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getting schooled

Esther Dyson's 10 lessons for health entrepreneurs

promises worth keeping

Joe Biden's new book is a map for moonshot thinking

why are you here?

Jerry Levin on the importance of storytelling

2018 ISSUE 01

06092011

startuphealth.com $5.99

2018 Healthcare Predictions from Bob Kocher, Bryan Roberts & Unity Stoakes

at u fe

HOW AN ARMY OF HEALTH TRANSFORMERS TACKLING 10 HEALTH MOONSHOTS IS ACCOMPLISHING ONE IMPOSSIBLE DREAM

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PREMIER ISSUE!

Joe Biden Jerry Levin Esther Dyson Jonathan Larsen Dr. Jessica Mega Reed Mollins Sally Poblete Dr. Nick Turkal Jo Schneier Sundeep Bhan Anish Sebastian Asif Khan Polina Hanin Steven Krein and many more


JOIN THE MOVEMENT TO TRANSFORM HEALTH

TOGETHER WE WILL IMPROVE THE HEALTH AND WELLBEING OF EVERYONE IN THE WORLD

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StartUp Health Magazine


welcome to STARTUP HEALTH MAGAZINE At StartUp Health we believe that with the right mindset, a moonshot vision, and the spirit of an entrepreneur, anything is possible. We also know that something magical happens when you bring together people who are passionate about impacting people’s lives for the better around common goals. That’s why since 2011, we’ve been organizing a global army of Health Transformers to solve the world’s biggest health challenges. Now more than ever we think that it’s important to share the stories of the entrepreneurs and innovators who are doing the extraordinary each day with passion, purpose, imagination, persistence, courage and humility. These are the people who are reimagining the future of health and impacting people’s lives. We hope you will join us in supporting Health Transformers everywhere. Together we will achieve the impossible. Together we will improve the health and wellbeing of everyone in the world.

Unity Stoakes Co-founder & President

Steven Krein Co-founder & CEO

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IN THIS ISSUE

Vice President Joe Biden and Dr. Howard Krein, Chief Medical Officer of StartUp Health and Board Member of the Biden Cancer Initiative, deplane from Air Force II in 2016.

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Funding Report

18

Health Transformer Profiles

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Insights Dr. Nick Turkal + Steven Krein

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Sally Poblete, Founder at Wellthie

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Sundeep Bhan, Co-founder at Prognos

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42

Jerry Levin: Who are you and why are you here?

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Reading List Joe Biden's new book gives a roadmap for moonshot mindsets

Asif Khan, Co-founder at Caremerge

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Dr. Jessica Mega on Googlepowered health innovation

28

Jo Schneier, Co-founder at Cognotion

51

Getting Schooled by Esther Dyson

30

Reed Mollins, Co-founder at Doctor.com

54

2018 Healthcare Predictions by Bob Kocher + Bryan Roberts

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Chris Cutter, Founder at LifeDojo

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StartUp Health Company Index

35

Vinay Gidwaney, Co-founder at Maxwell Health

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StartUp Health Portfolio M&A Activity

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Anish Sebastian, Co-founder at Babyscripts

Insights Dr. Howard Krein The Quest to Reach 10 Health Moonshots

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Insights Unity Stoakes

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Infographic The StartUp Health Journey

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The Health Transformer Mindset Scorecard

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ISSUE 1

PUBLISHER

Unity Stoakes EDITOR-IN-CHIEF

Logan Plaster

STARTUP HEALTH CONTRIBUTORS

Jerry Levin Executive Chairman & Advisor Steven Krein CEO & Co-founder Jennifer Hankin Chief of Staff Katya Hancock Director, StartUp Health Network Callie Fisher Leader, Event Experiences PHOTO EDITOR

Paul Newson

EDITOR-AT-LARGE

Jeremy Lehrer

CONTRIBUTING EDITOR

Esther Dyson

ASSOCIATE EDITOR

Laura Sansouci

StartUp Health Magazine is published by StartUp Health Holdings, Inc. Copyright 2018. All rights reserved. StartUp Health and Health Transformer are registered trademarks.

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StartUp Health Magazine

WHY WE MADE A HEALTH MAGAZINE ALL ABOUT PEOPLE

I

t's easy to get caught up in the excitement of "health innovation." With record funding and deal volume in the digital health industry, you'd be forgiven for seeing this market in dollars and cents. But healthcare isn't like other industries. It's not about selling the most widgets. It's about making it possible for people – even ones own family and neighbors – to live healthier, more productive lives, regardless of their means. As a result, behind every disruptive software service and slick new healthcare device there is a story. These are human beings who, through a series of their own life circumstances, have decided to contribute to a health mission greater than themselves. Why did one person leave a lucrative career to build an app to reduce preterm labor? (Find out on page 37.) Why was another founder so passionate about making healthcare insurance easier to buy for small businesses and families? (Read about Wellthie on page 20). These back stories rarely make it into press releases or the news cycle. Yet, as Jerry Levin describes it on page 42, these stories – even the hard ones – are the secret to our ultimate success. After all, unless you understand where you came from, and why, how will you know where you're going? That's what this magazine is all about. Over the last 30 days our team embarked on a whirl wind blitz to gather data, glean insights and tell the tales of the real people and ideas behind the 10 Health Moonshots that are transforming health. Of course, this is only the beginning. The Health Transformers we've profiled have only begun their work of improving the lives of everyone on the globe. But when they make their next big move, we'll be ready to share it with the world.

Top to Bottom: Esther Dyson at the Meetup HQ in New York. Dropping in on Doctor.com co-founder Reed Mollins.

spotlight

mindset

moonshot

Meet Startup Health's new class of health transformers.

Meet Startup Health's new class of health transformers.

Meet Startup Health's new class of health transformers.

ISSUE 1

Stories of how an army of health transformers tackling 10 interconnected health moonshots are accomplishing one impossible dream

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Joe Biden Jerry Levin Jessica Mega Esther Dyson Reed Mollins Vinay Gidwanay Jonathan Larsen Nick Turkal Sally Poblete Sundeep Bhan Jo Schneier Anish Sabastian Asif Khan Chris Cutter Bob Kocher Bryan Roberts and many more

getting schooled

Esther Dyson shares her advice to health entrepreneurs

promises worth keeping

Joe Biden's new book provides a roadmap for moonshot thinking

Our team worked through a range of cover concepts for the launch issue.

why are you here?

Jerry Levin on the importance of storytelling

getting schooled

promises worth keeping

Esther Dyson's 10 lessons for entrepreneurs

Joe Biden's new book is a map for moonshot thinking

why are you here? Jerry Levin on the importance of storytelling

ISSUE 1

PREMIER ISSUE!

FEATURING

HOW AN ARMY OF HEALTH TRANSFORMERS TACKLING 10 HEALTH MOONSHOTS ARE ACCOMPLISHING ONE IMPOSSIBLE DREAM

10 healthcare predictions for 2018 StartUp Health funding brief Verily gives healthcare innovation the Google treatment

Logan Plaster Editor-in-Chief

Photographer Paul Newson captures Sally Poblete, CEO of Wellthie, for our Health Transformer profile section.

Joe Biden Jerry Levin Jessica Mega Esther Dyson Reed Mollins Vinay Gidwanay Jonathan Larsen Nick Turkal Sally Poblete Sundeep Bhan Jo Schneier Anish Sabastian Asif Khan Chris Cutter Bob Kocher Bryan Roberts and many more

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STARTUP HEALTH MAGAZINE

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Bring new ideas to life. Silicon Valley Bank helps leading life science innovators and investors move forward, fast. Contact: Kaitlin Berube Vice President, East Coast Life Science & Healthcare T 617.630.4164 kberube@svb.com Dennis He Vice President, West Coast Life Science & Healthcare T 415.764.4782 dhe@svb.com

svb.com ©2017 SVB Financial Group. All rights reserved. SVB, SVB FINANCIAL GROUP, SILICON VALLEY BANK, MAKE NEXT HAPPEN NOW and the chevron device are trademarks of SVB Financial Group, used under license. Silicon Valley Bank is a member of the FDIC and the Federal Reserve System. Silicon Valley Bank is the California bank subsidiary of SVB Financial Group (Nasdaq: SIVB).

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forecast

$11.3B

StartUp Health Raises $19.3M Led By Ping An Global Voyager Fund, GuideWell and Masimo

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n January 3, 2018, StartUp Health announced that it raised $19.3M from Ping An Global Voyager Fund, GuideWell, Masimo Corporation and a consortium of partners through StartUp Health Transformer Fund II. StartUp Health's mission is to organize, support and invest in " a global army of Health Transformers to achieve 10 Health Moonshots." “We are inspired by StartUp Health’s bold plan for solving the world's biggest health challenges and are very pleased to embark on this partnership to support a generation of health entrepreneurs together,” said Jonathan Larsen, Chief Innovation Officer of Ping An Group and Chairman & CEO of Ping An Global Voyager Fund. “StartUp Health has created a health moonshot factory which brings us early access to the innovators transforming health on a global level. Together, we will be able to speed up innovation cycles and make a significant impact on people's lives.” Ping An is the No.1 insurance group globally in terms of market capitalization and the 39th largest company in the 2017 Global Fortune 500. A key part of the StartUp Health’s plan since they launched in 2011 is to leverage the network effect by organizing entrepreneurs (“Health Transformers”) and to partner with the world’s leading organizations who can support these Health Transform8

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ers with capital, expertise and opportunities to scale. StartUp Health has amassed the world’s largest portfolio of over 200 digital health companies from five continents and 17 countries, and has created a global network of over 30,000 investors, customers, and partners. “From day one, we’ve had a synced vision and mindset with Ping An, GuideWell and our extraordinary network of partners committed to supporting health innovation,” said Steven Krein, Co-founder and CEO of StartUp Health. “We believe unique collaborations are required between those entrepreneurs pushing innovation forward and the world’s industry leaders in order to fix today’s most complex healthcare challenges.” Following the completion of StartUp Health’s inaugural fund which included 100 digital health companies, the StartUp Health Transformer Fund II will support and invest in more than 200 companies focused on achieving Health Moonshots over the next two years. Fund II already has 100 companies in its portfolio from 13 countries including Australia, Brazil, Canada, England, Finland, Germany, Israel, Kenya, Netherlands, Nigeria, Spain, and the U.S.

StartUp Health Magazine

$8.2B $6.2B

2015

2016

2017

DIGITAL HEALTH FUNDING SNAPSHOT "We partnered with Startup Health for their unparalleled ability to identify, attract, evaluate and on-board very highquality early startups from key digital health areas of interest to us." Jonathan Larsen, Chief Innovation Officer of Ping An Group; Chairman & CEO of Ping An Global Voyager Fund

2017 was the most active year for digital health funding to date with more than $11.3B in total funding across a record-setting 765 deals.

2017 DEAL ACTIVITY BY STAGE Seed: 29% Series A: 36% Series B: 21% Series C: 9% Series D: 4% Series E/F/G/H: 1%

LARGEST DEALS OF 2017 COMPANY TOTAL RAISED Grail

$914M

Guardant Health

$360M

Peloton

$325M

Auris

$280M

23andMe

$250M

Modernizing Medicine

$231M


Š Erickson/Jim Erickson/plainpicture

Acting as a health journey partner www.sanofi.com

Life is a health journey, with its ups and downs, and its challenges. These can be big or small, lifelong or temporary. As a health journey partner, Sanofi is beside people facing health challenges. All over the world, the thousands of women and men at Sanofi dedicate their lives to improving yours. Sanofi is about Empowering Life.

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insights

Partnering With Startups Can Help Systems Find Their Entrepreneurial Side

Dr. Nick Turkal President and CEO of Aurora Health Care + Steve Krein CEO & Co-founder of StartUp Health

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We're living in a unique moment in the history of healthcare. It's never been more important for leading organizations to start making bold changes that will help them nimbly adapt to the diverse needs of patients and better integrate new technologies that improve the quality of care. It's often said that healthcare is years behind the digital revolution curve. With the growing “consumerization” of the healthcare economy, this lag does a disservice to the growing number of patients who are now shopping for high-quality, affordable care. There are also growing pressures on the industry, including escalating costs, an aging population and adapting to requirements under the Affordable Care Act. Large hospitals and systems are consolidating and expanding, and while some of these networks have been successful, organizations that hesitate to reinvent themselves by embracing a culture of transformation will struggle long term. Too many executives at large, established institutions are still making the same mistake: They're not looking outside their own walls for new ideas and approaches. They're entrenched in a “stagnation mindset,” not collaborating in the development of solutions with entrepreneurs working to accommodate the care of the future. But by adopting a “healthcare transformer mindset,” thinking like an entrepreneur and looking to external partnerships, these executives can encourage disruption within their own organizations. Aurora Health Care, a large not-for-profit healthcare system based in Milwaukee, invested in StartUp Health, an organization leading a global movement to transform health by organizing the world's largest community of health and wellness entrepreneurs and stakeholders. This collaboration is consistent with Aurora's emphasis on transforming care processes and reflects a continued commitment to internal disruption. Collaborating with StartUp Health gives Aurora access to hundreds of vetted startups from all over the world that are looking for opportunities to deploy their solutions. It's a mutually beneficial re-

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StartUp Health Magazine

lationship that makes a big difference to the patients covered under Aurora's network. One of StartUp Health's more than 200 portfolio companies, Babyscripts, uses digital sensor technology to transform the way prenatal care is delivered. Typically, an expectant mother would need to visit her care center for 15 checkups during the course of a normal pregnancy. These frequent visits can be taxing and unrealistic, and each appointment provides only a snapshot of her health on any given day. An increasing number of soon-to-be moms in the Aurora network have access to a Babyscripts care package, which includes a wireless blood pressure cuff and scale for daily home use. Studies show that encouraging patients to participate in their own self-monitoring at home leads to better health outcomes. A mobile app sends push alerts for prenatal vitamins, and also alerts physicians if there are any abnormal biometric changes. Another common care challenge is patients who are “lost to follow-up.” This means the patient has stopped visiting the doctor, transferred to a different network or has been lost to administrators. With that in mind, another StartUp Health company, Caremerge, offers a software platform that acts as a coordinatedcare network between the system and care teams outside of that system. The information stored is compliant with the Health Insurance Portability and Accountability Act and allows caregivers, physicians, family members and patients to all be on the same page. Patients expect and deserve the best care at the lowest possible price. We're now living in a digital world, and many of the solutions in healthcare will require a re-imagination of the status quo. It's a limited approach to assume that all the answers can be found only internally. Instead, healthcare systems should be open to the best ideas from the startup ecosystem and provide a fertile testing ground for new approaches to flourish. Now is the most important time to collaborate and embrace startups. Together we can speed up the cycles of innovation and help patients live well.

