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Let’s talk about gaslighting and fundraising

“Most of the startups I give advice to about how to raise venture capital shouldn’t be raising venture capital,” an investor recently told me. While the idea that every startup isn’t venture-backable might run counter to the narrative to the barrage of funding news each week, I think it’s important to double click on the topic. Plus, it keeps coming up, off the record, on phone calls with investors!

As venture grows as an asset class, the access to capital has broadened from a dollar perspective, but I do think the difficulties that remain is an important dynamic to call out (and something no one talks about during an upmarket). Beyond the fact that only a small subset of startups truly can pull off scaling to the point of venture-level returns, it is still hard for even qualified founders to raise venture capital. Venture capital is still a heavily white, male-led industry, and as a result contains bias that disproportionately limits access for underrepresented founders.

Eniac founding partner Hadley Harris applied this dynamic to the current market boom in a recent tweet: A lot of people are misunderstanding this VC funding market. More money is flowing into the market but the increase is not evenly distributed. The market believes winners can be much bigger but not necessary that there will be more winners. It’s still very hard for most to raise a VC.

To say otherwise is to gaslight the early-stage or first-time founders that have spent months and months trying to raise their first institutional dollars and failed. So ask yourself: Seed rounds have indeed grown bigger, but for who? What comes at the cost of the $30 million seed round? Are the founders that can raise overnight from diverse backgrounds? Are investors backing first-time founders as much as they are backing second- or third-time entrepreneurs?

The answers might leave you debating about the boundaries, and limitations, of the upcoming hot-deal summer.

A few weeks ago, I wrote about the disconnect between due diligence and fundraising right now. Now we’ve moved onto the disconnect, and bifurcation, within first-check fundraising itself. There is so much more we can get into about the fallacy of “democratization” in venture capital, from who gets to start a rolling fund to the lack of assurance within equity crowdfunding campaigns.

We’ll get through it all together, and in the meantime make sure to follow me on Twitter @nmasc_ for more hot takes throughout the week.

In the rest of this newsletter, we will talk about fintech politics, the Affirm model with a twist, and sneakers-as-a-service.

Ex-Coinbase talks politics

The inimitable Mary Ann Azevedo has been dominating the fintech beat for us, covering everything from the latest Uruguayan unicorn to Acorn’s scoop of a debt management startup. But the story I want to focus on this week is her interview with ex-Coinbase counsel & former Treasury official, Brian Brooks.

Here’s what to know: Coinbase CEO Brian Armstrong notoriously released a memo last year denouncing political activism at work, calling it a distraction. In this exclusive interview, Brooks spoke about how blockchain is the answer to financial inclusion, and argued why politics needs to be taken out of tech.

We don’t want bank CEOs making those decisions for us as a society, in terms of who they choose to lend money to, or not. We need to take the politics out of tech. All of us do a lot of different things, and we have no idea on a given day, whether what we’re doing is popular with our neighbors or popular with our bank president or not. I don’t want the fact that I sometimes feel Republican to be a reason why my local bank president can deny me a mortgage.

Image Credits: Bryce Durbin/TechCrunch

The Affirm for X model

While Affirm may have popularized the “buy now, pay later” model, the consumer-friendly business strategy still has room to be niched down into specific subsectors. I ran into one such startup when covering Plaid’s inaugural cohort of startups in its accelerator program.

Here’s what to know: Walnut is a new seed-stage startup that is a point-of-sale loan company with a healthcare twist. Unlike Affirm, it doesn’t make money off of fees charged to consumers.

Image Credits: Bryce Durbin/TechCrunch

Everything you could ever want to know about StockX

In our latest EC-1, reporter Rae Witte has covered a startup that leads one of the most complex and culturally relevant marketplaces in the world: sneakers.

Here’s what to know: StockX, in her words, has built a stock market of hype, and her series goes into its origin story, authentication processes and a market map.

Image Credits: Nigel Sussman

Around TechCrunch

Found, a new podcast joining the TechCrunch network, has officially launched! The Equity team got a behind-the-scenes look at what triggered the new podcast, the first guests and goals of the show. Make sure to tune into the first episode.

Also, if you run into any paywalls while browsing today’s newsletter, make sure to use discount code STARTUPSWEEKLY to get 25% off an annual or two-year Extra Crunch subscription.

Across the week

Seen on TechCrunch

Okta launches a new free developer plan

New Jersey announces $10M seed fund aimed at Black and Latinx founders

Education nonprofit Edraak ignored a student data leak for two months

6 VCs talk the future of Austin’s exploding startup ecosystem

Dear Sophie: Help! My H-1B wasn’t chosen!

Seen on Extra Crunch

5 machine learning essentials nontechnical leaders need to understand

How we dodged risks and raised millions for our open-source machine language startup

Giving EV batteries a second life for sustainability and profit

And that’s a wrap! Thanks for making it this far, and now I dare you to go make the most out of the rest of your day. And by make the most, I mean listen to Taylor’s Version.

