Electronic health records (EHR) have long held promise as a means of unlocking new superpowers for caregiving and patients in the medical industry, but while they’ve been a thing for a long time, actually accessing and using them hasn’t been as quick to become a reality. That’s where Medchart comes in, providing access to health information between businesses, complete with informed patient consent, for using said data at scale. The startup just raised $17 million across Series A and seed rounds, led by Crosslink Capital and Golden Ventures, and including funding from Stanford Law School, rapper Nas and others.
Medchart originally started out as more of a DTC play for healthcare data, providing access and portability to digital health information directly to patients. It sprung from the personal experience of co-founders James Bateman and Derrick Chow, who both faced personal challenges accessing and transferring health record information for relatives and loved ones during crucial healthcare crisis moments. Bateman, Medchart’s CEO, explained that their experience early on revealed that what was actually needed for the model to scale and work effectively was more of a B2B approach, with informed patient consent as the crucial component.
“We’re really focused on that patient consent and authorization component of letting you allow your data to be used and shared for various purposes,” Bateman said in an interview. “And then building that platform that lets you take that data and then put it to use for those businesses and services, that we’re classifying as ‘beyond care.’ Whether those are our core areas, which would be with your, your lawyer, or with an insurance provider, or clinical researcher — or beyond that, looking at a future vision of this really being a platform to power innovation, and all sorts of different apps and services that you could imagine that are typically outside that realm of direct care and treatment.”
Bateman explained that one of the main challenges in making patient health data actually work for these businesses that surround, but aren’t necessarily a core part of a care paradigm, is delivering data in a way that it’s actually useful to the receiving party. Traditionally, this has required a lot of painstaking manual work, like paralegals poring over paper documents to find information that isn’t necessarily consistently formatted or located.
“One of the things that we’ve been really focused on is understanding those business processes,” Bateman said. “That way, when we work with these businesses that are using this data — all permissioned by the patient — that we’re delivering what we call ‘the information,’ and not just the data. So what are the business decision points that you’re trying to make with this data?”
To accomplish this, Medchart makes use of AI and machine learning to create a deeper understanding of the data set in order to be able to intelligently answer the specific questions that data requesters have of the information. Therein lies their longterm value, since once that understanding is established, they can query the data much more easily to answer different questions depending on different business needs, without needing to re-parse the data every single time.
“Where we’re building these systems of intelligence on top of aggregate data, they are fully transferable to making decisions around policies for, for example, life insurance underwriting, or with pharmaceutical companies on real world evidence for their phase three, phase four clinical trials, and helping those teams to understand, you know, the the overall indicators and the preexisting conditions and what the outcomes are of the drugs under development or whatever they’re measuring in their study,” Bateman said.”
According to Ameet Shah, Partner at co-lead investor for the Series A Golden Ventures, this is the key ingredient in what Medchart is offering that makes the company’s offering so attractive in terms of long-term potential.
“What you want is you both depth and breadth, and you need predictability — you need to know that you’re actually getting like the full data set back,” Shah said in an interview. “There’s all these point solutions, depending on the type of clinic you’re looking at, and the type of record you’re accessing, and that’s not helpful to the requester. Right now, you’re putting the burden on them, and when we looked at it, we were just like ‘Oh, this is just a whole bunch of undifferentiated heavy lifting that the entire health tech ecosystem is trying to like solve for. So if [Medchart] can just commoditize that and drive the cost down as low as possible, you can unlock all these other new use cases that never could have been done before.”
One recent development that positions Medchart to facilitate even more novel use cases of patient data is the 21st Century Cures Act, which just went into effect on April 5, provides patients with immediate access, without charge, to all the health information in their electronic medical records. That sets up a huge potential opportunity in terms of portability, with informed consent, of patient data, and Bateman suggests it will greatly speed up innovation built upon the type of information access Medchart enables.
“I think there’s just going to be an absolute explosion in this space over the next two to three years,” Bateman said. “And at Medchart, we’ve already built all the infrastructure with connections to these large information systems. We’re already plugged in and providing the data and the value to the end users and the customers, and I think now you’re going to see this acceleration and adoption and growth in this area that we’re super well-positioned to be able to deliver on.”
Johannesburg-based investment company Founders Factory Africa (FFA) today announced a partnership with Small Foundation that will see it select 18 agritech startups for an acceleration and incubation program.
Small Foundation is a Dublin-based philanthropic organization that focuses on the rural and agriculture sector in sub-Saharan Africa. With this partnership, Small Foundation is making an undisclosed investment in FFA to build and scale agritech startups on the continent.
“The partnership stands to make a significant impact across the continent by supporting agritech startups who can innovate and improve the delivery of a range of services to smallholder farmers and micro, small and medium-sized enterprises in the agricultural sector,” an excerpt in a statement read.
According to the South African-based venture development and investment company founded by Roo Rogers and Alina Truhina, early-stage founders will need to apply to join the Founders Factory Africa Venture Scale or Venture Build portfolios. These startups will have access to funding between $100,000 to $250,000 and hands-on technical support.
This is a change from when the company launched in 2018. FFA is an extension of the Founders Factory organisation that has invested in more than 130 companies globally. In 2018, FFA launched its first vertical in fintech when it partnered with the continent’s largest bank, Standard Bank, to invest in fintech startups. Some of the startups include Bwala, LipaLater, MVXchange and OkHi.