Article originally published in Modern Healthcare, April 2016


insights

Embrace ‘Moonshot Medicine’ To Make The Leap To A New Era Of Human Health The moonshot mindset embraces the idea that audacious goals are the best way to bring revolutionary changes to health. Over the past several decades, the term “moonshot” has been used broadly to describe an ambitious approach to tackling society’s most intractable challenges, starting with the work that led to the first moon landing in 1969 and now encompassing research on the world’s biggest health issues, such as ending cancer, curing infectious disease, and extending healthy life. Moonshot thinking has spawned powerful new initiatives in the past few years: from Calico, a Google moonshot company focused on extending life, to MD Anderson Cancer Center’s Moon Shots program, the Obama administration’s Precision Medicine Initiative, and former Vice President Joe Biden's Cancer Moonshot. StartUp Health, where I serve as the chief medical officer, has a 25-year plan to build an army

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Dr. Howard Krein Chief Medical Officer of StartUp Health; Senior Director of Health Policy and Innovation at Jefferson’s Sidney Kimmel Cancer Center; Board of Director of the Biden Cancer Initiative

of digital health entrepreneurs and innovators that we call Health Transformers to achieve 10 of the world’s biggest health moonshots. Although these massive and multifaceted efforts may have different names and goals, they operate under the shared ethos that the most effective way to bring real change to medicine is to move forward together, arm in arm, in giant leaps rather than incremental steps. It’s inevitable that audacious plans sometimes fall short of their stated missions or don’t happen as fast as we’d like. I’ve been struck by the recent reports about Dr. Patrick Soon-Shiong’s Cancer Breakthroughs 2020, not because of the specific criticisms of his business tactics but because of the short-term lens that’s being used to judge a health transformer’s progress. While success is important, so is trying: Trying to make a difference. Trying to make a change. Trying to speed up the progress of what we know will eventually come but is taking too long. Trying to spare another family from the horrific conversation that there’s nothing that can be done for their dying loved one. Disruption is always uncomfortable, and it doesn’t happen overnight. But as a result of the bold visions of health transformers striving to do what many believe to be impossible, I believe we are on the cusp of a medical revolution akin to the discovery of antibiotics or mapping the genome. This quest will usher in treatments that haven’t yet been imagined. In order to achieve the next great leap, we need to dream big, keep innovation open and transparent, collaborate more, and embrace the moonshot mindset. Over the past decade, the medical community has learned an enormous amount from the disruptive innovation approach of entrepreneurs, which often delivers game-changing new business models and solutions at a breakneck pace. Some ideas work, many don’t. The only way to make breakthroughs is by working passionately and around-the-clock to turn far-fetched visions into reality. With so much uncertainty for the future of science funding, and a culture of skepticism at the highest levels of government today, we will all be better off if we support those already in mid-leap, no matter how long it takes. One well-known disruptor, Mark Zuckerberg, wrote a poignant blog post that reminded me of a core mantra of disruptive innovation: “We always overestimate what we can do in two years, and we underestimate what we can do in ten years.” That mantra is especially fitting at a time when thousands of health entrepreneurs and “doctorpreneurs” are testing novel approaches to reinvent the future of medicine. I’m personally agnostic as to who announces the next breakthrough, as I want them all to succeed. As Joe Biden said at the National Cancer Moonshot Summit last June, these moonshots are “carrying the hopes and dreams of millions of people who want us to succeed, make a difference in their lives and their families. Not someday, but now.” Every day in my clinical practice with cancer patients, I witness the real power of undaunted, uncompromising hope. I firmly believe that a moonshot approach to medicine is what we need to push us into the next epoch of human health and longevity. 11


insights

The Quest to Achieve 10 Health Moonshots by Steven Krein & Unity Stoakes StartUp Health is organizing and supporting a global army of Health Transformers to achieve 10 Health Moonshots with a 25-year mission to improve the health and wellbeing of everyone in the world. Something magical happens when you bring together a group of entrepreneurs and leaders all passionate about transforming health, wellness and healthcare. That’s why StartUp Health is organizing a generation of Health Transformers with bold dreams who are committed to achieving moonshot challenges many still believe can never be conquered. "If you really want to change the world, you change people’s lives, inside and out, spiritually and physically,” says Jerry Levin, Chairman of StartUp Health. “That’s the broadest definition possible of society’s health  –  the world’s health  –  and this change can only come from the moonshot mindset of entrepreneurial innovation.” Over the past six years, we’ve organized thousands of entrepreneurs, innovators and organizations committed to transforming health. In addition to rapidly growing this global force, StartUp Health and our partners have made a long-term commitment and are investing in seeing these 10 Health Moonshots to fruition. There’s no end until our mission of improving global health is accomplished.

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Delivering quality care to everyone, regardless of location or income

Radically reducing the cost of care by a factor of a million

Access to Care Moonshot

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Cure Disease Moonshot

Curing disease using data, technology and personalized medicine

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Cancer Moonshot

Ending cancer as we know it

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Women’s Health Moonshot

Prioritizing women’s health, including preventive care and new research

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Children’s Health Moonshot

Ensuring every child has access to quality care, particularly in underserved areas

Cost to Zero Moonshot

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Nutrition & Fitness Moonshot

Providing access to a healthy environment and support for an active lifestyle

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Brain Health Moonshot

Unlocking the mysteries of the brain to improve health, wellness and mental health

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Happiness & Mental Health Moonshot

Connecting mind, body and spirit in the pursuit of happiness

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Longevity Moonshot

Adding 50 healthy years to every human life


insights

Predicting The Future: A Health Moonshot Revolution On A Global Scale

their mind, body, and spirit. Think of it as Headspace 2.0 -- as brain-hacking goes mainstream helping those with addiction, stress, PTSD, and mental and behavioral health needs. Most importantly, impact will be a baseline requirement for any health solution wanting to break through. And those with measurable outcomes and health moonshot visions will lead to our first Uber-sized success stories over the next decade. 2. Less logjams, more moonshots

At StartUp Health, we work with hundreds of Health Transformers, entrepreneurs and innovators every year -- from founders bootstrapping their way to success, to moonshot visionaries reshaping the future, to CEOs of the world’s largest companies trying to figure out how to keep pace with a dynamic landscape. It’s a unique perspective seeing in real-time what’s working in one part of the world and what’s not catching on in another. Two years ago in a column for Forbes I shared 13 health innovation predictions that would take shape in the near-term. Twelve of those predictions have already come true. And I think the thirteenth is just a matter of time. As we enter 2018, I’ve decided to revisit these predictions to review the progress being made. I’ve also outlined several new health innovation trends to pay attention to. Looking back at the crystal ball - a new look at the progress being made

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Unity Stoakes Co-Founder and President at StartUp Health

1. A second wave of digital health innovation

Two years ago, I forecasted a “second wave” of digital health transformation, and today we’ve seen massive adoption of wearable health devices, a huge injection of capital into digital health startups, formal FDA guidance and support for digital health applications, the entrance of tech giants like Apple, Amazon, and Facebook, and unexpected mega-deals like CVS/Aetna. The industry has leaped forward in every way imaginable, across the globe. What’s coming

While the healthcare industry (and government) focuses on the antiquated and ellusive EHR, more than a billion people will get CHRs - what I call consumerized health records that are useful and accessible. It will happen automatically as they go about their daily routines and as they use their watches, credit cards, cars, kitchens and bathrooms. Prediction: Apple, Amazon, Google, Microsoft, or someone else smart with a warchest, buys EPIC as a trojan horse into the industry. Also the same way the quantified-self movement caught the imagination of a legion of creators, and helped spawn rapid adoption of activity trackers in digital health’s First Wave, a more mainstream and impactful generation of consumer wellness-hacking tools will come to market empowering people to rewire, reset and re-energize

A few years ago we were only on the cusp of bold thinking in health -- too few pushed the boundaries toward moonshot-style investments with grand visions for reinventing health. Now we have VP Joe Biden’s well-recognized Cancer Moonshot (the Biden Cancer Initiative) and massive commitments declared by the Chan Zuckerberg Initiative and Silicon Valley leader Sean Parker. Big vision companies like Human Longevity Inc. (disclosure: a StartUp Health company), Verily, and Proteus are betting big on the future of prevention. And hundreds of new companies are organizing around StartUp Health’s quest to achieve 10 global health moonshots aimed at improving the wellbeing of everyone on the planet. What’s coming

Now that the power of health moonshot thinking is becoming ingrained in public consciousness, there will be a new generation of entrepreneurs, investors, industry leaders and governments who start dreaming of bigger and bolder missions to reimagine what’s possible. This trend will continue to grow, as communities and individuals who care about health rally around these moonshots, and as the era of point-solutions shift to platform-based models with the ability to impact billions of people. 3. Rise of the “Maker Movement” will customize health

The home-grown “maker movement” is transforming the industry with customized solutions. Mostly, this has taken the form of 3D printed products, such as personalized medical devices and homemade pills. We’ve continued on page 58

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infographic

The StartUp Health Journey: 2011-2018 THE MISSION: 100 YEARS OF PROGRESS IN 25 YEARS

MARCH 2011 Light Bulb Moment: Steven Krein, Unity Stoakes and Jerry Levin Meet at SXSW to Ideate on the Grand Vision to Transform Health APRIL 2011 HHS CTO Todd Park Invites StartUp Health to Washington to Announce Plan to Build 1,000 Digital Health Companies

JUNE 2011 StartUp Health Coins Term Health Transformerâ„¢ to Recognize SuperEntrepreneurs Focusing on Health Innovation JUNE 2011 President Obama and Vice President Biden Meet With StartUp Health Co-Founders to Discuss Transformation of Health

JUNE 2011 US CTO Aneesh Chopra and Steven Krein Announce StartUp Health Mission at Health Datapalooza Conference in DC JULY 2011 Esther Dyson Is the First Angel Investor to Back StartUp Health

2011

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JUNE 2014 StartUp Health Returns to the White House on 3rd Anniversary With 60 Health Transformers

MARCH 2012 StartUp Health Academy Launches With Inaugural Class of Health Transformers

APRIL 2013 StartUp Health Begins Global Expansion, Adding Companies From Israel and Ireland

MARCH 2012 California Health Care Foundation and AT&T Become First Corporate Sponsors of StartUp Health

JULY 2013 First Health Transformer From South America Joins Academy

APRIL 2012 Launch of First Innovation Fund Backed by Steve Case, Mark Cuban, Esther Dyson & Brad Feld OCTOBER 2012 Launch of StartUp Health Network to Organize BatteriesIncluded Investors and Customers

2012

AUGUST 2013 First Portfolio Company Acquired: Gene by Gene Acquires Arpeggi, a StartUp Health and GEBacked Company DECEMBER 2013 In 2013, 45 Health Transformers joined Startup Health

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AUGUST 2014 StartUp Health Launches StartUp Health NOW, a Weekly Web Show Featuring Health Transformers and Changemakers NOVEMBER 2014 Kaiser Permanente Ventures Invests in StartUp Health Innovation Fund DECEMBER 2014 In 2014, 80 Health Transformers joined Startup Health

2014


JUNE 2015 Aurora Health Care and StartUp Health Partner to Support Startups Transforming Care Delivery

JANUARY 2016 StartUp Health Festival convenes 1,000 of the world’s health transformers and leaders in San Francisco

JUNE 2015 Under Armour Acquires StartUp Health Company Gritness

APRIL 2016 Dr. Howard Krein, Chief Medical Ofcer, Travels Globe With VP Biden to Support White House’s Cancer Moonshot

JUNE 2015 Dr. Nick Turkal, CEO of Aurora Health Care, Joins StartUp Health Board of Directors

APRIL 2016 Investment in Human Longevity, Inc. and Launch of “Longevity Moonshot” to Change the Face of Aging

OCTOBER 2015 Opening of First StartUp Health Village in NYC

JUNE 2016 First Health Transformer From Africa Joins Academy

OCTOBER 2015 GE Ventures Expands Partnership to Help Build 25+ Digital Health Companies

JUNE 2016 150th Company Joins StartUp Health Coinciding With 5th Anniversary

OCTOBER 2016 StartUp Health Announces 10 Health Moonshots to Improve the Health and Wellbeing of Everyone in the World OCTOBER 2016 Zimmer Biomet acquires StartUp Health company Respondwell DECEMBER 2016 In 2016 60 Health Transformers joined Startup Health

NOVEMBER 2015 StartUp Health Ventures Launches to Invest Exclusively in Health Transformers NOVEMBER 2015 Global Platform Expands With Launch of StartUp Health Finland

2015

2016

JANUARY 2017 StartUp Health’s Global Army of Health Transformers Convenes in San Francisco for StartUp Health Festival, with Keynote from VP Joe Biden JANUARY 2017 StartUp Health Announces Global Partnership With Allianz to Advance Health Moonshots Worldwide MARCH 2017 Accenture Becomes Newest Member of the StartUp Health Network APRIL 2017 StartUp Health Announces Global Partnership with SAP Health MAY 2017 StartUp Health Launches Health Transformer Digital Magazine

JUNE 2017 StartUp Health & SAP Health Announce First Call for Innovation JUNE 2017 Biden Cancer Initiative Launches with StartUp Health Chief Medical Ofcer, Dr. Howard Krein, on Board of Directors

JANUARY 2018 Launch of StartUp Health Magazine JANUARY 2018 StartUp Health and the Global Army of Health Transformers return to San Francisco for the 6th Annual StartUp Health Festival

SEPTEMBER 2017 Generali Global Assistance Acquires StartUp Health Company CareLinx SEPTEMBER 2017 StartUp Health launches its second Transformer Fund to support 250 companies with investors including Ping An Global Voyager Fund and Guidewell DECEMBER 2017 In 2017, 70 Health Transformers joined Startup Health

2018

2017

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scorecard

DO YOU HAVE THE HEALTH TRANSFORMER MINDSET? by Steven Krein & Polina Hanin

MINDSETS

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t’s not what you think, it’s how you think. The words you choose and your energy are directly related to whether you attract or chase away the very people -- customers, investors and talent – you want and need to help you succeed. At StartUp Health we focus on mastering the Health Transformer Mindset™ so that entrepreneurs become magnets to attract the people and organizations needed to achieve Health Moonshots. For the first time, we are sharing the Health Transformer Mindset Scorecard so you can get started and benchmark your mindset. Or go to startuphealth.com/academy to complete our 10-Minute Mindset Audit using the interactive scorecard. Though it may only take 10 minutes to get started, these mindsets require a daily practice for true mastery. Do you have a long-term commitment to transform health?

Do you practice healthy habits and express gratitude?

You are not "all in" yet and not fully ready to commit your life to transforming health.

2

Supportive Relationships

You don't rely on others, would rather do everything yourself, and have no longterm relationships around you.

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Quarterly & Weekly Rhythm

You are heads down and don't feel the need to step back, celebrate wins, or recalibrate to figure out "what's working/ not working."

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Confidently Ambitious

You continue seeking reassurance from other people to make you feel more confident.

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Self Aware

You talk more than you listen and aren't able to clearly articulate what your unique ability is.

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Healthy Habits

You don't feel the need to take care of yourself because that's just the life of an entrepreneur.

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Value Creator

You believe you deserve all the credit for creating value and don't want to share it with others.

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Batteries Included

You find yourself in frequent nonconstructive arguments with your team and advisors, draining your energy, and the energy of those around you.

Are you creating a future bigger than your past? Are you batteries-included by always providing energy to others?

Coming in 2018, a book that codifies StartUp Health’s blueprint for the Health Transformer Mindset.

