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The human-focused startups of the hellfire
Disasters may not always be man-made, but they are always responded to by humans. There’s a whole panoply of skills and professions required today to respond to even the tiniest emergency, and that doesn’t even include the needs during pre-disaster planning and post-disaster recovery. It’s not a very remunerative industry for most and the mental health effects from stress can linger for decades, but the mission at the core of this work — to help people in the time of their greatest need — is what continues to attract many to partake in this never-ending battle anyway.
In the last three parts of this series on the future of technology and disaster response, I’ve focused on, well, technology, and specifically the sales cycle for new products, the sudden data deluge now that Internet of Things (IoT) is in full force, and the connectivity that allows that data to radiate all around. What we haven’t looked at enough so far is the human element: the people who actually respond to disasters as well as what challenges they face and how technology can help them.
So in this fourth and final part of the series, we’ll look at four areas where humans and technology intersect within disaster response and what future opportunities lie in this market: training and development, mental health, crowdsourced responses to disasters, and our doomsday future of hyper-complex emergencies.
Training in a hellfire
Most fields have linear approaches to training. To become a software engineer, students learn some computer science theory, add in some programming practice, and voilà (note: your mileage may vary). To become a medical doctor, aspiring physicians take an undergraduate curriculum teeming with biology and chemistry, head to medical school for two deadened years of core anatomy and other classes and then switch into clinical rotations, a residency, and maybe fellowships.
But how do you train someone to respond to emergencies?
From 911 call takers to EMTs and paramedics to emergency planning officials and the on-the-ground responders who are operating in the center of the storm as it were, there are large permutations in the skills required to do these jobs well. What’s necessary aren’t just specific hard skills like using call dispatch software or knowing how to upload video from a disaster site, but also critically-important softer skills as well: precisely communicating, having sangfroid, increasing agility, and balancing improvisation with consistency. The chaos element also can’t be overstated: every disaster is different, and these skills must be viscerally recombined and exercised under extreme pressure with frequently sparse information.
A whole range of what might be dubbed “edtech” products could serve these needs, and not just exclusively for emergency management.
Communications, for instance, isn’t just about team communications, but also communicating with many different constituencies. Aaron Clark-Ginsberg, a social scientist at RAND Corporation, said that “a lot of these skills are social skills — being able to work with different groups of people in culturally and socially appropriate ways.” He notes that the field of emergency management has heightened attention to these issues in recent years, and “the skillset we need is to work with those community structures” that already exist where a disaster strikes.
As we’ve seen in the tech industry the last few years, cross-cultural communication skills remain scarce. One can always learn this just through repeated experiences, but could we train people to develop empathy and understanding through software? Can we develop better and richer scenarios to train emergency responders — and all of us, really — on how to communicate effectively in widely diverging conditions? That’s a huge opportunity for a startup to tackle.
Emergency management is now a well-developed career path. “The history of the field is very fascinating, [it’s] been increasingly professionalized, with all these certifications,” Clark-Ginsberg said. That professionalization “standardizes emergency response so that you know what you are getting since they have all these certs, and you know what they know and what they don’t.” Certifications can indicate singular competence, but perhaps not holistic assessment, and it’s a market that offers opportunities for new startups to create better assessments.
Like many of us, responders get used to doing the same thing over and over again, and that can make training for new skills even more challenging. Michael Martin of emergency data management platform RapidSOS describes how 911 call takers get used to muscle memory, “so switching to a new system is very high-risk.” No matter how bad existing software interfaces are, changing them will very likely slow every single response down while increasing the risk of errors. That’s why the company offers “25,000 hours a year for training, support, integration.” There remains a huge and relatively fragmented market for training staff as well as transitioning them from one software stack to another.
Outside these somewhat narrow niches, there is a need for a massive renaissance in training in this whole area. My colleague Natasha Mascarenhas recently wrote an EC-1 on Duolingo, an app designed to gamify and entrance students interested in learning second languages. It’s a compelling product, and there is no comparative training system for engaging the full gamut of first responders.
Art delaCruz, COO and president of Team Rubicon, a non-profit which assembles teams of volunteer military veterans to respond to natural disasters, said that it’s an issue his organization is spending more time thinking about. “Part of resilience is education, and the ability to access information, and that is a gap that we continue to close on,” he said. “How do you present information that’s more simple than [a learning management system]?” He described the need for “knowledge bombs like flash cards” to regularly provide responders with new knowledge while testing existing ideas.
There’s also a need to scale up best practices rapidly across the world. Tom Cotter, director of emergency response and preparedness at Project Hope, a non-profit which empowers local healthcare workers in disaster-stricken and impoverished areas, said that in the context of COVID-19, “a lot of what was going to be needed [early on] was training — there were huge information gaps at the clinical level, how to communicate it at a community level.” The organization developed a curriculum with Brown University’s Watson Institute in the form of interactive PowerPoints that were ultimately used to train 100,000 healthcare workers on the new virus, according to Cotter.
When I look at the spectrum of edtech products existing today, one of the key peculiarities is just how narrow each seems to focus. There are apps for language learning and for learning math and developing literacy. There are flash card apps like Anki that are popular among medical students, and more interactive approaches like Labster for science experiments and Sketchy for learning anatomy.
Yet, for all the talk of boot camps in Silicon Valley, there is no edtech company that tries to completely transform a student in the way that a bona fide boot camp does. No startup wants to holistically develop their students, adding in hard skills while also advancing the ability to handle stress, the improvisation needed to confront rapidly-changing environments, and the skills needed to communicate with empathy.
