StartUp Health Magazine_2018 Issue 2 by StartUp Health

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

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2018 ISSUE 02

The travel entrepreneur transforming cardiology

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The company writing the future of dental care

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

Join the Movement

TOGETHER WE WILL IMPROVE THE HEALTH AND WELLBEING OF EVERYONE IN THE WORLD 2

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StartUp Health Magazine

marching together as ONE GLOBAL ARMY FOR GOOD To many, an “Army” conjures up a vision of soldiers preparing for battle. It’s a charged yet powerful concept, often associated with the heavy weight and pain of war. ¶ At StartUp Health, we are investing in a different type of army. An army for good, akin to other forces like the Peace Corps, Red Cross and Salvation Army, all on missions dedicated to improving people’s lives around the world. Ours is an army of Health Transformers—superhero entrepreneurs—who have the mindset, commitment and passion to make the extraordinary possible. ¶ What makes an army so powerful is the collective strength of people marching together towards common goals with purpose. The StartUp Health Army is on a mission to accomplish an audacious dream: to achieve 10 Health Moonshots that can each improve the health of at least a billion people. The success of our army is measured by our ability to better the wellbeing of everyone on the planet. ¶ Yes, we realize the scale of this goal sounds impossible, even crazy. But we believe that networked together we can make exponential progress by collaborating as one force for good. ¶ We hope you, too, will join the movement to transform health. StartUp Health is on a world tour visiting dozens of countries and cities meeting with fellow Health Transformers and innovators who want to be part of our army for good. You can learn more about it at startuphealth.com. Whether you are an entrepreneur who wants to be in StartUp Health, or someone who wants to support Health Transformers on their moonshot missions, we need your help. Together, we can and will reinvent the future of health.

Unity Stoakes President & Co-founder

Steven Krein CEO & Co-founder

Reimagining the Future of Health ÂŽ

Our family of companies and foundation have made it our mission to help people and communities achieve better health. We touch over 16 million health care consumers and 800 nonprofits. Our broad view of the health care continuum helps us discover new paths in the landscape, explore uncharted territory and guide the future of health. In this spirit, we collaborate with forwardthinking companies to bring a better health experience to peopleâ&#x20AC;&#x2122;s lives.

Insurance | Health Care Delivery | Population Health | Consumerism | Government 4 Issue 2 StartUp Health Magazine guidewell.com

In This Issue

36 11

20 03

Founders’ Letter

Editor’s Letter

Wisdom 11

Aneesh Chopra

Esther Dyson

Jerry Levin

Health Transformers to Watch

77 41

StartUp Health’s 10 Health

Bari Krein: A simple signature today can save you tomorrow

The Health Transformer Mindset Scorecard

The StartUp Health Journey

Mapping the StartUp Health Army

James Hare / eko.ai

Investors to Watch

Imran Cronk / Ride Health

Intro by Katya Hancock

Dr. Sandy Whitehouse / Tickit

Investor Profiles, including:

Health

Liz Rockett, Dr. Francesa Wuttke,

Victor Penev / Edamam

Mohamad Makhzoumi,

Rick Hennessey / SOLIUS

Amit Aysola, Ellie Wheeler,

Noe Foster / HealthTechApps

Steve Kraus, Irem Mertol,

West Shell III / Conversa

Vin Fabiani & Anna Haghgooie

Jonathon Feit / Beyond Lucid

Technologies 36

Office Visit with Doctor.com

Masterclass 40

Polina Hanin: But Why? How to ask better questions

Moonshots

Dr. Marco Huesch: What startups get wrong about china

Features 58 63 66 70

Genneve: The Sum of M The Finnish Line Swift Shift: Power to the Provider Cloud 9: Better Backup

75 77 80

Babyscripts: A Pregnancy App Worth Prescribing CareDox: Healthcare Gets Schooled Access.mobile: Access to Care that Crosses Borders MouthWatch: Live Feed

Companies to Watch 86

Cohero Health

CarePredict

Fit4D

Zeel

Greatist

Biome

Valera Health

@Point of Care

Life Recovery Systems

Cloudbreak

The List: StartUp Health’s Global Army

120

The Health Moonshot Vision

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StartUp Health Magazine

Editor’s Letter

A Moonshot Worthy of Our Full Commitment

hen I visit my parents at their house at the end of a winding road near the Chesapeake Bay, my twoyear-old daughter immediately runs down the first floor hallway and opens the door at the end. On the other side of that door are “mommom” and “pop-pop,” her great-grandparents, two stooped-but-smiling nonagenarians who just celebrated their 73rd wedding anniversary. When they said “I do” in Carlsbad, New Mexico, just days before my grandfather shipped off to Italy to finish out the second World War, they didn’t know where they’d be seven decades later. But they committed to the journey together, under the banner of a shared set of hopes and ideals. As StartUp Health CEO Steven Krein often says, long-term commitment is one of the critical mindsets that separates frustrated or would-be entrepreneurs from future-changing Health Transformers (complete the Health Transformer Mindset Scorecard on page 44). In his two decades of coaching, Krein has found that when companies pull out of a shortterm mindset and start thinking in terms of audacious long-term goals—what we here call Health Moonshots—it reorients their companies towards the things that matter most, and attracts the customers and collaborators they need to succeed. Long-term commitment comes in many forms, and it’s on display on nearly every page of this magazine, StartUp Health’s second print edition. For some, long-term commitment has meant rejecting the easy road. James Hare, Jean Anne Booth and Rick Hennessey could have sailed into the sunset following lucrative exits

from their previous ventures. Instead, each came out of early retirement to tackle a major problem in the health industry (read all eight Health Transformer profiles starting on page 20). For Jerry Levin, taking the long view has resulted in what he describes as “a personal revolution.” StartUp Health Magazine shines a spotlight on the entrepreneurs who In our conversation on not only have the skillset needed to page 14, the former CEO transform health (like Imran Cronk, of Time Warner turned photographed above on the roof of StartUp Health Executive his Manhattan office) but the longChairman speaks candidterm commitment to see the job through to completion. We call these ly about his decades-long individuals Health Transformers journey from a mindset of because they are creating the future power to one of empathy of health for everyone in the world. and understanding. Some lessons, Levin reminds us, you learn the old fashioned way – from our mistakes. Of course, long-term commitment is meaningless without the right object or goal. What would my grandparents’ 73 years mean without love or friendship? In the same way, the laudable long-term commitment put on display by the entrepreneurs in this magazine only matters when paired with a worthy goal. In this case, the goal—the Health Moonshot—deserves all the forward-looking, decade-dreaming commitment we can throw at it: Together we are going to improve the health and wellbeing of everyone in the world.

Logan Plaster Editor-in-Chief

PUBLISHERS Unity Stoakes / Steven Krein Netherland, a sad, witty novel by Joseph Oâ&#x20AC;&#x2122;Neill, reminded me why I love New York City and its unique inhabitants.

EDITOR-IN-CHIEF Logan Plaster

#goodreads

MANAGING EDITOR Jeremy Lehrer

what the startup health team is reading this summer

DEPUTY EDITOR Jennifer Hankin CONTRIBUTING EDITOR Esther Dyson PHOTO EDITOR Paul Newson CONTRIBUTING WRITERS Nicole Clark / Christine Grillo / David Sokol Cole Stryker / Neal Ungerleider

Sapiens: A Brief History of Humankind by Yuval Noah Harari. The author sweeps through human history, raising challenging questions about what lies ahead for our species.

Bad Blood: Secrets and Lies in a Silicon Valley Startup by John Carreyrou. A fascinating take on the rise and fall of Elizabeth Holmes and Theranos.

ASSISTANT EDITORS Laia Alonso / Nicolas Crockett Pear Poolvaraluk / Brandon Sinsheimer PHOTO ASSISTANT Caitlin Pintavorn

STARTUP HEALTH

Sick in the Head by Judd Apatow. An entertaining collection of interviews with comedians from the 1980s and 2010s.

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

Michael Horton Chief Financial Officer

Eric Waldo Chief Operating Officer

Jennifer Hankin Chief of Staff

Katya Hancock Partner

Polina Hanin Academy Director

Logan Plaster Media Director

Piper Leonard Senior Controller

Andrew Isaacs StartUp Health Ventures

Mark Liber Academy Manager

Maxim Owen Academy Manager Max Weiss Counsel Michael Karelis Video Producer Liz Tucci Data Lead

Lauren Doolan Academy Manager Never Split the David Pedra Callie Fisher Difference by Network Manager Chris Voss. Events Manager An FBI crisis Nicole Kinsey Liz Austin negotiator on Media Manager Media Manager how to master Anne Dordai interpersonal Andrew Solomon relationships. Academy Lead Network Lead Tara Salamone Media Lead

Eric Magalong Accountant

Aki Koivistoinen Ambassador, Europe

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StartUp Health Magazine

Being Mortal by Atul Gawande. An interesting look into aging and a helpful perspective on how we live life.

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Wisdom

Restraining Healthcare Cost Growth Will Open a World of Opportunity data sets that would tell us so much about how and where we’re spending our precious dollars and the value we’re getting as a result. That’s all changing, thanks to efforts The country’s biggest challenges over the next 50 years started under the Obama administration, and on which will involve our capacity to lift up the middle class, adthe Trump administration has effectively doubled down. dress the growing economic inequality, tackle issues Now, for instance, under a big opioid data initiative, more around climate change, and find opportunities to benefit data is being released than has been released in the past, in from the diversity of our society. All four of these arenas order to get to the bottom of the problem. are absolutely critical, and most will require additional Movement number two is that we have taken the mapublic investment, opportunity, and nilla folders in physicians offices involvement. However, there is one and we have digitized them and we massive constraint that is holding us OPEN HEALTH DATA: have put ourselves on a path to route A BIPARTISAN CONCERN back from being able to do all that -that information to patients or their we can as a country. That is the un“More and more trusted applications and services stoppable, continuing growth rate information about the that can help them make sense of it. in healthcare costs, much of which performance of the We are equipping patients. Every inseems unrelated to better outcomes. healthcare system is dividual patient and their loved ones To the extent that we can constrain opening up for use. want all the information they can get the rate of health inflation to overall That’s thanks to effor ts their hands on, so that they can more inflation over the next 20 years, we star ted under the effectively navigate this complicated will improve our country’s fiscal posiObama administration, healthcare delivery system. tion so much that it will open up othand on which the Trend number three is that the er opportunities. We’ll finally have Trump administration rewards of the system are shifting the margin for tax cuts, if that’s your has effectively from volume to value. The legal aupolitical preference, or climate mitidoubled down.” thorities that were put in place in gation strategies, if that’s your politithe Affordable Care Act and have cal preference, or to boost workforce expanded with the bipartisan MAdevelopment initiatives. All of that CRA legislation in 2015, pointed the country in a clear would be possible if Health Transformers, entrepreneurs, direction towards value-based reimbursement. That’s how innovators and stakeholders from every silo in the induswe are going to pay doctors, hospitals, nursing homes, try could find a way to work together to achieve that bold home health agencies, you name it. and ambitious goal of constraining healthcare costs while If you look at these three trends, they are clearly tailretaining or boosting quality. This is the challenge for our winds for the growing community of entrepreneurs and generation. Get this right, and then we can tackle everyinnovators who see the need to make a dramatic differthing else. ence in the system. It is this moment and time where this On the three trends shaping the future of healthcare crop of transformers, entrepreneurs and innovators can The opportunities that lie before us are catalyzed by three actually help collaborate with the different components indisputable trends. Trend number one is that more and of the delivery system. Many of these innovators, by the more information about the performance of the healthway, come from within the system. That’s important, and care system is opening up for use. For so long the healthhelps bring about more sustainable change. care system has been opaque, predominantly driven by CMS policy that has withheld access to the Medicare On the greatest healthcare challenge of our time: reducing the cost of care

Aneesh Chopra First Chief Technology Officer of the United States President at CareJourney

Wisdom

On health innovators who focus on improving quality, with cost only as an afterthought.

At a minimum, I believe everyone should be mindful of the larger forces at play. Whether their particular innovation is geared towards improving the lives of people living with diabetes, or finding particular ways we can extend the life of those living with cancer, these are all important areas for innovation. But, they must acknowledge that they are operating in an environment impacted by these larger trends. I don’t know if everyone needs to internalize that in their delivery model, but it will inevitably play a role as they think through the sales, marketing and execution side of the service.

However, there is one massive constraint that is holding us back from being able to do all that we can as a country. That is the unstoppable, continuing growth rate in healthcare costs, much of which seems unrelated to better outcomes.

On digital health interoperability: where we are and where we’re going.

Where we’re going is relatively clear. How fast we get there is what’s up for debate. We are going to a world of openly available APIs that will connect each of the siloed systems in a manner that benefits all of the privitations we can see in the healthcare delivery system. If you’re a patient, you have an unfettered right to assemble your records from each of the systems that have data on you. That is a right in HIPAA. We’ve just got to mature the technology, and the systems, and the workflows, and the culture, such that, when you invoke the right, it’s as easy as connecting your data sources to apps on your phone. The individual has the first order right to turn those islands of information into something that one can use to better understand where they have opportunities to better engage with the delivery system. The byproduct of openly available APIs to patients is that the incremental effort to make those same APIs available to doctors, insurance companies and others is relatively small. The byproduct of having these openly available data sets is that the marginal cost of enabling physicians, insurance companies and other stakeholders to obtain API access is modest. So the theory is, if the patient can get this data without any burden, then I can sign an agreement to offer that very same technology to insurance companies, doctors and others. The only remaining question will be at what marginal cost to society, and information blocking rules and how do we handle the emerging opportunities? That’s the issue. That’s where we stand. On the most interesting trends in health IT

The number one issue of interest to me is that the healthcare delivery system is organizing itself into accountable care organizations that operate, or aspire to operate, as health information fiduciaries, on behalf of a panel of patients that are assigned to them. That excites me the most, because that means each patient’s going to have a quarterback that can be entrusted with their data to help 12

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STARTUP HEALTH

HQ 6

Watch Aneesh Chopra’s full talk from the 2018 StartUp Health Festival 6 startuphealth.com

them make better decisions, in the same way the 401k revolution evolved into the way your financial advisors help you make sense of the very complex financial system. There has been a rise and there will continue to be a rise in organizations, mostly combined doctors and hospitals, in these accountable care organizations, who are all focused on making sure the information about you is used to help you navigate better. That’s the most important trend in my view. The second trend is the increasingly open and sharing philosophy that’s undergirding these accountable care organizations who are keen to ensure when they find areas to improve performance, that they are sharing those—let’s call them recipes, or algorithms or models— so that those ideas can scale. On the cultural move towards open data

Let’s start with an example. The National Academy of Medicine in July of this past year published a groundbreaking study on how we can tackle the cost-quality issues for those that are high need, high-cost patients. It’s a special report they published. But what was unique about this report is they inventoried care models that have been proven effective. So if you’re a patient with dementia, you might benefit from something called Mind at Home. And then, they open sourced an algorithm on how you can segment and group patients into categories that better match to each of the models. So this ability to read the study and then go back to your own data and run the very same models is definitely a positive phenomenon and part of this move. I would argue to some degree that this has been catapulted by publicly-funded research. But also, it’s now becoming the norm that when you publish a paper, you allow people to reproduce their studies. So if you read the Choosing Wisely campaign, and you have access to claims data, you could run up to 26 claims-based measures for Choosing Wisely, just by reading the article in JAMA, and including the appendix that allows you to run those models directly. So, there’s now becoming a shift in the culture, where it’s seen not as a proprietary asset, but as a opportunity, not only to share, but to encourage refinement and improvement.

What Is the One Thing Missing from Most Health Tech Business Models? Human Beings.

Esther Dyson Executive Founder of Way to Wellville 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!

" What is the best model for a consumer health startup? “Uber for X” is passé. So is “AI-enhanced” (though the reality is still worth working on). Then there’s blockchain for health, with its many modern iterations and mostly unclear benefits.

Though there’s no one best business model for everything, there is a common ingredient often missing from many startups’ models, especially those focused on consumer behavior. Too often they miss the very necessary human, local element. They add information—often with trackers—but forget that information alone is rarely enough to cause behavior change. Health startups would be wise to remember precision in motivation and in time, and how information is exchanged between humans. Precision Motivation

One way or another, your health app/service needs to know its customer, both medically/physically and motivationally. That is, it should know not just the individual’s physical makeup and their (perceived) health problems, but the individual’s “precision motivation.” Do they want material success? Do they want other people’s approval? Are they “doing it for the kids,” or to win their parents’ approval? Do they want to be part of a team or to individually beat the other guys? Are they afraid of being old and sick, or do they want to look good at the office tomorrow and at the bar next weekend? It’s amazing how much you can find out just by asking . . . or you can have an AI monitor the user’s reaction to the app’s behavior, and improve the performance of both the app and the user over time. You can also use personality assessments like those offered by Frame Health, an Los Angeles-based company that has licensed the Hogan personality assessment tool for healthcare use. MotiSpark, also in Los Angeles, lets the user select their own motivational video clips; who knows users better than the users themselves? Next, you need to understand how things are changing over time. Wearables are perhaps the most exciting development since sliced brea . . . I mean, the weight scale. For most people, seeing a line go up and down over time in an

app—whether it’s weight (outcome) or steps (input), is a huge improvement over numbers scratched on a sheet of paper, point-in-time PDFs and faxes from a lab, or even those same PDFs in a patient portal. The next exciting development in public health (not just around time) also focuses on tracking over time: continuous glucose monitoring (CGM). It’s becoming cheaper, less invasive, more convenient and FDA-cleared. Right now CGM is limited for practical purposes (cost and convenience, mostly) to people with diabetes, but over time I’d love to see every second-grader spend a couple of weeks with a CGM as part of a required grade-school curriculum that would show, not teach, the real-time impact of sugar and other macronutrients. For adults, it would make the science they may or may not know feel real and personal. Whether it’s CGM for diabetes, Oxitone for pulse oximetry or Oura/Whoop/SleepScore et al. for monitoring sleep, or one of many commodity wearables for monitoring activity, real-time feedback helps users monitor both their behavior and its impact. For some people, it’s enough to see the information for themselves. For others, sharing it is a key driver. Other People

The role of “other people” in your startup’s business model cannot be overstated. These other people can be the user’s own contacts—family, caregivers, friends—or strangers with whom they might find it easier to be candid or people with a similar condition who can actually share their experiences, as with Curatio, PatientsLikeMe or Supportiv. In addition, the peer groups can be enhanced with trained/paid online moderators (PLM and Supportiv). Or the “others” can be paid/trained experts (but without the peers), such as Fit4D’s remote clinical diabetes experts and Vida Health’s broader range of experts/coaches. Both of these companies sell both to consumers directly and to employers, take care of the back-end billing—both to pay the experts and to charge insurance providers when possible. Yet the best apps will have some kind of real-world component, whether that’s relationships with health clubs or tie-ins with retailers that want to increase traffic to their 13

Wisdom

(healthy) food aisles. Sure, that costs more to scale, and grows more slowly, but it also delivers more value and creates a competitive differentiation. Perhaps the startup ends up being acquired not by Humana or ShareCare, but by Starbucks or Uber. The ultimate health tech business model is likely to be much closer to retail and franchising than it is to the current app offerings or to traditional clinical care, which just aren’t that effective at behavior change for many people. I suspect that most apps will become commodities unless they have value added through some kind of local distribution or presence. For example, that could be a diabetesprevention app distributed by the YMCA along with its DPP program that offers group training in local places. We’re starting to see these novel business models with local tie-ins. We’ve got nutrition programs that link patients to registered dietitians who could be paid by Medicare/ Medicaid/insurance with the startup getting a cut (e.g. MealShare). Others add value by training and providing tools for a latent workforce, whether dietitians or nurses/ clinicians (Hawthorne Effect). Startups are bringing people together to re-weave the social fabric, using trained/ paid moderators to facilitate face-to-face group sessions for seniors (Wider Circles). Another take on this in-real-place paradigm is Boulder Care, which is developing an integrated combination of an app for users/caregivers and a dashboard and training for healthcare providers, focused on making MedicationAssisted Treatment for substance abuse more scalable and accessible. Overall, I love the franchise model, combining software with scalable organizations that provide training and quality control of people who interact directly with consumers. My hope for the future of digital health is that app vendors would add in the people component, both online and off, in cooperation with multi-location entities such as Meetup/WeWork, health club chains and enlightened retailers, or nonprofit services like the Nurse-Family Partnership. In this kind of partnership, they could craft curricula or protocols to create tightly quality-controlled but more scalable versions that combine intense training of care providers with apps for both paid nurses/caregivers/coaches and the users and their families. There are so many healthcare apps today, yet the market is still fragmented and the tools often ineffective in reaching beyond a few dedicated super-users. What is the magic missing ingredient to reach a broader, needier population? One way or another, it’s real people, in real places.

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In the Halls of Power, Character Is King In 2009, New York Magazine called Gerald “Jerry” Levin “perhaps the most powerful media executive in the world.” He helmed Time Warner as it merged with AOL at the height of the dotcom bubble. Now, at 79 years old, Levin sees his years atop the media giant in a new light, and has committed himself to coaching CEOs in understanding life beyond the boardroom. StartUp Health’s Logan Plaster sat down with Jerry to talk about power, its corrupting potential, and how transformational health companies must wield it wisely if they want to change the world. "

logan plaster:

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

There has been a lot of research done recently on the science of power, how having empathy is a useful tool for gaining power, but that power, in the end, clouds our empathy. The startup world is full of people who have power, want power, or perhaps have a misconception about power. How have you seen power used wisely or unwisely over your career? jerry levin:

We say money corrupts, I think power corrupts. It breeds a false sense of papal infallibility. Even though we have corporate governance and boards of directors and shareholders, the CEO pretty much navigates in a free-form way based on their personal psychodynamics. I’m a believer that corporate strategy is largely a reflection of the personality of the CEO who is going to use their power to stay in her or his comfort zone. That isn’t necessarily the right place to be. plaster: How did you experience that personally? levin:

For so many years, Time Warner—from music to movies to sports—was an essential part of my comfort zone and my emotional interest. You think because of the checks and balances there is an analytical approach to every decision, but in fact there is something else playing into it, and it’s the personality, the childhood traumas, the whole gestalt of what it means to be a growing human being. I used to play a game with myself to try and figure out the next strategic move of every media company in our set based not on the past history but the personality of the CEO. Power is normally put in market terms—you

plaster:

Who has embodied the character of the emotionally intelligent CEO, as you are describing?

want to have the biggest market cap or the fastest growing stock. The difference, and the reason why I’m so intrigued to be in the entrepreneurial environment, is that it’s not particularly hierarchical. You see it in the physicality of the dispersed workforce, and the fact that the office doesn’t have hierarchical furniture, but also in the reaching out for ideas and the aggregation of the team that’s more horizontal.

levin:

plaster:

What kind of advice might you give to a room full of startup CEOs regarding the corrupting potential of power? levin:

The basic message is: Pay attention to understanding the emotions within yourself and the people around you. Understand that the exercise of your office needs to take into account the humanity of the people who are actually driving the company. At some point, you’re either going to die, retire or have a heart attack—something is going to intervene. Have you been paying attention to yourself and your family in a meaningful way? What’s your value system? Is it about cash as gain, or character as gain? Empathy is a good word to use. In my old days at Time Warner, if a relationship—with anyone—wasn’t relative to the business of Time Warner I didn’t have time for it. They were distracting me from my monomaniacal emphasis on this one thing in my life, to the exclusion of everything else. Instead, look at the people in the company, who are now the team. What’s going on with them, in a deeper way? There may be something going on in their family. I missed the boat trying to understand this. It never occurred to me that someone might be depressed or struggling with an illness or dealing with a sick loved one. I just didn’t pay attention. But that’s not who I am anymore. plaster:

What if the CEO thinks they have this vision, but are blinded by power. They have head knowledge, but lack the heart? What practices can help you build towards empathy? levin:

First, at any meeting, instead of starting with your agenda, you can go around the room and find out what’s going on with each person today. It doesn’t have to do with anything related to the business. Is there any way we can help? This is difficult, but if you have a board that is sensitive to the humanity of the people being dealt with, the same thing can happen. You can come into a board meeting and say, “I don’t have all the answers. I’m wrestling with it right now.” That’s not going to play out every time, but it’s a picture of what could take place if the relationships weren’t all Wall Street driven.

J ERRY L EVIN O N T H E P O WER O F DAILY RE F L E C T IO N -“ It ’ s b e e n like a personal revolution. There used to be a steel gate in front of my emotions. No o n e co u l d get to me or figure me out in a negotiation. I didn’t want to appear weak b y e xp r e s s i n g fears. I f i n a l ly r e co g n i z e d that everyone h a s ce r t a i n f e a r s . To g e t them out a n d d i s cu s s them, you’re just going to be a happier p e r s o n .”

Bill McDermott at SAP. He had a near-death experience, falling down a flight of stairs. I’m not saying he wasn’t sensitive before that, but since the incident, he’s totally committed to this idea. You can see it when he talks to someone in the company. Recently, all these SAP tech people went to France because of issues around the European Union’s stance on privacy standards. Bill then talked about the need for inclusion, and declared that in France they are looking to hire people with autism. In the midst of addressing regulators and the financial community, to come up with that says a lot about the company and its value system. Almost all companies have a mission statement. They’re usually cliches. But you can tell in an organization almost immediately whether there is authenticity to a value system. plaster:

It reminds me of the saying: “I want my flowers while I’m alive.” Don’t wait until you have a near-death experience to learn these management lessons. levin:

Exactly. I was reading a piece by Arianna Huffington where she noted the difference between obituaries and bios. At a funeral, they don’t recite a list of employment. They recite the impact you had on people. We live in an age where very few people really take in the fact that they need to be mindful today, because tomorrow isn’t guaranteed. I recall a speech I used to give to Wall Street execs. I’d say that at one point, content was king. At another point, distribution was king. At a fundamental level, cash is always king. But the only thing that matters is character. Don’t get me wrong; I didn’t live up to my own standards. The trappings of power give you a false sense of understanding and security. You think you have a lifetime appointment, which is not the case. plaster:

What are the practices that you’ve found helpful in accessing the core values of empathy and happiness? levin: The old me would read a million newspapers, sleep

four hours a night, and try to be the smartest guy in the room. The new me meditates morning and night and tries to understand on a daily basis: Who am I, what is my purpose? Whenever I meet anyone, I want to find out what their purpose is, not what they do. I meditate with my wife, anywhere from 15 minutes to a couple hours. It’s a question of priorities. When we meditate we like to express gratitude, but also ask, “Is there something we’re supposed to be doing today?” At night time, we see if we accomplished it, or whether we need to go deeper. It takes time, and you have to be open.

Investors

StartUp Healthâ&#x20AC;&#x2122;s mission would be impossible without the support of our like-minded investors. Thank you.

Jerry Levin Former CEO, Time Warner

Nick Turkal, MD President & CEO, Advocate Aurora Health

Mark Cuban Owner, Dallas Mavericks

Brad Feld Managing Director, Foundry Group

Steve Case Chairman & CEO, Revolution

Esther Dyson Executive Founder, Way to Wellvile

Wayne Kimmel Managing Partner, SeventySix Capital

Ira Brind Partner, Brind Investments

Roger Ehrenberg Managing Partner, IA Ventures

Leandro Sigman Chairman, Insud Pharma

Jason Finger Founder & Former CEO, Seamless

Nan Gardetto President, EveryDayGood Foundation

Doug Galen CEO, RippleWorks

Linda Holliday CEO, CITIA

Jon Kaplan Head of Global Sales, Pinterest

plus 50 additional angel and institutional investors 16

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StartUp Health Magazine

StartUp Health Insights s

Snapshot

Chinaâ&#x20AC;&#x2122;s Funding Surge China is proving to be the most consistent and well-funded country in the international digital health market, with funding totals in Beijing rivaling major American cities.

$522M

Dollars invested in mainland China during first half of 2018, across 14 total deals.