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Long-term Commitment

Are you confidently ambitious about your Health Moonshot? Are you coachable and self-aware of your unique abilities?

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Do you surround yourself with supportive relationships? Do you recalibrate every 90 days and celebrate weekly wins?

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UNCOMMITTED ENTREPRENEUR

THE HEALTH TRANSFORMER MINDSET™ SCORECARD


GRAB A PENCIL Take some time away from your day-to-day grind to assess your entrepreneurial health and mindset, and identify areas for growth over the next 90 days.

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"It’s not what you think, it’s how you think." 6

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You are working on other things as backup until you have more certainty you're on the right path to transforming health.

You are committed for the next 18-24 months but don't have a clear vision beyond that on how you'll transform health.

You are "all in" and will do whatever it takes for as long as it takes, because it's your life's mission to transform health.

You try to rely on others, but spend too much of your time convincing or "selling" them.

You have plenty of people around you, but still feel lonely and wish you had more supportive relationships.

You are continually surrounded by like-minded, supportive people who encourage and believe in you.

You constantly feel like you haven't accomplished "enough" so you try to catch up over weekends, with each week and month blending into the next.

You intuitively know what you need to do each week and quarter without writing it down, but time periods pass without you achieving what you planned.

You recalibrate every 90 days, begin each week with a written plan, and end each period celebrating and sharing the iterations and progress you made.

You seek, but rarely listen to, other people's feedback and never operate in your unique ability.

You know what your "unique ability" is but aren't leveraging other people's unique abilities often enough to amplify your efforts.

You are coachable and self-aware of your unique abilities, and the unique abilities of other people, so you continually improve your capabilities and results.

You don’t know your unique ability and don’t seek help from others.

You know your "unique ability" but don’t tap into others’ unique abilities.

You are coachable and self-aware of your, and others, unique abilities.

You feel burnt out, know you need to take better care of yourself and your relationships, but lately don't make the time.

You make some time for yourself and your relationships, but not often enough as work takes priority.

You take care of yourself, have a clear mind and healthy body, and regularly practice gratitude, both to yourself and with others.

You believe in sharing credit with others for value creation but continually ask them to justify why they deserve it.

You are trying to build a future that is bigger than your past but you don't rely on the best resources and capabilities to help you.

You are continually making your future bigger than your past, always attracting and developing new capabilities and resources.

You always try to give energy to those around you, but constantly feel your interactions with other people drains your energy.

You provide energy to those closest to you, but have not eliminated people from your life and business that drain your energy.

You are always providing energy to others and have no tolerance for those who drain energy, filling your life with only “batteries included” people.

FRUSTRATED ENTREPRENEUR

HEALTH ENTREPRENEUR

HEALTH TRANSFORMER

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ORGANIZING A GLOBAL ARMY OF HEALTH TRANSFORMERS Health Transformers are the entrepreneurs and innovators dedicating their lives to reinventing the future of health. They have the courage, heart and intuition to reimagine what’s next. On the following pages we've profiled eight of these founders and CEOs, sharing notes about their business endeavors as well as a bit of their personal stories. Each Health Transformer is different, but when you connect these extraordinary leaders together to achieve health moonshots, anything is possible.

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Challenge Question For each profile we have asked an investor or industry expert to ask a constructive challenge question. This issue our experts are: Andrey Ostrovsky, MD (AO) Former Chief Medical Officer at CMS Esther Dyson (ED) Investor/Advisor


Wellthie Q&A: Sally Poblete

Cognotion Q&A: Jo Schneier

Maxwell Health Q&A: Vinay Gidwaney

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Prognos Q&A: Sundeep Bhan

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Doctor.com Q&A: Reed Mollins

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35

Babyscripts Q&A: Anish Sebastian

37

Caremerge Q&A: Asif Khan

LifeDojo Q&A: Chris Cutter

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health transformers

01 Wellthie

A New Approach to Health Insurance Puts Small Businesses Front and Center INSURANCE VETERANS RESHAPE THE LAN Likening itself to "The Zillow for Health Insurance" Wellthie is a cloud-based e-commerce solution that is transforming the way small businesses and consumers find and use their health insurance. Modernizing the way brokers sell insurance to small businesses and individuals, Wellthie provides a branded online storefont with a user-friendly design to simplify the sales process. Included tools allow brokers to foster longterm relationships and expertly guide users to the perfect plan. Wellthie's team is using decades of experience in the insurance industry to offer health insurance buyers the same ease and confidence they would feel shopping on Amazon. The team believes that finding insurance shouldn't give you a headache, and their proprietary rules-driven solution includes a myriad of tools and insights to support brokers, carriers, small businesses, and individual users.

Wellthie.com @Wellthie Total Funding: $5 Million Founded: 2013

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What was it that got you passionate about health insurance?

It’s necessary for everyone to secure their financial and healthcare wellbeing. Thus the name Wellthie. Everyone gets stressed out by it. It’s like getting a root canal. That’s a universal reaction of most people, be it as an individual, as an employee, as a business owner – young or old, it doesn’t matter. My audacious goal is helping people have a more simple interaction buying insurance. It’s having a more confident process, getting the help and support they need from the right experts, connecting people to the right products. The interaction that humans have with insurance is so daunting and stressful – it’s a worthwhile moonshot for that reason. Many studies have shown that those who are insured take better care of themselves, get access to coverage, and seek preventive services. I want to increase access. That is what we’re going after. We’re really excited about it. Did you ever have a moment in your career when you felt those insurance pain points?

Dossier

HQ: New York City

SPOTLIGHT Sally Poblete, Founder & CEO of Wellthie

I had a complicated pregnancy and that resulted in a boatload of medical bills. I had to navigate my insurance. That was painful – and I am an expert. I knew exactly who to call,

StartUp Health Magazine

Market Metrics 5 Million The U.S. has over 5 million small businesses. 50% Less than 50% of American small businesses offer insurance to their employees 89% of American small businesses feel it’s important to offer coverage. 40% of consumers are visiting insurance websites ready to buy. --Source: wellthie.com

what to do and what to say. It was a whole runaround, not just long hold times but a lot of emotion and effort at a time when, as a new mom, you’re just trying to cope with parenthood. I also started my career running a small family business. Taking care of our 20 employees and figuring out how we could afford insurance was something that I had to deal with. I saw the pain as a manager/operator of a small business. Both personal experiences helped shape what we’re doing today. What are you hearing when you talk to your customers?

Our customers are insurance companies and brokerages that are trying to reinvent, looking at startups saying, “We want to innovate. We are an industry that has been doing the same old processes for a long time and we’re ready. We’re looking to startups to help us make things better. How do we partner?” That’s exciting because the pace of change in the industry is traditionally very slow. What we’re hearing is an appetite and a momentum for change. That is why I think entrepreneurs are in the right place at the right time to be innovating. What do you envision insurance will look like 15 years from now?

How do you, I, and business owners together have a collaborative, transparent, easy way to understand, buy, and optimize our insurance? In the same way we buy all the other goods and services that you and I are used to, that we get in a snap of a finger on Amazon Prime. It’s like finance, it’s a big and complicated product, but my vision for users is for there to be more confidence and transparency. To buy insurance and know what I’m getting. I’m getting the best value and the best fit for me and my company.


Great pull quote Great pull quote Great pull quote Great pull quote Great pull quote Great pull qat pull quote Great pull quote Great pull quote Great pull quote Great pull quote Great puote

You started out your work life in a smaller family business and moved into corporate insurance, and now you have come full circle. What’s your strategy for growing while maintaining the nimbleness of the small startup?

It is about empowering team members to take on challenges and solve them. We have built a company where I, as an insurance expert, am not the one providing the answers. It’s the culture of amazing, passionate, intelligent individuals who buy into that mission and feel completely empowered to solve problems. It sounds simple but it’s really hard to achieve. It starts with hiring people who are hungry to learn and make a difference. When you have those people, coupled with the right vision and an environment where it’s okay to take risks and try things. It may not work out right the first time and we’re going to keep trying. That’s where things happen. One of the other management philosophies I espouse is creating an environment where people can cre-

atively disagree, fostering intellectual tension. Where any team member regardless of age or background can provide diverse views and help the team make the best decision and solve the problem in the most creative way. In a meeting if everyone’s agreeing I ask why. What’s a different way to look at this? When you’re intentionally bringing a diverse group of people together, that is by design in order to create new and different ideas that get mixed in the pot to make the best outcome. Give me an example of a time you look back on and say, that's why I love being an entrepreneur.

We just went national this Fall. Prior to us, there hasn’t been a national platform from which you can access small business benefits through brokers. Everyone wants to be national but the amount of variability, nuance, data, and diversity in insurance across every state is tremendous. We have successfully figured out the diversity and created a platform, soft-

Our customers are insurance companies and brokerages that are trying to reinvent, looking at startups saying, “We want to innovate . . . How do we partner?” That’s exciting because the pace of change in the industry is traditionally very slow. What we’re hearing is an appetite and a momentum for change. ware, data, aggregation and all of the things needed in order to make that happen. Our team did it. We didn’t have a roadmap to follow, we had to improvise as we went along. It's a whole company working together to make that happen. Weaving into my being a minority and a woman entrepreneur in technology, healthcare, insurance, and as a mom – parents get the biggest satisfaction when they see their kids exceed what they thought they could do themselves. “Wow, how did they figure that out? This is really cool!” It’s the same high I get as a parent. When our team is conquering, overcoming obstacles, creating new things that didn’t exist before; that, to me, is the best high. That’s why I’m doing this.

Challenge Question How will the new tax law impact your company's future? -AO

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Imagine that one day you could plug in a couple of your own data points and then see a trajectory of your own path and what you can do differently. -SUNDEEP BHAN, CO-FOUNDER & CEO OF PROGNOS 22

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health transformers

02 Prognos

These Big Data Pros Are Predicting Disease Earlier Than Ever BIG DATA, BIGGER SOLUTIONS At the heart of Prognos is a seemingly simple question: What if we could detect diseases sooner? To get at that problem, Prognos founders Sundeep Bhan and Jason Bhan embraced big data in a big way. Located in New York, Boston and Bangalore, Prognos does the heavy lifting of analyzing massive amounts of lab data that is already gathered in the course of a tpyical patient journey. In fact, they've collected data on about 180 million people in the U.S., working with close to 14 billion medical record data sets. The Prognos team has worked with these data sets for seven years, becoming experts in mining them for insights. They’ve built more than a thousand algorithms that help track 50 disease progressions. All of this analysis, happening at unprecedented scale, allows the company to predict diseases earlier than ever before.

Dossier prognos.ai @prognosAI Est: 2010 HQ: New York City Total Funding: $43.2 Million

SPOTLIGHT Sundeep Bhan, Co-founder & CEO of Prognos

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Why is it so important to catch diseases even a little earlier?

People are affected every day with some disease or cancer. We know that if you can find out about these problems earlier, we can have a big impact on the outcomes from a personal patient perspective as well as from a healthcare system perspective because that can drive lower costs and better outcomes.

Sundeep Bhan collaborates with Prognos co-founder and cousin Jason Bhan in their New York headquarters.

What did your entrepreneurial journey look like?

What are the opportunities and limitations for AI in this space?

There’s a lot of misinformation out there around AI People say you just take all this data and you plug it into a machine and it’ll just figure everything out. That’s obviously not the case. First, you have to know what you’re looking for. Second, you have to know how to clean and normalize the data. When you take a lot of this data in its raw form, it’s a mess. It’s dirty. It’s not normalized. Even naming conventions are all different. In order to do analysis on all this information in the most efficient way, first you have to work with the data at a structural level. Using AI and machine learning to mine massive data sets is very hot right now. Is this getting to be a crowded market?

The opportunity is enormous, so it’ll

attract a lot of smart people. And the timing is right. IBM Watson, Google and others are all sort of dabbling and looking at this data set from different perspectives. I think like anything else in business it comes down to where your focus is going to be, where you’re creating value and what problems you are solving for your clients and that’s where you can build a business. In terms of AI, these data sets we are working with are beyond human scale. So you need to go to AI and machine learning to be able to do it.

Challenge Question How will your technology address big data challenges in the Medicaid space when the Medicaid claims database isn't available for public consumption? -AO How will the splintering of the market into lots of different subsets for one diagnosis change drug companies’ business models, and ultimately your own? -ED

It started all the way back when I was a kid in Kashmir, in India. I always had this entrepreneurial spirit. My grandfather was an entrepreneur. I remember following him around our family orchards which supplied apples and nuts to the rest of the country. I would pretend that I was his business partner. When I was maybe ten years old I had this business idea to take all these books and magazines and comic books and charge kids in my neighborhood a fee to come and read the books. I wanted to create this great library and see if people would pay to read the books! Fast forward and now Prognos is my third company, which I started with my cousin Jason, who is a physician.

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What’s your moonshot? If this kind of predictive technology were to truly take off in our society, this is the kind of world that we could live in 15, 20 years from now?

I think there are two perspectives, the healthcare system perspective and the personal perspective. Imagine that one day you could plug in a couple of your own data points and then see a trajectory of your own path and what you can do differently. As you have more and more of this information, not only can you predict disease earlier but you can also look at things that will have an impact on preventing or ultimately eradicating disease. That’s the ultimate form of where this could go. That’s the general goal. What about more specifically?

Think about how we discover drugs. All the studies right now are in very controlled settings. Now in the real world there’s all this data that’s available. Let’s say we were able to take data from failed studies – FDA didn’t approve it – and then you can go back and match that data up with this real world diagnostic data that we have. You’d start to see what else was going on with those patients, not just what was being studied for that trial. And that can lead to either new indications for that drug or redesigning that trial for maybe a different subset of the population, where it would work. And then all of a sudden some of these diseases, like diabetes, are no longer just one disease, but 20 more unique diseases. So you can start to do that and then start to treat each of those sub-segments. That’s tangible; that I think is in the next ten to 15 years.

03 Caremerge

An All-in-One Platform for Senior Living Care Coordination A GRAND PLAN FOR GRANDMA With a cloud-based set of web and mobile communication and care-coordination solutions for senior living, Caremerge allows staff, hospitals, doctors, and family members to collaborate and keep up-to-date on their senior residents. Caremerge eases the communication gaps and provides a one-stop-shop for doctor's recommendations and patient activities, allowing all the stakeholders to be on the same page, no matter the physical distance between them. Launched in 2010 over a dining room table in Oak Park, IL, Caremerge now has 450 client locations and a 99% client retention rate with partners like Leading Age, Enquire Solutions, HealthMEDX, CareLinx, StartUp Health and many more. The Caremerge apps improve care coordination and communications while engaging families and reducing hospital readmissions. Creating meaningful connections between providers, families, and seniors while meeting valuebased care needs, this network makes keeping up to date on a patient or loved as easy as checking Facebook for updates. Dossier caremerge.com @Caremerge Total Funding Amount: $20.1 Million HQ: Chicago Est: 2010

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SPOTLIGHT Asif Khan, Co-founder & Chairman at Caremerge

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Tell us a piece of your story. Have you always been an entrepreneur?

