adapt and improve. them to listen to the voice of a radiologist explaining test results. Argentina-based FutureDocs, offers a product called ConsultorioMovil—free to doctors and patients—that helps to manage chronic disease, especially in the fields of dermatology, neurology, rheumatology, diabetes and ophthalmology. What started with “pill reminder” apps has become more robust, offering information and tools that help patients achieve better adherence, which translates to better outcomes. It seems that entrepreneurs such as Spanier, García and the Gusmão brothers have figured out how to turn the challenges of Latin America into opportunities. They observe what’s happening—and what is successful—in more technologically advanced regions, and then they adapt. They identify needs specific to Latin America, such as resource gaps and rudimentary tech, and they innovate. They anticipate and ride out economic stability by staying flexible. In the end, this cohort of engineers and medical professionals are developing products that fill a gap, make medical data useful and provide better healthcare delivery—and posting impressive growth while doing so.

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INDUSTRY INFLUENCERS --

How Healthcare Heavyweights Are Shaping Digital Health Transformation A linchpin of any successful health moonshot is radical collaboration â&#x20AC;&#x201C; silo-breaking, aisle-crossing, globe-spanning collaboration. Âś For StartUp Health, that has meant partnering with industry veterans like those on the following pages, who have a mind to rethink old problems and have the muscle to see moonshots to completion.

INDUSTRY INFLUENCERS katya hancock

StartUp Health’s New Fund Unites Industry Heavyweights with Health Transformers A conversation with Katya Hancock, StartUp Health Investor Relations Director & Partner

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Global Thesis StartUp Health portfolio companies are in 22 countries across 6 continents.

Industry Reach “We’ve had over 5000 companies apply to StartUp Health since 2012 and we have 10,000 companies in our proprietary database.” -Hancock

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On StartUp Health’s most recent fund, Transformer Fund II

Like our first fund, Fund II invests in Health Transformers committed to achieving health moonshots. The fund is designed to support companies through StartUp Health Academy – our coaching platform – and the StartUp Network, our media platform. In addition, StartUp Health Ventures evaluates portfolio companies for potential follow-on investing when they break out and hit specific milestones. A portion of this fund is allocated specifically for follow-on investments. When we invest, that investment comes backed by the full power of the StartUp Health platform. We put the wind at their backs and share their stories with the world. We also bring a powerful cohort of likeminded co-investors to the table in the form of our LPs. And it goes beyond our LPs. We’ve been building relationships with some of the best investors in the industry for the past seven years. Some of those investors have invested in our funds and many have invested in our companies in the past and appreciate that we are vetting the vast universe of startups in our industry and are able to bring deals to them. This cohort of co-investors is incredibly valuable. The fund really has unparalleled StartUp Health Magazine

Why are there are so many pharma companies in the fund?

Pharma companies aren’t all created equal. Some are more embracing of innovation and have more mature digital strategies than others and they see that they need to go “beyond on the pill”. The average cost to bring a drug to market from beginning to end now is over $2B. Say only 10% of potential patients even know about the drug or have the information they need to continue using the drug effectively. What is that pharma company going to do? They have to use digital solutions to engage patients and treat them as a consumer. They need to support their core products in innovative ways to ensure their efficacy. The pharma companies that joined Fund II are on the front edge of this trend. On brokering high-level collaborations

deal flow. We’ve had over 5,000 companies apply to StartUp Health since 2012 and we have 10,000 companies in our proprietary database. Investors know our decisions are backed by significant data, and that we can identify innovative health solutions emerging in the market.

We’re connecting the dots and helping ensure that the parties in the fund are like-minded and have a similar mindset. It’s an important way for companies to identify who else in the market has an aligned vision and commitment to reimagine health. We provide opportunities for them to connect at events like the StartUp Health Festival.

On the industry’s reaction to the Fund II announcement

How is StartUp Health’s business model unique?

The reaction has been overwhelmingly positive. The industry is excited to see us succeed because we’re an indicator of the robustness of the early stage digital health ecosystem. We’ve been around for over seven years now, our thesis from day one has been to provide long-term support for our companies. The progress our portfolio has made and also caliber of LPs we’ve brought together in this fund are both significant milestones for us and further underscore that our approach is an effective one.

We are fully aligned with our founders and only succeed when they do. We have built a modern media company and essentially our own printing press, to tell our company’s stories every week, month and quarter to the stakeholders and consumers that matter. We embrace moonshot thinking, and coach our Health Transformers to do so too. We truly believe that on the path we’re on we can improve the lives of billions of people around the world.

Partnering to Achieve the Impossible Each investor in StartUp Health’s Fund II brings a unique ability to advance health moonshots globally. Katya Hancock explains: NOVARTIS -“Novartis has massive reach in terms of their distribution, businesses and the amount of patients and providers that they touch. The number one thing about Novartis that appealed to us from our first meeting was the high caliber of people leading the organization. It starts at the top with their CEO, Vasant (Vas) Narasimhan, MD. Vas has an energy, an open-mindedness and an ability to tolerate risk that’s different than most pharma CEOs. He’s brought on leadership in both their global and US businesses that have a similar mindset. He created the role of Chief Digital Officer, and brought on Bertrand Bodson from outside the industry. Not many pharma companies have a Chief Digital Officer, let alone one that has full access to the CEO and is extremely influential across all business units. That speaks volumes on its own about their commitment to this space.”

PING AN -“Ping An is the largest insurance company in the world. Jonathan Larsen, the CEO of the Ping An Global Voyager Fund (a $1B fund) ran a big piece of Citigroup’s business in Asia and had over 80,000 people reporting to him. In terms of health innovation, Ping An has built the Good Doctor telemedicine platform which spun out for its own $1B IPO in 2018. They have the ability to add new health solutions to their platform incredibly quickly and roll out new health solutions to millions of people across China. They also have an incredibly sophisticated understanding of global markets and and Chinese healthcare landscape because of the team they’ve recruited and the scope of the organization. This is critical as we work to tie leaders together around the globe and encourage cross-pollination at a whole new level.”

CHIESI -“Chiesi is a family organization, run by a brilliant group of people based in Italy. StartUp Health is Chiesi’s first investment into the digital space, but they’ve come in ready to make major moves and partner with companies at a commercial level. Their clinical focus is in respiratory but they’ve also developed lifesaving neonatal drugs, which is an exciting addition to our Children’s Health Moonshot and have some life-changing rare disease drugs. Rare diseases are so underserved in terms of research dollars, and if you’ve spent any time with rare disease patient communities they are truly inspiring. Strategically, we’re also excited to have a member of the fund with deep roots in the European markets. Chiesi has decades of experience with the regulations that affect consumers in health across the continent.”

OTSUKA -“Otsuka’s main focus is on mental health, which aligned perfectly with our Mental Health and Happiness Moonshot. It’s critical for us to work with partners and LPs who are moving the needle in these areas. They’re also a Japanese company, and there’s some very interesting technology coming out of Japan, particularly in the aging space. In getting to know Otsuka’s leadership we’ve found them to be a very likeminded partner, and one we’re excited to do more with over the years.”

MASIMO -“Masimo was founded in the late 80s by Joe Kiani, a man who was seriously ahead of his time. He built the company from the ground up, took it public, scaled to a very profitable business, and is still their CEO. The device company has been a pioneer in patient monitoring and has a strong footprint at nearly every hospital. But it comes back to the entrepreneurial mindset – which Kiani and Masimo have in spades.

