Ginger, a provider of on-demand mental healthcare services, has raised $50 million in a new round of funding.
The new capital comes as interest and investment in mental health and wellness has emerged as the next big area of interest for investors in new technology and healthcare services companies.
Mental health startups saw record deal volumes in the second quarter of 2020 on the heels of rising demand caused by the COVID-19 epidemic, according to the data analysis firm CB Insights. More than 55 companies raised rounds of funding over the quarter, even though deal amounts declined 15%, to $491 million. That’s still nearly half a billion dollars invested into mental health in one quarter alone.
What started in 2011 as a research-based company spun out of work from the Massachusetts Institute of Technology has become one of the largest providers of mental health services primarily through employer-operated health insurance plans.
Through Ginger’s services, patients have access to a care coordinator that is the first point of entry into the company’s mental health plans. That person is a trained behavioral health coach — typically someone with a master’s degree in psychology with a behavioral health coaching certificate from schools like Duke, UCLA, Michigan or Columbia and 200 hours of training provided by Ginger itself.
These health coaches provide the majority of care that Ginger’s patients receive. For more serious conditions, Ginger will bring in specialists to coordinate care or provide access to medications to alleviate the condition, according to the company’s chief executive officer, Russell Glass.
Ginger began offering its on-demand care services in 2016 and counts tens of thousands of active users on the platform. The company charges companies a fee for access to its services on a per-employee, per-month basis and provides access to mental health services to hundreds of thousands of employees through corporate benefit plans, Glass said.
More than 200 companies, including Delta Air Lines, Sanofi, Chegg, Domino’s, SurveyMonkey and Sephora, pay Ginger to cost-efficiently provide employees with high-quality mental healthcare. Ginger members can access virtual therapy and psychiatry sessions as an in-network benefit through the company’s relationships with leading regional and national health plans, including Optum Behavioral Health, Anthem California and Aetna Resources for Living, according to a statement.
“Our entire mission here is to break the supply/demand imbalance and provide far more care,” said Glass in an interview. “Ultimately we want Ginger to be available to help anybody who has a need. Being accessible to anybody, anywhere, is an important part of the strategy. That means direct-to-consumer will be a direction we head in.”
For now, the company will use the money to build out its partner ecosystem with companies like Cigna, an investor in the company’s latest $50 million round. Ginger will also look to getting government payers to reach more people. Eventually direct-to-consumer could become a larger piece of the business as the company drives down costs of care.
It’s also investing in automation and natural language processing to automate care pathways and personalizing patient care using machine learning.
The company’s $50 million Series D round was co-led by Advance Venture Partners and Bessemer Venture Partners, with additional participation from Cigna Ventures and existing investors such as Jeff Weiner, executive chairman of LinkedIn, and Kaiser Permanente Ventures. To date, Ginger has raised roughly $120 million.
Even as Ginger is working through the existing network of employer benefit plans and standalone insurance providers to offer its mental health services, other startups are raising money to offer employer-provided mental health and wellness plans. SonderMind is working to make it easier for independent mental health professionals to bill insurers, AbleTo helps employers screen for undiagnosed mental health conditions and SilverLight Health partners with organizations to digitally monitor and manage mental health care.
Meanwhile, other startups are going direct-to-consumer with a flood of offerings around mental health. Well-financed, billion-dollar-valued companies like Ro and Hims are offering mental health and wellness packages to customers, while Headspace has both a consumer-facing and employer benefit offering. And upstart companies like Real are focusing on providing care specifically for women.
With its funding round, Ginger is adding David ibnAle, a founding partner at Advance Venture Partners (AVP), which is the investment firm behind S.I. Newhouse’s family-owned media and technology holding company, Advance; and the digital health investment guru Steve Kraus from Bessemer Venture Partners.
“AVP invests in companies that are using technology to tackle large-scale, global challenges and transform traditional businesses and business models,” said David ibnAle, founding partner of Advance Venture Partners. “Ginger is doing just that. We are excited to partner with an exceptional team to help make high-quality, on-demand mental health care a reality for millions of more people around the world.”