The following year, it took on a second investor in South African healthcare company Netcare Group and, via the partnership, invested in health-tech startups like RxAll, Redbird and Wellahealth.
Last year when we reported this partnership, startups in FFA’s Venture Scale accelerator program received a £30,000 cash investment and £220,000 in support services. Those in the Venture Build program received £60,000 cash and £100,000 toward support.
For this third partnership, Truhina says FFA will be investing a total of $300,000 in cash and hands-on support for companies in its Venture Scale program. However, startups in Venture Build will be receiving up to $250,000 in funding.
The Venture Scale program involves providing support for existing startups operating in seed to pre-Series A stages. On the other hand, the Venture Build program is for founders wanting to launch a startup in Africa, who may or may not have a concept or an idea.
Currently, there are 23 companies across FFA’s Scale and Build portfolios. These startups, mainly from Ghana, Kenya, Nigeria and South Africa, have collectively raised more than $7 million during and after the program. Truhina says FFA plans to increase this number to nearly 90 startups in total by 2024.
“We will build, scale and invest in 88 startups with current FFA investors (Standard Bank, Netcare and Small Foundation) until 2024. We plan to continue to take on new investors and continue to work on the continent indefinitely,” she said.
While FFA is dedicating a fund for agritech startups, it has invested in other startups with agritech solutions for instance Nigeria’s Foodlocker. The company forecasts foodstuff demand through machine learning and helps buyers procure goods from smallholder farmers. But despite this proposition, FFA classifies the startup as a fintech investment.
“Foodlocker was a company we selected and invested in under our Fintech portfolio, as the startup has a financial component. With Small Foundation, we are setting up a new dedicated agritech sector,” said Truhina. Small Foundation joins Standard Bank and Netcare in the peculiarity of assistance offered to FFA portfolio startups. From sector expertise and footprint across the continent to access to clients, POCs and pilots, these investors are trying to fill in the gap in sectors ripe for exponential growth.
But though fintech has caught on well with both local and international investors, the same cannot be said for health tech and agritech. According to Briter Bridges, fintech accounted for 31% of the total $1.3 billion raised by African startups. Health-tech startups accounted for 9%, while agritech startups represented just 7%.
Small Foundation wants to improve this number in its own little way, and concurrently has a plan to “end extreme poverty in sub-Saharan Africa by 2030.” Conor Brosnan, the CEO and chair of the foundation, holds that tackling the sector’s biggest issues with the FFA will bring the company toward achieving this objective.
“This is a pivotal time to invest in the growing area of agritech in Africa, which has transformative potential for local livelihoods. We are excited to see FFA’s highly skilled teamwork with immensely talented African entrepreneurs to deliver scaled solutions to some of the biggest challenges faced by the sector,” he said.
In three years, Founders Factory Africa has managed to enlist the services and finances of three influential partners. Yet, it has 55 more startups to invest in before 2024, so we should expect an increased investment activity and more partnerships to fund startups in other sectors.
The firm also has fresh capital in the works for its portfolio companies as it advances, though. It’s in the process of raising a $35 million “Africa Seed Fund” which will exist alongside FFA and execute follow-on capital in some portfolio companies.
Being an expectant mom can be frightening, as can mothering an infant or toddler. The answers don’t come automatically, and while there’s no shortage of books and websites (and advice from grandparents) about how to parent at every stage, finding satisfying information often proves a lot harder than imagined.
There are online social groups that deliver some of the social and emotional support that new parents need, no matter where they live. There are many dozens of mom communities on Facebook, for example. However, it’s because there’s room for improvement on this theme — big groups can feel isolating, bad information abounds —that Oath Care, a young, four-person San Francisco-based startup, just raised $2 million in seed funding from XYZ Ventures, General Catalyst, and Eros Resmini, former CMO of Discord and managing partner of the Mini Fund.
What is it building? Founder Camilla Hermann describes it as a subscription-based mobile app that’s focused on improving the lives of new mothers by combining parents who have lots in common with healthcare specialists and moderators who can guide them in group chats, as well as one-on-one video calls.
More specifically, she says, for $20 per month, Oath matches pregnant and postpartum moms in circles of up to 10 based on factors like stage of pregnancy, age of child, location, and career so they can ask questions of each other, with the help of a trained moderator (who is sometimes a mother with older children).
Oath also pushes curriculum that Oath’s team is developing in-house to members based on each group’s specific needs. Not last, every group is given collective access to medical specialists who can answer general questions as part of the members’ subscription and who are also available for consultations when individualized help is needed.
Hermann says the pricing of these 15-minute-long consultations is still being developed, but that the medical experts with whom it’s already working see the app as a form of lead generation.
It’s an interesting concept, one that could be taken in a host of directions, acknowledges Hermann who says she was inspired to cofound the company based on earlier work developing a contact tracing technology created to track outbreaks like Ebola in real time.
As she said yesterday during a Zoom call with TechCrunch and her cofounder, Michelle Stephens, a pediatric clinician and research scientist: “We’ve fundamentally misunderstand something really important about health in the West; we think that [changes] happen to one person at a time or one part of the body at a time, but it always happens in interconnected systems both inside and outside the body, which fundamentally means that it is always happening in community.”
