Health
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Should startups build or buy telehealth infrastructure?
Digital health in the U.S. got a huge boost from COVID-19 as more people started consulting physicians and urgent care providers remotely in the midst of lockdowns. So much so that McKinsey estimates that up to $250 billion of the current healthcare expenditure in the U.S. has the potential to be spent virtually. The prominence of digital health is undoubtedly here to stay, but how it looks and feels from provider to provider is still a debate among sector startups.
But for providers who want to deliver care virtually across the country, it’s not as simple as adding a Zoom invite to an annual check-up. The process requires intention every step of the way — right from the clinicians delivering remote care to the choice of payment processor.
Providers and healthcare startups can choose white-label solutions such as publicly-listed Teladoc and Truepill, which have been around for a long time, and have powered the operations of unicorns like Hims and Hers, Nurx, and GoodRx as they look to scale in a compliant but efficient manner.
Turnkey solutions might be tempting to companies looking to take advantage of this opportunity, but startups still have to decide what to outsource and what to build. Should you rely on others for staffing your practice? Do you build your own payment processing service in-house? Do you integrate with Zoom or build your own video-conferencing software? These questions are crucial to think about early on to prepare for future scale regardless of whether a startup is B2B or B2C.
More than just Zoom
SteadyMD, which in March raised a $25 million Series B led by Lux Capital, wants to be the infrastructure layer that makes it easier for other companies to offer telehealth services. It is hoping to address a pain point it ran into years earlier: The complexity of launching compliant telehealth services in all 50 states.
The company launched in 2016 with the intent to provide high-quality, virtual primary care for brick-and-mortar shops. Through that process, SteadyMD built a suite of tools to make it work with EMR integrations, doctor-patient communication channels, digital recruiting and forecasting software, and prescription referrals and operations. The burdensome process struck a chord with the co-founders and they pivoted the company to where it is today: an “AWS for healthcare”.
SteadyMD offers a suite of services to its customers, the least of which, says co-founder Guy Friedman, is its video-conferencing platform.
“It’s not about the technology capacities,” Friedman says. “The very large companies that have a lot of resources are using us to help them increase their capacity as workforce.”
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Direct-to-consumer orthodontic startup Impress raises $50M to scale across Europe
As the famous phrase goes, “software is eating the world” — and now software is eating dentistry. Or, perhaps more accurately, the arena of orthodontics — the specialty of dentistry that deals with things like braces — is slowly but surely being digitalized.
To whit, Impress, a Southern European player in direct-to-consumer orthodontics, has raised a $50 million Series A funding round led by CareCapital (a dental division of Hillhouse Capital in Asia), along with Nickleby Capital, UNIQA Ventures and investors including Michael Linse, Valentin Pitarque, Peter Schiff, Elliot Dornbusch and others. All existing shareholders, such as TA Ventures and Bynd VC, also participated.
Impress is an homage to the direct-to-consumer startups in this area in the U.S., such as SmileDirect, and now plans to scale across Europe from its existing bases in Spain, Italy, Portugal, the U.K. and France.
The company was founded in 2019 in Barcelona by orthodontist Dr. Khaled Kasem and serial entrepreneurs Diliara and Vladimir Lupenko.
Speaking from Barcelona, Lupenko told me that the idea was to “combine the best orthodontic tradition with the most innovative technology in the sector.”
As things stand, most of the time, consumers can usually only access cosmetic teeth alignment treatments or orthodontic medical treatments in conventional clinics. The new wave of clinics employs 3D scans and panoramic X-rays to check nerve and bone health.
Impress’s model is to offer these high-quality medical treatments directly to consumers, by developing its own chain of orthodontic clinics, which also put an emphasis on design and a “modern” patient experience, it says.
As Diliara Lupenko says: “We didn’t copy what other companies in the space were doing and approached the market from a different angle from the get-go. We doubled down on the doctor-led digital model which brought us way better conversion rates and treatment quality even though on paper it looked complex in the beginning. It’s still very complex but we were able to crack it and scale exponentially.”
Impress now has 75 clinics in Spain, Italy, the U.K., France and Portugal, which optimize costs and automate key parts of the value chain.
It now says it’s approaching €50 million in annual run-rate and is projected to grow to €150 million of revenue in 12 months.
Andreas Nemeth, managing partner of UNIQA Ventures GmbH commented: “Impress’s customer-centric focus, as well as its demonstrated ability to blitzscale, attracted us to the business. Vladimir and his team leverage technology to create a seamless customer journey for invisible orthodontics and optimized their cost structure in a unique way using software.”
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Disease-related risk management is now a thing, and this young startup is at the forefront
Charity Dean has been in the national spotlight lately because she was among a group of doctors, scientists and tech entrepreneurs who sounded the pandemic alarm early last year and who are featured in a new book by Michael Lewis about the U.S. response, called The Premonition.
It’s no wonder the press — and, seemingly moviemakers, too — are interested in Dean. Surgery is her first love, but she also studied tropical diseases and not only applied what she knows about outbreaks on the front lines last year, but also came to appreciate an opportunity that only someone in her position could see. Indeed, after the pandemic laid bare just how few tools were available to help the U.S. government to track how the virus was moving and mutating, she helped develop a model that has since been turned into subscription software to (hopefully) prevent, detect, and contain costly disease outbreaks in the future.