What’s going on with the UK’s coronavirus contacts tracing app? Reports in the national press today suggest a launch of the much delayed software will happen this month but also that the app will no longer be able to automatically carry out contacts tracing.
The Times reports that a repackaged version of the app will only provide users with information about infection levels in their local area. The newspaper also suggests the app will let users provide personal data in order to calculate a personal risk score.
The Mail also reports that the scaled back software will not be able to carry out automated contacts tracing.
We’ve reached out to the Department for Health and Social Care (DHSC) with questions and will update this report with any response. DHSC is the government department leading development of the software, after the NHS’s digital division handed the app off.
As the coronavirus pandemic spread around the world this year, digital contacts tracing has been looked to as a modern tool to COVID-19 by leveraging the near ubiquity of smartphones to try to understand individual infection risk based on device proximity.
In the UK, an earlier attempt to launch an NHS COVID-19 app to support efforts to contain the virus by automating exposure notifications using Bluetooth signals faltered after the government opted for a model that centralized exposure data. This triggered privacy concerns and meant it could not plug into an API offered by Apple and Google — whose tech supports decentralized coronavirus contacts tracing apps.
At the same time, multiple countries and regions in Europe have launched decentralized contacts tracing apps this year. These apps use Bluetooth signals as a proxy for calculating exposure risk — crunching data on device for privacy reasons — including, most recently, Northern Ireland, which is part of the UK.
However in the UK’s case, after initially heavily publicizing the forthcoming app — and urging the public to download it in its daily coronavirus briefings (despite the app not being available nationwide) — the government appears to have stepped almost entirely away from digital contacts tracing, claiming the Apple -Google API does not provide enough data to accurately calculate exposure risk via Bluetooth.
Decentralized Bluetooth coronavirus contacts tracing apps that are up and running elsewhere Europe have reported total downloads and sometimes other bits of data. But there’s been no comprehensive assessment of how well they’re functioning as a COVID-fighting tool.
There have been some reports of bugs impacting operation in some cases, too. So it’s tricky to measure efficacy. Although the bald fact remains that having an app means there’s at least a chance it could identify contacts otherwise unknown to users, vs having no app and so no chance of that.
The Republic of Ireland is one of the European countries with a decentralized coronavirus contacts tracing app (which means it can interoperate with Northern Ireland’s app) — and it has defended how well the software is functioning, telling the BBC last month that 91 people had received a “close contact exposure alert” since launch. Although it’s not clear how many of them wouldn’t have been picked up via manual contacts tracing methods.
A government policy paper published at the end of last month which discussed the forthcoming DHSC app said it would allow citizens to: identify symptoms; order a test; and “feel supported” if they needed to self isolate. It would also let people scan a QR codes at venues they’ve visited “to aid contact tracing and help understand the spread of the virus”.
The government paper also claimed the app would let users “quickly identify when they have been exposed to people who have COVID-19 or locations that may have been the source of multiple infections” — but without providing details of how that would be achieved.
“Any services that require more information from a citizen will be provided only on the basis of explicit consent,” it added.
Ahead of the launch of this repackaged app it’s notable that DHSC disbanded an ethics committee which had been put in place to advise the NHS on the app. Once development was handed over to the government, the committee was thanked for its time and sent on its way.
Speaking to BBC Radio 4’s World at One program today, professor Lilian Edwards — who was a member of the ethics committee — expressed concern at the reports of the government’s latest plans for the app.
“Although the data collection is being presented as voluntary it’s completely non-privacy preserving,” she told the program, discussing The Times’ report which suggests users will be nudged to provide personal data with the carrot of a ‘personal risk score’. “It’s going to involve the collection of a lot of personal, sensitive data — perhaps your health status, your retirement status, your occupation etc.
“This seems, again, an odd approach given that we know one of the reasons why the previous app didn’t really take off was because there was rather a loss of public trust and confidence in it, because of the worries partly about privacy and about data collection — it not being this privacy-preserving decentralized approach.”
“To mix the two up seems a strange way to go forward to me in terms of restoring and embedding that trust and confidence that your data won’t be shared with people you don’t want it to be,” Edwards added. “Like maybe insurers. Or repurposed in ways that you don’t know about. So it seems rather contrary to the mission of restoring trust and confidence in the whole test and trace endeavour.”