141M 105M 100M 176M Beijing

Shanghai

Zhenjiang

Hangzhou ($75M), Guangzhou ($65M) & Chengdu ($36M)

Ping Anâ&#x20AC;&#x2122;s Marco Huesch tells us what startups get wrong about China, page 56

4 4

Download the StartUp Health Insights report at startuphealth.com/insights 17

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Visit us at caredox.com

Health Transformers 8 inspiring women and men creating the future of health

James Hare eko.ai

Victor Penev Edamam

West Shell III Conversa

Imran Cronk Ride Health

Rick Hennessey SOLIUS

Jonathon Feit Beyond Lucid Technologies

Dr. Sandy Whitehouse Tickit Health

Noe Foster HealthTechApps

24 30

Health Transformers

Q&A

James Hare eko.ai

This Travel Entrepreneur Came Out of Early Retirement to Transform Cardiology "

Q&A

You’re a big traveller. Where is home for you?

Home is now Singapore. That said, I keep one foot here and one foot in Europe at all times. My immediate family is in both. Give us a flyby of your career.

Born in Detroit to a serial entrepreneur father, I grew up knowing that when I hit 18, I was going to leave Detroit. My first job out of college was in Switzerland. I was constantly looking for opportunities to start companies, and so after a couple years, I ended up going to Ukraine to start my own company doing offshore programming. I went to business school in California, stayed there for a couple years and built my second company. I realized that the opportunity in Europe was much larger than the US because Travelocity, Expedia and all of those guys are there. So we started eDreams in Spain. Then I met the love of my life in Singapore and settled down there—it’s been 6 years. You retired after selling eDreams, what drew you back in? We know you love kitesurfing. Why not just kitesurf into the sunset?

A SERIAL ENTREPRENEUR and world traveler, James Hare is on a moonshot

Dossier

mission to detect heart disease within one second. After successfully founding eko.ai and exiting two companies in Europe—eDreams and Asani Technologies—Hare moved CEO / Co-founder to Singapore to retire. But when he met, and fell in love with one of the world’s lead- eko.ai ing cardiologists, he was introduced to a new world of problems to solve. Hare re@_ekoai entered the business world and together, the two decided to radically change the way HQ: Singapore physicians read echocardiograms. Using a proprietary bank of millions of annotated echo images and deep machine learning, Hare and his team are transforming a test that used to take 30 minutes and making it practically instantaneous. Hare hails from Detroit but has trotted the globe since college, moving from Harvard to Stanford to Silicon Valley, then more recently to Spain and Singapore. His resume has covered the gamut—he cut his teeth at Netscape in the 1990s and helped plan the World Economic Forum in Davos—but it has all built to this retirementcancelling project. We caught up with James Hare to learn more about his startup journey and where he’s heading next.

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StartUp Health Magazine

Well, I was a bit of a health freak, one of those guys who watched everything they ate, constantly measuring their blood levels. I was following this person, who now became my wife, who was a cardiology rock star. She was always giving advice at the biggest conferences around the world. My network became the top cardiologists and then I realized that there was this crazy blank space in my area of knowledge about the heart. I asked myself why—as available as echocardiography is—is it still slow and expensive? Because of the network I had, I was able to enter hospitals and start this focus group of cardiographers to see

what they did. I found that they all hated the software that they used, and that’s when the entrepreneurial urge started to kick in again. The dumbest thing in the world is being retired and not being able to sleep. I quickly put together a team using a huge body of images across Asia. Also, most people don’t realize the AI talent that is here in Asia. We put together a bunch of labs in Asia, US and Europe for validation, and that became eko.ai.

How competitive is this space?

Other companies do not have quite the body of images that we have. There’s a company in the Bay Area and another in the UK. The first has a broad source of data, but it’s US focused. Our data is Pan-Asia and US. They also focus on a narrow part of this problem. We’re trying to automate the whole thing—when a patient walks into the doctor’s office, we want to give the doctor everything that they need. As for the " "

“Our pace and timeline always gives [our academic team] an initial look of shock. This pace is not only doable but it’s energizing, it’s fun!” What was it about echocardiograms that made them ripe for disruption?

The echo machines are relatively cheap, but image quality are lower than other techniques like MRIs and CT scans. But there’s a trade-off where there’s no radiation, and it’s cheaper and faster. That’s the challenge when it comes to automation because of the fidelity issues. What we’re trying to do has been done for the less frequent, higher-quality image fidelity. But it hasn’t been done for the echocardiogram, so it’s like the low-hanging fruit that we’re trying to tackle. What’s your method for cracking this challenge?

The key is having access to the data— we have 3.5 million curated, labeled images with patients’ full consent to commercialize them. Another challenge is having a cross-functional team to make this happen—software, machine learning, cardiology, and capital for starting up. Trying to go from academia to the real world is also a challenge.

other, they focus on one niche of the echo world called stress echo. Basically, they both have a good set of data, but are focused on narrow parts of the problem. We’re not trying to solve one singular problem, we’re trying to find one complete solution. How’s the transition from working in the travel industry into an industry of saving people’s lives?

It’s inspiring. At the start of this journey, I felt the need for a solution for my own heart exam. I found out that my doctors were worried about my left ventricle, and it’s because they’re used to the standard measurement used for the local Asian population. They had no idea of differences between African-American and Asian standards. This was when I realized that their solution to this problem was sticky notes or nothing! The more I look into this industry and see the pace of innovation, the more I realize there’s room for improvement. Although regulatory processes are needed in this area, I’m trying to push our people and our project

into market as soon as possible. It’s like a bucket of cold water at times with the academic team…. our pace/ timeline always gives them an initial look of shock. This pace is not only doable but it’s energizing, it’s fun. I definitely drank the Kool-Aid when I was working back at Netscape in Silicon Valley where everyone has this sense of mission, and everyone’s moving at a fast pace, so I wanted to bring that to my company now. What’s next for eko.ai?

In six months we hope to have our regulatory approval in at least two regions: US and Europe. We’ve already started collaborating with the FDA. We’ll have a product commercialized in multiple echo core labs in US and Asia. We have to build up our sales team. You said earlier that your father is a serial entrepreneur as well. What did that look like growing up?

During middle school and high school, my father made sure that I had no free time. Any free time was spent going to work with him, which meant a wholes series of jobs at his company, 1-800-FLOPPIES, from shipping computers to managing phone lines to selling product. I grew up with a mindset that being an entrepreneur was the most normal thing in the world. He’s the quintessential serial entrepreneur.

Global Teams Productivity Apps “My number one tool is Trello—I put my entire personal life into Trello, it’s ridiculous. The combination of Trello, Zoom, Stride (Slack’s competitor), and Github— you can move mountains.”

What was it about his character that you carried onto your own career?

If anyone meets my dad, the first and last impression is that he is the perennial optimist. He combines that with a core mentality of always setting goals.

Health Transformers

Imran Cronk ride health

Need a Lift? How a Young Entrepreneur Is Tackling an Age-Old Healthcare Problem "

IMRAN CRONK MIGHT BE a

fresh-faced 23-year-old, a recent graduate of the University of Pennsylvania, but his startup, Ride Health, is taking on one of healthcare’s oldest problems. The aim is elegantly simple—help people get to and from needed healthcare appointments. But coordinating between health systems and transportation companies is more complicated story. Here’s how it Dossier works. Ride Health Ride Health coordinates with CEO / Founder both patients and ridehealth.com providers to ensure that low-income, @ride_health disabled, and elderly HQ: NYC individuals who face transportation barriers have a safe and efficient mode of transportation to and from appointments. The platform is powered by predictive analytics and is available through a HIPAA-compliant, web-based platform. Ride Health makes it quick and easy for providers to communicate with patients about their transporation needs. This provider-patient connection allows for complete transparency, which in turn will save time for care coordinators, improve patient experience and improve follow-up visit attendance. The platform is accessible via SMS text messaging or even a landline. Cronk’s fresh perspective is resonating with the industry. He’s onboarded four health system customers, and has seen 100% growth in rides for multiple months running. We caught up with him at his new Chelsea office to learn more about the company’s trajectory.

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StartUp Health Magazine

Q&A Among the founders profiled in this issue, you stand out as the youngest. How did you launch Ride Health so quickly after graduating from UPenn?

During my undergrad I was interested in healthcare admin and policy. I thought I’d spend the rest of my life working in large health systems or CMS, tackling health policy issues. Healthcare felt like a calling; it appealed to me that the better you do

What changed your direction and kickstarted your entrepreneurial interests?

During the summer of freshman year, I volunteered in a community hospital in North Carolina. I was in the emergency department waiting area, and my job was to help visiting families find their patients. One night, this patient was discharged into the waiting area and he told

“We put a strong value on intellectual humility—not assuming that we know all the answers. “ "

your job, the more lives you can save and improve. But starting a company was the furthest thing on my mind.

me that he didn’t know how to get home. He went to the nurses station, but they told him that the system couldn’t afford to provide a way for every patient to go home and that he’d have to figure something else out. I asked him what he was going to do, and he said he was considering walking. He lived nearly nine miles away. This gentleman was 60-70 years old, off-balance and had blurry vision. No part of this sounded like a good idea. The only thing I could think of was to give him a ride home. It was a little odd to provide a ride to a stranger in the middle of the night, and the experience stuck with me. I kept asking myself why it happened. What’s the issue here? It sparked my curiosity. Over the years I did some research into this intersection between transportation barriers and healthcare access, and that’s what led me to Ride Health when I finished school. Where is Ride Health in terms of product maturity?

Ours is a fully mature and stable product. It allows care coordinators and social care workers to go in and set up rides for their patients. Whether this is in a hospital or health system, with whatever insurance plans, they can create new patient profiles and set up rides for patients. And based on specifications, know where the patient lives, the appropriate communication method, and configurations based on patient’s level of need (wheelchair involved or not, etc.) We communicate with the transportation providers to ensure that the transportation of the patient is successful. We also

communicate with the patient details about the ride before and after. From the transportation network perspective, it’s everything from Uber (our partner for on-demand curb to curb rides), to dozens of local medical transportation companies which provide the more medically complex rides (e.g. wheelchair accessible vehicles). We’re going to make it a lot easier for these transportation companies at the level of stretcher vans, ambulances (BLS/ALS level) to get paid for those trips and for facility-based coordinators who are calling those vehicles to get the authorization for those trips in a more streamlined manner. We’re going farther up the chain of complexity in the medical transportation sector, and improving workflows on the facility and transportation side. Makes it easier for payers too. What’s the business model?

The facilities pay for the vast majority of our trips and we’re working on ways for insurers to pay directly to transportation providers.

Stat Deck

95% On-time appointment arrival rate

99% Ride Health patient satisfaction

30% Cost savings on a per-ride basis

How is being in your early 20s a leg up in the digital health ecosystem? How is your mindset different from your older peers?

First, I have very few responsibilities compared to entrepreneurs who already have families and mortgages to think about. I’m very flexible, mobile and have few things tying me down. Obviously that won’t be the case forever, but for now, this is an advantage for me. Second, I’m able to take that fresh look into the system from the outside. I listen to them, in an active and thoughtful way, and try to put things together. 23

Health Transformers

We put a strong value on intellectual humility, on not assuming that we know all the answers. Do you feel that your generation has been misunderstood by the current business world?

I do feel that in some ways. There’s a lot of raw desire to improve the world that we’ve inherited. I also think there’s a sense of productive humility that I see in my peers. It’s hard to speak for everyone, but you have to be able to speak across generations and appreciate the contributions that everyone’s done. For example, I spend a lot of time speaking with hospital administrators and transportation care coordinators who are 30-50 years older than me. I learn so much from them everyday. I guess it goes both ways. My generation can under-appreciate the wisdom of those with more experience, too.

Dr. Sandy Penn Whitehouse tickit health

How One Doc Is Using EvidenceBased Research to Improve Healthcare Communication

What are the greatest challenges of being a young founder?

On one hand, when thinking about the capital market, investors like the idea of investing in someone who’s completely fresh and new because that’s where many successful companies have come from. It’s important not to be biased towards age. There aren’t that many entrepreneurs who are in their early 20s. On the other hand, some institutions do expect to work with experienced industry veterans. It can be a little disconcerting for them to sit across the table from someone fresh out of college. Once the conversation starts, however, the concerns generally fade away quickly.

Issue 2

DR. SANDY WHITEHOUSE , the CEO and co-founder of Tickit Health, was a Dossier " physician long before she considered becoming an entrepreneur. The AustraTickit Health lia native lived briefly in the United States before settling in Canada, where she CEO / Co-founder became a clinical associate professor at the University of British Columbia. Six tickithealth.com years ago she identified a problem. After going back to school for a masters in @TickitHealth communications, she realized that there was a severe disconnect between the hard HQ: Vancouver science of medicine, and healthcare’s ability to communicate effectively with patients. Poor communication between providers and patients was so bad that it was affecting outcomes. So Whitehouse and her team focused on youth—those most disengaged from the health system—and used deep research into the science of communication to create digital tools that gather data from patients in a seamless, organic way. The platform creates a contextual, responsive conversation with the user that begins at intake, before the patient sees any providers, and pulls out valuable information. We talked with Dr. Whitehouse about Tickit Health’s current partnerships and the unique challenges of starting a health company in Canada.

StartUp Health Magazine

Why did you decide to transition to the wild world of startups after 25 years in medicine?

What has it been like working with your son on this endeavor? Businesses that start in the family have their distinct joys and challenges.

Between Australia, the US and Canada, you bring a global perspective to your understanding of behaviorial health and healthcare communications. What lessons have you learned about the state of behavioral health for adolescents around the globe.

I think it was very special, actually. Daniel, my son, came along and he’s What’s really interesting is that the an inspiring young man, and he was issues that young people are facing very enthusiastic about what I was in all three areas are quite similar. doing and he was very complemenThe levels of anxiety, depression and tary to me in that I had a lot of the suicide rates, are increasing. There is medical knowledge and a lot of exa suicide epidemic happening and I perience, but he had the passion and think that’s global. But how it’s bethe drive and the connections. It deing handled is really very different. veloped into a very special In the United States, there’s relationship and I think a big increase in schoolwe could read each other’s based healthcare centers, thoughts and we were able and a lot of primary care is to bring each other’s skills STARTUP HEALTH being done in schools, so forward. we are finding a big opporWhat’s unique about 6 tunity there. In Australia, Connect launching a health the schools are much more with Dr. startup in Canada? interested in wellbeing, but Whitehouse There are opportunities and read not from a medical perspecTickit and challenges. The opportive, so it’s much more of a Health’s tunity is that there’s a lot of psychological approach. So latest Tear government support and Sheet. in Australia we are working 6 grants for helping develop much more with communistartuphealth.com research. Also, the governty clinics and we are creating ment and the trade comdifferent tools for schools

that are more about wellbeing than health. Canada is facing more challenges partly due to the bureaucracy of the healthcare system. With Canada we are mainly working with research and grants across the country. There is no strong infrastructure for setting up care for mental health, or the screening that we are doing. "

There was a problem that I was trying to solve. I took a pivot and went back to university and did a master’s degree in communications. When I did that, I realized that we had very good science in medicine but the communication issues were so problematic for people that they were affecting outcomes. I wanted to improve the communication between patients and providers, particularly young people at that time. And then I realized that the best way to do that was to take an entrepreneurial approach because working within the system is so slow.

mission steps in and helps with marketing. There’s a lot of infrastructure support at a government level. We’ve had some substantial support in terms of grants and tax credits, over $500,000 dollars worth of support. So that’s a huge benefit. Our labor costs are somewhat less than in the US, so that’s another benefit. Even though I am an advocate for the Canadian healthcare system, there are really significant challenges in introducing new technologies. It’s a mammoth. It’s a really difficult system to enter into. It moves very slowly, it’s a lot of bureaucracy, and there’s a lot of confusion about how much progress the system wants to make on the technological side, so I think it’s not well aligned.

“The levels of anxiety, depression, suicide rates, are increasing. There really is a suicide epidemic happening and I think that’s global. But how it’s being handled is really very different.” "

Q&A

What developments in the product and in the company at large are you most excited about in the next six months?

With Seattle Children’s, we created a proprietary tool for them called Check Yourself, a mobile screening tool for youth risk behaviors. Check Yourself asks questions on risk behaviors in a Q&A style, and delivers direct feedback based on answers to motivate changes in behavior. That’s rolling out in four states across the US in a number of different schools. As a result of that we’ve now created a tool for middle schoolers, and that’s rolling out to 50 schools. That’s a different version of the Seattle tool. We are in the process of partnering with an evaluation company that does reporting for different state governments around youth health. These partnerships give us a much greater reach, which is very exciting. How does being a 25-year veteran physician change the way you lead Tickit Health?

I think it has a big impact. Quality is very important to me. We are focused on being evidence-based. The passion and drive has come from the experience that I have of wanting to see lives saved and to have a real impact. I think that the importance of the work pervades our culture here and drives really high quality work. We measure success in different ways and not just with the bottom line. I want to leave a legacy that we’ve made a step in improving the care for hard-to-reach populations, that we’ve given them a voice.

Health Transformers

Victor Penev edamam

This Founder Is Providing the Data Needed to Make Smarter Food Choices Q&A "

FOR VICTOR PENEV, CEO AND

co-founder of Edamam, the entrepreneurial drive has come as a combination of DNA and extreme circumstances. Penev grew up in communist Bulgaria. When the regime lost power and the economy fell into a state of flux, Penev learned what it meant to spot an opportunity and capitalize. He started his first business selling jeans on the unregulated market when Dossier he was 18 and he’s Edamam been happily taking CEO / Co-founder business risks ever edamam.com since. Penev built and sold Bulgaria’s @EdamamCo largest internet HQ: Los Angeles company, NetInfo. BG, which he describes as a combination of Yahoo! and Google for a Bulgarian audience. Now, with Edamam, Penev is on a mission to organize the world’s food knowledge. He and his team have created the world’s largest food database, which, when delivered to enterprise customers via API, can help people make smarter food choices. From nutrition data to meal analysis to diet recommendations, Edamam helps customers answer the abiding question: “What should I eat?” The natural language processing software has been put to use by The Food Network, Bon Appetit, Nestle and others. We caught up with Penev to talk about his entrepreneurial path from Bulgaria to California, what gets him centered in the morning, and what’s on the menu tonight.

How did you get into food data?

The operating word there is food, not data. I’ve always loved cooking and eating—I think I have probably cooked almost everyday for the last 30 years. And I’m a serial entrepreneur, that’s where the data part comes in. When I sold my last company in Bulgaria, I took a year off, looking for what to do next and it was kind of clear to me that combining food and technology would be the

Victor Penev at Sofia Tech Park, a coworking space in Sofia, Bulgaria.

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StartUp Health Magazine

Healthy Habits Victor Penev is a certified yoga instructor and spends up to two hours each morning practicing yoga, getting centered for the day.

way to go. After months of research I realized that people would love to know what’s in their food because of the impact it has on their wellbeing and health, but that data is not readily available, or it’s contradictory or incomplete. It’s just disorganized. Which is why I came up with the idea: let’s organize the world’s food knowledge and give it back to people so they can make smart food choices. How has organizing food data for Edamam changed the way you see your own nutrition?

It’s made me more conscious. I always knew that food is the ultimate medicine. What I didn’t know is how many people are sick out there because of not eating right. What I’ve learned over the last six or seven years is that there are quite a few chronic conditions that we can actually worsen or heal with diet. Of course there are things that are obvious like

HEALTHY HABITS

Cook Like Victor I love variety and experimentation. I grew up in Bulgaria, so Mediterranean cooking is something I can do with my eyes closed. I

cook very local and seasonal, so whatever is sold in the green market would be something I cook. Right now if I were in New York, I would probably get fresh striped bass or black sea bass from the fish monger. I might get fresh shelling peas or sugar snap peas, some salad, and fry-bake the fish, do a simple

salad or a puree of peas. And then add some fresh mint, which is always in season. For dessert it would be cherries, or strawberries with ricotta and lemon zest. Every time it’s different. I really try to cook as much as possible based on what’s in the market, not on a preconceived notion.

diabetes, hypertension and being overweight. But other health issues I didn’t expect, like psoriasis, which is a skin disease that is very much impacted by diet. And that’s taken a new significance for me. Honestly, as I age I am becoming more sensitive to how my body responds to various foods. On the other hand, I’m not going to obsess about calorie count or fat or whatnot. If something is delicious, by all means. I’m not against a big scoop of ice cream or something really fatty like a good bacon strip. How are people currently interacting with Edamam’s technology platform?

We figured that to have the biggest impact we need to work with the businesses that touch people at the points of making a food choice. It was a conscious decision to switch to a B2B model and we essentially empower businesses in the food, health and wellness space with nutrition data solutions. The platform is fully built to deliver certain solutions like real-time nutrition analysis and meal recommendations. But we have big and bold plans, at least for the next 30 to 40 years, to make it absolutely

seamless for people to have the right monitors and recommendations on what they should be eating to be healthy.

Tell us more about your entrepreneurial journey in Bulgaria and what laid the groundwork for you to be a serial entrepreneur.

You’re already looking 30-40 years out. What will nutrition look like in 2058?

Part of it is personal attitude. I think to be an entrepreneur you have to have a certain risk profile and I do have that risk profile. The choice of taking a slightly less safe path that can make a change, I would take that versus the security of a month-tomonth. Part of it is how I grew up. I grew up in communist Bulgaria but when I was 18 or 19, that’s when the communists fell and there was a space of two to three years that was all black market. You cannot help but be part of something that is changing constantly and you need to adjust to it. And that opened my eyes to that way of life, that’s when I started my first business which was basically buying and selling stuff, it wasn’t anything complicated. But entrepreneurship is not about technology. You can be doing anything entrepreneurial as long as you’re comfortable with the risk and you see an opportunity that you can fulfill.

Ultimately people are going to chose with their gut and with their taste buds. But what is lacking right now is a feedback loop. Something that knows you well enough that can, in any given point of time, wherever you are, recommend something for you to eat. Obviously, it’s your choice after that, if you take the recommendation. But the reality is that most people want to eat healthy, they want to feel good, and given the choice of two equally delicious meals, one healthy and one unhealthy, they’ll chose the healthy meal. So what we imagine is a virtual nutritionist that lives in the cloud and has many access points. It could be in today’s world through your mobile device, in your refrigerator, in your watch. But it can be also things like little implants that measure your biochemistry in real time, so that it offers a picture of what your biochemistry looks like— things like regular genome checkups and microbiome checkups. Or the microbiome can be nanobots that you swallow with a pill that send data about your microbiology and what your health is, and what your genome is. So, those are the data outputs– your genome, your microbiome, your biochemistry, your likes and dislikes, your allergies, anything that is personal. And then we take all this data and we marry it against meals that we have in our data set, meals that line up with whatever is in your fridge.

How did it impact you to learn entrepreneurship on the black market?

Entrepreneurship is not something you learn. You learn how to do business. Entrepreneurship is an attitude of seeing an opportunity and being willing to take the risk to fill that opportunity no matter what the cost. And the passion and the perseverance to go through it. That’s what defines an entrepreneur. I believe that everyone in the world should start a company at least once, so that they see if that’s them or not. I’m not saying that everyone’s an entrepreneur, I think it’s a minority but if it’s you, you may change the world and may live a much happier life.

Health Transformers

Q&A

Rick Hennessey SOLIUS

What drew you to tackle vitamin D deficiency with SOLIUS?

SOLIUS Is On a Mission to Bring Revolutionary Light Therapy to the Masses "

Q&A

WHEN RICK Hennessey sold his last company for just north of $100 million,

he thought he’d be all smiles. But a string of family illnesses—including his own wife’s struggles with Seasonal Affective Disorder, left him frustrated, wishing he could do more. He put his money behind a company developing promising light therapy, delivering vitamin D without the harmful radiation. Soon, he became the company’s most enthusiastic advocate. Now, six years later, Hennessey is back at the helm, as CEO of SOLIUS, which he believes can bring a new kind of healthcare—far beyond vitamin D—at a disruptive price. SOLIUS is a free-standing booth that uses light science to strengthen the body’s systems by stimulating the production of critical hormones and peptides. Having completed a successful trial on Bainbridge Island, across the Puget Sound from Seattle, Hennessey and his top brass have their sights on making SOLIUS available on every corner.

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StartUp Health Magazine

Dossier CEO SOLIUS.com @SOLIUSinc HQ: Bainbridge Island, WA

I sold my last company for over $100 million. Coming out of that, you’d think you would just be celebrating. But I was frustrated because I had a lot of family members who were having health challenges and there weren’t any solutions for them. That’s when I decided to invest in solutions that currently aren’t available in the market. The idea was to find the future of medicine—a better way to treat people that was safer, more effective. I ran into these scientists who had developed really incredible light science. It activated human gene expression as a better way to prevent and treat diseases. Light, to some people, seems innocuous. Then you dig deeper and realize that the largest organ in your body is your skin, and the way it takes in light has an incredible impact on human health. In order to thrive, humans need fresh air, clean water, proper nutrition, and sunlight. There are Clean Air Acts, water filtration systems and nutrition companies. But no one is doing a good job at figuring out how to harness the benefits of sunlight, which are enormous. Just one of those benefits happens to be vitamin D. It was also personal for me. My wife suffers from Seasonal Affective Disorder (SAD), along with a thyroid disorder. We’re fortunate enough that every winter I could send her to California for four to five days a month to get sun, and she felt way better. This past winter, when she was in the SOLIUS trial, was the first winter she never asked to go South. She stopped taking her thyroid medicine—her thyroid was balanced. And it was the first time we’ve been able to lift her vitamin D levels because she couldn’t get them high enough with pills. So just to

cused on places where people already go for health. That could be wellness centers, the right kind of clinic, pharmacy or health club. Those areas are overwhelmed with inbound requests for our machines already.

The SOLIUS light therapy booth was first trialed on Bainbridge Island in Washington.

How big can light therapy become?

We want to bring a new science into an incredibly large market. It’s so disruptive because it completely drops the price on people’s care. The idea that we could be so transformative

This might be the most important thing I’ve ever done. After having such an impact on my own family members, I realized that everybody else needs this. People deserve to feel happy and feel good. We believe that we bring that, just like the sun does, but in a safer, more effective way. What’s the bigger vision for SOLIUS, beyond vitamin D?

In developing SOLIUS over six years, we not only had to tackle the science, but also a way to deliver it to the human body so that it works without burning someone. Once we developed the product with vitamin D delivery in mind, we realized that this could be the future of medicine. We were instigating mechanisms in the body similar to how drugs were effecting the body. We decided that if this was the future of medicine, we had a responsibility to bring it to the market in a way that everybody could use, enjoy, and afford. So we created SOLIUS, a self-service machine that allows everybody to access this incredible light therapy technology at a low cost.

“This might be the most important thing I’ve ever done. After having such an impact on my own family members, I realized that everybody else needs this.” "

How does it feel to be able to bring a product to market that would impact your own spouse in a personal way?

seeing the impact on my own family has been incredible. We honestly can’t believe it.

What is the business model?

It is really simple. We put the SOLIUS machine into a location and we share revenues. We do that because it allows our partners to become immediately profitable and there’s no cost to them. Our customers pay just $50 a month. That enables us to build recurring revenue that compounds every time we initiate a new market. What has the response been like?

We’ve had our first trial where we asked people to pay. We expected to get 20 people to pay $50 a month. Within the first month, through one small ad, we had 150 people sign up. They go in on their own, have the treatment, and they’re done within 2-4 minutes. They leave feeling great. People are saying things like, “I’ve never felt this good,” and “Don’t end the trial!”

Good Rays To get the same effects of a single SOLIUS session, you’d need to eat 11lbs of salmon, drink 273 glasses of milk or take 70 vitamin D pills per week.

is really fun. A lot of people aren’t going to understand what we’re doing at first, and that’s okay. But the clinical trials proving our outcomes are coming. What was it like transitioning from a business more focused on the bottom line, to saying, “the next thing I do I want to really change people’s lives.”

In the middle of building this other business that had a successful market, I had my children. This changes human beings. It made me want to be part of a legacy, something that I could be proud of, that actually had an impact on other people. I think when you start making money you realize it’s not the only thing.

Track Record Hennessey has had five successful exits, the last for $116M in four years off of $7M in capital raised.

Where do you foresee the SOLIUS booths existing?