In the 1980s, when I was in sixth grade, I convinced all the neighborhood kids to create this nonprofit library because we all had these amazing books. I pulled it together in my extra room on the side of my house. We had a big board, we painted it, and we had a budget. So everybody who took the book out, they gave ten cents or whatever the money was at that time. Then we pooled our money and we bought more books. This was in Pakistan. I came to United States when I was 18. I went to college at the University of North Florida and then worked for five years until I finally got my Green Card. Then I moved to Chicago and started working at GE. GE paid for my MBA. Entrepreneurs, they find a way. So you worked at GE. How did that more corporate environment shape you as an entrepreneur?

At GE my work was very entrepreneurial. I was obviously doing my job but I was always taking on projects or coming up with ideas to make things better. I created software to help the engineers design electric substations at a much faster pace.


Caremerge has found its way but my big vision is still unsolved. I just can’t let it go. You fall in love in this complex thing and you just can’t get it out of your head. Somebody needs to solve it. And I think I’m the right person." Why leave the stability of GE to strike out on your own?

I was part of the Health Information Exchange Group at GE. I was really struggling to figure out: How do you share healthcare information about individuals? And so I wrote some white papers. I concluded that it was just not going to work because there was no financial business model behind it. There was no model to sustain the maintenance, support, and ongoing innovation. No hospital wanted to share their information and different EHRs didn’t want to make it easy for people to access their information. The biggest problem was nurses and doctors – they don’t have time to look into some clunky system and find out the information is three months old. As I was contemplating that, my mom got really sick and she was put on ventilators in Pakistan. My parents are retired; they’re highly knowledgeable, educated people. So I got there and it was very disheartening to see my dad, who is such a strong person, extremely weak because he couldn’t figure out what all this paperwork meant. I was very frustrated and I said, “I commend you for all the wonderful things you are doing here in Pakistan for less fortunate people. But you don’t have your information organized. You don’t know who Mom was seeing, who was her primary physician, which medications she was taking. You have no information. This is ridiculous.” My dad said, “Well, you tell me

that you’re a global product leader, whatever you are in GE. You live in the most advanced country in the world, the United States. You work for one of the biggest companies in the world in healthcare. What can I do? How do you keep track of your medications? Do you know which medications you took three months ago?” I said, “Wait a second, that’s a good point. I don’t.” That’s the whole problem that I was trying to solve with this Health Information Exchange and I was concluding that it just wasn’t going to work. When this happened, it was destiny if you will, a calling. I know so much about this and so many big companies have tried to do this and here I am: hopeless, helpless, and can’t help my parents. Something needs to be done. So I came back and resigned from GE. How would you describe Caremerge currently?

We pivoted several times, as in any startup. Where we landed is a wellness and engagement solution for assisted living, memory care, independent living facilities for high-risk patients. We provide the staff very simple tools to do their jobs. As they do, we disperse different information to the patient or the residents themselves and also to the family members. Necessary information for the staff so they can make better choices for the seniors in their care, whether it’s clinical care, nonclinical care, or wellness.

Market Metrics

68% of Americans in their early 70s go online.

Millennials represented 78% of new hires in senior living.

With the proliferation of mobile technologies, internet and social media, six out of every 10 seniors uses the Internet.

The three stakeholders in seniorliving facilities are staff, residents and families. We created an enterprise solution so they can all do what’s important to them without bugging each other and asking for information. The extremely big idea that we had is focused into those three stakeholders. What's your bigger picture vision, beyond senior-living care coordination?

The bigger vision is still unsolved. How do you help people live longer and in self-sustaining better lives while reducing the costs? The oldest five percent of the population in the U.S. is costing us $2 trillion – half of the healthcare expense. How do you bring costs down? We made a dent in it with Caremerge, but with a broader scope, it’s still unfulfilled. So that’s what I’m starting to work on next. Would you say that health tracking technology exists, those dashboards exist, but the overarching system has not been pulled together?

Yes, you could say that. I think the challenge is a lot of the systems are cost-prohibitive for post-acute care. Where is the money going to come from? You can orchestrate a business model in a very creative way, where they get the right tools that they can afford but at the same time the insights as well. The other challenge is people who are the five percent of the oldest population, they don’t know what the internet is. So asking them to use a Smartphone or tablet to log in and tell you how their blood pressure is, forget about it. How do you solve this problem for the five percent of the oldest population and provide risk stratification for people who are responsible for those seniors in realtime? I’m not going to spill all my beans. I’m still in the customer discovery phase, but I think in the near future I should have it. 25


health transformers caremerge

I’m glad that you touched on coming up with creative business models to make it work financially. So often people think that the thing that’s missing is the technology, but you have these small entities like a senior-living facility and they just have to make it work with next year’s budget. They’re losing money and they’re shutting down. We can’t afford it as a nation. If these skilled nursing facilities shut down, all these patients are going to start going back to the hospital. That’s a bad idea because that’s a higher cost of care. It just can’t work. I would imagine that these projects feel personal to you as you think about your own parents getting older.

Exactly. And because it’s a free app or free service, anybody around the world can use it. We’re not going to work on languages at this point but if you can speak English or understand it, you can sign up for free and start using it. We’re getting a lot of tremendous data that will power the AI as we grow. How do you keep the startup mentality as Caremerge grows? How do you stay nimble?

As we are growing Caremerge we are close to 70 people; I already feel that we’re not as nimble. We can’t really just spin because we have 650 customers to take care of. It’s important to realize you've got to move and pivot early on and find your niche. Find your core competency, what you’re really good at, what problem you’re solving and go at it, just keep doing it. If you try to do other things you dilute your efforts. You’re distracted and not good at anything because you’re trying to do everything. So that’s where you scale it. You just keep refining processes, keep improving the infrastructure and performance. Those incremental improvements over what you’re doing are improving the product and building a solid future. Healthcare especially can burn you if you try to do too much. You've got to be aware of not diluting your efforts.

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transformer mindset

Asif Khan's Pearls for Health Transformers 1 You need a relentless, 100 percent commitment to your goal. 2 You must be self aware enough to know what you aren't good at, so you can find the right people to help you solve the problems at hand. 3 You should seek to create value in everything you do, and not only for yourself but for your customers. Even for you competitors. Just create more value as you move forward in your life.

Challenge Question Who actually pays for the product/ service? Do the care facilities get reimbursement from Medicare? Do you have cost-savings data? -ED Have you or would you engage in riskbased contracts with your customers that are themselves getting involved in value based payment? -AO

Dr. J. Craig Venter’s latest venture, Human Longevity Inc. is on a quest to decipher the human genome.

“When we first sequenced the first human genome, it cost $100 million to do that. It took 9 months, it took a $15 million computer for one and a half teraflops, and it wasn’t a replicable event. The government spent about $3 billion doing a shabbier version, and it was not replicable either. Not much has happened in the last 15 years, except incredible technology changes. I was basically waiting until the computer technology and the sequencing technology got to a critical point, and that’s when we started Human Longevity. It was below $2,000 to sequence a human genome. With cloud and distributor computing, it totally changes what’s possible. Our $50 million computer today, you can get a card for your PC for $100.”

-dr. j. craig venter

FOUNDER, CEO AND EXECUTIVE CHAIRMAN OF HUMAN LONGEVITY, INC.


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health transformers

04 Cognotion

Fixing the Elder Care Workforce Crisis, One Smart Film At a Time HEALTHCARE'S LEARNING COMPANY Cognotion is taking on two massive challenges at once. The first is the tidal wave of baby boomers aging into retirement and in need of high-quality healthcare assistance. According to Cognotion cofounder Jo Schneier, in the next five years we’ll need to add five million employees to the elder care workforce. The second problem is on the labor side. Sixty-four percent of the U.S. population doesn’t get a four-year degree. These women and men struggle to find their entry point into the American economy, let alone work that provides meaning. Into this unique supply-demand equation steps Cognotion, a digital learning company with an ear for story-telling. Cognotion is simplifying the process of training people to take on elder-care healthcare positions using a unique multimedia methodology. With their Hollywood-caliber production quality, Cognotion's training modules – which can certify learners in 20 different health positions – look more like Grey's Anatomy than a typical online classroom.

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How did you get started?

I come from the education tech space, mostly, and I spent a number of years working with struggling students. The classroom environment wasn’t the easiest place for them. And many of them never had a moment where they felt like they had a teacher who really saw them, where they felt like they could really succeed in school. What weaknesses do you see in the current style of online learning?

Most education is like this. You’ve got a great Shakespeare play. People come and see it. They can see the sweat dropping off the actor’s brow. They’re laughing. They’re into it. And most online education at its

Dossier cognotion.com @cognotion Est: 2013 HQ: New York City Total Funding: $4 Million

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best is somebody stands in the back of that theater and films with their iPhone and you have some squinty thing. And you put it online and you think: Well, why didn’t that work? It worked in the theater. Why isn’t it working here?

SPOTLIGHT Jo Schneier, Co-founder & CEO of Cognotion

StartUp Health Magazine

Challenge Question How can you scale to many more kinds of jobs? How do you recruit and select the students? -ED

Why is storytelling so critical to behavior change?

I spent many years working on behavioral change using technologybased solutions and working with behavioral research scientists. We looked at how we could change patient behavior. And what we discovered was that if we used story-based narrative training, scenario training that was very engaging, we could get people interested enough and emotionally connected with the material where we were able to change their behavior over an extended period of time. We’re applying that in the products that we build, where we take somebody from the place where they say: I have no hope, no future, this economy is not for me; to a place where they are able to say: I can be the hero of my career. That is a core underpinning of the work that we do.


Has this been effective in the past?

About ten years ago or so I started working with these behavioral research scientists out of NYU, focused on the spread of HIV in marginalized communities. They wanted to tackle the problem of getting people to begin to take medication and then to increase adherence to medicine over an extended period of time. Let’s say we were working with a heterosexual woman of color, low income bracket, who’s married to a person of color who’s male, who doesn’t identify as being gay or bi but has sex with men and so that man becomes HIV-positive and passes it on to his wife. Well, how do you get that woman to start to take medication when she’s got to admit to all of these other things that are happening in her life? What we found was we needed to have these really open, honest dialogues with people and really understand: What were their biggest fears? What were the things that were really blocking them? And then we needed to trust them. Knowing your own story and owning your own story is at the core of everything that we do. Your ability to be honest with yourself and understand your own humanity and where you’re taking your own life. We want each person to have that experience. It’s part of what makes us human. How do you translate this concept into e-learning?

We get asked a lot: Can you actually translate this into something that’s online? And my answer is: Every great video game and every movie that changed your perception of something has done this. We’re not the first ones to do this. My real inspiration was Sesame Street. It’s this really engaging program that kids watch without thinking about it as being educational. They don’t sit there and say: Oh,

“If we can play a small part in reminding people in the U.S. that they have hope, that there’s space for them, that there is a future for them in this country; that to me would be one of the most satisfying things that I could have achieved in my life.” -jo schneier, co-founder & ceo of cognotion

God, my school day has just increased by an hour. How did they do that? They found the right technology to reach those kids. They brought together a tremendous group of creatives with learning experts and were able to craft something that’s kind of magical, such that the kids that sit and watch Sesame Street will have better outcomes in terms of their literacy than if you send the kids to Head Start. And that’s phenomenal. So for me when I look at Cognotion, it’s not that I’m moving away from something personal but that I’m actually able to give people a personal experience on a large scale. How do you bring that "magic" to Cognotion's training?

The creative team that I’ve assembled, most of them work in the TV and movie industry. They film all of the big shows, a lot of the actors act in a lot of the big shows. These are

people who are used to creating material that is engaging because that is the nature of the business. And so they’ll take our educational content that’s the case studies and then they’ll rewrite it into what looks like Gray’s Anatomy or House. Cognotion's next great challenge?

The biggest challenge is that the healthcare industry moves pretty slow. Even if an employer knows that this is going to benefit them, this process still takes a long time. We’ve been really focused on facilities and growing into that space. And we’ve only just started to touch on the home market. The future of healthcare is going to be in the home, especially for the aging population, they don’t want to go into facilities. They want to be able to age in place.

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health transformers

05 Doctor.com

This Startup is Taking the Pain Out of Online Physician Reviews CONTACT INFORMATION WAS JUST THE BEGINNING Doctor.com's objective is elegantly simple: make sure every doctor has accurate contact information online. That harder-thanit-sounds mission then became the launchpad for a broader service that helps physicians manage their online reputations. Fifty percent of healthcare providers in the United States have no reviews online, and the remaining providers have so few as to be statistically irrelevant. In contrast, the vast majority of patients are using online reviews to make decisions. So Doctor.com went beyond the standard patient review models and created their own Chromebook-based "review hubs" in doctor's offices around the country. That has resulted in exponentially more patient reviews. And more data means more signal, less noise. And that feedback means better healthcare for all. In the last 12 months the business has tripled, with hundreds of hospitals on board and over 35,000 providers utilizing the platform.

Dossier doctor.com HQ: New York City @doctor Est: 2012 Total Funding: $5 Million

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SPOTLIGHT Reed Mollins, Co-founder of Doctor.com

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Why is it so important in healthcare to provide accurate contact information for doctors?

Nobody’s ever going to want to go to the doctor. It’s not consumerism in the same way a restaurant is. So we need to remove every single hurdle and every single barrier because people already don’t want to do it. Knowing who works where and what they do is a Moonshot. The government spends millions of dollars a year trying to do it and is only 50 percent accurate. The worst example, in my view, is when someone is seeking mental health services. On average they make 30 phone calls before they find a doctor who doesn’t have a full schedule and is accepting new patients. If it was being done on purpose it would be cruel; it would inhumane. We’re doing this because the data is shitty. It’s a seemingly humble mission that is the first important step to real change. What inspired you to tackle these problems?

It’s the kind of thing where I didn’t wake up one day and say, “I’m going to solve the physician data challenge.” My co-founder – my best friend since we were kids – he and I had always wanted to work together on a project, and he gained access

StartUp Health Magazine

In the News On December 13, Doctor.com completed a merger with Connect Healthcare, a leading provider of data management and reputation improvement solutions for hospitals and large health systems.

through our third co-founder to the domain Doctor.com. I was working in textiles, in sales analytics. He was a web-developer, web-designer type. And said: Okay, cool, we got this domain. This is better than a photosharing app. Let’s try to do this. And we backed our way into how we could make money. When you’re backing your way into how to make money, what you’re really doing is looking for problems that you think are solvable, at least on the scale to get you your first dollar. When we saw this problem, we said, “Wow, not only can we solve this on a small scale for each individual, but we can go individual by individual and eventually we’ll just solve the thing altogether.” It became evident that it was a problem worth solving by just doing the work. Sure, there are some missions which on their own are inspiring but not every mission feels inspiring on day one. You need to make meaning. You need to find ways to make what you’re doing meaningful to yourself and to others. And that has really been an important part of this for me because I’m a mission-driven guy. The good news is if you start from the monetization, you’re going to find problems to solve. We’ve chosen what I think is a big, exciting, worthwhile mission. And we’re trying to do it in the best, whitest-hat way ever. How is your initiative to install review hubs in private practices going so far and what is planned for the coming year?