Warmly,

N

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Walnut wants to crack open flexibility for healthcare bills

Healthcare insurance, if you’re lucky to have it, only covers a subset of conditions in the United States. As a result, patients can often get burdened with horror story charges, like huge deductibles, out-of-network costs and expensive co-pays. So for the uninsured and insured alike, innovative ways of managing big bills are in high demand — especially as uncertainty remains around how COVID-19 and long-haul symptoms will be handled by patients and payers.

Walnut, founded by Roshan Patel, is a point-of-sale lending company with a healthcare twist. Walnut uses a “buy now, pay later” model, popularized by Affirm and Klarna, to help patients pay for healthcare over a period of time, instead of in one $3,000 chunk. Walnut works with healthcare providers so that a patient’s bill can be paid back through $100-a-month increments for 30 months, instead of one aggressive credit card swipe.

A patient using Walnut to pay healthcare bills. Image Credits: Walnut

It’s a sweet deal, but Patel added one more detail that he thinks makes Walnut stand out: The startup doesn’t charge any interest or fees to consumers.

“Almost every ‘buy now, pay later’ company in e-commerce charges interest or fees, and every personal loan provider charges interest or fees, but we do not,” he said. “And that’s really important to me, not making healthcare any more expensive than it already is. It’s a very patient-friendly product.”

Companies that use the buy now, pay later model with zero interest or fees need to make revenue somehow, and in Walnut’s case it is by charging healthcare providers a percentage of each sale or transaction.

If a provider’s collection rate for an out-of-pocket is 50%, Walnut would go to them and say “give us a 40% discount, and we’ll guarantee the cash for you upfront.” The startup will take the risk, and then the provider is able to make 60% of the collection rate.

Now, ideally, a provider would want to get 100% of payments they are owed, but that is wishful thinking. Patel explained that a large number of bills go unpaid due to bankruptcies or a default on payments (the average collections rate for hospitals out of pocket is less than 20%). Because of this, a company like Walnut has room to offer at least some stable upfront cash to hospitals, even if it ends up being 60% of overall bills versus 100%.

The company uses “extensive underwriting models” to figure out if a patient should qualify for a loan. Patel says that the startup goes beyond using credit score, which he describes as an “outdated metric”, and instead looks at thousands of data points from different providers, from side hustle income to spending habits on things like groceries and bills.

Walnut’s biggest challenge, says Patel, is to underwrite the population and pay the healthcare provider upfront in cash. It then collects from the patient on the back end, which comes with its own amount of risk.

“To be able to take on that risk for patients that are less credit-worthy is a very challenging problem, and I don’t think it’s really solved yet in healthcare,” he said.

The startup is starting by working with small private practices of one to five physicians that focus on specialties like dentistry, dermatology and fertility.

A big part of Walnut’s success will be determined by if it can attract people that truly need flexible financing options. For example, the company doesn’t have any hospitals as a partner yet, which would tap a larger group of patients that likely need flexible financing options the most. Right now, “the people who get elective-care surgery are the ones that can afford it.”

But Patel doesn’t see this as a disconnect; instead, he sees it as an opportunity to widen access to elective medical care to more people.

“I talked to a person last week who has no teeth and wants dentures but it costs $6,000,” he said. “That person should be able to afford it, and we enabled them to pay $100 a month for it.”

Walnut’s two biggest customer groups are the uninsured (people who have lost their jobs from COVID-19), and consumers who have high deductible plans.

Walnut isn’t the first. PrimaHealth Credit, Walnut’s closest competitor, offers point-of-sale lending procedures for elective medical procedures. Think surgeries like cataract work or dental work. The company said the service is currently available in Arizona, California, Florida, Oklahoma and Texas, and will be expanded to all 50 states this year. Walnut, comparatively, is mostly focused on the East Coast and plans to expand nationwide by the end of this year.

PrimaHealth’s average loan size is $1,800, and Walnut’s average loan size is $5,000.

The company is currently piloting with a handful of healthcare providers in dermatology, dentistry and fertility. It has had more than 500 patient loan applications, totaling over $4.6 million in application volume year-to-date. Patel says that Walnut only accepted a fraction of these applications, but declined to share what percent of money it has lent so far. As Walnut refines its model, it might be able to cover other categories.

Up until this point, Walnut has been lending off of its own balance sheet. In order to truly scale, it will need to get a new source of capital — either a credit line, debt financing round or venture capital — to offer more loans. Patel says that the startup is in talks with banks, and turned down a debt offer due to size and rate.

Venture capital seems to be the solution for now: The startup announced that it has raised a $3.6 million seed round from investors including Gradient Ventures, Afore Capital, 2048 Ventures, Supernode Ventures, TA Ventures, Polymath Capital, Tack Ventures, Awesome People Ventures, Newark Ventures and NKM Capital. Angels include the CEOs of Giphy and PillPack, and the CTO of Rampm Financial as well as an NFL coach. The company is also a part of Plaid’s inaugural accelerator.

“I don’t want to be yet another startup trying to offer you an undifferentiated insurance plan,” Patel said.

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Ghana’s Redbird raises $1.5M seed to expand access to rapid medical testing in sub-Saharan Africa

For patients and healthcare professionals to properly track and manage illnesses, especially chronic ones, healthcare needs to be decentralized. It also needs to be more convenient, with a patient’s health information able to follow them wherever they go.