Right now we already have more demand than we can meet, so we’re fo29

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StartUp Health Magazine

Health Transformers

Noe Foster healthtechapps

This Hawaiian Serial Entrepreneur Is Gamifying Concussion Care

Q&A What led you into concussion care?

My background is with health insurance. Iâ&#x20AC;&#x2122;ve worked on the executive level for health plans. I did experience one concussion, somewhat humorously in a Costco parking lot. And my co-founder, Kyle, has experienced two sports concussions, one while playing football in high school and another while snowboarding.

" NOE FOSTER HAS ALWAYS found a way to bring scrappy entrepreneurship into her work, even in the midst of monoliths like the military and the health insurance industry. The startup bug bit early. Foster dropped out of college as a fashion major in Hawaii to start a clothing line which she grew to three retail locations. Her path then wound through the Air Force reserves where she served as a medic, and then to executive leaderDossier ship at a health HealthTechApps insurance plan. CIO / Co-founder Fosterâ&#x20AC;&#x2122;s unique healthtechapps.com experience has @HealthTechApps coallesced in HealthTechApps, HQ: Honolulu which she founded with Kyle Chang and Paul Newell. Their MePrint technology offers a new way to monitor people who have suffered a concussion. The iOS app and HIPAA-compliant web portal allows those who have suffered a concussion the ability to communicate symptoms in a video blog format. The system also analyzes symptoms and trends, communicating data to patients and caregivers, helping to avoid repeat injuries. The platform allows for physicians to receive up to 20x more data than they would in a traditional office visit. Foster has her eyes set on the world of competitive sports at the moment, where concussions and re-injury are a daily concern, but for MePrint, the playing field is just the beginning.

eight years, and our first client was UnitedHealth. They had just won a $1.5 billion contract with Medicaid, so they hired my team to do a strategy and execution of the key piece of that contract. That experience helped me blend the small scrappy thinking of how to mobilize quickly.

So you came from the insurance side, which gives you an insider’s insight into the payment challenges of an app like this.

We built our revenue model from the inside out because of the intel that we had from my experience working at the executive level at a health plan. I knew about the longterm costs of a concussion, and also, the importance of focusing on certain key health populations that health plans are interested in retaining for the lifetime of that member. I think that’s the thing that differentiates our team. It is our diversity and inside perspective with health insurance and health plans. How was the transition from a corporate insurance company to working on your own startup?

Many years ago, when I was 21, I started my first business. I was a fashion design major and I dropped out to start a fashion line that ended up opening three retail stores and mail order. It was called Point of View. It was all playwear for tennis and golf. Everything was designed by myself and our team of designers. Having that experience as a first time entrepreneur really helped me understand how much I liked the idea of learning everything about the business early on and which pieces of the business I like best. After doing that for 12 years, I had enough of retail, and so I decided to go into the medical field. I enlisted into the Air Force Reserves, and I trained as a medic and started working in the healthcare field. Through a series of events, I was hired as a manager of a healthcare plan and promoted into the exec team, where I stayed for seven years working on Medicare and Medicaid. After that, I decided to consult specifically for Medicare and Medicaid health plans, and military healthcare projects. I opened a consulting company called The Strategist. I ran that company for 32

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What inspired you to keep striking out on your own, in the midst of these large systems like the Air Force and health insurance?

Lightning Round Flights to the Mainland We’re in California 2-4 weeks every other month. Go-To Workflow Tool We use Zoom and Trello a lot. Healthy Habits I start my day off at a yoga class early in the morning at 7am.

StartUp Health Magazine

It’s definitely a part of my DNA. I got the bug. My parents also had businesses, but they were very different. I was blessed with a grandfather who was always experimenting with new things. He was very encouraging about trying new things and exposing me to different ways of thinking. When I think about who was the first person to teach me about design thinking, it was my grandfather. He was always experimenting, prototyping, testing things out, never worrying about failing. He was always saving, recycling, and refurbishing things from scratch, way before it was even popular. It was always a learning experience. Having someone like that just made experimenting and pushing things to the edge exciting rather than worrisome. That gave me the freedom to try things. Tell us a little more about MePrint and where it’s heading.

Initially, we were very focused on our customers being large health plans because that’s where my experience is. Recently, we’ve found a better onboarding which is with sports tech first. Several months ago, we were invited to pitch at a sports tech event—we were one of the five teams out of 400 selected to pitch. Sports tech is much more open and ready to experiment with different types of platforms, especially next-generation platforms like ours, much quicker. For the last couple of

years, we’ve been working carefully with a Major League Soccer Group (MLS) team in California, the San Jose Earthquakes. Their trainers have been phenomenal. They help us test early iterations of our MePrint platform. The elite teams are interested in finding tech to improve performance. The MLS is really invested in academy teams—high school students who they groom. They’ll typically spend $70-80K per year for each academy player because the team pays for all of their training. Often, after the second or third concussion, the athlete has to retire. There’s a real interest in using our tech to prevent reinjury and accelerate training. That go-to market strategy is something you’re rolling out currently?

Yes, in the next six months. We have a sports tech expert, Brian Cop, who has worked with large sports tech companies to help them scale rapidly. We’re pursuing a global growth strategy for that because there’s an international interest to find tools to improve the performance of academy teams. We think athletes are an ideal group to be our first customers because they’ll use our platform in ways that someone else with a concussion who’s not as committed to recovery wouldn’t. What kind of environment is Hawaii for a startup?

Because Hawaii is such a melting pot of cultures, and growing up here we embraced the best of all cultures, it’s comfortable to embrace other ways of thinking about things. On the other side, it’s challenging for tech companies. Very little has been invested into tech here. A positive is that we’re able to get in front of decision makers a lot easier.

Health Transformers

West Shell III conversa

How a Five-Time Entrepreneur Has Upgraded the DoctorPatient Conversation "

WEST SHELL III IS NOT your pro-

totypical startup founder. That is to say he knows exactly what he’s getting into. Shell helmed four companies over 28 years before launching his current venture, Conversa, with his co-founder Dr. Philip Marshall. That said, like so many entrepreneurs, Shell’s decision to start a healthcare company is personal. The son of a real estate entrepreneur, Shell grew up with three sisters Dossier who each suffered from multiple health Conversa conditions that CEO / Co-founder needed monitoring. conversahealth.com In each case, Shell @conversahealth saw that once they HQ: Portland, OR left the four walls of the doctor’s office, they were basically on their own. Frustrated by the lack of communication between his sisters and their doctors, Shell saw an opportunity to help all patients through improved health communication. And so Conversa was born, a digital checkup platform that delivers personalized messaging to patients and actionable data to the care team. By buildling out the right messaging tools, Shell and his team hope to make conversation the cornerstone of health.

Q&A What’s your philosophy around creating your startup’s executive team?

After having managed four other early-stage companies, you learn very quickly that creating a disruptive company requires different skillsets. You need to be able to make quick

shifts in your thinking, and you need to attract the right talent quickly. It’s all about the team, and I believe that hiring a senior team is crucial even though it requires spending more. You’ve got to have adults in the room because they understand what it takes to scale a business and gain the confidence of your customers and stakeholders. I’ve worked with a lot of talent over the past 30+ years of being a CEO, so I was fortunate to get a number of them to join the Conversa team. The senior team makes my life a lot easier and de-risks the business. When did you learn that you needed to invest early in the executive team?

With my first company, Pacific Marketing Group (now Highway One Communications), I was there for 11 years, and I literally calculated

Stat Deck

80% of Northwell Health’s patients stated they felt more engaged in their care with Conversa.

STARTUP HEALTH

HQ 6

Read back articles about how Conversa is changing the health comms landscape. 6 startuphealth.com

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that throughout those years, I generated 76% of the business. That was exhausting. Of course, it was fun juggling various roles, but that’s tough to scale. Ever since I’ve hired a seasoned executive team who have children and lived through experiences, the level of accountability goes up, and so does the quality of decision-making. They understand the risk profile because they have an enormous amount to lose, so the team ends up making calls that have a much higher propensity to succeed. Was there anyone in your life who inspired you to become an entrepreneur?

My father was an entrepreneur. He created what was probably the largest real estate company in the Midwest. In the early 1980s, the economy was awful and the real estate market had just imploded. At one point his company was almost bankrupt, but my father took a $1 salary, rolled up his sleeves, and built his business from the ground up. That was pretty inspirational. He raised me to be a value creator — I’ve always loved to create things and compete. From an early age, I was leading all sorts of teams, from my high school soccer team to the college newspaper. I love bringing people together to make something important. In my early years, I received great management training from companies like Johnson & Johnson, but I was unsatisfied with my career path. I didn’t want to continue arresting the decline of someone else’s mature business. I’d rather be responsible for my own fortune. Once I got the taste of building a company, I decided I never wanted to do anything but that.

StartUp Health Magazine

What shifted in the national healthcare conversations that paved the way for Conversa, with its emphasis on chatbots.

Things started to change when health systems started hiring transformation officers and patient experience officers — people who were in charge of innovation and patient-centered satisfaction. Everything in the healthcare space used to be physician-centric. It was about time we saw patients as an integral part of the health system. For us to deliver a higher standard of care, we needed to recognize that patients deserve continuous, collaborative care at the time that they need it, and not just during the clinical encounter. In order for health organizations to be successful these days, they must not only improve their reimbursement models and clinical workflows, but also increase their patient satisfaction. It’s a major shift to realize that that data can actually improve the patient experience and make everybody happier instead of just making everybody miserable. How has your personal experience of the healthcare system driven you?

I had a whole bunch of tests done last year and received no follow-ups. I had to be the one reaching out to my doctors, which seems crazy to me. But more importantly, my three sisters are the ones who drove me to create Conversa. In each case, the health system failed them. They did not receive the educational materials and personalized information to help them manage their conditions. Once they left the clinical encounter, they stopped being patients. So when we tested Conversa to fill the gap in follow-up communication, it became clear to me that every patient has a unique set of health issues that need personalized care plans and information...one-size-fits-all solutions don’t engage patients in a way that drives behavior.

Over the last quarter, what has been your proudest achievement for Conversa?

The biggest win by far is Northwell Health — they’re the largest health system in New York with 21 hospitals, and they’ve embraced Conversa completely. We’re initiating a system-wide roll-out of our platform across seven different service lines. We’ve gone from an initial pilot to doing a Medicare discharge across the big six use cases. Also, we’re about to deploy our service to the emergency department where we’ll offer Conversa to pre- and post-surgery patients as a means to a followup. Collecting these use cases will help us understand how we can help that patient journey become more successful for both the care team and the patient. Moreover, for several early customers we are seeing ongoing engagement with chronic care patients that has sustained for over a year and counting. Engaging with patients regularly on a week-to-week basis empowers them to address their health routinely, instead of episodically. What’s one piece of advice you’d give to a healthcare entrepreneur?

From the top down, you’ve got to set a culture that embraces change and embraces making tough calls. When it comes to partnering up with health systems, you really need to find the right system that has the leadership in place to welcome new innovative technologies because otherwise, you’ll waste your time. For Conversa, Northwell was a perfect fit because their executive team focused on improving patient experience and transforming clinical workflows. The commitment from both sides is a key piece to the partnership.

Health Transformers

Jonathon Feit beyond lucid technologies

Pulling Out the Stops to Reimagine the EMS Industry

FOR JONATHON FEIT AND

Christian Witt, the founders of Beyond Lucid Technologies, the pain points needing to be addressed in EMS are incredibly personal. Witt lost is own father and sister in an automobile accident 300 miles outside of Albuquerque, New Mexico. That day, Witt recalls, the EMTs weren’t able to communicate the situation Dossier clearly to the Beyond Lucid receiving hospital Technologies and activate a triage team before CEO / Co-founder their arrival. beyondlucid.com This tragedy HQ: San Francisco drove a deep dive into EMS, where communication problems cause the industry about $3 billion in additional costs each year. Witt and Feit founded Beyond Lucid Technologies as a way to connect first responders with each other and with their receiving hospitals. The SaaS platform brings together all of the relevant information needed by emergency medical services (EMS) and fire department crews before they arrive on scene, and transmits vital patient information to the hospital while the patient is in route via Beyond Lucid’s proprietary Mediview platform. We caught up with Jonathon to learn about the unique challenges of innovating in the EMS market.

Stat Deck Q&A You’ve had a circuitous path to Beyond Lucid. How did you end up in the world of EMS telemedicine?

I like to ask the obvious questions that no one else seems to be asking. I did this in digital publishing and now in the EMS world. We were the first in our industry to put a camera in a patient care record, which is so mindboggingly not genius, it’s remarkable. If you are transporting a patient that is sick and out of sorts, and you need to capture their insurance information so you can bill them, you need to have that visual data. One fire company I know of, which uses a different system than ours, can spend up to 72 hours trying to bug the hospital to get the insurance information about a patient they transported, for billing purposes. Of course, to address the obvious questions in healthcare, you have to understand everything surrounding them, from use cases to ergonomics to data security. And, you have to understand how that technology service impacts the bottom line. Is it

50% Approximately half of critical patient data is lost at each handoff in the prehospital environment.

60% Beyond Lucid’s MEDIVIEW EHR platform reduces fire/ EMS documentation time by 60% from the national average. That’s about 10 minutes saved per record.

just a nice-to-have? Will users actually adopt it? That’s the stuff that I’m good at. It’s a combination of user experience design, and technology and innovation. One of the books I used in my class I taught at Boston University was called The Art of Innovation by IDEO. The reason why I used it was because part of it is about brainstorming, and part of it is about how everything you come up with has to have a practical application. But what’s interesting is how locked into inertia people get. Why do we do the things we do? Because we always have. What is the greatest challenge about innovating in the EMS market?

When you consider the hype of the digital health business in particular, the single most lacking thing is evidence—evidence which leads to value. And the bar in EMS is incredibly high. It has to work. Period. You can’t put a beta in the back of an ambulance. We made mistakes, but the concept of failing a class doesn’t exist in our industry. It can’t. People get hurt. You have to find a way to survive. You have to find a way to provide what people want. In our case, that might have meant providing a low cost option when our competitors were more expensive, or in other cases it was providing customization that people could afford. About 25% or so of our business is rural, and a lot of those rural providers could not find anyone else who was willing to take care of them. I don’t care whether you are large or small, to your community you are the most precious and essential resource when it hits the fan.

Office Visit

Doctor.com

The Secret to Better Online Physician Reviews? Office Pickling. INTRO

Three out of four Americans say online ratings and review sites have influenced their decision when choosing a physician. Enter Doctor.com, which used the foundation of a powerful domain presence to centralize essential practice information, patient reviews and appointment booking on one platform. Like Yelp for the medical world, Doctor.com has become the go-to platform for physicians seeking to manage their online presence and reputation. We stopped in at their bustling Union Square office to meet the team and learn more about what makes the physician data aggregator successful.

Flagship Partner HealthGrades, the leading online platform for patients to find and connect with the right doctor or hospital, was initially perceived as a competitor to Doctor.com. Then, Doctor.com became HealthGrade’s exclusive patient appointment booking partner. The content from the company’s patient feedback platform goes directly onto HealthGrade’s site. Currently, HealthGrades helps about a million people a day find and connect with healthcare providers. Consumers can use Healthgrades.com to search profiles of more than 1.1 million physicians, including physicians in all specialties nationwide. They have nearly seven million published reviews and ratings of physicians by patients. 36

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Leadership Profile Andrei Zimiles, co-founder and CEO, co-founded Dimestore Media, early employee at Game Trust. Reed Mollins, co-founder, Chief Strategy Officer, was co-founder and EVP of sales at PracticeBrain, a precursor to Doctor.com that the company acquired. Jorge Sierra, co-founder and director, built and trained successful sales teams at Yodle and ZocDoc. Gary Millin, cofounder and executive chairman, cofounded Mail.com—its June 1999 IPO raised $50M—and co-founded MediaSentry, which sold to SafeNet for $20 million in 2005.

StartUp Health Magazine

How Doctor.com Handles Negative Reviews Don’t fight them. Instead, increase the volume of reviews. At Doctor.com, hiding or gaming reviews, which other review sites do, is seen as short-sighted, ethically wrong and ultimately against customers’ best interests. Mollins notes, “Everyone is going to be a patient, and they are going to have to rely on the wisdom of crowds.” Key Innovation Doctor.com’s patient feedback platform is a Chrome-based device that sits in the doctor’s offices, ensuring patients review their physician while they’re still on site. After all, who remembers to write reviews when they get home?

This page Clockwise from top: Jessica Nikci in Sales; James Kurz, VP of Finance; Jan Biernacki, Engineering. Facing page Clockwise from left: Mara Kaufman, VP of Client Services; Matt Davis, Client Services; Danny Olivo, Client Services.

Healthy Habits Office Pickling in 11 Easy Steps

2018 Traction This year Doctor.com closed its largest enterprise deal, which was 50% larger in magnitude than any previous contract. They have started going head-to-head on RFPs against the biggest names in the healthcare industry. They have three more enterprise bids currently in the works. Recently, Google signed up Doctor.com as a feature partner for Google My Business, a process which took the company two years. GMB helps customers find and connect with local businesses. The company is the only one in this initial class that’s exclusively focused around healthcare.

Reed Mollins on Collaborating with Perceived Competitors “The endemic data challenges that we all face, even the simple stuff like who works where and what do they do, is crucial in healthcare. No one is going to solve that alone. It takes companies like us and HealthGrades, hospitals, medical associations, health systems themselves, organizations like CAQH. Basically, it’ll take a village to sort out this information through putting a system in place for patients. So you end up in this place where you have friendly competitors where you’re going for the same mission but you recognize that that’s better than your competitive overlap.”

Office Culture Every Wednesday, Doctor.com holds a ‘Lunch and Learn’ to get to know members of the team. The topics range widely from internal decision-making to beer fermentation—including beer tasting—to musicology. “It’s an opportunity to let everyone share their knowledge to the office,” says Mollins. The Doctor.com staff has also started pickling at work, says Mollins. “I believe in the power of fermentation to benefit the microbiome. On Wednesdays we go to the Union Square farmers market in the morning and pick up whatever’s in excess and pickle it at the office. Right now we have spicy green beans, mediterranean red cabbage and kimchee with fish sauce for the vegetarians.”

Clean jars well. Trim veggies of choice. Make the brine–equal parts vinegar and water*. Divide veggies (tightly packed) and spices of choice into jars. Boil the brine. Add brine to jars. Tap to remove air bubles. Seal. Refrigerate. Wait 48 hours. Share with friends. *Doctor.com prefers lactofermentation, a pickling method that doesn’t involve vinegar.

Dental care and expertise...

ANYTIME & ANYWHERE Teledentistry is more than just software. Itâ&#x20AC;&#x2122;s a change of mindset in how dental care can be delivered. TeleDentÂŽ is a complete teledentistry solution that changes what is possible in dentistry.

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StartUp Health Magazine

Learn more at mouthwatch.com/teledent

StartUp Health Insights s

Snapshot

Top Investors in Digital Health According to StartUp Health Insights Midyear Report, eight of this year’s top nine investors are investing at multiple stages. More investors are keeping an eye out for transformative technology and growth potential, regardless of stage.

Don’t miss our rundown of 10 health investors to watch—including Liz Rockett of Kaiser Permanente Ventures.

s DEAL COUNT BY MIDYEAR 2018 (Change over midyear 2017 as noted) Early Stage

Mid Stage

Late Stage

Khosla Ventures

NEA

Founders Fund

10 Deals (+6)

9 Deals (+3)

8 Deals (+4)

Thrive Capital

Greylock Partners

Venrock

6 Deals (+6)

5 Deals (+4)

5 Deals (+1)

General Catalyst

First Round Capital

Polaris Partners

5 Deals (+2)

5 Deals (+3)

5 Deals (+5)

4 4

Get to know the women and men investing in digital health on page 50

Download the StartUp Health Insights report at startuphealth.com/insights

Masterclass

or provide a set of actions that will allow the CEO to reach the answer that is best for them in due time. To do that, we use strategic thinking tools that can either take five minutes to sprint through or five hours to pour over. One of our favorites is the “5 Whys” methodology, popularized by Sakichi Toyoda (and perhaps many four year olds), as a way to get to the core of an issue at hand. It works every single time.

Polina Hanin Academy Director, StartUp Health

But Why?

Challenge #1: No one is investing in my company

For timeless wisdom on how to get the answers you need to run your business, just tap into your inner four-year-old.

hich customer

STARTUP HEALTH

HQ 6

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

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should I pursue? How should I differentiate myself ? How would you classify my company? As the Director of the StartUp Health Academy, these are questions that I get every day from entrepreneurs. They seek a response, and it’s a response that any advisor can technically give, so it’s tempting to just start doling out answers. Pharma! Integrate with EPIC! I dub thee “Population Health”! But are these answers going to be “right”? More specifically are they going to be right for your company? At StartUp Health, where we work with hundreds of entrepreneurs across 250+ companies, we’ve made a tough command decision. We don’t dole out advice. We just don’t do it. Instead, we coach. Our goal is not to deliver an answer, but rather help the CEO reach an answer him/herself StartUp Health Magazine

[Note that even the challenge itself isn’t stated as “I need money” or “How do I get money”, which is what we hear most of the time. So we first start with restating the need into a challenge.] 1. [Why is that?] Investors say that I’m too early 2. [Why is that?] Because I only have one customer 3. [Why is that?] Because getting customers takes up to 18 months 4. [Why is that?] Because no one is willing to champion me through 5. [Why is that?] Because my company isn’t a top priority

This is how you get from a challenge of needing investment dollars to realizing that the problem is actually a marketing and positioning issue. You’re not seen as a valuable partner to your target customer. Another version of that same exercise for a business with a different customer type and business model could have led to this: Challenge #2: No one is investing in my company 1. [Why is that?] Investors say that I’m too early 2. [Why is that?] Because I only have one customer 3. [Why is that?] Because our conversion rates are too low 4. [Why is that?] Because we don’t have enough clinics in our pipeline 5. [Why is that?] Because no one is dedicated to finding customers to put through the pipeline

Be careful of the infinite loop trap. Challenge #3: No one is investing in my company 1. [Why is that?] Investors say that I’m too early 2. [Why is that?] Because I only have one customer 3. [Why is that?] Because we don’t have a large enough pipeline 4. [Why is that?] Because we don’t have anyone on the team who knows healthcare 5. [Why is that?] Because we need investment capital to hire the right people

If you find yourself in this kind of position, take a really good look at your responses for each of the Whys. It’s likely that you selected the most obvious one, instead of the real one. In the above example, #4 is clearly an excuse that leads to an even easier justification for #5. The natural inclination for the immediate challenge might have been “I need introductions to investors” as a way to solve the basic need. But that doesn’t actually get to the root cause, and root causes have a way of cropping back up later. Throwing money at the problem when you still only have one customer and don’t have a plan for how to grow and expand, will only result in a lot of wasted money. As coaches, our goal is to constantly ask founders questions. They will be difficult and will force you to think. It’s not our job to give out answers, but to arm people with the right set of tools, so that they’re empowered to respond, no matter the challenge. 6 Meet Polina Hanin during the StartUp Health World Tour this fall as she travels to Spain, Bulgaria, South Africa and the Czech Republic meeting with Health Transformers.

StartUp Health s

Mission

The Quest to Achieve 10 Health Moonshots

Access to Care Moonshot

Cost to Zero Moonshot

Delivering quality care to everyone, regardless of location or income

Radically reducing the cost of care by a factor of a million

Cure Disease Moonshot

Curing disease using data, technology and personalized medicine

Cancer Moonshot

Ending cancer as we know it

Women’s Health Moonshot

Prioritizing women’s health, including preventive care and new research

Children’s Health Moonshot

Ensuring every child has access to quality care, particularly in underserved areas

Nutrition & Fitness Moonshot

Providing access to a healthy environment and supporting an active lifestyle

Brain Health Moonshot

Unlocking the mysteries of the brain to improve health, wellness and mental health

Mental Health & Happiness Moonshot

Connecting mind, body and spirit in the pursuit of happiness

Longevity Moonshot

Adding 50 healthy years to every human life

Masterclass

Bari Krein, JD, LLM Chief Strategy Officer, StartUp Health

A Simple Signature Today Could Save You Tomorrow

W hile

many

entrepreneurs don’t realize it, the decisions they make in the early stages of their companies can have a huge impact years later. Before joining the launch of StartUp Health as chief strategy officer, I was a senior attorney at the Securities and Exchange Commission and a partner at a national law firm specializing in business transactions, initial public offerings and public company reporting. I was also general counsel of a public company during the dot-com era. In all of these roles, I’ve seen again and again the completely avoidable mistakes that entrepreneurs make. They make them for seemingly good reasons: to save money on legal fees, to avoid rocking the boat by requiring their co-founder or employee friends to sign agreements, or because they’re so impassioned that they want to get started yesterday. These decisions can cause legal, financial and regulatory migraines— 42

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along with the accompanying delays and stress, not to mention lost equity, frayed relationships and possible additional owed taxes—in the life of your business. Also, timing in business is often critical, whether you’re in need of capital, planning an acquisition or preparing for an IPO. If you act with foresight now, you’ll avoid unnecessary obstacles and demonstrate a business acumen that will serve you well in the long term. In this ongoing column, I’ll look at common mistakes and how to avoid them. First lesson: Every single person who accepts an offer at your company, whether as a fulltime employee or independent consultant, must sign a confidentiality and invention assignment agreement. This should go without saying, but from what I’ve seen, people still need to hear it. It is essential to have a clear understanding about these items with everyone from your top management and co-founders to your administrative support team, and to get their signatures on the legal framework you create; where appropriate, your agreements should include non-solicitation and noncompete provisions. People ignore the imperative of these contracts because they think to themselves, “This is my friend, I don’t need to do this. I’ll do it later.” In the context of business, that is extremely naïve. When you’re establishing a business, you have to consider the long-term consequences of lacking the legal clarity—about ownership of work product and about competition—that these agreements provide. If you value what you’re doing and you value the company you’re building, you’ll want to make sure these agreements are clear and signed by everyone who works for you. All employees should be subject to proprietary invention and assignment provisions. These generally ensure that whatever the employee

creates, develops, participates in, contributes to, or essentially “touches” relating to the company’s intellectual property ends up as owned by the company. In addition, anything the company needs to secure or procure its protective rights is granted in the agreement. If you get the contracts signed by your staffers when they’re hired, it’s not an issue. But when you have to ask for them later, you often end up paying dearly. That was one of the tips I learned from the “war rooms” where I’ve worked. The lesson was underscored for me during an IPO when the legal team and underwriters discovered that there were several employees who had not signed agreements yet had been contributors—in some instances, critical—to the development of the company’s intellectual property. As a result, the company had to eat hay. These agreements would have cost the company nothing to obtain as a condition of employment. Instead, it had to purchase the rights in order to have clear, clean rights for its IPO. Needing to obtain these late in the game could be a costly proposition for any business. And beyond the cost component, the delay of having to negotiate these agreements could significantly affect the timing of your IPO and, ultimately, your share price. As you build your business, these apparently small details—the contract that gets signed and filed away—can have surprisingly large impacts that seem far out of proportion to their genesis. It’s like the proverbial butterfly flapping its wings in New Mexico that causes a sandstorm in China. Investors or acquirers always want to know that you have clear ownership of your intellectual property and that your competitive advantages are protected. Build your business on a solid foundation: Get your contracts drawn up and signed.

StartUp Health Insights s

Snapshot

Power to the Patient In the first half of 2018, the most-funded digital health companies were those focused on patient empowerment. Six out of eight top investors made major investments in this category.

$1.1B 105 $10M Total Raised in Patient Empowerment

Spotlight MyPeople Health -MyPeople Health is empowering patients by proactively addressing their hereditary cancer risk. Their platform guides patients through their care journey by providing a personalized easy-to-navigate roadmap including appointment scheduling, claim management and coordination services. Through MyPeople Health, patients can achieve peace of mind by drastically reducing cancer risk up to 95%, saving hundreds of hours and thousands of out-of-pocket expenses.

Deal Count

Average Deal Size

4 Read about the investors breaking records in digital health on page 97 4 Download the StartUp Health Insights report at startuphealth.com/insights

Masterclass

Steven Krein CEO and Co-founder at StartUp Health

The Health Transformer Mindset Scorecard™ Want to achieve a Health Moonshot? Master these eight mindsets.