GUIDEWELL -“GuideWell is the Florida Blue Cross Blue Shield plan. It’s really significant for us to have one of the Blues as a partner because the Blue plans cover so many American lives and they collaborate with each other. GuideWell, specifically, covers the majority of Floridians, with a high elderly population. This is important to us, given the focus of our Longevity Moonshot to add 50 healthy years to everyone’s life. The team at GuideWell is also forward-thinking. They have the GuideWell Innovation Center on the Lake Nona campus where they’ve been supportive of the ecosystem over the years, and have a big focus on solving the opioid epidemic, which is a critical issue.”

STARTUP HEALTH

HQ 6

Connect with investors dedicated to achieving health moonshots on StartUp Health HQ 6 startuphealth.com

INDUSTRY INFLUENCERS bertrand bodson

NOVARTIS

Giving a Pharma Giant a Tech Startup Makeover Bertrand Bodson, the new Chief Digital Officer at Novartis, is only a year into his post, yet he’s already changing the DNA of the pharmaceutical giant, building on his years spent transforming retail experiences. Interview by Logan Plaster

HQ Basel, Switzerland CEO Vasant (Vas) Narasimhan, MD Top-Selling Drugs (‘17): 1. Gilenya 2. Cosentyx 3. Gleevec/ Glivec 4. Lucentis 5. Tasigna 23,000 scientists, physicians, and business professionals Research and Development sites in more than 80 countries worldwide. News Novartis recently launched Biome, a “digital innovation lab” geared to accelerate the growth of health tech startups.

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You started with Novartis in January 2018 after more than a decade working in digital transformation within the retail industry. Tell us more about your background.

I started at Amazon more than 15 years ago when it was still what I’d call a “startup plus.” That was fascinating and I’ve been involved in digital transformations ever since. I ran my own business, and then I helped transform Argos, a brickand-mortar retailer in the UK into a digital e-retailer that could compete with Amazon. We took our smallformat stores and turned them into a new kind of asset by leveraging those stores as local distribution centers and reshaping the buying experience completely. You could order your washing machine online at 6pm and have it delivered before 10pm the same night. That work helped Argos catch the eye of Sainsbury’s, which is like the UK version of Walmart, which acquired Argos in 2016. How would you characterize the transition from retail to pharma?

It’s a whole new world. There is a lot to learn, especially from a biology and science perspective so one can be credible and understand the business challenges. There are also a lot of analogies between the two worlds. The markets I worked in previously got disrupted quite dramatically, and now you see all the same signs in healthcare with the likes of StartUp Health Magazine

Google, Microsoft and Amazon, all moving into this space. When you see the startups, the vibrancy of the StartUp Health ecosystem, you can sense that it’s really time for something big to happen. This period of disruption is an incredible opportunity. I love StartUp Health’s health moonshots, and this is our chance to have our own, with the muscle of a $200 billion market cap organization that spends $10 billion each year on R&D. I couldn’t resist the challenge. There are also a lot of analogies in terms of mindset. How do we use data wherever we can to enhance the customer experience, especially those that have a 50% drop-off rate in terms of medication adherence? How do we build the right tech infrastructure and backbone? How do

we create systems that meet patients and doctors wherever they are, rather than requiring them to come to us? How do you create more nimble teams? At Amazon we called them “two-pizza teams.” If a team was too big to share two pizzas, you had to break it down. So the question became, how do we bring this entrepreneurial spirit into Novartis. That’s a core element of my role. How have you seen tech solutions begin to manifest during your first year as Chief Digital Officer at Novartis?

The appetite for change is massive and we’re seeing it across the organization. In November we announced the launch of reSET, the first FDAauthorized prescription digital therapeutic for Substance Use Disorder,

which we’ve launched in partnership with Pear Therapeutics. This shows how we’re using data and digital to reimagining medicine. If successful, this could open up the entire area of digital therapeutics. In terms of research, we’re mining more than two million years of clinical trial data and pre-clinical data to find new biomarkers and new nd points for example. This is happening on all of our major brands; we’re right in the thick of it. In clinical trials, we’re working with partners like Science 37 on decentralized trial models to help address the fact that only five percent of eligible patients get access to clinical trials. Instead of requiring them to come to us, we’re using telemedicine technology to bring trials to patients. In the commercial space, we’re working with Aktana to equip our 20,000 pharma sales reps with an AIpowered digital assistant that mines data from the 100,000 interactions they have with doctors each day to help make their meetings as personalized and meaningful as possible. We are starting with a focus on our two biggest products Entresto and Cosentyx and are currently live in six priority markets. What have been some of the challenges of bringing digital transformation to such a large organization? How can you do it successfully?

Thankfully, there is a massive appetite for this change among the executive team. Together we committed to what we call our 12 digital lighthouses, which are priority areas where we want to have significant impact. For those we agreed to commit the resources, budget, teams and attention needed to go after them at scale. More importantly, we’ve embarked on a cultural transformation at Novartis, encouraging teams to be inspired by curiosity and adopt an entrepreneurial mindset.

One of my key priorities is to take the 120,000 associates working at Novartis and bring them onboard with this digital transformation. For some of them, it’s about demystifying what data and digital is all about. For others, it comes down to running simulations to give people the opportunity to get hands-on with our data and systems. But the big challenge is how we change the way we work to be more agile. That requires daily stand-ups, regular meetings to assess progress and getting the right people around the table. It requires breaking things down into more of a startup mentality, while still maintaining Novartis’ muscle. That sounds like a massive organizational shift. How much of this challenge is around mindset, versus being a technological challenge?

Half of my job really is about helping create the right company culture and it helps that we’re reshaping the company culture more broadly, something Vas our CEO, is championing across the organization. If this cultural shift is a success, what will Novartis look like three to five years from now?

I’d love it to feel like “StartUp Novartis” to some extent. I want it to have that kind of pace without us losing our muscle and ability to scale. I want to see us embracing partnerships in even greater ways, hence why we recently launched the Biome and HealthX, a digital innovation lab and series of open innovation challenges so we can better partner with the health tech ecosystem to develop digital solutions that scale. This is all helping boost the entrepreneurial mindset within the organization, that natural curiosity to know more about technology and the ways in which data and digital can help us. I’m also massive on partnerships because I fundamentally believe that the world will change dramati-

Half of my job really is about helping create the right company culture . . . I’d love it to feel like “StartUp Novartis” to some extent. I want it to have that kind of pace without us losing our muscle and ability to scale. cally in the future. It won’t just be big pharma because we don’t have all the answers. Many people out in the market are part of the answers and they could be incredible partners. I’m not a big fan of vendors, and people at Novartis know that, but I’m a massive fan of partners. When you enter a world where science, data and technology are really getting closer to each other, the question becomes, how do we find the partners who can really help us accelerate growth? How do we show those potential partners that we’re open for business? Who is an out-of-the-box partner on your radar?

We are really interested in China and the ways in which the country has completely reshaped its health system in the last three years. There are 700 million people using WeChat and now they’re using that infrastructure to deliver AI-powered triage, telemedicine through WeDoctor and built an insurance layer into it as well. Earlier in the year we launched a pilot with Tencent in China that involves adding QR codes to the labels of Entresto and Exforge, two 95

What advice do you give to entrepreneurs interested in partnering with a top tier pharma company?

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Where do you see great untapped opportunities for health entrepreneurs going forward?

What common themes have you seen in working with entrepreneurs lately?