Redbird, a Ghanaian health tech startup that allows easy access to convenient testing and ensures that doctors and patients can view the details of those test results at any time, announced today that it has raised a $1.5 million seed investment.  

Investors who participated in the round include Johnson & Johnson Foundation, Newton Partners (via the Imperial Venture Fund) and Founders Factory Africa. This brings the company’s total amount raised to date to $2.5 million.

The health tech company was launched in 2018 by Patrick Beattie, Andrew Quao and Edward Grandstaff. As a founding scientist at a medical diagnostics startup in Boston, Beattie’s job was to develop new rapid diagnostic tests. During his time in Accra in 2016, he met Quao, a trained pharmacist in Ghana at a hackathon whereupon talking found out that their interests in medical testing overlapped.

Beattie told TechCrunch that while he saw many exciting new tests in development in the U.S., he didn’t see the same in Ghana. Quao, who is familiar with how Ghanaians use pharmacies as their primary healthcare point, felt perturbed that these pharmacies weren’t doing more than transactional purchases.

They both settled that pharmacies in Ghana needed to imbibe the world of medical testing. Although both didn’t have a tech background, they realized technology was necessary to execute this. So, they enlisted the help of Grandstaff to be CTO of Redbird while Beattie and Quao became CEO and COO, respectively.

L-R: Patrick Beattie (CEO), Andrew Quao (COO) and Edward Grandstaff (CTO). Imge Credits: Redbird

Redbird enables pharmacies in Ghana to add to their pharmacy services rapid diagnostic testing for 10 different health conditions. These tests include anaemia, blood sugar, blood pressure, BMI, cholesterol, Hepatitis B, malaria, typhoid, prostate cancer screening and pregnancy.  

Also, Redbird provides pharmacies with the necessary equipment, supplies and software to make this possible. The software —  Redbird Health Monitoring — is networked across all partner pharmacies and enables patients to build medical testing records after going through five-minute medical tests offered through these pharmacies.

Rather than employing a SaaS model that Beattie says is not well appreciated by its customers, Redbird’s revenue model is based on the supply of disposable test strips.

“Pharmacies who partner with Redbird gain access to the software and all the ways Redbird supports our partners for free as long as they purchase the consumables through us. This aligns our revenue with their success, which is aligned with patient usage,” said the CEO.

This model is being used with more than 360 pharmacies in Ghana, mainly in Accra and Kumasi. It was half this number in 2019, which Redbird has since doubled despite the pandemic. These pharmacies have recorded over 125,000 tests in the past three years from more than 35,000 patients registered on the platform.

Redbird will use the seed investment to grow its operations within Ghana and expand to new markets that remain undisclosed.

In 2018, Redbird participated in the Alchemist Accelerator just a few months before launch. It was the second African startup after fellow Ghanaian health tech startup mPharma to take part in the six-month program. The company also got into Founders Factory Africa last April.

According to Beattie, most of the disease burden Africans might experience in the future will be chronic diseases. For instance, diabetes is projected to grow by 156% over the next 25 years. This is why he sees decentralized, digitized healthcare as the next leapfrog opportunity for sub-Saharan Africa.

“Chronic disease is exploding and with it, patients require much more frequent interaction with the healthcare system. The burden of chronic disease will make a health system that is highly centralized impossible,” he said.Like previous leapfrog events, this momentum is happening all over the world, not just in Africa. Still, the state of the current infrastructure means that healthcare systems here will be forced to innovate and adapt before health systems elsewhere are forced to, and therein lies the opportunity,” he said.

But while the promise of technology and data is exciting, it’s important to realize that health tech only provides value if it matches patient behaviors and preferences. It doesn’t really matter what amazing improvements you can realize with data if you can’t build the data asset and offer a service that patients actually value.

Beattie knows this all too well and says Redbird respects these preferences. For him, the next course of action will be to play a larger role in the world’s developing ecosystem where healthcare systems build decentralised networks and move closer to the average patient.

This decentralised approach is what attracted U.S. and South African early-stage VC firm Newtown Partners to cut a check. Speaking on behalf of the firm, Llew Claasen, the managing partner, had this to say.

“We’re excited about Redbird’s decentralised business model that enables rapid diagnostic testing at the point of primary care in local community pharmacies. Redbird’s digital health record platform has the potential to drive significant value to the broader healthcare value chain and is a vital step toward improving healthcare outcomes in Africa. We look forward to supporting the team as they prove out their  business model and scale across the African continent.”


Early Stage is the premier “how-to” event for startup entrepreneurs and investors. You’ll hear firsthand how some of the most successful founders and VCs build their businesses, raise money and manage their portfolios. We’ll cover every aspect of company building: Fundraising, recruiting, sales, product-market fit, PR, marketing and brand building. Each session also has audience participation built-in — there’s ample time included for audience questions and discussion. Use code “TCARTICLE” at checkout to get 20% off tickets right here.