MINDSETS

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Long-term Commitment

You are not “all in” yet and not fully ready to commit your life to transforming health.

Supportive Relationships

You don’t rely on others, would rather do everything yourself, and have no longterm relationships around you.

Quarterly & Weekly Rhythm

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

Confidently Ambitious

You continue seeking reassurance from other people to make you feel more confident.

Self Aware

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

Healthy Habits

You don’t feel the need to take care of yourself because that’s just the life of an entrepreneur.

Value Creator

You believe you deserve all the credit for creating value and don’t want to share it with others.

Batteries Included

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

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

The words you choose and your energy are directly related to whether you attract or chase away the very people – customers, investors and talent – you want and need to help you succeed. At StartUp Health we focus on mastering the Health Transformer Mindset™ so that entrepreneurs become magnets to attract the people and organizations needed to achieve Health Moonshots. Here we are sharing the Health Transformer Mindset Scorecard so you can get started and benchmark your mindset. Though it may only take 10 minutes to get started, these mindsets require a daily practice for true mastery. Take the 10 Minute Mindset Audit at startuphealth.com.

UNCOMMITTED ENTREPRENEUR

Entrepreneurs, take the 10 Minute Mindset Audit and then sign up for the next free StartUp Health Masterclass at www.startuphealth.com

You are working on other things as backup until you have more certainty you’re on the right path to transforming health.

You are committed for the next 18-24 months but don’t have a clear vision beyond that on how you’ll transform health.

You are “all in” and will do whatever it takes for as long as it takes, because it’s your life’s mission to transform health.

You try to rely on others, but spend too much of your time convincing or “selling” them.

You have plenty of people around you, but still feel lonely and wish you had more supportive relationships.

You are continually surrounded by like-minded, supportive people who encourage and believe in you.

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

You intuitively know what you need to do each week and quarter without writing it down, but time periods pass without you achieving what you planned.

You recalibrate every 90 days, begin each week with a written plan, and end each period celebrating and sharing the iterations and progress you made.

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

You keep making your plans more realistic and less transformative because you keep hearing reasons your idea won’t succeed.

You always convey confidence with an ambitious vision and story for transforming health, regardless of how many times you get knocked down.

You seek, but rarely listen, to other people’s feedback and never operate in your unique ability.

You know your “unique ability” but aren’t leveraging other people’s unique abilities often enough to amplify your efforts.

You are coachable and self-aware of your and other people’s unique abilities, so you can continually improve your capabilities.

You feel burnt out, know you need to take better care of yourself and your relationships, but lately don’t make the time.

You make some time for yourself and your relationships, but not often enough as work takes priority.

You take care of yourself, have a clear mind and healthy body, and regularly practice gratitude, both to yourself and with others.

You believe in sharing credit with others for value creation but continually ask them to justify why they deserve it.

You are trying to build a future that is bigger than your past but you don’t rely on the best resources and capabilities to help you.

You are continually making your future bigger than your past, always attracting and developing new capabilities and resources.

You always try to give energy to those around you, but constantly feel your interactions with other people drains your energy.

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

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

FRUSTRATED ENTREPRENEUR

HEALTH ENTREPRENEUR

HEALTH TRANSFORMER™

The Journey s StartUp Health’s First Seven Years

In 2011, Steven Krein and Unity Stoakes met with former Time Warner CEO Jerry Levin at SXSW and solidified a 25-year vision for transforming health around the world. That encounter led to the founding of StartUp Health, which is now seven years into an audacious moonshot: Improving the health and wellbeing of everyone in the world. How will we get there? By investing in entrepreneurs who share a moonshot vision and a transformer mindset.

2013 2012 JUNE 2011 StartUp Health coins term Health Transformer™ to recognize “super entrepreneurs” focusing on health innovation

2011 MARCH 2011 Steven Krein, Unity Stoakes and Jerry Levin meet at SXSW to begin sharing the grand vision to transform health

JUNE 2011 President Obama and Vice President Biden meet with StartUp Health co-founders to discuss transformation of health

APRIL 2011 HHS CTO Todd Park invites StartUp Health to Washington to announce plan to support 1,000 digital health companies

JUNE 2011 US CTO Aneesh Chopra and Steven Krein announce StartUp Health mission at Health Datapalooza in DC JULY 2011 Esther Dyson is the first angel investor to back StartUp Health

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MARCH 2012 StartUp Health Academy launches with inaugural class of Health Transformers MARCH 2012 California Health Care Foundation and AT&T become first corporate sponsors of StartUp Health APRIL 2012 Launch of first StartUp Health Fund backed by Steve Case, Mark Cuban, Esther Dyson and Brad Feld OCTOBER 2012 Launch of StartUp Health Network to organize “batteriesincluded” investors and customers

APRIL 2013 StartUp Health begins global expansion, adding companies from Israel and Ireland JULY 2013 First Health Transformer from South America joins Academy AUGUST 2013 First portfolio company acquired: Gene by Gene acquires Arpeggi, a StartUp Health and GEbacked company DECEMBER 2013 In 2013, 45 Health Transformers joined Startup Health

2014 JUNE 2014 StartUp Health returns to the White House on 3rd Anniversary with 60 Health Transformers

AUGUST 2014 StartUp Health launches StartUp Health NOW, a weekly web show featuring Health Transformers and changemakers NOVEMBER 2014 Kaiser Permanente Ventures invests in StartUp Health Innovation Fund DECEMBER 2014 In 2014, 80 Health Transformers joined Startup Health

2015 JUNE 2015 Aurora Health Care invests in StartUp Health to support startups transforming care delivery JUNE 2015 Under Armour acquires StartUp Health company Gritness

JUNE 2016 First Health Transformer from Africa joins Academy OCTOBER 2015 Opening of first StartUp Health Village in NYC NOVEMBER 2015 StartUp Health Ventures launches to invest exclusively in breakout Health Transformers NOVEMBER 2015 Global platform expands with launch of StartUp Health Finland

2016 JANUARY 2016 StartUp Health Festival convenes 1,000 of the world’s Health Transformers and leaders in San Francisco APRIL 2016 Dr. Howard Krein, Chief Medical Officer, travels the globe with VP Biden to support White House’s Cancer Moonshot APRIL 2016 Investment in Human Longevity, Inc. and launch of Longevity Moonshot to change the face of aging

JUNE 2016 150th company joins StartUp Health coinciding with 5th anniversary OCTOBER 2016 StartUp Health announces 10 Health Moonshots to “improve the health and wellbeing of everyone in the world” OCTOBER 2016 Zimmer Biomet acquires StartUp Health company Respondwell DECEMBER 2016 In 2016 60 Health Transformers joined Startup Health

2017 JANUARY 2017 StartUp Health’s “Global Army of Health Transformers” convenes in San Francisco for StartUp Health Festival, with Keynote from VP Joe Biden JANUARY 2017 StartUp Health announces global partnership with Allianz to advance Health Moonshots worldwide

APRIL 2017 StartUp Health announces global partnership with SAP Health MAY 2017 StartUp Health launches Health Transformer blog JUNE 2017 Biden Cancer Initiative launches with StartUp Health Chief Medical Officer, Dr. Howard Krein, on Board of Directors SEPTEMBER 2017 Generali Global Assistance Acquires StartUp Health company CareLinx SEPTEMBER 2017 StartUp Health launches its second fund to support 250 companies with investors including Ping An, Guidewell & Masimo DECEMBER 2017 In 2017, 70 Health Transformers joined Startup Health DECEMBER 2017 Launch of StartUp Health HQ, a global virtual headquarters for Health Transformers and members of the StartUp Health Network DECEMBER 2017 200th company joins StartUp Health

In 2018, StartUp Health welcomed the 250th company into its global army of Health Transformers

2018 JANUARY 2018 Launch of StartUp Health Magazine JANUARY 2018 2,000 innovators from 40 countries join 220 Health Transformers from 110 StartUp Health companies at the 6th annual StartUp Health Festival MARCH 2018 First Health Transformer from China joins Academy MARCH 2018 StartUp Health Academy expands to 21 countries with addition of Pakistan and Singapore JULY 2018 Opening of StartUp Health Village in Silicon Valley

Save the Dates This fall, StartUp Health kicks off its World Tour 2018 with Health Transformer events in Spain, France, Germany, Bulgaria, Finland, Argentina, South Africa and across the United States. -Join StartUp Health and 2,000 of the world’s top health tech investors and entrepreneurs at the StartUp Health Festival, taking place in San Francisco in January.

A Global Vision s Mapping the StartUp Health Army

450+ Health Transformers --75 Cities --21 Countries --6 Continents 48

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Spotlight Joint Academy (Sweden) -Osteoarthritis is a rising problem across the globe; half of the worldâ&#x20AC;&#x2122;s population aged 65 years or older suffers from joint conditions. Joint

Academy, formerly Arthro Therapeutics, has created a digital platform to treat these millions of people suffering from chronic joint pain, all while reducing costly and dangerous surgeries. CEO and co-founder Jakob Dahlberg took the clinically-

validated treatments designed by his father, a physician renowned for his work in osteoarthritis, and made it available for the masses at the click of a button.

Spotlight Alem Health (Singapore) -Alem Health is on a mission to give everyone worldwide access to world-class radiologists at affordable prices. For hospitals, imaging centers and radiologists in developing countries, AlemHealth has developed a low-cost AI Radiologist-in-a-Box that connects these centers to a global provider network, and provides them with AI at the point of care, all at a price they can afford. For patients, AlemHealth provides a directto-patient second opinion portal with local payments integration so anyone anywhere can request a second opinion.

Investors To Watch StartUp Health began in 2011 when our CEO, Steven Krein, asked a room full of 2,000+ entrepreneurs, investors and customers at Health Datapalooza to raise their hands and take the pledge to transform health together. Since that day we have been hard at work organizing stakeholders around the world who are committed to supporting the entrepreneurs working so hard to reinvent the future of health. Investors are a critical piece of the puzzle and we have been fortunate to build a vibrant global community of thousands of venture capitalists, corporate VCs, foundations and angel investors. Not all investors are created equal, and through our years of conversations, collecting feedback and data from entrepreneurs, and by tracking $45B+ in funding activity in our proprietary database, StartUp Health Insights, we have identified key traits that great investors share. These traits go far beyond the ability to deploy capital. In the end, a great investor should become a startup CEO’s champion, sounding board and friend. The following is the first of a series in which we will give recognition to some of the leading stakeholders in health. This issue we profile

10 investors recognized for their leadership in our industry. They’ve been nominated by our Health Transformers, the StartUp Health Team and StartUp Health investors. Each of these investors brings a unique combination of experience and knowledge to their role. Some are part of new and exciting funds that deserve more of our attention. What these investors all have in common is the transformational mindset we at StartUp Health look for in our own investors and Health Transformers. These investors understand that innovating in healthcare takes time, and they are committed to helping entrepreneurs through the journey. This means developing long-term relationships with entrepreneurs and giving them critical feedback along the way, even when an investment is not an immediate fit. Once they have made an investment, great investors apply this mindset to their CEO relationships, acting as their champions over time, and magnifying their networks. We hope you enjoy the first Investors to Watch. Thank you for being a part of StartUp Health’s mission to improve the health of everyone in the world.

Intro by Katya Hancock Interviews by David Pedra & Andrew Solomon Illustrations by Yudhistira Darwan

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those can, and will, disrupt the healthcare industry, and there is learning that has to take place by both entrepreneurs and investors.

LIZ ROCKET T Firm: Kaiser Permanente Ventures Location: San Francisco, CA Time at Firm: 3 Years Recent Investment: GenomeMedical Liz Rockett, director at Kaiser Permanente Ventures, focuses on investments in healthcare IT, digital health and tech-enabled services. Liz has over 15 years of healthcare experience, having previously worked at Outcome, The Advisory Board Company, TriZetto Group and Imprint Capital Advisors. Liz received an MBA from UC Berkeley and a BA from Princeton. Q&A What are current investment challenges unique to digital health? The market and its commercial pathways are still being defined. I see digital health moving more into therapeutic and diagnostic arenas. There is such a need for innovation, but there are real challenges in figuring out how to sell into large and very entrenched healthcare systems. What are you most excited about, either technology, trends or changes within digital health? I’m actively learning about a few areas including AI and machine learning. I feel we’ve only scratched the surface on how

What advice do you have for entrepreneurs? Keep talking to customers and the stakeholders around customers. What an entrepreneur wants to deliver and what the market needs may not be aligned. It’s only through those conversations that you can figure out how to align the vision you’re trying to bring with what the industry needs. Also, having the humility and curiosity to actively engage with people who could be your future purchasers, the importance of that can’t be overstated. Kaiser Permanente Ventures is a StartUp Health Investor.

FRANCESCA WUT TKE Firm: MSD Global Health Innovation Fund Location: Barcelona Time at Firm: 2 Years Recent Investment: Anecdote.me

Asten Bio-Pharma advisors. Q&A What differences have you noticed in venture investing across your varied experiences? Early stage digital health investing is far more experimental and there is the ability to help shepherd the company to the next stage of growth, which is really exciting. In therapeutic investing, the risk is much more on the product side, while in early stage digital health the risk is much more on the management team and whether or not they are able to operationalize or execute on their vision. What are the investment challenges unique to digital health? I am focused on the European market, and I would say that one of the biggest differences is the size of deals, but that is starting to change, both in terms of the valuation of European companies and in terms of the amounts they are raising. We are starting to see some really big valuations, especially in the news of late. So I think going forward there will be much more scrutiny, more than there already is, on how companies are valued, and what the right amount of capital is to raise, in order to get those companies to their next inflection point. What advice do you have for founders? Garner the ability to take advice, learn from it and appropriately take action.

Dr. Wuttke is a NYC-born, Cornell-educated PhD with 25 years of global healthcare and investing experience. Before joining MSD as a managing director in 2016, Wuttke held multiple roles at Mt. Sinai School of Medicine, Symphony Capital and Novartis. She is also the co-founder of 51

Investors to Watch

MOHAMAD “MO” MAKHZOUMI Firm: NEA Location: San Francisco, CA Time at Firm: 15 Years Recent Investment: Paladina Mo is a general partner at NEA and the global head of the firm’s healthcare services and healthcare IT investing practice. Prior to NEA, Mo held roles at Summit Partners and UBS Investment Bank. Mo received a BS from the University of Pennsylvania. Q&A How did you get into venture investing? I come from a healthcare family – my parents and sisters are physicians at Hopkins. While at Penn I was pulled into the policy side of healthcare and was fascinated by how broken it was and talked my way into a summer internship at NEA. I fell in love with this industry as it lets you exercise your finance, policy and analytical muscles, while helping entrepreneurs achieve their visions and dreams and impacting patients at a local level. What are the investment challenges unique to digital health? There are two acute challenges. The first is how do you handicap the non-healthcare incumbents? An Amazon, a 52

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Walmart, a CVS. Today, not only do you have to factor in large healthcare incumbents but you have to factor in non-traditional incumbents. There will be more non-healthcare companies getting into the space, which creates a huge opportunity, but it’s also a huge challenge when you’re trying to handicap an investment and chart your growth path. The second challenge is a constant state of churn and uncertainty on the regulatory side, almost day-to-day. What are you most excited about, either technology, trends or changes within digital health? At risk models. The system is 90% fee-for-service today, but fee-for-value is where it’s headed. At risk, fee-for-value business models is the core of our investing thesis right now at NEA. Companies that are helping risk-bearing entities manage their spend are attractive to us.

AMIT AYSOLA Firm: Wanxiang Healthcare Investments Innovation Fund Location: Chicago, IL Time at Firm: 2 Years Recent Investment: Higi Amit Aysola is the managing director of Wanxiang Health-

care Investments, the venture capital arm of Wanxiang America Corporation. Amit has over 15 years of consulting, operations, and investment banking experience in the healthcare industry. Amit received an MBA from Duke University and a BS & MS from University of Michigan. Q&A How have you changed since you began as a healthcare investor? I’m taking a bit more of a portfolio approach. I’m looking to diversify the investments we have at Wanxiang as much as possible. We are not a typical LP-backed VC fund as we are balance sheet investors. I view that as a competitive advantage because I can modify my investment thesis based on trends I see in the market. When I say portfolio diversity I really mean in terms of the platform’s capabilities, the customers these companies sell to, and the types of revenue streams they bring in. I really try to make investments across the broad spectrum of healthcare technologies. There are still some key elements that I look for with all companies, namely that a company is addressing a key pain point, offers an “adoptable” workflow, and ideally presents a clear ROI story. However, I am looking to expand beyond healthcare IT. I’m looking to invest in devices, diagnostics and I’m even looking to invest in ones that a typical healthcare VC investor would not look into – like water. To me clean water is the #1 healthcare crisis on our planet right now. It’s also a utility which means that actual customers are municipalities, who are very risk averse. Another thesis that I really like is “food as medicine.” I try to keep an open mind when evaluating opportunities – sometimes you have a

thesis in place, and other times a thesis will find you. How has your vision for healthcare changed with the entrance of companies like Apple and Amazon? If you look at Apple, Amazon etc...these companies represent key delivery systems through which we will manage our healthcare in the future. Emerging businesses will need to think through how they will either compete against or partner with these companies.

ELLIE WHEELER Firm: Greycroft Location: New York City, NY Time at Firm: 7 Years Recent Investment: Summer Ellie Wheeler is a partner at Greycroft, investing in internet and mobile startups across the digital ecosystem in both B2C and B2B. Prior to joining Greycroft, Ellie worked at Lowercase Capital, Cisco and Summit Partners. Ellie received an MBA from Harvard and a BA from Georgetown. Q&A What are the investment challenges unique to digital health?

It’s a fairly crowded landscape and there’s a number of companies solving just one part of the puzzle. Being narrowly focused in the early stages can be very good because you can’t tackle everything at once, but at the same time customers don’t often want to buy 14 different solutions. Sifting through what has the potential to be more of a platform versus a point solution is key. It’s okay to be a point solution but it has to be a big enough of a point solution. On the B2B side, the age old sales cycle is still there. You need to bake enough time in to really show ROI as it’s going to take a while to sell, implement and gather data over time to show that your product or service is working. What are you most excited about, either technology, trends or changes within digital health? I’m paying attention to companies that are thinking about the patient as the end consumer. By thinking through the customer experience from end to end, you can do some really interesting things, not just in care delivery but in variety of other services. In the near term it’s still a B2B pay, but I like the trend of refocusing the experience and design of that experience on the patient. What advice do you have for entrepreneurs? Don’t start direct to consumer. The math doesn’t work and you’re going to find that out the hard way that you have to pivot. Second, be able to tell a compelling story of ‘I’m starting here in a focused manner with this point solution.’ Have it explain what that enables you to do later, why it’s strategic and why you’re starting where you’re starting.

STEVE KRAUS Firm: Bessemer Location: Boston, MA Time at Firm: 14 Years Recent Investments: Q ventus, Subtle Medical Steve Kraus is a partner at Bessemer Venture Partners and leads the firm’s healthcare investing activities. Prior to joining Bessemer, Steve worked for a growth-stage, private-equity firm and as a consultant at Bain & Company. Additionally, he has worked on a number of political campaigns throughout his career. Steve received an MBA from Harvard and a BA from Yale. Q&A How did you get into healthcare investing? My path is very unorthodox. I thought I was going to be a journalist growing up but got burnt out by writing to a deadline. During my time at Bain & Co. I was staffed on a healthcare project and ultimately realized that that is what I love. Healthcare is perfect blend of business and contributing to society. I then worked as the deputy campaign manager for the democratic candidate for Massachusetts governor; we ran against Mitt Romney. Our running mate, Chris Gabrielli, founded Bessemer’s healthcare practice. I had no career path or 53

Investors to Watch

aspiration to be a venture capitalist but he was a great guy, had been successful, and I was like, I want to be that guy when I grow up. So after we lost the campaign he recruited me to come work for him. What are the similarities between being a VC and a journalist? A lot of the things you do as a VC and a journalist are similar. As a journalist you spend a lot of time talking to people, listening to their stories and trying to figure out what is fact versus fiction and if you think it’s fiction trying to run it down. It’s very similar to what you do as a venture capitalist. Today alone I spoke to four to five entrepreneurs, and part of it is developing trust with them, much like you would do with your sources as a journalist. It’s sort of a two-fold job, while you are trying to analyze their business in a meeting, you are also trying to sell yourself and build trust with the entrepreneur. I find that those interviewing skills and being able to ask tough questions that don’t make someone dislike you are very useful. Advice for founders? I try to laugh a lot, because I think we all work too much and I find that laughter is the best stress reliever.

flowing into the space while exits have been modest, coupled with regulatory uncertainty, is causing some traditional customers to put a pause on their willingness to buy from startups, because of fatigue of prior health tech purchases and lengthy sales cycle that exist.

IREM MERTOL Firm: McKesson Ventures Location: San Francisco, CA Time at Firm: 1 year Recent Investment: TruVeris Irem Mertol is a director at McKesson Ventures, focused on early to growth-stage investments across healthcare technology and services. Prior to joining McKesson Ventures, Irem held roles at Burd Health, Omada Health, Caremerge, Goldman Sachs and Merrill Lynch. Irem received an MBA from Stanford and a BS from from Duke University. Q&A What are the investment challenges unique to digital health? The combination of higher valuations and limited exits in the market. We’re hopefully starting to see more M&A activity with the entrance of new tech players like Amazon, Apple and Google, along with the growth of larger health IT players. New money

What are you most excited about, either technology, trends or changes within digital health? There are two trends our team is excited about. One is what we’re calling the digital supply chain – the idea of digitallyenabled consumer-centric care, encompassing the new plumbing of healthcare as we continue to improve interoperability and information exchange. The other one is value-based care. We’re focused on the shift of care outside of large health systems to lower costs; whether it’s retail, ambulatory, post acute or home care. What advice do you have for entrepreneurs? In terms of both team members and investors, founders should surround themselves with people who bring a mix of healthcare domain expertise and traditional tech experience. Second, select the right partners you want sitting around the table with you. Don’t always go for the investor that offers the highest valuation. Instead, think about who will best be able to help you scale.

Don’t always go for the investor that offers the highest valuation. Instead, think about who will best be able to help you scale. 54

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VIN FABIANI Firm: HLM Venture Partners Location: Boston, MA Time at Firm: 20 Years Recent Investment: RubiconMD

What advice do you have for entrepreneurs? First, building a business in healthcare is harder than you think. Second, there might not be one solution for any EMR. Find the EMR that is in practice that you want to sell to and work towards that. Vin Fabiani is a StartUp Health investor.

Vin is a partner at HLM Venture Partners where he leads the firm’s industry accelerator relationships and is a board director/observer in a number of its portfolio companies. Prior to joining HLM, Vin spent eight years at First Data (formerly The Boston Company). Vin received a BS from American University. Q&A What are the investment challenges unique to digital health? Adoption and getting to scale. Specifically in the B2B space, enterprise sales are more capital intensive and take longer. Timing is everything – identify the need and the buyers that will pay to solve that need and time it correctly. What are you most excited about, either technology, trends or changes within digital health? Institutions are starting to be more receptive to new technology and we’re seeing buyers more receptive to putting processes in the cloud than ever before. We’re also seeing more acceptance of telehealth.

ANNA HAGHGOOIE Firm: Sandbox Location: Chicago, IL Time at Firm: 10 Years Recent Investment: SonarMD Anna Haghgooie is a veteran healthcare investor, and the current managing director of Sandbox Industries in Chicago. With experience as a public market analyst, startup operator and venture investor, the Booth MBA alum has a deep understanding of the healthcare ecosystem. Q&A How did you get into healthcare investing? I started my career as a public markets analyst and was assigned to the healthcare group. I really tried to become a student of the underlying incentive structures in healthcare. I started to think about how those incentives could change to improve

the system and started to spend more time with entrepreneurs and people who were trying to disrupt from the outside or the periphery and just decided that was where I wanted to spend my career. I think I really caught the bug working for a healthcare startup during business school. I believed that my generation really had the potential to transform how healthcare operates especially given what was happening with technology at the time. Ultimately, I think it was that sort of entrepreneurial spirit mixed with investing that landed me here. You mentioned that your generation was really in a position to change healthcare. How do you think that mission is going? I have a lot more empathy for the people who tried to fix healthcare back in the 80s and 90s. When I diagnose the problem for why change is so hard in healthcare, I do think it has to do with the fact that each of the players have had such an adversarial relationship over the years. I think it is hard to align interests and drive value-based care when you have a foundation of mistrust, people speaking different languages, a lack of transparency between two sides. So even if there is some alignment on the outcomes we are after, getting from that foundation to that shared outcomes has been challenging. What I thought would happen in ten years is probably going to take 30, but I’m still hopeful.

Investors to Watch

What Startups Get Wrong About China A Conversation with Dr. Marco Huesch, Managing Director & Chief Medical Officer of the Ping An Global Voyager Fund, as told to StartUp Health preface Marco Huesch has been at his current post for less than a year, but his knowledge of the Asian business market reaches back decades. First as a Peace Corps volunteer in Asia, and then as a physician in Australia, Huesch fell in love with the region. He spent years as a management consultant in the Pacific Rim before returning to clinical research in the United States. His role at Ping An’s Global Voyager Fund puts him in the unique position of introducing Western health startups to the Chinese market via one of the world’s biggest business titans. Ping An is the world’s largest insurer, one of the world biggest investment companies (the Global Voyager Fund is a $1 billion fund) and is a StartUp Health investor. In his search for startups that can synergize with Ping An’s many healthcare business units, Huesch has seen a range of common misconceptions. Side-step these pitfalls and you might have a chance at landing a lucrative contract in China.

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CHINESE CONSUMERS DON’T SPEND A LOT ON HEALTHCARE Despite China’s standing as the second largest economy in the world and having the GDP of a developed country, the nation has a dramatically lower annual healthcare spend per capita than its western counterparts—less than $1,000 per year. Often companies will look at the United States healthcare market and identify a delta between the current price point for something and their proposed price point. That difference is the crux of their business model, and is attractive to investors and users. In China, that delta is much smaller. You may not be able to do a direct-to-consumer product if it costs more than a hundred Renminbi ($15 USD). To successfully expand into China, American businesses need to see beyond the rich, coastal cities in China and understand the financial constraints of average citizens. #02

CHINESE CONSUMERS HAVE LESS OF AN INSURANCE CUSHION In the United States, people are used to having a financial cushion from their insurance company, or healthcare subsidies from their employer. They also generally enjoy higher household incomes. American businesses often forget that in China, essentially half of health expenditures are out-of-pocket for consumers.

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JUST BECAUSE YOU GOT CLEARED IN AMERICA DOESN’T MEAN YOU’LL GET CLEARED IN CHINA Another great misconception is that if you have regulatory clearance in the United States then that automatically means a fast or easy pass to clearance in China. Regulatory systems all around the world reflect the culture, political realities, trade and investor policies of their region. This hits particularly hard with small startups that don’t have a local partner acting as a guide. In America you can take your product pretty far on your own, building on a broad, deep infrastructure for innovation. But it takes special resources and knowledge to aid a company through regulatory clearance, marketing development and distribution in China. #04

YOUR IDEA MIGHT NOT BE AS NOVEL AS YOU THINK IT IS Often, startups from the United States and Europe entering the Chinese market think that their innovation is more novel and distinctive than it actually is. Consider the team that has spent a lot of good engineering and science to come up with a wearable device. It’s attractive to investors because it’s direct-to-consumer and has clinical usefulness. It’s been patented in the United States, therefore there are assumptions made about the wearable’s uniqueness. However, China is a different environment, and it has a wellestablished ecosystem of folks who are fast

at developing tech and fast at using flexible manufacturing processes to quickly get ahead of the market. In China, the bar for developing wearable tech is very, very high. As a result, as investors, the bar for us to consider a foreign company and an innovator in that space is just as high. There are just so many good, local companies that have products, have been cleared, understand the market and are produced locally. #05

NOT EVERY BUSINESS MODEL TRANSLATES There are many business models which really have no parallel use case in China. For example, take an innovation aimed at an entitlement program for contracting clinicians for Medicaid or Medicare Advantage. There’s no analogy for that kind of company in China. Or take the startup doing data science around predictive analytics, run off of an EMR. In China, every academic center has people working on that concept. We have fantastic EMR programs that do all of that analytics work, so it’s very hard for an American startup to compete in that space.

