StartUp Health Magazine 2022 Q1 by StartUp Health

ISSUE 09

DEEP

IMPACT

StartUp Health launches the first crossdisciplinary health moonshot to address Type 1 diabetes, uniting entrepreneurs, scientists, investors, philanthropists, industry, academia, patients, and families.

"The Type 1 Diabetes Moonshot will be built on a level of collaboration that the world hasn’t seen before." -David Weingard Chief Impact Officer T1D Moonshot

How one founder supported his team in Ukraine

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FOUNDERS’ LETTER

A Collaborative Strategy for Achieving Deep Impact “To achieve health moonshots we unite the stakeholders that matter most to break down silos and speed up innovation.”

StartUp Health’s vision for achieving health moonshots – solving big audacious and seemingly impossible health challenges – has always been driven by our belief that transformational progress is most effectively driven through collaboration and leveraging the power of network effects to speed up impact. Our premise is that by uniting a global army of Health Transformers and marching together, we can accomplish even the most complex missions. For more than a decade, we have used this model to focus on a broad list of integrated health moonshots ranging from Access to Care to Curing Disease to Mental Health to Longevity. After more than 400 investments, and years of working with a vast network of stakeholders, we’ve learned a lot. It turns out, the hard part in this plan is not in defining big goals, or inspiring the world’s most extraordinary innovators to action, or even advancing technology or science. The biggest opportunity is in breaking down silos and driving a level of collaboration the world too rarely sees. For too long the forces and funds needed to address the greatest health challenges of our time have been separated, and often competing. Yet at the core, collaboration is essential to achieving any moonshot. Collaboration sounds good, but in practice it isn’t easy. We all know this from our day to day lives. Take any large group, and it’s not long before basic decisions and simple tasks start to take longer than necessary. Conflict often ensues. Transformational progress is stunted. The clear-eyed reality is that the vast industry of healthcare is driven by competition, and what’s disturbing is that the system’s core business models and incentive structures are often at odds with what we believe should be the ultimate goal of keeping people healthy and well. Today, the baseline in the world of healthcare can be summed up as fragmented, com-

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StartUp Health’s T1D Moonshot Impact Board brings together leaders from every sector on a shared mission of speeding up innovation in Type 1 diabetes. DAVID WEINGARD Chief Impact Officer, T1D Moonshot

DAVID PANZIRER Trustee, Helmsley Charitable Trust

ROBERT ORINGER Chairman & Board Director, AMG Medical; Chair, Locemia Solutions

JENNIFER SHERR, MD, PHD Professor, Yale School of Medicine

SARAH OLTMANS Chief of Grant Strategy, Robin Hood TYPE 1 DIABETES MOONSHOT IMPACT BOARD

MIKE MASON SVP and President, Lilly Diabetes, Eli Lilly

SEAN DOHERTY Chairman, JDRF T1D Fund

CLAUDIA GRAHAM, PHD, MPH* Former SVP of Global Access, Dexcom; Board of Directors, JDRF

NORMA S. KENYON, PHD* Deputy Director, DRI; CIO, Univ. Miami School of Medicine

*In process startuphealth.com 3

FOUNDERS’ LETTER

StartUp Health's initial objective is a 10-year goal of (1) making sure that everyone with T1D has tools and resources to thrive, and (2) preventing and delaying onset of T1D altogether. plex, confusing and competitive. Not exactly fertile ground for innovation to thrive. That’s why we are steadfast in our belief that what’s needed more than ever is to double down on the equation that has defined StartUp Health from the beginning: Health Transformers x The Network Effect = The Transformation of Health. Our biggest learning, however, is that to really break down silos that are slowing progress we must go deeper into our health moonshot framework by uniting disparate (and sometimes competing) stakeholders from patients and families to caregivers, clinicians, entrepreneurs, scientists, industry, investors, governments, foundations, and donors. To date we’ve done this broadly in an effort to cross-pollinate thinking and wisdom across health moonshots. Now we must go deeper to connect and align stakeholders within each moonshot. A mission control to guide collaboration and drive deep impact If the first required element is to foster meaningful collaboration in order to achieve health moonshots then you need an organizing platform to set the targets, manage the process, and ultimately simplify and unite the fragmented pieces. Over the past decade we have built one global mission control (StartUp Health’s global platform and community) to chart this course and make tremendous impact. Now it’s time for us to expand by going deep which is why we are launching a family of dedicated health moonshots each united by a specific mission, driven by their own impact board, and fueled by aligned partners. We will supercharge our efforts by supporting even more entrepreneurs and innovators through these dedicated health moonshots, and work toward bridging the gap that still exists between R&D and commercialization so we can deliver innovation to the world in a direct and tangible way. Too many good ideas are still trapped on the shelf or locked up in a lab. And too many parties are still marching forward alone. We intend to change that.

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Starting with a dedicated moonshot for Type 1 Diabetes To demonstrate this approach to dedicated health moonshots, we are starting by launching a focused 25 year mission to prevent, manage, and cure type 1 diabetes (T1D). Soon we will follow with the launch of a dedicated Alzheimer’s Moonshot with many more to follow. With the launch of the T1D Moonshot, StartUp Health will leverage its same global platform, yet lean in with a dedicated fund to support a generation of solutions developed across academia, nonprofit, and commercial environments and be built on a level of collaboration that the world hasn’t seen before. We’ve started this mission by assembling a world-class T1D Moonshot Impact Board that unites patients, caregivers, industry leaders, entrepreneurs, scientists, funders, and innovators from many groups who have already made tremendous impact and contributions to T1D. For the first time, these leaders will all be sitting on the same Impact Board, aligned by the same health moonshot mission. Together we will combine the energy of passionate entrepreneurs with the world’s top investors and institutions who care deeply and are aligned on the same global impact metrics. StartUp Health’s T1D Moonshot builds on a series of investments StartUp Health has already made in the diabetes space more broadly and we are proud to share that the Cecelia Health, founder David Weingard, who has been a Health Transformer in our community for many years will serve as Chief Impact Officer of the T1D Moonshot. This launch of dedicated health moonshots is also an invitation to all stakeholders and funders who can fuel more health moonshot missions with us. If you believe in a collaborative, global approach to solving big audacious health challenges like preventing, managing and curing T1D or eradicating Alzheimer’s, we want to meet you. Email us at moonshots@startuphealth.com. To partner with us on the Type 1 Diabetes Moonshot, email T1D@startuphealth.com.

Steven Krein CEO, Co-founder & Managing Partner

Unity Stoakes President, Co-founder & Managing Partner

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EDITOR’S LETTER

Far From Finished

Until 1921, Type 1 diabetes was a fatal diagnosis, killing people within weeks or months. Then, in 1922, a couple of scientists in Canada figured out how to use insulin (initially from animals) to control a patient’s blood glucose levels. The finding began saving lives immediately and earned the scientists the Nobel Prize. Newspapers heralded it as a cure. Seventy years later, when I was 10 years old, my 25-year-old piano teacher died from Type 1 diabetes. He was driving down the highway towards his home when his blood sugar levels dropped dangerously low. He blacked out and drove his sedan into oncoming traffic. Thirty years after that, my friend's child was diagnosed with Type 1 diabetes at age six. She wears a continuous glucose monitor on her arm –a marvel of science that decreases her health risks tremendously – but her parents are still glued to their phones, watching her numbers and worrying about the next dip or spike. The point is that in healthcare there is a tension: we’ve come so far, yet we have so far to go. This issue of our magazine is dedicated to our new cross-disciplinary approach to fighting Type 1 diabetes, but there are innumerable examples of this tension. Over the last twenty years, child mortality declined by 53%, yet, according to one study, anxiety and depression among children has increased by nearly 30% since 2016. (Read how Raffay Mirza and Labib Tazwar are upgrading children’s health on page 72). Similarly, in women’s health, maternal mortality is down 38% between 2000 and 2017, but the rate of suicide attempts during pregnancy and after childbirth nearly tripled over the previous decade. (Read how Maureen Fura is innovating to fight postpartum depression on page 35). This tension between the past and future, between what’s been accomplished and what needs to be done, is in some ways the essence of innovation. We celebrate progress, it excites and energized us, yet we are far from finished. Even in realms where a “cure” has been found, issues of global access remain. Today’s health innovations aren’t end points, but building blocks for tomorrow. As health innovators we can’t let past success lull us into complacency, or future challenges scare us into inaction. As we celebrate victories, let’s continue to move with urgency, so that the promises of health and wellbeing are available to all people, everywhere.

Logan Plaster Editor-in-Chief

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In This Issue 2 Founders' Letter 6 Editor's Letter 8 Health Transformer News 14 Meet the Newest Health Transformers 16 BrightPay Health 21 Vous Vitamin 26 9am Health 31 Tellescope 35 Mammha 40 Pear Suite 45 Lazzaro Medical 49 MyGenoMD 53 Cognishape 58 TYDEi Health 62 Akenta Health 66 WAVR 72 Huey Health 77 Scan.com StartUp Health News 80 Introducing the Type 1 Diabetes Moonshot 90 Leading from the Front 94 StartUp Health Insights 2022 Q1 Funding Report 106 Health Moonshot Snapshots

EDITOR-IN-CHIEF Logan Plaster DEPUTY EDITOR Jennifer Hankin CONTRIBUTING EDITORS Nicole Kinsey, Rachel Freeman Lauren Schafer, Tara Salamone

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Health Transformer News at a glance A selection of portfolio company headlines from the first few months of 2022.

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

CES 2022: Five Tech Trends to Watch in an Unusual Year: CarePredict WALL STREET JOURNAL 1/2/22

AARP Innovation Labs Takes a Holistic Approach to Elder Tech: De Oro Devices TECH CRUNCH 1/5/22

Cityblock Health Hires Former KFC U.S. CMO Andrea Zahumensky AD AGE 1/10/22

MM+M Announces Third Class of 40 Under 40 Honorees: Sacha Heppell of SmartTab MM&M 1/25/22

MedArrive Teams Up With Tele-Ophthalmology Startup Spect to Provide Eye Screening in Patients’ Homes FIERCE HEALTHCARE 1/31/22

Crosscope Partners with BALCO Medical Centre for AI-Based Cancer Care BIOSPECTRUM ASIA 1/31/22

Rose Health Wins Cambia Grove Startup Competition for Its Mental Health Platform GEEKWIRE 2/3/22

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HEALTH TRANSFORMER NEWS // AT A GLANCE Under the leadership of CEO and co-founder Naheed Kurji (pictured) Toronto-based Cyclica has spun out startup Perturba Therapeutics.

Banner|Aetna Forms Partnership with Type 2 Diabetes Reversal Company Virta

DC Mental Health Care Startup Hurdle Health Is Expanding to Reach More People of Color

Cyclica Spins Out Startup, Perturba Therapeutics, From University of Toronto

Q&A w/ Jakob Dahlberg, CEO of Joint Academy: Helping to Digitise GP Visits and Tackling Joint Pain

MODERN HEALTHCARE 2/9/22

BETAKIT 2/11/22

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WASHINGTON BUSINESS JOURNAL 2/15/22

MED-TECH INNOVATION NEWS 2/21/22

The Case for Repurposing Established Drugs in Novel Combination Therapies by Jackie Iversen, RPh, MS, Sen-Jam Pharmaceutical

$5M RAISED

Children’s Minnesota Expands Partnership with AvoMD, After Successful Pilot to Enhance Patient Care

Virta Health's Diabetes Support Moves Into the Workplace

PHARMACY TIMES 2/22/22

CHILDREN’S MINNESOTA 2/22/22

Maverick Medical AI Closes $5M Seed Funding FINSMES 3/7/22

FINANCIAL TIMES 3/13/22

30 Under 30: Meet Max Sims, MindTrace Technologies PITTSBURGH BUSINESS TIMES 3/18/22

Addiction Tech: inRecovery, Sana, and Quit Genius Working to Curb Soaring Opioid Overdose Deaths CALIFORNIA HEALTHLINE 3/18/22

The K'ept Health App: Helping Close the Health Equity Gap ABC 7 NEWS 2/24/22

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HEALTH TRANSFORMER NEWS // AT A GLANCE

UnaliWear Kanega Watch Review: A Fall-Detecting Watch You Can Control with Your Voice PC MAG 4/1/22

Sana Health Wins American Academy of Pain Medicine (AAPM) Innovation Challenge AAPM 3/19/22

Cityblock Health Names Dr. Toyin Ajayi CEO AXIOS 3/22/22

cliexa Selected for Mayo Clinic's New AI Startup Program FIERCEHEALTHCARE 3/24/22

Medwise.ai Receives Innovate UK Backing for Search Platform MED-TECH INNOVATION 3/28/22

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Juan Pablo Segura of Babyscripts on Why Digital Transformation Is Imperative to Combat Healthcare’s Labor Crisis HIT CONSULTANT 4/5/22

Quit Genius Expands Further into Insurer Space with New Evry Health Deal MOBIHEALTHNEWS 4/6/22

How Particle Health Is Connecting Data Silos TECHREPUBLIC 4/7/22

Hucu.ai co-founders Laura Mckee and Assif Khan

Why Glen Tullman Is Backing Virtual Diabetes Clinic 9am Health MEDCITY NEWS 4/17/22

Cala Health's Wrist-Worn Device Is Helping to Relieve Essential Tremor in Patients DALLAS OBSERVER 4/20/22

Gennev CEO: How to Have Hard Talks About Menopause

$15M RAISED Us2.ai Secures $15M Series A to Improve Detection of Cardiovascular Disease DIGITAL NEWS ASIA 4/22/22

CollabCare and Hucu.ai Partner to Improve Communication for Older Adults and Families MEDGADGET 4/25/22

OPRAH DAILY 4/19/22

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Meet the newest

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

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BRIGHTPAY HEALTH VOUS VITAMIN 9AM HEALTH TELLESCOPE MAMMHA PEAR SUITE LAZZARO MEDICAL MYGENOMD COGNISHAPE TYDEI HEALTH AKENTA HEALTH WIDE AWAKE VR HUEY HEALTH SCAN.COM

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HEALTH TRANSFORMERS Shielvonda Haith, CEO & Co-founder Archie Otu, CTO & Co-founder brightpay@startuphealth.com 16 StartUp Health Magazine / DEEP IMPACT

MEET THE HEALTH TRANSFORMERS

BrightPay Is Making Medical Payments as Easy as Using Apple Pay and Affirm After facing a surprise medical bill for their child, Shielvonda Haith and Archie Otu set out to build a medical payment platform that could bring peace of mind to patients, while making sure providers stayed in the black..

COST TO ZERO MOONSHOT VINTAGE: 2022/Q1 BRIGHTPAY.INFO

We’ve said it before and we’ll say it again: there is a direct line between healthcare costs and access to care. We all know someone who has skipped out on healthcare interventions because they couldn’t afford it. Maybe that was you. Sometimes we’re afraid to even ask for the price. In a 2020 NHIS survey, one in 11 adults reported delaying or going without medical care due to cost reasons. Other studies have put that number as high as 50%. Wherever the true number lies on that spectrum, the story is the same — millions of people reach crisis moments in their health and their first thought is: “Can I afford to get treated?” It’s a multi-pronged problem. The first bit is simply knowing how much a procedure is going to cost. Next time a physician recommends you get an outpatient surgery, try asking them how much it will cost.

There’s a good chance you’ll get a blank stare. Now call your insurance company and ask the same question. You’re likely to be on the phone for three hours and still get an estimate that could be off by thousands of dollars. How can patients budget for a procedure when they don’t know the cost? Once a patient knows the amount to pay, there’s the logistics of how we pay. Some clinics send paper bills, which are liable to get lost. Others ask patients to pay by check, whether they have access to checks or not. Still others ask for prepayment of thousands of dollars, which can put patients in precarious financial situations. Finally, there are the predatory lenders who help patients pay for medical bills upfront — preying on fear and anxiety — in exchange for sky-high interest rates. If all of that weren’t difficult enough, medical payments present nearly as much startuphealth.com 17

MEET THE HEALTH TRANSFORMERS / BRIGHTPAY

hassle and headache on the provider side of the equation. For these folks, who often run relatively small medical practices, looking up procedure costs and insurance coverage is an onerous, manual process. Some of these businesses turn to enterprise billing software, but that’s expensive and comes with features they don’t need. It doesn’t have to be that way, say Shielvonda Haith and Archie Otu, co-founders of BrightPay. With their app, they’ve designed a better way for patients to pay their bills, while also giving providers peace of mind. origin story

In early 2021, Shielvonda Haith and her husband Archie Otu were informed that their five-year-old daughter needed an emergency dental procedure. If she didn’t get it, her other teeth could fall out. They had three weeks to make the decision. Like any concerned parent, their desire and impulse was to immediately schedule the surgery. But also like most parents, cost was a consideration. Haith and Otu were both healthcare professionals and knew enough about insurance to ask for a pretreatment estimate of the cost. Haith had worked in healthcare administration as well as in multiple startups while Otu was a health insurance actuary. The cost came back at $4000 but grew to over $7700 in out-of-pocket expenses by the time everything was complete, despite the fact that they had good health insurance. They moved forward with the procedure because it was medically necessary, but had to spend hours working with the dentist and the anesthesiologist to come up 18 StartUp Health Magazine / DEEP IMPACT

with a manageable payment plan. In the end, the experience was stressful (“Can we afford to take care of our daughter?”), expensive (the anesthesiologist wanted their $1700 fee upfront), and inflexible (working out a payment plan was extremely difficult). And this was true for Haith and Otu despite the fact that they were two insured working professionals who had inside knowledge of the healthcare and health insurance industries. “We’re very familiar with plans and benefit structures,” says Haith, “and yet we got into a very difficult health insurance situation. Most people don’t know to ask for a pre-treatment estimate. Even if they do, that estimate can be off, like it was by thousands of dollars in our case. Then, unless you advocate fiercely for yourself, there’s no guaranteeing that you can get a payment plan for these large out-of-pocket expenses.” Thankfully, their knowledge and advocacy carried them through, and they were able to afford the procedure and structure their payments. But the experience opened up a broader healthcare challenge faced by both patients and healthcare providers. By combining their experience in health tech and insurance, Haith and Otu knew they could build a better digital payment platform, one that combines price transparency with layaway-style payment plans, wrapped in a package that’s easy for doctors to use. BrightPay was born, and the team immediately went into heavy research mode. They surveyed hundreds of patients to refine their offering and launched an alpha app in November 2021. The team got a

When patients use BrightPay to pay for more expensive care, they’ll be given the option of low or no-interest payment plans. This layaway model, which follows in the footsteps of popular payment platforms Affirm and Bread, stands in contrast to the credit model used by companies like Care Credit, which can impose interest rates as high as 20%.

boost when it was accepted into the Antler investment portfolio, and their next move is to release a new version of their app, with expanded features, in the second quarter of 2022. under the hood

When the new version of BrightPay drops, the opening feature — and the feature that gets Haith the most excited — is their “eligibility and transparency” tool. This tool makes the most of new rules and regulations around data interoperability to pull pricing and insurance data right into the app so that patients and their providers can quickly assess the out-of-pocket cost of a procedure. This tool quickly gives the patient some peace of mind about what’s coming and helps them plan their next move.