For her part, Stephens — who was introduced to Hermann at a dinner years ago — says her motivation in cofounding Oath was born out of research into childhood stress, and that by “better equipping parents to be those positive consistent caregivers in their child’s life,” Oath aims to help enable stronger, more intimate child-parent bonds.
It might sound grand for a mobile app, but it also sounds like a smart starting point. Though the idea is to match mothers in similar situations at the outset to help bolster theirs and their children’s health, it’s easy to imagine the platform evolving in a way that brings together parents in numerous groups based on interests, from preschool applications to autism to same-sex parenting. It’s easy to see the platform helping to sell products that parents need. It’s easy to imagine the company amassing a lot of valuable information.
Indeed, says Hermann, the longer-term vision for Oath is to create rich datasets that it hopes can be used to improve health outcomes, including by identifying health issues earlier. Relatedly, it also hopes to build relationships with health systems and payers in order to increase access to its products.
For now, Oath is mostly just trying to keep up with demand. Hermann says the “small and scrappy” company found its first 50 users through Facebook ads, and that this base quickly tripled organically before Oath was forced to create a growing waitlist for what has been a closed beta until now. (Oath is “anticipating a full launch in late summer,” says Stephens.)
That’s not to say the company isn’t thinking at all about next steps.
While right now it is “laser focused on building out the most exceptional experience for this specific cohort of users in this specific period of time of their lives,” says Hermann, once it builds out many more communities of small trusted groups with “high engagement and high trust,” there is “a lot you can layer on top of that. It’s virtually limitless.”
If you think cyberattacks are scary, what if those attacks were directed at your cardiac pacemaker? Medtronic, a medical device company, has been in hot water over the last couple of years because its pacemakers were getting hacked through their internet-based software updating systems. But in a new partnership with Sternum, an IoT cybersecurity startup based in Israel, Medtronic has focused on resolving the issue.
The problem was not with the medical devices themselves, but with the remote systems used to update the devices. Medtronic’s previous solution was to disconnect the devices from the internet, which in and of itself can cause other issues to arise.
“Medtronic was looking for a long-term solution that can help them with future developments,” said Natali Tshuva, Sternum’s founder and CEO. The company has already secured about 100,000 Medtronic devices.
Sternum’s solution allows medical devices to protect themselves in real-time.
“There’s this endless race against vulnerability, so when a company discovers a vulnerability, they need to issue an update, but updating can be very difficult in the medical space, and until the update happens, the devices are vulnerable,” Tshuva told TechCrunch. “Therefore, we created an autonomous security that operates from within the device that can protect it without the need to update and patch vulnerabilities,”
However, it is easier to protect new devices than to go back and protect legacy devices. Over the years hackers have gotten more and more sophisticated, so medical device companies have had to figure out how to protect the devices that are already out there.
“The market already has millions — perhaps billions — of medical devices connected, and that could be a security and management nightmare,” Tshuva added.
In addition to potentially doing harm to an individual, hackers have been taking advantage of device vulnerability as the gateway of choice into a hospital’s network, possibly causing a breach that can affect many more people. Tshuva explained that hospital networks are secured from the inside out, but devices that connect to the networks but are not protected can create a way in.
In fact, health systems have been known to experience the most data breaches out of any sector, accounting for 79% of all reported breaches in 2020. And in the first 10 months of last year, we saw a 45% increase in cyberattacks on health systems, according to data by Health IT Security.
In addition to Sternum’s partnership with Medtronic, the company also launched this week an IoT platform that allows, “devices to protect themselves, even when they are not connected to the internet,” Tshuva said.
Sternum, which raised about $10 million to date, also offers cybersecurity for IoT devices outside of healthcare, and according to Tshuva, the company focuses on areas that are “mission-critical.” Examples include railroad infrastructure sensors and management systems, and power grids.
Tshuva, who grew up in Israel, holds a master’s in computer science and worked for the Israeli Defense Force’s 8200 unit — similar to the U.S.’s National Security Alliance — said she always wanted to make an impact in the medical field. “I looked to combine the medical space with my life, and I realized I could have an impact on remote care devices,” she said.
For a continent with such stark inequality, Africa has seen limited innovation to increase access to healthcare and reduce healthcare delivery costs. Over the years, there has been continued investment in traditional care models despite the overwhelming evidence of inefficiency and escalating costs. The pandemic also laid these problems bare, exposing the vulnerabilities of the continent’s healthcare system.
Health tech startup Quro Medical is trying to scale alternative models for African healthcare starting from its home country, South Africa. The company, which provides services to manage ill patients in the comfort of their homes, is emerging from stealth to announce the close of its $1.1 million round. The round was led by Kenya-based Enza Capital and South African VC firm Mohau Equity Partners.
Quro Medical was founded by Dr Vuyane Mhlomi, Zikho Pali and Rob Cornish in 2018. CEO Mhlomi understood the pressing need for South African healthcare innovation from his own experience before and after he became a doctor.
It is known that hospitals in Africa experience excessive demands, which places strain on bed capacity. At the same time, it hinders effective patient treatment and recovery. Raised in Cape Town by his parents, Mhlomi experienced this firsthand. His parents suffered from chronic health conditions and he had to spend hours in clinics and hospitals waiting to see doctors.
Later, an opportunity to study medicine took him to the University of Oxford. Upon completion, he returned to South Africa where he knew the problem he faced previously was one to solve, hence Quro Medical.