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Amazon will expand its Amazon Care on-demand healthcare offering US-wide this summer

Amazon is apparently pleased with how its Amazon Care pilot in Seattle has gone, since it announced this morning that it will be expanding the offering across the U.S. this summer, and opening it up to companies of all sizes, in addition to its own employees. The Amazon Care model combines on-demand and in-person care, and is meant as a solution from the search giant to address shortfalls in current offerings for employer-sponsored healthcare.

In a blog post announcing the expansion, Amazon touted the speed of access to care made possible for its employees and their families via the remote, chat and video-based features of Amazon Care. These are facilitated via a dedicated Amazon Care app, which provides direct, live chats via a nurse or doctor. Issues that then require in-person care are then handled via a house call, so a medical professional is actually sent to your home to take care of things like administering blood tests or doing a chest exam, and prescriptions are delivered to your door as well.

The expansion is being handled differently across both in-person and remote variants of care; remote services will be available starting this summer to Amazon’s own employees, as well as other companies that sign on as customers, starting this summer. The in-person side will be rolling out more slowly, starting with availability in Washington, D.C., Baltimore, and “other cities in the coming months” according to the company.

As of today, Amazon Care is expanding in its home state of Washington to begin serving other companies. The idea is that others will sign on to make Amazon Care part of an overall benefits package for employees. Amazon is touting as a major strength of the service the speed advantages of testing services, including results delivery, for things including COVID-19.

The Amazon Care model has a surprisingly Amazon twist, too — when using the in-person care option, the app will provide an updated ETA for when to expect your physician or medical technician, which is eerily similar to how its primary app treats package delivery.

While the Amazon Care pilot in Washington only launched a year-and-a-half ago, the company has had its collective mind set on upending the corporate healthcare industry for some time now. It announced a partnership with Berkshire Hathaway and JPMorgan back at the beginning of 2018 to form a joint venture specifically to address the gaps they saw in the private corporate healthcare provider market.

That deep pocketed all-star team ended up officially disbanding at the outset of this year, after having done a whole lot of not very much in the three years in between. One of the stated reasons that Amazon and its partners gave for unpartnering was that each had made a lot of progress on its own in addressing the problems it had faced anyway. While Berkshire Hathaway and JPMorgan’s work in that regard might be less obvious, Amazon was clearly referring to Amazon Care.

It’s not unusual for large tech companies with lots of cash on the balance sheet and a need to attract and retain top-flight talent to spin up their own healthcare benefits for their workforces. Apple and Google both have their own on-campus wellness centers staffed by medical professionals, for instance. But Amazon’s ambitions have clearly exceeded those of its peers, and it looks intent on making a business line out of the work it did to improve its own employee care services — a strategy that isn’t too dissimilar from what happened with AWS, by the way.

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Norrsken Foundation is closing on an oversubscribed impact venture fund at €125 million

About four years ago, social impact organization Norrsken Foundation launched a small program investing around €30 million in capital it had received from its wealthy patron, Klarna co-founder Niklas Adalberth.

Now, that initiative has become its own impact investment firm, Norrsken VC and, according to people familiar with the firm, is about to close on its first independent investment vehicle — a €125 million ($149) fund focused on investing in startups that are, as its website suggests, “solving the world’s biggest problems.”

Norrsken VC did not respond for a request for comment about the firm’s fundraising plans.

Already, the young firm has invested in companies that would be standouts among any venture capital portfolio. Norrsken VC is one of the early backers behind Northvolt, which just received a $14 billion order for its batteries for electric vehicles from Volkswagen.

Electrification is actually a big theme for the early-stage firm, which counts the electric plane technology developer, Heart Aerospace, and autonomous electric vehicle developer Einride, and the battery monitoring and data management startup, Nortical, among its other portfolio companies.

Einride scored another huge coup recently. TechCrunch reported that the company was close to closing on $75 million in new funding even as it explored a potential SPAC for its business.

Indeed, Norrsken Foundation’s work in investing presaged a surge in climate and sustainability-focused activity from both venture investors, public markets and entrepreneurs looking at how to aid in the transition from fossil fuels to renewable resources and other zero carbon sources of energy.

That thesis on energy consumption extends to other areas of the firm’s portfolio, including companies like the energy efficient data center designer and technology developer, Submer.

If electrification and efficiency are one area of focus in the climate fight, Norrsken has also made moves to combat waste and improve efficiency in the food chain, as well. It’s probably the largest area of focus for the firm’s current portfolio outside of electrification, and there appear to be some early winners emerging in that category.

Those range from startups focused on agriculture like WeFarm and Ignitia, to consumer waste in the food industry through investments in Olio, Matsmart and Whywaste.

Taken together the climate and sustainability thesis has been the largest and most opportune investment target, but healthcare and wellness are also within the firm’s investment mandate. Startups like Winningtemp are an interesting indication of the firm’s thesis. That startup provides ways to monitor and support employees’ mental health.


Early Stage is the premier “how-to” event for startup entrepreneurs and investors. You’ll hear firsthand how some of the most successful founders and VCs build their businesses, raise money and manage their portfolios. We’ll cover every aspect of company building: Fundraising, recruiting, sales, product-market fit, PR, marketing and brand building. Each session also has audience participation built-in — there’s ample time included for audience questions and discussion. Use code “TCARTICLE at checkout to get 20% off tickets right here.