We are now the largest purchaser of Chromebooks in the healthcare space. We have thousands of these out in the world and they’re collecting tens of thousands of reviews. The verified feedback that we collect is so good that it’s being syndicated to partners who are excited to display it. The patient feedback being


increases the volume of communication, and then that drug-seeking behavior or the person didn’t get their antibiotics or met your office staff on a bad day – that’s going to just become noise in the line. What will Doctor.com do once it has pulled together the best physician data on the web?

Challenge Question How is your site incorporating standardized quality measures for providers, especially the Medicaid Core Set measures? -AO What is the procedure for challenging negative reviews? -ED

written on the review hub is instantly going on Doctor.com and Healthline, as well as on Vitals and Health Grades, YP, DocSpot and Bing. The back half of 2018 is going to be about layering in follow-up appointment booking, the check-in process, the pharmaceutical pickup; and starting to layer in these additional valuable services. The whole thing is Chrome OS-based, running a completely HIPAA-secure kiosk app, so at will we can develop new forms and features and with a push of a button push them out to thousands of devices. is there a potential dark side to a future where healthcare is dominated by patient reviews?

I think in a lot of ways the future is coming whether any of us like

it or not. The consumerization of healthcare is very real and it’s very active. Are there people who are, for example, drug-seeking? They go to their pain management physician and when he won’t give them more opioids they go online and just blast him on Yelp? That is a part of what happens. And there is a darkness to that. But I think that one of the things that doctors are coming to understand is that when patients have a connection with their physician you tend to have better clinical outcomes. And while there is this dark side of patient feedback bias that I think doctors are scared about, one of the reasons why we love the device is that it’s about volume. How many of your patients in total do you think like the care that you give them and do you have a connection with? One of the reasons why the review hub kiosk is so essential is because it

Three years ago now, the Office of Inspector General went in and they tested the National Plan and Provider Enumeration System (NPPES) and the Medicare Provider Enrollment, Chain, and Ownership System (PECOS). Neither of them was found to be better than 50 percent accurate. The foundational underlying data is garbage. I feel like there’s going to be a million small changes that are going to be possible when you get there, when you have clean, accurate data around the web for everybody to find. In five years, I do not think there’s going to be a problem with online listings management. When you Google a doctor’s name, you’re going to find accurate information for where they work and what they do. We will solve this problem for the entire industry. That I see as being essential, and we’ve done it because we’ve created a valuable proposition for both the doctor and the hospital. And we’ve done it by tying together all of the places where their patients are actually going.

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health transformers

06 LifeDojo

This Wellness Program Allows Employees to Choose Their Own Path By the Numbers

BUILDING HABITS THAT LAST LifeDojo is a 12-week habitchange program that is disrupting the traditional corporate wellness model by empowering the user to design their own path to wellbeing. Built for desktop, Android, and iOS to provide employees ondemand access to their own evidence-based change program and personal coach, this technology is drastically increasing engagement and measurable long-term results. Thirty-two behaviorchange programs are organized into 4 themes, allowing employees, patients, or consumers to choose their direction, the method used to achieve their goal, which apps to use as tools, how often to engage, and which personal coach will guide them. Mastering stress, mental resilience, healthy eating, and fitness programs are included in the customized plan for change. LifeDojo is demonstrating 4.4x ROI by reducing costs, improving productivity, and leading 45% of employees to meaningful behavior change that lasts 6 months or more.

lifedojo.com HQ: San Francisco @lifedojo Est: 2013 Total Funding: $7 Million Issue 1

SPOTLIGHT Chris Cutter, Founder & CEO of LifeDojo

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What’s the heartbeat of LifeDojo right now?

This year was about going global. We’re in 13 countries. Our global distribution partners or sales partners operate in 80 countries. Within the U.S. we’ve been able to show that we can get the trifecta in population health: high enrollment, sustained engagements and long-term behavior change. Getting to the point where our program works on desktop, tablet, and mobile allows us to reach more people in more places. What makes your approcah to behavior change unique?

Dossier

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My background is in public health. I’ve worked in the chaos of population health, and I think there is a fundamental misunderstanding coming out of the medical community about how you do behavior

StartUp Health Magazine

74% of employees complete all 12 weeks of their program --156 institutions have implemented LifeDojo programs to improve the physical and mental health of their populations. --Enterprise Clients Include Goodyear Rogers Communications Komoto Healthcare

change for the majority of people. Other tech companies are trying to put behavior change in a pill. They’re trying to create a program where if you take these 40 steps in this order and you change these specific behaviors, then we’re going to be able to change you. The problem with that is it only appeals to the one or two percent of people that are already motivated and it really turns off people that are ambivalent about change. But because it’s so appealing to the medical community, this notion that you can have a predictable 50-step pattern for anyone to change, they keep funding it. I’ve worked in low-income communities where over 50 percent of the population is obese. The moment you say to them, “Well, what do you think is going to work?” they come up with stuff you never would have thought. And then you say: I’m here to help and to support you in whatever you think the pathway is. So it’s basically empowerment versus paternalism. Our solution says, “What topic have you always wanted to change? Have you always wanted to reduce your stress levels? Have you always wanted to eat healthier? Have you always wanted to be more mentally resilient?” So they pick a theme. Let’s say they choose stress: They’re presented with the eight evidencebased ways to reduce stress. There’s only about eight that are evidencebased. Then it asks, “How many days a week do you think you can fit that in?” They choose from five different coaches. The coaches are trained in person-centered coaching, which is 90 percent questions, ten percent statements. Very different than traditional coaching, which is 90 percent statements and advice and ten percent questions.


You’re a unique example of someone coming out of the social work world and into the tech startup world. How did that uniquely position you for the work that you’re doing?

Coming from public health and social work, particularly in high-risk communities where we were on the ground going into public housing in dangerous neighborhoods in New York, you get past all of the theory and you get to the raw reality of people's lives. You get into the nuances. When somebody walking down the street that works in a health-tech company sees somebody really overweight, their first thought is, “If they only took a program, or if they only worked harder or were more disciplined it would fix them.” When I see that person walking down the street in those communities, I think of the thin walls in their room that disallows them from sleeping. I think of the fact that their mother, grandmother, sister and brother eat deep fried food three times a day. I think of how cheap hamburgers are. I think of all that stuff that makes it pretty much impossible for that person to not be overweight. That’s a very different way of thinking about behavior change. There is no pill or program I can give them. They have to be guided through the process of asking, “How do I change these environmental things?” How do those insights transition to more privileged communities?

We just did a co-presentation with one of our customers at the Silicon Valley Employers’ Forum. The talk was about the mental health rate, the depression and anxiety rate, and the burnout rate. Silicon Valley is at the same rate as some of the worst communities in the U.S. That’s why people are burning out. They’re getting paid more but it doesn’t matter because they’re lonely and depressed.

I’ve always been driven by this frustration and impatience. Are we really this far behind where we could be? We could be so much further along as a society if we just gave everybody a better chance."

It’s a dog-eat-dog world and they’re expected to work 70 hours a week and they have no resilience tools. I know a lot of social workers and people in public health who want to do good, but not many of them end up starting health-tech companies. So what was it in your experience or in your DNA that made you this individual?

Fundamental to my own world view and my convictions around what drives me, why I worked in really dangerous communities with gangs, is tied to a very deep-seated passion that every single person should have the surroundings and the environment to maximize who they are. I’ve always been driven by this frustration and impatience. Are we really this far behind where we could be? We could be so much further along as a society if we just gave everybody a better chance. So much of it comes down to mental and physical health.

What would healthcare look like in 10 or 15 years if there was really strong adoption of this program? What do you hope to see?

The vision is to give every single person this platform and a personal coach. Seventy-three percent of Americans create New Year’s resolutions every year, so it’s a natural drive of people to want to change. If you give them this tool where they can choose anything, that is going to significantly improve the physical and mental health of the entire population. Once we prove that out, the economics of preventive health have been solved. No longer do you wait until someone’s sick to serve them as a healthcare organization. You are incentivized in trying to get outcomebased care, value-based care going. We can find a way to do it economically and yet get the same outcomes. We’ve Uberified coaching. We’ve significantly reduced the cost of this to the point where a healthcare organization like Kaiser could give this to every single person in their membership and it would financially make sense. So the Moonshot is that there is an opportunity for the faulty software of human beings to finally get fixed, but we have to reach everybody. So it’s really about scaling this to become the universal behavior change app and that’s why we’re called LifeDojo. In a Dojo in martial arts it takes about eight years to get your black belt in karate or jujitsu. It takes a lot of focus and discipline, and you do one thing at a time. Our platform’s the same way. The vision is a 12-week, universally applicable behavior change model. No matter what habit you choose, this system and approach – with your choice and input – gets you to behavior change.

Challenge Question What peer-reviewed evidence do you have that shows how Life Dojo is different from all the other employee wellness solutions? -AO What outcomes data do you have so far? -ED

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Reimagining the Future of Health A family of forward-thinking companies focused on helping people and communities achieve better health. We are at the forefront of the transformation of health care, embracing emerging technologies and collaborating with startups and major industry leaders to advance innovations to market.

Insurance | Health Care Delivery | Consumerism | Government 34 Issue 1 StartUp Health Magazine www.guidewell.com


health transformers

07 Maxwell Health

This Fast-Growing Startup is Giving Health Insurance the Full Digital Make-Over A HEALTH INSURANCE PLATFORM TO RULE THEM ALL Maxwell Health is revolutionizing benefits management for employers and families with tools to streamline administration and a mobile app that makes choosing and using benefits a breeze for individuals. The platform, a subscription service accessed through benefits advisors and insurance or retirement companies that license the technology, combines management, enrollment, and benefits usage into one streamlined experience. Maxwell Health has partnered with enterprise players such as Transamerica, Metlife, Guardian, Unum, and Sunlife Financial, creating a marketplace which makes navigating the maze of offerings and options more intuitive. Founded in 2012 by brothers Veer and Vinay Gidwaney with a vision to help families achieve health and financial security, the company seeks to disrupt the insurance industry the same way digital platforms transformed the way we travel.

Dossier maxwellhealth.com @maxwellhealth Est: 2012 HQ: Boston Total Funding: $56.9 Million

SPOTLIGHT Vinay Gidwaney, Co-founder and Chief Product Officer at Maxwell Health

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Why did you decide to get into healthcare benefits?

Most people think it’s a necessary evil but we look at it as an amazing opportunity to change people’s behavior. There’s a lot of forms to sign, confusing terminology, and not a lot of technology, especially for small businesses. But the main reason that we got into this business is not just to solve those administrative problems. It’s because there’s a sacred conversation that’s happening every year at a kitchen table where families are coming together to make decisions around benefits. Both the benefits that their employer helps to fund and also things that they can get on the market themselves. That is an incredibly important conversation because it drives a lot of health and financial outcomes. Ultimately our vision is to use the benefits conversation as a way to deliver health and financial security for every American family, not by just making insurance understandable, but by completely reinventing the workflow. How are you applying tech to health insurance in a new way?

We’re making sure that everything is digitized, everything is connected to the insurance companies. We're us-

Market Metrics

In ongoing research out of Carnegie Mellon it was found that 71 percent of people surveyed couldn’t define the basic cost-sharing features of a healthcare plan, including terms like “deductible,” “copay,” “coinsurance,” and “out-ofpocket max." --Source: NBER.org

ing technology to make the process easier and deliver a better experience. We’re moving towards a subscription, outcome-based economy. You don’t buy music anymore, you subscribe to entertainment. We want to deliver a subscription service that gets you peace of mind if something goes wrong, and also tools, services, and technologies to help you and your family stay healthy. We think benefits is a great opportunity to deliver that. Benefits technology has been stuck in the Stone Ages. We have not seen as much growth in that area, for a good reason – it’s incredibly complicated. There’s over three trillion different ways you can configure benefits on our product. Technology has finally made it possible for us to build a scalable software in this space. 35


What personal experiences have informed how you’ve led Maxwell Health?

There’s a world view that drives what we do here. We believe that there are parts of our society and our economy that are just too complicated and too difficult for people to be successful in. It’s the job of technology to push those complexities below the surface and deliver something that’s an amazing experience. Technology is making life more simple, giving us the time to pursue our own goals and potential, pushing away unnecessary complexities. In the world of healthcare and financial security, the complexity in the business has disabled people’s ability to act. We have made it too hard to be healthy, too hard to be financially secure and too easy to just sit back and not do anything about those things. That’s what drives our passion around building a great consumer experience that’s affordable and easy to get to. There’s definitely some personal motivations behind this. My brother Veeer and I are co-founders of this company and we’ve always worked together. Back in 2000 we started our first software company. I had finished high school, didn’t go to university, and he dropped out to join me. Our first funder was our father. He passed away over a weekend of a sudden heart attack and that taught us a few things. We went into entrepreneurship as children really, with this assumption that if it doesn’t work out, we can always go home. For that security net to be gone over a weekend was humbling and it has framed how we approach life. I worked in a neuroscience lab at MIT for a few years on treatments for people with epilepsy and Parkinson’s. You start to realize the power of technology but also how inaccessible it is because of the economics behind it and the system that tries to deliver it. We’ve got a lot of first36

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hand knowledge of the challenges, whether it’s deeply rooted in our psyche like our father’s passing, or more tangible and experiential, like working in biotech. Is there’s something about the DNA of Maxwell Health that’s unique because it’s led by two brothers?

At a tactical level there’s a lot of efficiency that comes from working with your brother. We know each other very well, we know our strengths and weaknesses, we complement each other. I have friends who start companies and struggle with finding the right co-founder, or having a co-founder, and I don’t envy that. I’ve always had my brother on my side and there’s ultimate trust in our relationship. One thing it brings to the atmosphere is a family environment. We think about treating each other with kindness and respect. The values our parents raised us with – we try to make sure that our colleagues have the same values. From a family business point of view, values are incredibly important to how we think about our team and our growth. How do you maintain that family environment and that entrepreneurial spirit as you break certain barriers in terms of company size?

The first tenet that drives us is transparency. I spend a lot of my time thinking about the product direction, thinking deeply about what our customers want. Everything that I do from a brainstorming point of view is in one document, public to the company – one massive Google slide that anybody can go into and look at my latest thinking on something. The hardest thing that we can do is getting everybody on the same page. I’d rather do things transparently to bring people along on the ride, to seek their feedback and counsel as we make decisions.

StartUp Health Magazine

With about 140 employees, this all comes down to individual relationships. I like to remind people that we’re not in the technology business; we’re in the people business. We’re about people working together with other people, whether it’s within the company or outside the company. Whether it’s a customer or a partner, we have to figure out how to work effectively together. That’s what defines our success. Despite all the processes that you build, all the technology that you use to work more effectively as a company grows, if you’re not good at working with each other as people, it’s all going to fall down. If your dream is realized, what will healthcare look like for your children in a job ten years from now?