I love seeing these two worlds collide, because we have so much to learn from each other. I see it with our recent partnership with Pear Therapeutics, to some extent. They naturally say, “Guys, let’s move so we can bring good ideas to market faster!” On the Novartis side, we say we have to build the infrastructure to support it, making sure we have reimbursement, patient support, regulatory frameworks, etc. It can be a sort of marriage of adults and adolescents that I find brilliant, each pushing the other. The key is for us to be clear about what we’re really good at, where we can help startups and where we need to get out of the way. For instance, in pharma right now we are generally not good at creating great customer experiences. We don’t excel in user design. Often we’ll do a project and then we’ll think we’re done, whereas any good startup in the world would keep iterating, and sees their first version as their worst version. How do you cultivate your own sense of curiosity in this new role?

I feel like I was born curious and the jump to the pharma space is a sign of that. There’s a lot of reading that goes into it. I’m taking some classes at MIT right now on the fundamentals of biology, to make sure I can understand the basics of the science. I have tutors at Novartis who are helping me better understand our key drugs. I’m spending a ton of time on R&D from that point of view. To a broader extent, being exposed to startups offers a wave of curiosity and new ideas.

StartUp Health Magazine

“Many researchers at Novartis are pursuing the possibility that AI could help explain why some patients respond to therapy when other seemingly similar patients do not. To explore this further data scientists have joined forces with tech startup PathAI to train an AI system to learn to see the same patterns pathologists see.” "

It can be hard for an entrepreneur to work with pharma, whether it’s a team of three or a more mature startup that’s raised $40 million. These organizations are large so it’s difficult to find an entry point and when you do you get bounced across different divisions. There’s incredible speed on the entrepreneurs side and incredible strength on the pharma side. So we spent time thinking about how we could make this much easier, and show that we are serious. That’s why we created the Novartis Biome digital innovation lab in San Francisco. It’s not only a co-working space, but provides participating partners with access to a custom 12-month curriculum and internal mentors. We asked entrepreneurs: What else do you need from us? Many said that they needed data. So we’ve been working on building some personalized sandboxes for startups, depending on their needs. Others really wanted to get access to validation studies in real clinical settings. That’s why we created a partnered lab with HITLAB and Columbia University. The partnership with StartUp Health really makes sense in this regard too because instead of building it from scratch, we’re considering how we can tap into this “global army for good.” That doesn’t mean that

every startup will become a partner, but it creates a culture of collaboration and entrepreneurial spirit which is so important.

key cardiovascular drugs, which patients can scan via WeChat for more information on the drug, disease, reimbursement and to see whether or not the product is counterfeit. This is a good example of how by using the expertise of both parties we can unleash the potential of data and digital to enhance the patient experience, and eventually provide better care to people in need. It’s really a foray into reimagining healthcare as we know it.

We have 6,000 scientists, 250 data scientists and 20PB of data. We have and are managing more data than ever before, it is also more complex and we are focused on finding new insights, faster and with more accuracy than ever before. Within research the acceleration of AI has opened up the possibility to generate insights and find patterns that are beyond traditional human capabilities. For example, many researchers at Novartis are pursuing the possibility that AI could help explain why some patients respond to therapy when other seemingly similar patients do not. To explore this further, data scientists have joined forces with PathAI to train an AI system to learn to see the same patterns pathologists see. This is part of a larger effort at Novartis to leverage data and digital technologies in ways that could help drug developers bring drugs to market faster – something we are deeply committed to. From a commercial perspective, we have 12 mega launches coming up in the next three years. That’s massive for us. If I were an entrepreneur, I would look at these launches and really try to understand them and see what the key pain points for each are. I would look at the big gravitational centers in pharma and help address those issues. I’d encourage entrepreneurs to be at the core of the dialogue that we’re already having. Final Remarks

It still takes 10 years and $2.5 billion to get a drug to market. Somewhere there must be a better way to do that. We need entrepreneurial blood, data and scientific knowledge to come together to reimagine medicine. That’s our moonshot, and we’ll take all the help we can get.

INDUSTRY INFLUENCERS giacomo chiesi

CHIESI

Consider the Middle Mid-sized pharmaceutical companies seem boutique compared to their Fortune 100 counterparts, but with revenues in the billions, they offer a unique opportunity for targeted digital health partnerships. by Giacomo Chiesi & Ameya Phadke

HQ Parma, Italy CEO Ugo Di Francesco (Mar 2012–) Revenue 1.69 billion EUR (2017) Number of employees 5,300 Founded 1935

Call for Innovation StartUp Health and Chiesi are excited to announce a Call for Innovation to find companies around the globe focusing on a critical need: rare disease solutions.

The last several years have seen a massive uptick in partnerships between the pharmaceutical industry and digital health companies. Whether you look at commercial deployment deals aimed at a digitally-enabled pharmaceutical product (like Otsuka’s $88M embedded pill partnership with Proteus), the creation of new companies (such as the Sanofi’s JV with Verily), or multibillion dollar acquisitions (like Roche’s $2.1B acquisition of Flatiron Health), it’s clear that pharma companies are a growing part of the digital health boom. The pharma companies just mentioned are household names, sitting among the largest pharma organizations in the world. But there’s a group – and an opportunity – that tends to be conspicuously absent from the public eye: mid-size pharma. These are pharmaceutical companies that may sell billions of dollars worth of therapeutic products annually, yet fly under the radar to some degree, and certainly don’t get the same level of press coverage for their digital health initiatives. That begs the question: “What role does mid-size pharma play in the digital health boom?” At Chiesi, we’ve seen the opportunities and the promise firsthand, and believe that there’s some unique advantages that being a mid-size pharma company has given us in our digital journey. For starters, it’s important that we

large internal teams focused on digital health. In the end, though, the greatest potential advantage in partnering with a mid-sized pharma company is this: Focus. These companies often have a focus on key therapeutic areas, focus on geographies and focus on key business needs.

define what “mid-size” means. From our perspective, if you rank biopharma companies based on revenue, this segment would roughly cover companies ranked between 30-65 on the list. The typical mid-size biopharma company does between $1B-$4B in annual sales. They are often concentrated in a smaller number of therapeutic areas than their larger peers, and while they’re typically multinational, they often have a specific geographic as well. To get more concrete, we’ll use our company, Chiesi, as an example. We are focused in three therapeutic areas: respiratory care, neonatology and special care/ rare diseases. We did roughly €1.7B in revenue in 2017, and while we sell our products all over the world, a significant amount of our commercial footprint is in Europe. What’s significant, beyond these statistics, is that most mid-size pharma companies, like Chiesi, are early in their adoption of digital health, and in many cases, don’t yet have

Here are three things we’ve learned about the value of focus and how it can benefit digital health partners. #01

FOCUSED USE CASES Companies in the mid-size pharma segment sell products across, on average, about 6 out of 13 possible broad therapeutic areas. Compare that to the top 10 largest biopharma companies, which sell products across almost twice that many therapeutic areas. What does this mean for a startup? Quite simply, it means that the smaller entity may have a more coherent digital health strategy and a more unified set of digital initiatives across which to spread a limited pool of organizational resources. In other words, founders can avoid being a small fish in a very large pond. If you’re one of a small number of 97

digital health partners that could define the success or failure of a partner’s digital health strategy, you’ll be a higher priority for them, and thereby get access to their internal resources and knowhow.

#03

FEWER INTERNAL HEADWINDS

#02

AVOID DEATH BY A THOUSAND PILOTS The reality is, mid-size pharma companies often lack the interest (and candidly, the bandwidth) to engage in seemingly endless cycles of exploratory proofs of concept, without a strategic decision at the end of it (or a concrete benefit). So, these companies are less likely to embark on a digital health collaboration unless there’s some significant tangible benefit to them that might trigger a bigger picture decision. Rather, if there’s a concrete opportunity to enable a mid-size player to “punch above its weight class” via a digital solution enabling it to compete more effectively with other, much larger companies, that’s an extremely compelling argument that’s likely to find an executive level audience. It’s particularly important to remember that these companies have the commercial footprint, domain knowledge and financial ability to deploy your digital solution at scale if the opportunity is right.