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YOU CAN’T SKIP ANY OF THE HARD WORK There continue to be great opportunities for startups interested in expanding into the Chinese market, but breakthrough success will be reserved to those who can think far ahead in the journey, moving from basic one-sided tech innovation to two-sided thinking. Figure out how your product can delight two sets of users at once. Then, bring a product to China that STARTUP HEALTH has gone so far down the development path that 6 only rational response Connect from investors and users with Marco Huesch is to invest in the comand others pany and use it, because working to there’s really no feasible transform health in ability to duplicate it. China. In other word, you can’t 6 write a line code and startuphealth.com expect open arms. You can’t skip the hard work.

It’s important to remember that there’s a natural cycle to innovation. We’ve reached a part of that cycle where there’s a lot of ‘me too’ innovation. The first AI startups several years ago were remarkably distinctive and blew everyone away at conferences. Now, even a small country like Singapore has very sensible competitors to what is being done by the leading Israeli and American AI companies. The same goes for retinal scanning algorithms. What was once a groundbreaking announcement by Google is now a reality at half a dozen companies in Beijing.

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The Sum of M This isn’t your mother’s menopause. Founder Jill Angelo is using her startup, Genneve, to rewrite the script for women’s health and use menopause as a window into female longevity. words by Nicole Clark photos by Paul Newson

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The Sum of M

I I always thought sleep would be like riding a bicycle, and that for the rest of my life I’d be able to do it intuitively. I love to sleep. But these days, nighttime slumber eludes me because my legs tingle and spasm me awake, and my brain won’t shut up about the future. Until recently, I blamed myself for my persistent inability to sleep, and chalked it up to the pressures of adulthood, pumping my ears with nighttime meditations and sound baths in vain attempts to lull me to sleep. It wasn’t until I took Genneve’s Menopause Assessment that I considered the giant roadblock to restful nights was caused by something bigger than myself. That perhaps my sleeplessness and other physiological changes I’d observed in my body added up to the sum of M. Genneve is a new digital health company that serves as a resource for women’s health in midlife and menopause. In July 2018, four weeks into the launch of their new Menopause Assessment, Genneve had over 300 assessments submitted. Mine was one of them. My interest was piqued by the assessment’s mention of sleep disturbances and restless leg syndrome. I figured, I’m edging close to perimenopause and should know what’s on the other side, and so I took the assessment. Turns out, the other side isn’t so far away. The assessment walked me through questions about my age and patterns of sleep, sex, mood (read: roller coaster) and eating; without jumping to quick conclusions about 60

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my health, it helped me understand specific areas of my well-being that I’d need to be aware of as I age. The tone of the questions, like the smart but fun tone of Genneve’s blog, made the assessment personable, as if Genneve’s Director of Health, Dr. Rebecca Dunsmoor-Su, MSCE, was the one asking me about brain fog. “I created this Menopause Assessment based on 20 years of treating women in midlife,” Dunsmoor-Su says. “Because every woman’s experience of menopause is different, the survey helps determine exactly what’s going on in each woman’s body.” Within 24 hours I received a customized assessment with relevant links to follow-on blog articles, pieces like “menopause and new facial hair: oh, pluck this,” where I learned I’m not the only female plucking strange dark chin hairs when no one’s looking. Jill Angelo, the CEO and founder of Genneve says she’s in the “Oh wow” category of women. When asked if she’s always been in-theknow about menopause, or if she had an “oh wow” moment of daunting learning, she replies, “Oh wow,” as in, “Oh wow, I had no idea how much menopause could change my life.” Angelo has been in the tech space for 20 years and spent 15 of those years at Microsoft as the chief of staff to the chief marketing officer. Part of her responsibilities there entailed growing and retaining the software giant’s senior women workforce. It is reassuring to know that at one point she was surprised by the realities of menopause. I was. My mother was. My aunt was. Most women I’ve had the chance to speak with about “the M-word” treat it like Pandora’s box, holding down the lid with all of the muscle they can muster, for fear of what’s inside. My usual captioned motto for this kind of scary, steep learning curve is,

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Angelo believes that menopause is a lens into longevity as it relates to noncommunicable diseases (NCD) like Alzheimer’s, endometrial cancer, mental health issues, and heart disease.

“The more you know, the more you realize how much you don’t know.” Not Angelo. “The more I learn about menopause, the more bullish I am in making it something that every woman has control over—in terms of understanding what’s going on in her body and what to do about it,” she says. Charting New Territory Genneve is 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, which includes a women’s right to physical and mental health and well-being. This larger-than-life mission is pushing Angelo and the possibilities for menopause health correlations into new territory. The company is building the firstever women’s health database to correlate menopause precision health to longevity and well-being in women. Similar to consumer usage of apps to manage diabetes symptoms, or apps that serve as data-loggers for women’s menstrual symptoms or for tracking ovulation, Genneve offers a HIPAA-compliant Menopause Assessment and an app for women to access on-demand resources, individual wellness recommendations, and telehealth physicians to find relief for menopause symptoms. The company’s model forms a trifecta of support for women— Genneve informs them with content and personal recommendations, surrounds them with community, and closes the access-to-care gap. “There is a shortage of ob/gyns,” notes Dunsmoor-Su. “Oftentimes women wait two to three months to see someone, or they go see their general practitioner, who doesn’t know as much about health issues related to menopause.”

JILL ANGELO CEO/FOUNDER AT GENNEVE -Jill Angelo is tech-execturned-women’s healthcare advocate who was named as one of Inc. Magazine’s 2016 Most Impressive Women Entrepreneurs. Jill maintains a delicate balance between data gathering and community building, in order to revolutionize the way we talk and think about the “M Word” - as a lens into longevity.

Angelo adds, “We are closing that accessibility gap by providing trusted professionals who are vetted by us and made accessible to women via a scheduled chat or video call to get questions answered by someone they can trust.” Genneve launches its telehealth component in September 2018, which is also the month of the startup’s one-year anniversary. The company’s process for vetting physicians will evolve as the community grows. For now, its assessment process includes two partnerships: one, with the North American Menopause Society to source specialists; and the second, with an experienced telehealth talent recruiter—Enzyme Health, a startup founded by a former telehealth attorney—to help source, qualify and manage Genneve’s team of contracted telehealth providers. A Cut Above the Rest With more than $1 billion in Femtech (female technology) funding expected to pump through the global healthcare market between 2015 and 2018, Genneve has to differentiate itself from other women’s health tech companies. Other appbased companies like Glow, Ovia Health, MavenClinic and Menopause View offer similar telehealth capabilities, and access to resources, too, but are limited in scope—many times they are just for women menstruating or having babies. Also, Genneve has something extra that none of them have. Lube. What started as a means to generate additional revenue to support the company’s startup costs has turned into a successful product offering that is here to stay. Genneve offers a line of female intimate dryness products designed specifically for menopausal women, including personal lubricants and body washes.

“It was kind of a scrappy way to fund our endeavors, but it continues to be a meaningful part of what we do,” observes Angelo. “Intimate dryness leads to painful sex. Painful sex is the most common symptom and experience shared by women in this stage of life. By offering a product like this we’re hitting on one of the top challenges that women struggle with. In addition, we’re supporting our company.” As the community grows and the data cloud expands, Genneve gets smarter in helping women today and in health innovation for the future using the power of AI. Angelo believes that menopause is a lens into longevity as it relates to non-communicable diseases (NCD) like Alzheimer’s, endometrial cancer, mental health issues and heart disease, specifically. A recent study by neuroscientist Lisa Mosconi adds a timely stamp of credibility to Angelo’s vision. Mosconi’s research indicates that estrogen stimulates neural activity and may help prevent the buildup of plaques that are connected to the onset of Alzheimer’s disease. Uprooting Deep-Seeded Stigmas My mother instructed me on two matters regarding menopause: use black cohosh to calm hot flashes and pound the pavement, literally, to avoid the onset of osteoporosis. Gleaning these instructions required a keen ear for catching piecemeal knowledge bits. I plucked the bit about staving off osteoporosis through running not through motherly advice directed at me but during one of her brief “this menopause thing is for the birds” pronouncements. “Keep walking the dog, honey,” she said in a recent phone call. “It’ll save your bones from becoming brittle.” 61

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In 1985, a landmark report of the Public Health Service Task Force on Women’s Health Issues concluded that “the historical lack of research focus on women’s health concerns has compromised the quality of health information available to women as well as the health care they receive.” Since the publication of that report, there have been medical and technological advancements that have transformed the way we understand and address the health needs of women. However, much of the progress for at least the past two decades has been centered on sexual and reproductive health, with little focus on the perimenopause, menopause, and postmenopause stages of a woman’s life. Thus my mother’s heartfelt, shotin-the-dark, dog walking advice. You know, for my bones. Part of this imbalance can be attributed to necessity. Global maternal mortality and morbidity rates were unacceptably high and created a burden of disease for women in many countries. This health risk needed to be mitigated, and efforts to do so have been successful. Since the Global Strategy for Women’s and Children’s Health was launched by the UN in 2010, an estimated 2.4 million deaths of women and children have been averted. But the hyper focus on a woman’s reproductive health also stems from deep-seeded cultural stigmas that imply a woman’s worth diminishes with age, or when she loses her ability to reproduce. Cultural barriers like this are difficult to pinpoint and remedy because it requires a collective discussion and eventual agreement that we humans need to raise our consciousness. And as, Dun62

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“I’ve worked in women’s health my entire life and I can tell you, people don’t like to talk about these things,” she says. “Some chalk it up to politics, but we must move beyond that kind of polarization in a bid to do away with stigmas.” smoor-Su notes, it can be tough to get people to the table, let alone to the doctor’s office for a talk. “I’ve worked in women’s health my entire life and I can tell you, people don’t like to talk about these things,” she says. “Some chalk it up to politics, but we must move beyond that kind of polarization in a bid to do away with stigmas. The reality is, women face the double-whammy of sexism and ageism. This country places a lot of value on youth, and as women age, they’re told their value decreases.” Angelo nods and observes, “When I started Genneve, I knew there was little focus on women’s health in midlife, but I didn’t realize the extreme lack of personal health transparency and accessibility to physicians with regards to menopause. It’s my mission to change that, globally, and we’ll do it one woman at a time.”

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Interested in collaborating with others to improve women’s health around the globe? Join StartUp Health’s Women’s Health Moonshot on StartUp Health HQ. hq.startuphealth.com

The Finnish Line Despite its small populationâ&#x20AC;&#x201D;a modest 5.5 millionâ&#x20AC;&#x201D;the Nordic nation has earned a global reputation for its design, education system and tech scene. Now, Finland is making its mark as a hub for digital health startups. We profile a few key players and take you on a tour of Helsinki, the city where much of the action is happening. by Aki Koivistoinen Photos by Pauli Savolainen

I In recent years, Finland has become the home to a buzzing community of startups and budding entrepreneurs. Thanks to standouts like SuperCell and Rovio (creator of Angry Birds) Helsinki has a particular reputation as a home for gaming startups, but the digital health ecosystem is alive and growing, particularly in the areas of medical data analytics, artificial intelligence, medical devices and health ICT (information and communications technologies). Finland has long been a hotbed for innovation, partly due to its own limitations. The scarcity of resources has forced its citizens to maximize the potential in people, collaboration, design and technology. With its free educational system routinely ranking at the top in the world, Finland is turning out an enviable workforce, one that only adds to its reputation for stability, predictability and lack of corruption.

Health startups in Finland operate within a healthcare system that is often held up as an example for the world. Finnish healthcare is ranked in the top five for value-based care in the world, and its 5.5 million people are covered by universally available healthcare. Only about 5% of inpatient care is provided by private providers and the cost per capita for healthcare is half of that in the United States. Collaborations within Finland have given health startups an added boost. University Hospital Clinics and The National Biobanks have increased collaboration with corporations and startups. Some major platform based projects such as FinnGen (a unique study that combines genome information with digital health care data) and the CleverHealth Network (focusing to global demand for digital and AI-based health solutions) bring together Finnish health sector expertise with startups and corporations such as GE Healthcare, Pfizer and AstraZeneca. Every city has its challenges, and Helsinki will always struggle against its relatively small size and lack of capital compared to major tech hubs. But entrepreneurs in Helsinki enjoy a walking community where meetups and cross-pollination are easy. Labor costs are are 35% less than in the United States, and Finns have an enduring reputation for honestly and a can-do mentality. Not to mention that Finland has recently ranked as the happiest country in the world according to World Economic Forum, World Happiness Report 2018. 63

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8 Companies Shaping Finland’s Health Tech Ecosystem -1 Myontec produces wearables that use muscle activation technology to measure leg muscles, which, accompanied by an easy user interface, allows individuals the ability to receive instant feedback and measure real time data. Pictured: Janne Pylväs, CEO of Myontec, with team. 2 LymphaTouch provides lymphedema patients or those with pre/post-op swelling and scarring with immediate relief and accelerates patient recovery time. Pictured: Kristo Kivilaakso, CEO of LymphaTouch, with team. 3 LS CancerDiag uses a low-cost diagnostic method to detect Lynch syndrome mutations and tumors before they appear. Pictured: Founder and chairman, professor Minna Nyström and CFO Niklas Lahti checking the test results shown by Dr. Minttu Kansikas.

Allas Seapool in the heart of Helsinki City. 5 Path Surgery aims to make healthcare accessible and affordable for all individuals who wish to travel for overseas treatment through all-inclusive medical packages. Pictured: Founders Antti Mauno and Robert Rantapere. 6 Chabla is a mobile sign language interpretation app for hearing impaired individuals that provides users access to live interpretation 24/7.

7 Goodlife Technology provides an interactive virtual coaching service for individuals undergoing physical therapy. 8 Nightingale Health uses a proprietary blood analysis platform to provide comprehensive metabolic data to combat and solve chronic diseases. (See opposite page for story.)

4 Buddy Healthcare uses data analytics and a mobile care coordination platform to optimize the pre- and post-surgery experience for patients. Pictured: Jussi Määttä, CEO of Buddy Healthcare and Teemu Suna, CEO of Nightingale Health having a meetup at 4

Helsinki Highlights -Helsinki is a city to explore—the hip capital is bubbling with cozy restaurants, design saunas, heart-warming cafés, boulevards, green spaces and island swimming spots (at summer time). The huge public saunas are also the ideal place to recuperate and, in the traditional Finnish manner, relax with new-found friends. Helsinki’s secret is that you can get everywhere even without a car. Helsinki is surrounded by many beautiful islands which can be reached from the city center in just 15 minutes.

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Every August Flow Festival brings a fascinating line-up of bands and artists to a trendy international crowd in a historic environment. Beautiful design and avantgarde cuisine top off the experience. World Heritage Site Suomenlinna is a cultural treasure. Its

construction began in the mid-18th century, when Finland was still part of Sweden. Today, the fortress and its museums, restaurants and events are a memorable experience for visitors of all ages. Lonna is a small island with a nice restaurant, a waffle

cafe and some hot parties during summer time. Vallisaari is perfect for hiking and exploring nature. Pihlajasaari is the most popular summer island in the city, providing tourists and locals alike a place to relax on the beach and swim.

Where to Work -Health Innovation Village is a digital health ecosystem hub and co-working space that is located on the GE Healthcare campus and houses over 40 startups. The GE Healthcare Helsinki site is home to about 800 GE employees as well as many medium-sized health tech companies. Terkko Health Hub is an event space, co-working area and a startup community focusing on health and life sciences, located in the Helsinki’s medical campus. Maria01 is home to startups, venture capitalists and the extended ecosystem to help each other succeed in the competitive startup environment. Top Events in Finland -Slush has grown from a 300 person assembly to a world-renowned event, now spreading globally. Today Slush is Europe’s biggest startup event, attracting 20,000 attendees and over 2,600 startups. Arctic15 is an annual startup business event that brings together 450 startups, 300 investors, corporations and media from more than 50 countries for networking. Arctic15 is known for its focus on 1-on-1 meetings.

The Break Away

Predicting Disease Will Change the World A conversation with Teemu Suna, CEO of Nightingale When asked to explain what Nightingale does, Teemu Suna answers without any flourish, in the matter-of-fact manner common among Finnish entrepreneurs: “We prevent people from getting sick.” This humorously understated—yet accurate—answer belies the magic that is one of the world’s most exciting digital health companies. Nightingale is a five-year-old, venture-backed enterprise that aims “to improve risk prediction and prevention of chronic diseases, such as diabetes and heart disease, and provide a metabolic profiling technology that measures blood biomarkers (molecules that indicate the presence of disease).” “Essentially what we are doing is predicting the risk of people having diabetes or cardiovascular disease 10 years before its onset,” says Suna. Nightingale has raised over $18M to date and is poised to become a global force in disease prediction. What sets the firm apart is how far upstream they are going to solve problems. Instead of addressing specific disease pain

points, Nightingale is leveraging its groundbreaking microfluidics technology to make sure the problems other companies are solving do no come to exist in the first place. Nightingale’s proprietary blood analysis platform provides comprehensive and affordable metabolic data at the molecular level. The technology analyzes small blood samples to better understand the risk factors behind chronic illness. Unlike other solutions in this space, Nightingale’s tests provide 220 biomarkers per sample (similar solutions provide only a handful) supporting the company’s mantra that “healthcare is changed based on evidence.” The firm’s technology has been used and featured in over 150 peer-reviewed journal publications and is used by leading researchers around the world, such as those at the University of Toronto and Murdoch Childrens Research Institute. In addition to the exponential value that this technology adds in the disease prevention space, both in academic research and in healthcare, the platform is also a groundbreaking development in the drug discovery space. The robust profile of 220 biomarkers “enhances drug target identification and validation by uncovering a comprehensive picture of drug target interactions across human metabolism - even at the preclinical stage.” Is Suna daunted by the largeness of his moonshot mission, that of preventing disease and changing the world? Not in the slightest. “What we are doing just makes sense.”

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Power to the Provider Assaf Shalvi saw workforce inefficiencies he didnâ&#x20AC;&#x2122;t like in an arena increasingly essential to the aging US population: caregiving. With Swift Shift, heâ&#x20AC;&#x2122;s optimizing the way homecare agencies work. WORDS BY DAVID SOKOL PHOTO BY PAUL NEWSON

In the field of nursing, a home-care agency spends almost half of its recruiting resources to replace practitioners who have simply opted out of jobplacement communications. Swift Shift was conceived to re-engage these and other existing staff, by giving them more control over their assignments. 66

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report / Swift Shift

R Ryan McDermott is a Pennsylvaniabased recruiting manager at Bayada Home Health Care, a provider of home care services that operates from 311 offices across the country. Bayada is one of the 12,181 Medicare-certified home health agencies that connect elderly, hospice and special-needs patients with help. According to the Centers for Medicare & Medicaid Services, these agencies scheduled more than 110 million physician-ordered nursing and therapy visits to 3.5 million beneficiaries in 2016. In the United States, professionals like McDermott are the glue that hold together his industry. He and his peers in client services are responsible for recruiting caregivers and assigning them to specific patients. Until recently, though, this essential group of administrators had only one tool for getting health and personal-aide services into the field. Traditionally, a new full-time patient required schedulers to phone multiple agency employees to determine their availability for the work. “We would have to offer the work by calling through an alphabetized list or calling the ‘usual’ people,” McDermott explains. Once the manager identified caregivers for the necessary two 68

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or three shifts, she would undertake another round of calls and voicemails to coordinate specific shifts. The exercise would be replayed in miniature for a sick day or, in the case of a very temporary assignment, it would start all over again just several weeks later. In 2014, Assaf Shalvi co-founded Swift Shift in an attempt to untangle agencies’ fragmented, analog approach to scheduling while at the same time empowering home care workers. The company’s platform quickly struck a chord. Agencies like Bayada, Interim HealthCare, and Epic Health Services now use it to manage their staff of registered nurses, occupational and physical therapists, health professionals and domestic aides, and to quickly assess who is available to work. In less time than it takes to make one phone call, the agency can notify numerous caregivers who might be able to respond to an assignment. Caregivers get these notifications on their Swift Shift smartphone app, and their responses populate the company’s proprietary software at the agency. The roots of Shalvi’s innovation go back to the early 2000s and 2010s, when he was working in operations for organizations in Israel and the United Kingdom. During that period, he observed how scheduling protocols drove a wedge between supply and demand. The demand was there, but the supply process was enormously inefficient. While spearheading a back-to-work program for Maximus, a global human resources outsourcer that specializes in health and human services, he further bristled over the tangled logistics of putting applicants in entry-level positions. Most important, he became keenly aware of how communications gridlock in an office shortchanged the very people who needed to work. “I once read a quote from Jack Welch, who said, ‘Control your destiny, or someone else will,’” Shalvi

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Current data shows that out of 100 nurses that apply for employment at a home health agency, only two or three will complete the entire onboarding process to complete even one visit. recalls. “When you’re working 14 hours a day to provide for your family, or paying a résumé writer to maybe get hired for a five-hour shift once a week, how are you controlling your destiny?” Meanwhile, he watched as the monetization of Internet and mobile technologies failed to close inequality gaps. “Uber has done a great job of helping people reap benefits from these innovations, but even they could do a much better job of empowering drivers,” he says, his voice shifting into ever higher gears of passion. Swift Shift’s namesake platform does not eliminate the middleman, because agencies are better equipped to conduct payroll and coordinate government regulation. Rather, the company reforms the middleman behavior: Whenever an opportunity becomes available, the scheduler pushes a notification to caregivers, who can apply for the assignment based on its location, open times, required skills and other criteria; workers also log on to the app to search for available shifts on the day of their choosing. The platform increases efficiency, minimizes phone tag and engenders a greater sense of control in the workforce.

PAIN POINTS --

Median caregiver turnover rate hit 66.7 percent in 2017, according to the ninth edition of the Home Care Benchmarking Study, published by the research consultancy Home Care Pulse.

Reflecting on the traditional protocol for patient intake, Shalvi considers the scenario from the caregiver’s point of view. “Saying yes to a scheduler is easier than saying no, because you might not get called again, and you never know when one of your other cases will end,” he says. “But perhaps you’ve said yes to a new case that requires two hours of travel time each way, or to significant parking costs that reduce your net income.” Because wages are often locked in at low rates to reflect Medicare payments, Shalvi opines that “a restaurant job” could be easier and less stressful. That a person can do a cost-benefit analysis in favor of unskilled work, Shalvi adds, explains why turnover in the home care industry is so high. “Every year, an agency must have 50,000 employees so that it can deliver 20,000 home-care shifts any given week,” he says. Median caregiver turnover rate hit 66.7 percent in 2017, according to the ninth edition of the Home Care Benchmarking Study, published by the research consultancy Home Care Pulse. Commenting on the high levels of turnover that have plagued the industry for years, the elder-focused journalist Chris Farrell writing for Forbes pegged the phenomenon to a “dismal combination of low wages, inconsistent work schedules and poor advancement prospects.” And he backs up his diagnosis with Bureau of Labor Statistics numbers; the department’s May 2017 report, the most recent available, shows that home health care aides made an average of $11.67 per hour. Nursing assistants earn an average hourly wage of $13.72, while registered nurses earn $35.36. In 2015, Shalvi began contracting Swift Shift to home care agencies, to share with their nurses and other caregivers, and it became quickly apparent that the platform could help all the partners of the home health

care endeavor. Bayada’s McDermott observes that Swift Shift has unburdened schedulers while allowing “employees to make decisions about what work opportunities are the right fit for them based on their own scheduling and personal commitments—even weeks in advance.” Caregivers are able to quickly respond to work opportunities. And Swift Shift is developing new features of its app so that agencies can recruit from outside their existing talent pools. In early 2018, when Swift Shift allowed all-new caregivers to upload their profiles to the platform via its Boost feature, a former home health aide who had left the industry to earn her nursing degree found job placement at Bayada after receiving a notification of available work via Boost. Although McDermott says it is too soon to collect reliable metrics, this and other anecdotal evidence suggests that Swift Shift is improving the speed and satisfaction with which Bayada caregivers are finding work. It also may be changing the conditions that impact turnover. “Swift Shift brings more nurses and aides to the surface,” for one thing, McDermott says. In addition, “we were pleased to receive comments from several offices that they have engaged employees to work on cases that they never would have thought would be a good match, but because Bayada adopted Swift Shift, it opened that opportunity up for them for more work.” The agency, which began rolling out Swift Shift to its Philadelphia-area workers, is now piloting the application in its pediatric offices in four states and fielding interest from other offices in its nationwide network. Bayada’s move corresponds with plans by Swift Shift to introduce the app to other agencies across the country, though Shalvi notes that his vision goes beyond breadth of coverage. He hopes operations professionals will collect and analyze data from

Swift Shift, so that they can improve their matching of caregivers to patients. More radically, Shalvi wants to see an end to caregivers’ “dismal combination.” Swift Shift estimates that it reduces a scheduler’s workload by two hours each day, and Shalvi thinks agencies should redistribute Medicare payments to caregivers to reflect the overhead saved by the new tool. Combined with the efficiency and predictability gains that Swift Shift is already achieving for caregivers, Shalvi believes that Medicare redistribution could ultimately triple the earnings of the home-care workforce. A sea change of any magnitude, he hopes, will compel caregivers to stick with the profession at a time when their service is more needed than ever. Observers have long flagged the disparity between professional caregivers and demand in the United States, and the aging population is bringing this problem to a head. According to the Population Reference Bureau, the number of Americans ages 65 and older is projected to surpass 98 million by 2060. And in various projections of the nursing industry alone, the Bureau of Labor Statistics estimates a shortage of more than one million nurses during the next decade. “There are millions of unpaid caregivers who are stepping in,” Shalvi says of this gap, adding that it applies to all demographic cohorts. “Consider the child who was born with medical conditions who, because we don’t have enough nurses, spends the first six months of her life in hospitals not being with her parents. Think of those parents who visit their newborn baby less regularly simply because they cannot find a nurse to cover a particular night of home care. There are so many people for whom home care impacts life. We have to deliver more of it, more efficiently.”

report / Cloud 9

Better Backup

PHOTO BY JACK FINNIGAN

During a mental health crisis, police officers on the scene can now enlist a cadre of mental health specialists and dataâ&#x20AC;&#x201D;through Cloud 911. By Cole Stryker

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D Dwayne Jeune was mostly okay

as long as he took his medication. One of the estimated 10 million Americans with a serious mental health disorder, Jeune had schizophrenia. On the last day of July 2017, during the humid days of the New York City summer, Jeune couldnâ&#x20AC;&#x2122;t remember if he had taken his medication. And he started acting strange. His mother, Dulcina, began worrying about him and called 911 for help, telling the operator that her son had schizophrenia and was not violent. Officers arriving on the scene said that Jeune approached them with a knife, and they initially tazed him. When he continued to move toward them, one officer fired four shots at Jeune, killing him in his own home. While some 7,000+ officers in the NYPD have trained in Crisis Intervention Training, which helps officers understand how to handle emotionally disturbed individuals, the officer who shot Jeune had not. In January, his mother filed a wrongful-death lawsuit against the City for $20 million, alleging that the officer did not understand how to intervene in situations involving mental illness.