Maybe that can’t be done with software. Maybe. Or perhaps, no founder has just had the ambition so far to go for broke — to really revolutionize how we think about training the next generation of emergency management professionals and everyone else in private industry who needs to handle stress or think on their feet just as much as frontline workers.
That’s the direction where Bryce Stirton, president and co-founder of public-safety company Responder Corp, has been thinking about. “Another area I am personally a fan of is the training space around VR,” he said. “It’s very difficult to synthesize these stressful environments,” in areas like firefighting, but new technologies have “the ability to pump the heart that you need to experience in training.” He concludes that “the VR world, it can have a large impact.”
Healing after disaster
When it comes to trauma, few fields face quite the challenge as emergency response. It’s work that almost by definition forces its personnel to confront some of the most harrowing scenes imaginable. Death and destruction are given, but what’s not always accounted for is the lack of agency in some of these contexts for first responders — the family that can’t be saved in time so a 911 call taker has to offer final solace, or the paramedics who don’t have the right equipment even as they are showing up on site.
Post-traumatic stress is perhaps the most well-known and common mental health condition facing first responders, although it is hardly the only one. How to ameliorate and potentially even cure these conditions represents a burgeoning area of investment and growth for a number of startups and investors.
Risk & Return, for instance, is a venture firm heavily focused on companies working on mental health as well as human performance more generally. In my profile of the firm a few weeks ago, managing director Jeff Eggers said that “We love that type of technology since it has that dual purpose: going to serve the first responder on the ground, but the community is also going to benefit.”
Two examples of companies from its portfolio are useful here to explore as examples of different pathways in this category. The first is Alto Neuroscience, which is a stealthy startup founded by Amit Etkin, a multidisciplinary neuroscientist and psychiatrist at Stanford, to create new clinical treatments to post-traumatic stress and other conditions based on brainwave data. Given its therapeutic focus, it’s probably years before testing and regulatory approvals come through, but this sort of research is on the cutting-edge of innovation here.
The second company is NeuroFlow, which is a software startup using apps to guide patients to better mental health outcomes. Through persistent polling, testing, and collaboration with practitioners, the company’s tools allow for more active monitoring of mental health — looking for emerging symptoms or relapses in even the most complicated cases. NeuroFlow is more on the clinical side, but there are obviously a wealth of wellness startups that have percolated in recent years as well like Headspace and Calm.
Outside of therapeutics and software though, there are entirely new frontiers around mental health in areas like psychedelics. That was one of the trends I called out as a top five area for investment in the 2020s earlier this year, and I stand by that. We’ve also covered a startup called Osmind which is a clinical platform for managing patients with a psychedelic focus.
Risk & Return itself hasn’t made an investment in psychedelics yet, but Bob Kerrey, the firm’s board chairman and the former co-chair of the 9/11 Commission as well as former governor and senator of Nebraska, said that “it’s difficult to do this if you are the government, but easier to do this in the private sector.”
Similar to edtech, mental health startups might get their start in the first responder community, but they are hardly limited to this population. Post-traumatic stress and other mental health conditions affect wide swaths of the world’s population, and solutions that work in one community can often translate more broadly to others. It’s a massive, massive market, and one that could potentially transform the lives of millions of people for the better.
Before moving on, there’s one other area of interest here, and that is creating impactful communities for healing. First responders and military veterans experience a mission and camaraderie in their service that they often lack once they are in new jobs or on convalescence. DelaCruz of Team Rubicon says that one of the goals of bringing veterans to help in disaster regions is that the veterans themselves “reconnect with identity and community — we have these incredible assets in these men and women who have served.” It’s not enough to just find a single treatment per patient — we oftentimes need to zoom out to the wider population to see how mental health ripples out.
Helping people find purpose may not be the easiest challenge to solve as a startup, but it’s certainly a major challenge for many, and an area fermenting with new approaches now that the the social networking wave has reached its nadir.
Crowdsourcing disaster response
Decentralization has been all the rage in tech in recent years — just mention the word blockchain in a TechCrunch article to get at least 50 PR emails about the latest NFT for a toilet stain. While there is obviously a lot of noise, one area where substance may pan out well is in disaster response.
If the COVID-19 pandemic showed anything, it was the power of the internet to aggregate as well as verify data, build dashboards, and deliver highly-effective visualizations of complex information for professionals and laypeople alike. Those products were developed by people all around the world often from the comfort of their own homes, and they demonstrate how crowds can quickly draft serious labor to help respond to crises as they crop up.
Jonathan Sury, project director at the National Center for Disaster Preparedness at the Earth Institute at Columbia University, said that “COVID has really blown so much of what we think about out of the water.” With so many ways to collaborate online right now, “that’s what I would say is very exciting … and also practical and empowering.”
Clark-Ginsberg of RAND calls it the “next frontier of disaster management.” He argues that “if you can use technology to broaden the number of people who can participate in disaster management and respond to disasters,” then we might be reaching an entirely new paradigm for what effective disaster response will look like. “Formal structures [for professional frontline workers] have strengthened and that has saved lives and resources, but our ability to engage with everyday responders is still something to work on.”
Many of the tools that underpin these crowdsourced efforts don’t even focus on disasters. Sury pointed to Tableau and data visualization platform Flourish as examples of the kinds of tools that remote, lay first responders are using. There are now quite robust tools for tabular data, but we’re still relatively early in the development of tools for handling mapping data — obviously critical in the crisis context. Unfolded.ai, which I profiled earlier this year, is working on building scalable geospatial analytics in the browser. A lot more can be done here.