“Providers can log into the system and within a few clicks, start to see pricing and insurance coverage information based on the patient’s insurance,” says Haith. “Plans are now sharing more data, which has allowed us to push our product forward faster,” adds Otu. The next piece of the platform has to do with payment logistics — making it easier to pay and get paid. This starts with simple digital payments. No more checks, no more wonky payment portals. Plugging in your credit card information to pay a medical bill should be as easy as ordering a sweater online or swiping your phone for Apple Pay at the grocery store. So that’s what they built. One of Haith’s favorite customer success stories came from a doctor who said her patients asked if they could use BrightPay to pay other bills, like their home mortgage. When patients use BrightPay to pay for more expensive care, they’ll be given the option of low or no-interest payment plans. This layaway model, which follows in the footsteps of popular payment platforms Affirm and Bread, stands in contrast to the credit model used by companies like Care Credit, which can impose interest rates as high as 20%. On the healthcare provider side, BrightPay has positioned itself as a customizable a la carte solution that’s affordable for small and mid-sized practices, and easy to implement. In their research, Haith and Otu discovered that many of the medical billing programs on the market were too expensive and cumbersome, weighed down by features that many clinics didn’t need. So they designed BrightPay such that clinics startuphealth.com 19

MEET THE HEALTH TRANSFORMERS / BRIGHTPAY

“To know that our solution will get people to the place where they can say yes to the care that they need, especially for their kids, is huge,” says Haith. “Not having to worry about finding the money before the treatment begins. At the same time, we can make the provider feel good and at ease about offering financial assistance. That’s really what makes us feel good. That’s what we want to see going forward."

can pay a simple subscription for the tools they need and skip the ones they don’t. why we’re proud to invest

While BrightPay is about making it easier to pay medical bills, and get paid by patients, it’s never just about the money. When asked about the emotional toll that patients (particularly parents of sick children) experience when facing a difficult bill, Haith tears up. “To know that our solution will get people to the place where they can say yes to the care that they need, especially for their kids, is huge,” says Haith. “Not having to worry about finding the money before the treatment begins. At the same time, we can make the provider feel good and at ease about offering financial assistance. That’s really what makes us feel good. That’s what 20 StartUp Health Magazine / DEEP IMPACT

we want to see going forward. They don’t have to worry about the money. They can focus on being emotionally calm as they prepare for a procedure.” We’re proud to support Health Transformers who recognize the humanity behind the Cost to Zero and the Access to Care Health Moonshots. We’re also bullish on BrightPay because they represent a geographic missing link in the move to digital medical payments. This is an industry where small and midsized practices need to be transitioned to digital payment platforms one at a time. That means there is a strong regional element, and Haith and Otu see themselves as leading the charge in the Southeast United States. “There’s so much opportunity for innovation in health,” says Haith. “It’s good that we’ve got competitors focusing on the West Coast. Plus, the mom-and-pop operations that we work with are often missed or overlooked by the larger players. By focusing on our region first, we’re benefiting providers more and having a greater impact on our community.” For Haith, it’s not just about making a single medical payment. The goal is to lower barriers to care holistically while also helping medical practices get paid. It’s about creating a frictionless relationship between patients and providers, for the good of all. 4 BRIGHTPAY@STARTUPHEALTH.COM

MEET THE HEALTH TRANSFORMERS

HEALTH TRANSFORMERS (L-R) Romy Block, MD, FACE, Co-founder Brad Helfand, CEO Arielle Levitan, MD, Co-founder vousvitamin@startuphealth.com

Vous Vitamin Uses PhysicianBuilt Algorithms to Deliver a Personalized Vitamin Subscription in a Single Pill Doctors Arielle Levitan and Romy Block noticed that many of their patients were confused about which vitamins and supplements to take. With Vous Vitamin, they created a customizable vitamin program that takes into account an individual’s lifestyle and health needs, using all the best and latest research.

NUTRITION & FITNESS MOONSHOT VINTAGE: 2022/Q1 VOUSVITAMIN.COM

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MEET THE HEALTH TRANSFORMERS / VOUS VITAMIN

Picture this common scenario: your doctor suggests you start taking some vitamin D and you dutifully head to the drug store to buy some. But once you enter the aisle, you get completely overwhelmed with choices. Do you need vitamin D2 or D3? How much do you need? Should you take the one your friend swears by or the one that celebrity mentioned on her blog? Is it better to get the one that pairs it with calcium? Why does this one cost twice the amount as that one? Or maybe you should just take a multivitamin with a little bit of everything in it, including vitamin D? That’s just the tip of the vitamin confusion iceberg. There are also medication interactions to worry about and hormone levels to consider. Vitamin deficiency is a concern, but then there’s the problem of overdose. Eight out of ten US consumers are taking one or more dietary supplements a day and there are 25,000 emergency room visits a year related to vitamin overdose or medication interaction. It’s no wonder that many people simply shy away from all vitamins because of confusion and health concerns. Mass market multivitamins attempt to offer consumers a one-size-fits-most solution. The result is a pill with minimal dosing of many different vitamins. In other words, you get vitamins you don’t need wrapped up with not enough of the vitamins you do need. No two people have the same diet, family history, or lifestyle, and yet the vitamin industry treats every person the same. To get around this, some people attempt to customize their vitamins themselves, a confusing process of mixing

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and matching what they hope are the right things in the right amount in an industry with no FDA regulation. When doctors Arielle Levitan and Romy Block encountered this vitamin confusion among their patients, they knew there had to be a better solution. origin story

Drs. Arielle Levitan and Romy Block were friends and neighbors long before they went into business together. The two women, who each had three kids, would take long walks together through their Chicago neighborhood and compare notes about the challenges they were facing in their medical practices. One was an internal medicine physician and the other was an endocrinologist. One day they noticed a pattern in their patients. On one hand was vitamin deficiency — their patients weren’t getting the vitamins they needed for their health. On the other, confusion — patients were reaching out to them for information about what vitamins or supplements were best for their situation. To address the issue, the doctors did what they do best: research. After two years of investigating best practices for vitamins, their research resulted in the book, The Vitamin Solution: Two Doctors Clear the Confusion About Vitamins and Your Health. The book went on to win many awards, including a Gold in the USA Best Book Awards: Health: Diet & Exercise category, and the Health Category President’s Choice Award for the Beverly Hills Book Awards. Drs. Levitan and Block appeared on talk shows and news programs as vitamin experts. But they wanted to do more

So you need more vitamin D. Do you need vitamin D2 or D3? How much do you need? Why does this one cost twice the amount as that one? Vous Vitamin has stepped in to solve vitamin confusion with their personalized vitamin subscription.

than talk about vitamins. They wanted to actually provide their patients with the best vitamins to promote optimal health according to their various needs and life stages. The two friends put their data into action, harnessing digital technology and their research to create the first version of Vous (as in the French for ‘you’) Vitamin. The premise was simple: all natural vitamin supplements, customized to the unique health needs of each individual, at an affordable price. While other competitors in the customized vitamins market took standard supplements a consumer could buy off the shelf and bagged them together in daily serving pouches, Drs. Levitan and Block found a US manufacturer that enabled them to custom manufacture their

supplements, while carefully monitoring quality. They took into account their patients’ desires and complaints about consuming vitamins, making sure their product was a single pill, smooth-coated and easy to swallow. under the hood

Here’s how it works: first you create a personal profile on the Vous Vitamin website by answering questions about your lifestyle, such as diet, fitness patterns, health status, your demographics, medications you take, and more. That data gets analyzed by the physician-designed algorithm and you are presented with a custom multivitamin formula, which allows you to see both the composition of your vitamin and each component’s dosage. The dosing levstartuphealth.com 23

MEET THE HEALTH TRANSFORMERS / VOUS VITAMIN

els are tied to the latest clinical evidence to ensure that you receive the health benefits for your body. After seeing your formula, you can decide whether to try it out for a month or sign up for a recurring subscription. “We are trying to get you to the right vitamins, not the most vitamins,” explains CEO Brad Helfand. “Other companies are incentivized to get you to keep taking more and more different kinds of supplements. We want to keep you in a trusting, longterm, data-based relationship.” Helfand joined the company in 2018 and his own story attests to how Vous Vitamin addresses the problem of vitamin confusion. Helfland was the quintessential lost vitamin shopper, wandering the store wondering which vitamin D supplement to take. His own confusion on the matter led him to start reading up on the industry. An article on personalized vitamins in Shape magazine caught his eye one day because it kept quoting Dr. Arielle Levitan, co-founder of Vous Vitamin. A tiny bell went off in Helfand’s head: “Isn’t my wife’s doctor a Dr. Levitan?” Sure enough, they were one and the same. Helfand got in touch with Dr. Levitan and began a dialogue about the issue, before eventually becoming an angel investor and then later bringing his 20 years in the healthcare industry to the company as CEO. “As a healthcare consultant, I found it so curious that the vitamin aisle was so de-linked from the rest of my healthcare experience,” says Helfand. “Vous Vitamin educates the consumer on what they are taking and why, sends adherence messages to make sure they understand the necessity 24 StartUp Health Magazine / DEEP IMPACT

We’re very excited to back Vous Vitamin because cofounders Drs. Arielle Levitan and Romy Block are not only practicing physicians, seeking to solve problems for real patients, but they also put in the work to become worldrenowned experts in the field of vitamins. Then, after having initial success, they were wise enough to expand their team to include seasoned operator Brad Helfand.

of sticking with what they’re taking, and teaches them what they could feel from their vitamins versus what they should never feel from their vitamins.” It is a relational approach that allows customers to ask questions about their vitamins, update their medical information over time, and provide the company a feedback loop on their experience to make sure their vitamin keeps working for them over the years. While Vous Vitamin is primarily a direct to consumer company, they are developing enterprise partnerships, including the first corporate vitamin education and access program for corporate wellbeing. They are also partnering with chronic disease platforms such as Pops, a digital health coaching tool for diabetes patients, to provide education and coaching about the role of vitamins in disease management. Additionally, the Vous Vitamin assessment

is available by kiosk in certain drugstores and grocery stores, with more retail partnerships on the horizon. With their eye on meal kits, digital fitness apps, and the beauty and wellness industry, Vous Vitamin looks to expand rapidly in the future to ensure more people get just what they need and nothing that they don’t. why we’re proud to invest

Vitamins aren’t the first thing you think about when you think about health innovation or health tech. Which is precisely why this lagging, under-regulated field was in need of some creative disruption. Anyone walking down the vitamin aisle of a drug store or walking through a GNC could immediately see the problem. We’re proud to back a team that’s shaking up this massive industry that has been characterized by too little knowledge, too little transparency, too many pills, and broken health incentives. And it’s not just any team. We’re very excited to back Vous Vitamin because cofounders Drs. Arielle Levitan and Romy Block have the minds and hearts to do the job. Not only are they practicing physicians, seeking to solve problems for real patients, they also put in the work to become world-renowned experts in the field of vitamins. Then after having initial success, they were wise enough to expand their team to include seasoned operators like Brad Helfand to help them scale. That’s allowed Levitan and Block to keep their focus on patients and on improving their product. We’re also bullish on Vous Vitamin because we’re entering the age of personalized medicine. We no longer live in a one-size-

fits-all world, and healthcare is no exception. Why should any patient take the exact same multivitamin as another person with a completely different health profile? It doesn’t make practical sense, and now we have the technology to make customized solutions affordable. Finally, we’re proud to back Drs. Arielle Levitan and Romy Block because they built their health moonshot mission on the bedrock of a real friendship. Long before Vous Vitamin, before the award-winning book, before the celebrity appearances, they were two moms with six kids in tow, taking walks around a Chicago neighborhood. That friendship and love emanates from the Vous Vitamin brand, and is sure to give them the support they need to persevere when the startup journey gets rough. As we’ve seen in startups across our portfolio, that long-term commitment that bonds this team will spill over into how they love and serve their customers. Put it all together and you’ve got an exciting health startup with the potential of re-imagining the entire vitamin industry, delivering people the vitamins they need to stay healthy longer. Join in welcoming Drs. Levitan and Block and the Vous Vitamin team to StartUp Health. 4 VOUSVITAMIN@STARTUPHEALTH.COM

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How 9am Health Is Making Virtual Diabetes Care Easy, Affordable, and Just Plain Better Building on their success with diabetes startup mySugr, Frank Westermann and his veteran team are upgrading virtual diabetes care. In less than a year they’ve brought on industry-leading investors and deployed 9am Health in 47 states. 26 StartUp Health Magazine / DEEP IMPACT

ACCESS TO CARE MOONSHOT VINTAGE: 2022/Q1 9AM.HEALTH

HEALTH TRANSFORMERS (L-R) Bernhard Schandl, CTO & Co-founder Frank Westermann, Co-CEO & Co-founder Paul Geevarghese, COO & Co-founder Anton Kittelberger, Co-CEO & Co-founder 9amhealth@startuphealth.com

Diabetes care has come a long way in the last 100 years. In 1922, a 14-year-old boy named Leonard Thompson received the world’s first injection of insulin to treat diabetes. It saved his life, and the discovery has saved millions of

lives since. In the 1980s, glucose monitors became available for home use, and millions of people were unshackled from the hospital. They began the daily rituals of drawing and testing their blood, and then managing their glucose levels with diet or shots of insulin. Today, daily finger pricks startuphealth.com 27

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and insulin injections have been largely replaced by continuous glucose monitors that beam glucose numbers to your smartphone and pumps that provide a quick, painless dose of insulin when needed. These advances have literally meant the difference between life and death, turning diabetes from a life-threatening emergency into a chronic condition. However, it’s possible for the dramatic advancements in technology to cloud the fact that people with diabetes still face incredible challenges, frustrations, and expenses. We’ve come so far, yet there is still much work to do. This paradigm plays out every day with the 37 million Americans who have type 2 diabetes. They are asked to spend large portions of their lives setting up and attending doctor’s appointments, waiting in waiting rooms, coordinating and picking up medications, and getting blood work done. It’s an unacknowledged part-time job that is daunting and frustrating, not to mention expensive. But it’s about more than a frustration. When type 2 diabetes patients hit one of these roadblocks, a portion of them drop off of the care path entirely. They stop taking their medications, checking their A1c levels, or calling their doctor. And that leads to a cascade of bad health outcomes. It’s time for a digital platform for allaround diabetes care that builds on the technology advances of the past century. 9am Health, under the leadership of Frank Westermann and Paul Geevarghese, is stepping into that gap with a new product that’s already making waves. 28 StartUp Health Magazine / DEEP IMPACT

MILLION AMERICANS HAVE TYPE 2

DIABETES origin story

A few days before our interview for this story, Westermann and Geevarghese were on a pitch call. Suddenly, mid-sentence, Westermann got light-headed and his phone began to beep. Geevarghese knew exactly what was happening and what to do next. “Everyone knows each other’s beep sounds,” says Geevarghese with a laugh, referring to the continuous glucose monitors that let people living with diabetes know that their blood sugar is out of line. Westermann flashed his business partner his glucose reading, which showed he was hypoglycemic. After a quick, knowing look, Westermann stepped away from the call and reached into their dedicated “hypo snack” drawer for when someone’s

blood sugar drops. Geevarghese picked up the pitch without a pause. The people on the other end of the call never knew what happened. When you ask an entrepreneur why they’re passionate about their work, they might say that it’s just who they are, that it’s “in their blood.” For Frank Westermann and Anton Kittelberger, co-founders of 9am Health, this is literally true. Both have type 1 diabetes, as do many of the members of their team. “We really understand the challenges of being a patient,” says Westermann. “We also understand the ways the system is broken. We want to help people with diabetes, that’s our whole mission.” But personal experience will only take you so far. Westermann and his team also happen to be some of the most experienced operators in the diabetes space. Before launching 9am Health, Westermann — along with 10 members of their current team — ran a company called mySugr, which helped people with diabetes track their glucose levels, exercise, and diet. In 2017, after garnering a million users, they sold mySugr to Roche for upwards of $100M. Now they’re back with what they see as the next evolution in digital diabetes care, and the industry is paying close attention. Within a few short months of launch, 9am Health landed a $16M series A coled by 7wireVentures and Human Capital, with participation by StartUp Health. “Even three years ago, it wasn’t possible to build the fully virtual diabetes care clinic that was as good or better than in-person,” says Westermann. “Now it’s possible.”

under the hood

The bold headline on 9am Health’s colorful website is “Diabetes care that fits your life.” It’s not one product, but a platform of products and services designed to address every challenge and frustration for a person living with diabetes, starting with type 2 and expanding from there. You could break 9am Health down into three goals: convenience, affordability, and increased quality. To make care more convenient, 9am Health leverages a team of “patient care advocates.” They are like a customer support team backed by a virtual health engine. Instead of patients ping-ponging their way between doctors, labs, and pharmacies, 9am Health packages it all into one platform with a single point of communication. “You can fire any question to our chat, and we’ll be your concierge and advocate,” says Geevarghese. “We’re going above and beyond. We’re not just going to tell you that you need to increase your dose; we’re going to send you a text message or an email and probably a nice graphic or a video telling you why you need to increase your dose and when to do it.” Many at 9am Health have diabetes, says Geevarghese, and they understand “how crappy it can be” when you have a high deductible, or you’re caught between insurances, or you just don’t know what to do. That team will spend time over the phone or text, just helping the patient figure things out. In terms of cost, there are two sides of the coin. As a cash-pay product, 9am Health is offering a cheaper alternative startuphealth.com 29

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to the high-priced brand-name drugs and services that many people purchase out of pocket. But they’re also offering a competitive alternative for people with insurance. “We’re more affordable than many of the copays that exist,” says Geevarghese. 9am Health is making care more convenient and affordable, but they’re also providing a new level and quality of care. For instance, through their platform, users can gain access to nutritionists and health coaches, something they probably didn’t have before. And in the future, patients will be able to reach out to a mental health provider when their disease is taking a mental and emotional toll. 9am Health is launching direct to consumers but is also already working on their employer sales track to provide 9am Health as a health benefit to employees why we’re proud to invest

9am Health is an ambitious startup with a highly experienced team that has demonstrated an ability to build and deploy products quickly. We’re proud to back a team that can rapidly move from mission statement to commercialization (they’re already in 47 states) because that means more patients can benefit from their innovation. Part of the reason they’ve moved so quickly — going from launch to Series A in six months — is that the 9am Health team members not only have experience in the diabetes market but actually have experience working with each other specifically. Half of the current team were also colleagues at mySugr before it was sold to Roche. That fact — something you 30 StartUp Health Magazine / DEEP IMPACT

don’t see every day in startups — speaks highly of the company’s leadership and management. We’re also excited about 9am Health because they know how to land a good partner. From day one, co-founder Frank Westermann knew that 7wireVentures would be the perfect investor/partner because of the firm’s experience running Livongo. “If I could dream of an investor, it would be 7wireVentures. Glen Tullman is super invested in and passionate about the diabetes experience,” says Westermann. Just this month, Westermann and team closed a $16M series A with 7wireVentures as a co-lead. Finally, we’re proud to back 9am Health because they have the vision and expertise needed to make real progress on StartUp Health’s dedicated Diabetes Moonshot. This is a massive health moonshot. Globally, nearly half a billion people are affected by type 2 diabetes alone, and our current care paradigms are broken. We push people from doctor to pharmacy to laboratories, wasting precious time and loading them up with questions and uncertainties. The time is now to leverage the best in digital health and virtual care coordination for the good of this community. By doing just that, 9am Health is positioned to make care easier, more affordable, and a few notches better. That’s something we can whole-heartedly get behind. 4 9AMHEALTH@STARTUPHEALTH.COM

MEET THE HEALTH TRANSFORMERS

Tellescope Is Delivering a Developer-Friendly Tech Stack to Healthcare Startups Co-founders Sebastian Coates and Derek Strauss are building modular, flexible patient engagement tools to help digital health companies scale faster and help more patients. COST TO ZERO MOONSHOT VINTAGE: 2022/Q1 TELLESCOPE.COM

HEALTH TRANSFORMERS (L-R) Derek Strauss, COO & Co-founder Sebastian Coates, CEO & Co-founder tellescope@startuphealth.com

There was a time in the nottoo-distant past when “health innovation” meant introducing the world to the building blocks of virtual care. For some that meant delivering HIPAA-compliant chat so doctors could text their patients securely. For others it was selling a Zoom-like video telemedicine experience. But, as COVID-19 pushed the world to virtual care, we’ve seen an evolution in healthcare startups. More and more, innovative companies are building on top of the virtual care foundation of the last decade. The focus is shifting from fundamentals to building specialty products that have a high impact with targeted audiences. No longer are offerings like secure chat and EHR integration market differentiators — they’re table stakes. The challenge, then, for today’s leading healthcare startups is how to get a professional tech stack up and running quickly enough to survive and scale. If you’re a bootstrapped mental health startup focused on teenagers, for instance, you can’t wait a year while your in-house developer

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designs HIPAA-compliant chat. Patients expect high-tech features from day one, regardless of the size of your team. Often, startups launch with a mix-andmatch platform of Google Sheets, email, and EHR integration. That works while they’re small, but a point comes in their development when they need one central place that pulls together all communication and patient workflows. At this point, many startups turn to onesize-fits all patient engagement platforms. The problem here is that innovative health companies are by their nature unique and have unique workflow challenges. As a result, these off-the-shelf tech stack tools only get the company 80–90% of the way to full functionality. Figuring out that last specialized mile of tech can easily eat up the team’s time and tech budget. It was this challenge that inspired Sebastian Coates and Derek Strauss to found Tellescope. Together, they’re building a flexible, developer-friendly platform that helps innovative health companies round out their tech stack, scale quickly, and stay focused on the patients they set out to serve. origin story