Concerns have also been raised about another element of the government’s digital response to the coronavirus — after it rushed to ink contracts with a number of tech giants, including Palantir and Google, granting them access to NHS data.
It was far less keen to publish details of these contracts — requiring a legal challenge by Open Democracy, which is warning over the impact of “Silicon Valley thinking” applied to public health services.
In another concerning development, privacy experts warned recently that the UK’s test and trace program as a whole breaches national data protection laws, after it emerged last month that the government failed to carry out a legally required privacy impact assessment ahead of launch.
Infermedica, the Poland-founded health tech startup that offers an AI-driven platform for preliminary diagnosis and triage, has raised just over $10 million in Series A funding.
The round is led by the European Bank for Reconstruction and Development (EBRD) and digital health fund Heal Capital. Existing investors Karma Ventures, Inovo Venture Partners and Dreamit Ventures also participated.
Infermedica says the investment will be used for platform R&D to further enhance its patient triage and symptom-checking features and clinical decision support analysis. The company is also planning to expand operations in Germany and the U.S. The new capital means the startup has raised $15 million in total to date.
Founded in 2012 in Wrocław by CEO Piotr Orzechowski, Infermedica describes itself an “AI-driven, customisable, multi-language” platform that aids patient care and healthcare service delivery. Like a plethora of competitors, such as Ada Health, Babylon and Your.MD, it combines the expertise of doctors with its own algorithms to offer symptom triage and advice to patients.
Image Credits: Infermedica
Notably, the company operates a B2B model, working with insurance companies, telemedicine companies and health systems that want to offer digitally delivered symptom-checks. It positions itself as “API-first,” as well as whitelabeling its platform on behalf of customers.
“We’re focused on improving the way patients make decisions about their symptoms,” explains Orzechowski. “According to studies, the majority of internet users search online when they’re feeling unwell, but it’s hard to find accurate and personalized answers about our own health. To help everyone evaluate their symptoms in a quick and reliable way, we’ve developed a carefully curated AI platform that asks diagnostic questions and computes likelihoods of primary care conditions. With nearly 40,000 hours of physician work and 6,000,000 completed user checkups, we are among the most trusted vendors of symptom checking technology.”
To that end, current Infermedica clients include health insurance companies, such as Allianz, Global Excel and Medis, where digital triage claims to help optimise healthcare costs. The startup also sells into hospital systems, including Sana Kliniken, and is used to identify the urgency of a patient’s case and to collect information prior to a hospital visit. In addition, its API is used by technology companies, such as Microsoft’s integration of the platform into its health bot.
On competition, Orzechowski says there are several “great companies” in the space, but argues that each of them does something different in terms of their product or marketing focus. “What makes Infermedica unique is that we are API-first,” he says. “We’re solely focused on providing the most powerful AI triage and pre-diagnosis component, and we integrate easily with all other platforms such as chatbots, patient portals and EHRs. We want to become like Stripe, but for medical diagnosis.”
Meanwhile, Infermedica makes money by licensing its technology to its B2B clients. The startup’s SaaS model sees it charge based on the number of performed API calls or completed patient checkups.
In a sign of the growing importance and value of digital healthcare in the world of medicine, two of the industry’s publicly traded companies have agreed to a whopping $18.5 billion merger.
The union of Teladoc Health, a provider of virtual care services, and Livongo, which has made a name for itself by integrating hardware and software to monitor and manage chronic conditions like diabetes, will create a giant in the emerging field of telemedicine and virtual care.
“By expanding the reach of Livongo’s pioneering Applied Health Signals platform and building on Teladoc Health’s end-to-end virtual care platform, we’ll empower more people to live better and healthier lives,” said Glen Tullman, Livongo Founder and Executive Chairman. “This transaction recognizes Livongo’s significant progress and will enable Livongo shareholders to benefit from long-term upside as the combined company is positioned to serve an even larger addressable market with a truly unmatched offering.”