Oftentimes there are ways to coordinate the coordinators. Develop for Good, which I looked at late last year, is a non-profit designed to connect enterprising computer science students to software and data projects at non-profits and agencies that needed help during the pandemic. Sometimes these coordinators are non-profit orgs, and sometimes, just very active Twitter accounts. There’s a lot more experimentation possible on how to coordinate efforts in a decentralized way while still engaging with professional first responders and the public sector.
Speaking of decentralization, it’s even possible that blockchain could play a role in disaster and crisis response. Many of these opportunities rest on using blockchain for evidence collection or for identity. For example, earlier this week Leigh Cuen took a careful look at an at-home sexual assault evidence collection kit from Leda Health that uses the blockchain to establish a clear time for when a sample was collected.
There is a lot more potential to harness the power of crowdsourcing and decentralization, and many of these projects have applications far outside disaster management itself. These tools not only solve real problems — they provide real community to people who may not be related to the disaster itself, but are enthusiastic to do their part to help others.
The black swans of black swans
In terms of startups, the three markets I identified — better training, better mental health, and better crowdsourcing collaboration tools, particularly around data — collectively represent a very compelling set of markets that will not only be valuable for founders, but can rapidly improve lives.
In his book Normal Accidents, Charles Perrow talks about how an increasing level of complexity and coupledness in our modern technical systems all but guarantee disasters to occur. Add in a warming world as well as the intensity, frequency, and just plain unusualness of disasters arriving each year, and we are increasingly seeing entirely novel forms of emergencies we have never responded to before. Take most recently the ultra-frigid conditions in Texas that sapped power from its grid, leading to statewide blackouts for hours and days in some parts of the state.
Clark-Ginsberg said, “We are seeing these risks emerge that aren’t just typical wildfires — where we have a response structure that we can easily setup and manage the hazard, [we’re] very good at managing these typical disasters. There are more of these atypical disasters cropping up, and we have a very hard time setting up structures for this — the pandemic is a great example of that.”
He describes these challenges as “trans-boundary risk management,” disasters that cross bureaucratic lines, professions, societies, and means of action. “It takes a certain agility and the ability to move quickly and the ability to work in ways outside typical bureaucratic structures, and that is just challenging full stop,” he said.
The Future of Technology and Disaster Response
- Part 1: The most disastrous sales cycle in the world: The future of sales
- Part 2: Data was the new oil until the oil caught fire: Data and AI
- Part 3: When the Earth is gone, at least the internet will still be working: Connectivity
- Part 4: The human-focused startups of the hellfire: Training, mental health and crowdsourcing
Even as we begin to have better point solutions to the individual problems that disasters and their responses require, we can’t be remiss in neglecting the more systematic challenges that these emergencies are bringing to the fore. We have to start thinking about bringing humans together faster and in more novel ways to be the most effective, while coupling them flexibly and with agility to the best tools that meet their needs in the moment. That’s probably not literally “a startup,” but more a way of thinking about what it means to construct a disaster response fresh given the information available.
Amanda Levin, a policy analyst at the Natural Resources Defense Council, said that “even if we mitigate, there are huge pressures and huge impacts today from a warming world … even if we stop emissions today, [they] will still persist.” As one of my interviewees in government service who asked to go unnamed noted about disaster response, “You always are coming up short somewhere.” The problems are only getting harder, and we humans need much better tools to match the man-made trials we created for ourselves. That’s the challenge — and opportunity — for a tough century ahead.
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Expectful’s new chief executive experienced the trauma she just raised millions to solve
Nathalie Walton almost didn’t become a mother. Her risky pregnancy caused her placenta to burst during childbirth, almost killing her and her son last year. Walton, who feels lucky to have survived, says the haunting experience made her an example of a reality she had long known: To be a pregnant Black woman is to be at risk, regardless of economic background.
The stress of her pregnancy led Walton to download Expectful, a meditation and sleep app for new mothers. She recalls stabilizing, emotionally and physically, within a week, bringing an otherwise “soft landing” to a volatile pregnancy.
Weeks after delivering her son, Everett, Walton just so happened to hear of an advisory role opening at Expectful. Even though she was mid-maternity leave from her managerial role at Airbnb, she jumped at the opportunity.
“I definitely had a full-time job, I had a newborn baby,” Walton said. But, she says, it was an opportunity to be entrepreneurial in a sector she cared about. Even if it was just for a few months.
And now, Walton is the chief executive of the company. The business is pivoting its product strategy to grow beyond recorded meditations. Walton helped it raise its first millions in venture capital, making her one of the few dozen Black female founders to do so. New financing and the boom of the mental health focus amid the coronavirus pandemic puts Expectful in a coveted spot. And it puts Walton, who is at the helm of a company for the first time, in a pressure-cooker spotlight.
Even in the world of startups, going from user to chief executive in less than a year is a remarkable feat. But it’s not one that she rushed.
A quarter-life crisis
Walton graduated from Georgetown and immediately joined the New York banking world. After a few years as an analyst at JP Morgan, though, she became unsatisfied with the work.
“I think I had a quarter-life crisis,” Walton said. Searching for new opportunities, she ended up at a prospective students day at Stanford University in what would become a pivotal moment in her life.
“For the first time, I met entrepreneurs and saw an actual concept that you can pursue a career you like, be successful and make a difference in the world,” she said. Walton eventually applied, and got accepted, to Stanford Graduate School of Business (GSB), a prestigious program that produces founders and top executives. It was then that she realized she wanted to be a chief executive one day.
“I admired them, but I just didn’t see the pathway for me to get there,” she said, of the entrepreneurs she met, who were then largely white and male. “I didn’t have the confidence.”