If you partner with a mid-size company, the odds are significantly lower that you’re competing with an internal team that’s trying to homebuild something similar. These teams don’t often exist yet at mid-size companies (certainly not to the extent that they do at larger organizations), and mid-size companies often lack the bandwidth to take on multiple competing initiatives, particularly in an emerging area like digital health. If a mid-size pharma company does indeed embark on a partnership with you, there’s a good chance that you’re one of a relatively small number of partners, which means that you’ll get more commitment from the organization. ****** The bottom line is digital health companies looking to partner with pharma need to consider the fact that there are several different phenotypes of companies within the industry. While a digital health CEO’s natural tendency might be to think that “bigger is better,” you just might want to take a long-hard look at that boutique, yet multibillion dollar pharma partner that isn’t on your radar.

Making a match: Is a midsize pharma company the right partner for your business? It’s important to critically examine what kind of partner you might be the best fit for (and conversely, what kind of partner might be the best fit for you). At Chiesi, we’ve found that asking these questions early on in partnership discussions, often saves a lot of potential buyer’s/seller’s remorse later on. For example, we’ve found that some characteristics that might be a better fit with companies in this segment are: g Companies with solutions that fit use cases closely aligned with a pharma partner’s core therapeutic and geographic focuses with a quantifiable, objective ROI argument g Companies with a functional and somewhat battle-tested (not necessarily finished) product with the capability and a concrete strategy to support deployment at scale in the near future, while being willing to leverage the pharma partner’s domain expertise to help them make a good product even better g Companies that are focused on executing on a specific set of objectives, poised for longer term commercial viability, whether or not their capabilities fit latest buzzwords and trends.

Giacomo Chiesi is Head of Global Corporate Development at Chiesi Farmaceutici, where he oversees all of Chiesi’s corporate development activities, as well as Chiesi Ventures. Ameya Phadke is Sr. Manager, Technology & Digital Partnerships at Chiesi Farmaceutici, where he leads the company’s transactions and partnering efforts in technology and digital health. The opinions and views expressed in this article are solely those of the authors, and do not represent the views of Chiesi Farmaceutici S.p.A. or any of its affiliates, including Chiesi USA. This article is for informational purposes only and should not be taken as legal or regulatory advice or opinion. 98

Issue 3

StartUp Health Magazine

INDUSTRY INFLUENCERS dr. william carson

OTSUKA

HQ Chiyoda, Tokyo, Japan CEO Kazumichi Kobayashi Revenue 531.2 billion JPY (2017) Number of employees: 5,634 (2017)

Opening Digital Frontiers in the Mental Health Moonshot Dr. William H. Carson isn’t your typical pharma CEO, particularly a pharma company from Japan. The South Carolina native spent most of his career in academia, not in the boardroom, as he helped to develop one of the world’s biggest-selling psychiatric drugs. Now, as the CEO of Otsuka’s development and commercialization arm, Carson is tapping into his years of inpatient work while also leveraging the company’s drive towards innovation. Otsuka’s recent investment in StartUp Health’s Fund II underscores the company’s long-held belief that drug interventions are only a piece of the moonshot to improve mental health for all people. StartUp Health editor Logan Plaster caught up with Dr. Carson to talk about Otsuka’s DNA, the mental health moonshot and Carson’s vision for the future.

Otsuka has made a global name for itself producing a blockbuster drug, Abilify. But Otsuka has also developed a digital health team in New Jersey, which is looking at health from a different vantage point. Why branch out from traditional big budget pharma sales into digital health?

Otsuka historically has been a company that has embraced innovation. Mr. Otsuka, the patriarch of the

launch because we didn’t know how patients, providers, payers, families and doctors were going to utilize this system. We are looking to make sure that we cover the ground in this limited launch phase so that we have enough data to really understand across those patient populations how it will be used.

company, always loved innovation. The company’s Japanese sales force was the first sales force in Japan that went all Prius. Then, when the iPad was introduced in Japan, the whole salesforce was utilizing them within the first month. The company worked with IBM to develop a patient monitoring system with behavioral health networks in Florida. That was very much outside of the work that you typically do in a pharmaceutical company. It had to do with algorithmic patient management, how patients flow through the system. In addition to these digital health projects on one side we also had digital medicine on the other with our Abilify MyCite, which was approved in 2017. Your ingestible Abilify MyCite with its ability to be tracked wirelessly was a groundbreaking product and collaboration with Proteus. What’s the status of that project?

We’re expanding Otsuka’s relationship with Proteus, pushing towards further offerings in the digital medicine category. In terms of Abilify MyCite, we planned a limited

Beyond your forays into digital health and digital medicine, you’ve also branched into the broader startup ecosystem with your investment in StartUp Health’s second fund. What benefit did you see in joining with a global army of entrepreneurs?

Our interest in StartUp Health is in line with our company’s DNA, and it helps us know what’s coming next. We want to make sure that if there’s an innovative organization or venture out there that could help our patients, we see it early and can help bring them to the world. However we end up working with them, StartUp Health provides a place for us to be able to see a lot of different groups at one time. Our sense is that while we can continue to develop drugs, we also need to think about all of the other innovative things that are happening in healthcare, and we find that at StartUp Health. You mentioned siteless clinical trials. We talked about ingestibles. What other technologies are you seeing coming down the pike that excites you for the next five to 10 years?

Wearables are of great interest. There 99

are now great digital interventions for things like constant sensing of people’s blood sugar for diabetes. I wish that somebody could wear something that told them their schizophrenia was out of control and then alert us to intervene. It’ll be a long time before that happens with almost any psychiatric disorder, but what about simply observing behaviors? For certain types of patients, are there patterns of behavior, speech or interactions, that would allow us to tell that a patient was decompensating? Let’s say as an opioid addicted person, there are things that might trigger you to use. Maybe it’s as simple as having a GPS monitor, like you’re not supposed to go over there because that’s where you are more likely to buy or use drugs. Then, if we know that you’re about to hit a trigger, what do we need to do that you would be responsive to? Is sending a text message going to be enough to stop you? As you know, StartUp Health has a Mental Health Moonshot, bringing together companies who are dedicated to improving mental health across the globe. With your experience across the spectrum of mental health, from inpatient psychosis to generalized anxiety, where do you think we – and the industry at large – need to be focusing our attention?

From a psychiatric patient perspective you probably need to have several types of moonshots. For all intents and purposes the brain is still a black box. No one can really tell you where does memory sit, versus where does depression sit. We sort of know but it’s not like saying I know exactly how you get an ulcer. I think that is really the ultimate moonshot – to know the causative factors for these mental illnesses. That’s going to be extremely difficult because I actually 100

Issue 3

I hope for the rest of my life to work on getting people with mental illness out of the prison system. I don’t think that prisons are places for people to have their first diagnosis. think that most psychiatric illnesses are syndromic. Maybe it’s inflammation, maybe it’s infection, maybe it’s neurochemical disregulation. Another moonshot is around the idea of stigma. How can we use the best innovations and technology to help patients with psychiatric and behavioral disorders, regardless of their background. To put it more concretely, I hope for the rest of my life to work on getting people with mental illness out of the prison system. I don’t think that prisons are places for people to have their first diagnosis. And I think that we have to determine whether the action that caused the person to be in jail is actually a manifestation of a psychiatric disorder. A person walking down the street naked could go to jail, but the cause for their nakedness is that they’re manic and their mania told them they were a supreme being. So yes, I mean the person is naked, they have to go someplace, but is that place actually jail? I don’t think so. Maybe there needs to be a virtual community mental health center where we use a combination of a device, an app and intervention and medications, which keep

StartUp Health Magazine

people healthy enough so that they can live in houses. There’s significant research that people should be sheltered first. Then you worry about their substance abuse treatment or their psychiatric treatment. Tests in multiple communities have determined that just getting a roof over people’s heads helps with regards to them getting better. We are in a digital age, and we are asking questions and getting tons of data. But it’s what we do with that data that matters. And if we know from research that sheltering first works for those struggling with addiction, why aren’t we doing it? What do you see as the role for telemedicine in mental health, in extending the reach of group therapy and recovery counseling?