“We were connected by our belief that the private healthcare sector can and should be doing more to shoulder the burden of healthcare provision in this country and on the continent generally,” Mhlomi told TechCrunch. “These escalating costs are the primary barrier to accessing healthcare in the private sector, leaving an overwhelming burden on our public health system.”
The CEO argues that acute patient care at home leads to better clinical outcomes and improved patient experience. This is the principle on which Quro Medical is established. In the long run, it wants to build the largest virtual hospital ward in Africa, with superior clinical outcomes to conventional care at a lower cost.
Unlike hospitals, getting healthcare at home can feel safer, which is an extra proposition for Quro Medical. According to COO Pali, apart from hospitals’ high costs, patients are at risk of getting hospital-acquired infections. But while it might appear that Quro Medical is offering the same old traditional home care with a mix of telemedicine service, that’s not precisely the case. Pali says the company incorporates clinical data and remote healthcare monitoring to provide real-time, data-driven clinical interventions. “We are focused on saving lives and enhancing patient care. The technology is the enabler, making all of this possible,” adds Mhlomi.
Patients are admitted into the company’s care in lieu of a general ward hospital admission. Then Quro Medical makes revenue from filing a claim with medical aid and insurance companies paid via reimbursement. The healthtech startup also collects out-of-pocket payments from patients.
The pandemic reinforced the company’s importance in offering remote patient monitoring services, a significant aspect of its business that garnered a check from Enza Capital.
“As our collective healthcare systems struggle to care for patients beyond the walls of a hospital, which we’ve seen exacerbated with the onset of the COVID-19 pandemic, remote patient monitoring and healthcare delivery will undoubtedly form a core part of the lasting solution,” said Mike Mompi, partner and CEO at the firm.
Nevertheless, this period has seen health tech startups offering out-of-hospital services struggle to have their services reimbursed. So how has Quro fared? Pretty well, apparently. The company claims to successfully convert most of its major medical schemes (health insurance) in South Africa as clients. They account for more than 90% of the total medical scheme market in the country.
Quro Medical has grown to work with about 150 doctors. Mhlomi believes his company is a first mover in Africa, meaning that he expects other players’ arrival in line with the trends in other markets. The company that has grown to work with 150 doctors now has plans to accelerate its hospital-at-home services and scale its operations across the country to meet its growing client base’s demands. It also wants to attract and retain talent and extend into other African markets.
Speaking on the investment for Mohau Equity Partners, CEO Dr Penny Moumakwa said, “We are very excited to be invested in Quro, they are a dynamic management team, building out a global medical solution, that will showcase the ability of entrepreneurs on the African continent in advanced digital healthcare.”
Based in Ho Chi Minh City, Docosan helps patients avoid long waits by letting them search and book doctors through its app. The company announced today it has raised more than $1 million in seed funding, which is claims is one of the largest seed rounds ever for a Vietnamese healthtech startup. The investment was led by AppWorks, the Taiwan-based early-stage investor and accelerator program, with participation from David Ma and Huat Ventures.
Founded in 2020, the app has been used by about 50,000 patients for bookings and now has more than 300 individual healthcare providers, ranging from small family pediatric clinics to neurosurgeons at large private hospitals, co-founder and chief executive officer Beth Ann Lopez told TechCrunch. Providers are vetted before being added to the platform and have on average 18 years of clinical experience.
Lopez said advance doctor bookings aren’t the norm in Vietnam. Instead, people who use private healthcare providers have to “choose between over 30,000 private hospitals and clinics spread across the hospital with huge variations in price and quality. This is why people use word of mouth recommendations from their family and friends to choose a healthcare provider. Then they show up at a hospital or clinic and wait in line, sometimes for hours.”
Docosan’s users can filter providers with criteria like location and specialty, and see pricing information and verified customer reviews. It recently added online payment features and insurance integrations. The company, which took part in Harvard’s Launch Lab X plans to launch telehealth and pharmacy services as well.
For healthcare providers on the app, Docosan provides software to manage bookings and ease wait times, a key selling point during the COVID-19 pandemic because many people are reluctant to sit in crowded waiting rooms. Lopez said another benefit is reducing the number of marketing and adminstrative tasks doctors have to do, allowing them to spend more time with patients.
The startup plans to expand into other countries. “Docosan is a solution that works well anywhere with a large, fragmented private healthcare system,” said Lopez. “We would all benefit from a world in which it’s as easy to find a great doctor as it is a book a Grab taxi.”
In press statement, AppWorks partner Andy Tsai said, “We noticed Docosan’s potential early on because of its participation in the AppWorks Accelerator. Docosan’s founders demonstrated strong experience and dedication to the healthcare issues in the region. We are proud to be supporting Docosan’s vision of better healthcare access for all.”
Are you 100% sure that your children are brushing their teeth properly? A New York-based startup called Willo has been working for several years on a device that should transform the tooth-brushing experience for children.
Willo isn’t a new toothbrush — electric or not. It’s an oral care device that doesn’t look like a toothbrush at all. The startup has worked with dental professionals to start from scratch with oral care in mind.
The device can be quite intimidating when you don’t see it in action as it takes quite a bit of shelf space and you don’t know what you’re supposed to do. But when you see it in action, it looks easier than expected. Willo specifically targets children because they tend to struggle to reach every tooth and brush properly.