So, she set that hope aside and pursued intrapreneurship, which would let her join a stable organization and act as a mini-founder within it. Employees in this role are tasked with building a startup within a startup, whether that is rooting an innovative idea or leading an experiential team. Corporations have long embraced this idea to bring momentum to otherwise red-tapey processes.
Walton joined eBay and soon rose to work as the head of business operations and development. Her work helped the company break into 3D printing.
Over the years, this has been the defining characteristic of Walton: join an organization, build a scrappy idea from scratch, and then do it all over again. She has held roles in Airbnb and Google that all required her to have the agility of a founder convincing people on a moonshot vision, and the rigor of a manager who can get a deal done.
She had the same vision heading into an advisory role at Expectful. But when Walton landed a key Expectful partnership with Johnson & Johnson, then-CEO and founder Mark Krassner had an idea.
‘It was on my mind from day No. 1’
Before starting Expectful, Krassner experienced the benefits of meditation firsthand. He also saw his mother face depression, which made him realize how meditation could have a positive impact on others. After seeing research that showed how meditation could positively impact a pregnancy, he began thinking of a solution in this cross-section. He eventually started a course on Teachable, a startup that lets anyone create and monetize an online class, with 15 moms and a guided meditation.
Over time, the idea stuck. Krassner eventually turned his course into a 12-person startup. Under his leadership, Expectful grew to profitability and over 13,000 paid users. Its conversion rate from free to paid users was five times higher than industry standards, the company claims.
That said, from the moment Mark Krassner started Expectful, he knew he was an unlikely founder. He doesn’t have any children, so leading a meditation and sleep app for new mothers comes with its own hurdles.
“As a male founder with no kids, it was on my mind from day No. 1,” Krassner said. He eventually wanted to put a female at the head of the company, he says. Walton was the obvious choice.
Walton returned to Airbnb after her maternity leave right as Airbnb had aggressive COVID-19 layoffs. While her job was saved, her team disappeared as part of the cuts. She started looking for jobs, and received lucrative offers from Facebook, Apple, Google and Amazon. When she told Krassner she was leaning toward a lead product manager position at Amazon, he replied with an offer to take over Expectful’s entire business.
“I think it caught her off guard,” Krassner said, who is still a board member at the company. “Usually you don’t think a CEO is looking for [a new CEO] unless things are going to hell in a handbasket.”
The new Expectful
Expectful began as a guided meditation library, which will continue to be its core. But now, Walton wants to take advantage of that momentum and evolve the company into a “go-to wellness resource for hopeful, expecting and new parents.”
The language suggests that the startup is evolving in how it markets itself. Right now, the site has a number of references to “motherhood” and women. But Walton says Expectful defines a mother by anyone who identifies themselves as one. While the startup primarily has content geared toward the gestational parent, or the one who gives birth to the child, Walton says they have a “a partner’s library for non-gestational parents that identify as non-gestational mothers, fathers, or however they choose to identify.”
Walton plans to pivot the startup in three phases: content, marketplace and community.
For content, Expectful wants to organize pregnancy-related information. Currently, a lot of information or advice around pregnancy lives in books or in-person classes. But the learning experience, which Walton says is similar to middle school-style lectures, doesn’t feel built for this century.
The next step in her plan is digitizing the service providers that help women through pregnancy. In simpler words, replace the disorganized recommendations in Facebook groups for parents.
“When I went to ask my OB-GYN for recommendations for a doula, she gave me a sheet of paper with the names of 10 doulas,” she said. “You have to text the doula, ask them questions and if they want to meet up — it all feels yucky.” Expectful wants to put all that information in one platform so moms can access tips and recommendations from the ease of their homes.
The end-product here would be a peer-reviewed platform that can help a mom find everything from a therapist to a live-in nanny, with reviews built-in.
Finally, Walton wants to invest in the community. Expectful recently launched Mother Circles, which connects postpartum mothers into support cohorts led by a doula facilitator. The circles include six weekly video calls, a group chat and 500 hours of on-demand doula support.
Image Credits: Expectful
Part of Walton’s focus through all of these priorities is to invest in Black maternal health outcomes. Her own experience, she says, showed her how even a “Stanford-educated wellness junkie” such as herself can be at a high-risk for pregnancy because of her skin color.
It’s a lofty goal, even with the promising growth and strong library of guided meditations. The competition is steep. One of Expectful’s closest competitors is Peanut, a social network for moms used by over 1.2 million people. Mahmee, a digital support network for postpartum mothers, has raised $3 million and views itself as complementary to Expectful. Headspace has launched its own motherhood meditation series, but it is not as comprehensive as Expectful’s.
“I think we’re able to connect with women in a way that some of these other companies aren’t,” Walton said. “People are paying for the service, so they clearly need it.”
While Walton declined to share new user metrics, she said that the company’s revenue has grown 100% since March 2020.
Long-term, Expectful wants to mimic Peloton’s playbook in terms of getting premium content and community to the right audience. Still, growing from a startup to a venture business requires more than just ambition and market fit. It requires the ability to exponentially grow and keep growing.
A handful of investors believe that Walton’s Expectful can do it. Expectful raised $3 million in a seed financing round led by Harlem Capital. Indicator Ventures, Sequoia Scout Fund, Joyance Partners, Break Trail Ventures, Chinagona Ventures, Powerhouse Capital, AVG Basecamp Fund and Babylist also participated. Angel investors included Ellen Pao, Mike Smith and Ashley Mayer. The round also included $1.2 million in convertible SAFE notes, making the financing round a total of $4.2 million.