The groups doing telemedicine need to track data and come up with real best practices. This is where AI, algorithms and machine learning come into play, because we have to learn from the data that we generate. After all, every patient is different – the urban folks may need one thing while the rural folks need something else. Some people may need shelter while others need immediate intervention. We have to mine for these insights in the data that we gather. That’s one more moonshot – interpreting all the data we gather in a way that allows us to take appropriate action, for the good of everyone involved. When we think about the power of the digital world that we live in and our ability to address these big questions with data and technology, I wish I were 20 years younger starting my own health startup with the support of StartUp Health. That would be very exciting.

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special report

“If not us, then who?”

Terry Stone explains why Oliver Wyman launched a Women in Healthcare Leadership initiative

Oliver Wyman has established itself as a force within the healthcare community, an industry leader providing deep insights and valuable consulting expertise. Oliver Wyman’s now turned its critical eye on one of the largest problems faced by many industries, healthcare included: lack of women leadership. Oliver Wyman’s team is launching a Woman in Healthcare Leadership initiative to analyze the state of disparity and uncover the root cause of barriers affecting women’s mobility into leadership positions. Worthy of note from Oliver Wyman analysis: although 65 percent of the healthcare

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workforce is female, just over a quarter of the healthcare workforce’s leaders are women. This is despite the fact that women as end-consumers make 80 percent of healthcare buying and usage decisions. We caught up with the leader of this initiative, Terry Stone, at Oliver Wyman’s annual Health Innovation Summit, to learn more about Oliver Wyman’s work, including a new report examining the gap in female healthcare leadership they released at January’s StartUp Health Festival.

uWhat was the genesis of the women in healthcare leadership initiative?

Consumer-driven companies realize the criticality of having their leadership team mimic their customer base. Most healthcare companies don’t have that same strength of diversity in leadership. We therefore set out to create this initiative to address a real challenge in the healthcare industry. We believe given Oliver Wyman’s platform and our executive access, we can have a real impact. And, because our global Health & Life Sciences team is comprised of several women leaders, we sat there and thought, “If not us, then who?”   uWhat are the funda-

mental issues you saw in the industry that signaled this was the right time for this type of program? What type of validation did you receive during the process?

Women are bumping up against a constraint preventing them from entering into the C-suite. What’s interesting in healthcare is we don’t have a “women in healthcare” problem – over 65 percent of the workforce is female. But, we do have a “women in healthcare leadership” problem – between 25 to 35 percent

of senior leadership is female. When we started this project, we gathered data on thousands of executives and hundreds of executive teams. We’ve found healthcare, not unlike other sectors, is filled with plenty of common barriers, including unintended bias. And, factors like women are still taking on more home responsibilities, and struggling to find mentors. And it may be a combination of these aspects that contributes to women’s paths to the C-suite being longer than their male counterparts – on average two to five years longer for CEOs, for example A promotion to senior level means taking a chance on someone. To get promoted and make it into the C-suite, you need trust with senior leaders – something often difficult for women to achieve in a leadership environment where they’re outnumbered. Trust, studied time and time again, is determined (according to the famous Academy of Management Review study from the 90s) by three main things: proven ability, integrity, and benevolence. Let’s take the latter concept, benevolence. Although benevolence is perhaps a bit more intangible than ability or integrity, this component of trust in particular is tied to the greater ability to relate empathy and care about another person independent of someone’s work. But barriers get in the way of executing this, for example, regarding subtle yet unintentional differences between men and women in the workplace. People naturally bond with people like themselves – and it’s easy to see this in physical similarities or differences like gender, race, and age. This can lead to spend-

ing more time with each other out of the office in events like after-work drinks or a round of golf on the weekend. However, this time outside of work contributes to building up this benevolence factor of trust. We’ve found those women who make it to the top place high regard on the idea that “the results speak for themselves”. They believe this is true throughout the course of their career. They take on the gnarliest problems and prove themselves to be great problem solvers. Women often put less attention on the criticality of sponsors and mentors. That said, females who make it to the top realize the importance of that dimension. uWhat type of orga-

nizational cultures or leadership have more success in getting women into leadership positions?

There are some companies out there doing this well, which has a lot to do with leadership and organizational culture. Women who reach the top need to have a variety of experiences, and in most cases good mentors and sponsors, to acquire a diversity of experience. If there is a belief within an organization – whether it’s cultural or embodied by leadership – that values competency and potential and creates opportunity, women are more likely to have key leadership roles. There is also a high probability of more women in the C-suite in organizations where the chief executive officer has a non-traditional background. These types of organizations set the tone of valuing competency and capability over

focusing on the need to follow a standard career path. uWhat are you ex-

cited or hopeful about that you’ve learned through your conversations?

We’re starting to get excited about the focus on communication and how we can help organizations support men and women to better understand one another. As we continue our work on this and get underneath what is explicit, we’re learning the implicit s tuff that influences how we see things. We’re getting people in business to better understand the essential ways they color the world and how they see things differently.

uOliver Wyman partnered with StartUp Health on this year’s Women’s Health Moonshot award. Why was this partnership important for Oliver Wyman?

The level of enthusiasm and focus on disruption and innovation at the StartUp Health Festival is quite infectious. Everything about the vibe and the energy of presenters and attendees excites our Oliver Wyman team. Related to the women in healthcare leadership initiative in particular, we value the very early commitment to raising awareness and addressing the problem. This mindset creates more opportunity for women, and a sense of possibility that this is the exact thing healthcare needs to increase diversity across its leadership ranks.

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A Global Vision s Mapping the StartUp Health Army

450+ Health Transformers --75 Cities --22 Countries --6 Continents 104

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Spotlight Helparound (Israel) -Helparound is on a mission to transform the navigation of life-changing diagnoses. For specialty drugs hitting the market,

helparound is a mobile intelligence concierge platform that streamlines each patientâ&#x20AC;&#x2122;s path to therapy via a network of specialty patient services: hub support, co-pay programs, specialty pharmacy, nurse chat, etc.

Spotlight Eko.ai (Singapore) -Eko.ai is automating the fight against heart disease. Their machine-learning software is leading the way, transforming what today is a 30-minute manual analyses only performed by professionals into a click that takes seconds and can be performed by all. AI based echos will eventually replace the stethoscope and democratize heart health, putting the worldâ&#x20AC;&#x2122;s most trained cardiologist on everyoneâ&#x20AC;&#x2122;s mobile phone.

