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Mental health app Wysa raises $5.5M for ’emotionally intelligent’ AI

It’s hard enough to talk about your feelings to a person; Jo Aggarwal, the founder and CEO of Wysa, is hoping you’ll find it easier to confide in a robot. Or, put more specifically, “emotionally intelligent” artificial intelligence.

Wysa is an AI-powered mental health app designed by Touchkin eServices, Aggarwal’s company that currently maintains headquarters in Bangalore, Boston and London. Wysa is something like a chatbot that can respond with words of affirmation, or guide a user through one of 150 different therapeutic techniques.

Wysa is Aggarwal’s second venture. The first was an elder care company that failed to find market fit, she says. Aggarwal found herself falling into a deep depression, from which, she says, the idea of Wysa was born in 2016. 

In March, Wysa became one of 17 apps in the Google Assistant Investment Program, and in May, closed a Series A funding round of $5.5 million led by Boston’s W Health Ventures, the Google Assistant Investment Program, pi Ventures and Kae Capital. 

Wysa has raised a total of $9 million in funding, says Aggarwal, and the company has 60 full-time employees and about three million users. 

The ultimate goal, she says, is not to diagnose mental health conditions. Wysa is largely aimed at people who just want to vent. Most Wysa users are there to improve their sleep, anxiety or relationships, she says. 

“Out of the 3 million people that use Wysa, we find that only about 10% actually need a medical diagnosis,” says Aggarwal. If a user’s conversations with Wysa equate with high scores on traditional depression questionnaires like the PHQ-9 or the anxiety disorder questionnaire GAD-7, Wysa will suggest talking to a human therapist. 

Naturally, you don’t need to have a clinical mental health diagnosis to benefit from therapy. 

Wysa isn’t intended to be a replacement, says Aggarwal (whether users view it as a replacement remains to be seen), but an additional tool that a user can interact with on a daily basis. 

“Sixty percent of the people who come and talk to Wysa need to feel heard and validated, but if they’re given techniques of self help, they can actually work on it themselves and feel better,” Aggarwal continues. 

Wysa’s approach has been refined through conversations with users and through input from therapists, says Aggarwal. 

For instance, while having a conversation with a user, Wysa will first categorize their statements and then assign a type of therapy, like cognitive behavioral therapy or acceptance and commitment therapy, based on those responses. It would then select a line of questioning or therapeutic technique written ahead of time by a therapist and begin to converse with the user. 

Wysa, says Aggarwal, has been gleaning its own insights from more than 100 million conversations that have unfolded this way. 

“Take for instance a situation where you’re angry at somebody else. Originally our therapists would come up with a technique called the empty chair technique where you’re trying to look at it from the other person’s perspective. We found that when a person felt powerless or there were trust issues, like teens and parents, the techniques the therapists were giving weren’t actually working,” she says. 

“There are 10,000 people facing trust issues who are actually refusing to do the empty chair exercise. So we have to find another way of helping them. These insights have built Wysa.”

Although Wysa has been refined in the field, research institutions have played a role in Wysa’s ongoing development. Pediatricians at the University of Cincinnati helped develop a module specifically targeted toward COVID-19 anxiety. There are also ongoing studies of Wysa’s ability to help people cope with mental health consequences from chronic pain, arthritis and diabetes at The Washington University in St. Louis and The University of New Brunswick. 

Still, Wysa has had several tests in the real world. In 2020, the government of Singapore licensed Wysa, and provided the service for free to help cope with the emotional fallout of the coronavirus pandemic. Wysa is also offered through the health insurance company Aetna as a supplement to Aetna’s Employee Assistance Program. 

The biggest concern about mental health apps, naturally, is that they might accidentally trigger an incident, or mistake signs of self harm. To address this, the U.K.’s National Health Service (NHS) offers specific compliance standards. Wysa is compliant with the NHS’ DCB0129 standard for clinical safety, the first AI-based mental health app to earn the distinction. 

To meet those guidelines, Wysa appointed a clinical safety officer, and was required to create “escalation paths” for people who show signs of self harm.

Wysa, says Aggarwal, is also designed to flag responses to self-harm, abuse, suicidal thoughts or trauma. If a user’s responses fall into those categories Wysa will prompt the user to call a crisis line.

In the U.S., the Wysa app that anyone can download, says Aggarwal, fits the FDA’s definition of a general wellness app or a “low risk device.” That’s relevant because, during the pandemic, the FDA has created guidance to accelerate distribution of these apps. 