Every American family should have the opportunity to subscribe to better health and financial security. I should be able to say for my $500 a month: keep me healthy. Give me the security net that I need to be successful in my life. Give me the time and the freedom to pursue my own goals. When our children are growing up and entering the workforce, it should be abundantly clear and easily understood that if you choose to eat healthy, take care of your body, take care of your friends, and live a moral and ethical life, the world is going to be designed around rewarding you for that. I don’t mean putting cash in your pocket, but making sure that you have the time and the energy to pursue your passions and be happy.

Challenge Question How will elimination of the individual mandate affect Maxwell Health? -AO What sort of outcomes data do you have from your initial customers? Often benefits are sold as benefits, but over time employers will want evidence of cost savings. -ED


health transformers

08 Babyscripts

An App to Eliminate Preterm Labor by 2027 SPECIAL DELIVERY Babyscripts, founded by onetime consultants Anish Sebastian and Juan Pablo Segura, seeks to ensure healthy babies and moms by improving prenatal care. It does so through an app that functions as a user’s manual, health monitor, and early-warning system. The platform answers pertinent questions – How much coffee can I drink? What floor is labor and delivery at my physician’s hospital? What are the implications of my risk for gestational diabetes? – and connects to devices the company provides, which currently are a Bluetooth-enabled blood pressure cuff and scale. The app makes the gathered data accessible to physicians, so they can observe progress, and prompts the mother with follow-up questions if her vitals are out of the norm. If they are, an alert is sent to the provider, who can then decide next steps. An app for mothers is an unlikely project for two millennial bachelors who were newbies to the healthcare field. The duo, who met while working as consultants at Deloitte, built their company on a data obsession combined with a pragmatic altruism: Babyscripts’ long-term goal is to eliminate pre-term births by 2027.

Dossier getbabyscripts.com @Babyscripts Est: 2013 HQ: Washington D.C. Total Funding: $9.8 Million

By the Numbers -----------SPOTLIGHT Anish Sebastian, CEO and CoFounder of Babyscripts

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What’s the value proposition for Babyscripts?

We look at the maternal journey in healthcare as fraught with all kinds of issues. In that sense, our focus and value proposition is pretty simple. We want to deliver prenatal care and pregnancy care in the best, most efficient way possible. And that involves heavily leveraging technology, whether it’s Internet of things devices, mobile technologies, big data – the various terms people use to describe our tools. From a product standpoint, that’s now translated to the enterprise platform that delivers a lot of digital, virtual, tele-enabled care, remote monitoring, risk-specific modules. Tell me about the process and tools your platform uses to collect data.

The devices we provide are based on the underlying risk of the patient and they’re all connected. Most pa-

2000+ pregnancies remotely monitored --15 healthcare system partners, with access to 100,000 pregnancies

tients will get a blood pressure cuff; some will get a scale. In the future, others will get a glucometer. We’re continually expanding the base of products that we can include and focusing on collecting important bits of data from the patient’s home. Everything in the kit is a commodity device. It’s a blood pressure cuff with a Bluetooth chip in it. That was a strategic choice. We ended up staying away from novel devices because, just getting the remote monitoring with non-novel devices was going to be quite the challenge as it is. A novel device – for instance, some kind of intrauterine monitoring tool – isn’t part of standard of care today. If you were to bring that in, it would compound the problem—not to say we don’t think there is some value in that data. We started off with our focus on, “How can we take the standard of care that already exists today and make that that much more reliable and easy to access?” One of your selling points is that you can lower the cost to the OB with fewer visits. How do you decrease visits while still maintaining high-touch medicine?

Our approach is not about having the patient come in less often; it’s about taking a risk-based approach to care. Most clinicians would probably agree that for low-risk, very uncomplicated cases, it makes sense in the second trimester and early part of the third trimester to space out appointments while continuing to collect key data points from the patient’s home. That was our thesis in building the platform. While we initially started off with what we now call the “schedule optimization module,” which is focused on having patients come in less often, we recently deployed another module called the “care navigation module,” where the goal is to have them come 37


...She ended up delivering the baby earlier. She told us: “Babyscripts saved my life and my baby’s life.” From a founder’s standpoint, her story was one of those moments that makes it all worth it." in more often. This is typically for Medicaid patients with some level of socioeconomic risk, where they generally would only come in about two to five times for care. The goal is to get them to come in more frequently. When did you have the idea to focus on pregnancy?

As two bachelors, Juan Pablo and I weren’t thinking about pregnancy care as a starting point. There are much larger markets like diabetes or heart disease that we thought would be much more lucrative, but they didn’t produce the results we were looking for. When we were talking to Dr. Nancy Gaba, Chair of the Ob-Gyn department at George Washington University, she started explaining to us, “My patients are young. They’re between the ages of 18 and 35. Pregnancy is a ninemonth condition. It’s defined. These patients have a natural acclimation to change and behavior modification. And by the way, from a reimbursement standpoint, it’s all capitated.” My response was, “Okay, wow, I just got schooled. Let’s go.” She set up an ob-gyn team of incredible champions who we worked with, and that 38

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collaboration led to the first product. As a data person, I always say that the data never lies. When we looked at our actual compliance and engagement with this first sample of patients, it was through the roof. At that point we started to focus on what questions within pregnancy and prenatal care we could go after. We could have gone after making pregnancy more convenient and angles like that. But we wanted to go after something that I could wake up in the morning saying: “Alright, that’s the fight.” For us it’s all about reducing pre-term birth. That is the most profound impact you can make around a pregnancy. You’ve been an outsider in multiple ways. As a man entering the pregnancy world, and coming into healthcare from consulting. Hasn’t that been an obstacle?

I’m a total outsider. But my advantage coming in was that I was always obsessed with data. I was a data geek. Even back in my consulting days I was hacking things left and right. I was finding the best way to track additional steps about myself. And this was before the Fitbit IPO happened or before these things became main-

StartUp Health Magazine

stream. From there, I started to pursue this strong line of questioning and discovery that began with the notion of: If all this data can be collected from the consumer’s home or wherever they are, can this be valuable in the larger view of healthcare? Why is it so important to have a long-term vision in health innovation?

Healthcare's long sales cycle impacts product strategy. It impacts fundraising strategy. It impacts growth strategy. In healthcare people talk about unicorns, but I don’t see something like that ever happening in this field. If it takes me ten months to sell into a customer and then two years to fully install, I’m three years into it and I might have five customers. Which is a major accomplishment – and by that time, you have a team of 20 or 50 people. In terms of understanding what will make pregnancy better for a woman, did you have any “Aha” moments?

We have a whole process in place for when something’s out of the ordinary. One of our moms had an elevated blood pressure, so the platform took off at that point and asked the patient to take it again, asked symptomatic questions. And it turned out that that mom was extremely sick and she was rushed to labor and delivery because the clinic was notified. She ended up delivering the baby earlier. She told us: “Babyscripts saved my life and my baby’s life.” From a founder’s standpoint, her story was one of those moments that makes it all worth it.

Challenge Question What has been your progress to date in getting Medicaid to reimburse your solution? -AO Given that your two founders won’t ever be pregnant, I’d be especially interested to know who else is on your team and on your board. -ED


WHAT'S YOUR HEALTH MOONSHOT? Google is honored to be a Lead Innovation Partner of the StartUp Health Festival. Together we can make the impossible possible.

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ALL EARS. When it comes to our clients and their business issues, we listen. When practical solutions are needed for complicated problems that extend around the world, we listen. We are a law firm that leads with our ears. We hear your concerns. We understand your business. Then we act.

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CHANGING THE FUTURE STARTS WITH A MOONSHOT MINDSET

Jerry Levin: Who are you and why are you here?

Esther Dyson's lessons for health entrepreneurs

StartUp Health Portfolio M&A Activity

42 51

Joe Biden's new book offers a guide for moonshot thinking.

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Dr. Jessica Mega on Google-powered health innovation

Bob Kocher & Brian Roberts: 2018 market predictions

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StartUp Health Company Index

48 56

59 41


Moonshot Mindsets

Who are you & Why are you here? Jerry Levin, the former CEO of Time Warner turned Executive Chairman of StartUp Health, has something to say to CEOs: Knowing yourself and telling your story – even the hard parts – is the secret to building a company that can change the world. Interview by Logan Plaster

Startup Health talks a lot about having a ‘Moonshot Mindset.’ How would you describe that mindset?

The aspiration here is to go to the ultimate point of health, wellness, happiness for everybody in the world. It’s not geographically local. It’s not taking one step and saying that that disruption is sufficient. What’s the ultimate objective? For people to be disease free, emotionally free and have access to care without any cost. And we're not just talking about one particular community, but all people. It’s not traditional entrepreneurship. It’s magnificent transformation through what seem like impossible goals. But that’s the whole idea – the impossible dream. There’s nothing else quite like it because it’s also assembling a community, an army of transformers as we’re describing them, who have the same purpose, the same mindset and they want to come together on a permanent basis. It’s not a quick fix, looking for a quick exit. Nowhere in that explanation did you talk about return on investment.

Of course it’s about financing and return too, but in the context of blowing up the system, not merely changing it. And it’s long-term thinking, not a couple of years but 20 years, however 42

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StartUp Health Magazine

long it takes to get to this ultimate position where everybody has the comfort of being healthy so they can enjoy their lives. And when we say everyone, that’s the Moonshot aspect – everyone on the planet. StartUp Health has identified 10 Health Moonshots, like the Cancer Moonshot and the Children's Health Moonshot. Is there one of these missions that particularly inspires your work?

The first is providing access to healthcare for everybody on the planet at no cost. Every woman, man and child is entitled to live a life that’s free of all the things that hamper our ability to have self-realization. The idea that we might accomplish this at no cost seems almost impossible. And yet we look at what’s happened with smartphones and the availability of zerocost opportunities – information, entertainment – it’s happened like a thunderclap. There’s no reason why it can’t be tooled to do the same thing for health and wellness. How would you put these moonshot initiatives into historical perspective, as someone who listened as President Kennedy staked his claim on traveling to the moon in 1962?

Traveling to the moon had been in sci-


“ Recognize that a meeting

isn’t just about a protocol. There’s an emotional backdrop. ence fiction. It had been that craving that seemed outside of all possibility. And yet JFK put it in inspirational terms. And once you do that, all the resources are highly directed towards that goal. As a result, the excitement at the end of that decade with the transmission of someone actually stepping out of a manmade vehicle and walking on the moon for the first time had a catalytic effect which is hard to dramatize. I was in Manhattan in 1969, getting ready to launch HBO. I sat in front of a television set with a lot of family and friends. Watching the moon landing, it was as though we had transcended a dream. And that’s why words are important. Kennedy made his clarion call and then we fulfilled the word in ways that seemed impossible. The galvanizing effect of that is enormous. That process of setting a goal that seems impossible but had been part of the human aspiration is very similar to what we’re talking about at StartUp Health. It seems impossible. Health, happiness, wellbeing – they seem too fundamental. But we’ve seen men walk on the moon. I recall the large computers of IBM and now that same processing power is around my wrist. That too would have seemed impossible at the time.

How do you help young entrepreneaurs – who didn’t witness that shattering of the impossible with the first moonshot – embrace impossible dreams like bringing health and wellness to every human being?

It comes down to stories. There’s a story behind everybody’s change and aspirations. The story of StartUp Health is really the personal stories of entrepreneurs’ lives. It forms them, it unlocks their value system. It unlocks their passion and gives them a mindset that’s not just giving lip service. It’s the power of those individual stories that informs their self-realization and what they want to accomplish. And so they come together with others who have not the same story but similar background stories. Most of my adult life was in the storytelling business through the media, journalism, movies, television and music. And now I see the reality of the stories of people’s lives. If you can provide an environment where they can manifest a solution to the stories that drove them in the first place, that’s the highest form of coming together to make change.

A focus on storytelling can sound more like group therapy than business development. How does that shake out in practice as each company actually seeks to grow and expand in the market?

Usually the stories that people have, which actually form their identity, remain unexpressed. Business is not typically a safe place for exposing my story and sharing why I’m motivated in a certain direction. Usually in business there’s one objective – disrupt and make money. In our case, it’s all about self-realization. You as an individual can accomplish more if you know the source of your inspiration. The only way you bring wellness to others, including developing the technology, is if you understand yourself and have a life that’s open, authentic and purposeful. Then you can not only have a business plan that helps others but you can run a business that goes beyond the bio to making fundamental connections. Understanding your story isn’t therapy. It’s the way a business ought to be organized to serve the public interest as well as to give a return. If you have that dual mindset, and the team that you’re working with has that mindset, and the money that came in to drive it has that mindset – that’s a uniform 43


Moonshot Mindsets capacity that I don’t think exists in too many places.

Startup Health talks about building an army of health transformers, about breaking down walls between disciplines. Why is it so important to create a broad-based collaboration? How do we get there?

You’ve talked about the importance of introducing transparent storytelling into business in order to better understand and direct the company’s motivations. What does that look like in a cold, corporate world?

It’s all a question of being open. It can even come out in the structure of a meeting or a video conference. You can jump right in to the agenda and the cash flow reports and the business plan. Or, you could start the meeting with, “Let’s hear what’s going on for you today and how can we help?” Recognize that a meeting isn’t just about a protocol. There’s an emotional backdrop. If that can be addressed in a way where people are joining together – that’s just a healthy way to live. Most people draw a line between their business life and their personal life and that shouldn’t exist. It’s all one authenticity. Of course you can get to the six-month financials and all the things that make your organization work. It’s all in how you approach it. Your message of self-realization might sound like a departure from your days as CEO of Time Warner. Walk us through that transformation.

Well, my story gets very personal. It is tragic for me, but it helps people, including CEOs, to understand that life has twists and turns and you have to be emotionally and philosophically integrated. I lost a son who was very close to me. We had the same birthday and loved all the same things. He taught in the roughest school in the Bronx and I was very proud of him, took him to all our events. One day he was murdered by one of his students looking for drug money. The fact is that I was ill-prepared for this trauma and I made the enormous mistake of going back into business. I should have left at that time. What happened was that I put a steel trap over my emotions. Nothing could get to me. It was after 9/11 that those feelings were rekindled and I couldn’t 44

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take business anymore. I’ve given more than a few talks to groups of CEOs and the message is obvious: Make sure you know what’s important. Don’t have a division between your personal life and your business life. Make each day count. I didn’t share my story for the longest time. But opening myself up to these emotions and sharing my story has helped others to open up. Do you find any irony or conflict in the idea that you’re talking about the importance of future wellness being so tied to our internal wellbeing and yet the thrust of medical tech innovation is to find a technological solution to health problems?

Sometimes you get consumed by the technology, but I don’t see a conflict. The question is: Why are we adapting algorithms and data? It’s to provide healthy living – that’s the objective. The story behind the “why” becomes very important. The two concepts actually go hand in hand. If a tech company is self-realized and in a mindset community, the team is going to operate much more successfully, just like an individual operates better if they understand who they are. If you look at the stories and the solutions across the portfolio in StartUp Health, you’ll see the use of technology to solve a problem, but the underlying motivation and the reason for it and where it’s going, what track it’s on, that’s the difference.