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The StartUp Health Company Index The companies that form the StartUp Health Academy, listed by primary Health Moonshot. PAGE 106–126

STARTUP HEALTH

HQ 6

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

ACCESS TO CARE MOONSHOT Improving the appointment experience for both providers and patients New York, NY appointmentnotify.com

Prevent death and suffering caused by medical errors Karachi, Pakistan azaadhealth.com

Improving care in underserved markets through intelligent mobile engagement Denver, CO accessmobile.io

Replace every paper handout given to patients with a personalized digital plan Woodbridge, CT advicecoach.com

Access to world class radiologists at affordable prices Singapore alemhealth.com

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Eliminate healthcare disparities through telemedicine El Segundo, CA cloudbreak.us

Collect and manage the world’s medical clinical and procedural data Akron, OH clus.io

Giving every patient in the world access to their own doctor New York, NY beamhealthgroup.com

Deliver the promise of superprecision imaging to cure cancer, for everyone, everywhere Madison, WI cubismi.com

Eliminating all barriers to navigating the healthcare system Chicago, IL care-advisors.com

Providing accessible, affordable teledermatology care Chicago, IL dermio.com

Enable patient-centered care collaboration and system navigation for patients with complex, chronic diseases Vancouver, British Columbia careteam.me

On-demand, top-quality dermatology care for all people Palo Alto, CA directderm.com

Allowing patients and consumers with hearing disorders to access care Helsinki, Finland chabla.me

Providing every patient with a trusted healthcare journey New York, NY doctor.com

Ensure everyone on the planet has clean food and water Bengaluru, India earth2orbit.com

Eliminating the safety risk of medical devices New York, NY ehealthanalytics.net

Digitize physical rehabilitation for better outcomes Helsinki, Finland goodlife.technology

Transforming the navigation of lifechanging diagnoses Tel Aviv, Israel helparound.co

Revolutionize obesity treatment Los Angeles, CA inhealthonline.com

Solving social determinants of health and low-clinical needs issues for all Americans San Francisco, CA jisekihealth.com

Transforming healthcare delivery in the United States and Africa Columbia, SC ehnusa.com Creating a holistic community ecosystem to improve the population’s health Denver, CO julota.com Streamlining the connection between surgeons, care teams, and patients New York, NY forcetherapeutics.com

Free mHealth technologies and digital education for every patient and doctor Buenos Aires, Argentina futuredocslatam.com

Helping doctors focus on the patient, instead of administrative tasks San Francisco, CA gogohealth.com

Providing any consumer with their primary care needs for $100 per month Morristown, NJ hoyhealth.com

Enable healthcare professionals to securely exchange patient information with one another Winter Garden, FL icoreconnect.com

Eliminating hospital readmissions for chronic/elderly patients by 2028 West Lafayette, IN imoonlite.com

Provide chronic disease management and prevention videos worldwide Wichita, KS kingfit.io

Revolutionizing healthcare for chronic conditions using Blockchain and AI San Antonio, TX lealabs.com

Extending the point of care to any patient, any place, any time, on any device Richmond, VA lifewiregroup.com

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Uniting providers to make care accessible and affordable in India Madurai, India livigro.com

Empowering every care team to be heroes with AI Palo Alto, CA lucidact.com

Automating surgical processes in the operating room Houston, TX msbiotics.com

Revolutionize the patient experience around imaging Ponta Grossa, Brazil medcloud.co

Meet more health innovators on StartUp Health HQ.

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Changing the culture around patient monitoring to simplify healthcare New York, NY multisensordiagnostics.com

Bring doctors and patients together, improving patient care and reducing healthcare costs New York, NY medisprout.com

Provide patients and their caregivers with free, easy and seamless control of their healthcare information Dallas, TX mypurplefolder.com

Unlocking patient’s 3D data so surgeons and patients have access to critical care New York, NY mirrorme3d.com

Improve access to healthcare in Africa Abuja, Nigeria mobidoc.ng

Bringing all healthcare in Latin America into the digital era Buenos Aires, Argentina omniasalud.com

Providing digital access to schedule complex exams and procedures New York, NY opendr.com

Developing accessible, affordable dental products and telehealth solutions New York, NY mymouthwatch.com

HQ Q&A Anna Chrisman Managing Director of EBD Group and KNect365 Life Sciences

Ensure medical care can transcend borders Shanghai, China medebound.co

Why is moonshot thinking important right now? With the allure of tangible cures to some cancers, this is a perfect time to act boldly and make exponential progress. What do you see as the great health challenge of our time? I believe that neurodegenerative diseases are a great threat to human health. Age-dependent disorders,

StartUp Health Magazine

such as Alzheimer’s disease, Parkinson’s disease and Huntington’s disease, are increasingly prevalent as the elderly population increases around the world. Effective treatments are desperately needed. What area of digital health generally shows the most promise? A significant bottleneck to getting new treatments to market is clinical trials. This is an area where

digital health is beginning to have a real impact. Digital health tools and techniques are helping to recruit subjects, utilize devices and apps and incorporate real-time monitoring of behaviors into their assessment of new treatments. What gives you hope and optimism about the future of health? There is a genuine interest and need for collaboration

between all parts of the life science ecosystem. The large amount of investment capital available today, coupled with a healthy risk appetite, is helping to push forward novel discoveries that have high potential as breakthrough medicines. Finally, the digitization of healthcare promises to open new, powerful discoveries and accelerate the adoption of personalized approaches to healthcare.

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Bridge the gap between international hospitals and patients Helsinki,Â Finland pathsurgery.com

Curing the behavioral health crisis with primary care Palo Alto, CA psycheanalytics.com

Reimagining decentralized biobehavioral research and clinical trials Atlanta, GA quantextual.co

Ensuring that no sick patient has difficulty finding immediate medical care Orlando, FL quickrcare.com

Eliminating preventable organ transplant rejection Houston, TX realtimeclinic.com

No patient will forego care and miss appointments due to addressable social determinants New York, NY www.ride-health.com

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Transforming health brand reputation through patient engagement New York, NY rivews.com

Stop the spread of sexually transmitted diseases (STD) in our lifetime Los Angeles, CA safehealth.me

Making access to healthcare as simple as answering a call Crofton, MD simplevisit.com

Optimizing communication between patients and providers to transform outcomesÂ Vancouver, Canada tickithealth.com

Creating the largest healthcare marketplace New York, NY

Help providers leverage technology to deliver affordable, accessible, and effective healthcare Houston, TX valhalla.healthcare

Assure an uninterrupted continuum of care Bethlehem, PA xverity.com

Make healthcare paperless New York, NY yosicare.com

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The StartUp Health Company Index f continued from page 110

Have 9 billion people live healthy lifestyles Dusseldorf, Germany yourcoach.health

Everyone has the tools and knowledge necessary to take care of themselves and their loved ones Boston, MA zeleo.io

Providing patients with pricing for and information on dental clinics Los Angeles, CA zentist.io

Eliminate the healthcare information gap New York, NY zubialive.com

COST TO ZERO MOONSHOT

Ending prehospital mortality in emergency response Walnut Creek, CA beyondlucid.com

Eliminating fraudulent medical claims through biometric authentication Deerfield Beach, FL bioclaim.com

Lowering healthcare administrative cost using health data Chicago, IL etyon.com

Ensuring the aging experience is filled with peace of mind and joy Chicago, IL caremerge.com

Using ultrasound technology to enable realtime precision fluid management Sudbury, Canada flosonicsmedical.com

Provide dignity in work and dignity in care through native mobile, story-based training solutions New York, NY cognotion.com

Make healthcare more affordable for everyone, everywhere New York, NY coverus.io

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Universalize financial security to all by empowering patients to pay medical billsÂ San Francisco, CA empower-capital.com

Help doctors and hospitals work together to provide better care to Americans suffering from heart disease San Francisco, CA biome.io

Giving clinicians access to the right information, at the right time Livingston, NJ atpointofcare.com

Making value-based healthcare universal Columbus, OH aver.io

Transform doctor-patient communication form verbal conversation to a digital resource throughout the care continuum Tampa, FL doco.la