Sebastian Coates and Derek Strauss met while interning at Vertex Pharmaceuticals. The two were still in college at the time and were drawn to the internship because it offered a unique chance to experience health innovation up close. At Vertex, the two focused on how to apply emerging technologies like blockchain to clinical trials. “What was really exciting was the ability to take new technologies and make them 32 StartUp Health Magazine / DEEP IMPACT

easy to use in industries that affect patients’ lives,” says Coates. “That’s been our philosophy ever since.” After they left Vertex, Strauss did a stint in technology consulting at Ernst & Young, and Coates finished out his degree in computer science. Then, in 2020, the freshlyminted graduates were invited to join the TechStars accelerator. The idea was to take their education and experience and tackle the problem of health data security, building on blockchain technology. But as they got deeper into the market and interviewed healthcare companies and stakeholders, an exciting new challenge emerged. Strauss recalls meeting a startup that was offering health coaching to women. They looked for months for a tech solution for connecting with patients in a streamlined way that felt customized to their needs. They needed a platform that brought patient data into one place with patient communications. Their inability to find the right patient engagement software set their launch back by months. “We found out from so many businesses that their big challenge in getting to market quickly and securely comes down to their ability to manage relationships and communicate effectively, and then deliver virtual care,” says Coates. But their opportunity wasn’t in reinventing the patient engagement wheel. They discovered that many companies already had engagement and workflow platforms they liked, and which worked for the majority of their workflow. The problem was that there were critical gaps and companies lacked the internal tech teams to connect the dots. Coates and Strauss

Tellescope is a company of the moment. The market is shifting from foundational virtual care offerings to more specialized, targeted — hopefully higher-impact — products. We’re proud to back a team and company that has anticipated that shift and is building the toolkit for the next phase of virtual care. Winston Churchill said, “Generals are always prepared to fight the last war.” If we’re going to use technology to revolutionize health for everyone on earth, we can’t focus on the rear-view mirror, on solving the last challenge. We have to anticipate tomorrow’s hurdles, and that’s where Tellescope shines.

realized that their opportunity was in nimbly filling those gaps in ways that allowed customers to keep their existing software intact. “That inspired us to immerse ourselves in building developer tools, embracing the idea of flexibility,” says Strauss. By giving companies these tools, says Coates, they could give them a six month head start on implementing patient engagement programs. When they graduated TechStars in January 2021, it was with a clear understanding of the industry challenge they wanted to solve. They went full time and started developing their platform from day one. under the hood

On one hand, Tellescope is a patient engagement software platform that any digital health company can use to centralize patient communication, workflows, and EHR integrations. Companies can buy it off the shelf and be up and running with these tech tools within a day. The core patient engagement portal puts all aspects of

a patient’s communication and care journey into a single viewable thread, not unlike a channel conversation in Slack. When customers start out on Tellescope, they define any number of care journeys for their patients, a process that’s completely customizable. Once these are created, every patient can be brought through that journey. Clinicians can then automate tasks, delegate responsibilities, and measure engagement. The platform is also designed to be collaborative, where clinicians and coaches can work simultaneously and populate the care journey in real time. While this off-the-shelf software option is strong, where Tellescope really differentiates itself is in its flexible developer tools. The company uses an API approach that any company can plug into, regardless of their tech stack. “Let’s say I’m a developer and I want a secure chat to add to our internal team dashboard,” says Coates. “We’ve already got an app on the app store for our patients. But it’s going to take me a month to build out this chat function and make sure

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it’s HIPAA compliant. And I have a lot of other stuff on my plate. With Tellescope I can cut and paste a component into our team dashboard, which will allow my team to chat securely with patients, and I can plug that feature into the front end of the app. It took me a day instead of a month, and now we have chat. We can do that with video, file upload, engagement tracking. My life is now 10x easier.” The approach is all about flexibility and customization. Each component of Tellescope can be integrated into the client’s own products and can be customized to their brand. One way to think about the platform is to compare it to how Wordpress revolutionized web design. Using a range of plug-ins, Wordpress created a middle road between one-size-fits-all templated websites and costly custom sites. In the future, Coates and Strauss plan to use Tellescope to collect data around patient interactions and then use machine learning to serve actionable predictions back to the healthcare providers. why we’re proud to invest

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ror, on solving the last challenge. We have to anticipate tomorrow’s hurdles, and that’s where Tellescope shines. We’re also excited to back this startup because they’ve designed a product that supports the entire health innovation ecosystem. This is an invention that enables more invention, and that gets to the heart of StartUp Health. We believe that the mindset and energy inherent in entrepreneurship — as much as the innovations themselves — needs to be supported globally. Tellescope brings tools to this community of problem-solvers that will speed up progress in exciting ways that we can’t even imagine. “We see all these new businesses not as a few more thousands every year, but that they will actually become the major healthcare players of the next decade,” says Coates. “Most of our healthcare will be delivered in these innovative new models. If it’s the innovators who win out in the end, that’s great. If it’s the legacy companies and clinics that have to play catch-up, and they win in the end, that’s great too. We can help either way. We see the market as being in its infancy.” Sebastian Coates and Derek Strauss are bringing their fresh vision to patient engagement, with an eye towards customization and flexibility, and we think it’s going to help a lot of people. Join us in welcoming the Tellescope team to StartUp Health. 4 TELLESCOPE@STARTUPHEALTH.COM

HEALTH TRANSFORMER Maureen Fura, CEO & Founder mammha@startuphealth.com

Mammha Provides Screening and Care for Moms Struggling with Depression and Suicide After years of advocacy work focused on pregnancy-related depression and suicide, Maureen Fura created a tech-enabled mental health screener for moms that pairs with a network of trained peer-support specialists.

WOMEN'S HEALTH MOONSHOT VINTAGE: 2022/Q1 MAMMHA.COM

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If someone asked you about major health risks for the mother during and after pregnancy, what would you say? Hemorrhage? Infection? Blood pressure-related issues like preeclampsia? Would self-harm and suicide even come to mind? Yet self-harm (suicide or overdose) is one of the leading causes of death for new moms and the numbers are rising. A study released in 2020 found that rates of suicide attempts during pregnancy and after childbirth nearly tripled over the previous decade, from 0.2 to 0.6%, and those numbers are likely to be under-reported since maternal mortality statistics reported by the CDC don’t factor in suicide death. Even though perinatal mood and anxiety disorders (PMADs) are the most common complication of pregnancy and childbirth, less than 5% of women are screened for depression during their pregnancy and postpartum period. More women will suffer from a mental health complication during their pregnancy and postpartum period than gestational diabetes and preeclampsia, yet their doctor likely won’t mention it as a possibility. Perhaps the doctor doesn’t know what to say. Perhaps he or she doesn’t know where to point their patients for help if a mental health issue comes up. Maybe they don’t want to scare the mother with these statistics, fearing that they’ll make matters worse. So even though a woman receives more medical attention during a pregnancy than she does at any other time of her life — while simultaneously being at higher 36 StartUp Health Magazine / DEEP IMPACT

risk for mental health complications — she is neither screened for maternal depression or given any help if she brings it up herself. On the off chance her doctor does raise the issue, finding and affording the right intervention, like therapy or a support group, presents its own challenge. Mental health issues are often time sensitive. The feelings, thoughts, and situations come fast and care needs to be prompt. As Adrienne Griffen, executive director of the Maternal Mental Health Leadership Alliance, puts it, “We cannot wait for women to raise their hand and ask for help because by the time they do that, they needed help many weeks ago.” origin story

Maureen Fura, CEO & Co-founder of Mammha, lived this story. She can clearly remember the morning she found out she was pregnant. It was the morning of the first suicidal thought she ever had. “I was in graduate school and a newlywed. My husband and I were living in the small coastal town of Monterey, California. I had never had a mental health issue in my life. I woke up one morning and I could see myself hanging from a tree. Suicidal thoughts just started to come, ideations, really fast. I knew something was wrong. An hour later, I took a pregnancy test.” She knew this wasn’t normal. She knew something was wrong and so she voiced her concerns to her OB at her very first prenatal appointment. Her doctor said, “You should be happy. You’re having a baby.” This pattern repeated itself over

Self-harm (suicide or overdose) is one of the leading causes of death for new moms and the numbers are rising. A study released in 2020 found that rates of suicide attempts during pregnancy and after childbirth nearly tripled over the previous decade, from 0.2 to 0.6%, and those numbers are likely to be under-reported.

and over again as Fura looked for a doctor who could help her. “I told every doctor, every OB I talked to how I was feeling. I waved a red flag and felt like my concerns and cries for help were ushered out of the exam room.” Eventually Fura found a therapist who named what she was experiencing and she got the help she needed. She felt like a survivor and wondered “am I the only one?” She wasn’t. She found another mom who experienced similar maternal mental health complications and together they began to interview and record other stories, a project that became the documentary Dark Side of the Full Moon. Fura discovered the lack of care she received was the rule, not the exception, in postpartum healthcare. Raised by a mother who taught her to always look for ways to lend a hand, Fura became a maternal mental health (MMH) advocate, helping found the National Coalition for Maternal Mental Health and

spearheading the first National Awareness Campaign for MMH. She lobbied congress for seven years, increasing the visibility of the problem and the number of MMH-related deaths. But even as awareness grew in the medical community thanks to these efforts, she kept hearing doctors remain at a loss as to what they could actually do to shift the problem. “A change in knowledge isn’t equal to a change in behavior. People knew women were dying but they still didn’t know what they could do to stop it.” Fura wanted to do more than educate about the problem. She wanted women to get the care they needed when they needed it. She wanted them to have what she didn’t get to have during her pregnancy. She wanted something that was easy for doctors to use and easy for women to access, something tangible to close the MMH gaps in patient care. And so, Mammha was born. under the hood

Mammha started as a natural evolution of Fura’s advocacy. The idea was simple: provide women with routine mental health screening during the pregnancy and post-partum period and provide doctors the tools to talk about mental health issues with their patients and trusted resources to point them to if an issue arises. “It’s the only product moving the needle on patient engagement and routine screening,” Fura explains. “Doctors don’t want to screen because what if the patient says something is wrong? They don’t know how to have that conversation and they don’t know where to send the pastartuphealth.com 37

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tient for help. Mothers might be fearful to bring up an issue, or feel like they don’t have the words.” Mammha streamlines the process for both parties. The moms quickly screen themselves on their phones using the Mammha HIPAA-compliant mobile and web-based platform. The doctors get their results, along with talking points on how to follow up with the mother. And perhaps most significantly, there is immediate support on what to do next. If a patient screens positive for mental health concerns, they are instantly connected with a Mammha Care Coordinator who connects them with low- to no-cost resources and provides them with ongoing support, check-ins, and care. Providing a trusted, trained care coordinator turned out to be the missing piece in the puzzle. Doctors feel more safe screening patients because they know the Mammha care coordination specialist will be a liaison to the services their patients need. Moms feel supported because the Care Coordinators are certified peer-support specialists — women with lived experience and training in supporting other women. “The Care Coordinator follows the patient through to wellness,” says Fura. “Sometimes it’s six weeks, sometimes it’s 10 months. It’s not always therapy or medication. Sometimes it’s needing a support group. Sometimes it’s just needing someone to talk to who knows what you’re going through. The level and type of communication depends on mom.” Mammha currently partners with Children’s National Hospital, the top NICU 38 StartUp Health Magazine / DEEP IMPACT

in the country, as well as other hospitals in Florida, California, and Washington DC. NICU moms screen the highest for depression and anxiety, making ongoing support especially important for them. To that end, the March of Dimes is funding a new pilot program with the goal of bringing Mammha into all 70 family NICU centers across the US. The program launches this March in three hospitals in Virginia. In 2021, Mammha was one of eight finalists selected by HITLAB for the Women’s Health Tech (WHT) challenge. Additionally, Mammha won Johnson & Johnson’s Washington DC QuickFire Challenge to address maternal mortality. Innovators from across the globe were invited to submit potential science and technology solutions aiming to address

racial and socioeconomic disparities that impact health in communities like the District of Columbia. Their success, Fura explains, is because the team at Mammha has been in the shoes of the women they are serving. “Mammha is made by women for women. That’s what makes it really effective. We have physicians informing us that have had this experience themselves. We know what levers to pull, what to say. We know how women find their way to care. That’s what’s really making the difference.” why we’re proud to invest

Like so many of the best health innovation startups, Mammha was born from personal experience. Before she founded this company, Maureen Fura was a patient and then a passionate health advocate. Every tool she builds, every feature she rolls out, is based on intimate knowledge of the pain of real patients. We’re proud to support a founder who has walked in the shoes of her users and has dedicated her life to helping them. We’re also excited about Mammha because it addresses a massive unmet need. This isn’t a tweak, an upgrade on current practice. This is stepping into a gaping hole in the healthcare system — postpartum depression screening — and providing a life line. Mothers are dying. Obstetricians are desperate for tools that until now just haven’t existed. We’re bullish on Mammha because Maureen Fura has built a foundation of national partnerships, which has led to rapid early growth. Fura spent years in

Washington DC advocating for women’s health, and she’s been able to leverage those connections to get Mammha implemented more broadly. Their recent partnership with the March of Dimes is a perfect example of this and showcases Fura’s ability to bring together disparate pieces of maternal health. Finally, we’re excited to support and invest in Mammha because it puts genuine community at the center. The killer “app” in Mammha isn’t a line of code. It’s the growing family of trained peer-support specialists ready to hop on a call with a struggling mom. In this way, Mammha uses new technology, but does so in a way to tap into, and amplify, the oldest tool in the toolbox. It’s all about friendship, shared experience, lived wisdom, and love. And when you create a network of peer-support, you also start to tackle the problem of access, bringing help and care to places that are low on healthcare resources. It turns out that the greatest increases in pregnancy-related suicidal thoughts were seen among Black, lowincome, and younger individuals, so issues of access and equity need to remain top of mind. And that’s precisely where Mammha shines brightest. Join us as we welcome Maureen Fura and the Mammha team to StartUp Health. 4 MAMMHA@STARTUPHEALTH.COM

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HEALTH TRANSFORMERS Colby Takeda, CEO & Co-founder Lee Colburn, CPO & Co-founder Nick Lockett, CTO & Co-founder pearsuite@startuphealth.com 40 StartUp Health Magazine / DEEP IMPACT

MEET THE HEALTH TRANSFORMERS

Pear Suite’s Dashboard Helps Organizations Address Social Determinants of Health in Seniors Colby Takeda and his team brought together experience in aging, healthcare operations, and tech to build a SaaS platform that moves organizations from reactionary healthcare to proactive wellness. HEALTHY LONGEVITY & AGING MOONSHOT VINTAGE: 2022/Q1 PEARSUITE.COM

Healthcare for seniors has a serious numbers problem. According to a report by the National Academy of Medicine, 90% of the money spent on healthcare for older patients is used for medical services that respond to disease and injuries as they occur. The problem is that all of that spending only drives an estimated 10% in improved outcomes. In other words, the vast majority of our spending on senior healthcare is spent on the tip of the iceberg and ignores the massive areas of life that actually drive healthy outcomes. These are things like neighborhoods and living environments, transportation, access to care, access to healthy food options, relationships, community, and economic stability. These are known as the social determinants of health (SDoH), and while their importance is now widely acknowledged and researched, the healthcare system’s ‘diagnose,

then treat’ cycle is not currently built to address them. When it comes to older patients, that paradigm needs to change, and quickly. The population of people over the age of 65 in the US is set to rise from its current number of 54 million to 80.8 million by 2040 and the national caregiver shortage continues to worsen. Not only that, but as the pandemic both revealed and exacerbated, there is a severe loneliness and social isolation problem, especially among older adults. There are significant links between loneliness and negative health implications, such as a recent study that found social isolation and loneliness increased the risk of heart disease in older women by as much as 27%. Another longitudinal study estimated that the health impact of poor social relations was equivalent to smoking 15 cigarettes a day. Realistic solutions for healthy aging need to consider social constartuphealth.com 41

MEET THE HEALTH TRANSFORMERS / PEAR SUITE

nectedness even as they attempt to solve for the problem of staff shortages and a rapidly growing number of older Americans. Thankfully, a dedicated team of entrepreneurs is leveraging technology to tackle these issues, helping senior-serving health and community organizations address SDoH issues in intuitive ways so that seniors can thrive as they age. origin story

Colby Takeda was just 25 years old when he became the administrator of a newlyopened assisted living facility in Hawaii. All of a sudden, the care and wellbeing of 150 residents was in his hands. His to-do list was daunting — hiring and training staff (including a nursing team), developing nutritious meal programs, planning fun activities, making sure people stayed engaged and healthy — in short, creating a place where the residents could thrive and age gracefully. Takeda, who studied public health and exercise science, wanted more for his residents than a reactionary approach to their health that only responded to sickness. He wanted to create an environment that proactively promoted wellness. To that end, he helped his company as a champion of new technologies. He was one of the first users of the platform Sagely, which helped to manage activities. The entire network of communities transitioned from paper to electronic medical records (EMR). He made sure the entire building had wifi (making theirs the first facility in the chain to do so), helped his residents understand how to connect with family over Facetime, and hosted digital photography 42 StartUp Health Magazine / DEEP IMPACT

classes. Following this formative experience, Takeda flipped to the other side of the aging coin and worked for The Blue Zones Project by Sharecare, helping over 60 communities across the country implement changes that make the healthy choice the easy choice for residents as they age. Takeda ran the policy and strategic partnerships for the Project, exploring strategies and techniques to make the places where people live, work, pray, play and learn healthier, enabling people to not only age in place but thrive as they did so. Seeing these two sides of the aging coin up close (long-term care and aging in place), provided Takeda with a clear picture of what was broken in how society thinks about health as people age. Takeda began to imagine a product that could help move the needle on social drivers of health while reducing the load on the already burdened healthcare workers in the aging field. What was needed, he thought, was a simple solution for addressing these SDoH that was actionable, scalable, and affordable. The seeds for Pear Suite were sown. But Takeda couldn’t do it alone. Through a mutual friend and colleague, he met Lee Colburn, who serves as CPO. Colburn, a former Army officer who served in Afghanistan, worked as an executive consultant for Kaiser Permanente, and thoroughly understands healthcare operations and the importance of leveraging data in care coordination. Next they brought in Nick Lockett as CTO. Lockett added years of experience in data, artificial intelligence, and voice analytics, both at large companies like Microsoft and several

other startups. “We’re doers,” Takeda emphasized, when asked what made this founding team work. “We get the job done no matter what. We have different backgrounds — aging, finance, analytics, operations, technology — but we each have our own story of why older adults matter to us.” While many technology companies start with the technology and try to find a market, Pear Suite took the opposite approach. The founders talked about the real problems they personally encountered in the healthcare industry and imagined the tool they wished they had. They utilized their connections at the University of Hawaii to test their ideas, taking advantage of several startup launchpads at the college to identify market opportunities and needs, and do proper customer discovery. By the time they officially launched Pear Suite in 2021, they were ready to hit the ground running. under the hood

The heart of Pear Suite is its online platform that upskills non-licensed staff to assess the needs and interests of older adults and guide them towards social solutions. It’s a software-as-a-service (SaaS) model that is often referred to as the “Salesforce of social care.” With this platform, organizations can connect more of their members to community resources, such as Meals on Wheels and transportation, have them access public benefit programs, including Medicaid, SNAP, and the Affordable Connectivity Program (broadband), and promote preventative well-being activities, like vaccinations, regular physical activity, and social engagement.