It’s tech that companies with global operations might want to understand better. It has also attracted $8 million in seed funding Venrock, Alphabet’s Verily unit, and Sweat Equity Ventures. We talked late last week with Dean about her now 20-person outfit, called The Public Health Company, and why she thinks disease-focused risk management will be as crucial for companies going forward as cybersecurity software. Our chat has been edited for length; you can also listen to our longer conversation here.
TC: You went to medical school but you also have a master’s degree in public health and tropical medicine. Why was the latter an area of interest for you?
CD: Neither of my parents had college degrees. I grew up in a very modest setting in rural Oregon. We were poor and by the grace of a full ride scholarship to college I got to be premed. When I was a little girl some missionaries came to our church and talked about disease outbreaks in Africa. I was seven years old, and driving home that evening with my parents, I said, ‘I’m going to be a doctor, and I’m going to study disease.’ It was outrageous because I didn’t know a single person with a college degree. But . . my heart was set on that, and it never deviated from it.
TC: How did you wind up at the Santa Barbara County Public Health Department, instead of in private practice?
CD: It’s funny, when I was finishing up my residency — which I started doing general surgery, then I pivoted into internal medicine — I had a number of different doctors’ private practices come to me and try to recruit me because of the shortage of women physicians.
[At the same time] the medical director from the county public health department came and found me and he said, ‘Hey, I hear you have a master’s in tropical medicine.’ And he said, ‘Would you consider coming to work as the deputy health officer, and communicable disease controller, and tuberculosis controller, and [oversee the] HIV clinic and homeless clinic?’ And . . . it was, for me, a fairly easy choice.
TC: Because there was so little attention being paid to all of these other issues?
CD: What caught my attention is when he said communicable disease controller and tuberculosis controller. I had lived in Africa [for a time] and learned a lot about HIV, AIDS, tuberculosis, vaccine-preventable diseases — things you don’t see in the United States. [And the job] was so in lockstep with who I was because it’s the safety net. [These afflicted individuals] don’t have health insurance. Many are undocumented. Many have nowhere else to go for health care, and the county clinic truly serves the communities that I cared about, and that’s where I wanted to be.
TC: In that role — and later at the California Department of Public Health — you developed expertise in multi-drug-resistant tuberculosis. Was your understanding of how it is transmitted — and how the symptoms present differently — what made you attuned to what was headed for the U.S. early last year?
CD: It was probably the single biggest contributor to my thinking. When we have a novel pathogen as a doctor, or as a communicable disease controller, our minds think in terms of buckets of pathogen: some are airborne, some are spread on surfaces, some are spread through fecal material or through water. In January [of last year], as I was watching the news reports emerge out of China, it became clear to me that this was potentially a perfect pathogen. What does that mean? It would mean it had some of the attributes of things like tuberculosis or measles or influenza — that it had the ability to spread from person to person, likely through the air, that it made people sick enough that China was standing up hospitals in two weeks, and that it moved fast enough through the population to grow exponentially.
TC: You are credited with helping to convince California Governor Gavin Newsom to issue lock-down orders when he did.
CD: Everything I’ve done is as part of a team. In March, some amazing heroes parachuted in from the private sector, including [former U.S Chief Technology Officer] Todd Park, [famed data scientist] DJ Patil, [and Venrock’s] Bob Kocher, to help the state of California develop a modeling effort that would actually show, through computer-generated models, in what direction the pandemic was headed.
TC: How did those efforts and thinking lead you to form The Public Health Company last August?
CD: What we are doing at The Public Health Company is incorporating the genomic variant analysis — or the fingerprint of the virus of COVID virus as it mutates and as it moves through a population — with epidemiology investigations and [porting these with] the kind of traditional data you might have from a local public health officer into a platform to make those tools readily available and easy to use to inform decision makers. You don’t have to have a mathematician and a data scientist and an infectious disease doctor standing next to you to make a decision; we make those tools automated and readily available.
TC: Who are your customers? The U.S. government? Foreign governments?
CD: Are the tools that we are developing useful for government? Absolutely. We’re engaged in a number of different partnerships where this is of incredible service to governments. But they are as useful, if not even more useful, to the private sector because they haven’t had these tools. They don’t have a disease control capability at their fingertips and many of them have had to essentially stand up their own internal public health department, and figure it out on the fly, and the feedback that we’re seeing from private sector businesses has been incredible.
TC: I could see hedge funds and insurance companies gravitating quickly to this. What are some customers or types of customers that might surprise readers?
CD: One bucket that might not occur to people is in the risk management space of a large enterprise that has global operations like a warehouse or a factory in different places. The risk management of COVID-19 is going to look very different in each one of those locations based on: how the virus is mutating in that location, the demographics of their employees, the type of activities they’re doing, [and] the ventilation system in their facility. Trying to grapple with all of those different factors . . .is something that we can do for them through a combination of our tech-enabled service, the expertise we have, the modeling, and the genetic analysis.
I don’t know that risk management in terms of disease control has been a big part of private sector conversations, [but] we think of it similar to cyber security in that after a number of high-profile cyber security attacks, it became clear to every insurance agency or private sector business that risk management had to include cyber security they had to stand up. We very much believe that disease control in risk management for continuity of operations is going to be incredibly important moving forward in a way that I couldn’t have explained before COVID. They see it now and they understand it’s an existential threat.
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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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Longevity startup Gero AI has a mobile API for quantifying health changes
Sensor data from smartphones and wearables can meaningfully predict an individual’s ‘biological age’ and resilience to stress, according to Gero AI.