Provide 1 Billion people with affordable access to care San Jose, CA healthbanc.com

Improving the emotional connection between patients and providers Edwards, CO healthwidesolutions.com

iShare Medical won top prizes at the 2017 LaunchKC contest and 2016 SBA InnovateHER Kansas City Business Challenge. Getting rid of unnecessary, costly and wasteful health services Englewood, NJ hindsait.com

Reinventing how we engage, communicate, and transact with patients about their billing between visits Bridgeport, CT inboxhealth.com

Creating the OR of the future through smart surgical tools Cleveland, OH indago.io Eradicate workplace inefficiencies Santa Clara, CA manageupprm.com Providing secure nationwide sharing of medical records Kansas City, MO isharemedical.com

Revolutionizing rehabilitation by providing the fastest and most effective physical therapy solutions Boston, MA kinetxx.com

Sourcing critical patient information for early recognition, notification and intervention Atlanta, GA konnarockhealthcare.com

Reduce the cost of healthcare delivery with our virtual clinical assistant Melville, NY mdops.com

Replacing error-prone live operator services with patient data on providers’ phones New York, NY medxcom.com

Empower healthcare organizations to educate and help patients manage their own on their health Los Altos, CA openhealth.cc

Empower patients to fully control their health data, without the responsibility of managing it themselves New York, NY particlehealth.com

Streamlining and securing medical record sharing, giving patients more control Atlanta, GA patientory.com

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Create accurate and beautiful software that impacts health and medical literacy for the future healthcare practitioners and their patients Galway, Ireland pocketanatomy.com

Be the first to predict disease before it happens New York, NY prognos.ai

Providing price transparent prescriptions at the click of a button New York, NY qwikscript.com

Helping providers eliminate chronic disease using data and patient engagement Conshohocken, PA saturncare.com

Driving medical billing costs to zero Milwaukee, WI siftmd.com

Reducing patient premiums by eliminating billions of dollars in fraudulent claims Deerfield Beach, FL SmartyPerks.com

Giving providers contextualized prescription information at the right time Denver, CO rxrevu.com TedCas is bringing voice and gesture control to the operating room.

Attract the next 5M nurses and caregivers to the homecare industry New York, NY swiftshift.com

Making voice and gesture control the ‘standard’ for all operating theaters Pamplona, Spain tedcas.com

Empower healthcare providers to connect patients with the financial resources they deserve New York, NY vivor.com

Modernizing the small business insurance shopping experience New York, NY wellthie.com

Make image communication between providers effortless Palo Alto, CA wingumd.com

Bringing precision evidence to the point of care Richmond, VA zignifica.com

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TODAY 30% of the healthcare C-Suite is female, yet women make 80% of care decisions and represent 65% of the workforce

TOMORROW Oliver Wyman envisions a world of diverse and equal leadership Join our Women in Healthcare Leadership Initiative that is building the community and insight to close the gender gap. www.oliverwyman.com/ women-in-healthcare-leadership

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CURE DISEASE MOONSHOT

Melissa Manice founded Cohero Health to create innovative tools for people with asthma and COPD.

Automating the fight against heart disease Singapore eko.ai

Provide clinically-proven support programs to patients on specialty medications New York, NY adheretech.com

Making rare disease drugs more affordable and available San Francisco, CA altheahealth.com

On a mission to cure the root cause of IBS, Autism, ALS, and multiple sclerosis Hong Kong asiabiome.com

Improving early detection and tracking of respiratory diseases San Francisco, CA breathresearch.com

Improving the health and lives of people with diabetes and chronic conditions New York, NY ceciliahealth.com

Transforming respiratory disease management through smart mobile tech New York, NY coherohealth.com

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Making conversation the cornerstone of health Portland, OR conversahealth.com

Delivering point of care management to the fingertips of all patients Boulder, CO curacase.com

Empowering pharma to more efficiently discover novel medicines Toronto, Ontario cyclica.com

Make physical therapy affordable and engaging to all Los Alamos, NM dynofit.com

Giving clinicians and researchers access to actionable genetic information Houston, TX genebygene.com

Preventing and reversing chronic joint pain worldwide Stockholm,Â Sweden jointacademy.com

Solving the national epidemic of STDs and HIV Teaneck, NJ knownowhealth.com

Transform the black box of medical lab tests to drive cooperative, value-driven applications of clinical lab data Columbus, OH lablink.org

Saving lives through early detection of lynch syndrome Helsinki,Â Finland lscancerdiag.com

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Automating and improving patients’ access to the right health care, anywhere Barcelona, Spain mediktor.com

Revolutionizing real-time glaucoma management Sudbury, MA qura.bi

Solving the global burden of chronic diseases Helsinki, Finland nightingalehealth.com

Putting patients in charge of their health data Los Angeles, CA sanguinebio.com

Keeping people healthier at home through hospital-grade digital continuous care Kfar Saba, Israel oxitone.com

Using genetic insight to put an end to adverse drug reactions Boca Raton, FL parallelprofile.com

Bringing relief to the opioid epidemic Huntington, NY sen-jam.com

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Humanize healthcare by providing the people who need care the most with lifesaving technology Baltimore, MD vheda.com

END CANCER MOONSHOT Revolutionizing a way to better treat and prevent disease that can enhance or replace pharmaceutical drugs Bainbridge Island, WA solius.com Preventing hereditary cancers by identifying everyone who should be screened Santa Clara, CA genidsolutions.com

Making adherence to healthy behaviors more understandable and enjoyable Kansas City, KS playithealth.com

Stop chronic disease before it starts by leveraging the patientprovider relationship Paducah, KY preventscripts.com

Oxitone is bringing hospital-grade continuous monitoring into the home

Providing safe, clinically-proven skincare for those with compromised skin Philadelphia, PA lindiskin.com Bring wireless personalized drug delivery to every patient in the world Denver, CO velocedigital.com

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Reducing the burden of cancer by addressing risk upfront Chicago, IL mypeoplehealth.com

Transforming cancer assistance care, improving treatment quality for millions of patients around the world Sao Paulo, Brazil otawa.net

Empowering all women in menopause to take control of their symptoms Seattle, WA genneve.com

Transforming current diagnosis for pelvic pain in women Hammondsport, NY orateldiagnostics.com

Revolutionizing the treatment of cancer by addressing patients’ nutritional issues New York, NY savorhealth.com

Providing product-specific pregnancyexposure prescription drug data Los Angeles, CA pregistry.com

Ensure better pregnancies Washington, DC getbabyscripts.com

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Improving children’s health by connecting schools, families, payers, and healthcare providers New York, NY caredox.com

Allowing behavioral health practices to help more individuals with autism to meet their full potential Kansas City, MO pathfinderhi.com

WOMEN’S HEALTH MOONSHOT

Educating women to end preventable pregnancy or childbirth problems Nairobi, Kenya jabotech.co.ke

Enabling hospitals to virtualize care coordination and increase accesibility to care Helsinki, Finland buddyhealthcare.com

CHILDREN’S HEALTH MOONSHOT

A device that reminds and guides asthma patients on taking their medications Manchester, England aerobithealth.com

Creating a simple, no-pills-required way to treat childhood developmental disorders San Francisco, CA pigpug.co

NUTRITION & FITNESS MOONSHOT

Be the nutrition data provider to all food, health and wellness businesses worldwide New York, NY edamam.com

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Empowering chronic illness patients everywhere via the worldâ&#x20AC;&#x2122;s first e-dietitian Boston, MA personalremedies.com

Optimize employee productivity by connecting consumer health data and work performance San Jose, CA fitbliss.com