To better understand how it works, consider the current model of addressing SDoH. A patient fills out a paper survey asking them questions about their challenges. Perhaps the patient indicates that they can’t easily get around their home and are at a higher risk of falling. If they’re lucky, a social worker may try to help them, but more often, that survey is filed away and likely never seen again. No one follows up or suggests options to keep that person independent at home, and in the matter of months, that individual has a life-changing fall that results in rehabilitation, dependence on caregiving support or long-term care, and potentially even death. Family members aren’t aware of the importance of social drivers of health for their aging parent or grandparent. No interventions take place that could have improved outcomes and saved our healthcare system. Imagine instead a community health worker, what Pear Suite calls a “care navigator,” talking to that older adult to learn about their social history and interests, understanding all about their home environment, and exploring appropriate solutions that are both empowering and preventative. By phone, that older adult is guided along care journeys that may include resource-linking to a nearby general contractor for home modifications and a virtual friendly hand-hold to ensure engagement is maintained and members are not forgotten. Staff can assign an older adult to a predesigned care journey or create a new one, emphasizing the importance of choice, cultural sensitivities, and health equity and access considerations. Through the use of AI-powered quesstartuphealth.com 43

MEET THE HEALTH TRANSFORMERS / PEAR SUITE

tionnaires, automated texts and calls, and voice analytics, data can do more than simply monitor lifestyle changes over time — it can predict risk and opportunities across a variety of social care domains. Imagine a dashboard that simultaneously tracks the next steps of multiple older adults struggling with different challenges, and collects data to tie social solutions to improved health outcomes, reduced costs, and increased revenue. While Pear Suite primarily partners with health plans focused on value-based care and addressing SDoH, senior centers, health centers, churches, and other community-based organizations are also utilizing Pear Suite to better engage older adults. Pear Suite also takes the burden off of licensed healthcare professionals by mobilizing a broader workforce. With this software, anyone — medical assistants, nursing students, volunteers, and even church members — can be a virtual care navigator, more older adults can be reached, for less, all while ensuring no member falls through the cracks. “All of these tech-enabled tools are really designed to build a relationship over time,” explains Takeda. “If we can develop an accessible way to better understand the whole person, not just the patient, we can nudge someone towards getting a vaccine they need, towards going in for an annual wellness visit, towards getting screenings done by their physician. why we’re proud to invest

In a world where too many entrepreneurs could be described as having “a product in search of a market,” we’re proud to 44 StartUp Health Magazine / DEEP IMPACT

back Pear Suite because they started with a deep personal understanding of the challenges in the senior care market. Takeda and Colburn lived it firsthand and are now building the platform they wished they’d had. Speaking of the team, this threesome brings diverse and complementary skill sets to the table, from population health to operations to technology development. We’re also excited to back Pear Suite because they’re poised for growth in 2022. They currently serve 10,000 older adults in 13 healthcare organizations in Hawaii, and recently signed a contract that will allow them to provide care to 60,000 more people. Techstars Los Angeles, an accelerator program, chose Pear Suite as one of 12 companies for their 2022 class, and will invest money, mentoring, and resources into the company. Finally, and most importantly, we’re proud to back Takeda and the Pear Suite team because they’re taking a bite out of one of the most critical healthcare problems in society today. Improving our care of older people — going beyond reactionary medicine to proactive steps that foster wellbeing — isn’t just a nice idea, it’s an imperative. As the number of seniors increases in coming years, we will have to have scalable technology platforms like Pear Suite to handle increasing demand so that no patient falls through the cracks. Pear Suite has already helped many organizations and patients move beyond reactive health maintenance to an interactive model that fosters “thriving at every age.” We can’t wait to see what they do next. 4 PEARSUITE@STARTUPHEALTH.COM

MEET THE HEALTH TRANSFORMERS

Lazzaro Medical Is Building a Platform of Robotic Surgical Techniques, Devices, and Diagnostics to Restore Healthy Breathing to Millions Renowned surgeon Richard Lazzaro, MD, FACS, and serial entrepreneur Rob Israel are bringing to market a new suite of diagnostic techniques and medical devices to treat patients suffering from tracheobronchomalacia (TBM), a life-threatening disease characterized by chronic cough and shortness of breath.

HEALTH TRANSFORMERS Robert Israel, CEO & Co-founder ACCESS TO CARE MOONSHOT

Richard Lazzaro, MD, FACS,

VINTAGE: 2022/Q1

Chief Medical Officer & Co-founder

LAZZAROMED.COM

lazzaromed@startuphealth.com

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Take a deep breath. Fill your lungs, and exhale. Because the simple act of breathing is so natural, we often take it for granted. Our bodies breathe involuntarily, yet this simple act powers everything we do. But when that most virtuous of cycles breaks down, bad things happen, and a person’s quality of life can change forever. Each year millions of people suffer from chronic cough and shortness of breath. You likely know someone personally who suffers from this. Some have asthma, others bronchitis or COPD, but they all share a similar fate. Their inability to breathe deeply and effectively begins as a nuisance, like a cough, but grows over time into a debilitating condition that deprives them of sleep, energy, and often, years of life. Many people with chronic cough have a condition called tracheobronchomalacia or TBM. TBM occurs when the cartilage in the trachea weakens and begins to collapse over time causing airway constriction. This results in decreased airflow making breathing more difficult. TBM can be life-threatening and has been characterized as the “most common respiratory problem people have never heard of.” In the US alone, it’s been estimated that over 50% of COPD patients account for approximately 8M people suffering from this devastating disease, masquerading as a chronic cough and shortness of breath. If a patient does see a physician who recognizes TBM, a dynamic CT scan can confirm the diagnosis. If the CT shows a severe tracheal collapse — often pegged

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at 90% reduction in size — the patient could be a candidate for a surgery called a tracheobronchoplasty or TBP. This openchest surgery is so lengthy and invasive that very few patients qualify for it. For the few who do, the recovery can be more challenging than the original disease. What if there was a solution for patients with chronic cough or shortness of breath that gave them the ability to breathe again, and there was a better, safer way to rebuild a collapsing trachea? And what if this solution could give the breath-of-life back to millions because, in fact, TBM is going massively underdiagnosed, hiding in plain sight as COPD? These are the questions being answered by Dr. Richard Lazzaro and Rob Israel, the founders behind Lazzaro Medical. The company has pioneered a robotic, Minimally-Invasive Tracheal Repair (MITR™) technique and device that makes this new life-giving procedure fast, safe, and extremely effective in the remediation of TBM. origin story

Six years ago, a patient came to Dr. Richard Lazzaro at Lenox Hill Hospital in New York City and told him she was dying. She had TBM and her airway had collapsed to the point that she could barely breathe. She had three weeks to live. A traditional open tracheobronchoplasty (TBP) was too dangerous to consider. She needed a miracle. Dr. Lazzaro was a renowned expert in TBP, but, as it happened, he was also a trailblazer in robotic thoracic surgery. Hearing her story, he saw an opportunity

to reinvent the antiquated open TBP surgical procedure by applying the latest in non-invasive, robotic techniques. During the surgery, Dr. Lazzaro used the Da Vinci XI Surgical Robot to minimally invasively sew a fine surgical mesh to the exterior of her trachea, effectively scaffolding the organ back into a healthy shape. Three days later, she left the hospital. Her TBM was fully remediated and she could breathe naturally again. Dr. Lazzaro knew he was onto something big. He and his colleagues published their findings in The Journal of Thoracic and Cardiovascular Surgery. The publication reported a high success rate, high patient satisfaction, and low complications on 42 procedures. At 90 days, there were no reintubations, tracheostomies, or deaths. Dr. Lazzaro has performed approximately 150 robotic TBPs to date and is the leading robotic surgeon in this field. Dr. Lazzaro with the help of Rob Israel, a long-time friend who built and exited multiple successful businesses, created Lazzaro Medical. The company is developing a suite of medical devices used for TBM diagnosis and treatment and is positioned to scale the Minimally-Invasive Tracheal Repair (MITR™) procedure. Mr. Israel has built a team with deep expertise around Dr. Lazzaro including seasoned respiratory industry veterans, the head of thoracic surgery at the Cleveland Clinic, and a rocket scientist turned medical device innovator who worked on the Webb Telescope for NASA. “We’re building a universe for curing TBM,” says Israel. “There are millions of

people suffering from this devastating condition, but in the past, the cure was as bad, if not worse, than the disease.” Lazzaro Medical is in the process of closing its first institutional round of financing. under the hood

Lazzaro Medical consists of a suite of products that support their robotic, minimally invasive TBM surgery. The LM Scaffold System™ is an interlocking mesh that is sutured to the exterior trachea to reshape and strengthen it. Over time, tissue encapsulates the mesh to further support the airway. Lazzaro Medical is seeking FDA approval for the scaffold system. Dr. Lazzaro and his team have also designed a new kind of dual lumen endotracheal tube that simplifies and streamlines the robotic TBM procedure. Current double lumen tubes used in these types of procedures must be repeatedly deflated, moved, and reinflated to allow for delicate suturing. These actions create significant risk of losing control of the airway. Loss of the airway during surgery can result in patient death. The LM Double Lumen™ is designed to de-risk and protect the airway during the robotic TBP while shaving off costly operating room procedural time. LM Dual Lumen™ is designed to collapse in place, allowing the surgeon to apply sutures without moving the tube and significantly reducing the potential of “losing” the airway during surgery. Additionally, the LM Dual Lumen™ has the potential to disrupt the dual lumen endotracheal tube business across multiple procedures beyond TBM repair. startuphealth.com 47

Finally, Lazzaro Medical is developing the LM Scope™, a diagnostic tool for use by ENT doctors and other pulmonary specialists during in-office visits to rapidly diagnose TBM earlier and more effectively. The LM Scope™ is being designed to replace the more complex and costly dynamic CT scan and bronchoscopy. why we’re proud to invest

When you hear directly from a patient who has undergone Dr. Lazzaro’s minimally-invasive TBM surgery, the impact hits you in the heart. A quick YouTube search reveals a CBS News in New York interview of one of Dr. Lazzaro’s first robotic TBP patients. The man, in his mid-60s, had a debilitating chronic cough which kept him from sleeping more than 15 minutes at a time. It was slowly killing him. Dr. Lazzaro reconstructed the man’s airway using his new robotic TBP procedure. When the CBS interviewer asked the man if the procedure was a success, he broke down. “Such a game changer,” he says in the video, wiping tears from his eyes. Then the interviewer asks, “Did [Dr. Lazzaro] save your life?” The man nods, holding his head in his hands, too overcome to speak. StartUp Health is proud to back Rob Israel, Dr. Lazzaro, and the entire Lazzaro Medical team because they can save millions of lives just like this man and the woman from six years earlier, people in need of a miracle. With smarter, safer surgical procedures and tools, thoracic surgeons can literally breathe new life into people gasping for their breath. We’re also bullish on Lazzaro Medical 48 StartUp Health Magazine / DEEP IMPACT

because thoracic surgeons, ENT doctors, and other pulmonary specialists have only begun to scratch the surface on curing TBM. “The future of TBP seems bright,” writes Dr. Lazzaro et. al. in The Journal of Thoracic and Cardiovascular Surgery. “TBM is a vastly underdiagnosed condition that has remained virtually untreated for decades. The prevalence of TBM has been estimated to be as high as 10% in the general population, but data from the Society of Thoracic Surgeons General Thoracic Surgery Database shows only 262 tracheoplasties performed from 2002 to 2017.” Finally, we’re excited to back Lazzaro Medical because it represents a critical component of the Longevity Moonshot. The trachea is made of cartilage and breaks down over time. We strive to live longer, healthier lives. To do that, we need to cultivate technologies that allow us to breathe deeply and get the oxygen we need to think, sleep, and live with vitality — at every age. 4 LAZZAROMED@STARTUPHEALTH.COM

HEALTH TRANSFORMERS (L-R) HEALTH TRANSFORMER Islam Mansour, CEO & Co-founder Maureen Fura, CEO & Founder Ahmed Abdelkader, CTO & Co-founder mammha@startuphealth.com mygenomd@startuphealth.com

MygenoMD Is Making Genetic Health Data Accessible and Actionable Islam Mansour was working as a pharmacist in Germany when he realized that too many medications are one-sizefits-most. Now, with the MygenoMD platform, he’s helping patients understand and access genetic testing in order to personalize their care.

ACCESS TO CARE MOONSHOT VINTAGE: 2022/Q1 MYGENOMD.COM

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No two patients are exactly the same, yet when it comes to medications and healthcare procedures, we live in a one-size-fits-most world. Exciting new technology has given birth to the idea of “personalized medicine” — where treatments are tailored to the individual — but the field still has a long way to go to reach the average patient. Nowhere is a patient’s uniqueness manifested more clearly, or beautifully, than in their DNA. Embedded in a person’s genetic profile is one of the keys to personalized medicine. Our DNA can shed light on our future disease risk and help us understand how we’ll respond to treatments. There’s been an explosion in the availability of genetic tests in recent years, led by consumer-focused companies like 23andMe and Ancestry.com. One estimate suggests that there are 75,000 genetic tests available. Yet they’re still seen as a novelty, even a hobby, rather than as a foundational part of everyday health. The gap between the power of genetic testing and its usage in daily health is part mental/emotional and part logistical. It starts with basic knowledge. Many patients don’t know what a genetic test is, how to get one, why it’s important, or how to use it to guide health decisions. Other patients know the power of genetic testing, but don’t want the information for fear that it will tell them something negative that dooms the rest of their life. Logistically, if a patient understands the power of their genetic information, and gets a DNA test, they may find it difficult to get that information interpreted. There

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are very few genetic counselors relative to the population, even in the world’s most advanced healthcare systems. Patients can wait months to meet with a specialist. Finally, there’s the technical challenge of integrating genetic information into a person’s health record. Today, this information is largely siloed, held apart from electronic health records, which makes it difficult for physicians to act upon it. In this gap steps Islam Mansour, CEO and Founder of MygenoMD. With their platform, Mansour and his team are helping patients understand genetic testing, get tested, and then integrate that data into their routine healthcare in order to live longer, healthier lives. origin story

Islam Mansour was working as a pharmacist in Munich, Germany, when an old idea began to take a new shape. It all started with his patients, in whose faces he saw reflections of his own family. Mansour had a long family history of chronic disease, including his aunt who died of cancer and his mother who had diabetes. Even as a young man, Mansour had contemplated this health history and how it might shape his own life. He tried a number of preventative health solutions off the shelf in the hopes of changing his health trajectory, but none felt specific to his situation. These questions led Mansour to study computer programming and bioinformatics before completing a degree in pharmacy. When he finally began seeing patients as a pharmacist, he was in a problem-solving frame of mind.

The next phase is to integrate a patient’s genomic data into continuous remote monitoring systems and then share that information with physicians on a dashboard that is actionable and highly integrated with the patient record. That will “create a new dimension in the healthcare experience,” says Mansour.

What he witnessed as he dispensed pills was that patient after patient was getting a drug or therapy that wasn’t specific to their needs. “We waste a lot of money on drugs that don’t work,” says Mansour. “According to the pharma giant GSK, 90% of drugs work on only 30–50% of people.” The answer? Use a patient’s genetic profile to personalize every patient’s health

experience. Mansour could see that in the macro health market, genetic testing was exploding. Yet at the pharmacy counter every day he met patients who didn’t understand the value of these tests, and therefore weren’t benefiting from the science. So Mansour launched MygenoMD and set about to create a patient-friendly app that could weave a patient’s genetic data into their daily health decisions. In the short time since launch, Mansour and his team have inked five major partnerships, enabling them to reach more than 300k patients. They’ve also taken part in the P4 Accelerator Programme, which has helped them expand their footprint to the UK and secure partners like the NHS. The next step is to take their early learnings in Germany and establish a headquarters in the United States. under the hood

Like a helpful pharmacist, the foundation of the MygenoMD app is education and communication. Information about genetic testing is delivered through a virtual assistant, a chatbot that answers common questions in a way that engenders trust. What is a genetic test? How do I get tested? What do my numbers mean? Answers are just a click away. In his research, Mansour has found that trust is a major barrier to patients getting and using genetic data. This is sensitive information and people need to know they’re in safe hands. One way Mansour is building trust is delivering the app through the avenue of the local physician. They’re working with doctors their patients already know. startuphealth.com 51

MEET THE HEALTH TRANSFORMERS / MYGENOMD

As Mansour builds out features, MygenoMD will become a secure repository for a patient’s genetic data, and then a telehealth hub for finding a physician and getting care on the go. The next phase is to integrate a patient’s genomic data into continuous remote monitoring systems and then share that information with physicians on a dashboard that is actionable and highly integrated with the patient record. That will “create a new dimension in the healthcare experience,” says Mansour. “Physicians will be able to monitor their patients remotely and deliver personalized information, leading to better clinical decision-making and efficiency.” Pharmaceutical companies have already approached MygenoMD to help them reach patients with information about new drugs that could be tailored to a genetic subset of the population. As a result, Mansour is developing tools for pharmaceutical clients aimed at speeding up clinical trials and bringing more personalized medicines to market. why we’re proud to invest

The COVID-19 pandemic has reshaped our thinking about health in inextricable ways. Part of that evolution has been the increased understanding that while we’re one global community, we each have a unique health profile and journey. We’re proud to back Islam Mansour and his team at MygenoMD because they understand this changing moment and are building the tools for tomorrow’s patient journey. More importantly, we’re proud to back MygenoMD because applying genetic data 52 StartUp Health Magazine / DEEP IMPACT

to routine healthcare has the ability to help millions of people live longer, healthier lives. We have at our fingertips the tests needed to understand future disease risk. If used wisely, these are the kinds of signposts in the road that can steer a person towards healthier choices, even save their life. Genetic information can help people get tested for diseases earlier, potentially catching cancers sooner and start life-saving treatment. We need more entrepreneurs like Mansour working on this overarching health moonshot of access, of putting the best of today’s health tools in millions more hands. Finally, we’re bullish on MygenoMD because they’ve got the ingredients for leapfrog innovation. Mansour, the child of an Egyptian family, began his professional life in Germany, and is now bringing his company to the United States. By taking the best of each world and learning from cultural differences, MygenoMD has the potential to think more creatively about today’s health challenges. We need entrepreneurs who think about health technology and access with a global lens, unconstrained by the norms of a single nation or culture. Islam Mansour and his team are still in the early stages, but we’re incredibly excited to see how their platform makes genetic data more accessible and actionable to patients. Join us in welcoming MygenoMD to the StartUp Health family. 4 MYGENOMD@STARTUPHEALTH.COM

MEET THE HEALTH TRANSFORMERS

Cognishape Helps Seniors Fight Cognitive Decline With a Chatbot Grounded in Science Co-founders Oren Meir, Gal Nachum, and Dr. Daniela Aisenberg have joined forces to revolutionize the cognitive training industry with a virtual tool that builds brain function in practical ways that improve everyday life. BRAIN HEALTH MOONSHOT VINTAGE: 2022/Q1 COGNISHAPE.COM

HEALTH TRANSFORMERS (L-R) Oren Meir, CEO & Co-founder Gal Nachum, Chairman & Co-founder Daniela Aisenberg, PsyD, Chief Scientist & Co-founder cognishape@startuphealth.com

Older adults are the fastestgrowing age group in the world. In many regions, the population aged 65 will double by 2050, and the latest population projections estimate the number of people aged 80 or over will triple in the next 30 years. At the same time, more than 40% of people over the age of 60 cope with known cognitive issues, and a billion people in the world right now don’t feel like their cognition is what it used to be. If you are one of these older adults, there are two main options for fighting cognitive decline. The problem is that the option that works isn’t widely available and the option that is widely available doesn’t work. For instance, after experiencing a medical trauma, a person might receive neuro-pyschological

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rehab that improves daily cognitive function. This is the first option, one that uses proven, effective methods for cognitive training. But it’s available only in a limited fashion, provided by a few specialists in a few particular circumstances. Because these methods aren’t available to the general population, consumers turn to option two to sharpen their minds: brain games. It’s a huge market; more than 250M people use this type of product. However, these games don’t actually show real-life efficacy. In 2014, 69 leading neuroscientists at Stanford University and other institutions issued a statement that the scientific evidence does not back up the claims that these brain games improve cognition. Essentially, what researchers found was that what happens on the screen stays on the screen. Playing the game sharpens your cognitive skills, but only within the game itself. It doesn’t translate outside of the game into daily life. This is known as ecological validity; a term in psychology for how test performance predicts behaviors in real-world settings. There’s nothing wrong with playing a round of Sudoku or Words With Friends, they just can’t help you remember your third grandchild’s name or plan your day better. There’s a disconnect, then, between what actually works to improve cognition and what people can access and use in their ordinary lives. The neural-plasticity revolution revealed that the brain is flexible and can train and change. There is a growing population that wants to know how. Cognishape exists to bridge that gap between effective methodology and the 54 StartUp Health Magazine / DEEP IMPACT

vast population of older adults, now, and in the future, who deserve real tools with real benefits. origin story