Still, Wysa may not perfectly categorize each person’s response. A 2018 BBC investigation, for instance, noted that the app didn’t appear to appreciate the severity of a proposed underage sexual encounter. Wysa responded by updating the app to handle more instances of coercive sex. 

Aggarwal also notes that Wysa contains a manual list of sentences, often containing slang, that they know the AI won’t catch or accurately categorize as harmful on its own. Those are manually updated to ensure that Wysa responds appropriately. “Our rule is that [the response] can be 80%, appropriate, but 0% triggering,” she says. 

In the immediate future, Aggarwal says the goal is to become a full-stack service. Rather than having to refer patients who do receive a diagnosis to Employee Assistant Programs (as the Aetna partnership might) or outside therapists, Wysa aims to build out its own network of mental health suppliers. 

On the tech side they’re planning expansion into Spanish, and will start investigating a voice-based system based on guidance from the Google Assistant Investment Fund. 

 

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Telemedicine startups are positioning themselves for a post-pandemic world

Telemedicine, in its original form of the phone call, has been around for decades. For people in remote or rural areas without easy access to in-person care, consulting a doctor over the phone has often been the go-to approach. But for a large swath of the world used to taking half a day off work just for a 15-30 minute doctor’s appointment, it may seem like telemedicine was invented only last year. That’s mostly because it wasn’t until 2020 that telemedicine, in its myriad forms, debuted into the mainstream consciousness.

It’s impossible to predict how healthcare institutions will operate post-pandemic, but with so many people now accustomed to telemedicine, startups that provide services around virtual care continue to be poised for success.

Telemedicine has faced an uphill battle to become more relevant in the U.S., with challenges such as meeting HIPPA compliance requirements and insurance companies unwilling to pay for virtual visits. But when COVID-19 began raging across the globe and people had to stay home, both the insurance and healthcare industries were forced to adapt.

“It’s been said that there are decades where nothing happens, and then there are weeks when decades happen,” said StartUp Health co-founders Steven Krein and Unity Stoakes in the company’s 2020 year-end report. That statement couldn’t be truer for telemedicine: Around $3.1 billion in funding flowed into the sector in 2020 — about three times what we saw in 2019, according to the report. A health tech fund and insights company, StartUp Health counts Alphabet, Sequoia and Andreessen Horowitz as some of its co-investors.

Now that people see the benefits and conveniences of “dialing a doc” from the kitchen table, healthcare has changed forever. It’s impossible to predict how healthcare institutions will operate post-pandemic, but with so many people now accustomed to telemedicine, startups that provide services around virtual care continue to be poised for success.

The state of telemedicine

Major players in the field now look at the state of healthcare as, “before COVID and after COVID,” Stoakes told Extra Crunch. “In the post-pandemic world, there’s a significant transformation that’s occurred,” he said. “It’s all accelerated; the customers have shown up. There’s more capital than ever and consumers and physicians have adapted quickly,” he added.

In the U.S., healthcare is first and foremost a business, so while there are treatment approaches that have long been proven to improve patient outcomes, if they didn’t make sense financially, they weren’t instituted at scale. Telemedicine is a great example of this.

A 2017 study by the American Journal of Accountable Care showed that telemedicine can be quite useful for managing healthcare. “The use of telemedicine has been shown to allow for better long-term care management and patient satisfaction; it also offers a new means to locate health information and communicate with practitioners (e.g., via e-mail and interactive chats or video conferences), thereby increasing convenience for the patient and reducing the amount of potential travel required for both physician and patient,” the study reads.

But as we’ve seen, it took a global healthcare emergency to drive widespread adoption of virtual healthcare in the U.S. Now that investors recognize the potential, they are increasingly pouring money into startups that promise to take telemedicine to the next level. Some of the investors backing these newer companies include StartUp Health, Andreessen Horowitz, Sequoia, Alphabet, Kaiser Permanente Ventures, U.S. Venture Partners, Maveron, First Round Capital, DreamIt Ventures, Human Ventures and Tusk Venture Partners.

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Esper raises $30M Series B for its IoT DevOps platform

There may be billions of IoT devices in use today, but the tooling around building (and updating) the software for them still leaves a lot to be desired. Esper, which today announced that it has raised a $30 million Series B round, builds the tools to enable developers and engineers to deploy and manage fleets of Android-based edge devices. The round was led by Scale Venture Partners, with participation from Madrona Venture Group, Root Ventures, Ubiquity Ventures and Haystack.