Under the terms of the agreement, each share of Livongo will be exchanged for 0.5920 shares of Teladoc health plus a cash payment of $11.33 for each share. The deal, based on Teladoc’s closing price on August 4, 2020, is roughly $18.5 billion. It’s an eye-popping figure for a company that was, at one point, trading below $16 per-share.
But the new reality of healthcare delivery in the era of COVID-19 rapidly accelerated the adoption of digital and remote care services like those Livongo was selling to its customers — and investor came calling as a result.
The combined company is expected to have pro forma revenue of $1.3 billion representing 85 percent year on year growth, on a pro forma basis. For 2020, the combined company expects adjusted EBITDA to reach $120 million.
“This merger firmly establishes Teladoc Health at the forefront of the next-generation of healthcare,” said Jason Gorevic, the chief executive officer of Teladoc Health, in a statement. “Livongo is a world-class innovator we deeply admire and has demonstrated success improving the lives of people living with chronic conditions. Together, we will further transform the healthcare experience from preventive care to the most complex cases, bringing ‘whole person’ health to consumers and greater value to our clients and shareholders as a result.”
The companies emphasized their combined ability to engage with patients and monitor and manage their conditions using technology. Teladoc Health’s flywheel approach to continued member engagement combined with Livongo’s proven track record of using data science to build consumer trust will accelerate the combined company’s development of longitudinal consumer and provider relationships, the companies said in a statement.
Teladoc currently counts 70 million customers in the United States with an access to Medicare and Medicaid patients that Livongo’s services could reach. The combined company also pitched the operational efficiencies that could be created through the merger. Teladoc estimated that there would be “revenue synergies” of $100 million two years from the close of the deal, reaching $500 million on a run rate basis by 2025, according to a statement.
Gorevic will run the combined company and David Snow will serve as the chair of the new board — which will be comprised of eight current Teladoc board members and five members of the Livongo board.
The company expects the deal to close by the end of the fourth quarter, subject to regulatory approvals. Lazard advised Teladoc on the transaction while Morgan Stanley served as the financial advisor to Livongo.
Stix, a direct-to-consumer women’s health brand, today announced the close of a $1.3 million seed round. Investors such as BDMI, Rogue Women’s Fund, Vamos Ventures, Founders Factory New York, as well as angels like Heidi Zak (ThirdLove) Laurence Franklin (Coach) and Steve Gutentag and Demetri Karagas (30 Madison) participated in the round.
There is no shortage of men’s health startups out there to ease the awkwardness and stress of getting products for hair loss or erectile disfunction. But when it comes to something as common and straightforward as purchasing a pregnancy test, women must still make a run to the drug store.
Stix offers competitively priced pregnancy tests and ovulation tests that customers can purchase online. As a diagnostics product, Stix is FDA-approved and everything from the instructions to the promotional language has to go through the approval process, according to Plotch. The cofounder and CEO says that both the pregnancy tests and ovulation tests are more than 99 percent accurate.
The Stix pregnancy test costs $13, and includes two tests, free shipping and instructional materials. The ovulation test, which includes seven tests, costs $17.
The company has also taken measures to ensure that the delivery of these products is discreet for customers who don’t want their roommates, whether it’s a live-in partner or parent or just a regular roommate, to know they’re purchasing a pregnancy test.
Stix uses PayPal to stay discreet on the credit card bill, and doesn’t include ‘Stix’ on the return address of the shipped products.
“The entire experience is really based on learning and education,” said Plotch. “We believe that all women deserve access to these products and peace of mind throughout the experience. So, unlike other brands, we don’t focus on the outcome of the test. We don’t care whether or not you’re trying to get pregnant. We just want to make sure that you have accurate results and the information that you need to understand them.”
Beyond the physical products, Stix also offers the Stix Library, an educational resource online that includes content around Stix products (of course), pregnancy, ovulation, birth control, and more general health information.
“What we’ve found is that there is a huge problem around the lack of proper sex education in this country,” said Plotch, adding that it provides an opportunity for Stix to fill in the gaps.
When asked if Stix would ever get into the birth control space, Plotch said that Stix has “high goals” and that “nothing is out of the question in the near future.”