Around the country, police officers are increasingly enlisted to encounter individuals who have mental health disorders. While some interventions resolve peacefully, others end with a fatality. According to a study by the Treatment Advocacy Center, people with untreated mental illness are 16 times more likely to be killed during an encounter with law enforcement. Cloud 9, a startup based in Austin, Texas, has built a mobile communication platform that aims to address this problem. Co-founders J.C. Adams, an entrepreneur, and Dr. Elizabeth Truong, a psychiatrist, have intimate experience with mental illness, having lost friends and loved ones. Both have dedicated their lives to “provide healthcare to those who need it most,” as Adams says, echoing the company’s tag line. The startup initially sought to realize this mission with the company’s flagship product, designed to promote ongoing treatment for those managing a mental health concern. The platform enables clients to video chat with a therapist, track their progress via questionnaires, and facilitates behavioral selfreporting. As Adams and Truong considered the numerous dimensions of mental health intervention, they realized that there were other players who could benefit from better access to expertise, information, and protocols for helping individuals with mental illness. While law enforcement officers may not have significant mental health training, they are increasingly the ones who are enlisted to contend with the unpredictable realities of our modern mental health crisis. Sometimes these situations resolve with police helping someone to get professional help or admitting her to a psychiatric ward. In other cases, untrained police and other emergency response workers aren’t able to respond appropriately

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$32B

A recent study by the University of Texas puts the annual cost of jail and ER treatment for the mentally ill at over $32 billion.

to distress calls, and the situation escalates into violence or a fatality—as it did with Dwayne Jeune. Adams and Truong’s new product, called Cloud911, is a communication platform poised to drastically reduce the financial toll of the modern mental health crisis while simultaneously offering a humane and compassionate resource for officers. The partners see the platform as the complement to the company’s namesake product geared to those with mental health disorders. “It’s a dual-treatment solution, so they work together in different parts of the healthcare ecosystem in order to prevent a crisis situation from occurring, and also intervening at the correct time when a crisis situation has occurred,” says Truong. Cloud911 equips emergency response teams with mobile technology, so that a police officer can quickly access data about the person gathered from previous encounters with the broader mental health system. For example, once an officer knows the person’s name, they might learn that they don’t have a history of violence, that they have a tendency to go off their medication, that they have had prior suicidal ideations, or that they have a sister who can assist with deescalation. All of this information is stored securely on a cloud network, and maintained with compliance to HIPAA and CJIS (Criminal Justice Information Services) regulations. The platform gives officers access to experts, too. When on the scene, they can connect a struggling person with a mental health professional via on-demand video chat at the point of the crisis. Some cities have acknowledged the value of this approach by augmenting patrols with trained mental health professionals who “ride-along” with police in areas like homeless tent cities, where mental health crises are likely to flare up. But maintaining such a fleet is costly. And police officers don’t necessarily

need the added pressure of a thirdparty looking over their shoulder on every call. Cloud911’s on-demand intervention facilitates the presence of mental health professionals without imposing the cost of in-person ride-alongs. Mental illness is not a crime, but when the people tasked with handling a mental health crisis are people who fight crime for a living, the line blurs. This leads to unnecessary ER visits or incarcerations, followed by legal proceedings and probations, all of which is expensive for city and county governments, and some of which is unnecessary or actively counterproductive for the person struggling with mental health problems. A recent study by the University of Texas puts the annual cost of jail and ER treatment for the mentally ill in the United States at over $32 billion. Adams describes this system as “a failed cycle.” “When a crisis occurs, law enforcement arrive—hopefully we avoid a tragedy—but typically the dumping ground is the emergency room or county jail, where mental healthcare services are not provided,” says Adams. “People get kicked out, and they keep coming back. It’s a revolving door that we can no longer afford.” Cloud911 aims to provide emergency response workers with a toolbelt that will enable them to respond to mental health crises so they can make good decisions under intense circumstances, compassionately, and cost-effectively. Police officers called to respond to a mental health crisis would have instant access to therapists, unique behavioral data, and best practices. In addition to providing help to those with mental illness, Cloud911 promises to ease the legal and emotional pressure on police and other emergency response teams. The technology is designed to walk them continued on page 116

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A Pregnancy App Worth Prescribing Some expectant moms going to obstetrician appointments at Aurora Health Care, one of the Midwest’s largest care providers, are coming home with something unexpected: a kit of bluetooth-enabled medical devices and a prescription for an app. By Neal Ungerleider Illustrations by Blair Nakamoto

In the world of pregnancy care, no-show rates for ob-gyn visits among pregnant Medicaid patients have historically been high. For some, it may be lack of transportation. Others may struggle to get the time off work. Whatever the reason, missed obstetric appointments mean that a pregnant woman isn’t getting the care that she needs. She may have unknown risk factors that are affecting her pregnancy. In addition, missed appointments create logistical issues and lost income for providers. Aurora Health Care, one of the Midwest’s largest healthcare systems, tried a new approach to this challenge: Prescribe a smartphone app – Babyscripts – that allows doctors to remotely monitor pregnant women. The intervention, a first for such a large health system, had a remarkable impact. Before the Babyscripts program, patients in the Medicaid group saw their obgyns, on average, only three times during their pregnancies. Those using the app met with their physicians seven times—more than double the rate. ***** When they started researching potential health care initiatives, Anish Sebastian and Juan Pablo Segura were not originally thinking about creating a pregnancy app. 72

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In 2013, the two bachelors knew they wanted to create an app related to a chronic health condition, designed to support short-term and long-term wellbeing. It would use biometric data to shape behavior and give physicians a wealth of information to better treat patients. They initially considered focusing on diabetes and heart disease. In the process of examining possibilities, Sebastian and Segura had a conversation with Dr. Nancy Gaba, chair of George Washington University’s ob-gyn department. Gaba told them that expectant mothers were a perfect audience for the sort of wellness-nurturing, big data–based endeavor they wanted to launch. Sebastian recounts the conversation with enthusiasm. “‘My patients are young,’” he recalls Gaba saying. “‘They are between the ages of 18 and 35. Pregnancy is a nine-month condition. These patients have a natural acclimation to change and behavior modification. And by the way, from a reimbursement standpoint, it’s all capitated. I don’t know what the real discussion is here, right?’” And thus BabyScripts was born. Sebastian is the company’s CEO and Segura is president. The business is based in Washington, DC, and its current clients include 15 health care systems operating in 13 states. Unlike many commercial pregnancy apps—the What To Expect and the Pregnancy+es of the world— Babyscripts is structured around a B2B (or B2MD) model that involves partnering directly with care providers or insurers. Although an expectant mom could hypothetically download the Babyscripts app to her phone, it wouldn’t be enabled unless her doctor had a partnership with the company. Physicians in the Babyscripts fold give their ob-gyn patients access to iOS or Android versions of the HIPAA-compliant app; a kit is giv-

en or mailed to them, containing a bluetooth–enabled scale and blood pressure cuff. The patient checks her blood pressure and weight at home and the data is uploaded via her cellphone to Babyscripts’ servers, and the information is accessible to the physician. Data from the devices are used for early interventions—making sure expecting moms get the care they need and are monitored regularly between appointments. The medical teams are notified if the biometrics—weight, blood pressure— are off-kilter. “We can collect data remotely from the mom but then filter it appropriately through to her care team,” Sebastian says. “For instance, if weight gain is too low, that triggers an alert and the care team can react in real time and intervene.” Alongside Aurora Health Care, other customers and partners include George Washington Medical Faculty Associates, Sutter Health, and Privia Health. Each organization offers patients a slightly different iteration of the Babyscripts app; care providers can add a diabetes module, for instance, or customize the messages patients receive. Patients interact with their care providers through their smartphone

app; on the other side, physicians use a web dashboard to analyze data and communicate with patients. Babyscripts’ customization capabilities were evident in the Aurora trial at Milwaukee’s Aurora Sinai Women’s Health Center. As part of the initiative, Babyscripts added a “care navigator” module to the app that connected a care specialist, typically a social worker, with patients. The functionality, Sebastian explains, is “very much targeted to underserved patient populations” like women receiving Medicaid, who make up approximately half of all pregnancies in the United States. For their Babyscripts collaboration, the Aurora team identified a subset of expectant mothers who they felt needed more intervention than a typical low-risk pregnancy, and they offered those patients the option to use the care navigator module. Social workers would write to patients directly through the app, which would also generate automated daily messages about pregnancy care. Although one dimension of Babyscripts’ mission is to reduce unnecessary in-office visits, the goal for Aurora was slightly different: to make sure that patients made it to the office. In addition, says Sarah Nicholson, Babyscripts’ SVP of business 73

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development, the Aurora Sinai trial aimed to increase touchpoints with Medicaid patients and increase their adherence to the prenatal schedule. The collaboration was successful. Not only did patients come in more frequently for appointments, they sent an average of four messages a week through the app. With a growing patient base, Sebastian and Segura intend to expand the company’s use cases and services for both patients and care providers. Since gestational diabetes presents significant risks during pregnancy, Babyscripts will be introducing an IoT glucometer that connects with the app, enabling patients and physicians to closely monitor blood sugar levels. The co-founders intend to expand their customer base to insurance firms. And since postpartum care is integral to the wellbeing of new mothers, Babyscripts is bulking up its postpartum offerings. Babyscripts made its first acquisition earlier this summer when it purchased pregnancy app maker iBirth, which builds customized and branded digital patient education apps for care providers. Judith Nowlin, iBirth’s co-founder, is joining Babyscripts as chief growth officer; the company’s staff is joining Babyscripts as well. Terms of the acquisition weren’t disclosed. Sebastian speaks highly of Nowlin and her work. A childbirth educator and doula, Nowlin first launched iBirth in 2009, during the first wave of smartphone healthcare apps. Among the pioneering pregnancy apps in the App Store, it offers extensive educational content about pregnancy and postpartum follow-up materials. “Over the course of almost a decade, Nowlin and her team have been able to create this incredible experience for patients with dynamic and rich content,” says Sebastian. Babyscripts intends to use this knowledge base to build out the educational portion of Babyscripts’ product. 74

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The Aurora Sinai trial centered around increasing touchpoints with Medicaid patients, reducing the no-show rate and increasing adherence to the prenatal schedule. ¶ Patients didn’t just more than double their attendance rate; they also sent an average of four messages a week through the app, and doubled the frequency of prenatal appointments.

Pregnancy is a unique market for entrepreneurs, since customers will inevitably phase out of their potential audience. The fact that pregnancy typically lasts for nine months makes it different from chronic conditions like diabetes. Even taking postpartum use into account, the Babyscripts’ consumer uses the app for slightly more than a year, at most, and moves on. Although there are hundreds of mostly customer-facing pregnancy apps in the Android and iOS app stores, concrete numbers about the size of the pregnancy app market are limited. There’s plenty of anecdotal evidence—and lots of listicles in magazines and websites—about the use of pregnancy apps, yet industrywide statistics remain a bit elusive. Despite that, pregnancy apps and digital pregnancy services remain a hot business. Thanks to developerfriendly innovations like Apple’s HealthKit and a wave of APIs for consumer wearables, the barriers for entry to the pregnancy tech market are lower than ever.

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Babyscripts’ decision to partner with healthcare providers sets it apart from the competition. Instead of being an unknown quantity that patients assess through crowdsourced reviews, the app gets its stamp of approval directly from physicians. Considering the pervasiveness of smartphones, it’s inevitable that wearables and smart devices would make their way into the realm of pregnancy care. The fact that doctors and health systems are giving Babyscripts their endorsements show that in the world of IoT devices and apps, Babyscripts makes an invaluable contribution to care, to the wellbeing of babies and moms alike.

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Healthcare Gets Schooled Providing free medical services, a system for electronic medical records, and a library of health information resources, CareDox aims to support wellness for millions of students. By Christine Grillo

H Hesky Kutscher learned

from personal experience that having access to a child’s medical records can mean a critical difference in care. “As a father, I very quickly realized how important it was to make sure that wherever my kids are, whomever we see, I want to make sure we get the right care,” he says. “I had a personal experience with my own daughter where had we not had access to her medical record, we would have misdiagnosed rashes she had as hives instead of what she was actually experiencing.” In the midst of parenting and daily life stressors, Kutscher had forgotten that his daughter was

allergic to penicillin. Because the doctor had access to her medical record which contained this information, they were able to solve the problem. Kutscher took his insight and made access to medical records the central premise of CareDox, a company he started in 2014 that provides a sophisticated, secure EHR, which is a platform for electronic medical records, specifically geared to students. Consider: There is a legion of documents pertaining to a student’s medical history and conditions—records of immunizations, booster shots, parent consent forms, allergies, illnesses, visits to the nurse and ongoing care for chronic conditions such as asthma or diabetes. It stands to reason that the more accessible and organized a student’s medical history is, the more likely he or she is to receive the appropriate care—and since there is a well-established link between a student’s health and academic achievement, CareDox sees itself not only as improving medical records management, but as working toward greater

opportunities for overall health and learning. CareDox’s sophisticated electronic health record platform allows school nurses, parents, guardians and other outside providers involved in the student’s care to store and access these medical documents for all of their students, with full adherence to HIPAA and the Family Educational Rights and Privacy Act (FERPA). Care providers at schools log in to the EHR where they are able to update and access students’ records; a provider might make notes about a visit to the nurse’s office or a call from a concerned parent. Parents are able to log in from home to update health forms and read up on relevant issues posted by providers. And when a healthcare team is deployed school-wide to do preventive care—flu shots for all students, for example—every student record reflects that service. Kutscher founded CareDox after chairing High Gear Media, a publisher that connects car-seeking audiences, via mobile and desktop devices, 75

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with content and tools to help them make better purchasing decisions. His mission for CareDox goes beyond a platform for medical information: He wants to democratize access to healthcare for all students, regardless of their economic status. To that end, CareDox’s goal is to ensure that “every child is proactively seen by the health ecosystem, and getting the right care.” As one part of implementing this goal, the company provides no-cost preventive healthcare services to the schools in its network. In addition to deploying a team of nurses to deliver schoolwide flu shots, CareDox coordinates routine childhood immunization boosters such as Tdap (tetanus, diphtheria, and pertussis) and provides a mechanism for in-school well-child visits, which the American Academy of Pediatrics recommends every child receive annually. CareDox also handles the paperwork for services such as the flu shots. In a more traditional scenario, a parent must schedule a visit with the doctor, take the child for the immunization, pay the co-pay, and then possibly follow up with lingering insurance claims. When CareDox coordinates services, however, it bills insurance providers directly. The “paper trail” exists on the portal, and parents don’t have to do anything more than sign a permission form. Where some children might fall through the cracks because of insurance bureaucracy that effectively prohibits the provision of care, with CareDox, every student gets the same services. Advised by a strong clinician community since its founding, the company has found that school districts are more than happy to team up to deliver care. In the last year, CareDox has increased its clinical services presence from two states to eight. To date, its largest partner is Miami-Dade County Public Schools in Florida, the fourth largest school district in the United States, with 76

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Schools across the country are finding the CareDox proposition to be well-suited to their needs. Between 2015 and 2017, CareDox grew from serving 1 million students to serving 3.9 million. 392 schools and 345,000 students. Another customer, the Houston Independent School District, has 215,000 students and 283 schools. Because the business model relies on revenue from payers—a mix of private health insurance companies, Medicaid and other governmentfunded health initiatives—the platform costs nothing for the school district. Schools across the country are finding the CareDox proposition to be well-suited to their needs. Between 2015 and 2017, CareDox grew from serving 1 million students to serving 3.9 million. Reduction in absenteeism is one of the company’s goals: as school health clinicians have attested, when an entire school community is immunized against flu, absences are reduced and learning increases. As the United States demographics evolve, we may find that getting children the recommended routine healthcare services is more challenging than it has been in the past. According to a 2014 study by the US Department of Health and Human Services (HHS), 22 percent of US children live in households with incomes below the Census Bureau’s poverty threshold. The same study showed that almost 20 percent of US children under 18 years of age have a special healthcare need as defined by having a chronic medical, behavioral or developmental condi-

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To date, CareDox’s largest partner is Miami-Dade County Public Schools in Florida, the fourth largest school district in the United States, with 392 schools and 345,000 students.

tion. It doesn’t take much of a leap to imagine overworked and stressed households with parents who don’t have the time or means to get their kids to doctor’s offices for shots and checkups. And while overall American children are fairly well covered for preventive healthcare services, the proportion of children receiving well-child visits declines with age. According to HHS, 89 percent children aged four and younger had received a preventive visit in the past year, compared to 79 percent of children 5–11 years of age and 72 percent of those aged 12–17 years. Other factors that affect healthcare delivery are health insurance status and type of insurance, parental education, race and ethnicity. CareDox may be able to help close some of the gaps in coverage. Studies that have explored the challenges to adherence have found that some of the barriers to pediatric medication adherence, which is lower than adult adherence, include the complicated daily hassles of living, stress, and family conflict. So CareDox has made a foray into chronic condition care, starting with asthma. Whether the condition is chronic or acute, as with Kutscher’s daughter, his company aims to improve students’ health, and with it, the quality of their education. As CareDox expands its reach and scope, we might see a future in which the program provides on-site dental care or services geared toward emotional wellbeing. “We are saving and changing lives of families by focusing on the children who need it most, and reducing overall healthcare costs for kids,” says Kutscher.

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Access to Care That Crosses Borders Combining behavioral science and texting, access.mobile is revolutionizing the way that hospitals and clinics communicate with patients. By Jeremy Lehrer

A Access to medical care is a global problem—an issue that affects developed countries and developing countries alike. In nations ranging from India to the United States, Bolivia, Uganda and the Dominican Republic, there are millions of people who need health care expertise and treatment that they are not getting. In the US alone, a 2016 CDC report estimated that there were 28.6 million people who did not have health care coverage, a litmus of access to treatment for conditions chronic and acute. A World Health Organi-

zation report released in 2016 noted that there were 1.7 billion people who have tropical diseases for which they haven’t been treated. The same WHO publication cited a statistic about maternal health: “In 2015, the maternal mortality ratio (MMR)— the number of maternal deaths per 100,000 live births—was estimated at 216 globally. Almost all of these deaths occurred in low-resource settings and could have been prevented.” For years now, Kaakpema Yelpaala has been working to ensure that the underserved are able to get care. “From a very young age, I had the belief that everybody has the right to have access to quality health care services,” he says. Yelpaala, who goes by the nickname “KP,” grew up in Sacramento; his parents were from Ghana, and many of his relatives still lived there during his childhood. As a young man, he saw family members in Ghana experiencing undue suffer77

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ing from what were relatively ordinary ailments, like hypertension and diabetes; one uncle eventually died from complications due to diabetes. The family history inspired him to pursue a medical degree, but he soon understood that he needed to take a different tack. “As I went down the pre-med path, I realized that I’m an entrepreneur and that numerous health care issues are systemic,” says Yelpaala, “so the clinical approach alone isn’t going to solve the problem.” Yelpaala got a master’s in public health from Yale University. During the 2000s, he worked in several countries in Africa and the Caribbean implementing healthcare initiatives for the Clinton Foundation. Among the projects were an effort to support rural healthcare and another to help governments ensure HIV-positive individuals would have access to antiretroviral drugs. “Our mandate was to work with governments and all the partners to get people on the treatments sustainably,” explains Yelpaala. At the Clinton Foundation, he worked on teams that designed, implemented, and scaled the programs; in so doing, he learned entrepreneurial skills while giving practical expression to his public health studies. During this time, Yelpaala lived in Kenya, Tanzania and Rwanda and traveled to other countries in the region—among them Ethiopia and Ghana—and began noticing how cell phones had become pervasive. In many areas, mobile telecommunications businesses had built up the cellular network quickly, leapfrogging the landline infrastructure. Yelpaala came to a conclusion: “I thought, it’s inevitable that digital innovation and specifically digital innovation tied to the mobile device is going to transform healthcare,” he recalls. “This isn’t an if—it’s a when.” Because there was no legacy infrastructure that might present obstacles to innovation, many countries 78

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offered a blank slate. So, in 2011, Yelpaala launched access.mobile with the mission to increase access to healthcare by leveraging the ubiquitous platform of the cell phone. The company partners with hospital systems and medical centers to design SMS communications for their patients. What Yelpaala and his colleagues call “communication campaigns” are sets of strategically conceived text messages that hospitals use to promote specific behaviors: so that Shahnaz will, for instance, take the medication she’s been prescribed, or that Gabriel will have information on services relevant to his heart condition, or so that Mrs. Mbire will learn more about her diabetes and what she can do to manage it. access.mobile is the behind-the-scenes scribe for hospitals to support their patients’ health, healing, and wellbeing. After starting in Uganda, the company currently has clients in Ke-

nya, Tanzania and the United States, and a cumulative patient base of 2.5 million. access.mobile’s behavioral scientists and public health experts begin a project by examining social determinants of health and the demographic of the hospital’s population to craft a series of communications that would have the most beneficial impact on the group. Location of residence, language, literacy level, all are evaluated in the process of determining what messaging—what content, in what language, in what style of language—is warranted. Once that information is gathered and analyzed, access.mobile develops the set of messages for various purposes and specifically targeted to the demographics identified. “Effective communication for patients is really a data problem,” says Yelpaala. “For someone to be able to effectively communicate

digitally—or to even develop the right content—you have to understand the profile of that patient. We take data on social determinants of health, and clinical information relating to that patient profile, as well as demographic data, and use those to then determine what the most effective communication is going to be for someone.” The messages and patient information are accessible to physicians and administrators through a HIPAAcompliant web-based platform,

Yelpaala’s choice to begin his business in Uganda is in some ways a political act, one that flips the narrative. Instead of bringing innovation from the US to Africa, Yelpaala is proving it in African countries and then bringing it to the United States and other countries. called amHealth, that has electronic medical record (EMR) integration capabilities. Much of the messaging, like appointment reminders, is automated, though users at the hospital can send messages when needed. amHealth can also receive responses from patients and respond appropriately. To tailor its messages to specific populations, amHealth draws on clinical data, public data, and other sources. Describing a hypothetical scenario, Yelpaala notes, “We can segment and say that people who live in this area that are male between the age of this and that and have this condition and speak this language will get this text.” If patients have expressed a language preference, the platform uses that; if not, initial messages allow patients to opt-in to their preferred language. The partnership doesn’t end once hospitals are sending texts. That is,

rather, the beginning of a refinement process. The messages, the resulting behaviors, and associated information stored in the EMR generate data. For instance: Did patients generally click through the message, or did they opt out? Did Shahnaz pick up the prescription, and did Gabriel come to the follow-up appointment—in short, did they do what the texts requested them to do? With that information, Yelpaala and his team can further refine the scripts so they’re more effective. If a particular message is not generating the desired behavior, it can be revised. Yelpaala summarizes the access.mobile development process as having three legs: “First, the content generation; second, the HIPAA compliant dissemination based on the segmentation and social determinant data; and then the analysis of the impact of a campaign based on the objective and the populations we’re targeting.” Writing may be one aspect of what the access.mobile team does, but everything the company does is ultimately aimed at producing the behavioral change that will lead to better outcomes for patients. In that sense, Yelpaala is an expert in the psychology of change. “Behavior change ultimately requires the confluence of motivation, ability and a trigger,” he explains. “You’ve got people’s motivation and how motivated they are to adopt or change a certain behavior, and then you have the ability they have to change that behavior—is it hard or is it easy for them. In behavioral science you’re trying to understand that end user, that patient, or that consumer and where they sit in that spectrum, and what type of incentives will trigger that appropriate behavior. Through social determinants, clinical data and content, we believe that you can use those tools in a more personalized way to get better outcomes. And if we can change behavior in a positive way toward treatment compliance, toward whatever

it is we’re trying to achieve, we’re going to improve outcomes and reduce costs.” The Nairobi Hospital has been an access.mobile client since January, 2017. Timothy Otieno, director of information communications technology at the hospital, worked with access.mobile when he was head of information services at Gertrude’s Children Hospital, also in Nairobi. He chose access.mobile because of its user-friendliness—“My staff and the patients don’t have to be experienced with tech to use it,” he says—and the way that messages can be tailored and automated to be sent. amHealth automatically sends reminders when appointments are made and the day before the appointment. Patients at healthcare facilities throughout East Africa are primarily walk-ins. The Nairobi Hospital offers appointments, so one of the hospital’s goals was to encourage the behavioral shift so that patients keep their appointments. “Being able to notify patients about labs, prescriptions, appointments and other medical needs via mobile greatly impacts adherence,” says Otieno. And he has the statistics to back him up: six months after the access.mobile messaging debuted, missed appointments at Anderson, one of the hospital’s appointment-only clinics, were down by 84%, while patient intake was up 220%. The standardized messaging across departments—for things like appointment reminders and post-visit thank yous—aided in more effective communication and reduced the logistical burden for administrators in different departments. access.mobile also has sets of messages related to WHO holidays raising awareness about various health issues and more generally about prevention, diagnosis and treatment of different ailments. Otieno has found the messaging platform has a more emotional compocontinued on page 116

Live Feed Teledentistry company MouthWatch offers a new spin on the future of dental careâ&#x20AC;&#x201D;one that will increase access for vulnerable populations. By Cole Stryker

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I I recently visited my wife’s grandparents near Yuma, Arizona, just a short drive from the Mexican border. During the visit, grandma and grandpa invited us to accompany them to a small town in Mexico called Los Algodones. We parked on the US side of the border, and made our way along a fenced-off walking path. This

walkway stretches across the border and past a customs office, finally opening out into the town of Los Algodones. As we strolled through the town’s main square, we were greeted by dozens of salesmen hawking sombrereros, tchotchkes—and dental care. Los Algodones is also known as Molar City, because of the over 300 dental clinics that are located here. Each year, thousands of Americans drive and charter buses down to Mexico for what’s known as “dental tourism.” The folks making the trip are usually elderly, often living on tight retirement budgets. Many have put off

dental work for years, or even decades. In the US, a mouthful of cavities might cost upwards of $30,000 without dental insurance. But here, the dentists of Los Algodones can take care of cavities, root canals, bridges, and more for roughly a tenth of the cost. According to recent studies by the National Association of Dental Plans, the amount of Americans living without dental coverage has dropped from around 40% to 23% in the last few years. Yet there are still approximately 75 million people in the US who don’t have coverage. It’s common wisdom that preventative dental care saves

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money in the long run, but a large population of Americans simply can’t afford routine checkups and cleanings, or don’t have access to a nearby clinic. According to the American Dental Association, “59% of adults indicated that they forgo dental care due to cost ... and 19% because they cannot find a convenient location or appointment time.” MouthWatch, based in New Jersey, has developed a suite of tools that enables dentists to address this problem. Central to the MouthWatch toolbox is an intraoral camera that looks vaguely like a toothbrush. Instead of bristles at the top of the brush, the device has a highquality camera and LED lights. Hygienists can use the camera to relay images to an off-site dentist during an exam. The cameras, which connect with MouthWatch’s proprietary teledentistry software, allow hygienists to go out into the field, expanding the practice’s reach. Imagine a mobile unit squad of hygienists setting up a “pop-up” operatory at a corporate campus to examine busy employees between meetings. Or going to a school, a nursing home, or a rural community center that’s far from any dental practice. Now the dentist doesn’t have to be there physically with the patient, because the hygienists can broadcast images of the patients’ teeth back to the “home base,” and the dentist can consult remotely if further analysis is required. If the dentist determines that more care is needed, then that patient can set up an appointment to come into the office. MouthWatch founder Brant Herman founded the company seven years ago after he observed an encounter at his father’s dental practice. A well-to-do woman came in for a checkup, and Herman’s father 82

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According to the American Dental Association, Americans spend over $117 billion annually on dental care, so increases in efficiency could mean revenue increases in the billions for the industry.

used an intraoral camera to show the patient images of the plaque and calculus buildup behind her teeth. When the woman saw the side of her teeth that she normally couldn’t see, she was horrified. It was the sort of “a-ha” moment that likely encouraged the patient to come in for more frequent cleanings. She had no idea her teeth looked like that. When Herman saw this reaction, he saw an opportunity. If his father’s practice had these cameras in every operatory, it would be a brilliant means of ensuring that every patient has a chance to see exactly why they need to come in more often. And if he could sell the devices directly to patients to keep at home, dentists could do remote consultations. Patients would check their teeth at home and send the imagery to their dentist, who could provide dental advice remotely, or tell them it was time to come in for an examination. The problem that Herman found is that these cameras don’t come cheap. They’re often shipped bulging with bells and whistles that most dentists rarely use. So he set about developing a cheaper intraoral camera, with the initial plan to persuade patients to buy them for home use It became quickly apparent to Herman that the “special sauce” of his new product was not in the camera, but in the promise of networked communication between the different participants in the dental care cosmos. The bigger opportunity was not selling to patients, but to practitioners. “We saw the need to create a teledentistry specific platform that would help large and small practices,” says Herman. “If you have an IT department and multiple software packages, you could do teledentistry, but we wanted to make it as easy as possible and scalable.” MouthWatch took care of the

technological backbone by developing TeleDent, a communications platform that allows for multipleperson video chat and the sharing of images taken by the intraoral camera, as well as patient paperwork and clinical data. There are a number of unexpected benefits from the platform. For example, referrals become more smooth. Typically a dentist would palm the business card of a trusted oral surgeon to a patient in need of that type of care. But the chances of the patient never following up, or becoming paralyzed by options, are high. Instead, with MouthWatch, the dentist could call up the oral surgeon right there in the operatory, introduce the patient, show the surgeon the problem using the intraoral camera, and set up an appointment. This way, everyone collaborates to provide the best treatment plan and the patient is well-informed—everyone’s on the same page. That innovation could be a game changer, for small practices especially. But perhaps the “bigger” idea is in the potential for MouthWatch to enable practices to reach more patients—often those who are most in need of care— with increased efficiency. The platform promises to do this by essentially untethering the hygienist and the dentist. An hour of a hygienist’s time costs the practice more or less 10% of the cost of an hour with the dentist, and much of preventative care can be accomplished by a hygienist with a minimal amount of oversight from the dentist. According to the American Dental Association, Americans spend over $117 billion annually on dental care, so any marginal increase in efficiency could mean revenue increases in the billions for the industry. A mobile unit creates additional touchpoints for new patients, while

keeping costs low, since the dentist can stay at the home base providing the high-level restorative care that he or she is equipped (and paid) to provide. This untethering of the hygienist changes the care paradigm. In the past, there wasn’t any way to squeeze more patients into a workday without sacrificing quality of service, so dentists were forced to find new revenue streams, often leading to them upselling upmarket patients with cosmetic services like botox or whitening. MouthWatch currently has 35 active pilot programs. Some clients are paying to implement it, and some are pro bono public health programs, such as Smart Smiles, an organization that connects public health hygienists with students who require

IN THE CLASSROOM --

Students at NYU’s dentistry program use the MouthWatch intraoral camera on a mannequin, then use the TeleDent software to send clinical notes and treatment requests to an imaginary dentist.

preventive care and other services at their schools. New York University’s dentistry program has integrated TeleDent into the curriculum of second year dental students. The students use the MouthWatch intraoral camera on a mannequin, then use the TeleDent software to send clinical notes and treatment requests to an imaginary dentist. Mouthwatch also has over 30 established customers who use their cameras and TeleDent platform. The clients include pop-up operations, group practices and dentists managing multiple locations. These days Herman is focused on making sure his software can act as a practice management suite while also playing well with the myriad practice management software platforms, so that doctors can integrate TeleDent into their extant tech framework. In addition to creating efficiencies that enable dentists to see more patients, MouthWatch can be leveraged as a marketing sales tool, which opens the practice up to new patients who might not have otherwise encountered the practice. “You can only do so much with AdWords and social media marketing and Yelp reviews,” says Herman. “You’ve got to go where the patients are.” At mobile or “pop-up” practices, hygienists can pass along marketing messaging and literature to new patients, ideally transforming one-off customers into repeat patients. MouthWatch’s teledentistry tech can certainly help toward that end. But it’s also poised to usher in an “Industrial Revolution” in dentistry that ensures more patients have access to care, while increasing the productivity of dental professionals. Considering the scores of buses ferrying patients to Mexico for “dental tourism,” the solution—and the audience for it—is very much in need. 83

Taking Noninvasive Monitoring to New Sites and Applications

™

For over 25 years, Masimo has been an innovator of noninvasive patient monitoring technologies, striving to improve patient outcomes and reduce the cost of care by taking noninvasive monitoring to new sites and applications.

masimo.com Caution: Federal (USA) law restricts this device to sale by or on the order of a physician. See instructions for use for full prescribing information, including indications, contraindications, warnings, and precautions. Rad-97™ NIBP and Rad-97 with NomoLine™ Capnography are not licensed for sale in Canada.