The company argues that there are thousands of device manufacturers who are building these kinds of devices on Android alone, but that scaling and managing these deployments comes with a lot of challenges. The core idea here is that Esper brings to device development the DevOps experience that software developers now expect. The company argues that its tools allow companies to forgo building their own internal DevOps teams and instead use its tooling to scale their Android-based IoT fleets for use cases that range from digital signage and kiosks to custom solutions in healthcare, retail, logistics and more.

“The pandemic has transformed industries like connected fitness, digital health, hospitality, and food delivery, further accelerating the adoption of intelligent edge devices. But with each new use case, better software automation is required,” said Esper CEO and co-founder Yadhu Gopalan, who founded the company together with COO Shiv Sundar. “Esper’s mature cloud infrastructure incorporates the functionality cloud developers have come to expect, re-imagined for devices.”

Image Credits: Esper

Mobile device management (MDM) isn’t exactly a new thing, but the Esper team argues that these tools weren’t created for this kind of use case. “MDMs are the solution now in the market. They are made for devices being brought into an environment,” Gopalan said. “The DNA of these solutions is rooted in protecting the enterprise and to deploy applications to them in the network. Our customers are sending devices out into the wild. It’s an entirely different use case and model.”

To address these challenges, Esper offers a range of tools and services that includes a full development stack for developers, cloud-based services for device management and hardware emulators to get started with building custom devices.

“Esper helped us launch our Fusion-connected fitness offering on three different types of hardware in less than six months,” said Chris Merli, founder at Inspire Fitness. “Their full stack connected fitness Android platform helped us test our application on different hardware platforms, configure all our devices over the cloud, and manage our fleet exactly to our specifications. They gave us speed, Android expertise, and trust that our application would provide a delightful experience for our customers.”

The company also offers solutions for running Android on older x86 Windows devices to extend the life of this hardware, too.

“We spent about a year and a half on building out the infrastructure,” said Gopalan. “Definitely. That’s the hard part and that’s really creating a reliable, robust mechanism where customers can trust that the bits will flow to the devices. And you can also roll back if you need to.”

Esper is working with hardware partners to launch devices that come with built-in Esper-support from the get-go.

Esper says it saw 70x revenue growth in the last year, an 8x growth in paying customers and a 15x growth in devices running Esper. Since we don’t know the baseline, those numbers are meaningless, but the investors clearly believe that Esper is on to something. Current customers include the likes of CloudKitchens, Spire Health, Intelity, Ordermark, Inspire Fitness, RomTech and Uber.

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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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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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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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The health data transparency movement is birthing a new generation of startups

In the early 2000s, Jeff Bezos gave a seminal TED Talk titled “The Electricity Metaphor for the Web’s Future.” In it, he argued that the internet will enable innovation on the same scale that electricity did.

We are at a similar inflection point in healthcare, with the recent movement toward data transparency birthing a new generation of innovation and startups.

Those who follow the space closely may have noticed that there are twin struggles taking place: a push for more transparency on provider and payer data, including anonymous patient data, and another for strict privacy protection for personal patient data. What’s the main difference?

This sector is still somewhat nascent — we are in the first wave of innovation, with much more to come.

Anonymized data is much more freely available, while personal data is being locked even tighter (as it should be) due to regulations like GDPR, CCPA and their equivalents around the world.

The former trend is enabling a host of new vendors and services that will ultimately make healthcare better and more transparent for all of us.

These new companies could not have existed five years ago. The Affordable Care Act was the first step toward making anonymized data more available. It required healthcare institutions (such as hospitals and healthcare systems) to publish data on costs and outcomes. This included the release of detailed data on providers.

Later legislation required biotech and pharma companies to disclose monies paid to research partners. And every physician in the U.S. is now required to be in the National Practitioner Identifier (NPI), a comprehensive public database of providers.

All of this allowed the creation of new types of companies that give both patients and providers more control over their data. Here are some key examples of how.

Allowing patients to access all their own health data in one place

This is a key capability of patients’ newly found access to health data. Think of how often, as a patient, providers aren’t aware of treatment or a test you’ve had elsewhere. Often you end up repeating a test because a provider doesn’t have a record of a test conducted elsewhere.

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Healthcare is the next wave of data liberation

Why can we see all our bank, credit card and brokerage data on our phones instantaneously in one app, yet walk into a doctor’s office blind to our healthcare records, diagnoses and prescriptions? Our health status should be as accessible as our checking account balance.