Stix is currently a team of three women, and plans to use the funding to continue growing the team, which is currently 100 percent white. Plotch added that the company has a commitment to diversity and that the team will “definitely look different” on the heels of this round.
Sight Diagnostics, the Israel-based health-tech company behind the FDA-cleared OLO blood analyzer, today announced that it has raised a $71 million Series D round with participation from Koch Disruptive Technologies, Longliv Ventures (which led its Series C round)and crowd-funding platform OurCrowd. With this, the company has now raised a total of $124 million, though the company declined to share its current valuation.
With a founding team that used to work at Mobileye, among other companies, Sight made an early bet on using machine vision to analyze blood samples and provide a full blood count comparable to existing lab tests within minutes. The company received FDA clearance late last year, something that surely helped clear the way for this additional round of funding.
“Historically, blood tests were done by humans observing blood under a microscope. That was the case for maybe 200 years,” Sight CEO and co-founder Yossi Pollak told me. “About 60 years ago, a new technology called FCM — or flow cytometry — started to be used on large volume of blood from venous samples to do it automatically. In a sense, we are going back to the first approach, we just replaced the human eye behind the microscope with machine vision.”
Pollak noted that the tests generate about 60 gigabytes of information (a lot of that is the images, of course) and that he believes that the complete blood count is only a first step. One of the diseases it is looking to diagnose is COVID-19. To do so, the company has placed devices in hospitals around the world to see if it can gather the data to detect anomalies that may indicate the severity of some of the aspects of the disease.
“We just kind of scratched the surface of the ability of AI to help with with a wish with blood diagnostics,” said Pollak. “Specifically now, there’s so much value around COVID in decentralizing diagnostics and blood tests. Think keeping people — COVID-negative or -positive — outside of hospitals to reduce the busyness of hospitals and reduce the risk for contamination for cancer patients and a lot of other populations that require constant complete blood counts. I think there’s a lot of potential and a lot of a value that we can bring specifically now to different markets and we are definitely looking into additional applications beyond [complate blood count] and also perfecting our product.”
So far, Sight Diagnostics has applied for 20 patents and eight have been issued so far. And while machine learning is obviously at the core of what the company does — with the models running on the OLO machine and not in the cloud — Pollak also stressed that the team has made breakthroughs around the sample preparation to allow it to automatically prepare the sample for analysis.
Pollok stressed that the company focused on the U.S. market with this funding round, which makes sense, given that it was still looking for its FDA clearance. He also noted that this marks Koch Disrupt Technologies’ third investment in Israel, with the other two also being healthcare startups.
“KDT’s investment in Sight is a testament to the company’s disruptive technology that we believe will fundamentally change the way blood diagnostic work is done,’ said Chase Koch, President of Koch Disruptive Technologies . “We’re proud to partner with the Sight team, which has done incredible work innovating this technology to transform modern healthcare and provide greater efficiency and safety for patients, healthcare workers, and hospitals worldwide.”
The company now has about 100 employees, mostly in R&D, with offices in London and New York.
As COVID-19 infections surge in parts of the U.S., many workplaces remain empty or are operating with skeleton crews.
Most agree that the decision to return to the office should involve a combination of business, government and medical officials and scientists who have a deep understanding of COVID-19 and infectious disease in general. The exact timing will depend on many factors, including the government’s willingness to open up, the experts’ view of current conditions, business leadership’s tolerance for risk (or how reasonable it is to run the business remotely), where your business happens to be and the current conditions there.
That doesn’t mean every business that can open will, but if and when they get a green light, they can at least begin bringing some percentage of employees back. But what that could look like is clouded in great uncertainty around commutes, office population density and distancing, the use of elevators, how much you can reasonably deep clean, what it could mean to have a mask on for eight hours a day, and many other factors.
To get a sense of how tech companies are looking at this, we spoke to a number of executives to get their perspective. Most couldn’t see returning to the office beyond a small percentage of employees this year. But to get a more complete picture, we also spoke to a physician specializing in infectious diseases and a government official to get their perspectives on the matter.
While there are some guidelines out there to help companies, most of the executives we spoke to found that while they missed in-person interactions, they were happy to take things slow and were more worried about putting staff at risk than being in a hurry to return to normal operations.