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Socure raises $100M at $1.3B valuation, proving identity verification is hotter than ever

The COVID-19 pandemic has accelerated digital adoption in a way that no one could have ever anticipated, and as more people conduct more services online and via mobile devices, businesses have had to work even harder to validate users and security. One company working to serve that need, Socure — which uses AI and machine learning to verify identities — announced Tuesday that it has raised $100 million in a Series D funding round at a $1.3 billion valuation.

Given how much of our lives have shifted online, it’s no surprise that the U.S. digital identity market is projected to increase to over $30 billion by 2023 from just under $15 billion in 2019, according to One World IdentityThis has led to skyrocketing demand for the services provided by identity verification companies. 

The founding team set out on a mission to be able to verify 100% of “good IDs” in real-time while “completely eliminating” identity fraud across the internet.

Historically, Socure has been focused on the financial services industry, but it plans to use its new capital to further expand into “every consumer-facing vertical” including online gaming, healthcare, telco, e-commerce and on-demand services.

The startup’s predictive analytics platform applies artificial intelligence and machine-learning techniques with online/offline data intelligence (from email, phone, address, IP, device, velocity and the broader internet) to verify that people are, in fact, who they say they are when applying for various accounts.

Today, Socure has more than 350 customers including three top five banks, six top 10 card issuers, a “top” credit bureau and over 75 fintechs such as Varo Money, Public, Chime and Stash.

In 2020, Socure grew its customer base by over 85% year over year and expanded its workforce by over 50% to about 240 people today.

Accel led Socure’s latest financing, which included participation from existing backers Commerce Ventures, Scale Venture Partners, Flint Capital, Citi Ventures, Wells Fargo Strategic Capital, Synchrony, Sorenson, Two Sigma Ventures and others. 

The round comes less than six months after the company raised $35 million in a round led by Sorenson Ventures, and brings the New York-based company’s total raised to $196 million since its 2012 inception.

Socure founder and CEO Johnny Ayers says his company’s identity management products can help B2C enterprises achieve know-your-customer (KYC) auto-approval rates of up to 97%. This means that financial institutions can more easily capture fraud, for example, via Socure’s single API. The company also claims that by more easily verifying thin-file (those without much credit history) and young consumers, it can help reduce the underbanked population.     

The pandemic and resulting shutdowns resulted in a massive demand for trusted digital identity, Ayers believes.

“This growth tracks with a larger trend marked by the broad migration of businesses to accept applications and onboard new customers online, with many companies accelerating their transformation from digital-first to digital-only,” he told TechCrunch.

Overall fraud attempts among Socure’s existing customer base nearly doubled in the second quarter of 2020 — with certain segments seeing rises as high as 150%, according to Ayers.

“These instances did not involve actual fraud but instead were flagged by Socure as suspicious and blocked prior to inflicting damage,” he said.

Looking ahead, the company plans to use its new capital to also enhance its product offering as it continues to develop patents. 

Accel partner Amit Jhawar will join Socure’s board as part of the funding round.

In a blog post, Jhawar described Socure as “a purpose-built solution designed to handle the wave of new online users because its machine learning models have learned from every identity it has already seen.”

As former COO at Braintree and general manager at Venmo, Jhawar knows a thing or two about the importance of identity verification, especially in the financial services space.

He wrote: “I knew immediately that the Socure solution would be a game-changer because the solution can be used in every step of the customer lifecycle, from account creation to login to transaction.”

Socure also has hinted that it has an IPO in its future.

In a written statement, Ayers said: “We are incredibly grateful for the chance to innovate and partner to solve this problem with some of the greatest companies in the world and are energized for the opportunities that lay ahead for Socure, especially as we make our march to a potential IPO.”

Via email, he told TechCrunch that the company will “potentially” look at public markets in 2022 or 2023, when it feels “the time is right for the business.”

The story was updated post-publication with live comments from Socure


Early Stage is the premier “how-to” event for startup entrepreneurs and investors. You’ll hear firsthand how some of the most successful founders and VCs build their businesses, raise money and manage their portfolios. We’ll cover every aspect of company building: Fundraising, recruiting, sales, product-market fit, PR, marketing and brand building. Each session also has audience participation built-in — there’s ample time included for audience questions and discussion. Use code “TCARTICLE at checkout to get 20% off tickets right here.

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With $19M A round, Halo Dx combines data streams to better diagnose cancers, dementia and more

Healthcare is one of the most complex industries out there, creating frustration on the consumer side but also the opportunity for huge improvements from, in a way, rather simple methods. Halo Diagnostics (or Dx for short) has raised a $19 million Series A to improve diagnosis of several serious illnesses by crossing the streams from multiple tests and making the improved process easily available to providers. They’ve also taken the unusual step of taking out an eight-figure line of credit to buy outright the medical facilities they’ll need to do it.

As anyone who’s had to deal with major health concerns can attest, the care you get differs widely from one provider to another depending on many factors, not least of which are what your insurance covers and what methods are already in use by the provider.