“Historically when I look at what black women raise fundraising, I feel fortunate that I’ve been able to raise this round,” Walton said.
Harlem Capital founding partner Henri Pierre-Jacques said that “obviously, given our focus we weren’t going to invest in a white male.” Walton’s “founder-market fit” is what made the firm invest, even with the hairy dynamic of an exiting CEO.
Mayer, head of communications at Glossier, was the one who introduced Walton to the woman who told her about the advisory role of Expectful. She says that Nathalie’s “path to entrepreneurship feels inevitable.
“It was always just a question of finding the space where her passions collided,” Mayer said.
As a new mother and new founder, Walton has had a busy balancing act of a year.
“I’m working more now than I have really in the last decade,” she said. “But I’ve never been more fulfilled because, as someone who went through this, and I’m still going through this, I feel so personally the level of pain that so many women suffer through.”
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Calm raises $75M more at $2B valuation
Calm, a well-known meditation app, has raised new capital at a valuation of $2 billion. The round was anticipated after the company was reported to be hunting for up to $150 million at a valuation of $2.2 billion; perhaps Calm will follow in the steps of Robinhood and add a second tranche to the round in time.
Prior investor Lightspeed Venture Partners led the investment, which also saw participation from Insight, TPG and Salesforce CEO and new Slack owner Marc Benioff, among others.
That Calm was able to secure more capital is not surprising. The company has a history of quick revenue growth, and is reportedly profitable, to boot. And the investment comes after mental health-focused startups as a category have performed well from a venture capital perspective.
The coronavirus pandemic has likely also played into Calm’s attractiveness as an investment. Since the beginning, researchers have warned about the psychological toll that a pandemic could have on humanity. A recent Pew Research study suggested that people who have lost their jobs during the pandemic might be feeling higher levels of distress during this time. Rival service Headspace offered an annual subscription to its platform for free for those that are unemployed.
Calm responded to the toll of coronavirus by launching a page of free resources, and focusing on a partnership with nonprofit health system Kaiser Permanente. Kaiser was the first health system to make Calm app’s Premium subscription free for its members.
The startups sells a consumer service for around $70 per year, or $15 per month. And the startup has built out a corporate arm, “Calm for Business,” that likely brings revenue stability that augments its consumer efforts.
As part of a release concerning today’s news, Calm detailed a number of nearly useful growth metrics. The service has over 100 million downloads, up from 40 million downloads in February 2019. It also grew up from 1 million paying users to 4 million paying users in the same time period (we asked if that data was inclusive of any Calm for Business customers, a question Calm did not answer).
Other TechCrunch queries regarding the company’s economics, revenue growth and performance compared to its pre-COVID plan also went unanswered.
Calm and rival service Headspace have now raised a combined $434 million according to Crunchbase data, underscoring how attractive their models have proved to venture capitalists. According to a Bloomberg interview, Calm is considering acquiring smaller companies in the wake of its new capital event.
Regardless, Calm now has a refreshed war chest heading into 2021 and a plan to go hunting. That should generate a headline or two.
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Mental health startups are raising spirits and venture capital
A spate of startups focused on mental health recently made enough noise as a group that they caught the eye of the Equity podcast crew. Sadly, the segment we’d planned to discuss this topic was swept away by a blizzard of IPO filings that piled up like fresh snow.
But in preparation, I reached out to CB Insights for new data on the mental health startup space that they were kind enough to supply. So this morning we’re going to dig into it.
Regular readers of The Exchange will recall that we last dug into overall wellness venture capital investment in August, noting that it was mental health startups inside the vertical that were seeing the most impressive results.
The Exchange explores startups, markets and money. Read it every morning on Extra Crunch, or get The Exchange newsletter every Saturday.
I wanted to know what had happened even more recently.
After all, Spring Health recently raised $76 million for its service that helps companies offer their workers mental health benefits, Mantra Health disclosed that it has raised $3.2 million to help with college-age mental health issues and Joon Care announced $3.5 million in new capital to “grow its remote therapy service for teens and young adults,” per GeekWire.
Sticking to theme, Headway just raised $32 million to build a platform that “helps people search for and engage therapists who accept insurance for payments,” according to our own reporting, and online therapy provider Talkspace is pursuing a sale — it looks like an active time in the mental health startup realm.
So, let’s shovel into the latest data and see if the signals that we are seeing really do reflect more total investment into mental health startups, or if we’re overindexing off a few news items.
The state of mental health venture investing
To prepare the ground, let’s talk about the general state of healthcare investing in the venture capital world. Per CB Insights’ Q3 healthcare VC report, venture capital deal volume and venture capital dollar volume reached new record highs in the sector during Q3 2020.
The quarter’s 1,539 rounds and $21.8 billion in invested capital were each comfortably ahead of prior records set in Q2 2018 for round volume (1,431) and Q2 2020 for dollar volume ($18.4 billion) for healthcare startups.
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Five success factors for behavioral health startups
Courtney Chow is an associate with Battery Ventures in San Francisco who focuses on early and growth-stage internet, software and services companies.
Justin Da Rosa
Contributor
Contributor
Justin Da Rosa is a vice president with Battery Ventures in San Francisco. He focuses on consumer internet, online marketplace and software investments.
Telehealth, or remote, tech-enabled healthcare, has existed for years in primary medical care through companies like Teladoc (NYSE: TDOC), Doctors on Demand and MDLIVE.
In recent years, the application of telehealth had rapidly expanded to address specific chronic and behavioral health issues like mental health, weight loss and nutrition, addiction, diabetes and hypertension, etc. These are real and oftentimes very severe issues faced by people all over the world, yet until now have seen little to no use of technology in providing care.