The ‘longevity’ startup — which condenses its mission to the pithy goal of “hacking complex diseases and aging with Gero AI” — has developed an AI model to predict morbidity risk using ‘digital biomarkers’ that are based on identifying patterns in step-counter sensor data which tracks mobile users’ physical activity.
A simple measure of ‘steps’ isn’t nuanced enough on its own to predict individual health, is the contention. Gero’s AI has been trained on large amounts of biological data to spots patterns that can be linked to morbidity risk. It also measures how quickly a personal recovers from a biological stress — another biomarker that’s been linked to lifespan; i.e. the faster the body recovers from stress, the better the individual’s overall health prognosis.
A research paper Gero has had published in the peer-reviewed biomedical journal Aging explains how it trained deep neural networks to predict morbidity risk from mobile device sensor data — and was able to demonstrate that its biological age acceleration model was comparable to models based on blood test results.
Another paper, due to be published in the journal Nature Communications later this month, will go into detail on its device-derived measurement of biological resilience.
The Singapore-based startup, which has research roots in Russia — founded back in 2015 by a Russian scientist with a background in theoretical physics — has raised a total of $5 million in seed funding to date (in two tranches).
Backers come from both the biotech and the AI fields, per co-founder Peter Fedichev. Its investors include Belarus-based AI-focused early stage fund, Bulba Ventures (Yury Melnichek). On the pharma side, it has backing from some (unnamed) private individuals with links to Russian drug development firm, Valenta. (The pharma company itself is not an investor).
Fedichev is a theoretical physicist by training who, after his PhD and some ten years in academia, moved into biotech to work on molecular modelling and machine learning for drug discovery — where he got interested in the problem of ageing and decided to start the company.
As well as conducting its own biological research into longevity (studying mice and nematodes), it’s focused on developing an AI model for predicting the biological age and resilience to stress of humans — via sensor data captured by mobile devices.
“Health of course is much more than one number,” emphasizes Fedichev. “We should not have illusions about that. But if you are going to condense human health to one number then, for a lot of people, the biological age is the best number. It tells you — essentially — how toxic is your lifestyle… The more biological age you have relative to your chronological age years — that’s called biological acceleration — the more are your chances to get chronic disease, to get seasonal infectious diseases or also develop complications from those seasonal diseases.”
Gero has recently launched a (paid, for now) API, called GeroSense, that’s aimed at health and fitness apps so they can tap up its AI modelling to offer their users an individual assessment of biological age and resilience (aka recovery rate from stress back to that individual’s baseline).
Early partners are other longevity-focused companies, AgelessRx and Humanity Inc. But the idea is to get the model widely embedded into fitness apps where it will be able to send a steady stream of longitudinal activity data back to Gero, to further feed its AI’s predictive capabilities and support the wider research mission — where it hopes to progress anti-ageing drug discovery, working in partnerships with pharmaceutical companies.
The carrot for the fitness providers to embed the API is to offer their users a fun and potentially valuable feature: A personalized health measurement so they can track positive (or negative) biological changes — helping them quantify the value of whatever fitness service they’re using.
“Every health and wellness provider — maybe even a gym — can put into their app for example… and this thing can rank all their classes in the gym, all their systems in the gym, for their value for different kinds of users,” explains Fedichev.
“We developed these capabilities because we need to understand how ageing works in humans, not in mice. Once we developed it we’re using it in our sophisticated genetic research in order to find genes — we are testing them in the laboratory — but, this technology, the measurement of ageing from continuous signals like wearable devices, is a good trick on its own. So that’s why we announced this GeroSense project,” he goes on.
“Ageing is this gradual decline of your functional abilities which is bad but you can go to the gym and potentially improve them. But the problem is you’re losing this resilience. Which means that when you’re [biologically] stressed you cannot get back to the norm as quickly as possible. So we report this resilience. So when people start losing this resilience it means that they’re not robust anymore and the same level of stress as in their 20s would get them [knocked off] the rails.
“We believe this loss of resilience is one of the key ageing phenotypes because it tells you that you’re vulnerable for future diseases even before those diseases set in.”
“In-house everything is ageing. We are totally committed to ageing: Measurement and intervention,” adds Fedichev. “We want to building something like an operating system for longevity and wellness.”
Gero is also generating some revenue from two pilots with “top range” insurance companies — which Fedichev says it’s essentially running as a proof of business model at this stage. He also mentions an early pilot with Pepsi Co.
He sketches a link between how it hopes to work with insurance companies in the area of health outcomes with how Elon Musk is offering insurance products to owners of its sensor-laden Teslas, based on what it knows about how they drive — because both are putting sensor data in the driving seat, if you’ll pardon the pun. (“Essentially we are trying to do to humans what Elon Musk is trying to do to cars,” is how he puts it.)
But the nearer term plan is to raise more funding — and potentially switch to offering the API for free to really scale up the data capture potential.
Zooming out for a little context, it’s been almost a decade since Google-backed Calico launched with the moonshot mission of ‘fixing death’. Since then a small but growing field of ‘longevity’ startups has sprung up, conducting research into extending (in the first instance) human lifespan. (Ending death is, clearly, the moonshot atop the moonshot.)
Death is still with us, of course, but the business of identifying possible drugs and therapeutics to stave off the grim reaper’s knock continues picking up pace — attracting a growing volume of investor dollars.