It all started with a midlife crisis. Oren Meir, a seasoned entrepreneur in Israel, was looking at his career and wondering, “what is my legacy?” He was proud of what he had done and enjoyed the successes that came along the way, but he wanted something more. He wanted the next chapter in his life to revolve around impact. What could he make that could improve many people’s lives? Meir became attracted to the longevity industry. From a business perspective, it was a rapidly growing, relatively untapped market. From an impact perspective, using technology to solve big problems for a population that is largely overlooked felt like a worthwhile challenge. “Startups are usually young people who want to do stuff for other young people,” says Meir. “This entire population, which is the world’s largest and going to become larger, is ignored because it’s not as sexy.” As Meir began exploring options, a mutual friend mentioned that Gal Nachum, another entrepreneur active in the Israeli market, was also playing around with ideas for the longevity space. Meir and Nachum put their heads together and started researching and asking questions. They quickly came across the problem of cognitive decline and the disconnect between what scientists know actually helps and the kind of “brain games” available en masse. “There’s an ability to train the brain but

no one has made the solution widely available. Everyone is waiting for it to come,” Meir explains. The bones of what Cognishape would become started to take shape, but they needed an expert in neurological science to flesh it out and design the interventions that actually worked — an expert like Daniela Aisenberg, PsyD. Dr. Aisenberg is a clinical psychologist and the head of the Clinical Psychology of Adulthood and Aging MA program at Ruppin Academic Center. Her career centered on identifying cognitive abilities that decline with age and finding easy, low-cost interventions that can improve and moderate such decline. “I clearly remember the phone call I received from Gal,” says Dr. Aisenberg. “I was at the door of a meeting, and he called me and I couldn’t stop talking to him.” What hooked her was the idea of making some of the interventions that she knew worked — the things she did in her lab with one student and three older adults — available on a massive scale. “I didn’t know startups. But he was talking to me about my area of expertise and exactly the thing I’ve been trying to do: make interventions that work for cognitive decline more accessible to older adults.” Together, the three dreamed up a tool that would take what worked in the lab and bring it to the world. They knew it needed to be simple, without a high technological barrier to entry. They didn’t want a user to have to learn new skills to get started. They wanted to find an ordinary, familiar way to engage with older

adults. The answer was instant messaging. “People know what to do with a chat interface,” says Meir. “They know how to send and receive messages. They do it with their kids and grandkids, and they can do it with Cognishape.” under the hood

At its core, Cognishape is an AIdriven conversational tool that delivers clinically-proven cognitive interventions through daily tasks that the user performs in their own home or living situation. It is available through multiple familiar interfaces: text messaging, What’sApp, FB Messenger, Amazon Alexa, Google Home, and more. Instead of expensive weekly sessions with an expert that require access, scheduling, transportation, and assistance, Cognishape is available to its users wherever they are, whenever they want, helping support aging-in-place and autonomy. Three times a day, Cognishape reaches out to the user and asks them to perform a task that lasts about five minutes. The tasks vary to address the many different components of cognition, not just memory retrieval. For instance, Cognishape might ask someone, “What is the longest distance you can walk between two places on the same floor in your house?” Once they’ve responded, Cognishape will ask them to try doing it. A task like this addresses visual perception, mental manipulation, working memory, spatial attention, and magnitude perception. Or, Cognishape might have the user ask a friend or family member for five random words. If there is no one to supply those startuphealth.com 55

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words, Cognishape supplies them itself. Next it asks the person to create a short story using those words, tapping into selfcompetence and verbal fluency. Based on the responses it receives, Cognishape personalizes and optimizes the experience for the user, varying the levels of difficulty and complexity of the tasks, making sure the user is challenged but not frustrated by the experience. Because training the brain with these tasks takes time and dedication, the founders knew they had to pay particular attention to retention. How do you keep people coming back day after day? Through their pilots, they found a few main motivating factors for their customers. The first was the perceived value of the tasks. Some of this perceived value came from the customers feeling like the skills from the app actually transferred to their daily functioning, while some of it was simply enjoying the novelty of the assignments, like being told to call a friend and tell them a joke. It became a bright spot in their day. One woman reported that when her husband had to go through surgery and she was in the hospital by his side, Cognishape got her through that time by providing moments of excitement and happiness each day. Another main motivating factor that kept people going turned out to be the relational component. Over time, users develop an emotional connection with Cognishape, giving it nicknames, apologizing if they missed a task, even teasing the bot when it glitched. Loneliness is a major contributing factor to cognitive decline and has been found to increase the 56 StartUp Health Magazine / DEEP IMPACT

risk of developing dementia by as much as 20%. The mere fact that Cognishape initiates communication with its users, contacting them three times a day, creates a sense that there is an entity that cares for that person, that knows they exist and wants the best for them. “One of our users had some issues in her life. Her family was far away and when her dog died, she felt alone in the world,” Dr. Aisenberg recalls. “She wrote to say

how meaningful Cognishape was for her, saying ‘Cognishape, you held my hand.’” The three founders just spent over a year validating their hypotheses, making sure that Cognishape provided measurable cognitive improvement in the areas it is designed for, while retaining users. “We wanted to make sure we had a working product; that we came with something real in our hands, something real to offer,” Meir emphasized. Now that they know it is real, they are rounding out their team, recently adding a natural language processing (NLP) and chatbot expert to lead the technology development. They just fundraised $1M in a pre-seed round and are looking for additional partners, with a preference for US-based investors to spread their reach. why we’re proud to invest

When StartUp Health announced this year that we were launching a dedicated health moonshot to address Alzheimer’s, it was a call for innovation. It’s a call driven less by market opportunity — though there’s plenty of that, as with any great challenge — but more by need and impact. Call it a silver tsunami or the gray swell, whatever you like, the number of people over 65 is ballooning to a degree that will reshape nearly every aspect of life for decades to come. And on the forefront of every aging mind — literally — is the specter of cognitive decline. This fight to repair and train the mind represents the front lines of the battle for healthy aging, so we’re incredibly proud to support Cognishape as they take a leading role in the effort.

We’re also excited to back Meir and his team because their tool represents a needed evolution in technology. With the proliferation of smartphones, we saw the explosion in “brain games” like crossword puzzles and Sudoku. These became version one in the digital fight against cognitive decline. Rather than build another brain game, or merely tweak the old models, Meir, Nachum, and Dr. Aisenberg are building a new framework based on clinical evidence. It’s true innovation in a field that has seen too much repetition. We’re proud to back Cognishape because of their laser focus on accessibility. For decades, we’ve had well-researched cognitive tools to help patients recover from brain injuries. But these tools have been locked up, only used by a tiny group of specialists. Cognishape is doing the hard technical work to make those tools scalable and available to an entire generation of people. “We want as many older adults as possible to have Cognishape in their lives,” says Meir. “We’re all aging, there’s no point in fighting or denying it. It’s time to make it a good thing. And that’s what we’re here for.” 4 COGNISHAPE@STARTUPHEALTH.COM

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HEALTH TRANSFORMERS John Hatchell, CEO & Co-founder Bart Cant, CTO & Co-founder tydei@startuphealth.com 58 StartUp Health Magazine / DEEP IMPACT

MEET THE HEALTH TRANSFORMERS

TYDEi Health Is Using Web 3.0 Tech to Modernize Hospital Supply Logistics and Transactions Fifteen years in medical device sales taught John Hatchell that hospital supply logistics were inefficient and dangerous. So he and his team built a blockchainpowered platform to bring transparency and accountability to the entire process. COST TO ZERO MOONSHOT VINTAGE: 2022/Q1 TYDEI.IO

When a patient goes to the hospital, whether for routine care, emergency surgery, or anything in between, they only see the tip of a very big iceberg. If they need surgery, they only care that the procedure is done right, not that stock rooms are organized or that implantables have been purchased on time. Behind the doctors, nurses, and clerks is a vast infrastructure of products and supplies that have to be managed from minute to minute. Under today’s healthcare paradigm, some of that stock is owned and tracked by the hospital, and some by outside vendors, like medical device manufacturers. In other words, critical, life-saving equipment and supplies are tracked on two separate systems that often can’t communicate with one another. Today, there’s no shared database for

inventory that lets everyone at a hospital know that they’re prepared for every procedure. Instead, inventory is often tracked by sight — literally a nurse or clerk has to check the shelves prior to surgery. That “system of trust” where humans are expected to be accurate 100% of the time leads to inevitable inaccuracies and lapses. Depending on the size of the facility, there can be millions of dollars worth of inventory that is unaccounted for by both the hospital and the device vendors. That extrapolates out to nearly $200B in product across the United States. How many patients are negatively affected by a lack of coordination in hospital logistics? It’s a difficult number to pin down, but every time a nurse or clerk has to search for a supply or re-order a device, time is wasted and care is delayed. There’s a lack of digital accountability about what supplies are where and who

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MEET THE HEALTH TRANSFORMERS / TYDEI HEALTH they belong to. What if that system of trust could be replaced with a system of truth? Founder John Hatchell and his TYDEi team are using blockchain technology to do just that — upgrade hospital inventory to save time, money, and ultimately patient lives. origin story

For fifteen years John Hatchell and his co-founder Charles Weidman worked in the fast-paced business of medical device sales. John was a Stryker rep, selling to orthopedic surgeons. Because he was repping expensive and complex equipment, he needed to know everything about the devices and their capabilities. That knowledge earned him a place in the surgical suite on a daily basis, not only advising on equipment availability but actually consulting on the surgery itself. It also gave him a 360-degree view of the healthcare machine. “It’s an interesting business,” says Hatchell. “You get to experience healthcare at the ground level in a way that most people don’t. You’re working in every area of the hospital, from shipping and receiving to sterile processing to stock rooms to the surgical suite.” Not to mention program launches with Csuite executives and direct sales to clinics. Hatchell saw everything. Hatchell left his job in device sales in early 2020, two weeks before COVID-19 shut down the United States. As he plotted his next move, the challenges he’d witnessed in healthcare gnawed at him. He began to do a deep dive into blockchain technology, wondering if the world of Web 3.0 could hold some of the 60 StartUp Health Magazine / DEEP IMPACT

answers he was seeking. As he learned more about distributed ledgers and smart contracts, he started to see a way that this technology could solve some of the biggest problems in hospital logistics. “Blockchain has all of this promise, but it also has a lot of implementation challenges in healthcare,” says Hatchell. “There’s a lot of red tape and bureaucracy. When you talk about healthcare, you’re actually dealing with multiple oligopolies that are well established. Not only do you have to find the right use cases for the technology, but you have to get people to adopt it.” Finding that right product-market fit to connect Web 3.0 technology and hospital supply chain turned out to be the secret sauce, and when Hatchell grasped it, TYDEi was born. Together with his co-founders Charles Weidman and Bart Cant, Hatchell set about bringing a new perspective on blockchain to the world of healthcare. under the hood

At TYDEi, Hatchell and his team have built a platform that modernizes the management of the medical device supply chain, taking the process from an administrative mess to a smooth retail-like experience. They’re doing this through a blockchain-enabled system that creates a transparent, real-time marketplace between hospitals and vendors. It starts with cleaning up the data. TYDEi looks at what products are utilized in a procedure, captures that data, and makes sure that data is standardized with the records of the FDA. “That piece is a challenge,” says Hatch-

ell, “because that information has historically been put into systems using a shorthand. So we standardize that data so it’s easy to curate. It makes the data more useful.” No more will facilities have to rely on paper-based processes where a record of what is being utilized is represented by a sticker on a paper. No longer will they photocopy that paper and send it to multiple departments in order to recognize the product that was utilized, track the product, and then offer payment for it. “Our smart contracts are able to automate all of that. We kick off purchase orders from the time products are scanned and validated safe for use in the operating room. We skip multiple steps of paperwork, redundancy, and bureaucracy. Then we share the data record instantaneously with the vendor as well.” They also use smart contracts to validate products for product safety and compliance. Right now, when a product is used in a procedure, the only people who can really validate that those products are safe to use or are being used as intended are the provider and, maybe, the sales rep who is in the room providing some quality control. TYDEi is built for the nurses tasked with taking a record of the products that are used in a surgery. It’s also built for purchasing teams and administrators, so they have tools for managing costs and waste. They can look at their spending more accurately and the value of the products that are on their shelves. They can spot waste and abuse earlier, and manage their facilities accordingly.

why we’re proud to invest

We’re proud to back John Hatchell and his team because while they’re hardly the first to apply blockchain technology to healthcare, their angle is a fresh one. By leveraging their combined 30 years in enterprise medical device sales, TYDEi is coming at the industry with an insider’s understanding of hospital operations. Their experience also makes them extremely pragmatic, knowing how to balance the needs of inside and outside sales teams, surgeons, nurses, and C-suite executives. John and his team have seen and experienced the antiquated paperbased systems holding hospital logistics together, and they’re fixing the problem from the inside. We’re also proud to back Hatchell and his team because they’re seeing early positive results. They’re currently in the throes of a hospital pilot where they’ve gotten high marks for user experience and money saved and they’ve got another major partnership in the works for authorizing/ facilitating payments. Much more on this front coming soon. Finally, we’re excited to invest in TYDEi because they’re on a mission to drive down healthcare costs by tackling one of the most complex, entrenched problems in health. By streamlining medical supply logistics, TYDEi can hit multiple goals at once. They can make patients safer, decrease hospital waste, drive down costs, and improve the worklife of healthcare providers. That’s a health moonshot mission we can heartily get behind. 4

TYDEI@STARTUPHEALTH.COM

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HEALTH TRANSFORMER Marco Paschina, CEO & Founder akenta@startuphealth.com

Akenta Health Is Fighting Heart Disease with Their High-Touch, Mobile-First Platform Marco Paschina is taking lessons he learned as a fintech founder to improve care for the millions of people with cardiovascular disease, combining physician assessments with hands-on health coaching. 62 StartUp Health Magazine / DEEP IMPACT

CURE DISEASE MOONSHOT VINTAGE: 2022/Q1 AKENTAHEALTH.COM

Every 36 seconds, someone in the United States dies of heart disease. That’s one in four deaths. Heart disease, an umbrella term that covers conditions like cardiovascular disease (CVD) and coronary artery disease (CAD), is the world’s biggest killer, claiming the lives of more than 17 million people each year globally. It’s also breaking the bank. It’s estimated that heart disease costs the United States around $363 billion a year. With the world’s population getting older, these risks and costs are on an aggressively upward trajectory. So why does this deadly and costly disease so rarely make headlines? One reason is that it progresses so slowly. One day your doctor tells you you have high cholesterol, and it’s likely genetic. You do nothing. Two years later it’s a little higher, and you’ve stopped exercising. Three years later you’ve gained 15 pounds around your middle and your blood pressure is higher. Not to mention that you’ve been socially isolated and mildly depressed due to a global pandemic. Taken alone, each factor and behavior seems benign, but together, over time, they are quietly injuring the heart and the blood vessels that keep you alive. We also struggle to tackle heart disease because the habits and behaviors that put us in danger are so difficult to change. Eating junk food, drinking alcohol, ignoring exercise, and smoking cigarettes — for many people, the behaviors that contribute to heart disease read like an itinerary for a great weekend. And for those who do want to change their lives for the healthier, many end up in a vicious cycle of broken New

Year’s resolutions. Finally, we fail at addressing heart disease because of a basic lack of knowledge. Most people who have heart disease don’t know they have it. Research has shown that eight in 10 cases of heart disease can be prevented by managing healthy lifestyle choices and risks, but we can’t fight what we don’t see or comprehend. For all of these reasons, and a few others, serial entrepreneur Marco Paschina stepped up to the plate and created Akenta Health, a platform for helping people understand and manage heart disease so they can live longer, fuller lives. origin story

Marco Paschina was born and raised in Milan, Italy, but he had his sights set on the United States. The first stop was Boston for a degree in finance and entrepreneurship from Boston University. He dipped his toes into the world of consulting with a stint at Price Waterhouse Coopers and was almost lured to New York City for a longer-term gig, but a chance encounter his senior year changed his trajectory. Paschina was running a fintech club at Boston University when a friend from Colombia approached him. He told him about how many young people in Colombia are unable to attend college because there aren’t good financing options. They simply don’t have access to banks. Paschina was intrigued. Maybe this was a way he could build a company while making a difference in the world. They came up with an online solution for offering more accessible student loans in Colombia. After a year working on the startuphealth.com 63

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project from Boston, Paschina packed his bags and moved to Bogotá to take the startup to the next level. “I always wanted to do something that could have a social impact,” says Paschina. “Knowing that I could make a business and also help thousands, even millions, of people, made me happy.” In less than three years, the company — which was bootstrapped and profitable — financed more than 50,000 students. In 2020, Paschina began looking for his next business challenge. Because of his global business exposure, he had a sense that the digital health movement happening in the United States was going to continue to grow, and that Latin America and Europe would follow similar trends. He also observed that many of the founding principles of fintech that he’d been working with were being ported over to healthcare. What brought it all together was his family. Paschina had two grandparents die of heart disease and his father, aunt, and uncle all have high blood pressure, putting them at high risk for the disease. In his own father he observed the challenges of addressing such a quiet and progressive disease. Sometimes he’d take his medications, sometimes he wouldn’t. Some days he’d try to be healthier and exercise, then he’d stop altogether, not having seen any visible results. So he asked himself, “How can I leverage technology to make life easier for people like my dad?” The result of that question was Akenta Health, a mobile-first platform that utilizes heart assessments, education, and regular health coaching sessions to 64 StartUp Health Magazine / DEEP IMPACT

make heart disease prevention more comprehensive and heart-healthy habit change more sustainable. under the hood

Akenta Health starts with an online screening. Patients are taken through what’s called a 10-year ASCVD risk assessment, which measures their risk of having a cardiovascular problem, like a heart attack or stroke, in the next 10 years. As a part of that process, the patient is sent a welcome pack complete with a blood pressure cuff and an at-home lab test. Using that data, patients are stratified into risk categories. Those who fall into the middle range — at risk of future heart disease but not yet an emergency — are invited to join the program. Those who are low risk don’t need the program, and those who are high risk are referred to specialty care. The patient then has their first meeting with their assigned physician, held virtually on the app. Together, the patient and physician review their health picture and set major health goals. That leads to an introduction to a health coach — a registered dietician — who takes that framework and works with the patient on micro-goals. Akenta is a combo therapy that pairs pharmaceuticals with lifestyle coaching. Every month, the patient meets with the same physician to recalibrate medications and revisit health goals. The other three weeks of the month the patient meets with their health coach and gets into the details of habit change. The key here is end-to-end continuity and consistency. “With chronic conditions, you really

need to develop a relationship with your doctor,” says Paschina. “That’s when they start to feel comfortable with changing their lifestyle.” While the physicians and coaches on the platform are independent contractors, they are paired with the same patient for the duration of their care in order to build trust. Akenta charges a per-member-permonth (PMPM) fee, not per visit, in order to encourage providers to slow down and focus on long-term goals. Akenta has completed a clinical trial with an initial batch of patients and is quickly moving towards commercialization. When fully launched to the public, it will be a unifying platform, bringing together the often-disparate sectors of heart health, like assessments, medications, education, and coaching. It will also be a companion for the millions of people who are anxious about their heart health but just don’t know where to start. why we’re proud to invest

Even though Marco Paschina was living in Bogotá, Colombia, when he conceived the idea for Akenta Health, his mind was in Italy with his family. He has built a mobile-first solution for fighting heart disease in order to help people like his father, aunt, uncle, and grandparents. We’re proud to back a founder whose personal experience drives him towards a commitment to global impact. We know how important this is as a driver when the road gets bumpy. But while a single family sparked this entrepreneurial journey, the potential impact is as vast as it comes. We’re proud to invest in a mobile-first platform that ad-

dresses the biggest killer in the world, heart disease, and offers hundreds of millions of people the chance to live a fuller, longer life. We’re also excited to back Paschina on this journey because his previous experience and fintech knowledge sets him up for the challenges ahead. While helping Colombian students get better college loans, Paschina learned the ins and outs of B2B2C sales. He worked through universities to get to individual student clients, which required distinct and complementary sales strategies. He’s putting that exact same skillset to work at Akenta, selling the platform to patients through the avenue of their insurer. All of the lessons Paschina learned in customer acquisition and enterprise sales will pay dividends in his new venture. “As I work on Akenta, I notice how health tech is following a similar pattern as I saw in fintech,” says Paschina. Finally, we’re bullish on Akenta because while the United States is the initial target market, Paschina has the heart and knowledge to go global. “The next digital health boom is going to be in Latin America. What’s happened in the United States in the last 20 years is going to happen in Latin America in the next 20.” Paschina has experience innovating in Europe, the United States, and Latin America, and we’re excited to see how he uses that foundation to leapfrog forward and create something original, for the good of the whole world. 4 AKENTAHEALTH@STARTUPHEALTH.COM

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WAVR Uses Immersive Media to Improve the Patient Experience and Reduce Costs An all-star team representing surgery, interactive multimedia, and healthcare technology have joined forces to harness the power of virtual reality in the doctor’s office — with the goal of reimagining the patient experience and reducing the use of dangerous sedatives.