Kids are supposed to grab the handle and put the mouthpiece in their mouth. They can start brushing by pressing the button and that’s it. They don’t have to do anything else. The silicone-based mouthpiece also features soft bristles. It starts vibrating in your kid’s mouth when they press the button.
The handle is connected to a bigger home station that contains a water tank with a special rinse liquid. Kids don’t have to use toothpaste and don’t have to rinse their mouth. Everything is handled by the device.
Finally, Willo is a connected device, which means that parents can track oral care in a mobile app. You can also set up multiple users — your kids will have to swap the mouthpiece before using the device.
Image Credits: Willo
If you’re thinking about buying a device for your children, Willo costs $199. You then have to pay $13 per month to receive rinse pods as well as new mouthpieces that always fit.
While the product is going live today, the startup has already tested it with real families. These children rated the device 4.73/5 and parents gave an NPS of 70+. They’ve all kept using Willo after the testing phase.
Behind this product, there’s a team of 33 people in France and the U.S. They have filed over 50 patents over the past 7 years — 30 of them have been granted so far. The company has raised $17 million in total funding from Kleiner Perkins, Bpifrance and Matt Rogers’ fund Incite.
It’s true that the concept of a toothbrush hasn’t changed at all. Making a device that changes the way you brush your teeth is an ambitious bet. But it’s clear that the startup has made a lot of efforts to tackle this challenge. Now let’s see if they manage to convince parents.
Image Credits: Willo
“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.
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
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
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.
Seen on TechCrunch
Seen on Extra Crunch
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.
Hello and welcome back to Equity, TechCrunch’s venture capital-focused podcast, where we unpack the numbers behind the headlines.
Natasha and Danny and Grace were all here to chat through the week’s rigamarole of news. Alex took some well-deserved time off, but that meant we got to poke a little fun at him and create a Special Edition segment to start off the show.
Jokes aside, this week was yet another spree of creator economy, edtech, and new fund announcements, with fresh and unexpected news hailing from Natasha’s home state, New Jersey.
Here’s what we got into:
What a show! We’ll be back with the full trio next week, and until then, stay safe and thank you for listening.
Meet Nabla, a French startup launching a new app today focused on women’s health. On Nabla, you’ll find several services that should all contribute to helping you stay on top of your health. In short, Nabla lets you chat with practitioners, offers community content, helps you centralize all your medical data and will soon offer telemedicine appointments.
Nabla’s key feature right now is the ability to start a conversation with health professionals. You can send a message to a general practitioner, a gynecologist, a midwife, a nurse, a nutritionist, or a physiotherapist.
While text discussions are not going to replace in-person appointments altogether, they can definitely be helpful. By increasing the number of interactions with health professionals, chances are you’ll be healthier and you may even end up booking more in-person appointments.
Other French startups have been providing text conversations with practitioners. For instance, health insurance company Alan lets you message a general practitioner — but you have to be insured by Alan. Biloba also lets you chat with a doctor — but the company has been focusing on pediatrics.
Nabla has a different positioning and offers this feature for free — there’s a limit as you can only send a handful of questions per month though. If it’s a common question, you may find the answer from the community. Nabla’s doctors will curate community content as well.
Using a free product to talk about your health feels suspicious. But that’s because the startup is well-funded and plans to launch premium features.
Image Credits: Nabla
The startup has raised $20.2 million (€17 million) and is already working with a team of doctors who are ready to answer questions from the company’s first users — or patients. Investors in the company include Xavier Niel, Artemis, Rachel Delacour, Julie Pellet, Marc Simoncini and Firstminute Capital.
One of the reasons why Nabla could raise so much money before releasing its app is that the three co-founders have a track record in the tech ecosystem.
Co-founder and CEO Alexandre Lebrun previously founded VirtuOz, which was acquired by Nuance, and Wit.ai, which was acquired by Facebook. More recently, he’s worked for Facebook’s AI research team (FAIR).
Co-founder and COO Delphine Groll has been heading business development and communications for two major media groups Aufeminin and My Little Paris. And Nabla’s co-founder and CTO Martin Raison has worked with Alexandre Lebrun at both Wit.ai and Facebook.
In addition to text conversations, Nabla shows all your past interactions in a personal log. You can connect that log with other apps and services, such as Apple’s Health app, Clue and Withings. This way, you can see all your data from the same app.
As you may have guessed, the startup truly believes that machine learning can help when it comes to preventive and holistic care. By default, nothing is shared with Nabla for machine learning purposes. But users can opt in and share data to improve processes, personalization and more.
Eventually, Nabla wants to optimize the interactions with doctors as much as possible. The startup says it doesn’t want to replace doctors altogether — it wants to enhance medical interactions so that doctors can focus on the human and empathetic part.
Nabla plans to launch a telemedicine service so that you can interact with doctors in real time as well as a premium offering with more features. That’s an ambitious roadmap, and it’s going to be interesting to track Nabla over the long run to see if they stick to their original vision and find a loyal user base.
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.
The European Union may investigate Facebook’s $1BN acquisition of customer service platform Kustomer after concerns were referred to it under EU merger rules.