Iman Abuzeid, CEO and co-founder at Incredible Health, a startup that helps hospitals find and hire nurses, said her company was half-remote even before COVID-19 hit, but since then, the team is now completely remote. Whenever San Francisco’s mayor gives the go-ahead, she says she will reopen the office, but the company’s 30 employees will have the option to keep working remotely.
She points out that for some employees, working at home has proven very challenging. “I do want to highlight two groups that are pretty important that need to be highlighted in this narrative. First, we have employees with very young kids, and the schools are closed so working at home forever or even for the rest of this year is not really an option, and then the second group is employees who are in smaller apartments, and they’ve got roommates and it’s not comfortable to work at home,” Abuzeid explained.
Those folks will need to go to the office whenever that’s allowed, she said. For Lindsay Grenawalt, chief people officer at Cockroach Labs, an 80-person database startup in NYC, said there has to be a highly compelling reason to bring people back to the office at this point.
Google Vice President of Engineering Dave Burke provided an update about the Exposure Notifications System (ENS) that Google developed in partnership with Apple, as a way to help public health authorities supplement contact tracing efforts with a connected solution that preserves privacy while alerting people of potential exposure to confirmed cases of COVID-19. In the update, Burke notes that the company expects “to see the first et of these apps roll out in the coming weeks” in the U.S., which may be a tacit response to some critics who have pointed out that we haven’t seen much in the way of actual products being built on the technology that was launched in May.
Burke writes that 20 states and territories across the U.S. are currently “exploring” apps that make use of the ENS system, and that together those represent nearly half (45%) of the overall American populace. He also shared recent updates and improvements made to both the Exposure Notification API, as well as to its surrounding documentation and information that the companies have shared in order to answer questions state health agencies have had, and hopefully make its use and privacy implications more transparent.
The ENS API now supports exposure notifications between countries, which Burke says is a feature added based on nations that have already launched apps based on the tech (that includes Canada, as of today, as well as some European nations). It’s also now better at using Bluetooth values specific to a wider range of devices to improve nearby device detection accuracy. He also says that they’ve improved the reliability for both apps and debugging tools for those working on development, which should help public health authorities and their developer partners more easily build apps that actually use ENS.
Burke continues that there’s been feedback from developers that they’d like more detail about how ENS works under the covers, and so they’ve published public-facing guides that direct health authorities about test verification server creation, code revealing its underlying workings, and information about what data is actually collected (in a de-identified manner) to allow for much more transparent debugging and verification of proper app functioning.
Google also explains why it requires that an Android device’s location setting be turned on to use Exposure Notifications – even though apps built using the API are explicitly forbidden from also collecting location data. Basically, it’s a legacy requirement that Google is removing in Android 11, which is set to be released soon. In the meantime, however, Burke says that even with location services turned off, no app that uses the ENS will actually be able to see or receive any location data.
CRISPR tech startup Mammoth Biosciences is among the companies that revealed backing from the National Institutes of Health (NIH) Rapid Acceleration of Diagnostics (RADx) program on Friday. Mammoth received a contract to scale up its CRISPR-based SARS-CoV-2 diagnostic test in order to help address the testing shortages across the U.S.
Mammoth’s CRISPR-based approach could potentially offer a significant solution to current testing bottlenecks, because it’s a very different kind of test when compared to existing methods based on PCR technology. The startup has also enlisted the help of pharma giant GSK to develop and produce a new COVID-19 testing solution, which will be a handheld, disposable test that can offer results in as little as 20 minutes, on site.
While that test is still in development, the RADx funding received through this funding will be used to scale manufacturing of the company’s DETECTR platform for distribution and use in commercial laboratory settings. This will still offer a “multi-fold increase in testing capacity,” the company says, even though it’s a lab-based solution instead of a point-of-care test like the one it’s seeking to create with GSK.
Already, UCSF has received an Emergency Use Authorization (EUA) from the FDA to use the DETECTR reagent set to test for the presence of SARS-CoV-2, and the startup hopes to be able to extend similar testing capacity to other labs across the U.S.