END ADDICTION MOONSHOT VINTAGE: 2022/Q1 WIDEAWAKEVR.COM

HEALTH TRANSFORMERS Joseph Gough, Co-founder Steve Woolf, Co-founder James Clarkson, MD, Co-founder wavr@startuphealth.com

There are many reasons to feel anxious in medical facilities. Human beings of all ages endure their fears, phobias, and legitimately painful procedures every day of the year in every hospital across the country. The provider burnout exacerbated during the pandemic has made matters worse. Our dedicated frontline healthcare workers are absorbing the stress and anxiety of patients. This unsustainable patient/provider dynamic of stressful fear and anxiety is reaching a boiling point. WAVR delivers a powerful new tool to fix this omnipresent problem and not just in invasive medical procedures. The minor surgery world is also being disrupted. Hand surgery, for instance, is one of those niche areas of healthcare that you might not think much about. But when someone you love needs it, nothing is more important. And, it turns out that it’s actually not that niche either. Each year in the United States, there are more than 400,000 carpal tunnel release surgeries performed — one of the

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James Clarkson, MD, Chief Medical Officer and Co-founder at WAVR, stands in front of a portrait of Sir William Bowman, father of ophthalmology, and next to a bust of William Arbuthnot Lane, who invented orthopedic plates and sterile technique. Clarkson can claim both men as distant relatives, and he uses that connection to history to spur innovation.

most common hand surgeries — not to mention the hundreds of thousands of hand injuries requiring tendon repair, skin grafts, skin flaps, and fracture reductions. Usually, when a patient is told they need an upper extremity surgery, they are

offered a surgery time slot in a hospital operating room where the surgeon has privileges. That decision kicks into gear an entire industrial apparatus. The operating room, which comes with a hefty facility fee, requires ancillary staff for pre-operative workup, peri-operative sup-

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MEET THE HEALTH TRANSFORMERS / WIDE AWAKE VR

port, and post-operative step-down. Add to that the cost of an anesthesiologist and you’ve got a sizable medical bill on your hands. What the patient may not know is that surgeons are required to maintain what’s called “block time utilization.” In order to preserve their ability to perform these surgeries, the surgeon must consistently fill that block of time with patients. The result is a misaligned incentive when it comes to deciding which patients need the full operating room experience and which patients can be more safely managed in the doctor’s office. There is a movement afoot to move more minor surgeries out of the expensive operating room and into the doctor’s office, where they can be handled faster and safer, under local anesthesia. One recent study published in the journal Plastic and Reconstructive Surgery showed that performing these hand procedures in the office took half the time. Even more impressive were the findings surrounding trigger finger tendon release, where the costs were decreased by a whopping 70% per finger, with no changes in quality scores. The risk of over-utilizing operating rooms and industrial hospital workflows isn’t just financial. Older patients can experience delirium, even to the point of long-term cognitive decline, after receiving general anesthesia. For younger patients, using general anesthesia or sedation for a simple hand surgery still carries risk factors and is far less convenient. The anesthesia makes it necessary to miss breakfast, avoid diabetic medications, and find a ride to and from your lengthy surgi68 StartUp Health Magazine / DEEP IMPACT

cal appointment. General anesthesia can also cause nausea and/or vomiting and requires some patients to have clearance from cardiologists or other specialists. So that brings us back to the surgeon’s office. A hand surgery needs to be performed, but the patient is nervous. They want to be “knocked out” so that they don’t have to witness the event. What if there was a way to accomplish this while avoiding the expense, risk, and inconvenience of the operating room and general anesthesia? Dr. James Clarkson and his team at Wide Awake VR are tackling this challenge by using virtual reality during surgery, and their results could change the game completely. origin story

James Clarkson, MD, FRCSC, FRCS, MSC, is a plastic surgeon who trained in the British National Health Service (NHS) for 12 years before moving to the United States in 2008. He has been working as an attending in Lansing, Michigan, since 2010, performing everything from head and neck microvascular reconstruction to more basic leg reconstructions, before finally focusing on hand surgery. Over the first eight years he saw what he thought were a few surprisingly bad outcomes from routine surgeries. He saw a death in someone who just needed a leg flap and a stroke in someone who just needed a tendon transfer on the back of her hand. When he explored the root causes behind these bad outcomes he discovered that in the world of operating room surgery, complications had become part of the business. So he dug deeper.

Once they put on the headset, the patient is transported: to a foreign land, to watch a documentary, or to come face to face with a celebrity. This still is from an immersive experience about life in the White House created by Felix and Paul.

Clarkson has always taken a historical perspective to his work as a surgeon, preferring to put today’s challenges into a 100-year context. That’s in part because he is a direct descendent (his grandmother’s grandfather) of Sir William Arbuthnot Lane, a famous British surgeon from the turn of the 20th century. Lane was a pioneer in the use of sterile techniques in surgery, like gowns, gloves, masks, and he invented the first orthopedic plates. To innovate in this way required Lane to go against the sacred cows of his time, like the notion that you never open a closed fracture for fear of infection. Clarkson holds this personal history dear and takes it as inspiration, even entitlement, to challenge the norms and assumptions of modern surgery. The irony that Clarkson discovered

as he questioned the troubling surgery complications around him was that the groundbreaking innovations achieved by his forebear had become the source of a new problem. We’ve taken the ideas and institutions around sterile operating environments and we’ve gone too far, says Clarkson, adding that we’ve reached a point of diminishing returns on the “industrialization of surgery.” Clarkson took it as a personal challenge in his practice to perform surgeries in the most appropriate location for the patient. He knew that many hand and wrist surgeries could be done quickly, safely, and cost-efficiently in his office, rather than in an operating suite under stringent sterile conditions and general anesthesia. So he began to educate his patients on the facts of being fully sedated for surgery. Many startuphealth.com 69

MEET THE HEALTH TRANSFORMERS / WIDE AWAKE VR

were still fearful of the idea and opted to be “‘knocked out” instead. Clarkson, like Lane before him, decided to fight this battle with innovation and the new tools of media technology. This time it was a virtual reality headset. Clarkson’s response to the anxious patient: “I won’t put you out, but I can put you somewhere else.” For over four years, Dr. Clarkson experimented with off-the-shelf VR platforms to distract patients from the anxiety and discomfort of hand surgery. This avoided the over-use of operating rooms and general anesthesia in many cases. However, the cobbled-together consumer VR tools were far from the streamlined solution he was seeking. Clarkson took his early body of work and published his findings in the Journal of Plastic Surgery in 2019. His presentation of these findings at a Southern California conference brought him back in contact with an old friend, David Wheeler. Wheeler is the former Creative Director at Electronic Arts (EA) and has been responsible for billion-dollar media franchises like “Medal of Honor.” Wheeler had been collaborating with a digital health entrepreneur on an immersive media venture and patented technology. That entrepreneur and inventor was Joseph Gough, and their medicinal VR company would soon become Wide Awake VR or WAVR. Clarkson joined the founding team at WAVR soon after. By deploying the WAVR solution in his practice, his entire workflow changed. Now the startup is working to develop new, more-effective 70 StartUp Health Magazine / DEEP IMPACT

VR content for surgery and to scale the idea in exciting ways. With the COVID pandemic driving so many patients away from the operating room, WAVR has now been used on hundreds of patients, which to Clarkson’s knowledge, is the world’s largest cohort of VR-immersed surgical patients. He surveys his patients about their experience during the surgery and is one of the only surgeons to have published research on the topic. under the hood

Today, Dr. Clarkson performs approximately 60% of his hand surgeries in the office, rather than in an operating room. In these cases, the patient is given a local anesthetic so they don’t feel the pain of the procedure. Then they’re offered a virtual reality headset in order to distract them. Once they put on the headset, they’re transported: to a foreign land, to watch a documentary, or to come face to face with a celebrity. “We’ve found that the presence of Barack Obama standing two feet away from you, talking to you in the oval office, is particularly compelling,” says Clarkson. The University of Michigan has also adopted the technology in a clinical trial within their pediatric surgery group. In this use case, children are underwater watching a giant blue whale swim past them. These types of award-winning content offerings are part of the transformational experience. The patient is still present enough to talk to the surgeon throughout the surgery. Clarkson likens it to driving a car while talking to someone. Your attention

is on the road, but you can continue to converse with the passenger. “That’s what VR does. It focuses their attention and makes their surgical experience a neutral, or even pleasurable experience, as opposed to a dreadful and frightening experience. We even give them educational post-operative information directly into the headset, so that they remain mindful of their post-operative recovery.” The type of content used by Wide Awake VR is critical. The object, however, isn’t to create a meditative experience, with waterfalls and soothing music, but rather to engage the mind. “There’s nothing more anxiety-producing than to be told to relax,” says Clarkson. “We want our patients intensely interested in what they’re looking at.” To that end, WAVR is in the early days of developing brand new content that will push the boundaries of engagement and distraction. For this they’re tapping the talents of Wheeler and his team of veteran interactive entertainment gurus. “We have so many ambitions about creating more content because there is still a total lack of VR material to fit these use cases.” why we’re proud to invest

Wide Awake VR occupies an interesting and important role in health innovation. While on one hand they are utilizing new tools and techniques (virtual reality), they are doing so with the end goal of reducing healthcare complexity. Put another way, they’re strategically inserting a bit of technology in order to significantly

ramp down our over-reliance on technology in the operating suite. We’re proud to back a company that isn’t just throwing more tech at a problem, but is rethinking resource allocation from the ground up, for the good of all patients. This requires bold thinking that challenges the status quo. We’re also proud to back the Wide Awake VR team because while they’re starting in the seemingly niche area of hand surgery, their approach tackles a massive triple objective. By reducing reliance on general anesthesia, WAVR is improving recovery times and reducing complications, particularly for older patients. By moving surgeries out of the operating room, they’re cutting cost and waste significantly. And by introducing engaging virtual reality, they’re turning an unpleasant experience into one that can actually be enjoyable and educational. Quality, cost, and patient experience are all getting an upgrade. Finally, we’re bullish on WAVR because they’ve assembled a uniquely powerful team. Dr. James Clarkson is a leading expert on the use of virtual reality in hand surgery, David Wheeler is an awardwinning video game designer, and Joseph Gough is a value-based healthcare technologist with deep industry experience. Dr. James Clarkson has already proven the power of VR in surgery. Now, having teamed up with the WAVR team, they’re taking the platform to the next level. We can’t wait to see what they build next. 4 WAVR@STARTUPHEALTH.COM

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HEALTH TRANSFORMERS (L-R) Raffay Mirza, CEO & Co-founder Labib Tazwar Rahman, Co-founder hueyhealth@startuphealth.com 72 StartUp Health Magazine / DEEP IMPACT

MEET THE HEALTH TRANSFORMERS

Huey Health Is Improving Care for People with Autism by Taking ABA Therapy Virtual Co-founders Raffay Mirza and Labib Tazwar Rahman joined forces to build a platform that could solve a care challenge they’d experienced in their own families. Now they’re sharing it with the world. CHILDREN'S HEALTH MOONSHOT VINTAGE: 2022/Q1 JOINHUEY.COM

Imagine this: after a year of visiting doctors and specialists and undergoing test after test, your child becomes one of the one in 44 children in the US who is diagnosed with an autism spectrum disorder (ASD). You’re told that applied behavioral analysis (ABA) therapy is the gold standard treatment for your child, but there are so few therapists available that you have to wait another six to 12 months before you can even begin. In the meantime, the medical bills are piling up and you’ve lost wages because of the time demands of caring for your child. Eventually, you get your child into regular ABA therapy only to discover that it takes an average of 15–30 hours a week. The therapist gives you “homework” — skills to practice with your child — but you’re so overwhelmed that you either forget about it or constantly feel like you’re doing it wrong.

This scenario is not rare. It’s the norm for family caregivers of people with ASD. The cost of caring for a child with ASD is approximately $60k a year, mostly through paying for special services and lost wages. While the financial burden is high, the time and emotional burden also take a toll on the entire family. No person has more than 24 hours in a day, and if a large portion of that time is spent meeting the needs of a disabled child, that’s time not spent with other children, your spouse, or meeting your own needs. An ASD diagnosis truly changes everything about a family’s dynamics. Raffay Mirza knows this all too well. His younger brother has ASD and he watched as it impacted every decision his family made. His father’s job meant they moved around quite a bit as he grew up, and Mirza saw the time and effort it took to establish and maintain a care routine and care prostartuphealth.com 73

MEET THE HEALTH TRANSFORMERS / HUEY HEALTH

viders for his brother in each new place. He saw the stress it put on his parents to constantly figure out a plan for his brother and how certain places they lived lacked the resources they needed. What would it look like, Mirza wondered, to create something that reduced the time and cost burden of care for a family? How could he free up more time for people like his mother, time they could spend with other children or doing something for themselves? How do you make ABA therapy more accessible and also transfer some of these skills to family members so they didn’t always have to carve out 15–30 hours a week for therapy? origin story

Mirza wasn’t the only one asking these questions. Through an online networking platform called “Lunch Club,” he met Labib Tazwar Rahman. Like Mirza, Rahman had a younger sibling with a disability, in his case, cerebral palsy. “I think we got matched up to talk because we were two brown people with disabled siblings who were interested in tech,” Mirza says with a laugh. The two discovered they had complementary skills: Mirza worked in mergers & acquisitions for Deloitte and understood the financial side of business and Rahman was a programmer studying computer science at Stanford University. Together they started to daydream about what they wished existed for their own families when they were growing up. At the same time, the pandemic was disrupting normal care for patients who relied on ABA therapy. And the disruption wasn’t 74 StartUp Health Magazine / DEEP IMPACT

“I think we got matched up to talk because we were two brown people with disabled siblings who were interested in tech,” Mirza says with a laugh. The two discovered they had complementary skills: Mirza worked in mergers & acquisitions for Deloitte and understood the financial side of business and Rahman was a programmer studying computer science at Stanford University. Together they started to daydream about what they wished existed for their own families when they were growing up.

all bad. An interesting thing happened when the ABA interventions that typically happened in person moved online: both the parents and the therapists experienced greater satisfaction. Parents got time back in their day, no longer constantly schlepping their child to and from appointments. They also felt more connected to what happened in a session and better able to apply the skills themselves. Therapists reported feeling better about their jobs because they were teaching family members to be more self-reliant in the long run. The icing on the cake was that insurance companies noticed better outcomes achieved at a lower cost. A light bulb went off for Mirza and Rahman. What if they could create a virtual care

platform for ABA therapy, one that modeled evidenced-based methods for parents and other family members, teaching them the skills they need to apply ABA methods regularly at home? What if they could give families back a few precious hours in their days and make caretaking a more satisfying experience? What if life could be different for families like their own? under the hood

Driven by their personal experiences and these questions, they created Huey. Huey is a digital provider of family coaching and behavioral therapy services. Essentially, it connects families to virtual ABA care and uses a Duolingo-style coaching experience within the platform so the families can practice using ABA in a way that is easy for them to do. Huey pairs families with a licensed ABA provider and also provides step-by-step guidance, video tutorials, practice sessions that can be recorded, and live feedback so that caregivers feel confident using ABA skills throughout the week, with better results for less money. Huey also creates a space for family members, teachers, and other people in the child’s community to get on the same page. Most children with ASD have some sort of physical diary that records likes, dislikes, foods to suggest and avoid, what to do if the child has a tantrum, among other guidelines. Huey takes that manual diary and brings it online so that every member of the child’s community can access disability-specific behavioral guidance for all sorts of situations, at all times. To begin, Huey will focus on autism and then Mirza and Rahman will build out

the platform for other disabilities. They anticipate going live in late 2022 and are in the process of becoming an in-network provider for insurance companies. ABA therapy for autistic children is considered medically necessary and is reimbursed in almost all 50 states. To make sure the product incorporates best practices, they have an advisory panel of ABA pioneers and professionals, affiliated with institutions like Stanford University, Harvard, Seattle Children’s Hospital, and the Rush University Medical Center. The intent is for Huey to become the provider itself and not just a resource for ABA therapists to use on their own. That way, Huey can uplift the care experience from start to finish, teaching and training ABA therapists to use their tools and maximize the impact for families. The coaching sessions will be tailored to each family’s unique domestic circumstances, keeping in mind how each child’s disability manifests itself on a day-to-day basis. The goal is not only to address immediate issues but equip all members of the family with the right skill set to deal with issues independently as they arise in the future. Care for autistic family members never really stops, and the responsibility of care often passes from the parents to the siblings later in life. “To this day,” Mirza explains, “we still go through it as a family and my brother is 25. We still need to understand how to apply different behavioral response techniques, different speech therapy techniques, and how to keep everyone on the same page with information like food requirements and behavioral needs.” startuphealth.com 75

MEET THE HEALTH TRANSFORMERS / HUEY HEALTH

We’re proud to back Mirza and Rahman because they’re addressing a high-need area that’s lacked innovation and investment for too long. Families caring for children with autism or other severe disabilities face massive financial and emotional challenges, yet they often bear the weight quietly. These stories rarely make headlines, yet they have a deep impact on families and communities, leading to burnout, depression, and anxiety.

why we’re proud to invest

With Huey, Mirza and Rahman built their platform to help their own families’ needs. We’re incredibly proud to back a team that’s solving problems out of their own lived experience because we know how powerful that motivation can be. By figuring out solutions to their own challenges, they are poised to offer a scalable model of care that provides better health outcomes at a lower cost, saves families time and money, and most importantly of all, improves relationships between children with autism and their families. We’re also excited to back Huey because they bring an important and interesting global perspective to the challenge of disability care. They’ve lived in a combined

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eight countries, from Pakistan to Australia to the United States, and gleaned lessons from each. They’re leveraging that experience to question the status quo and reimagine what virtual disability care could look like. It’s this global perspective that often leads to leapfrog innovation, as entrepreneurs see entrenched problems from a new angle. Finally, we’re proud to back Mirza and Rahman because they’re addressing a highneed area that’s lacked innovation and investment for too long. Families caring for children with autism or other severe disabilities face massive financial and emotional challenges, yet they often bear the weight quietly. These stories rarely make headlines, yet they have a deep impact on families and communities, leading to burnout, depression, and anxiety. We need smart, motivated entrepreneurs like Mirza and Rahman to take these challenges on, applying the best of technology to everyday care challenges. 4 HUEYHEALTH@STARTUPHEALTH.COM

MEET THE HEALTH TRANSFORMERS

stealth

Scan.com, the UK's Leading Online Marketplace for Diagnostic Imaging, Is Coming to Germany and the United States Founded in the UK in 2017, Scan.com (currently undergoing a rebrand) now scans more than 10,000 patients per year. The platform was designed to help private patients get quicker access to diagnostic scans, improving price transparency and understanding the differences in quality between providers. Founded by Charlie Bullock, Joe Daniels, and Oliver Knight, Scan.com is supported by a team of over 20 clinicians and consultant radiologists and has developed partnerships with some of the UK and Europe's largest health insurers and telehealth firms.