The liberation of financial data enabled by startups like Plaid is beginning to happen with healthcare data, which will have an even more profound impact on society; it will save and extend lives. This accessibility is quickly approaching.

As early investors in Quovo and PatientPing, two pioneering companies in financial and healthcare data, respectively, it’s evident to us the winners of the healthcare data transformation will look different than they did with financial data, even as we head toward a similar end state.

For over a decade, government agencies and consumers have pushed for this liberation.

This push for greater data liquidity coincides with demand from consumers for better information about cost and quality.

In 2009, the Health Information Technology for Economic and Clinical Health Act (HITECH) gave the first big industry push, catalyzing a wave of digitization through electronic health records (EHR). Today, over 98% of medical records are digitized. This market is dominated by multibillion‐dollar vendors like Epic, Cerner and Allscripts, which control 70% of patient records. However, these giant vendors have yet to make these records easily accessible.

A second wave of regulation has begun to address the problem of trapped data to make EHRs more interoperable and valuable. Agencies within the Department of Health and Human Services have mandated data sharing among payers and providers using a common standard, the Fast Healthcare Interoperability Resources (FHIR) protocol.

Image Credits: F-Prime Capital

This push for greater data liquidity coincides with demand from consumers for better information about cost and quality. Employers have been steadily shifting a greater share of healthcare expenses to consumers through high-deductible health plans — from 30% in 2012 to 51% in 2018. As consumers pay for more of the costs, they care more about the value of different health options, yet are unable to make those decisions without real-time access to cost and clinical data.

Image Credits: F-Prime Capital

Tech startups have an opportunity to ease the transmission of healthcare data and address the push of regulation and consumer demands. The lessons from fintech make it tempting to assume that a Plaid for healthcare data would be enough to address all of the challenges within healthcare, but it is not the right model. Plaid’s aggregator model benefited from a relatively high concentration of banks, a limited number of data types and low barriers to data access.

By contrast, healthcare data is scattered across tens of thousands of healthcare providers, stored in multiple data formats and systems per provider, and is rarely accessed by patients directly. Many people log into their bank apps frequently, but few log into their healthcare provider portals, if they even know one exists.

HIPPA regulations and strict patient consent requirements also meaningfully increase friction to data access and sharing. Financial data serves mostly one-to-one use cases, while healthcare data is a many-to-many problem. A single patient’s data is spread across many doctors and facilities and is needed by just as many for care coordination.

Because of this landscape, winning healthcare technology companies will need to build around four propositions:

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Vista Equity takes minority stake in Canada’s Vena with $242M investment

Vena, a Canadian company focused on the Corporate Performance Management (CPM) software space, has raised $242 million in Series C funding from Vista Equity Partners.

As part of the financing, Vista Equity is taking a minority stake in the company. The round follows $25 million in financing from CIBC Innovation Banking last September, and brings Vena’s total raised since its 2011 inception to over $363 million.

Vena declined to provide any financial metrics or the valuation at which the new capital was raised, saying only that its “consistent growth and…strong customer retention and satisfaction metrics created real demand” as it considered raising its C round.

The company was originally founded as a B2B provider of planning, budgeting and forecasting software. Over time, it’s evolved into what it describes as a “fully cloud-native, corporate performance management platform” that aims to empower finance, operations and business leaders to “Plan to Growtheir businesses. Its customers hail from a variety of industries, including banking, SaaS, manufacturing, healthcare, insurance and higher education. Among its over 900 customers are the Kansas City Chiefs, Coca-Cola Consolidated, World Vision International and ELF Cosmetics.

Vena CEO Hunter Madeley told TechCrunch the latest raise is “mostly an acceleration story for Vena, rather than charting new paths.”

The company plans to use its new funds to build out and enable its go-to-market efforts as well as invest in its product development roadmap. It’s not really looking to enter new markets, considering it’s seeing what it describes as “tremendous demand” in the markets it currently serves directly and through its partner network.

“While we support customers across the globe, we’ll stay focused on growing our North American, U.K. and European business in the near term,” Madeley said.

Vena says it leverages the “flexibility and familiarity” of an Excel interface within its “secure” Complete Planning platform. That platform, it adds, brings people, processes and systems into a single source solution to help organizations automate and streamline finance-led processes, accelerate complex business processes and “connect the dots between departments and plan with the power of unified data.”            