The trend is being fuelled by health and biological data becoming ever more plentiful and accessible, thanks to open research data initiatives and the proliferation of digital devices and services for tracking health, set alongside promising developments in the fast-evolving field of machine learning in areas like predictive healthcare and drug discovery.
Longevity has also seen a bit of an upsurge in interest in recent times as the coronavirus pandemic has concentrated minds on health and wellness, generally — and, well, mortality specifically.
Nonetheless, it remains a complex, multi-disciplinary business. Some of these biotech moonshots are focused on bioengineering and gene-editing — pushing for disease diagnosis and/or drug discovery.
Plenty are also — like Gero — trying to use AI and big data analysis to better understand and counteract biological ageing, bringing together experts in physics, maths and biological science to hunt for biomarkers to further research aimed at combating age-related disease and deterioration.
Another recent example is AI startup Deep Longevity, which came out of stealth last summer — as a spinout from AI drug discovery startup Insilico Medicine — touting an AI ‘longevity as a service’ system which it claims can predict an individual’s biological age “significantly more accurately than conventional methods” (and which it also hopes will help scientists to unpick which “biological culprits drive aging-related diseases”, as it put it).
Gero AI is taking a different tack toward the same overarching goal — by honing in on data generated by activity sensors embedded into the everyday mobile devices people carry with them (or wear) as a proxy signal for studying their biology.
The advantage being that it doesn’t require a person to undergo regular (invasive) blood tests to get an ongoing measure of their own health. Instead our personal device can generate proxy signals for biological study passively — at vast scale and low cost. So the promise of Gero’s ‘digital biomarkers’ is they could democratize access to individual health prediction.
And while billionaires like Peter Thiel can afford to shell out for bespoke medical monitoring and interventions to try to stay one step ahead of death, such high end services simply won’t scale to the rest of us.
If its digital biomarkers live up to Gero’s claims, its approach could, at the least, help steer millions towards healthier lifestyles, while also generating rich data for longevity R&D — and to support the development of drugs that could extend human lifespan (albeit what such life-extending pills might cost is a whole other matter).
The insurance industry is naturally interested — with the potential for such tools to be used to nudge individuals towards healthier lifestyles and thereby reduce payout costs.
For individuals who are motivated to improve their health themselves, Fedichev says the issue now is it’s extremely hard for people to know exactly which lifestyle changes or interventions are best suited to their particular biology.
For example fasting has been shown in some studies to help combat biological ageing. But he notes that the approach may not be effective for everyone. The same may be true of other activities that are accepted to be generally beneficial for health (like exercise or eating or avoiding certain foods).
Again those rules of thumb may have a lot of nuance, depending on an individual’s particular biology. And scientific research is, inevitably, limited by access to funding. (Research can thus tend to focus on certain groups to the exclusion of others — e.g. men rather than women; or the young rather than middle aged.)
This is why Fedichev believes there’s a lot of value in creating a measure than can address health-related knowledge gaps at essentially no individual cost.
Gero has used longitudinal data from the UK’s biobank, one of its research partners, to verify its model’s measurements of biological age and resilience. But of course it hopes to go further — as it ingests more data.
“Technically it’s not properly different what we are doing — it just happens that we can do it now because there are such efforts like UK biobank. Government money and also some industry sponsors money, maybe for the first time in the history of humanity, we have this situation where we have electronic medical records, genetics, wearable devices from hundreds of thousands of people, so it just became possible. It’s the convergence of several developments — technological but also what I would call ‘social technologies’ [like the UK biobank],” he tells TechCrunch.
“Imagine that for every diet, for every training routine, meditation… in order to make sure that we can actually optimize lifestyles — understand which things work, which do not [for each person] or maybe some experimental drugs which are already proved [to] extend lifespan in animals are working, maybe we can do something different.”
“When we will have 1M tracks [half a year’s worth of data on 1M individuals] we will combine that with genetics and solve ageing,” he adds, with entrepreneurial flourish. “The ambitious version of this plan is we’ll get this million tracks by the end of the year.”
Fitness and health apps are an obvious target partner for data-loving longevity researchers — but you can imagine it’ll be a mutual attraction. One side can bring the users, the other a halo of credibility comprised of deep tech and hard science.
“We expect that these [apps] will get lots of people and we will be able to analyze those people for them as a fun feature first, for their users. But in the background we will build the best model of human ageing,” Fedichev continues, predicting that scoring the effect of different fitness and wellness treatments will be “the next frontier” for wellness and health (Or, more pithily: “Wellness and health has to become digital and quantitive.”)
“What we are doing is we are bringing physicists into the analysis of human data. Since recently we have lots of biobanks, we have lots of signals — including from available devices which produce something like a few years’ long windows on the human ageing process. So it’s a dynamical system — like weather prediction or financial market predictions,” he also tells us.
“We cannot own the treatments because we cannot patent them but maybe we can own the personalization — the AI that personalized those treatments for you.”
From a startup perspective, one thing looks crystal clear: Personalization is here for the long haul.
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4 strategies for building a digital health unicorn
It’s an entrepreneur’s market in digital health today, with startups raising record-breaking funding at soaring valuations and debuting on public markets to eager investors.
According to CB Insights, as of March 3, 2021, there are 51 healthcare unicorns — “startups” — worth $1 billion or more around the world. Global venture capital funding, including private equity and corporate VC, into digital health was the highest ever in the first quarter 2021 at $7.2 billion, according to Mercom Capital Group.