DISEASE CURES & PREVENTION MOONSHOT VINTAGE: 2022/Q1 CURRENTLY IN STEALTH

HEALTH TRANSFORMERS Charlie Bullock, CEO & Co-founder Joe Daniels, CTO & Co-founder Oliver Knight, COO & Co-founder scan@startuphealth.com

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“

The Type 1 Diabetes Moonshot will be built on a level of collaboration that the world hasn’t seen before. -David Weingard, Chief Impact Officer, T1D Moonshot

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STARTUP HEALTH NEWS

A New, Radically Collaborative Way to Fight Type 1 Diabetes StartUp Health and a consortium of diabetes leaders launch the first dedicated moonshot to prevent, manage, and cure Type 1 diabetes, rallying once-siloed entrepreneurs, investors, foundations, industry, and academics. The cross-disciplinary team includes leaders from the Helmsley Trust, Yale University, Eli Lilly, JDRF's T1D Fund, and the Diabetes Research Institute.

In 1922, a 14-year-old boy named Leonard Thompson received the world’s first injection of insulin to treat Type 1 diabetes (T1D). It saved his life, and that year the Toronto Daily Star ran a full-width banner headline that read “Toronto Doctors On Track Of Diabetes Cure.” The discovery, which earned its inventors the Nobel Prize in Medicine, turned a fatal auto-immune disease into a condition which, with daily care and treatment, could be managed. In the hundred years since this discov-

ery, we’ve seen the invention of glucose monitors, which allowed people with diabetes to draw and test their blood, and then manage their glucose levels with shots of insulin from home. We then saw the advent of continuous glucose monitors (CGMs) which automate the blood testing process and beam glucose numbers to your smartphone. And yet, even with these advances, the optimism of the century-old Toronto Daily Star headline rings a bit hollow. A cure has not yet been found, and today 20 million people around the globe face the chalstartuphealth.com 81

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lenges, frustrations, and expenses of Type 1 diabetes. Parents of children with Type 1 fear sending their child to summer camp without a trained nurse on staff. Adults with Type 1 bear the daily stress of managing their blood sugars while coping with their professions, families, and lives – all to avoid the endless medical complications associated with diabetes. “Even with monitoring and insulin, my life is going to be shortened,” says Derek Devine a 35-year-old New Yorker with Type 1 diabetes. “There will be long-term health ramifications, which is why I have to go to the dentist, get my eyes checked and my feet examined.” Devine, who is a father of three, is both excited by recent developments (like news of a pancreas transplant) and also wary of more diabetes “gizmos.” In other words, we’ve come so far, yet there is still much work to do. Not that scientists and foundations haven’t been trying. There has been exciting research into Anti-CD3 therapies that could delay the onset of diabetes in children. Nonprofits like the Diabetes Research Institute Foundation and JDRF have raised hundredsd of millions of dollars to fund T1D research all over the world. Yet progress is still slow. One big reason? A lack of coordination and collaboration between major stakeholders. “As academics, you can come up with some great ideas, but it often takes a lot of people to get a clinical trial done,” says Jennifer Sherr, MD, PhD, a pediatric endocrinologist from Yale who has joined the Type 1 Diabetes Moonshot Impact Board. “We are constantly writing grants to test new things, but you can only get a limited pool of funds to support that endeavor. Then 82 StartUp Health Magazine / DEEP IMPACT

ISSUE 09 you look at just the sheer number of years it takes to complete research. Researchers can know what they think will happen, but they might not have the funds to make it occur faster.” Academia isn’t alone. When we look across the verticals of industry, government, foundations and investors we see isolated efforts and siloed progress. It’s time for a different model, one that goes deep on impact by creating a uniquely collaborative environment. We need to complement the extraordinary R&D efforts taking place with a focus on entrepreneurial innovation that brings new solutions to market and opens up global access to care. A New, Collaborative Model for Fighting Type 1 Diabetes In order to address systemic challenges in finding Type 1 diabetes treatments, StartUp Health has launched a dedicated T1D Moonshot designed to speed up progress. At the heart of this effort is a plan for breaking down silos between research and development and commercialization. For too long the forces and funds needed to address the greatest health challenges of our time have been separated. Our first step in this mission is to form a unique T1D Moonshot Impact Board that brings together renowned representatives from the worlds of investment, business, academia and foundations. There is amazing research being done at the world’s top institutions, but it needs to be translated into products and services that change people’s lives. There are passionate funders from world-class non-profits, but they need to be linked with companies and founders

"ENTREPRENEURS ARE THE MISSING PIECE."

-DAVID PANZIRER TRUSTEE, LEONA M. AND HARRY B. HELMSLEY CHARITABLE TRUST; IMPACT BOARD, STARTUP HEALTH T1D MOONSHOT startuphealth.com 83

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"WE NEED AN INTERSECTION WHERE SAVVY BUSINESS INDIVIDUALS CAN HELP [RESEARCHERS] BETTER UNDERSTAND HOW TO MOVE THINGS FORWARD. THAT'S GOING TO IMPACT SO MANY LIVES." -JENNIFER SHERR, MD, PHD PROFESSOR IN PEDIATRICS (ENDOCRINOLOGY), YALE SCHOOL OF MEDICINE; IMPACT BOARD, STARTUP HEALTH T1D MOONSHOT

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who have the grit to succeed in a competitive marketplace. This growing impact board will be empowered to make those connections and speed up innovation. Leading the Type 1 Diabetes Moonshot Impact Board as Chief Impact Officer is David Weingard, a serial entrepreneur and Type 1 patient who has been advocating for diabetes care for decades. He founded the StartUp Health-backed company Cecelia Health (formerly Fit4D), which connects people with diabetes with a certified diabetes clinician. For his work innovating and advocating in this space, Weingard was recently named the Dare to Dream Honoree by the Diabetes Research Institute Foundation. “We are in a crisis given the exponential growth of diabetes and the human and economic cost to society,” said Weingard. “With the launch of the Type 1 Diabetes Moonshot, StartUp Health will be accelerating global innovation with a focused collaborative innovation model designed to speed up progress. Creative and effective solutions developed across academia, nonprofit, and commercial environments will be collectively nurtured in scale to accelerate impact. The T1D Moonshot will be built on a level of collaboration that the world hasn’t seen before.” Another impact board member and passionate early partner of the T1D Moonshot is David Panzirer, Trustee for The Leona M. and Harry B. Helmsley Charitable Trust. Panzirer has multiple family members with Type 1 diabetes and has dedicated his life to improving management and outcomes for people with this condition. Through its Type 1 Diabetes Program, since 2009 Helmsley has invested nearly

$1B to better understand, diagnose, and treat Type 1. And yet, Panzirer is the first to note that obstacles to access still persist. “Most prescriptions for continuous glucose monitors are written out of diabetes specialty clinics, and all of these clinics are associated with major cities or academic centers,” says Panzirer. “So if you live in rural America, you’re not getting these devices. The large majority of people living with Type 1 diabetes aren’t even seeing an endocrinologist. In today’s telemedicine world, that’s just not okay. We have to do better." When asked why it was important to collaborate with startups – not just academics and non-profits – on the T1D Moonshot, Panzirer's answer was emphatic: "Entrepreneurs are the missing piece.” Sean Doherty, Chairman of the JDRF T1D Fund, brings deep funding expertise to the Type 1 Diabetes Moonshot Impact Board having catlyzed T1D venture capital since 2016. "We in the T1D community have very high confidence in the science behind T1D cure programs," says Doherty, who was previously a managing director at Bain Capital. "Now is the time for us to convince the commercial markets that there’s a business case to finally make scale investments in curative therapies." Representing academic diabetes research on the impact board is Jennifer Sherr, MD, PhD, a pediatric endocrinologist from Yale. Diagnosed with Type 1 in 1987, Dr. Sherr has been on a mission ever since to discover new treatments. But her work has been slowed by a lack of collaboration outside academia. “We need an intersection where savvy business individuals can help us better unstartuphealth.com 85

STARTUP HEALTH NEWS

derstand how to move things forward,” says Dr. Sherr. “That’s going to make it so much faster and impact so many lives.” Mike Mason comes to the T1D Moonshot Impact Board from Ely Lilly where he is the President of Lilly Diabetes. Like Panzirer and Sherr, T1D has hit Mason’s family personally, driving him to find solutions. “Only one in three people who live with Type 1 diabetes are currently in good glycemic control,” says Mason. “For those who care deeply about the health of people living with diabetes, we have to passionately strive for better solutions. The T1D Moonshot is a bold approach to bring real solutions to those living with Diabetes.” Robert Oringer joins the impact board from AMG Medical where he is the Chairman and Board Director. At AMG Oringer leads efforts to evaluate innovative diabetes technologies. Sarah Oltmans, who is the Chief of Grant Strategy from Robin Hood, will help the impact board keep a focus on opening up access to diabetes care in underserved communities. In her role at Robin Hood, Oltmans manages the strategic vision behind the distribution of $150M in grants annually to help New Yorkers find permanent pathways out of poverty. “Diabetes impacts millions of lives, with an accelerating diagnosis rate,” said Steven Krein, CEO and Co-founder of StartUp Health. “By collaborating as a networked community, we can accelerate the commercial development and availability of effective solutions so that we can change the face of diabetes forever.” “It’s time for a new era in the fight 86 StartUp Health Magazine / DEEP IMPACT

against diabetes,” says Unity Stoakes, President and Co-founder of StartUp Health. “It’s time to combine the energy of hundreds – even thousands – of passionate entrepreneurs with the world’s top investors and institutions.” Building on a Decade of Health Moonshot Investing The Type 1 Diabetes Moonshot builds on a framework for speeding up innovation that StartUp Health has been using for most of a decade. Every quarter, StartUp Health invests in a large, diversified portfolio of seed and early-stage startups from all over the world – like Cecelia Health with their high-tech, high-touch approach to T1D diabetes coaching. We unite the founders with a trusted global peer community and with programs and tools to help them “level up” through every stage of growth. We enable founders to continually reach a global audience at every stage using a powerful combination of brand media, events and marketing. We provide access to a growing global network of community-driven and curated relationships with investors, customers, partners, and press. While the first decade of StartUp Health focused on broad health moonshot themes like Access to Care and Women’s Health, the Type 1 Diabetes Moonshot is the first in a new series of health moonshots designed to go deep on a specific objective. By creating first-of-their-kind impact boards and lowering the barriers between entrepreneurs, investors, foundations and academia, we believe we can speed up progress while also earning

STARTUP HEALTH NEWS

A GLOBAL MISSION

THE HIGHEST INCIDENCE RATES FOR TYPE 1 DIABETES ARE FOUND IN SCANDINAVIA, FOLLOWED BY SAUDI ARABIA, THE UK, AND THE USA. -DIABETES UK

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The Type 1 Diabetes Moonshot Scorecard™

healthy returns in line with our historical fund performance. “For nearly a decade StartUp Health has laid the groundwork for this TID Moonshot, supporting scores of entrepreneurs in the fight against chronic disease,” says Stoakes. “Now it’s time to take that mission to the next level with organized support and global partners committed to bringing the next generation of diabetes solutions to the world.” To be clear, our 10-year vision isn’t to 88 StartUp Health Magazine / DEEP IMPACT

declare a cure. We’ve seen enough overpromising in the cure department, all the way back to that headline in 1922. Instead, we want to ensure that everyone with Type 1 diabetes has the tools and resources necessary to thrive. We also want to get to a place where we can prevent and delay the onset of Type 1 diabetes. These are audacious goals in themselves, and will take a kind of collaboration and investment that we haven’t seen in this sector yet. The launch of StartUp Health’s Type

StartUp Health has worked with its T1D Moonshot Impact Board members to develop a scorecard that can be used to vet investment and partnership opportunities. StartUp Health utilizes a range of proprietary scorecards to evaluate startups as well as partners, in order to invest at scale and speed up progress.

1 Diabetes Moonshot is a call for partnership. Entrepreneurs who are innovating in the Type 1 diabetes ecosystem are encouraged to apply at startuphealth.com and join the firm’s global army of more than 1,000 Health Transformers working to achieve health moonshots. If you’re an entrepreneur who believes that we need to leverage collaboration and moonshot thinking to deliver quality care to everyone in the world regardless of location or income, we want to meet you.

This launch is also an invitation to investors and partners. If you believe in a collaborative, global approach to fighting T1D, and if you believe we are stronger together, as an army of innovators and investors with a single health moonshot objective, we want to partner. Investors and partners interested in collaborating on StartUp Health’s T1D Moonshot can email us at T1D@startuphealth.com.

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STARTUP HEALTH NEWS

Leading from the Front: How David Sarabia of inRecovery Is Supporting His Team in Ukraine David Sarabia was on vacation in Mexico when he saw the headlines: Ukraine was under attack and Russian forces were moving in on the capital. After the initial shock of the news wore off, David snapped into action. He’d spent a good deal of time in Ukraine, cultivating a development team there for his company, which StartUp Health backed in 2017. And now that team was in trouble. So instead of taking his flight back to California, he booked a ticket to Poland. He had no plan and few connections, just a desire to help. For more than a month David stayed in Krakow, organizing supply runs into Ukraine while still running his company, which builds virtual care solutions for addiction recovery centers. When we heard about the important work he was doing we tracked him down for an interview. Exhausted but encouraged by the strength of the Ukrainian people, he shares a bit about his work and how others can help. Interview by Logan Plaster, excerpted from a podcast published April 19, 2022

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Let’s start with where you are right now. David Sarabia: I’m in Krakow. Tomorrow I’ll be in Lviv, Ukraine. I’ve been out here since the beginning of March, right when the war broke out between Ukraine and Russia. Where are you typically based? Sarabia: We’re based in San Diego and New York City but we have a distributed team. We have a product team – primarily development, design, and product – in Lviv and Kyiv in Ukraine. So, we have a massive interest obviously in what’s going on right now in the world and making sure that we take care of our people.

Take us to when you heard about the conflict, and your thought process around coming to Ukraine personally. Sarabia: I was on vacation in Tulum, Mexico with my girlfriend when everything broke out. I made the decision to just fly out to Poland. One of the major problems is that we tend to just see conflict from afar and we’re really desensitized to war. Knowing that my team is here with their families, close friends, and loved ones, I couldn’t call myself a leader of a company that has a team in Ukraine and just watch it from the sidelines.

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STARTUP HEALTH NEWS

David Sarabia and his band of collaborators have helped 250 families relocate and have sent 24 trucks with food, supplies, and medicine to Ukrainian war zones.

What was your strategy and what did you think was going to happen when you landed? Sarabia: I had no plan at all. I just landed here and figured it out. I rented a hotel room and started making calls and meeting people. It all came together very naturally. You know, there’s a major effort out here in Krakow and Poland in general with the refugees, with the situation with Ukraine. They’ve really been an incredible country. They’ve opened their doors to hundreds of thousands of refugees so far. When I came out here I saw that a 92 StartUp Health Magazine / DEEP IMPACT

handful of my friends from New York, London, and Switzerland, had individual efforts that they were mobilizing themselves, and so naturally I brought them all together, did the entrepreneurial thing and started making connections here within Poland. Within a couple of weeks we were just rockin’ and rollin’. We’ve been able to help over 300 families as of today to relocate and reintegrate. We are even using an instance of inRecovery’s platform to help with telehealth. The key thing is that we’ve been able to keep people together as families.

How did you adapt your addiction recovery platform to be useful in this context? Sarabia: We’re taking the same approach that we take with addiction. In addiction you get the treatment, but then you have to thrive in life, right? So, there's the treatment phase and then there’s the real-life phase. Reintegration is key with addiction care, with long-term, sustainable recovery. In the same model, we are applying the whole idea of peer support which is very, very important with both mental health and addiction. We are applying the mindfulness stuff that we have in our platform as well as telehealth services and just general case management services where you’re able to look at a person and how they’re doing and also apply reintegration tracks with specific goals. Or, maybe we’re able to give refugees buckets of things that they must do in order to get a job or go through this journey which is really very similar to when you’re reintegrating or coming back to society from active addiction. What is something that you wish your colleagues and friends in the United States knew about the situation in Ukraine that they wouldn’t get from the headlines? Sarabia: That it’s very real, and that there are people that are really truly suffering and that there’s a country that has the strongest will that I’ve ever seen. I have so much more respect for them now, understanding how they’ve united. It’s impacted

that country in such a negative way, but it’s also been extremely positive in terms of the unity that now exists there. And, I think there’s a massive amount of respect that is owed to their president for actually stepping up to the plate. I guess that’s what you do as a leader. When it comes to a crisis you either flee or you act. What is your advice to someone who wants to help the cause but isn’t quite sure how? Sarabia: There’s a lot of organizations you can donate to, and they’re all doing a good job. I don’t want to bring any organization down, but the efforts that are smaller and more private tend to mobilize faster and tend to have a quicker impact which is what’s needed right now. And, there’s a lot of these. We’re just one. We’re six people and some of our teammates that are working on this part-time, every now and then, and we’ve been able to accomplish a lot in a month. And it’s just starting. We’re putting together a protocol now that can be replicated. We want to operationalize our tools in different countries where people can just take them and run. But when it comes to leading in times of conflict, it’s not overly complicated. Show up for your people. Learn more about Sarabia's work in Ukraine and Poland at Recoverly.com.

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StartUp Health Insights | 2022 Q1 REPORT

2022 Q1: Global Health Innovation Funding Hits $9.3B We may be seeing a slowdown in the funding growth curve due to macro trends like a sustained war in Ukraine, supply chain disruptions, and rocky public markets. Yet, as StartUp Health's Jamey Edwards writes on page 105, “Don't let the headlines distract you from your health moonshot. Improving health globally is a marathon, not a sprint. Keep grinding. This too shall pass."