Products shown may not be available for use in all care areas.

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StartUp Health Magazine

PLCO-002143/PLMM-10890A-0818 PLLT-10103E

Masimo offers leading technology to care providers across the continuum of care—including hospitals, Emergency Medical Services (EMS), longterm care facilities, physician offices, and other care areas.1

Companies to Watch 10 digital health startups transforming the landscape

Cohero Health

Zeel

Valera Health

86 89 92

CarePredict

Greatist

@Point of Care

88 90 94

Fit4D

Biome

Life Recovery Systems

Cloudbreak Health

89 91 95 96 85

Cohero Health Chief Scientific Officer and co-founder Melissa Manice, PhD, MPH, with CEO Joe Condurso, in their Manhattan office.

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StartUp Health Magazine

Moonshot

Cure Disease, Access to Care

Employees 32

New York City

Cohero Health

$17.2M

The Future of Respiratory Care Has Arrived THE PITCH

Cohero is an engaging digital health management platform for asthma and COPD—consisting of connected devices and apps—that improves patient outcomes by increasing medication adherence, providing stats on lung function and environmental triggers, and enhancing clinician decision-making. Integral to it all: a brilliant design and beautiful user interface.

Investment

Leadership Profile CEO Joe Condurso’s 20+ years of health operations experience includes periods as a VP at Motorola Healthcare Group and Cardinal Health. Melissa Manice, PhD, MPH, co-founder and chief scientific officer, has a PhD in clinical research with a focus in biostatistics and chronic disease. Use Case Tim has been on asthma medication for two years. Tim estimated that he forgot to take his medication about 50% of the time. Tim reports he has been hospitalized overnight for his asthma five times in the last 12 months and been to the ER five times in the last year due to asthma. Tim received the Cohero Health HeroTracker Bluetoothpaired medication monitoring device for his Controller medication.

The BreatheSmart mobile application was loaded onto his mom’s cell phone. Text message reminders were sent through the mobile application twice a day, each day to remind Tim to take his medication on time. When Tim came in for his follow up visit three months later, he no longer felt it was hard to remember to take his inhaler. He had zero ER visits and zero hospitalizations due to Asthma over the period (compared to an average of 1.2/quarter prior to the study). Proprietary Tech Cohero Health’s devices are FDA Class I and Class II cleared asthma and COPD digital health products. Feature Set Cohero Health’s platform has multiple elements. The BreatheSmart mobile application offers a wealth of information on respiratory health and is tailored to the user. It has patient and clinician views in addition to a caregiver version, used by parents for young children or adults for aging parents or relatives. The platform offers population health risk profiling in respiratory health and predictive therapeutic insights. The HeroTracker sleeve for inhaler medi-

cations gathers stats on medication usage, while Cohero Health’s mSpirometer allows for clinical-grade lung function tests at home (or out). The platform gathers Electronic Patient Reported Outcomes (e-Pros), and it features responsive messaging, reminders, and alerts, in addition to tracking symptoms and triggers as they correlate to a real-time environmental data feed. Key Stats Cohero Health’s platform has clinically proven outcomes: it shows a 2.5x increase in adherence to medication over standard of care, with average patient adherence at 85%— above therapeutically optimal levels—and a 95% reduction in rescue medication use, meaning that the respiratory condition is under control. ¶ Patients using it have a 50% average reduction in emergency department visits. ¶ 92% average patient satisfaction score. Milestone Partner Dartmouth-Hitchcock led Cohero Health to evolve its business model. The hospital’s administration preferred to build its own chronic disease management software platform and integrate Cohero Health’s HeroTracker hardware devices into it. That led Cohero to retool its platform so it would support back-end data integration into a client’s existing chronic disease management platform; yet the front-end would remain Cohero Health’s patient-facing mobile app, BreatheSmart. 2018 Milestones Validated outcomes for both adult and pediatric patients. ¶ Introduced a new application dashboard for care managers, providers, and population health managers. ¶ Rolled out a new module—called “Symptoms and Triggers”—that allows a patient to identify triggers that cause respiratory exacerbations and features real-time weather, environmental and location-tracking data feeds designed to help prevent attacks. 87

Companies to Watch

CarePredict

Predictive Tech That Helps Keep Grandma Safe

Moonshot Longevity

THE PITCH

CarePredict’s Eldercare AI-Platform monitors the elderly, provides a touch-button communication system and assesses daily well-being autonomously. It can send caregiver alerts on early activity and behavior patterns corresponding to depression, falls and UTIs.

Employees 20

Plantation, Florida

Investment $10.2M

Leadership Profile Founder & CEO Satish Movva is a serial entrepreneur with 20+ years experience in healthcare tech. He grew his last startup, ContinuLink, a SaaS homecare/hospice platform, from launch to 350 customers and $700M in transactions before sale. Greg Zobel, COO, has worked at Lockheed Martin, Baxter Healthcare and Healthrageous. Dave Marsyla, CTO, founded Device Anywhere, which he sold for $60M. Jerry Wilmink, CBO, holds a PhD in biomedical engineering. He founded WiseWear and is the former director of the Department of Defense-funded Terahertz Lab. What CarePredict Monitors Using real-time indoor location tracking along with kinematics of the dominant arm, the wearable gathers data on activities of daily living ranging from eating, bathing, cooking 88

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and grooming to functional activities such as sleeping, sitting, standing and walking. A sophisticated AI platform utilizing deep learning neural nets predict upcoming issues. Milestone Partner LifeWell Senior Living, a thought leader in the senior group living industry, sought out a partnership with CarePredict. They conducted a 16-month pilot of prototyping and data collection. After the pilot, CarePredict introduced the system at the LifeWell locations. Why Stats Matter On average, CarePredict detects indications of a UTI 3.7 days in advance, depression a week before symptoms become pronounced and the probability of a fall seven to 10 days before one might occur. ¶ Twenty-five percent of seniors who fall and break a major bone will die

StartUp Health Magazine

On average, CarePredict detects depression a week before symptoms become pronounced, and the probability of a fall 7 to 10 days before one might occur.

in the first year and nearly all will die by year five. Senior living facilities get sued for falls whether or not they are at fault. With CarePredict’s industry-exclusive fall prediction, falls can be prevented, thus mitigating liability but much more importantly saving the lives of the seniors. Working with Customers CarePredict generates predictive analytics relating to upcoming health concerns for seniors. Yet historically, caregivers at senior living facilities are not trained to intervene in the health of the residents. The company has developed procedures and processes so caregivers understand how to react to the analytics. In addition, senior living facilities can selectively turn on the predictive analytics so caregivers can grow into the technology at their own pace. As CEO Movva says, the ultimate goal is to guide “the industry towards caring about the outcomes for the residents and not just worrying about the here and now.” Expanding Markets CarePredict has started focusing on intermediated B2C channels as well as international expansion. As Movva observes, “Aging is a global problem, and it is more acute of a problem outside America.” Japan, for instance, has a large and growing elderly community and a negative population growth leading to not enough caregivers. China has a growing population of seniors combined with slowing population growth due to the former one-child policy. In addition, CarePredict is also planning to expand to Mexico, Brazil, Argentina and Germany in 2019.

For This Diabetes Startup, the App is Just the Beginning THE PITCH

Fit4D, founded by David Weingard in 2009, is setting out on a bold mission: to improve the lives of the 30 million Americans in the US, and half a billion people in the world who suffer from diabetes. They are doing this by focusing on engaging the patients who typically fall through the cracks. By leveraging their Cecilia technology platform to scale a national network of certified diabetes educator (CDE) clinicians, Fit4D is getting patients back into care, while showing an enviable ROI to health plans and the pharma industry.

Moonshot

Access to Care

Fit4D

New York City

Leadership Profile CEO and founder David Weingard is a diabetes advocate living with Type 1 Diabetes. He has 15+ years of sales & business development experience at organizations like Microsoft, Computer Associates and a number of startups. Team includes former executives from Microsoft, Blue Cross & Blue Shield North Carolina, Prudential Healthcare, Accenture, JPM and Bayer. The Differentiator “Most patients who leave the doctor’s office, whether they’re newly diagnosed with diabetes or they were asked to change their medication, are completely overwhelmed,” says Weingard. “They don’t know what to do. They are fearful. Yet 50% of them don’t initiate or stay on their medications. These are people who are not going to download an app to self-management diabetes. They need someone that builds trust with them. Gets inside their world and understands their day-to-day life and helps them solve these challenges every single day. What we found is, unlike a call center, using certified diabetes educators who are knowledgeable in the disease and understand the medications and all the side effects makes all the difference in the conversation. It elevates the value of the conversation from an emotional and clinical perspective. Key Stats Fit4D has delivered a 20% increase in Rx adherence and 3x ROI for its pharma clients. Fit4D has shown a $380 annual savings and 3x ROI per member/patient for health plans. Fit4D engages on average 25-40% of patients received vs. industry standard of 10-15%. Fit4D has seen 95%+ patient/member satisfaction. Partners Clients include three of the leading five diabetes pharma companies in the world and multiple diabetes device companies. Its payer client portfolio includes regional and national organizations such as HealthFirst, Blue Cross Blue Shield of Nebraska and Humana.

Zeel

A Massage for the Masses THE PITCH

You can order Pad Thai and a black car with two clicks on your phone. Now, you can order up a Swedish or deep tissue massage just as seamlessly. Zeel is the leading purveyor of on-demand massage and its army of 11,000+ table-wielding massage therapists arrive at homes, hotels, workplaces, and events, in as little as an hour. What’s more, Zeel is building on new research about the health benefits of massage. According to the Mayo Clinic, “massage can be a powerful tool to help you take charge of your health and wellbeing.” While more research is needed, massage has shown benefits for those suffering from anxiety, digestive disorders, fibromyalgia and insomnia, among other conditions.

2018 Milestones For the second year in a row, Moonshot Zeel made the Inc. 5000 list Longevity of the fastest-growing private companies in America. This year, CEO and cofounder Samer Hamadeh was named a finalist for the Ernst & Young New HQ York Entrepreneur of the Year New York award. Zeel recently launched in Cleveland, Indianapolis, and Providence, making its service available in 90 cities, more than any other massage company in the nation. Notable Partnerships & Clients Zappos, SpaFinder, Hilton, Hyatt, IAC, Twilio, WeWork, Cooley, Industrious, Rosewood Sand Hill Road, Four Seasons Georgetown, Red Door Spa, Credit Karma, JP Morgan, DraftKings, Paychex, Cisco Meraki, Adidas and Live Nation. 89

Companies to Watch

Greatist

Helping a New Generation Get Healthy-ish THE PITCH

Built on top of the largest audience of healthy-minded millennials on the internet, Greatist is a health and wellness marketplace curating information, products and services. With their â&#x20AC;&#x153;healthy-ishâ&#x20AC;? mantra and an army of social savvy media makers, Greatist is making health content fun for a new generation.

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Leadership Profile Derek Flanzraich, CEO and founder, has business development and strategy experience with roles at NBC and Clicker Media Inc. Dria de Botton Barnes, editor in chief, brings 15+ years of media and content experience, including Food Network, Food.com and CafeMedia. Debra Hyman, head of marketing and partnerships, has 15+ years integrated marketing and branded content experience, including Time Inc., DailyCandy and NBCUniversal. Tara Schmitt, head of sales, has 20 years experience, previously with NBCUniversal, SheKnows Media and Hearst Digital.

StartUp Health Magazine

Differentiation Unlike other health and wellness publishers, Greatist has a uniquely friendly and shareable voice with an emphasis on high-quality workouts, recipes and lifestyle content. Greatist focuses on millennials across the country (85% of their audience is not on the coasts). Greatist reaches 8-12 million people every month through award-winning sciencebacked and expert-approved content from Greatist.com, plus many more millions across all social platforms. Milestone Partner The power of Greatist shines through when they work with brands who share a similar mission. Some of their most successful partnerships include a combination of both established and newer brands, across various categories, including Daisy, Delta, Kettle and Fire, BodyArmor and RX Bar.

Moonshot Nutrition & Fitness

Employees 30

Investment $8M

Biome

Better Cardiovascular Care for More Americans, at Half the Cost THE PITCH

“We’ve been very focused on resonating with millennials by speaking their language and meeting them where they are at.” 2018 Milestones Greatist changed its Instagram strategy and 10x’ed their following to over 750,000 followers. Key Stats The average reader spends an impressive five minutes on each piece of editorial and branded content. 80% of their audience is located outside of New York and California.

Biome delivers machine learning enabled performance applications that use communitydriven analytics and unique measures to help hospitals and doctors work together to ensure that the 11% of Americans suffering from heart disease receive better care at a significantly lower cost.

Moonshot Cost to Zero

San Francisco

Leadership Profile Biome’s team has operational, clinical and analytic expertise from tech companies like Oracle, Google and Verity as well as healthcare systems including Cota Healthcare, UCLA Health and Cedars-Sinai. Stuart Jacobson, CEO and founder, is a veteran of Oracle, Saba Software, and Kivera. Other leaders include: Rakan Khaki, VP, analytics; Sky Lawrence, VP, products; Sandy Ng, chief data scientist.

a light on their drivers of cost and quality. Doctors and hospitals need integrated clinical and financial tracking measures that are relevant to their specialty and their populations. In our experience, when our applications deliver this insight, care delivery becomes a self-optimizing system.”

Milestone Partner The Office of the President of the University of California Health System, the nation’s largest academic system, found Biome’s technology and business model compelling and implemented it in a novel cardiac surgery initiative to share knowledge, drive better outcomes and lower costs at each UC Medical Center (UCLA, UCSD, UCSD, Davis and Irvine). In 2015, Biome leveraged this experience to approach CedarsSinai Medical Center, the largest hospital in the west.

Notable Partnerships Sutter Health, Cedars-Sinai Medical Center, Robert Wood Johnson Foundation, OSF HealthCare, Sharp HealthCare, El Camino Hospital, SSM Health and the UC Medical Centers.

Sector Insights “Today, doctors are inundated with data, but lack the clinically relevant insight they need to do their best work,” says Stuart Jacobson. “Most products and internal projects tell providers ‘how they’re doing’ but lack insight into the underlying drivers of performance. To reliably deliver high performance care, doctors need precision measures, risk models and benchmarks that shine

2018 Milestones The company boasts 12 clients across 28 hospitals.

Key Stats 4x ROI for clients in the first year of partnership. ¶ 27% reductions in PCI bleeding events ¶ 35% reduction in blood utilization ¶ 50% cut in cardiac surgery readmissions ¶ 32% increase in early extubation, ¶ 8% reduction in complications ¶ 22% cut in cost of TAVR.

Companies to Watch

Valera Health ing Montefiore’s work in treating patients with conditions ranging from depression and comorbid chronic conditions, to bipolar disorder and schizophrenia, to antepartum and postpartum depression.

THE PITCH

Valera Health enables health systems and payors to scale an accessible and efficient behavioral healthcare platform. It’s all about delivering the right behavioral health services to the right patients at the right time.

Moonshot

Mental Health & Happiness

Brooklyn, New York

Investment $4.6M

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The Platform That Can Efficiently Scale Your Behavioral Health Service Leadership Profile CEO and co-founder Dr. Thomas Tsang (pictured) has experience finding innovative solutions, from his role as a Congressional staffer on the Committee on Ways and Means, to running a Federally Qualified Health Center, to being the CMO at Merck’s Services and Solutions business. President and co-founder Dr. Ofer Sharon is the former medical director for Merck Israel. Medical Director and co-founder Dr. David Mou is a psychiatrist at Massachusetts General Hospital and previously worked for Fidelity Biosciences. Real World Use Case “Group Health’s care management team has told us time and again, the connections they’ve made through the app have resulted in high levels of StartUp Health Magazine

rich engagement and increased member willingness to share openly the issues that are troubling them,” says Tsang. “They’ve seen lower incidence of 911 calls for suicidal ideation and care managers now know who’s in distress earlier and faster.” Milestone Partner McLean Hospital from the Massachusetts General Hospital System was their initial partner in the pilot, and they provided a cohort of mental illness patients to participate, and researchers to execute studies on Valera’s technology. Their next pilot was at Montefiore Health System, supporting their Behavioral Health Integration Program which has resulted in a contract spanning the entire health system and its DSRIP affiliate sites. Valera Health is now support-

2018 Milestones Increased validation and success in the clinical arena, proving that Valera Health delivers value to payers, provider teams and ultimately to patients. Dr. Tsang claims, “Patients express feeling ‘connected’ to their care teams and no longer feeling that they are alone in the world. They can access our programs when they want it and where they want it.” Recently, Valera Health kicked off a project with Group Health Wisconsin, a payer with over 75,000 high-need, high-complexity members. Valera has demonstrated results in depression improvement and remissions rates superior to usual standard of care which is significant in the digital tech space. Target Audience Forward-looking healthcare organizations including payers and provider groups that have huge unmet needs delivering a robust mental health service model. Future Projections Valera Health hopes to expand into multiple geographic markets and partner with leading health systems in the nation. They’ve been receiving inquiries from networks that have active presence in more than 10 markets.

HiVivibot.com/health

Meet Vivibot, a chatbot for young cancer survivors.

cancer sucks

UGGHH!

my friends donâ&#x20AC;&#x2122;t get it

scanxiety

Created by Hopelab. Visit Vivibot at HiVivibot.com/health

Inspired by hope, realized by science. Hopelab is a social innovation lab focused on designing science-based technologies to improve the health and well-being of teens and young adults. 93

hopelab.org

Companies to Watch

@Point of Care Moonshot

The Data Doctors Need, Delivered at the Right Time THE PITCH

@POC is a multifunctional software platform that increases engagement and compliance by enabling patients and clinicians to communicate, learn and share real-time data. It provides access to research, literature and drug information, and integrates a cognitive and machine learning engine to help clinicians make decisions about treatment.

Leadership Profile CEO and founder Robert Stern conceived and led Projects in Knowledge for over 30 years. He also launched the news site MedPage Today, later selling it to EverydayHealth in 2010. CTO David Setiadi was chief information officer at Projects in Knowledge for 8+ years. COO Michele Fallon Ingram was senior vice president, joint operations, at Projects in Knowledge. Real-World Use Case A cardiologist is seeing a cancer patient for heart failure, but she doesn’t have expertise in oncology. Thanks to @POC’s natural language processing, powered by their cognitive technology, she gets the answer to her in-practice patient management question, “I have a 45-year old heart failure patient who’s undergoing chemotherapy, and is developing a rash, and I don’t know what’s going on.” AI’s Competitive Advantage @POC’s clinical decision support tool uses AI and cognitive learning to support the natural language point-of-care questions posed by physicians. @POC serves three to five curated answers back in less than three seconds while clinicians are with the patient. Other companies provide clinicians with access to uncurated information, which gener-

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StartUp Health Magazine

Employees

Cost to Zero

New Jersey

ates 100+ results for various possible solutions, that provider have to sift through to get the most relevant answer for their patient.

STARTUP HEALTH

HQ 6

during 2018 which includes 180,000 physicians, and a balance of 70,000 nurses and pharmacists. @POC developed a custom app for the American Gastrointestinal Association, making the tool available to the organization’s 8,000 gastroenterologists.

Milestone Partner Follow @POC, The Multiple Sclerosis Asconnect with sociation of America comthe team and missioned @POC in 2014 read their latest Tear to develop a web and moSheet update. Key Stats bile app to aid the patient 6 After completing @POC’s care journey for multiple startuphealth.com rheumatoid arthritis edusclerosis patients. The app cational tool, 75% of pargenerates extensive analytticipants were competent ics to help them understand or highly competent in their ability their current physical health, cognito treat and manage RA, an increase tive skills and fatigue issues. @POC of 30% from pre-activity assessment. has partnered with The Dartmouth In a follow-up survey conducted 45 Institute and Geisel School of Medidays after training of the rheumatoid cine at Dartmouth on shared decision-making between physicians and arthritis educational tool, 87% of patients interacting digitally. clinicians indicated having changed key strategies in diagnosis and treatTraction ment as a result of the @POC interRevenue has increased by 30% since vention. the start of 2018, without any VC funding. @POC has increased its user base from 200,000 to 250,000

Eureka Moment

“First, we realized we shouldn’t be streaming data to doctors day and night. The only time physicians see the data is at the point of care, when it’s most useful and pertinent. Second, physicians need different information than patients. Physicians look for clinically relevant information and for validated measures—like fatigue, cognotion or psychosocial scales—particularly with chronic disease patients, like those with MS.”

-Robert Stern, CEO

Life Recovery Systems

THE PITCH

Life Recovery Systems is the maker of the ThermoSuit, a full-body cooling system that gives rapid, safe cooling therapy used to maximize outcomes for victims of stroke, heart attack and cardiac arrest.

Moonshot Brain Health

Target Audience Emergency physicians

New Jersey & Louisiana

Investment $5M

When “Time is Brain,” High Tech Rapid Cooling Saves Lives Leadership Profile Co-founder and vice president Robert Schock has a PhD in biomedical engineering; authored 20+ US patents and publications; co-inventor of the ThermoSuit System. Dr. Robert Freedman Jr., co-founder and chairman has 30+ years as an interventional cardiologist; national expert on cardiovascular med; received the Enrique Lopez Award for Medical Invention in 2009. How it Works The ThermoSuit uses a thin film of liquid for convection cooling, controlled by continuous feedback from a core body temperature probe. The technology was developed with the assistance of grants from the National Heart, Lung, and Blood Institute of the National Institutes of Health. Real World Use Case A 47-year-old male was found to be suffering heat stroke with body tem-

perature of 108°F, which is usually fatal if sustained for more than a few minutes. After attempts at surface cooling produced marginal results, the patient was placed in the ThermoSuit System (TSS) and cooled to 90.8 °F in 26 minutes, then removed from the TSS and gradually rewarmed. The patient’s impending kidney failure, muscle tissue breakdown and coma completely resolved, and the patient was discharged from the hospital, fully recovered, on day five. Milestone Partner Rapides Regional Medical Center in Alexandria, LA was a first adopter of the TSS and has a continuing training program. 2018 Milestones The ongoing “SISCO” study, in which victims of stroke are being rapidly cooled to reduce brain injuries, is proving to be LRS’s most promising development. They are

seeing better clinical results than others in the market. In 2018 they received IRB approval for a second clinical site, and FDA concurrence for inclusion of a broader range of patients in their stroke study. The study will now be able to include the use of the “cool and ship” approach, which will enable patients to be rapidly cooled at one hospital and then transferred to another for definitive and advanced treatments. This is expected to yield unprecedented levels of recovery of patients suffering the most severe forms of stroke. In the future, this approach will be especially beneficial to stroke patients who present to the 95% of hospitals that are unable to offer the most advanced forms of treatment. Future Projections By 2020, LRS expects to have collected new clinical data that will prove the unsurpassed benefits of their device in the treatment of stroke. They also expect to have partially completed their studies of the post-cardiac arrest and heart attack indications. LRS also plans cost engineering and improvements in ease of use, with faster cooling resulting in even better outcomes. 95

Companies to Watch

Cloudbreak

is a private broadband network that connects 800+ hospitals and medical centers nationwide. Cloudbreak Collective, a Telemedicine-as-a-Service (TaaS) marketplace, enables and incentivizes providers to collaborate virtually across institutions and support the care of patients.

Tapping Into the Wisdom of the Cloud THE PITCH

Telehealth as strategic altruism: Improving quality and access to care through a customizable telemedicine platform that makes specialists and interpreters easily available anytime, anywhere and on any device.