For men going in to get a prostate cancer screening, for instance, the common bloodwork and rectal exam haven’t changed in years, and really aren’t that great at predicting problems, leading to uncertainty and unnecessary procedures like biopsies.

Of course, if you’re lucky, your provider might offer multiparametric MRIs, which are much better at finding problems — and if you combine that MRI with a urine test that checks for genetic markers, the detection accuracy rises to practically foolproof levels.

But these tests are more expensive, take special facilities and personnel and may otherwise not fit into the provider’s existing infrastructure. Halo aims to provide that infrastructure by revamping the medical data stream to allow for this kind of multi-factor diagnosis.

“Basically doctors and imaging centers aren’t offering latest level of care. If you’re lucky you might get it, but in community medicine you’re not going to,” said Brian Axe, co-founder and chief product officer at Halo Dx. “As perverse as it sounds, what the healthcare industry needs to adopt the latest medical advancements is better financial alignment in addition to better outcomes. The challenge is the integrated diagnostic solution — how do you get these orders, go to market and talk with primary care providers?”

An added obstacle is that multi-modal testing isn’t really the kind of thing medical imaging or testing providers just decide to get into. An imaging center isn’t going to hear that a urine test improves reliability and think “well let’s buy the building next door and start doing that too!” It’s costly and complex to build out testing facilities, and getting the expertise to run them and combine the results is another hurdle.

So Halo Dx is parachuting in with tens of millions of dollars and purchasing the imaging and testing centers themselves (four so far), taking over their operations and combining them with other tests.

Assuming that much liability as a young company may seem like folly, but it helps that these imaging centers are strong businesses already — not derelict, half-paid-off MRI machines being operated at a loss.

“The imaging orders are coming in already; the centers are profitable. They’re coming on board because they see how technology is coming to disrupt them, and they want to help drive the change,” said Axe.

Prostate and breast cancers are the first target, but more and better data produce similarly improved diagnosis and treatment planning for more conditions, potentially (these are still being proven out), like Multiple Sclerosis, Parkinson’s and other neurodegenerative diseases.

With one company running multiple intake, imaging and testing facilities and integrating the results, it’s much more likely that providers will sign up. And Halo Dx is trying to bring some of the enterprise-grade software expertise to bear on the historically neglected field of medical data storage and communication.

Axe deferred to the company’s chief medical officer, Dr. John Feller, on the perils of that aspect of the field.

“Dr Feller describes this so well: ‘I have this state of the art MRI machine that can see inside your body, but because of the fragmented solutions that are out there, from intake to the storage centers, I feel like I’m living with pre-dot-com era tech and it’s crippling,’ ” Axe recalled. “If you want to look at records or recommend additional tests, software vendors don’t talk to each other or integrate. You have three providers that need to talk to each other and there’s a dozen systems between them.”

Axe compared the company’s approach here to One Medical’s — increasing efficiency and using that to make the relationship with the consumer lighter and easier, leading to more interactions.

In some ways it seems like a risky move, taking on nearly a hundred million in obligations and jumping into a hugely complex and highly regulated space. But the team is accomplished, the backers are notable, the potential for growth is there, and the success of the likes of One Medical have likely emboldened all involved.

Zola Global Investors led the round, and a who’s-who in medical and tech participated: Anne Wojcicki, Fred Moll, Stephen Pomeranz, Bob Reed, Robert Ciardi, Jim Pallotta and, believe it or not, Ronnie Lott of 49ers fame.

These and others involved make for a strong statement of confidence in both the model and the specific approach Halo Dx is taking to expanding and advancing care. Here’s hoping, however, that you won’t have to make use of their services.

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SESO Labor is providing a way for migrant farmworkers to get legally protected work status in the US

As the Biden administration works to bring legislation to Congress to address the endemic problem of immigration reform in America, on the other side of the nation a small California startup called SESO Labor has raised $4.5 million to ensure that farms can have access to legal migrant labor.

SESO’s founder Mike Guirguis raised the round over the summer from investors including Founders Fund and NFX. Pete Flint, a founder of Trulia, joined the company’s board. The company has 12 farms it’s working with and is negotiating contracts with another 46. The company’s other co-founder, Jordan Taylor, was the first product hire at Farmer’s Business Network and previously of Dropbox.

Working within the existing regulatory framework that has existed since 1986, SESO has created a service that streamlines and manages the process of getting H-2A visas, which allow migrant agricultural workers to reside temporarily in the U.S. with legal protections.

At this point, SESO is automating the visa process, getting the paperwork in place for workers and smoothing the application process. The company charges about $1,000 per worker, but eventually as it begins offering more services to workers themselves, Guirguis envisions several robust lines of revenue. Eventually, the company would like to offer integrated services for both farm owners and farm workers, Guirguis said.

SESO is currently expecting to bring in 1,000 workers over the course of 2021 and the company is, as of now, pre-revenue. The largest industry player handling worker visas today currently brings in 6,000 workers per year, so the competition, for SESO, is market share, Guirguis said.