BRAIN HEALTH MOONSHOT

Building the largest opt-in population health support community to measurably impact health San Francisco, CA fitfetti.com

Giving you the tools and analytics to better understand your body Los Angeles, CA fittrace.com

Prevent thousands of cases of Type II diabetes and save lives around the globe New York, NY fruitstreet.com

Striving to build the defining consumer products brand in health & wellness New York, NY greatist.com

Solve the crisis of preventable disease within large populations in a way that works for every individual regardless of circumstance San Francisco, CA lifedojo.com

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Improving health through better eating choices Cardiff, CA mealshare.pro

On a mission to put an end to the obesity epidemic Edina, MN metalogicscorp.com

Help companies and sports teams to reduce muscular level sick leave and the risks for potential injury Helsinki, Finland myontec.com

Reverse the type 2 diabetes and obesity epidemic using lifestyle data and machine learningÂ Kansas City, MO thepalette.io

Automating evidenced-based protocols to yield consistent results Los Angeles, CA brainpaint.com

Diagnosing disorders of the brain accurately in real-time across the globe Bethlehem, PA cerora.com

Giving Screenagers and Physicians superpowers to prevent costly re-injuries after a concussion Honolulu, HI healthtechapps.com

Recovering the quality of life for all stroke, heart attack, and cardiac arrest patients Kinnelon, NJ life-recovery.com

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Stock Code: 01833.HK 124 Issue 3 StartUp Health Magazine

The StartUp Health Company Index f continued from page 122

Become the global standard for measuring and assessing brain performance Corapolis, PA rc21x.com

Making stress management a routine part of chronic disease treatment San Francisco, CA neolth.com

MENTAL HEALTH & HAPPINESS MOONSHOT

Heal, educate and empower individuals by delivering VR-powered behavioral therapy Grand Rapids, MI promenavr.com

On a global mission to end the impossibility of behavior change Anaheim, CA bravely.io

Bringing mental healthcare to those who need it most Austin, TX oncloud911.com

Improve global behavioral health by transforming insight into action Fremont, CA sagesurfer.com

Restoring a patientfirst approach to care Boston, MA salubrisanalytics.com

LONGEVITY MOONSHOT

Using data visualization to motivate patients to change risky behavior Toronto, Canada aprilage.com

Making orthopedic apparel accessible to those who need it most Phoenix, AZ braceunder.com

Scaling senior care beyond reliance on human observation, planet-wide Palo Alto, CA carepredict.com

Helping seniors navigate the healthcare system Waltham, MA devoted.com No patient left alone Vancouver, Canada curatio.me

Using stress reduction to treat most chronic illnesses Tel Aviv, Israel eco-fusion.com

Transforming mental healthcare for atrisk youth Atlanta, GA tqintelligence.com

Take care of the 25 million Americans with untreated behavioral healthcare needs New York, NYvalerahealth.com

wayForward Increasing the life expectancy of black men by 10 years within the next 25 years Washington, DC henry-health.com

Telehealth platform for medical cannabis patients San Francisco, CA hellomd.com

Wiping out loneliness in older age and empowering seniors to thrive Oakland, CA help-full.com

Cure mental illness around the globe New York, NY wayforward.io

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Providing dedicated and customized digital tools in integration for practitioners Tel Aviv, Israel holiadvice.com

Add 50 healthy years to everyone’s life by decoding their personal health map Dallas, TX hormonetherapeutics.com

Leveraging genomic and clinical information to build a KnowledgebaseTM La Jolla, CA humanlongevity.com

Helping addicts beat addiction and reintegrate as thriving members of society Santa Monica, CA inrecovery.org

Zeel is making at-home massage available to everyone at the tap of a button.

Be the gold standard treatment method for lymphedema and rehabilitation patients Helsinki, Finland physiotouch.com

On a mission to bring lab tests to points of care worldwide Minneapolis, MN trakfertility.com

Capturing the lasting legacy and memories of life stories Columbus, OH lifebio.com

Using lifestyle data from GenZ for sports and health to democratize healthcare New York, NY supa.ai

Redefine when, how and from where families engage in supporting their loved ones’ independence Columbia, MD lyflynks.com

Fighting the sedentary lifestyle by promoting and measuring being active at work Detroit, MI tomesoftware.com

Lyf Lynks

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Reduce the chance of seniors going through bankruptcy because of healthcare costs New York, NY trusty.care

Extend independence with dignity for millions of vulnerable people Austin, TX unaliwear.com

Making top-quality massage therapy simple to access on demand New York, NY zeel.com

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w StartUp

Health’s Year in Review

January THE FINNISH LINE Helsinki emerges as Europe’s health tech hub

ANEESH CHOPRA Words of wisdom from America’s first CTO

THE SUM OF M Destigmatizing the Women’s Health Moonshot

April JOIN THE MOVEMENT Sign up today at startuphealth.com

2018 ISSUE 02

The travel entrepreneur transforming cardiology

06092011

startuphealth.com $5.99

The company writing the future of dental care

THE JOURNEY

A GLOBAL ARMY FOR GOOD What happens when thousands of entrepreneurs, innovators and investors march together to transform health and strive to create a brighter future for everyone on the planet?

The app empowering home care providers

The investor bringing health startups to China

The 8 mindsets of the Health Transformer

p Launch of StartUp Health, the first consumer print and digital magazine dedicated to the future of health, with the inaugural issue themed around A Global Army of Health Transformers

StartUp Health participates in Unite to Cure, sharing our mission to collaborate with entrepreneurs to achieve health moonshots, a global health event hosted by the Vatican and Cura Foundation in Vatican City 225th company joins StartUp Health Academy

June StartUp Health company Maxwell Health acquired by Sun Life Financial

250th company joins StartUp Health Academy StartUp Health Ventures completes follow-on investment in Cohero Health

November StartUp Health joins Novartis for its second annual innovation week in Buenos Aires, Argentina

StartUp Health company OpenBeds acquired by Appriss

September StartUp Health announces the close of StartUp Health Transformer Fund II, a $31M fund with investment from Novartis, Ping An Group, Chiesi Group, GuideWell, Otsuka and Masimo StartUp Health World Tour kicks off with events in Bulgaria and Spain

6th Annual StartUp Health Festival is held in San Francisco, bringing together 2,000 innovators from 40 countries

p The Health Transformer Showcase at Frontiers Health in Berlin, Germany features health moonshot stories from 12 portfolio companies StartUp Health Ventures completes follow-on investment in Trusty.care

Second issue of StartUp Health is published, themed around A Global Army for Good

StartUp Health Ventures completes follow-on investment in Zeel

October

StartUp Health company Sleep. ai acquired by SleepScore Labs

March p StartUp Health company Babyscripts acquires iBirth

July First companies from China, Pakistan and Singapore join StartUp Health Academy, bringing total countries represented to 21

August

2018

Opening of StartUp Health Village in San Francisco StartUp Health Ventures completes follow-on investment in Cecilia Health (fka Fit4D)

StartUp Health Ventures invests in Devoted Health, a Medicare Advantage focused health insurance company, led by brothers and serial health tech entrepreneurs, Todd and Ed Park. (Pictured: In 2011, Todd Park invited Steven Krein and Unity Stoakes to the White House to share their 25-year Health Moonshot vision.) StartUp Health Ventures completes follow-on investment in AdhereTech, Babyscripts and Doctor.com

December 260th company joins StartUp Health Academy StartUp Health Ventures completes follow-on investment in CarePredict and SOLIUS

First company from Belarus joins StartUp Health Academy, bringing total countries represented to 22

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Issue 3

StartUp Health Magazine

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