The massive influx of capital to healthcare should not be surprising; the pandemic has made it starkly clear that digital health is the future of healthcare. To that end, we should anticipate additional healthcare exits worth more than $1 billion in the near term. Which again, is great for entrepreneurs — as long as they understand how hard it is to build a unicorn in healthcare. Today, becoming a unicorn requires founders who are long on vision and operational experience.
Today, becoming a unicorn requires founders who are long on vision and operational experience.
Company founders most often turn to veteran investors for help with grand-slam strategies to create the next healthcare unicorn. That’s why many of them seek counsel from the Merck Global Health Innovation Fund: Because we have the experience, resources, successful track record and networks to build real scale in digital health.
During the pandemic, lots of investors jumped in to invest in digital health for the first time. But we’ve been investing for more than a decade. Two of our portfolio companies, Preventice Solutions and Livongo, exited last year as unicorns, rounding out the $6.2 billion in digital health market value MGHIF has exited over the last two years. And we are expecting two more unicorn exits in 2021. But we’re not stopping there; we’ll be investing our $500 million fund in drone-supported supply chain technologies, telehealth, AI, digital pathology, remote clinical trials and Internet of Medical Things (IoMT).
Given our success, here are four instrumental strategies to building a unicorn in digital health that we know work.
Raise the “right amount” of capital to build the right company
We often ask entrepreneurs: Would you rather own 20% of a $50 million company or 5% of a $1 billion company? To most, the answer is obvious. In our experience, too many entrepreneurs worry about dilution and never raise the right amount of capital.
It’s well known that companies with rapidly growing revenues are valued at a premium — but it’s important to remember that this is hard to do in healthcare. Getting to scale takes time because healthcare is so complicated and involves so many stakeholders.
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Fitness ring maker Oura raises $100M
It’s been a wild couple of years for Oura. Last year, in particular, proved to be a major driver for the wearable fitness manufacturer. With the pandemic bringing professional sports to a screeching halt in 2020, a number of major leagues have adopted the ring, including the NBA, WNBA, UFC and NASCAR.
The company has also been making a major push into health research courtesy of UCSF, which has published peer-review studies around the ring’s temperature monitor. That feature in particular has made it a big draw for the aforementioned leagues, as temperature spikes could point to larger issues, including the early stages of COVID-19.
Today the company is announcing a $100 million Series C. The round, led by The Chernin Group and Elysian Park (the Dodgers’ investment arm), brings the wearable company’s total funding up to $148.3 million. New investors include Temasek, JAZZ Venture Partners and Eisai, joining existing investors Forerunner Ventures, Square, MSD Capital, Marc Benioff, Lifeline Ventures, Metaplanet Holdings and Next Ventures.
The company initially set itself apart with its form factor, joining a crowded field that largely revolved around the wrist. Clearly, however, it’s come into its own over the last few years. To date, it’s sold more than 500,000 rings.
“The wearables industry is transitioning from activity trackers to health platforms that can improve people’s lives,” CEO Harpreet Singh Rai said in a press release tied to the news. “Oura focused first on sleep because it’s a daily habit, and lack of sleep has been linked to worsening health conditions including diabetes, cardiac disease, Alzheimer’s, cancer, poor mental health, and more.”
The company says the round will go toward R&D (both hardware and software development) and hiring, including additional marketing and customer experience. The round also sees the hiring of a number of key roles, including head of Science, Shyamal Patel; site leader Tommi Heinonen and Daniel Welch, who has been promoted to CFO.
“This year has shined a spotlight on gaps in our healthcare industry, and the increasing need for each of us to take control over our own health,” Forerunner Managing Director Eurie Kim said in the release. “Oura is emerging as the trusted leader and community in the space by empowering people with personalized data that provides actionable insights for health improvement.”
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IAC’s NurseFly rebrands to Vivian Health as it expands its healthcare jobs marketplace
NurseFly, the healthcare jobs marketplace owned by IAC, has rebranded to Vivian Health as it expands its range of services. Originally launched for traveling nurses (or nurses willing to travel for short-term positions), Vivian Health now includes listings for permanent positions, per diem shifts and local openings. It also added employer reviews and a pay database that uses information gathered from the 1.7 million jobs that have come through its system.
Founded in 2017, NurseFly was acquired by IAC in August 2019. It is used by providers like AMN Healthcare, Cross Country Healthcare, Host Healthcare, Trinity Health, SSM Health and Honor Health. During the pandemic, Vivian Health quadrupled its employee headcount in order to meet demand, founder and chief executive officer Parth Bhakta told TechCrunch in an email.
“Over the past year, we’ve grown to fill nearly 10% of all travel nursing positions across the United States, oftentimes helping fill a crisis position in a matter of hours rather than weeks,” Bhakta said. During that time, the platform heard from major health systems “that their challenges around hiring for permanent roles were oftentimes even more dire than filling their travel positions,” he added. “Permanent roles at health systems were taking months to fill, costing tens of thousands of dollars to hire, and leading to short-staffed facilities in the meantime.”
As a result of these conversations, Vivian Health’s team spent three months rebuilding the platform to serve a wider range of healthcare providers and employers. Its rebranding and expansion comes at a time when many healthcare professionals are reporting burnout as a result of the pandemic.
In a study of 1,300 respondents published earlier this month, Vivian Health found that 83% said their mental health had been affected by working in healthcare over the past year. About 43% said they had considered quitting the profession.