A spokeswoman for the Commission confirmed it received a request to refer the proposed acquisition from Austria under Article 22 of the EU’s Merger Regulation — a mechanism which allows Member States to flag a proposed transaction that’s not notifiable under national filing thresholds (e.g. because the turnover of one of the companies is too low for a formal notification).
The Commission spokeswoman said the case was notified in Austria on March 31.
“Following the receipt of an Article 22 request for referral, the Commission has to transmit the request for referral to other Member States without delay, who will have the right to join the original referral request within 15 working days of being informed by the Commission of the original request,” she told us, adding: “Following the expiry of the deadline for other Member States to join the referral, the Commission will have 10 working days to decide whether to accept or reject the referral.”
We’ll know in a few weeks whether or not the European Commission will take a look at the acquisition — an option that could see the transaction stalled for months, delaying Facebook’s plans for integrating Kustomer’s platform into its empire.
Facebook and Kustomer have been contacted for comment on the development.
The tech giant’s planned purchase of the customer relations management platform was announced last November and quickly raised concerns over what Facebook might do with any personal data held by Kustomer — which could include sensitive information, given sectors served by the platform include healthcare, government and financial services, among others.
Back in February, the Irish Council for Civil Liberties (ICCL) wrote to the Commission and national and EU data protection agencies to raise concerns about the proposed acquisition — urging scrutiny of the “data processing consequences”, and highlighting how Kustomer’s terms allow it to process user data for very wide-ranging purposes.
“Facebook is acquiring this company. The scope of ‘improving our Services’ [in Kustomer’s terms] is already broad, but is likely to grow broader after Kustomer is acquired,” the ICCL warned. “‘Our Services’ may, for example, be taken to mean any Facebook services or systems or projects.”
“The settled caselaw of the European Court of Justice, and the European data protection board, that ‘improving our services’ and similarly vague statements do not qualify as a ‘processing purpose’,” it added.
The ICCL also said it had written to Facebook asking for confirmation of the post-acquisition processing purposes for which people’s data will be used.
Johnny Ryan, senior fellow at the ICCL, confirmed to TechCrunch it has not had any response from Facebook to those questions.
We’ve also asked Facebook to confirm what it will do with any personal data held on users by Kustomer once it owns the company — and will update this report with any response.
In a separate (recent) episode — involving Google — its acquisition of wearable maker Fitbit went through months of competition scrutiny in the EU and was only cleared by regional regulators after the tech giant made a number of concessions, including committing not to use Fitbit data for ads for ten years.
Until now Facebook’s acquisitions have generally flown under regulators’ radar, including, around a decade ago, when it was sewing up the social space by buying up rivals Instagram and WhatsApp.
Several years later it was forced to pay a fine in the EU over a ‘misleading’ filing — after it combined WhatsApp and Facebook data, despite having told regulators it could not do so.
With so many data scandals now inextricably attached to Facebook, the tech giant is saddled with customer mistrust by default and is facing far greater scrutiny of how it operates — which is now threatening to inject friction into its plans to expand its b2b offering by acquiring a CRM player. So after ‘move fast and break things’ Facebook is having to move slower because of its reputation for breaking stuff.
Austin-based home lab testing kit startup Everlywell is expanding its scope considerably with two acquisitions, and a transformation that includes the establishment of a new parent company led by Everlywell CEO and co-founder Julia Cheek. The new entity, called Everly Health, will now offer services including at-home lab testing kits and education, population-scale testing through a U.S.-wide clinician network, telehealth and a payer-supported/enterprise self-collected lab test.
This is a big move for Everlywell, which was founded in 2015 (and which was a finalist in TechCrunch’s 2016 Disrupt SF Battlefield completion). The company has steadily iterated on its offerings, expanding its at-home testing from fertility products to food sensitivities and allergies, and last year, to at-home COVID-19 test collection.
Everly Health’s business now includes not only that kind of at-home consumer diagnostic and personal health education, but also many relationships through PWNHealth, which will rebrand to Everly Health Solutions, with health plans, employers and labs across the U.S.
Everlywell itself was actually a longtime partner of PNWHealth, which is what Cheek told me an in interview actually helped make the acquisition make so much sense to both companies. They’d been working together for years, and that collaboration had only deepened in the wake of the COVID-19 pandemic.
“What we found over the last year was we were collaborating on all these different enterprise partnerships to offer solutions, and so our cultures are really well aligned, and our teams have worked closely together,” she said. “And we both share this common ethos that we felt the urgent need to help people and to save lives, but also this discipline around consumer-friendly and enabled care, grounded in diagnostics.”
Overall, Cheek said that the decision to go out and acquire the pieces of the puzzle needed to deliver a more comprehensive care offering was partly driven by the pandemic, but that really just drove an acceleration of what Everlywell was already beginning to see before COVID-19. Freshly capitalized with the $175 million it raised last December, the startup was in a position to make some bold moves in order to make the most of the moment.
“Before the pandemic, but especially during and looking out to post-pandemic, we have just seen this massive acceleration of the need for consumer friendly testing services,” she said. “Our business has continued to grow exponentially, even since normal doctor’s appointments resumed, orders of magnitude, 300% growth. We sat back and said, since we believe healthcare is in a watershed moment post-pandemic, where do we think we need to actually be able to offer a full-service diagnostic solution as this entire space grows. So it’s Everlywell as a consumer-friendly brand, but it’s also this massive enterprise need for home testing, and broader consumer diagnostics.”