America’s complicated history of immigration and agricultural labor

The H-2A program was set up to allow agricultural employers who anticipate shortages of domestic workers to bring to the U.S. non-immigrant foreign workers to work on farms temporarily or seasonally. The workers are covered by U.S. wage laws, workers’ compensation and other standards, including access to healthcare under the Affordable Care Act.

Employers who use the visa program to hire workers are required to pay inbound and outbound transportation, provide free or rental housing and provide meals for workers (they’re allowed to deduct the costs from salaries).

H-2 visas were first created in 1952 as part of the Immigration and Nationality Act, which reinforced the national origins quota system that restricted immigration primarily to Northern Europe, but opened America’s borders to Asian immigrants for the first time since immigration laws were first codified in 1924. While immigration regulations were further opened in the sixties, the last major immigration reform package in 1986 served to restrict immigration and made it illegal for businesses to hire undocumented workers. It also created the H-2A visas as a way for farms to hire migrant workers without incurring the penalties associated with using illegal labor.

For some migrant workers, the H-2A visa represents a golden ticket, according to Guirguis, an honors graduate of Stanford who wrote his graduate thesis on labor policy.

“We are providing a staffing solution for farms and agribusiness and we want to be Gusto for agriculture and upsell farms on a comprehensive human resources solution,” says Guirguis of the company’s ultimate mission, referencing payroll provider Gusto.

As Guirguis notes, most workers in agriculture are undocumented. “These are people who have been taken advantage of [and] the H-2A is a visa to bring workers in legally. We’re able to help employers maintain workforce [and] we’re building software to help farmers maintain the farms.”

Opening borders even as they remain closed

Farms need the help, if the latest numbers on labor shortages are believable, but it’s not necessarily a lack of H-2A visas that’s to blame, according to an article in Reuters.

In fact, the number of H-2A visas granted for agriculture equipment operators rose to 10,798 from October through March, according to the Reuters report. That’s up 49% from a year ago, according to data from the U.S. Department of Labor cited by Reuters.

Instead of an inability to acquire the H-2A visa, it was an inability to travel to the U.S. that’s been causing problems. Tighter border controls, the persistent global pandemic and travel restrictions that were imposed to combat it have all played a role in keeping migrant workers in their home countries.

Still, Guirguis believes that with the right tools, more farms would be willing to use the H-2A visa, cutting down on illegal immigration and boosting the available labor pool for the tough farm jobs that American workers don’t seem to want.

Photo by Brent Stirton/Getty Images.

David Misener, the owner of an Oklahoma-based harvesting company called Green Acres Enterprises, is one employer who has struggled to find suitable replacements for the migrant workers he typically hires.

“They could not fathom doing it and making it work,” Misener told Reuters, speaking about the American workers he’d tried to hire.

“With H-2A, migrant workers make 10 times more than they would get paid at home,” said Guirguis. “They’re taking home the equivalent of $40 an hour. The H-2A is coveted.”

Guirguis thinks that with the right incentives and an easier onramp for farmers to manage the application and approval process, the number of employers that use H-2A visas could grow to be 30% to 50% of the farm workforce in the country. That means growing the number of potential jobs from 300,000 to 1.5 million for migrants who would be under many of the same legal protections that citizens enjoy while they’re working on the visa.

Protecting agricultural workers through better paperwork

Interest in the farm labor nexus and issues surrounding it came to the first-time founder through Guirguis’ experience helping his cousin start her own farm. Spending several weekends a month helping her grow the farm with her husband, Guirguis heard his stories about coming to the U.S. as an undocumented worker.

Employers using the program avoid the liability associated with being caught employing illegal labor, something that crackdowns under the Trump administration made more common.

Still, it’s hard to deny the program’s roots in the darker past of America’s immigration policy. And some immigration advocates argue that the H-2A system suffers from the same kinds of structural problems that plague the corollary H-1B visas for tech workers.

“The H-2A visa is a short-term temporary visa program that employers use to import workers into the agricultural fields … It’s part of a very antiquated immigration system that needs to change. The 11.5 million people who are here need to be given citizenship,” said Saket Soni, the founder of an organization called Resilience Force, which advocates for immigrant labor. “And then workers who come from other countries, if we need them, they have to be able to stay … H-2A workers don’t have a pathway to citizenship. Workers come to us afraid of blowing the whistle on labor issues. As much as the H-2A is a welcome gift for a worker it can also be abused.”

Soni said the precarity of a worker’s situation — and their dependence on a single employer for their ability to remain in the country legally — means they are less likely to speak up about problems at work, since there’s nowhere for them to go if they are fired.

“We are big proponents that if you need people’s labor you have to welcome them as human beings,” Soni said. “Where there’s a labor shortage as people come, they should be allowed to stay … H-2A is an example of an outdated immigration tool.”

Guirguis clearly disagrees and said a platform like SESO’s will ultimately create more conveniences and better services for the workers who come in on these visas.

“We’re trying to put more money in the hands of these workers at the end of the day,” he said. “We’re going to be setting up remittance and banking services. Everything we do should be mutually beneficial for the employer and the worker who is trying to get into this program and know that they’re not getting taken advantage of.”