One of the main reasons for burnout is working overtime, with 86% of their respondents reporting that their facilities are short-staffed, even as demand for healthcare professionals accelerates. According to the Bureau of Labor Statistics (BLS), about 17.3 million people were employed in the healthcare sector in 2018, and that number is expected to increase 15% to 19.9 million by 2028, making it one of the fastest-growing sectors.
“Crisis-level staffing shortages” are compounded by the amount of time, sometimes up to 120 days, it can take to hire a permanent employee. Shortening the amount of time it takes to fill positions has a ripple effect because clinicians need to work less overtime. Meanwhile, recruiters can focus on the right leads. Bhakta said employers have been able to use Vivian Health to fill permanent positions in as little as one week, and are typically able to do so within 30 days.
Vivian Heath built a proprietary data set of healthcare industry information through the 1.7 million jobs that have come through its systems and asks all of its staffing agency partners to include pay rates in their listings. As a result, job seekers are able to see how a position’s compensation compares against the market, while employers can quickly adjust their rates to be more competitive.
Bhakta said Vivian Health added pay information because “our business is built on transparency, which we believe is a crucial element in solving the healthcare hiring crisis.”
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Headway raises $70M at a $750M valuation to help connect therapists with people and insurance schemes
Mental health, and how it is getting addressed, has been one of the major leitmotifs of the past year of pandemic living. COVID-19 not only has led to a lot of people getting ill or worse; it has increased isolation, economic uncertainty and led to a lot of other kinds of disappointments, and that all has had a knock-on effect on our collective and individual state of mind.
Today a startup called Headway, which has been working on building a better way for people to attend to themselves — by way of a three-sided marketplace of sorts, by helping a person to find and afford a therapist via a free-to-use portal, by making it possible for those therapists to accept a wider range of insurance plans and by helping those insurance plans facilitate more therapy appointments for their patient networks — is announcing a major round of funding on the heels of strong growth.
The startup has raised $70 million, money that it will be using to continue expanding its platform with more partnerships, more hiring for its team (it wants to have 300 people this year) and opening in new regions, aiming to be nationwide this year in the U.S. This round, a Series B, has a number of big names attached to it: It is being led by Andreessen Horowitz, with Thrive, GV and Accel also participating. (The latter three are repeat investors: Thrive and GV led its Series A, while Accel led its seed.) This Series B is coming in at a $750 million valuation.
The rapid pace of funding, the backers and that valuation all underscore the timeliness of the concept, and also the traction that Headway is getting for its approach.
When we last covered Headway — it raised $26 million just last November, six months ago — it said it had registered some 1,800 therapists on its platform in the New York metro area, where it is based. Now that number is up to more than 3,000 with its network now covering not just NYC, but also New Jersey, Florida, North Carolina, Texas, Georgia, Michigan, Virginia, Washington, Illinois and Colorado. It has more than 2,000 patients joining the platform each month and has so far helped facilitate 300,000 appointments, with a current average of 30,000 appointments each month. Revenues have in the last year, meanwhile, grown nine-fold.
The approach that Headway is taking — creating not just a vertical search portal for therapists, but building a back-end system to help those therapists grow their business by making it easier for them to accept insurance coverage — comes directly out of the experiences faced by one of the startup’s co-founders.
Andrew Adams, the CEO of Headway, told me last year he came up with the idea after he moved to New York from California several years ago to take a job. In seeking a therapist, he found most unwilling to accept his insurance plan as payment, making getting therapy unaffordable.
This is a very typical problem, he said. Some 70% of therapists do not accept insurance today because it’s too complicated for them to integrate, since about 85% of all therapists happen to be solo practitioners. So something that should be accessible to everyone becomes something typically only used by those who can afford it, or have entered into social care programs that might provide it. But that leaves a massive gap in the middle.
“This is the defining problem in the space,” he said at the time. “Health insurance is built around a medical world dominated by billers and admins, but therapists are small practitioners and don’t have the bandwidth to handle that, so they don’t. So we thought if we could make it easier for them to, they would, and they have.”
And indeed, if you are needing to see a therapist, the very last thing you need or want to be doing is spending your time trying to work out the economics of doing so: You need to be focused on finding someone you feel you can talk to; someone who can help you.
The problem is a huge one. In the U.S. alone it’s estimated that there are some 82 million people who have treatable health conditions. Headway was founded on the premise that most of them currently do not seek that treatment because of cost or accessibility.
A lot of therapy has traditionally been about seeing people in person — and arguably the fact that we’ve had so much reduced contact with people has contributed to mental health issues this past year — but in the event, Headway has definitely adapted to the current climate.
The company says that some 89% of its appointments at the moment are being carried out remotely. This is down from 97% at the peak of the pandemic in the U.S., and has been slowly starting to taper off, the company said. Some of the increased volume, meanwhile, is a direct result of therapists working remotely — they can fit more people in to a daily schedule as a result.
In terms of insurers, the company currently works with Aetna, Cigna, United Healthcare, Oscar and Oxford and says the list will be growing. One interesting detail is that Headway has not only built out a bigger funnel for these insurers in terms of the practitioners they work with and individuals who can subsequently use insurance to pay for therapy, but conversely has served to be a conduit for those insurance groups in bringing more patients through to those therapists, who are now a part of their networks, by way of Headway’s platform.
Headway says that using its system can help a patient get an appointment within five days, versus the the 30-day average you typically face when using an insurance directory.