We believe behavioral health is particularly suited to benefit from the digitization trends COVID-19 has accelerated. Previously, we’ve written about the pandemic’s impact on online learning and education, both for K-12 students and adult learners. But behavioral health is another area impacted by the fundamental change in consumers’ behavior today. Below are four reasons we think the time is now for behavioral health startups — followed by five key factors we think characterize successful companies in this area.
Telehealth can significantly lower the cost of care
Traditional behavioral healthcare is cost-prohibitive for most people. In-person therapy costs $100+ per session in the U.S., and many mental health and substance-use providers don’t accept insurance because they don’t get paid enough by insurers.
By contrast, telehealth reduces overhead costs and scales more effectively. Leveraging technology, providers can treat more patients in less time with almost zero marginal costs. Mobile-based communications enable asynchronous care that further helps providers scale. Access to digital content gives patients on-going support without the need for a human on the other side. This is particularly useful in treating behavioral health issues where ongoing support and motivation may be necessary.
Technology unlocks supply in “shadow markets” of providers
Globally, we face an extreme shortage of behavioral health providers. For example, the United States has fewer than 30,000 licensed psychiatrists (translating to <1 for every 10,000 people). Outside of big cities, the problem gets worse: ~50-60% of nonmetro counties have no psychologists or psychiatrists at all.
Even when providers are available, wait times for appointments are notoriously long. This is a huge issue when behavioral health conditions often require timely intervention.
We are seeing new platforms build large networks of certified coaches, licensed psychologists and psychiatrists, and other providers, aggregating supply in what has historically been a scarce and a highly fragmented provider population.
Behavioral/mental health issues are losing their stigma
We believe the stigma associated with mental illness and other behavioral health conditions is dissipating. More and more public figures are speaking out about their struggle with anxiety, depression, addiction and other behavioral health issues. Our zeitgeist is shifting fast, and there’s an all-time high in people seeking help as the Google Trends data below demonstrates.
Image Credits: Google
Note: The anomalous dip in March/April ’20 was driven by mandatory shelter-in-place due to COVID-19.
Policy and regulations are changing quickly
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On-demand mental health service provider Ginger raises $50 million
Ginger, a provider of on-demand mental healthcare services, has raised $50 million in a new round of funding.
The new capital comes as interest and investment in mental health and wellness has emerged as the next big area of interest for investors in new technology and healthcare services companies.
Mental health startups saw record deal volumes in the second quarter of 2020 on the heels of rising demand caused by the COVID-19 epidemic, according to the data analysis firm CB Insights. More than 55 companies raised rounds of funding over the quarter, even though deal amounts declined 15%, to $491 million. That’s still nearly half a billion dollars invested into mental health in one quarter alone.
What started in 2011 as a research-based company spun out of work from the Massachusetts Institute of Technology has become one of the largest providers of mental health services primarily through employer-operated health insurance plans.
Through Ginger’s services, patients have access to a care coordinator that is the first point of entry into the company’s mental health plans. That person is a trained behavioral health coach — typically someone with a master’s degree in psychology with a behavioral health coaching certificate from schools like Duke, UCLA, Michigan or Columbia and 200 hours of training provided by Ginger itself.
These health coaches provide the majority of care that Ginger’s patients receive. For more serious conditions, Ginger will bring in specialists to coordinate care or provide access to medications to alleviate the condition, according to the company’s chief executive officer, Russell Glass.
Ginger began offering its on-demand care services in 2016 and counts tens of thousands of active users on the platform. The company charges companies a fee for access to its services on a per-employee, per-month basis and provides access to mental health services to hundreds of thousands of employees through corporate benefit plans, Glass said.
More than 200 companies, including Delta Air Lines, Sanofi, Chegg, Domino’s, SurveyMonkey and Sephora, pay Ginger to cost-efficiently provide employees with high-quality mental healthcare. Ginger members can access virtual therapy and psychiatry sessions as an in-network benefit through the company’s relationships with leading regional and national health plans, including Optum Behavioral Health, Anthem California and Aetna Resources for Living, according to a statement.
“Our entire mission here is to break the supply/demand imbalance and provide far more care,” said Glass in an interview. “Ultimately we want Ginger to be available to help anybody who has a need. Being accessible to anybody, anywhere, is an important part of the strategy. That means direct-to-consumer will be a direction we head in.”
For now, the company will use the money to build out its partner ecosystem with companies like Cigna, an investor in the company’s latest $50 million round. Ginger will also look to getting government payers to reach more people. Eventually direct-to-consumer could become a larger piece of the business as the company drives down costs of care.
It’s also investing in automation and natural language processing to automate care pathways and personalizing patient care using machine learning.
The company’s $50 million Series D round was co-led by Advance Venture Partners and Bessemer Venture Partners, with additional participation from Cigna Ventures and existing investors such as Jeff Weiner, executive chairman of LinkedIn, and Kaiser Permanente Ventures. To date, Ginger has raised roughly $120 million.
Even as Ginger is working through the existing network of employer benefit plans and standalone insurance providers to offer its mental health services, other startups are raising money to offer employer-provided mental health and wellness plans. SonderMind is working to make it easier for independent mental health professionals to bill insurers, AbleTo helps employers screen for undiagnosed mental health conditions and SilverLight Health partners with organizations to digitally monitor and manage mental health care.