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Notable Health seeks to improve COVID-19 vaccine administration through intelligent automation

Efficient and cost-effective vaccine distribution remains one of the biggest challenges of 2021, so it’s no surprise that startup Notable Health wants to use their automation platform to help. Initially started to address the nearly $250 billion annual administrative costs in healthcare, Notable Health launched in 2017 to use automation to replace time-consuming and repetitive simple tasks in health industry admin. In early January of this year, they announced plans to use that technology as a way to help manage vaccine distribution.

“As a physician, I saw firsthand that with any patient encounter, there are 90 steps or touch points that need to occur,” said Notable Health Medical Director Muthu Alagappan in an interview. “It’s our hypothesis that the vast majority of those points can be automated.”

Notable Health’s core technology is a platform that uses robotic process automation (RPA), natural language processing (NLP) and machine learning to find eligible patients for the COVID-19 vaccine. Combined with data provided by hospital systems’ electronic health records, the platform helps those qualified to receive the vaccine set up appointments and guides them to other relevant educational resources.

“By leveraging intelligent automation to identify, outreach, educate and triage patients, health systems can develop efficient and equitable vaccine distribution workflows,” said Notable Health strategic advisor and Biden Transition COVID-19 Advisory Board Member Dr. Ezekiel Emanuel, in a press release.

Making vaccine appointments has been especially difficult for older Americans, many of whom have reportedly struggled with navigating scheduling websites. Alagappan sees that as a design problem. “Technology often gets a bad reputation, because it’s hampered by the many bad technology experiences that are out there,” he said.

Instead, he thinks Notable Health has kept the user in mind through a more simplified approach, asking users only for basic and easy-to-remember information through a text message link. “It’s that emphasis on user-centric design that I think has allowed us to still have really good engagement rates even with older populations,” he said.

While the startup’s platform will likely help hospitals and health systems develop a more efficient approach to vaccinations, its use of RPA and NLP holds promise for future optimization in healthcare. Leaders of similar technology in other industries have already gone on to have multibillion dollar valuations and continue to attract investors’ interest.

Artificial intelligence is expected to grow in healthcare over the next several years, but Alagappan argues that combining that with other, more readily available intelligent technologies is also an important step toward improved care. “When we say intelligent automation, we’re really referring to the marriage of two concepts: artificial intelligence — which is knowing what to do — and robotic process automation — which is knowing how to do it,” he said. That dual approach is what he says allows Notable Health to bypass administrative bottlenecks in healthcare, instructing bots to carry out those tasks in an efficient and adaptable way.

So far, Notable Health has worked with several hospital systems across multiple states in using their platform for vaccine distribution and scheduling, and are now using the platform to reach out to tens of thousands of patients per day.

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Bot MD, an AI-based chatbot for doctors, raises $5 million for expansion into more Asian markets

Time is critical for healthcare providers, especially in the middle of the pandemic. Singapore-based Bot MD helps save time with an AI-based chatbot that lets doctors look up important information from their smartphones, instead of needing to call a hospital operator or access its intranet. The startup announced today it has raised a $5 million Series A led by Monk’s Hill Venture.

Other backers include SeaX, XA Network and SG Innovate, and angel investors Yoh-Chie Lu, Jean-Luc Butel and Steve Blank. Bot MD was also part of Y Combinator’s summer 2018 batch.

The funding will be used to expand in the Asia-Pacific region, including Indonesia, the Philippines, Malaysia and Indonesia, and to add new features in response to demand from hospitals and healthcare organizations during COVID-19. Bot MD’s AI assistant currently supports English, with plans to release Bahasa Indonesian and Spanish later this year. It is currently used by about 13,000 doctors at organizations including Changi General Hospital, National University Health System, National University Cancer Institute of Singapore, Tan Tock Seng Hospital, Singapore General Hospital, Parkway Radiology and the National Kidney Transplant Institute.

Co-founder and chief executive officer Dorothea Koh told TechCrunch that Bot MD integrates hospital information usually stored in multiple systems and makes it easier to access.A smartphone with Bot MDs medical AI assistant for doctors displayed on it

Image Credits: Bot MDWithout Bot MD, doctors may need to dial a hospital operator to find which staffers are on call and get their contact information. If they want drug information, that means another call to the pharmacy. If they need to see updated guidelines and clinical protocols, that often entails finding a computer that is connected to the hospital’s intranet.

“A lot of what Bot MD does is to integrate the content that they need into a single interface that is searchable 24/7,” said Koh.

For example, during COVID-19, Bot MD introduced a new feature that takes healthcare providers to a form pre-filled with their information when they type “record temperature” into the chatbot. Many were accessing their organization’s intranet twice a day to log their temperature and Koh said being able to use the form through Bot MD has significantly improved compliance.

The time it takes to onboard Bot MD varies depending on the information systems and amount of content it needs to integrate, but Koh said its proprietary natural language processing chat engine makes training its AI relatively quick. For example, Changi General Hospital, a recent client, was onboarded in less than 10 days.

Bot MD plans to add new clinical apps to its platform, including ones for electronic medical records (EMR), billing and scheduling integrations, clinical alerts and chronic disease monitoring.

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