It’s the kind of scale and “software eating the world” efficiency that has attracted Andreessen Horowitz to backing companies before, with the added detail of this being particularly relevant to the time we are living in.
“By getting the mental health provider community on the same page with insurance companies for the first time, Headway unlocks affordable mental healthcare for millions of Americans,” said Scott Kupor, managing partner at Andreessen Horowitz. “We’re incredibly excited to work alongside the Headway team.” Kupor is also joining Headway’s board with this round.
Cherry Miao, a former partner at Accel and Headway’s lead seed investor, is also joining as head of Finance & Data.
“I’ve been fortunate to work with some of the world’s most influential startups, and know that being part of Headway’s meaningful mission, robust business model, and incredibly talented team is a once-in-a-lifetime opportunity,” she said. “I’m thrilled to be helping rebuild America’s mental healthcare system for access and affordability.”
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Personalized nutrition startup Zoe closes out Series B at $53M total raise
Personalized nutrition startup Zoe — named not for a person but after the Greek word for ‘life’ — has topped up its Series B round with $20M, bringing the total raised to $53M.
The latest close of the B round was led by Ahren Innovation Capital, which the startup notes counts two Nobel laureates as science partners. Also participating are two former American football players, Eli Manning and Ositadimma “Osi” Umenyiora; Boston, US-based seed fund Accomplice; healthcare-focused VC firm THVC and early stage European VC, Daphni.
The U.K.- and U.S.-based startup was founded back in 2017 but operated in stealth mode for three years, while it was conducting research into the microbiome — working with scientists from Massachusetts General Hospital, Stanford Medicine, Harvard T.H. Chan School of Public Health, and King’s College London.
One of the founders, professor Tim Spector of King’s College — who is also the author of a number of popular science books focused on food — became interested in the role of food (generally) and the microbiome (in particular) on overall health after spending decades researching twins to try to understand the role of genetics (nature) vs nurture (environmental and lifestyle factors) on human health.
Zoe used data from two large-scale microbiome studies to build its first algorithm which it began commercializing last September — launching its first product into the U.S. market: A home testing kit that enables program participants to learn how their body responds to different foods and get personalized nutrition advice.
The program costs around $360 (which Zoe takes in six instalments) and requires participants to (self) administer a number of tests so that it can analyze their biology, gleaning information about their metabolic and gut health by looking at changes in blood lipids, blood sugar levels and the types of bacteria in their gut.
Zoe uses big data and machine learning to come up with predictive insights on how people will respond to different foods so that it can offer individuals guided advice on what and how to eat, with the goal of improving gut health and reducing inflammatory responses caused by diet.
The combination of biological responses it analyzes sets it apart from other personalized nutrition startups with products focused on measuring one element (such as blood sugar) — is the claim.
But, to be clear, Zoe’s first product is not a regulated medical device — and its FAQ clearly states that it does not offer medical diagnosis or treatment for specific conditions. Instead it says only that it’s “a tool that is meant for general wellness purposes only”. So — for now — users have to take it on trust that the nutrition advice it dishes up is actually helpful for them.
The field of scientific research into the microbiome is undoubtedly early — Zoe’s co-founder states that very clearly when we talk — so there’s a strong component here, as is often the case when startups seek to use data and AI to generate valuable personalized predictions, whereby early adopters are helping to further Zoe’s research by contributing their data. Potentially ahead of the sought for individual efficacy, given so much is still unknown around how what we eat affects our health.
For those willing to take a punt (and pay up), they get an individual report detailing their biological responses to specific foods that compares them to thousands of others. The startup also provides them with individualized ‘Zoe’ scores for specific foods in order to support meal planning that’s touted as healthier for them.
“Reduce your dietary inflammation and improve gut health with a 4 week plan tailored to your unique biology and life,” runs the blurb on Zoe’s website. “Built around your food scores, our app will teach you how to make smart swaps, week by week.”
The marketing also claims no food is “off limits” — implying there’s a difference between Zoe’s custom food scores and (weight-loss focused) diets that perhaps require people to cut out a food group (or groups) entirely.
“Our aim is to empower you with the information and tools you need to make the best decisions for your body,” is Zoe’s smooth claim.
The underlying premise is that each person’s biology responds differently to different foods. Or, to put it another way, while we all most likely know at least one person who stays rake-thin and (seemingly) healthy regardless of what (or even how much) they eat, if we ate the same diet we’d probably expect much less pleasing results.
“What we’re able to start scientifically putting some evidence behind is something that people have talked about for a long time,” says co-founder George Hadjigeorgiou. “It’s early [for scientific research into the microbiome] but we have shown now to the world that even twins have different gut microbiomes, we can change our gut microbiomes through diet, lifestyle and how we live — and also that there are associations around particular [gut] bacteria and foods and a way to improve them which people can actually do through our product.”
Users of Zoe’s first product need to be willing (and able) to get pretty involved with their own biology — collecting stool samples, performing finger prick tests and wearing a blood glucose monitor to feed in data so it can analyze how their body responds to different foods and offer up personalized nutrition advice.
Another component of its study of biological responses to food has involved thousands of people eating “special scientific muffins”, which it makes to standardized recipes, so it can benchmark and compare nutritional responses to a particular blend of calories, carbohydrate, fat, and protein.
While eating muffins for science sounds pretty fine, the level of intervention required to make use of Zoe’s first at-home test kit product is unlikely to appeal to those with only a casual interest in improving their nutrition.