A lot of thought and care was given to using the word “army.” I come from a highly competitive business world, and today’s tech world is no different. There’s legal protection for what I own and I don’t share a lot of secrets. What if you reverse the mindset and say: Sure, you’re coming up with a business plan that might overlap with somebody else’s business plan. If you’re on the same global track and have the same universal aspiration, then you’re going to look at the exchange of information and you’re not going to hold back just so you can gain leverage over someone else. We have to change the operating premise. Yes, there are going to be overlaps and different ways of approaching some of the same objectives. It’s okay to share because you have a mindset of coming together for a common goal. The reason why "army" fits, although it sounds harsh, is that it’s serving a distinctive, understood purpose, with tremendous collaboration. It’s a life and death collaboration. And I have a relationship with my team that goes beyond having each other's backs. We’re brothers and sisters in achieving a goal. That’s a very powerful organizing premise. What does the future of healthcare look like in your crystal ball?

Healthcare currently has a disease model. When somebody appears in a hospital setting, it’s to cure a disease. I’ve got this notion that the hospital of the future will involve a comfortable environment for people to disclose who they are, what their story is, what their life has been like. If you start with that, then you’re not just treating the person, you’re enhancing who they are. So much of enhancing wellness really comes down to understanding the person. If the person feels seen, heard and understood, then they’re open to whatever comes next.


Moonshot Mindsets

PROMISES WORTH KEEPING

In Joe Biden's latest book, Promise Me, Dad, the former Vice President shares his personal story of overcoming the loss of his oldest son Beau to cancer. Mr. Biden's honest and raw story, excerpted here, is an important reminder of why Health Moonshots matter and an inspirational lesson about the power of purpose and never giving up hope in the face of adversity. 45


PROMISES WORTH KEEPING

The days were getting shorter, so the light in the sky had started to fall away when the gate to our temporary home swung open and our motorcade edged beyond the fencing that surrounded the United States Naval Observatory in Washington, D.C. We were riding from our official residence at the observatory to Andrews Air Force Base, where my children and grandchildren were already gathering. Jill and I were anxious to be with them for our annual Thanksgiving trip. Family had been an essential escape in the five-and-a-half years I had been vice president; being with them was like flying in the eye of a storm—a reminder of the natural ease and rhythms of our previous life, and of the calm to come when my time in office was done. The job had been an incredible adventure, but there were so many things Jill and I missed from life before the vice presidency. We missed our home in Wilmington. We missed the chance to be alone in a car on a long drive where we could talk with abandon. We missed having command over our own schedule and our own movements. Vacations, holidays, and celebrations with family had become the respites that restored some sense of equilibrium. And the rest of our family seemed to need these breaks as much as Jill and I did. We had all been together just a few months earlier for our annual summer trip to one of the national parks. But five days of hiking, whitewater rafting, and long, loud dinners in the Tetons had apparently not been enough for the grown-ups. Jill and I were in our cabin packing for departure the last day when there was a knock on the door. It was our son Hunter. He knew Jill and I were going alone to the 46

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beach for a four-day retreat. But he wondered if maybe, because he and his wife had some free time, they might tag along. We said, Of course! Within a few minutes our other son, Beau, knocked. His in-laws had agreed to watch the children. Maybe we wouldn’t mind it if he and his wife joined us at the beach on Long Island. We said, Of course! I suspect there are parents who might feel put upon when asked to give up their alone time. I regarded these requests as the fruits of a life well lived: our grown children actually wanted to be with us. So we had had another wonderful four days at the beach together in August, but by November there was also a perceptible urgency to this need for togetherness that was a bit disquieting. And I was very mindful of it when Jill and I set out for our yearly escape to Nantucket, for another Biden Family Thanksgiving. We passed through the gates of the observatory, and I felt our government-required armored limousine make its customary gentle pivot onto Massachusetts Avenue, where local traffic had been halted to clear the path for our journey. I glanced at the squat, standing digital clock at the top of the driveway, as I had maybe a thousand times since we had moved into the official residence. Red numbers glowed, ticking away in metronomic perfection: 5:11:42, 5:11:43, 5:11:44, 5:11:45. This was the nation’s Precise Time, which was generated less than a hundred yards away, by the U.S. Naval Observatory Master Clock. Precise Time—synchronized to the millisecond—had been deemed an operational imperative by the Department of Defense, which had troops and bases in locations around the globe. 5:11:50, 5:11:51, 5:11:52. Our limousine was already accelerating out of the turn, with an abrupt force that pushed me back into the soft leather seats. The clock was behind us in a flash, out of sight, but still marking the time as it melted away—5:11:58, 5:11:59, 5:12:00. The motorcade arced toward the southeast, down one side of the circle around the observatory, and we could see the lights of the official residence as they flashed through leafless trees. I was happy to say goodbye to the house for a few days. Our departure meant that many of the naval enlisted aides who looked after us were free to spend the entire holiday with their own families.

Excerpt from Promise Me, Dad courtesy of Flatiron Books.


The procession gained speed once we hit the parkway and our motorcycle escorts nudged aside other travelers. The motorcade traced the southern edge of Washington, within sight of the monuments and public buildings: Arlington National Cemetery, the Lincoln Memorial, the Washington Monument—with the White House in the distance beyond it—the Jefferson Memorial, the United States Capitol. I had served in elective office in this city continuously since 1973, thirty-six years as a senator and six as vice president, but I had not grown indifferent to the beauty and import of these towering landmarks, which were now haloed in a glow of soft light. I still viewed those sturdy marble structures as representatives of our ideals, our hopes, and our dreams. My working life in Washington had given me a sense of pride and accomplishment from the day I arrived, and that feeling had not dimmed after almost forty-two years. The truth was, on November 25, 2014, I was as excited and energized by my work as I had been at any time in my career, though my current office was, it must be admitted, a truly odd job. There is a strange and singular elasticity to the responsibilities of a vice president. As a strictly constitutional matter, the holder of the office has very little power. He or she is charged with breaking a tie vote in the Senate—which I had not been called to do in nearly six years—and waiting around to take over if the president is somehow disabled. A previous occupant was famously quoted as saying that the office is “not worth a bucket of warm spit.” (That’s the expurgated version. He did not say “spit.”) The actual power of the office is reflective; it depends almost entirely on the trust and confidence of the president. Barack Obama had handed me big things to run from the beginning of our first term, and once he assigned me to oversee the Recovery Act of 2009, or budget negotiations with Senator Mitch McConnell, or diplomatic relations with Iraq, he did not look over my shoulder. I believe I did my job well enough to earn and keep his trust. He sought my advice as much as ever at the end of 2014, and seemed to value it, which meant there were days when I felt that I had it in my power to help bend the course of history ever so slightly for the better. And somewhere in the motorcade that evening, as we sped through the streets of Wash-

I had not grown indifferent to the beauty and import of these towering landmarks, which were now haloed in a glow of soft light. I still viewed those sturdy marble structures as representatives of our ideals, our hopes, and our dreams.

ington, was a car carrying the vice presidential military aide, who was in possession of the “nuclear football,” which had to be within my reach at all times. I was one of only a handful of people who had control of the codes that could launch a nuclear strike on almost any target on the planet. So a reminder of the grave responsibilities of the office and the trust reposed in me was there, at all times, twenty-four hours a day, seven days a week. But in spite of all that, in spite of position and standing, I was incapable of doing the thing I most wanted to do heading into that holiday week: to slow down that Master Clock at the top of my driveway, to make those red ticking numbers hesitate, to give myself, my family, and, most important, my older son, a little extra breathing room. I wanted the power to cheat time. 47


Moonshot Mindsets

DR. JESSICA MEGA: FEET ON THE EARTH, HEAD IN THE SKY Dr. Jessica Mega, Chief Medical Officer at Verily, has an expansive perspective on health innovation. She helped guide Verily from being a project within Google to standing on its own two feet, and in the process saw how tech giants can help power tomorrow's health transformation. Verily has its hands in a wide range of projects, from smart lenses to raising sterile mosquitoes to precision medicine. In your role as Chief Medical Officer, where are you investing most of your time right now?

The way I summarize my job is to keep my feet on the ground but keep my head in the sky. We’re continually thinking about big bold initiatives while understanding the steps that we need to take to get there. I spend time thinking about what are some areas of healthcare that we can impact today using some of the technologies that a company like Google and Verily has? We know that diabetes is a major health issue. And we know that by measuring glucose and providing more tools to patients, they can live healthier lives. So we have a whole host of solutions and tools trying to address a problem. The same may be said of mosquitoes. Vector-borne illness is a major cause of morbidity and mortality. If we can use some 48

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of the same technologies that are used to scale other infrastructures to scale mosquito rearing we can address a major problem today. We’re trying to create tools that help us think about how to handle the next generation of health information that may look a little bit different than what we’re used to.

the fundamentals that allow us to take new technologies and apply them. And again once the fundamentals are in place, you can start to move much more quickly.

There are so many ways that you could get mired down in the pragmatic side of a business. How do you keep your head in the sky as you say?

This person, like me, is going to be putting out a lot of fires on a day-to-day basis. You need to carve out a period of time to yourself to think, and to let people push you. I have to deliberately look for pockets where I can be absolutely creative. Find and create the space to do the things that are important and big but that you wouldn’t normally have the luxury of doing if you just go from one small fire to the next. One practical way we’ve accomplished this at Verily is to create a few weeks which are called “no meetings” weeks. Those are times where people work on either a really big project, where they have to code for a long period of time, or step back and think about the hard and exciting things that you normally wouldn’t get to in a day. There’s so much of an emphasis on short-term productivity and being busy and getting things out the door; but that may or may not be the best way to be truly transformative. We frame it as questioning convention. Are there more efficient systems? The key is to be excited when you uncover that ques-

You’re right, there are a lot of pieces that you need to get right in the beginning, where you need to think about really basic things. You have put the system in place. We have really exciting partnerships with the FDA around a precertification program. So we’ve got to get that piece right. Once you have that, what I’ve started to see is you can think more broadly about solutions that are out there. I’ll give you an example: We have an interesting problem across the world with blindness and diabetic retinopathy. Well, we know that there’s a lot of people taking pictures of their cats and the dogs and their kids and there’s a lot of infrastructure being built around image recognition. Could we take that same type of skill and apply it to reading images of the eye, so that people won’t need to go blind? The way that I personally try to keep this open mindset is to make sure that we have

Any practical advice for a CEO of a smaller company that really needs to think big picture but is struggling with the day to day?


tion, not be thrown off. I’m a physician and I’m used to doing things in a certain environment, and there’s a software engineer who is used to doing things in an environment. We start to question each other – that could lead to people digging their heels into the. But we try to embrace that as something exciting. You have to interact with folks that challenge your way of thinking, be open to those ideas and run with them. Is there a project right now that you feel like really challenges convention in an exciting way?

There’s one initiative that we’re doing that goes across our entire company. It’s called Project Baseline. We are trying to map health more comprehensively than ever before. If I were to ask someone traditionally what do they think is their health and what is their health record, they may turn to really traditional definitions, like what lives on their electronic health record or what prescriptions they have. But that’s just a fraction of health overall. What makes up health data is going to skyrocket in the future. It may start with sensor data to really understanding how someone may be moving every day. This might lead to insights about what behaviors are people choosing. A big question is: What is the infrastructure that you need to deal with health data in real time? And that is really challenging us on an infrastructure side. So I think this idea of unlocking comprehensive health data and organizing it and then bringing it and making it actionable is pushing all of us. One of our tools is what we call the Study Watch. And a piece of Study Watch shows how people walk and how they move in time and space. I don’t know that that’s going to end up changing care. Let me give you an example: I had a patient and they were walking up the stairs and they walk up the stairs in their house. It takes them about two minutes each day. If all of a sudden it’s taking them three minutes and four minutes and five minutes and they’re favoring one knee or the other, there’s a moment there potentially to get some physical therapy before they would need a knee replacement. And so I think just our different understanding of health is going to continue to grow as we have tools to further understand what it really means to have different biologic conditions. And so I don’t think there’s any one company that’s

– PRO TIPS – 1. Want to really open your mind and think outside the box about challenges? Start by getting the fundamentals down right first, and you’ll open yourself to broader thinking.

2. Surround yourself with people who will challenge your thinking, then get excited about their input rather than digging in your heels.

going to crack all of it. Verily was birthed out of Google Life Sciences. How did that impact your DNA and what do you see as the role of a tech giant compared to a small health startup?

We started off with a handful of people thinking about healthcare. We were imbedded within Google at the time but now have become a separate business unit. I think from an innovator’s perspective, where they have one or two people in their company, what I would be thinking about is leveraging infrastructure that folks are building but really being able to think about what’s the problem they’re uniquely going to solve. Sometimes people can move really quickly in that environment. Leverage the community around you. Figure out what’s the unique question you’re trying to answer. The thing that’s neat – and also frustrating – about healthcare is that there are a lot of issues that can be addressed and there’s plenty to tackle. We are all going to do better as we try to help one another. Do you have a personal motivation behind your desire to fix the healthcare system? What’s your story?

In my early days as a cardiologist, I absolutely loved taking care of patients and I loved bringing new solutions that were always getting better. In cardiology, we’ve made a huge amount of progress in terms of the different medicines we use, the different advice that we give. But the more time you spend, the more you realize there’s going to be different motivators, different features, different ways people metabolize drugs. And the more information we have, the more we can help stratify and really get people the right solutions at the right time. The motivator for me to join a company like Google was that I didn’t see other places where we could start to really harness all those insights. It’s a place where people love

3. Carve out "meeting-freeweeks" to focus on big picture challenges, or simply to finish a large project.

understanding and teasing out information. There’s a lot of talk of big data and deep data, but I have been so blown away by being with Google where it’s a group of folks who really want to get their hands dirty and understand what that all means. Because health data isn’t always straight forward. Here’s what it comes down to. I work in critical care cardiology and I would very frequently meet patients at the moment of an incredibly acute episode. So someone has a heart attack. Their blood pressure is falling. We can’t open their artery. We are doing everything we possibly can to keep them alive in the moment. In so many cases the moment where I could have been most effective would be upstream. If I understood that something was going to be happening I could have been able to intervene or I could have been able to think about a way to change the course. We as a society view health or disease as either there or not there. It’s a very binary thing. But what tools do we need to get ahead of this? Where can we start to make a difference? Is there something that you wish people understood about the work that goes on in Google healthcare community that is maybe misunderstood?

Google is an organization and group of people that understand the complexities of healthcare and life science. And we have brought together now whole teams of scientists, health economists, physicians together with software engineers and device developers. It’s a group that is really excited about healthcare and life science but also understands that that can be a really complicated place. There’s engineering risk and biological risk. So you can create an amazing tool and it may or may not work given the dynamism of biology. In the end, we are really realistic about what this endeavor holds but are also optimistic because there’s so much work that can be accomplished, by us and others. 49


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Moonshot Mindsets

GETTING SCHOOLED BY ESTHER DYSON Esther Dyson sits on the boards of 23andMe, Wellpass and Meetup, which was recently acquired by WeWork for $200 million. Besides that her storied career includes being the founding chairman of ICANN and training to be an astronaut. These days, she's most passionate about Wellville, a ten-year project to produce visible improvements in health and economic vitality among five communities in the United States. But she still finds time to act as a mentor and advisor to StartUp Health. When she is talking about what entrepreneaurs need to make it in today's market, Dyson doesn't mince words. The following are 10 lessons she thinks every health transformer needs to know.