The U.S. National Institutes of Health (NIH) is revealing the first beneficiaries of its Rapid Acceleration of Diagnostics (RADx) program, and San Mateo-based Helix is on the receiving end of $33 million in federal funding as a result. Helix is a health tech startup founded in 2015 that focuses on insights derived from personal genomics, but the company has also developed a COVID-19 test that detects the presence of SARS-CoV-2 using RT-PCR methods.
The funding will be used to support Helix’s efforts to scale its COVID-19 testing efforts, with the aim of achieving a rate of 100,000 tests per day by this fall, and then extending the throughput capacity even further after that. Helix’s test got FDA Emergency Use Approval (EUA) earlier this month, and has since been available nationally across the U.S., promising “next day” results.
Helix has also filed for an EUA for a second type of test, an NGS test that offers higher throughput for more testing volume, as well as increased sensitivity toward actually detecting the presence of the virus to avoid false negatives. This test, if approved, will be key to helping Helix achieve that much greater scale of testing capability that is the ultimate aim of the RADx program.
That second test system currently seeking approval would be able to process as many as 25,000 tests per day, and it uses a different method that would also help reduce the strain on the supply chain.
If you look at the most successful startups today, you’ll find plenty of proof that the hardware-enabled service (Haas) model works: Peloton, Particle, Latch and Igloohome all rely on subscriptions along with product sales. Even tech giants like Apple are rapidly reinventing themselves as service companies.
Yet, if you currently rely on device sales, the prospect of changing your entire business model might seem daunting.
At Minut, we are building smart home monitors (privacy-safe noise, motion and temperature monitoring) and recently made the transition despite the lack of resources on the process. Here are the seven lessons we learned:
Hardware has one advantage over software: customers understand there is a cost to your product. Now, this allows hardware startups to generate revenue with their first iteration, but it’s unsustainable as the company grows and needs to innovate: the software and user experience need continuous improvement and excellent support, just like in a software-only startup.
That’s why we see most hardware startups eventually launching a subscription model and limit what’s available for free. Even established companies — think Strava or Wink — often end up having to radically limit free features after years of operations.
Experienced founders and financial markets favor subscription models and recurring revenue. Market valuation multiples are typically much higher for companies that benefit from service revenue in addition to sales.
CVS Caremark launched its point solutions management program with a sleep service from Big Health nearly a year ago, and now it’s adding another of the digital mental healthcare startup’s products to its suite of managed point solutions.
The Daylight product, which is designed to help people alleviate worry and anxiety, will join an expanding list of digital therapeutics that CVS Caremark offers to manage for employer-directed healthcare plans.
Other services in the CVS Caremark portfolio of offerings include Sleepio, a personalized digital sleep program from Big Health; Hello Heart, which helps members understand and improve their heart health; Hinge Health, which provides an app-based coaching and wearable sensor for chronic back and joint pain management; Livongo which provides coaching, monitoring devices, and digital treatments for conditions including diabetes, hypertension, weight management, and diabetes prevention solutions; Torchlight, a caregiver support solution; and Whil, a digital training platform for mindfulness, stress resilience, mental well-being and performance.
“Plan sponsors increasingly see the value in health care point solutions for improving workforce productivity, satisfaction and overall well-being, however with so many options on the market, it can be challenging to identify trusted solutions that best meet the needs of their members,” said Sree Chaguturu, M.D., Chief Medical Officer, CVS Caremark, the pharmacy benefit management business of CVS Health, in a statement earlier this year. “We have analyzed pharmacy and medical claims to identify where these benefits can make a difference and employ a rigorous and transparent evaluation process to assure that any vendor included in Point Solutions Management meets high standards for safety, quality and user experience at the vendor’s lowest price in the marketplace.”
According to Chaguturu plan providers are interested in point solutions that can digitally compliment the care that patients receive from physicians that can help with self-management of chronic conditions.
These self-directed, digitally enhanced therapies are especially important at a time when more care is being conducted remotely thanks to the social distancing demands imposed by efforts to control the COVID-19 outbreak in the United States.