The new acquisitions do add some complexity to Everly Health’s business, since its Everly Health Solutions also serves a number of customers that would be considered competitive with Everlywell. Cheek points out that both businesses have a demonstrated track record of security and data integrity, compliant with HIPAA standards, and says that they’re setting up a strict firewall that will result in “complete data independence” of Everly Health Solutions to ensure there’s no possibility of anti-competitive behavior.
The companies will however share customer experience, design and product resources, however, and the plan is to build a unified brand focused on high-quality customer engagement across the board.
Everly Health hasn’t released the financial details of the transaction, but it has shared shared that PWNHealth CEO Sanjay Pingle will be acting in a transitional role in the combined company for the time being, and will serve on the board of Everly Health. Investors in PWNHealth, including Spectrum Equity, and Blue Cross/Blue Shield corporate VC Blue Venture Fund will also retain an ownership stake in Everly Health.
The home medical supply market in the U.S. is significant and growing, but the way that Americans go about getting much-needed medical supplies, particularly for those with chronic conditions, relies on outdated and clumsy sales mechanisms that often have very poor customer experiences. New startup Better Health aims to change that, with an e-commerce approach to serving customers in need of medical supplies for chronic conditions, and it has raised $3.5 million in a new seed round to pursue its goals.
Better Health estimates the total value of the home medical supplies market in the U.S., which covers all reimbursable devices and supplies needed for chronic conditions, including things like colostomy bags, catheters, mobility aids, insulin pumps and more, is around $60 billion annually. But the market is obviously a specialized one relative to other specialized goods businesses, in part because it requires working not only with customers who make the final decisions about what supplies to use, but also payers, who typically foot the bill through insurance reimbursements.
The other challenge is that individuals with chronic care needs often require a lot of guidance and support when making the decision about what equipment and supplies to select — and the choices they make can have a significant impact on quality of life. Better Health co-founder and CEO Naama Stauber Breckler explained how she came to identify the problems in the industry, and why she set out to address them.
“The first company I started was right out of school, it’s called CompactCath,” she explained in an interview. “We created a novel intermittent catheter, because we identified that there’s a gap in the existing options for people with chronic bladder issues that need to use a catheter on a day-to-day basis […] In the process of bringing it to market, I was exposed to the medical devices and supplies industry. I was just shocked when I realized how hard it is for people today to get life-saving medical supplies, and basically realized that it’s not just about inventing a better product, there’s kind of a bigger systematic problem that locks consumer choice, and also prevents innovation in the space.”
Stauber Breckler’s founding story isn’t too dissimilar from the founding story of another e-commerce pioneer: Shopify. The now-public heavyweight originally got started when founder Tobi Lütke, himself a software engineer like Stauber Breckler, found that the available options for running his online snowboard store were poorly designed and built. With Better Health, she’s created a marketplace, rather than a platform like Shopify, but the pain points and desire to address the problem at a more fundamental level are the same.
With CompactCath, she said they ended up having to build their own direct-to-consumer marketing and sales product, and through that process, they ended up talking to thousands of customers with chronic conditions about their experiences, and what they found exposed the extend of the problems in the existing market.
“We kept hearing the same stories again, and again — it’s hard to find the right supplier, often it’s a local store, the process is extremely manual and lengthy and prone to errors, they get the surprise bills they weren’t expecting,” Stauber Breckler said. “But mostly, it’s just that there is this really sharp drop in care, from the time that you have a surgery or you were diagnosed, to when you need to now start using this device, when you’re essentially left at home and are given a general prescription.”
Unlike in the prescription drug market, where your choices essentially amount to whether you pick the brand name or the generic, and the outcome is pretty much the same regardless, in medical supplies which solution you choose can have a dramatically different effect on your experience. Customers might not be aware, for example, that something like CompactCath exists, and would instead chose a different catheter option that limits their mobility because of how frequently it needs changing and how intensive the process is. Physicians and medical professionals also might not be the best to advise them on their choice, because while they’ve obviously seen patients with these conditions, they generally haven’t lived with them themselves.
“We have talked to people who tell us, ‘I’ve had an ostomy for 19 years, and this is the first time I don’t have constant leakages’ or someone who had been using a catheter for three years and hasn’t left her house for more than two hours, because they didn’t feel comfortable with the product that they had to use it in a public restroom,” Stauber Breckler said. “So they told us things like ‘I finally went to visit my parents, they live in a town three hours away.'”
Better Health can provide this kind fo clarity to customers because it employs advisors who can talk patients through the equipment selection process with one-to-one coaching and product use education. The startup also helps with navigating the insurance side, managing paperwork, estimating costs and even arguing the case for a specific piece of equipment in case of difficulty getting the claim approved. The company leverages peers who have first-hand experience with the chronic conditions it serves to help better serve its customers.
Already, Better Health is a Medicare-licensed provider in 48 states, and it has partnerships in place with commercial providers like Humana and Oscar Health. This funding round was led by 8VC, a firm with plenty of expertise in the healthcare industry and an investor in Stauber Breckler’s prior ventures, and includes participation from Caffeinated Capital, Anorak Ventures, and angels Robert Hurley and Scott Flanders of remote health pioneer eHealth.