Leadership Profile CEO and co-founder Jamey Edwards (pictured), a 4x honoree for Ernst & Young’s Entrepreneur of the Year Award, was CEO of Emergent Medical Associates from 2006 to 2015. During his 20+ years of entrepreneurship, Andy Panos, COO/ co-founder, started the healthcare interpretation services company that was eventually absorbed into Cloudbreak. CFO/co-founder William Hannan, a veteran of the healthcare, IT, and finance arenas, has previously been involved with the growth and sales of three startups. Milestone Partner The Ohio State University Medical Center has been a client for 14 years. “When we started the company in 2003, getting any hospital to understand the concept of utilizing a video conferencing platform to perform any type of clinical care was thought of as medicine from the Jetsons—way out in the future,” notes Edwards. Based in part on research OSU was doing into telemedicine, Cloudbreak and OSU collaborated on ways to bring clinical teams and other resources to the point of care using a video platform. Unexpected Success When OSU launched Cloudbreak’s Video Medical Interpreting service in its emergency room, it caught on 96

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Moonshot Cost to Zero

Employees 35

El Segundo, California

faster than the physician telemedicine solution. Now, Cloudbreak has over 300 devices throughout OSU’s system performing 4,000 encounters per month. Effective interpretation improves clinical care, patient flow and stakeholder satisfaction in addition to generating dramatic cost savings for the hospital. Partners Cloudbreak serves over 800 hospitals, including NYU Langone, Penn Medicine, Cedars-Sinai Medical Center, Allina Health System, OhioHealth, Catholic Health Initiatives, Kettering Health Network and The Hospital for Special Surgery. Product Offerings There are several elements of Cloudbreak’s offerings: Cloudbreak Catalyst is a clinical operating system that drives customized workﬂows for staff and has EMR and video interoperability. Cloudbreak Connect

StartUp Health Magazine

Investment $20M

Technological Jujitsu Cloudbreak’s approach is to make its proprietary broadband network work in service of a client’s existing tech infrastructure, both physical and digital. Thus, the Cloudbreak platform is private labeled, customized for each hospital’s specific use cases, workflow management and patient-experience philosophy. Vital Signs In Q2 2018, Cloudbreak had 830 hospitals in its network and hosted 85K monthly encounters. Cloudbreak has seen a 98% customer retention rate. Notable Accomplishments The Cloudbreak platform enabled facilities within Avanti Hospitals, a four-hospital community health system, to become an accredited stroke centers by connecting them to Tier 1 academic stroke consults from USC. The company’s installations at Cedars-Sinai resulted in $1.7M in annual savings. To date, the platform has been used by over 3M patients. The Takeaway As Edwards says, Cloudbreak’s platform allows providers a way “to enhance the care they give to patients, patients a chance to be seen on their terms where and when they want, and hospitals to bring much-needed resources into underserved communities or share their centers of excellence with communities that may need them.”

StartUp Health Insights s

Snapshot

Kind of a Big Deal Grail closed another round this year, topping our list of biggest deals for the second consecutive midyear report. Despite Grailâ&#x20AC;&#x2122;s dominance, the list is more diverse than ever.

Grail $300M Raised

HeartFlow $240M Raised

Helix $200M Raised

Oscar $165M Raised

PointClick Care $146M Raised 4 Read about our 10 Investors to Watch in digital health on page 50 4

Download the StartUp Health Insights report at startuphealth.com/insights 97

The Global Army An index of the companies that form the StartUp Health Army, listed by primary Health Moonshot.

ACCESS TO CARE access.mobile Improving care in underserved markets through intelligent mobile engagement Denver, CO accessmobile.io AdviceCoach Eliminating every patient’s fear that they won’t recover Woodbridge, CT advicecoach.com AlemHealth Access world class radiologists at affordable prices Singapore alemhealth.com AppointmentNotify A secure HIPAA-compliant marketplace for on-demand appointments New York, NY appointmentnotify.com Azaad Health Securely expanding the reach of medical records Karachi, Pakistan azaadhealth.com Livigro Uniting providers to make care accessible and affordable in India Madurai, India livigro.com Care Advisors Eliminating all barriers to navigating the healthcare system Chicago, IL care-advisors.com

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Careteam Technologies Empowering patients and families as they navigate life-changing events Vancouver, British Columbia careteam.me

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

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

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

Cloudbreak Health Eliminating healthcare disparities through telemedicine El Segundo, CA cloudbreak.us

Earth2Orbit Supporting global climate action by making human activities climate-smart Bengaluru, India earth2orbit.com

Clusio Helping clinicians track and validate medical procedures Akron, OH clus.io YourCoach Helping patients make sense of this fast paced, technology driven world Dusseldorf, Germany yourcoach.health Cubismi Revolutionizing medical imaging by creating a precise map of each patient’s body Madison, WI cubismi.com Dermio Providing accessible, affordable teledermatology care Chicago, IL dermio.com

eHealthAnalytics Eliminating the safety risk of medical devices New York, NY ehealthanalytics.net Electronic Health Network Eliminating the barriers to data for healthcare data consumers Columbia, SC ehnusa.com Force Therapeutics Streamlining the connection between surgeons, care teams and patients New York, NY forcetherapeutics.com FutureDocs Free mHealth technologies and digital education for every patient and doctor Buenos Aires, Argentina futuredocslatam.com

GoGoHealth Helping doctors focus on the patient, instead of administrative tasks San Francisco, CA gogohealth.com Goodlife Technology Making self-help wellbeing kiosks as common as ATMs Helsinki, Finland goodlife.technology Health-Connections Modernizing outcome and satisfaction data through valuable patient portals New York, NY health-connections.com HelpAround Transforming the experience of families facing life-threatening diagnoses Tel Aviv, Israel helparound.co Hoy Health Providing any consumer with their primary care needs for $100 per month Morristown, NJ hoyhealth.com

Julota Creating a holistic community ecosystem to improve the population’s health Denver, CO julota.com KingFit Providing diabetes education programs worldwide Wichita, KS KingFit.io LeaLabs Revolutionizing health care for chronic conditions using Blockchain and AI San Antonio, TX lealabs.com LifeWIRE Extending the point of care to any patient, any place, any time, on any device Richmond, VA lifewiregroup.com LucidAct Health Empowering every care team to be heroes with AI Palo Alto, CA lucidact.com

iCoreConnect Exchanging sensitive and protected information with anyone, anywhere Winter Garden, FL icoreconnect.com

M&S Biotics Automating surgical processes in the operating room Houston, TX msbiotics.com

inHealth Medical Services Virtual health coaching and medication management as treatment for obesity Los Angeles, CA inhealthonline.com

MedCloud Simplifying test management for diagnosis in all of its phases Ponta Grossa, Brazil medcloud.co

Jiseki Health Providing accessible, affordable health benefits through smart SMS clinical bots San Francisco, CA jisekihealth.com

MedeBound Connecting Chinese patients with American doctors through telemedicine Shanghai, China medebound.com

Spotlight

PreventScripts Powering primary prevention THE PITCH PreventScripts is flipping the script, from reactive medicine to proactive care. These healthcare transformations are helping primary care providers focus on preventative care by creating an automated prevention management platform. PreventScripts’ platform not only helps build better patient relations, but also helps monetize preventative care. ---TACKLING THE ISSUE PreventScripts is tapping into the world’s population who is currently living with obesity, prediabetes and prehypertension. Of the 1.75 billion individuals at-risk, 70 percent will progress into fullblown diabetes. Through PreventScripts approach, these at-risk patients can be monitored and empowered to drastically reduce their progression into lifestyle related diseases. Additionally, between 75 and 80 percent of healthcare costs currently come from lifestyle disease, something PreventScripts is addressing hands-on. ---CASE STUDY Through just a few behavior change science strategies, their beta product was able to help a 17-year-old Medicaid patient achieve a 3% weight reduction, 20% blood pressure reduction and a 6% improvement in a patient-reported outcomes score. ---KEY STATS Notable partnerships: Baptist Health, UCSF Family Practice Residency Program, The Village Pediatric and PediaTrust. ---MOMENTUM 2 Pilots 100+ Patients

The Global Army Medisprout Turning patients’ on demand needs and messages into reimbursable video visits New York, NY medisprout.com MirrorMe3D Enabling surgeons to plan, model and collaborate to achieve perfection New York, NY mirrorme3d.com

Path Surgery Making affordable, easy, and stress-free overseas treatment a reality Helsinki, Finland pathsurgery.com

Mobidoc Connecting patients with instant and remote health consults Abuja, Nigeria mobidoc.ng

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

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

Rivews Transforming healthcare brand reputation through patient engagement New York, NY yehup.com

Valhalla Healthcare Automating clinical documentation using AI Houston, TX valhalla.healthcare Xverity Revolutionizing the transition from the inpatient setting to at-home care Bethlehem, PA xverity.com

Quantextual.co Changing medical practice by making big data useful to physicians Atlanta, GA quantextual.co

Yosi Making healthcare paperless through our workflow management platform New York, NY yosicare.com

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

Zeleo Improving outcomes through our workflow and decision support engine Boston, MA bjondinc.com

RealTime Clinic Eliminating preventable organ transplant rejection Houston, TX realtimeclinic.com

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

Ride Health Helping disadvantaged patients access transportation to care New York, NY www.ride-health.com

ZubiaLive Giving everyone equal access to healthcare information New York, NY zubialive.com

Multisensor Diagnostics Changing the culture around patient monitoring to simplify healthcare New York, NY multisensordiagnostics.com MyPurpleFolder Connecting paient records at the tap of an app Dallas, TX mypurplefolder.com Omnia Salud Bringing all healthcare in Latin America into the digital era Buenos Aires, Argentina omniasalud.com openDoctor Providing digital access to schedule complex exams and procedures New York, NY opendr.com

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PrimalRed Matching individuals with inperson, local programs for health behavior change Berkeley, CA goprimalred.com

SimpleVisit On a mission to make access to healthcare as simple as answering a call Crofton, MD simplevisit.com Tickit Health Optimizing communication between patients and providers to transform outcomes Vancouver, Canada tickithealth.com

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The Global Army COST TO ZERO @Point of Care Giving clinicians access to the right information, at the right time Livingston, NJ atpointofcare.com Aver Making value-based healthcare universal Columbus, OH aver.io Beyond Lucid Technologies Ending prehospital mortality in emergency response Walnut Creek, CA beyondlucid.com BioClaim Eliminating fraudulent medical claims through biometric authentication Deerfield Beach, FL BioClaim.com Biome Analytics Delivering cardiovascular clinicians and heart centers with precision insight San Francisco, CA biome.io Caremerge Ensuring the aging experience is filled with peace of mind and joy Chicago, IL caremerge.com Cognotion Helping hire, retain and train allied health professionals New York, NY cognotion.com CoverUS Building the world’s most valuable health data marketplace New York, NY coverus.io

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Docola Streamlining workflow and publishing to support outcomes Tampa, FL doco.la EmPower Supplementing HSAs for employees through out of pocket credit programs San Francisco, CA empower-capital.com Etyon Health Lowering healthcare administrative cost using health data Chicago, IL etyon.com Flosonics Medical Using ultrasound technology to enable realtime precision fluid management Sudbury, Canada flosonicsmedical.com Healthbanc A healthcare rewards and payment system that allows patients to finance their care San Jose, CA healthbanc.com Healthwide Solutions Improving the emotional connection between patients and providers Edwards, CO healthwidesolutions.com Hindsait Getting rid of unnecessary, costly and waseful health services Englewood, NJ hindsait.com Inbox Health Ensuring transparent, affordable healthcare payment experiences Bridgeport, CT InboxHealth.com

Spotlight

UnaliWear The Wearable Giving Seniors Greater Independence THE STORY Jean Anne Booth thought she was sailing into the sunset. She’d spent 30 years working in semiconductors and had sold businesses to Apple and Texas Instruments. But while working for a scuba diving outfit off the coast of Florida, an idea burrowed into her head and wouldn’t leave. In the end, it was her own mother who pulled her back to shore and into business. Booth observed her own elderly mother, and saw the vulnerability that old age can bring. She noted that no one wants to reach the place of, “I’ve fallen and I can’t get up,” so many avoid getting much-needed medical alert systems. As a result, many don’t receive the care they need at critical moments. Faced with this challenge, Booth set out on a mission to create a smartwatch that can give senior citizens greater independence. Her company, UnaliWear, has created the Kanega watch that uses AI to learn the wearer’s lifestyle and predict degeneration, and detect adverse events like falls and tremors. Now multiple years in, Booth still runs every prototype by her mother to make sure her tech makes sense in the real world. ---WHAT’S SPECIAL ABOUT THE KANEGA WATCH? “It’s the entire system—our embedded hardware, software and AI machine learning,” says Booth. “Our secret process has to do with understanding and living for our population. That means coming up with the high contrast displays, easy-to-use battery pods, and a speech interface.”

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The Global Army Indago Creating the OR of the future through smart surgical tools Cleveland, OH indago.io iShare Medical Providing secure nationwide sharing of medical records Kansas City, MO iShareMedical.com Jaystreet Technologies Eliminating waste in healthcare by streamlining administrative tasks Manitowoc, WI jaystreettech.com Kinetxx Providing a cost effective teletherapy/virtual health solution for physical therapy Boston, MA kinetxx.com Konnarock Sourcing critical patient information for early recognition, notification and intervention Atlanta, GA konnarockhealthcare.com ManageUP PRM Eradicating workplace inefficiencies by automating task management Santa Clara, CA manageupprm.com MDOps Simplifying clinical documentation through instant, dictated notes Melville, NY mdops.com MedXCom Replacing error-prone live operator services with patient data on providers’ phones New York, NY medxcom.com

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Mondopoint Identifying medical products that do not drive improvements in outcomes Chicago, IL mondopoint.com Open Health Network Helping providers educate patients on their health issues and how to manage them Los Altos, CA openhealth.cc

Prognos Leveraging clinical diagnostic data and AI to drive decisions earlier in healthcare New York, NY prognos.ai Qwikscript Providing price transparent prescriptions at the click of a button New York, NY qwikscript.com

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

RxREVU Giving providers contextualized prescription information at the right time Denver, CO rxrevu.com

Pocket Anatomy Helping patients better understand their conditions using 3D anatomy software Galway, Ireland pocketanatomy.com

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

Sift MD Revolutionizing healthcare billing with data science and predictive analytics Milwaukee, WI siftmd.com SmartyPerks Reducing patient premiums by eliminating billions of dollars in fraudulent claims Deerfield Beach, FL SmartyPerks.com SnapDx Encouraging medication adherence by educating patients on the benefits Calgary, Canada snapdx.co Stethos Automatically and continuously monitoring heart and breath sounds New York, NY smartstethos.com Swift Shift Stoping the revolving door of home healthcare nurse recruitment New York, NY swiftshift.com TedCas Providing hands-free access to equipment in the operating Pamplona, Spain tedcas.com Vivor Empowering healthcare providers to connect patients with financial resources New York, NY vivor.com Wellthie Giving confidence to every consumer shopping for insurance New York, NY wellthie.com

WinguMD Allowing clinicians to take and send images on their personal devices Palo Alto, CA wingumd.com

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

Zignifica Finding relevant clinical research and classifying it reveal itâ&#x20AC;&#x2122;s significance Richmond, VA zignifica.com

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

CURE DISEASE Accel Diagnostics Enabling remote management and monitoring fo cardiac blood tests Pittsburgh, PA acceldx.com AdhereTech Increasing adherence and tracking utilization with a patented smart pill bottle New York, NY adheretech.com Althea Health Making rare disease drugs more affordable and available San Francisco, CA altheahealth.com BreathResearch Preventing asthma attacks and improving lung health San Francisco, CA breathresearch.com Cohero Health Transforming respiratory disease management through smart mobile tech New York, NY coherohealth.com Conversa Making conversation the cornerstone of health Portland, OR conversahealth.com

Dynofit Engaging and managing patients who have lost motor skills Los Alamos, NM dynofit.com eko.ai Disrupting the way heart disease is detected Singapore eko.ai Fit4D Improving the health and lives of people with diabetes and chronic conditions New York, NY fit4d.com Gene by Gene Giving clinicians and researchers access to actionable genetic information Houston, TX genebygene.com Joint Academy Preventing and reversing chronic joint pain worldwide Stockholm,Â Sweden jointacademy.com LabLink Helping patients understand their care while supporting patientdoctor relationships Columbus, OH lablink.org

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

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

Lindi Skin Providing safe, clinically-proven skincare for those with compromised skin Philadelphia, PA lindiskin.com

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

SOLIUS Enhancing or replacing pharmaceutical drugs with a new way to treat and prevent Bainbridge Island, WA solius.com

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

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

Synch Reversing chronic health conditions with natural and functional medicine San Francisco, CA syncholistichealth.com

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

Veloce Corporation Providing effective and targeted drug delivery Denver, CO velocedigital.com

Parallel Profile Using genetic insight to put an end to adverse drug reactions Boca Raton, FL ParallelProfile.com Play-it Health Making adherence to healthy behaviors more understandable and enjoyable Kansas City, KS playithealth.com PreventScripts Empowering providers’ at risk patients to stop disease before it startsr Paducah, KY preventscripts.com Qura Revolutionizing real-time glaucoma management Sudbury, MA qura.biz

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Vheda Health Providing all people with human, life-saving care Baltimore, MD vheda.com

END CANCER GenID Solutions Preventing hereditary cancers by identifying everyone who should be screened Santa Clara, CA genidsolutions.com Kuveda Turning cancer from a terminal disease into a chronic illness San Jose, CA kuveda.com

OTAWA Providing operational management to avoid redundancy and align incentives Sao Paulo, Brazil otawa.net Savor Health Increasing adherence and improving outcomes through AI-based nutrition New York, NY savorhealth.com

WOMEN’S HEALTH BabyMed Educating women to end preventable pregnancy or childbirth problems Nairobi, Kenya jabotech.co.ke Babyscripts Helping doctors virtually manage expecting moms Washington, DC getbabyscripts.com Genneve Empowering all women in menopause to take control of their symptoms Seattle, WA genneve.com

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The Global Army Oratel Diagnostics Transforming current diagnosis for pelvic pain in women Hammondsport, NY orateldiagnostics.com Pregistry Providing product-specific pregnancyexposure prescription drug data Los Angeles, CA pregistry.com Seed Creating a space and community to help all people take control of their fertility Barcelona, Spain

CHILDREN’S HEALTH Aerobit Health A device that reminds and guides asthma patients on taking their medications Manchester, England aerobithealth.com Buddy Healthcare Enabling hospitals to virtualize care coordination and increase accesibility to care Helsinki, Finland buddyhealthcare.com CareDox Delivering crucial health services to schools across America safely and efficiently New York, NY caredox.com Pathfinder Health Innovations Giving control and real-time insights to autism therapy and behavioral health centers Kansas City, MO pathfinderhi.com

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NUTRITION & FITNESS Edamam Organizing the world’s food knowledge to help people make smarter food choices New York, NY edamam.com FitBliss On a mission to optimize employee wellbeing & productivity San Jose, CA fitbliss.com FitFetti Preventing disease by getting your personal health journey sponsored like a pro-athlete San Francisco, CA fitfetti.com FitTrace Giving you the tools and analytics to better understand your body Los Angeles, CA fittrace.com Fruit Street On a mission to prevent and treat lifestyle disease New York, NY fruitstreet.com Greatist Striving to build the defining consumer products brand in health & wellness New York, NY greatist.com LifeDojo Making lasting behavioral change a reality for all—within 12 weeks San Francisco, CA lifedojo.com MetaLogics On a mission to put an end to the obesity epidemic Edina, MN metalogicscorp.com

Myontec Smart shorts measuring the leg muscles for mobility, metabolism, and rehabilitation Helsinki, Finland myontec.com Palette Using behavior data to end food-related chronic diseases such as diabetes Kansas City, MO thepalette.io Personal Remedies Bringing dietitians into the homes of chronic disease patients everywhere Boston, MA personalremedies.com Sandstone Diagnostics On a mission to bring lab tests to points of care worldwide Minneapolis, MN trakfertility.com

BRAIN HEALTH BrainPaint Automating evidenced-based protocols to yield consistent results Los Angeles, CA brainpaint.com Cerora Diagnosing disorders of the brain accurately in real-time across the globe Bethlehem, PA cerora.com CNS Therapy Making the 100M Americans suffering from chronic pain today pain-free Ventura, CA cnstherapy.com

Connect. Communicate. Care. A simple formula for telemedicine success. Cloudbreakâ&#x20AC;&#x2122;s unified telemedicine solution makes implementing complex telemedicine solutions as easy as, well, the push of a button, allowing you to integrate all of your telemedicine services into a single platform. Simplify your service delivery, ease your IT support burdens and surround your patients with your entire continuum of care anywhere, anytime, on any device and in any language.

Unified Telemedicine To learn more, call us at 614-468-6000, or visit www.cloudbreak.us

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The Global Army HealthTechApps Preventing concussion re-injuries after a concussion Honolulu, HI healthtechapps.com Life Recovery Systems Recovering the quality of life for all stroke, heart attack, & cardiac arrest patients Kinnelon, NJ life-recovery.com RC21X Providin geasily obtainable, cost effective, and objective data about brain performance Corapolis, PA rc21x.com

MENTAL HEALTH & HAPPINESS Bravely On a global mission to end the impossibility of behavior change Anaheim, CA bravely.io Cloud 9 Bringing mental health care to those who need it most Austin, TX oncloud911.com Curatio The world’s first social health prescription Vancouver, British Columbia, Canada curatio.me E=MC2, no limits... Inspiring ownership of wellbeing and possibilities for success Philadelphia, PA emc2nolimits.com

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“Understand that the exercise of your office needs to take into account the humanity of the people who are actually driving the company. “ -Jerry Levin, Executive Chairman of StartUp Health

Eco-Fusion Managing chronic diseases using phonebased personalized stress reduction Tel Aviv, Israel eco-fusion.com Henry Health Increasing the Life Expectancy of Black Men By 10 Years Within the Next 25 Years Washington, DC henry-health.com OpenBeds On a mission to improve access to the most effective behavioral health care Washington, DC openbeds.net Promena VR Harnessing VR to deliver digital, behavioral therapy to everyone in the world Grand Rapids, MI promenavr.com PsyInnovations Giving customized solutions to adults who have a mental illness New York, NY psyinnovations.com SageSurfer Creating a world where no one suffers alone Fremont, CA sagesurfer.com Salubris Analytics Salubris Analytics is restoring a patient-first approach to care Boston, MA salubrisanalytics.com Valera Health Enabling Americans with behavioral health conditions to live life to the fullest New York, NY valerahealth.com

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STARTUP HEALTH NETWORK --

Sharing the stories of the inspiring people who are creating the future of health. -StartUp Health HQ StartUp Health Magazine StartUp Health TV StartUp Health Insider Health Transformer Blog Social @ StartUpHealth StartUp Health Insights

New Health Transformer text

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The Global Army LONGEVITY AprilAge Using data visualization to motivate patients to change risky behavior Toronto, Canada aprilage.com Braceunder Smart, orthopedic apparel for injury prevention and recovery Phoenix, AZ braceunder.com CarePredict Scaling senior care beyond reliance on human observation, planet-wide Palo Alto, CA carepredict.com HelloMD Telehealth platform for medical cannabis patients San Francisco, CA hellomd.com Help-Full Help-Full’s mission is to wipe out loneliness in older age and empower seniors to thrive Oakland, CA help-full.com Holiadvice Providing dedicated and customized digital tools in integration for practitioners Tel Aviv, Israel holiadvice.com Hormone Therapeutics Add 50 healthy years to everyone’s life by decoding their personal health map Dallas, TX hormonetherapeutics.com

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

Trusty.care Delivering a platform for simple plan sign-ups for Medicare and Medicaid patients New York, NY trusty.care

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

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

LifeBio Capturing the lasting legacy and memories of life stories Columbus, OH lifebio.com LyfLynks LyfLynks is redefining the ways that families support their loved ones’ independence Columbia, MD lyflynks.com

WalkJoy Non-invasive device that restores near-normal balance and gait Long Beach, CA walkjoy.com Zeel Making top-quality massage therapy simple to access on demand New York, NY zeel.com

LymphaTouch Helping lymphedema patients recover for immediate relief and rehab Helsinki, Finland physiotouch.com Room2Care Network of private caregiver homes providing an alternative assisted living Miami, FL room2care.com SUPAspot Using lifestyle data from GenZ for sports and health to democratize healthcare New York, NY supa.ai Tome Software Fighting the sedentary lifestyle by promoting and measuring being active at work. Detroit, MI tomesoftware.com 113

JANUARY 7 - 8, 2019 | SAN FRANCISCO, CA STARTUPHEALTH.COM/FESTIVAL

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through a situation in order to mitigate risks. And beyond: because even when crises are successfully de-escalated, the path forward is not always obvious. For instance, does the person who is suffering need immediate medical care in an ER? Or perhaps a safe ride to a pharmacy or home? In addition to providing responders with data and therapy access for dealing with a crisis, the app can also suggest options for what to do next. The app, with its real-time database of availabilities at psychiatric facilities, can point emergency responders to a nearby hospital that has appropriate facilities for a person in crisis. This could enable responders to skip the ER and go straight to a psych ward, significantly cutting costs and expediting the necessary intervention. The Cloud911 platform has been tested through a pilot program in Houston. Preliminary data from the company’s own analysis, conducted in partnership with the University of Texas, indicates that 97% of Cloud 911 consults were considered by users to be superior to clinician ridealongs, and that the platform saved municipalities $847 per 911 crisis call, amounting to a 798% return on investment. The results of the pilot are giving Adams and Truong the case studies and statistics they need to build the business, and they are now fundraising and looking to partner with more city and county governments to launch additional programs. Adams envisions a future where the app is used to call in a drone delivery of emergency medication to the site of a crisis. Considering the very real-world repercussions of mental health issues, such futuristic propositions, like Cloud 911 itself, represent interventions based on treatment and knowledge, not force.

nent to it: “I have noticed how patient communications can go a long way in motivating patients and helping make them feel well-cared for,” says Otieno. With the success of access.mobile’s approach in East Africa, Yelpaala has been introducing the platform to hospitals in the United States. An ongoing pilot for Adventist Health White Memorial, a hospital in inner-city Los Angeles that has a mix of English- and Spanish-speaking clientele—90% of Hispanic origin—has generated valuable data. Patients in the hospital’s service area have a per capita income of less than $17,000, one of the lowest in the country. For the pilot, access.mobile developed messaging for patients with chronic care needs, including those with diabetes, hypertension and congestive heart failure; in addition, it developed messaging for pregnant women and new parents. Apurva Shah, lead for AH White Memorial’s clinical performance improvement for cardiology and surgery and of the hospital’s managed care data analysis, notes, “The final set of messages will target patients not just on their demographics, but using social determinants of health.” Because of access. mobile’s iterative refinement process— first introducing a set of messages, then honing them based on response rates and outcomes—Shah noticed the nuances of word choice and style. “Language matters,” he says. “Small changes in language phrasing affect behavior. When we sent messages about ‘health promotion,’ we got different responses than when we said ‘messages promoting a healthy lifestyle.’” For Shah, access.mobile brings insight into several realms key to successful medical outcomes. “access.mobile has experience in working with multicultural populations who experience many challenges to accessing care,” he says. “They understood our population. Their offering goes beyond a text-messaging platform. Between their technology, team, and experience, they are able to provide insights into effective

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outreach and engagement.” The US launch reflects Yelpaala’s intention to help communities on a more global basis. The expansion both in Africa and the US was aided by investment; after getting initial startup funds from friends and family, Yelpaala received series A funding in 2015 from Richelieu Dennis and Nyema Tubman, two Liberian-Americans who cofounded the beauty products company Sundial Brands, which had an estimated $240 million in 2017 sales and was purchased by Unilever last November (the amount was undisclosed). Dennis and Tubman quickly understood access. mobile’s market potential in Africa and Yelpaala’s ambition to bring the company’s innovation to other countries in the Americas, Europe, and Asia; their goals paralleled Yelpaala’s. “They have been mentors as I have been growing the business because they built Sundial from the ground up to be a successful global enterprise,” says Yelpaala. Dennis is also focused on investing in entrepreneurs who are solving problems in their communities, which made the fit with access.mobile, and its efforts to benefit underserved populations, particularly resonant. A typical Western narrative is that innovation always begins in the US and is then exported to other countries. Instead, Yelpaala is proving the market in East Africa and bringing it to the United States and other countries, with an intention to help underserved populations around the world. “A lot of our battle is about changing the narratives about not just the African population, but that this market segment, the underserved, presents an opportunity,” says Yelpaala. “They deserve to get solutions that create value for them. That’s at the heart of what I’m doing. This is a segment that has disposable income, that’s engaged on the phone, that has care needs, and where there’s value. There is a real market opportunity in this underserved segment that can improve people’s lives—and generate positive health outcomes.”

Our product and service offerings include health management, sub-health care, disease consultation and management, and health insurance, covering the entire internet healthcare industry chain.

To build the largest healthcare ecosystem in the world and promote healthy living empowered by technology.

Stock Code: 01833.HK

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StartUp Health Magazine

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The Health Moonshot Vision

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StartUp Health Magazine

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