For the latest in health innovation funding go to startuphealth.com/insights-reports 94 StartUp Health Magazine / DEEP IMPACT

When you look back at the ing down.” In our independent analysis, last 10+ years of global health which tracks global funding, and funding innovation funding, it’s easy at more round sizes and stages, we noted to get excited. After years and a small uptick in funding in Q1, year over years of predicting the promise of digital year. It didn’t reflect the aggressive growth health tools like telemedicine and remote we’ve seen for the last two years, but it patient monitoring, the last two years have also didn't get us overly concerned. That's turned the vision into a reality. Due to a because, as Alyssa Jaffee, Partner at 7wire range of market forces, Ventures, put it on a like a COVID-induced recent StartUp Health push towards virtual Fireside Chat: "healthTotal deal count is medicine and relaxed care isn’t going away. an important meareimbursement regula“Livongo plus Teladoc sure of entrepretions, we saw annual was the tip of the iceneurial activity, and investments in health berg," says Jaffee. "Our one we’ll continue innovation double in population is aging, to watch closely. a single year. In fact, chronic conditions are We believe that to more health tech fundworsening, and menachieve health mooning was raised in 2021 tal health is declining. shots it’s not enough than in the five years There is no reason we to back a few uniof 2013 to 2017 comcannot have more and corns. As an industry bined. This unleashing more companies that we need to invest of capital is historic and are exiting for billions in entrepreneurs at it unlocks the potential of dollars.” scale, at every stage, in health innovation At StartUp Health so that the best ideas that so many of us have we believe health inand products have a been talking and writnovation is still very chance to emerge ing about for a decade. strong, particularly As we closed out the when viewed through first quarter of 2022, a global lens. In the the big question was: how long will this first quarter of 2022 we tracked 274 acceleration in health investing continue? deals, making it second only to Q2 2021 In the first quarter of 2022 Rock in terms of total deal count over the last Health, which only reports funding in decade. In our 2021 year-end report, we the United States, noted a $700M drop wrote about the trend that funding inin investment dollars between Q1 2021 creases were inordinately impacted by a and Q1 2022. MobiHealthNews, in re- small number of mega deals occurring porting the story, concluded that “digi- in the most-funded cities in the world. tal health funding may be finally slow- We wrote then that “total deal count is startuphealth.com 95

StartUp Health Insights | 2022 Q1 REPORT

an important measure of entrepreneurial activity, and one we’ll continue to watch closely. We believe that to achieve health moonshots it’s not enough to back a few unicorns. As an industry we need to invest in entrepreneurs at scale, at every stage, so that the best ideas and prod-

ucts have a chance to emerge.” We stand by this statement and Q1 trended in the right direction. Follow the Money: Analyzing the Quarter's Top Deals Median deal size is holding steady at

10 Years of Global Health Innovation Funding Total Raised (Annual)

Total Raised in Q1 Only

$11.8B

$7.1B

$2.8B $560M 2013

$1.4B 2014

$8.2B $6.1B

$1.1B 2015

$2.1B 2016

$2.8B 2017

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Source: StartUp Health Insights | startuphealth.com/insights. Note: Report based on publicly available data through 3/31/22 on seed (incl. accelerator), venture, corporate ven

$16M, equal to 2021, but $6M higher than 2020. Time will tell if deal size is cooling off in a larger way. StartUp Health believes in investing at scale. We just backed our 400th company in Q1 and we have our sights set on 400 more. Improving health globally isn’t a horse

race where you pick a few big winners. It’s about investing in health problem solvers everywhere. If that means more deals at smaller average deal sizes, we’re here for it. Topping our list of the quarter’s largest US deals is the $325M raise by Somatus that will power their value-based kidney

$44.6B

$21.9B

$15.2B

$14B

$9.2B

$9.3B

2021

2022

$5.4B $3.0B 2018

$3.2B 2019

2020

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

StartUp Health Insights | 2022 Q1 REPORT

Top Health Innovation Deals (US) Company

Function

Amount Raised

Somatus

Clinical Workflow

$325M

TigerConnect

Clinical Workflow

$300M

Freenome

Research

$290M

Lyra Health

Wellness

$235M

Transcarent

Clinical Workflow

$200M

Alto Pharmacy

Patient Empowerment

$200M

DNAnexus

Population Health

$200M

Omada Health

Patient Empowerment

$192M

Maze Therapeutics

Research

$190M

A Place for Mom

Wellness

$175M

care platform. Chronic kidney disease (CKD) is a concern for 37M adults in the United States alone. We’re encouraged to see money flowing into this sector because CKD disproportionally impacts Black and Hispanic communities, as well as communities with poorer social determinants of health (SDOH) like housing and food insecurity. Millions of kidney disease

patients have suffered in the shadows for years, receiving in-clinic dialysis multiple times a week to stay alive. We’re hopeful that investment in companies like Somatus will encourage other health innovators to tackle this widespread problem. “It’s clear that value-based, technologyenabled kidney care is the future,” says Tim Fitzpatrick, CEO and Founder of

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Source: StartUp Health Insights | startuphealth.com/insights. Note: Report based on publicly available data through 3/31/22 on seed (incl. accelerator), venture, corporate ven

Top Health Innovation Deals (Outside the US) Company

Function

Doctolib

Patient Empowerment

$549M

MediBuddy

Clinical Workflow

$125M

MindMaze

Wellness

$105M

League

Wellness

$95M

MeMed

Biometric Data Acquisition

$93M

Distalmotion

Clinical Workflow

$90M

Big Health

Personalized Health

$75M

Scopio Labs

Clinical Workflow

$50M

Benchsci

Research

$50M

Resilience

Patient Empowerment

$45M

ikona health, a StartUp Health-backed company optimizing kidney care treatment pathways. “Kidney care-focused population health management companies are working closely with payers and large nephrology practices to reduce the cost of kidney care by delaying progression and improving the transitions to and

Amount Raised

treatment of kidney failure.” Another notable top deal is A Place for Mom, which raised $175M to scale their senior care platform that aims to improve home care. While plenty gets written about our rapidly aging population and the need to innovate around Alzheimer’s and dementia, age tech companies rarely

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

StartUp Health Insights | 2022 Q1 REPORT

if ever make our top deals list. With this raise, A Place for Mom is purportedly valued at over a $1B. They are just one company, and so much more needs to be done, but we’re hopeful this raise will bring more visibility to age tech and senior care

opportunities. Outside the US, our top deals list was dominated by Doctolib’s $549M funding round, which raised its valuation to $6.4B and made it the highest valued startup in France. With this financing, Doctolib is

Global Health Innovation Funding Average Deal Size, Year Over Year

$4.7M

$4.4M

$4.6M

2015

2016

$4.0M

$2.0M

2012

2013

2014

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Source: StartUp Health Insights | startuphealth.com/insights. Note: Report based on publicly available data through 3/31/22 on seed (incl. accelerator), venture, corporate ven

poised to shape digital health in Europe for years to come. In the next five years they plan to grow their medical appointment booking platform from 2,500 employees to 6,000 employees while expanding operations to 30 European cities.

If the theme with Doctolib is digital health consolidation and market penetration, we may be seeing a similar trend in India. MediBuddy raised $125M to scale their full service telemedicine and athome lab testing company, with the lofty

$16M

2020

2021 Q1

$10M

$7.3M $6.3M

2017

2018

2019

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

StartUp Health Insights | 2022 Q1 REPORT

Hubs of Health Innovation (US) City/Region

Funds Raised

2021 Total Deals

San Francisco Bay

$3.1B

Boston

$935M

New York

$907M

Los Angeles

$435M

Washington, DC

$353M

Seattle

$246M

Austin

$205M

Minneapolis / St. Paul

$145M

Chicago

$144M

Nashville

$98M

goal of bringing accessible healthcare to a billion people in India. “Digitization of the healthcare industry has helped people living even in the most remote parts of the country avail timely medical care by professionals,” Satish Kannan, Co-founder and CEO of MediBuddy, said in a statement. “With the latest round of funding, we will capitalize on strengthening our network of health-

care service providers and our team while launching new services on the platform.” In the United States, health innovation investing is still heavily skewed towards three top cities, San Francisco ($3.1B), Boston ($935M), and New York City ($907M). What’s more interesting, perhaps, is to see what new cities have made the list, and which may be carving out a reputation as a home for healthcare en-

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Source: StartUp Health Insights | startuphealth.com/insights. Note: Report based on publicly available data through 3/31/22 on seed (incl. accelerator), venture, corporate ven

Hubs of Health Innovation (OUS) City/Region

Funds Raised

2021 Total Deals

Paris

$681M

Israel

$240M

Geneva

$195M

Toronto

$179M

London

$170M

Bangalore (Bengaluru)

$125M

Berlin

$102M

Amman

$44M

Mumbai

$43M

Sydney

$42M

trepreneurship. New to the innovation hub list this quarter is Nashville, which saw $98M raised across four deals. With 12 deals and $435M raised, Los Angeles has seen the most growth and is now one of the most active and well-funded health tech hubs in the country. Our list of most-funded cities outside the United States has seen a shake-up. France is on top ($681M) almost exclu-

sively due to the massive raise by Doctolib. Newcomers to the list are Geneva, Berlin, Amman, and Sydney. Notably in Amman, Altibbi, the first and largest telemedicine platform in the Arab region, raised a $44M Series B. Tel Aviv, Toronto, and London (still the most active with 10 deals) remain well-funded hubs for health innovation, while major cities in China have notably dropped from the startuphealth.com 103

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

StartUp Health Insights | 2022 Q1 REPORT

Achieving Health Moonshots No Matter the Conditions There have been no shortage of negative headlines recently, from pandemics to global conflict to fluctuating markets. To get a dose of perspective on how to stay focused on achieving a health moonshot during ongoing change, we dialed up Jamey Edwards, Chief Health Transformer at StartUp Health. Jamey has been working in the health innovation space for more than a decade, and he is now working with StartUp

Health’s community of Health Transformers full time to help them best leverage moments like this. Listen to the whole conversation on our podcast at StartUp.Health. ---

These dynamic times are mindset challenges that we overcome, that make us stronger, that we learn from. Don't miss that opportunity to grow.

Don't let the headlines distract you from your health moonshot. Improv-

list this quarter. One thing is clear: the next few quarters will be ones to watch closely. How will the rockiness of the public markets impact private investment? What about the economic impact of the sustained conflict in Ukraine? Or, to think more about global impact, will investors see beyond the mega deals to fund a generation of healthcare problem solvers? Like many investors we have spoken with recently, we remain optimistic about the health innovation market. That’s not because we see a few multi-billion dollar exits on the horizon, but because we work with hundreds of health tech founders at every stage and know the passion, experience and wisdom that they’re bringing to bear to improve global health. Our global healthcare challenges are growing, but

ing health globally is a marathon, not a sprint. Keep grinding. This too shall pass.

3 Going public isn't for every company. Explore your exit options and plan accordingly.

4 If you have the opportunity to go public as a business in a market that feels like valuations are at all time lows and then you can ride the next wave up – that to me feels like really good solid thinking.

so is the wave of ingenuity coming from thousands of entrepreneurs and startups on every continent. We’ll be watching closely to see how investors and startups respond to the market. Stay tuned. This report was written and designed by Logan Plaster based on data collected and managed by Tara Salamone, Nicole Kinsey, and Jennifer Hankin. Additional analysis by Padma Rao and Priya Reddy. Report based on publicly available data through 3/31/22 on seed (incl. accelerator), venture, corporate venture, and private equity funding only. Companies tracked in StartUp Health Insights may fall under multiple moonshots and therefore will be represented throughout the report.

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Ready to Transform Health With Us?

StartUp Health’s investment platform fuels health moonshots To the Health Transformers of the World: We created StartUp Health to help you, the entrepreneur, thrive, scale and ultimately achieve health moonshots. StartUp Health is investing in a global army of Health Transformers to achieve 12 Health Moonshots. Since 2011, we have invested in over 390 innovative health companies, and we’re just getting started. Entrepreneurs, learn how to apply to StartUp Health at startuphealth.com/gettingstarted Investors, learn how you can back a diverse portfolio of private health innovation companies at healthmoonshots.com

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Health Moonshot snapshots

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ACCESS TO CARE COST TO ZERO DISEASE PREVENTION & CURES END CANCER WOMEN'S HEALTH CHILDREN'S HEALTH NUTRITION & FITNESS BRAIN HEALTH & ALZHEIMER'S MENTAL HEALTH & HAPPINESS HEALTHY LONGEVITY & AGING ADDICTION & OPIOID CRISIS PANDEMIC RESPONSE

108 110 112 114 116 118 120 122 124 126 128 130

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HEALTH MOONSHOT

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

Javier Cardona CEO & Co-founder 1DOC3

PORTFOLIO SPOTLIGHT

Toyin Ajayi, MD CEO & Co-founder Cityblock Health

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

Data as of 5/31/22. Sample of portfolio company investments and may not be representative of larger portfolio.

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151

ACTIVE PORTFOLIO COMPANIES

NOTABLE PORTFOLIO INVESTMENTS 2022

2021

2020

2019

2018

(Acquired by Press Ganey) 2017

2015

2014

(Acquired by AmWell) 2013

(Acquired by Press Ganey)

(Acquired by Sharecare & Generali)

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

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HEALTH MOONSHOT

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

Ed Park CEO & Co-founder Devoted Health

PORTFOLIO SPOTLIGHT

Bill Nordmark CEO Enlace Health

Enlace Health (fka Aver) delivers industry-leading, end-to-end solutions – from pilot to total risk – for all value-based care initiatives. To date, the company has analyzed 300B claims with 20% average savings, and a 7:1 payback ratio. Clients include some of the largest payors and EHR providers. In Q4 2021, the company raised $58M led by Cox Enterprises to accelerate the scale and deployment of its new Enlace Health brand.

Data as of 5/31/22. Sample of portfolio company investments and may not be representative of larger portfolio.

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ACTIVE PORTFOLIO COMPANIES

NOTABLE PORTFOLIO INVESTMENTS 2022

2021

2020

2019

2018

2017

2015

2014

2013

“I appreciate all of the hard work in making the StartUp Health Festival a successful, energetic, and motivating meeting! Now, batteries recharged and back to work!” -Linda Van Horn CEO & Founder, iShare Medical

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HEALTH MOONSHOT

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

Naheed Kurji CEO & Co-founder Cyclica

PORTFOLIO SPOTLIGHT

Frank Westermann Co-CEO & Co-founder 9am Health

9am Health is virtual diabetes clinic providing affordable medications, labs, and personalized care for people living with prediabetes and Type 2 diabetes. The founding team sold their last company, mySugr, to Roche in 2017 for upwards of $100M. 9am Health raised $16M earlier this year, co-led by 7wire Ventures and Human Capital, and is currently available in 47 states and Washington, DC.

Data as of 5/31/22. Sample of portfolio company investments and may not be representative of larger portfolio.

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ACTIVE PORTFOLIO COMPANIES

NOTABLE PORTFOLIO INVESTMENTS 2021

2020

2019

2018

2017

(Acquired by Labcorp) 2016

2014

2013

(Acquired by FamilyTreeDNA)

“StartUp Health taps us into a global network that provides not only support but also answers, advice, intelligence. It has fasttracked our business in a number ways.” -Lynda Brown-Ganzert CEO & Founder, Curatio

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HEALTH MOONSHOT

End Cancer Together we can end cancer as we know it

Kaitlin Christine CEO & Founder Gabbi

PORTFOLIO SPOTLIGHT

Nikhil Pooviah, MD Co-founder Elly Health

Elly is an app that delivers personalized audio experiences to improve the lives of patients, including those with cancer. Users engage with content around disease education, exercise, meditation and sleep practices, symptom management, and fellow patient stories. Clinical research has demonstrated that patients improved their quality of life by ~15% and patient activation by ~40% after 30 days using Elly. Their Phase I clinical study in oncology showed that Elly achieved $9k per patient per year in predictive cost savings, 86% user retention rate with user engagement of 2x per day, and an NPS score of 79.

Data as of 5/31/22. Sample of portfolio company investments and may not be representative of larger portfolio.

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ACTIVE PORTFOLIO COMPANIES

NOTABLE PORTFOLIO INVESTMENTS

2021

2020

2019

2018

2016

2014

“We were in the process of rolling out and preparing a launch of the world’s first blood-based, multi-cancer detection system. That launch brought us to a lot of questions, where StartUp Health was tremendously helpful.” -Jo Bhadki CEO & Founder, Quantgene startuphealth.com 115

HEALTH MOONSHOT

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

Jill Angelo CEO & Founder Gennev

PORTFOLIO SPOTLIGHT

Anish Sebastian CEO & Co-founder Babyscripts

Babyscripts is the most comprehensive and clinically validated maternity program to help manage expecting moms virtually, before and after birth. The Babyscripts technology is a combination of a smartphone app and internet-connected medical devices delivered via their “Mommy Kit,” which remotely monitors patients and allows providers to risk-stratify care, offering specific experiences to manage different risk conditions (e.g. diabetes, hypertension). Babyscripts works with more than 75 health systems in 32 states and the company is monitoring 250k women each year. Babyscripts has raised more than $37M to date.

Data as of 5/31/22. Sample of portfolio company investments and may not be representative of larger portfolio.

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ACTIVE PORTFOLIO COMPANIES

NOTABLE PORTFOLIO INVESTMENTS 2022

2021

2019

2018

2015

2013

“The coverage provided to us was a major plus, our investors found us via the online article and the magazine article. Your coverage gave us a 'blue check' and the investors now on our board are wellknown leaders with the industry.” -Sheena Franklin CEO & Founder, K’ept Health

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HEALTH MOONSHOT

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

Stephanie Canale, MD CEO & Founder Lactation Lab

PORTFOLIO SPOTLIGHT

Javier Evelyn CEO & Founder Alerje

Alerje is a Detroit-based company developing digital tools for food allergy management, impacting over 220M people worldwide. In Summer 2021, Alerje was granted a utility patent for their flagship epinephrine auto-injector smartphone case combo, in both the US and abroad, and received a Phase I SBIR grant from the National Science Foundation. Funds from the SBIR grant will be used to develop an OIT platform that collects, stores, analyses, and distributes clinically relevant data to build a bridge between patients and their care teams.

Data as of 5/31/22. Sample of portfolio company investments and may not be representative of larger portfolio.

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ACTIVE PORTFOLIO COMPANIES

NOTABLE PORTFOLIO INVESTMENTS 2022

2021

2020

2019

2018

2017

2013

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

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HEALTH MOONSHOT

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

Shireen Abdullah CEO & Founder Yumlish

PORTFOLIO SPOTLIGHT

Victor Penev CEO & Co-founder Edamam

Edamam organizes the world’s food knowledge and provides nutrition data services and value-added solutions to health, wellness, and food businesses. Using a proprietary semantic technology platform, it delivers real-time nutrition analysis and diet recommendations via APIs. Edamam has built the most extensive recipe database in the industry with 5M+ recipes and 800k individual foods, each tagged for 40+ diets and 130+ nutrients to address over 200 chronic conditions. More than 90k companies have subscribed to their APIs and partners and clients include Amazon, Food Network, McCormick, Microsoft, and Nestle.

Data as of 5/31/22. Sample of portfolio company investments and may not be representative of larger portfolio.

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ACTIVE PORTFOLIO COMPANIES

NOTABLE PORTFOLIO INVESTMENTS 2022

2021

2020

2019

2018

2014

2013

(Acquired by Zimmer Biomet)

“StartUp Health is such a credible resource for investors, entrepreneurs, and healthcare professionals. They’ve built a great culture, which is no small task. The team is authentic and passionate about what they do and it comes through in every encounter we have.” -Aubrey Sawyer President & Co-founder, inHealth startuphealth.com 121

HEALTH MOONSHOT

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

Sidney Collin CEO & Co-founder De Oro Devices

PORTFOLIO SPOTLIGHT

Renee Ryan CEO Cala Health

Cala Health is on a mission to transform the standard of care for patients living with chronic diseases using non-invasive wearable neuromodulation therapies. Their lead product, the Cala Trio, is the only non-invasive prescription therapy for essential tremor. In Q4 2020, the FDA granted Breakthrough Device Designation to Cala Trio for the treatment of action tremors in the hands of adults with Parkinson’s disease. The company recently raised $77M in new funding from investors including Ascension Ventures and Dolby Family Ventures.

Data as of 5/31/22. Sample of portfolio company investments and may not be representative of larger portfolio.

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ACTIVE PORTFOLIO COMPANIES

NOTABLE PORTFOLIO INVESTMENTS 2021

2022

2020

2019

2017

2016

2014

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

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HEALTH MOONSHOT

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

Thomas Tsang, MD CEO & Co-founder Valera Health

PORTFOLIO SPOTLIGHT

Raj Amin CEO & Co-founder Wise Therapeutics

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

Data as of 5/31/22. Sample of portfolio company investments and may not be representative of larger portfolio.

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ACTIVE PORTFOLIO COMPANIES

NOTABLE PORTFOLIO INVESTMENTS 2021

2020

2019

2018

2017

2014

2015

(Acquired by Dario Health)

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

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HEALTH MOONSHOT

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

Satish Movva CEO & Founder CarePredict

PORTFOLIO SPOTLIGHT

Victor Wang CEO & Founder care.coach

Care.coach is the health avatar automating care for seniors to solve loneliness. They’re currently deployed across two of the top three Medicare Advantage Insurers and >10% of all PACE (Program of All-inclusive Care for the Elderly) health plan sites nationally. Peer reviewed and customer outcomes include a 25% average reduction in depression scores, over three home visits saved per month per avatar, and nearly 10% reduction in annual ER visits.

Data as of 5/31/22. Sample of portfolio company investments and may not be representative of larger portfolio.

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ACTIVE PORTFOLIO COMPANIES

NOTABLE PORTFOLIO INVESTMENTS 2022

2021

2020

2018

2017

2016

2015

2014

2013 (Acquired by Sharecare & Generali)

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

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HEALTH MOONSHOT

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

Rachel Trobman CEO & Founder Upside Health

PORTFOLIO SPOTLIGHT

Yusuf Sherwani, MD CEO & Co-founder Quit Genius

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

Data as of 5/31/22. Sample of portfolio company investments and may not be representative of larger portfolio.

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ACTIVE PORTFOLIO COMPANIES

NOTABLE PORTFOLIO INVESTMENTS 2022

2021

2020

2019

2018

2017

2013

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

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HEALTH MOONSHOT

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

Cristian Pascual CEO & Co-founder Mediktor

PORTFOLIO SPOTLIGHT

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

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

Data as of 5/31/22. Sample of portfolio company investments and may not be representative of larger portfolio.

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140

ACTIVE PORTFOLIO COMPANIES

NOTABLE PORTFOLIO INVESTMENTS 2022

2021

2020

2017

2018

(Acquired by AmWell) 2016

2014

2013

(Acquired by AmWell)

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

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SIR FREDERICK BANTING In 1923, Banting was awarded The Nobel Prize in Medicine for the discovery of insulin, an innovation that saved millions of lives.

Dream Impossible

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