“The point solutions management platform is a platform designed for B2B2C.. Where plan sponsors are contracting through the platform to help their members,” said Chaguturu, in an interview. “We work with Big Health to support awareness of the application through our other platforms as well.”
Rather than go direct to consumer like any number of other mental health and wellness applications vying for customers, Big Health has chosen to work with employer provided healthcare plans and services like CVS Caremark’s because it can reach more people, said Big Health co-founder Peter Hames.
“CVS has shown real forward thinking in implmenting this platform to provide this conduit to digital care,” Hames said. “CVS Caremark administrates benefits to over 100 million people in America. The scope via the reimbursement space is huge… We could take a direct to consumer model. [But] my experience has shown me that going through this reimbursed pathway provides a much bigger vector.”
The two companies declined to disclose the financial terms of the arrangement between CVS and Big Health, but Chaguturu did say that the company did not invest in solutions offered through its program or have a financial interest in the business.
Big Health has raised over $54 million from investors including Octopus Ventures, Samsung Next, Glide Healthcare, Morningside Group, Kaiser Permanente Ventures, and Index Ventures, according to data from Crunchbase.
“The doctor’s office is dead.”
That’s the way Nick Desai, the co-founder and chief executive of the Los Angeles-based startup Heal describes the future of traditional healthcare delivery.
While Desai’s bluster may be wishful thinking, the doctor’s office is certainly changing, and that’s thanks in part to companies like Heal, which offer in-home and telemedical consultations — and health insurance providers like Humana that are backing them.
The two companies have announced a new partnership that will see Humana pushing Heal’s in-home and virtual care delivery services to the patients it covers and committing $100 million to spur the Los Angeles-based startup’s growth.
“Humana has a more strategic view of home-based care,” said Desai. “We want all payers to be this strategic. Most insurance partners offer Heal now but we want them to view it more strategically.”
For Desai, the home is the best place to get care because doctors can see the environment that may influence (and in some cases complicate or worsen) a patient’s condition. Heal, Desai says, also works with the digital technologies to provide more remote and persistent patient monitoring, so that doctors can have a better sense of a patient’s health over time, rather than at an acute moment of care.
“You want to talk to the doctor and get continuity of care,” said Desai. “We think we are… an accelerant for the adoption of those services.”
Things like iPhone-based EKG machines, remote diagnostics to determine diabetic retinopathy, digital hubs to provide remote monitoring of body mass and movement are all hardware offerings within Heal’s panoply of care and diagnostic solutions. “We want to be able to gather more and more of those diagnostics remotely,” Desai said. “Anything that makes care more accurate, more data driven, more timely we want to use and ask our patients to utilize so that they can get better care, more quickly and more affordably.”
The new financing from Humana will go to support Heal’s geographic expansion, product development, and sales and marketing, Desai said. Already, the company has expanded into new treatment areas, including teletherapy for mental health.
Discussion between Heal and the Louisville-based Humana began back in December and the two businesses only inked the final terms of their deal last week.
Heal telemedicine, telepsychology (CA only), and digital monitoring services are currently available in New York, New Jersey, Washington, California, Georgia, Virginia, Maryland, and Washington D.C. To date, the company has linked patients with over 200,000 home visits from doctors since its launch in 2015.
Under the terms of the agreement with Humana, will expand to geographies in Chicago, Charlotte and Houston as part of Humana’s “Bold Goal” program focusing on addressing and creating healthcare services that address social determinants and social needs for its population of insured patients.
“The partnership with Heal is part of Humana’s efforts to build a broader set of offerings across the spectrum of home based care, with high quality, value-based primary care being a key foundational element,” said Susan Diamond, Humana’s Segment President, Home Business, who is joining Heal’s Board of Directors as part of the partnership and investment. “We continue to see high levels of customer satisfaction and improved health outcomes when care is delivered in the home. Our goal is to make the healthcare experience easier, more personalized and caring for the people we serve—and is the hallmark of how Humana delivers human care.”
For Desai, the deal is also an indicator of not just his company’s growth, but the growth of the entire Los Angeles technology ecosystem.
“Heal’s funding just proves that LA is as much an epicenter of venture backed ecosystem as any in the country including Silicon Valley,” he said.