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 healthtech 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 healthtech 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 at 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 says to TechCrunch that while he saw many exciting new tests in development in the US, 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)
Redbird enables pharmacies in Ghana to add rapid diagnostic testing for 10 different health conditions to their pharmacy services. 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 5-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 over over 360 pharmacies in Ghana, mainly in Accra and Kumasi. It was half this number in 2019, and Redbird was able to double this number 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 startup mPharma to take part in the six-month-long program. The company also got into Founders Factory Africa last year 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 healthtech 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.”
Healthcare tech startup Ro has raised $500 million to help fuel continued growth of its hybrid telehealth/in-home primary care platform, which also includes a growing pharmacy business as the company pursues a strategy of vertical integration to optimize delivery and reduce costs for clients. The company’s latest raise is a Series D round, and means it has now raised over $876 million since its 2017 founding.
That may seem like a lot of money, but as Ro fo-founder and CEO Zachariah Reitano told me in an interview, it’s actually “peanuts” when it comes to the healthcare industry – which is part of why they founded the company in the first place.
“Sometimes people talk about how great it is to be in the healthcare arena, in tech circles,” Reitano said. “They say, ‘Oh, healthcare is a $4 trillion market – it’s so massive.’ But that’s the worst thing in the entire world; it’s awful how large it is. And I think what we have the opportunity to cut it in half with technology.”
That’s what Reitano says will be the primary focus of this round of funding: Fueling its efforts around vertical integration of healthcare services and technology, to further the eventual end goal of reducing costs to patients through the efficiencies realized in that process.
“To me, what I’m really excited about is being able to continue to invest in that infrastructure and add even more,” Reitano told me. “We’ll continue to invest in telemedicine, we’ll continue to invest in our logistics and pharmacy, and continue to invest in in-home care, as well as the connection between the three, and then we’ll also invest in additional diagnostics, remote patient monitoring – so collecting and distributing devices to patients to go from reactive to proactive care.”
Ro’s model focuses on primary care delivered direct to consumer, without involving any payer or employer-funded and guided care programs. The idea is to reduce costs through vertical integration and other efficiency engineering efforts in order to get them to the point where they’re effectively on par with your out-of-pocket expense with co-pays anyway. Reitano explained that the insurance system as it exists in the U.S. now only effectively masks individual costs, making it less clear that much of what a person pays out in healthcare costs comes out of their pocket anyway, whether it’s through taxation, or employers allocating more of the funds they have available for compensation to healthcare, vs. take-home pay.
That’s what’s behind Ro’s recent push into operating its own pharmacies, and growing that footprint to include more all the time. Zeitano told me that the company will have 10 pharmacies by the end o this year, and 15 by the end of next, all placed strategically around the country to ensure that it can provide next-day shipping to patients at ground shipping rates pretty much anywhere in the U.S.
Doing that kind of vertical optimization has enabled Ro to offer 500 common drugs at $5 per month, including treatments for heart disease, anxiety, depression and diabetes — with a plan to ramp it to 1,000 drugs available at that price by year’s end. That’s roughly equal to the co-pay required for many insurers for the same treatments.
Meanwhile, Zeitano says Ro has seen big changes in the healthcare system generally that favor its model and accelerate its hybrid care plans owing to the COVID-19 pandemic.
“I would say that there are two most profound impacts of the pandemic on the healthcare system,” he said. “One is that it simultaneously shed light on all of the inequities for the entire country to see, right at the same time where we all cared about it. So those things were sort of known for the people impacted day to day — the geographic inequity, the financial inequity, the racial inequity. If someone felt that that inequity, then they would talk about it, but it wasn’t something everyone cared about at the same time. So this massive spotlight was shed on the healthcare system. And the second was that everyone’s healthcare journey now starts online, even if it is going to end in person, it will still start online.”
Ro’s model all along has espoused this time of healthcare delivery, with remote care and telehealth appointments handling most day-to-day needs, and follow-up in person care delivered to the home when required. That obviously generate a lot of efficiencies, while ensuring that older patients and those with mobility issues also don’t need to leave the house and make a regular trip into their physician’s office for what amounts to a 15-minute visit that could’ve been handled over video.
According to most industry observers, Zeitano is likely right that healthcare probably won’t go back to the old, inefficient model of favoring primarily in-person care after the pandemic ends. One of the positive outcomes of the COVID-19 situation has been proving that telehealth is more than capable of handling a lot of the primary care needs of a lot of people, particularly when supplemented with remote monitoring and ongoing proactive health measures, too.
While Ro doesn’t work with insurance currently, Zeitano points out that he’s not against the concept entirely – he just says that health insurance as it exists now doesn’t actual work as intended, since it’s meant to pool risk against an, expensive, uncertain and rare outcome. Eventually, he believes there’s a place for insurance in the overall healthcare mix, but first the industry needs to face a reckoning wherein its incentive structure is realigned to its actual core customer – patients themselves.
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.
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 Identity. This has led to skyrocketing demand for the services provided by identity verification companies.
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.
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 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.”
TechCrunch has reached out to Socure and will update this story with more details.
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 negotiating contracts with another 46.
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 application, 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.
The H-2A program was set up to allow agricultural employers who anticipate shortages of domestic workers to bring in non-immigrant foreign workers to the U.S. 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 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.”
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 Retuers, 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.
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.”
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 help 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 touchpoints 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 multi-billion 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 towards 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.