Meanwhile, other startups are going direct-to-consumer with a flood of offerings around mental health. Well-financed, billion-dollar-valued companies like Ro and Hims are offering mental health and wellness packages to customers, while Headspace has both a consumer-facing and employer benefit offering. And upstart companies like Real are focusing on providing care specifically for women.
With its funding round, Ginger is adding David ibnAle, a founding partner at Advance Venture Partners (AVP), which is the investment firm behind S.I. Newhouse’s family-owned media and technology holding company, Advance; and the digital health investment guru Steve Kraus from Bessemer Venture Partners.
“AVP invests in companies that are using technology to tackle large-scale, global challenges and transform traditional businesses and business models,” said David ibnAle, founding partner of Advance Venture Partners. “Ginger is doing just that. We are excited to partner with an exceptional team to help make high-quality, on-demand mental health care a reality for millions of more people around the world.”
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Where is voice tech going?
Mark Persaud is digital product manager and practice lead at Moonshot by Pactera, a digital innovation company that leads global clients through the next era of digital products with a heavy emphasis on artificial intelligence, data and continuous software delivery.
2020 has been all but normal. For businesses and brands. For innovation. For people.
The trajectory of business growth strategies, travel plans and lives have been drastically altered due to the COVID-19 pandemic, a global economic downturn with supply chain and market issues, and a fight for equality in the Black Lives Matter movement — amongst all that complicated lives and businesses already.
One of the biggest stories in emerging technology is the growth of different types of voice assistants:
- Niche assistants such as Aider that provide back-office support.
- Branded in-house assistants such as those offered by BBC and Snapchat.
- White-label solutions such as Houndify that provide lots of capabilities and configurable tool sets.
With so many assistants proliferating globally, voice will become a commodity like a website or an app. And that’s not a bad thing — at least in the name of progress. It will soon (read: over the next couple years) become table stakes for a business to have voice as an interaction channel for a lovable experience that users expect. Consider that feeling you get when you realize a business doesn’t have a website: It makes you question its validity and reputation for quality. Voice isn’t quite there yet, but it’s moving in that direction.
Voice assistant adoption and usage are still on the rise
Adoption of any new technology is key. A key inhibitor of technology is often distribution, but this has not been the case with voice. Apple, Google, and Baidu have reported hundreds of millions of devices using voice, and Amazon has 200 million users. Amazon has a slightly more difficult job since they’re not in the smartphone market, which allows for greater voice assistant distribution for Apple and Google.
Image Credits: Mark Persaud
But are people using devices? Google said recently there are 500 million monthly active users of Google Assistant. Not far behind are active Apple users with 375 million. Large numbers of people are using voice assistants, not just owning them. That’s a sign of technology gaining momentum — the technology is at a price point and within digital and personal ecosystems that make it right for user adoption. The pandemic has only exacerbated the use as Edison reported between March and April — a peak time for sheltering in place across the U.S.
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Headspace raises $93 million in equity and debt as it pursues clinical validation for mindfulness
Headspace, the Los Angeles-based mindfulness and meditation company locked in a bitter competitive struggle with Calm for leadership in the mental wellness world, has raised new capital to try to take the pole position.
The company has just closed on $93 million in new equity and debt financing from a slew of investors as it pursues a number of clinical studies that could provide scientific validation for the somewhat nebulous claims around the benefits associated with mindfulness and meditation.
That clinical validation can also unlock new dollars in the form of government payments for mindfulness therapies that could be used to treat a variety of conditions. It also makes more valid the company’s pitch to companies as a useful component of an employee benefit program.
The company touted a pipeline of 70 clinical studies working in conjunction with academic partners, including Carnegie Mellon, University of California San Francisco and Stanford University.
Headspace’s new cash comes from investment firm blisce, with participation from Waverly Capital, Times Bridge (the investment arm of The Times Group of India), The Chernin Group, Spectrum Equity and Advancit Capital. A $40 million debt financing from Pacific Western Bank supplemented the $53 million in equity.
“Headspace has shown millions of people the power of using mindfulness to mitigate stress, anxiety, and other everyday issues while continuing to advance the field through clinically-validated research,” said Richard Pierson, the chief executive and co-founder of Headspace, in a statement. “As we think about the next ten years and beyond, we are focused on harnessing this power and applying it to other areas of our members’ lives to help them create healthy routines that last a lifetime — whether that is through our Headspace consumer app, the work we currently do with hundreds of employers, or with healthcare providers as we look to deliver better access.”
So far the company’s app has been loaded more than 62 million times in 190 countries. It already has over 2 million paid subscribers and more than 600 businesses are using Headspace’s on-the-job mental wellness tool.
The new money will be used to double down on its pitch to businesses and healthcare practitioners, according to a statement from the company, as well as to look at international markets. The company already has German and French versions of the app and has appointed the Apple executive Renate Nyborg to lead its European expansion.
As the new cash comes in, Headspace also has more money to compete for the attention of consumers with Calm, which raised an $88 million round (one that valued the company at over $1 billion) a little over a year ago.
Backed by TPG Capital and the entertainment agency CAA, Calm has recently inked deals with big time celebrities like LeBron James, who also has an equity stake in the company.
Calm’s approach seems to center more on a direct-to-consumer strategy that has seen the company enlist celebrities like James, John McEnroe, Matthew McConaughey’s and the English comedian, actor and writer Stephen Fry.
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TC’s Greg Epstein and Kate Clark talk mental health startups and the ‘Cult of the Founder’
Some weeks, tech ethics is in the news. And some weeks, it IS the news. This week was one of the latter.
There were so many ethically fraught news stories about technology companies over these past few days, I had trouble keeping track of them all. So I’m delighted that my latest interviewee for this series on ethics and technology is TechCrunch’s own Kate Clark, a reporter covering startups and venture capital.