Hadjigeorgiou readily agrees the program, as it is now, is for those with a particular problem to solve that can be linked to diet/nutrition (whether obesity, high cholesterol or a disease like type 2 diabetes, and so on). But he says Zoe’s goal is to be able to open up access to personalized nutrition advice much more widely as it keeps gathering more data and insights.
“The idea is, as always, we start with a focused set of people with problems to solve who we believe will have a life-changing experience,” he tells TechCrunch. “At this point we are not trying to create a product for everyone — and we understand that that has limitations in terms of how much we scale in the beginning. Although even still within this focused group of people I can assure you there’s tonnes of people!
“But absolutely the whole idea is that after we get a first [set of users]… then with more data and with more experience we can simplify and start making this simpler and more accessible — both in terms of its simplicity and also it’s price. So more and more people. Because at the end of the day everyone has this right to be able to optimize and understand and be in control — and we want to make that available to everyone.
“Regardless of background and regardless of socio-economic status. And, in fact, many of the people who have the biggest problems around health etc are the ones who have maybe less means and ability to do that.”
Zoe isn’t disclosing how many early users it’s onboarded so far but Hadjigeorgiou says demand is high (it’s currently operating a wait-list for new sign ups).
He also touts promising early results from interim trial with its first users — saying participants experienced more energy (90%), felt less hunger (80%) and lost an average of 11 pounds after three months of following their AI-aided, personalized nutrition plan. Albeit, without data on how many people are involved in the trials it’s not possible to quantify the value of those metrics.
The extra Series B funding will be used to accelerate the rollout of availability of the program, with a U.K. launch planned for this year — and other geographies on the cards for 2022. Spending will also go on continued recruitment in engineering and science, it says.
Zoe already grabbed some eyeballs last year, as the coronavirus pandemic hit the West, when it launched a COVID-19 symptom self-reporting app. It has used that data to help scientists and policy makers understand how the virus affects people.
The Zoe COVID-19 app has had some 5M users over the last year, per Hadjigeorgiou — who points to that (not-for-profit) effort as an example of the kind of transformative intervention the company hopes to drive in the nutrition space down the line.
“Overnight we got millions and millions of people contributing to help uncover new insights around science around COVID-19,” he says, highlighting that it’s been able to publish a number of research papers based on data contributed by app users. “For example the lack of smell and taste… was something that we first [were able to prove] scientifically, and then it became — because of that — an official symptom in the list of the government in the U.K.
“So that was a great example how through the participation of people — in a very, very fast way, which we couldn’t predict when we launched it — we managed to have a big impact.”
Returning to diet, aren’t there some pretty simple ‘rules of thumb’ that anyone can apply to eat more healthily — i.e. without the need to shell out for a bespoke nutrition plan? Basic stuff like eat your greens, avoid processed foods and cut down (or out) sugar?
“There are definitely rules of thumb,” Hadjigeorgiou agrees. “We’ll be crazy to say they’re not. I think it all comes back to the point that although there are rules of thumb and over time — and also through our research, for example — they can become better, the fact of the matter is that most people are becoming less and less healthy. And the fact of the matter is that life is messy and people do not eat even according to these rules of thumb so I think part of the challenge is… [to] educate and empower people for their messy lives and their lifestyle to actually make better choices and apply them in a way that’s sustainable and motivating so they can be healthier.
“And that’s what we’re finding with our customers. We are helping them to make these choices in an empowering way — they don’t need to count calories, they don’t need to restrict themselves through a Keto [diet] regime or something like that. We basically empower them to understand this is the impact food has on your body — real time, how your blood sugar levels change, how your bacteria change, how your blood fat levels changes. And through that empowerment through insight then we say hey, now we’ll give you this course, it’s very simple, it’s like a game — and we’ll given you all these tools to combine different foods, make foods work for you. No food is off limits — but try to eat most days a 75 score [based on the food points Zoe’s app assigns].
“In that very empowering way we see people get very excited, they see a fun game that is also impacting their gut and metabolism and they start feeling these amazing effects — in terms of less hunger, more energy, losing weight and over time as well evolving their health. That’s why they say it’s life changing as well.”
Gamifying research for the goal of a greater good? To the average person that surely sounds more appetitizing than ‘eat your greens’.
Though, as Hadjigeorgiou concedes, research in the field of microbiome — where Zoe’s commercial interests and research USP lie — is “early”. Which means that gathering more data to do more research will remain a key component of the business for the foreseeable future. And with so much still to be understood about the complex interactions between food, exercise and other lifestyle factors and human health, the mission is indeed massive.
In the meanwhile, Zoe will be taking it one suggestive nudge at a time.
“Sugar is bad, kale’s great but the whole kind of magic happens in the middle,” Hadjigeorgiou goes on. “Is oatmeal good for you? Is rice good for you? Is wholewheat pasta good for you? How do you combine wholewheat pasta and butter? How much do you have? This is where basically most of our life happens.
“Because people don’t eat ice-cream the whole day and people don’t eat kale the whole day. They eat all these other foods in the middle and that’s where the magic is — knowing how much to have, how to combine them to make it better, how to combine it with exercise to make it better? How to eat a food that doesn’t dip your sugar levels three hours after you eat it which causes hunger for you. Theses are all the things we’re able to predict and present in a simple and compelling way through a score system to people — and in turn help them [understand their] metabolic response to food.”
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