Early backers JMI Equity and Centana Growth Partners will remain active, partnering with Vista “to help support Vena’s continued momentum,” the company said. As part of the raise, Vista Equity Managing Director Kim Eaton and Marc Teillon, senior managing director and co-head of Vista’s Foundation Fund, will join the company’s board.

“The pandemic has emphasized the need for agile financial planning processes as companies respond to quickly-changing market conditions, and Vena is uniquely positioned to help businesses address the challenges required to scale their processes through this pandemic and beyond,” said Eaton in a written statement. 

Vena currently has more than 450 employees across the U.S., Canada and the U.K., up from 393 last year at this time.

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Alan raises $220 million for its health insurance and healthcare superapp

French startup Alan has raised a $220 million funding round at a $1.67 billion valuation (€185 million and €1.4 billion respectively). Coatue is leading the round with Dragoneer, Exor, and existing investors Index Ventures, Ribbit Capital and Temasek also participating.

Alan has been building health insurance products from scratch. When I first covered the company back in 2016, the startup had just managed to get approval from regulators to become an official health insurance company.

Since then, it’s been a not-so-slow-and-steady growth story as the company now covers 160,000 people. Overall, Alan generates over €100 million in annualized revenue. While most of that revenue is spent back on claims, it’s an impressive revenue trajectory.

Like other insurance companies, Alan has some capital requirements to comply with health insurance regulation. Alan has to raise more if it wants to insure more people. But that’s just part of the story as the startup still had enough cash on its bank account for the next 12 to 18 months.

“The context is that we managed to end the year 2020 very strong, finally — and I say finally because it’s been stressful until the last minute,” co-founder and CEO Jean-Charles Samuelian-Werve told me.

Alan managed to meet its goals and international expansion finally started to take off. Many startups try to raise when they’re in a strong position. You shouldn’t wait until you have your back against the wall and that’s exactly what’s happening here.

“We thought it was the right time and we had multiple term sheets. Even though valuation is really good we first looked at a partner that has a really long-term vision,” Samuelian-Werve said.

With today’s funding round, the company can iterate on its core product — health insurance — and everything that makes Alan a superapp — a single app that lets you access several services. In France, employees are covered by both the national healthcare system and private insurance companies. Alan sells its products to other companies so that their employees are automatically covered by Alan contracts. It’s a sort of B2B2C play.

9,400 companies have opted for Alan in France, Belgium and Spain — the company’s home market remains its main market. Clients include WeWork, Deliveroo, JustEat, Vitaliance and Big Mamma. By 2023, Alan wants to reach 1 million members.

In order to gain more customers, Alan is betting on three pillars — product innovation, customer satisfaction through additional services, and expansions to new verticals and markets.

When it comes to product innovation, Alan has designed a modular insurance builder. Small companies can subscribe to Alan in a few clicks. Big companies can tweak every single parameter to build the right insurance package for them.

After that, the company tries to make it easy to manage your health insurance. You’ll soon be able to automatically manage sick leaves, change the employee affiliation status, etc. As for employees, the company has always promoted a transparent offering. For instance, you should know how much you’re going to pay out of pocket when you see a doctor. You can see a map of doctors around you and how much they charge on average. This way, there’s no surprise.

Alan also tries to reimburse you as quickly as possible. If it’s a straightforward claim, the startup tries to analyze and categorize your claim as quickly as possible and then issue an instant SEPA transfer. Seventy-five percent of claims are reimbursed and available on your bank account in less than an hour.

These core product features definitely contributes to customer satisfaction. But Alan is expanding beyond insurance products with several additional services that should increase retention. For instance, you can chat with a doctor, get medical advice for your baby’s health, get a free meditation app subscription, start a telehealth appointment via a partner, talk with someone about your mental health, etc.

Those services contribute to turning Alan into a superapp for your health. Essentially, as soon as you’re insured by Alan, you become a member and can access all those services without additional charges.

Eventually, Alan plans to launch a personal care guidance service to help you contact the right healthcare professional based on your health issue. In Spain, Alan can already book appointments for you.

Finally, Alan plans to reach new customers through aggressive expansion goals. The company plans to hire 400 people within the next three years and expand to other industries with tailor-made insurance products, such as retail, wholesale and manufacturing.

While the company is still going to focus on France, Belgium and Spain in the near future, it is looking at opportunities across Europe. So let’s see where Alan is going to expand next.

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