Kate is one of the tech reporters on whom I rely most heavily for insight into what the hell is going on in Silicon Valley, and not just because she’s prolific, a fine writer, and so hardworking she seems to attend every VC dinner and startup product launch in Northern California (though she is all of those things).
I also turn to her (well actually, I turn to her Twitter — we’ve never met in person) because, though she would never claim to have any special training or authority in ethics, she has three of the top qualities I look for in an ethical leader: a passion for equitable inclusion; a well-modulated bullshit detector; and enough compassion for humanity to expect better of us all.
When Kate and I spoke on Wednesday afternoon, she was as harried as you might expect, at least based on her tweets.
Image via Twitter / Kate Clark / @KateClarkTweets
Alright anyone else that tries to generate headlines today is selfish and rude and must be stopped!!!
— Kate Clark (@KateClarkTweets) September 25, 2019
Greg Epstein: I’ve been looking forward to talking to you for a while now, and I certainly picked a busy day.
Kate Clark: Not as bad as yesterday.
Epstein: I follow your work closely; it informs mine. I’m sitting here in Cambridge, Massachusetts, where I work, and I’m thinking about the ethics of technology.
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Journey launches its real-time group ‘Peloton for Meditation’
Sitting silently with your eyes closed isn’t fun, but it’s good for you… so you probably don’t meditate as often as you’d like. In that sense, it’s quite similar to exercise. But people do show up when prodded by the urgency and peer pressure of scheduled group cycling or aerobics classes. What’s still in the way is actually hauling your lazy butt to the gym, hence the rise of Peloton’s in-home stationary bike with attached screen streaming live and on-demand classes. My butt is particularly lazy, but I’ve done 80 Peloton rides in four months. The model works.
Now that model is coming to mindfulness with the launch of Journey LIVE, a subscription iOS app offering live 15-minute group meditation classes. With sessions starting most waking hours, instructors that interact with you directly and a sense of herd mentality, you feel compelled to dedicate the time to clearing your thoughts. By video and voice, the teachers introduce different meditation theories and practices, guide you through and answer questions you can type in. Each day, Journey also provides a newly recorded on-demand session in case you need a class on your own schedule.
” ‘I tried Headspace’ or ‘I tried Calm .’ With a lot of the current meditation apps, people go on but they drop off very quickly,” says Journey founder and CEO Stephen Sokoler. “It means that there’s an interest in meditating and having a better life but people fall off because meditating alone is hard, it’s confusing, it’s boring. Meditating with a live teacher who can connect with you and say your name, who makes you feel seen and heard makes a huge difference.”
Journey subscriptions start at $19.99 per month after a week-long free trial. That feels a bit steep, but prices drop to $7.99 if paid annually with the launch discount, or you can dive in with a $399 lifetime pass. The challenge will be keeping users from abandoning meditation and then their subscription without resorting to growth hacking and annoying notifications that are antithetical to the whole concept. Journey has now raised a $2.4 million seed round led by Canaan and joined by Brooklyn Bridge Ventures, Betaworks and more to get the company rolling.
Sokoler’s own journey could set an example of the possibilities of sticking with it. “Meditation changed my life. I was fortunate enough to move to Australia, find a book on Buddhism, and then I had the willpower to start practicing meditation every day,” he tells me. “I lost 85 pounds. People ask me how I lost the weight and they expect me to say a diet like keto or Atkins, but it was because of the program I was in.” Suddenly able to sit quietly with himself, Sokoler didn’t need food to stay occupied or feel at ease.
The founder saw the need for new sources of happiness while working in employee rewards and recognition for 12 years. He built up a company that makes mementos for commemorating big business deals. Meditation proved to him the value of developing inner quiet, whether to inspire happiness, calm, focus or deeper connections to other people and the world. Yet the popular meditation apps ignored thousands of years of tradition when meditation would be taught in groups that give a naturally ethereal activity more structure. He founded Journey in 2015 to bring meditation to corporate environments, but now is hoping to democratize access with the launch of Journey LIVE.
“You could think of it as a real-life meditation community or studio in the palm of your hand,” Sokoler explains. Instructors greet you when you join a session in the Journey app and can give you a shout-out for practicing multiple days in a row. They help you concentrate on your breath while giving enough instruction to keep you from falling asleep. You can see or hide a list of screen names of other participants that make you feel less isolated and encourage you not to quit.
Finding a market amidst the popular on-demand meditation apps will be an uphill climb for Journey LIVE. While classes recorded a long time ago might not be as engaging, they’re convenient and can dig deep into certain styles and intentions. Calm and Headspace run around $12.99 per month, making them cheaper than Journey LIVE and potentially easier to scale.
But Sokoler says his app’s beta testing saw better retention than competitors. “If you’ve ever been to the New York Public Library, there’s so many books versus going to a local curated bookstore where something is right there for you. This is much more approachable, much more accessible,” Sokoler tells me. “There’s a paradox of choice, and having so many options makes it hard for people to stick with it and come back every single day.”
With our phones and Netflix erasing the downtime we used to rely on to give our brain a break or reflect on our day, life is starting to feel claustrophobic. We’re tense, anxious and easily overwhelmed. Meditation could be the antidote. Unlike with cycling or weightlifting, you don’t need some expensive Peloton bike or Tonal home gym. What you need is consistency, and an impetus to slow down for 15 minutes you could easily squander. We’re a tribal species, and Journey LIVE group classes could use camaraderie to lure us into the satisfying void of nirvana.
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