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Moonshot Mindsets

#01

#02

#03

EMBRACE DISSATISFACTION AS A MOTIVATOR TO ACTION

KNOW WHO IS GOING TO SELL YOUR PRODUCT

KNOW HOW YOUR INNOVATION INTERSECTS ACTUAL LIVES

A lot of people talk about cynicism as being a bad thing, as though if you’re cynical you’ve given up. But to me a cynic is a disappointed idealist. If you walk into healthcare startups and you’re just an optimist and you think you’re going to change things because what you’re doing makes so much sense, you’re going to run into trouble. You have to understand the trouble. Fundamentally you have to be disappointed in human stupidity and then still feel that you can figure out how to change it or address it. I guess you could call me a cynic in that I’m not surprised when people don’t take their medicines, people don’t invest in the longterm, people do stupid things. It still drives me crazy, but I know people are going to make bad decisions. On the other hand, what I tell people is that if I were a maid, I’d like a dirty room. What’s the fun of going into a clean room? If you’re good at fixing things, you want something worth fixing. The trick is, how do you maintain this healthy cynicism without losing optimism and activism? The right sort of experience and the right sort of attitude will help you acquire this mindset, but I’m not sure you can teach it. If you expose people to enough reality, they will probably become cynical. But the hope is that those feelings will lead to a motivation to change things, rather than give up. That’s the trick.

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I keep running into people with apps who think: Oh, this app is so great people will just use it. But there are very few things that people just use. Many entrepreneurs miss that everything needs to be sold and supported and installed, even an app. Because if you design the app, you understand how it works and you kind of forget that people who didn’t design the thing are going to be confused. This is where value-added resellers come into the picture. These are people or companies who take a product and resell it on behalf of another company, while also helping them to integrate it with their customers' other applications and tools and data sources. They even train IT people and the ultimate end-users on how to use the product. This reselling comes with a lot of added value. I recently went to a medical conference for family practitioners. At one table I passed there was a pile of 50 photocopied pages. Each page was a spreadsheet about something you should do during the patient encounter. There were 50 different things that various people thought the doctor should do when she talked to the patient. If I’m the doctor, I’ve got 15 minutes max. I have to spend five minutes entering data while I’m trying to talk to the patient. And you’re giving me 50 pages of stuff I need to page through and think about? Give me a break. Anybody who thinks that their product is wonderful needs to understand that they’re going to be page number 51. How are they going to stack up?

If you’ve got some great medical innovation, you probably think you’re competing with other medical devices. But the reality is you’re competing with somebody going out and having a beer, or somebody buying sneakers for their kid. There’s a whole world out there and many people don’t particularly like to think about their health problems. Having a great medical product or being really excited about human potential and curing people who are sick is great, but you still need to understand people’s lives and how what you’re offering fits into them. There’s a great story somebody told me about a guy who comes in to see the doctor about erectile dysfunction. The doctor does the patient interview and it turns out he’s diabetic. So, of course, the doctor says: Well, before we do anything, we need to deal with this diabetes and I’m going to put you on insulin and you need to do this, that and the other. The guy leaves and doesn’t do anything. He comes back and his diabetes has gotten worse. The moral of the story is: The guy came for erectile dysfunction. If you deal with his diabetes, it’s probably going to also deal with his erectile dysfunction, so don’t talk to him about the diabetes. Talk to him about how helping his diabetes will help his erectile dysfunction. Deal with the problem that’s important to the patient. If you deal with other medical problems at the same time, great. You’re not lying to the patient, just looking at things from their point of view: What is their problem and how can you help them solve it?


– BONUS ROUND – 1. Don’t go it alone. It goes back to the old saying: If you want to go fast, go alone. If you want to go far, go together.

#04

GET BROAD EXPOSURE WITHIN YOUR MARKET Talking about companies as if they were all the same is like talking about patients as if they were all the same. Depending on what your product/service is and depending on where you’re coming from, you’ll need exposure to different things you might be missing. One thing that StartUp Health brings to the party is connections to the right hospitals, doctors and patient advocates. I was recently meeting with two women who had been in pharma for 30 years. They knew hospitals and drugs, but now they’ve got a consumer product and need to get buy-in from cardiologists as well. They need to work to learn about the parts of the market that they’ve been missing.

2. Don’t act like your customers are stupid just because they’re not buying what you’re selling. Selling should involve more listening than talking.

3. Working with family is a two-edged sword. It can be very good. These are people you trust. But you can be too loyal to someone who isn't the best person for the job.

#05

#07

DON’T BE CEOOBSESSED

KNOW WHEN TO EXPLORE, AND WHEN TO EXPLOIT

The CEO is usually not the most enjoyable job. It’s a lot of responsibility and it can be boring. It could be much more fun to be the Chief Medical Officer or the Chief Designer, depending on what you want to do. It really is the team that makes the company work. It’s not the CEO and then a bunch of underlings. So many people think they want to be CEO, but why? Be part of the team, where you can do the stuff you really enjoy and there’s a team of people who are complementary to you.

#06

NARROW YOUR FOCUS! It’s so much better to have 80 percent of one market than 30 percent of five different markets. Do one thing well. Get really known and then your return on investment for expanding in that market is much higher than expanding in some new market. Two or three customers in one geographic area, they talk to one another. If you spend so much time on travel, the customers don’t talk, and there’s no synergy, no reinforcement effects. Don’t be all over the place. At some point, you’ll get to where it’s time to expand outside the place where you’re focused. But by then you'll have the resources to do so.

This is one of the great challenges of everything from neuroscience to human development to business. There’s explore versus exploit. It goes back to the issue of focus. You need to explore to find some wonderful people to work with. But then you should work with them instead of networking all the time in order to find somebody better. There’s an algorithm that says: 33 percent of the way through you should stop exploring and start exploiting. But of course, you don’t know where that 100 percent point is. Fundamentally what it means is this: Get the best you can within some time frame, some circle of possibilities, and then get to work making it work. This is the problem with Tinder. Yes, you should date a lot of people until you find somebody that’s good. But then you should marry them and make the marriage work. The quality of a marriage depends on what you do with that person, rather than continually asking if they are indeed the right person. Find a good team that’s got a lot of potential. But then focus on that team, don’t keep interviewing people to try and replace the people you’ve got. Shoot for optimal, not perfection. And then turn them into an effective team by being a good manager and a good leader. The same goes for your marketing. Don’t continually look to replace what you’ve got. Improve what you’ve got, then invest in what you found. Don’t keep looking for something better. This applies to just about everything.

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Moonshot Mindsets

For what is now an annual tradition, we are once again attempting to be healthcare soothsayers. We are proud to share with you our 10 healthcare predictions for 2018. In 2017, amazingly, eight of our predictions came true (read the full story on Forbes.com). For 2018, we are betting on the following:

10 HEALTHCARE PREDICTIONS FOR 2018 BY BOB KOCHER AND BRYAN ROBERTS PARTNERS AT VENROCK

01

02

03

04

05

Another Theranos

Hospital hiring slows

Successful HCIT exits

Amazon does not disrupt PBMs

AI makes a big impact

After a decade of sustained hiring every month, hospitals will stop. Many will downsize their administrative staffs as admissions continue to slowdown and reimbursement pressures intensify. We expect multiple months with net healthcare job losses which would be the first time this has occurred since the Bureau of Labor Statistics started tracking the data.

After a long wait, and more than $10 billion of venture capital invested in startups over the past five years, we will begin to see successful IPO and M&A exits. These will reassure growth investors to keep pouring money into companies with traction.

Despite daily rumors, we think Amazon will not shake up the PBM sector. Instead, Amazon will limit its healthcare market footprint to its existing consumer products and distributing nonregulated healthcare goods to healthcare providers (adopting a B2B and not B2C strategy).

While we don’t think bots are going to replace doctors anytime soon, we are bullish that AI and machine learning are going to go from an R&D project, to meaningfully improving cancer diagnostics, pathology, and image recognition. We think that training data sets and technical capabilities have gotten to the point where new products will be created that begin to make a difference.

We think at least one healthcare information technology company with an enterprise value of more than $1 billion (not including Outcome Health, which we could not have predicted tanking so spectacularly quickly) will be exposed as not having product results to support their hype. It will also expose embarrassed investors who did not do careful diligence and founders with poor integrity.

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Some of these unions will not end well, but one or two will reshape the industry’s assumptions of how healthcare works. Unity Stoakes Read Unity's market predictions on page 13

06

07

08

09

10

The ACA is repaired, finally

Medicare Advantage gains popularity

Payors become acquirers

CRISPR commoditizes

Big Pharma gets bigger

In 2018, a bipartisan effort will pass to improve the functioning of the ACA and we predict that Congress will act to help stabilize marketplaces and premiums. We will move on to focus more on MACRA and bending the cost curve which is beginning to bend in the wrong direction.

We think Medicare Advantage will gain in all dimensions. Seniors will increasingly choose it since it is more affordable, startups and incumbents will make big bets on growth, policy makers will enact favorable policies, and margins for payors and primary care providers will grow.

With the crumbling of the Anthem/ Cigna and Aetna/ Humana mergers, and emergence of Aetna/ CVS, we think that Anthem, Humana, Cigna, and Optum will all aggressively acquire “higher margin - less regulated than insurance” businesses.

CRISPR has been one of the great technical advances in biological and medical research in a long time, and the CAS-9 enzyme that enables it is the source of much IP litigation and conflict. In 2018, it will become obvious that there will be many enzymes that can enable gene editing and the CAS-9 IP limitations will fall away.

We think that after a few years of smaller acquisitions, the megamergers will ramp back up in 2018. We predict that both BMS and Astra Zeneca will get acquired by other big pharmas. We look forward to seeing what happens in 2018 and hoping that we can resist regression to the mean!

Bob Kocher (L) and Bryan Roberts are partners with venture capital firm Venrock.

55


THE INDEX The StartUp Health Portfolio, Organized by Health Moonshot

For an explanation of each Moonshot, see page 12

ACCESS TO CARE

COST TO ZERO

Accel Diagnostics

Multisensor Diagnostics

access.mobile

@Point of Care

Healthbanc

Patientory

Avado*

Healthwide Solutions

Pocket Anatomy

Aver

Hindsait

Prognos

Beyond Lucid Technologies

Inbox Health

RespondWell*

OpenDr

Infinite Arthroscopy

Saturn Care

AlemHealth

PrimalRed

BioClaim

Jaystreet Technologies

SnapDx

AMP

Punctil

Biome Analytics

Kinetxx

Stethos

Care Advisors

Quick'rCare

CakeHealth*

Konnarock

TedCas

Careteam Technologies

Ride Health

Caremerge

ManageUP PRM

Vivor

Chabla

Sense Health*

Cognotion

Maxwell Health

Wellthie

Cloudbreak Health

SimpleVisit

Docola

MDOps

WinguMD

Dermio

Sleep.AI

Docphin*

MedXCom

Zignifica

DirectDerm

SmartRX

EmPower App

Mondopoint

Doctor.com

Tickit Health

Etyon Health

Open Health Network

Force Therapeutics

Valhalla Healthcare

Flosonics Medical

FutureDocs

VoyagerMed

GoGoHealth

Xverity

Goodlife Technology

Yosi

Health-Connections

Zentist

Health123* healthconsult HealthTour HelpAround Medical iCoreConnect Jiseki Health KingFit M&S Biotics MedCloud Medicast* Medisprout Mobidoc MouthWatch

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CURE DISEASE AdhereTech

Fit4D

Skindroid

Althea Health

Gene by Gene

Solius

Arpeggi*

LabLink

Tute Genomics*

Arthro Therapeutics

LS CancerDiag

Veloce Corporation

BreathResearch

Mediktor

Vheda Health

Cohero Health

Nightingale

Zeleo

Conversa Health

Oxitone Medical

Curacase

Play-it Health

Cyclica

PreventScripts

DataGenno

Qura

Dynofit

RxREVU


*Denotes company has been acquired

END CANCER BabyMed Babyscripts Pregistry

WOMEN'S HEALTH

Seed

GenID Solutions

Lindi Skin

OTAWA

Kuveda

MyPeople Health

Savor Health

CHILDREN'S HEALTH Aerobit Health

Buddy Healthcare

Caredox

HEALTH& FITNESS

Pathfinder Health Innovations

BRAIN HEALTH

Basis*

Greatist

NuPlanit*

BrainPaint

Edamam

Gritness*

Palette

Cerora

Life Recovery Systems

FitBliss

LifeDojo

CNS Therapy

RC21X

FitFetti

MetaLogics

Sandstone Diagnostics

Fruit Street

Myontec

HealthTechApps

MENTALHEALTH&HAPPINESS Bravely

Curatio

Eco-Fusion

Promena VR

SageSurfer

Cloud9

E=MC2, no limits...

OpenBeds

PsyInnovations

Valera Health

LONGEVITY

AprilAge

HelloMD

inRecovery

Tome Software

Braceunder

Help-Full

LifeBio

UnaliWear

Care at Hand*

Holiadvice

LymphaTouch

WalkJoy

CareLinx*

Hormone Therapeutics

Room2Care

Zeel

CarePredict

SUPAspot

Human Longevity

57


insights

Stoakes: Predicting The Future continued from page 13

already seen the first FDA clearances of 3D-printed complex medical products including spines and hands. What’s coming

This area won’t be without challenges as regulators try to work out how to monitor and control the manufacturing of homegrown medicines and devices, but a robust ecosystem is emerging. Expect wild experimentation, new conferences for early adopters, and niche networks to serve these important conversations. Also watch for specialized investors, dedicated funds, and a rise in crowd-funding focused on the maker-movement for health. 4. Artificial intelligence (AI) finds purpose in healthcare

In 2015, I described how AI would make a big impact in healthcare. While bots won’t replace your doctor just yet as Venrock VC Bob Kocher also predicts, the industry has moved beyond IBM Watson. It’s already a major sub-sector and one of the most active areas of digital health investment. Numerous companies are receiving funding to focus on solutions dedicated to applying this technology to diagnosis, radiology, automation, and other aspects of medicine. In fact, StartUp Health Insights is tracking over 125 companies focused on AI. What’s coming

The machine learning capabilities of these solutions are reaching a tipping point and starting to make a real difference in care instead of just being theoretical. Other advancing trends including home-based devices (Alexa, Siri, Home), IoT, and clinical grade wearables for consumers, 58

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combined with machine learning capabilities will only speed up the effectiveness of these emerging platforms and opportunities to impact behavior change and health outcomes. 5. Growing experimentation with ‘healthbots’

Back in 2015, the idea of a friendly robot providing elderly care seemed strange and ridiculous to many. Now, it’s normal to talk to Amazon’s Alexa in your living room, or explore the idea of finding a ‘smart’ health aid for your aging parent. Consumers are starting to accept the idea that heathbots can be used to automate, improve, and simplify routine tasks that impact our time, lifestyle, and everyday wellbeing. What’s coming

Healthbots will increasingly focus on solving automation problems in healthcare, such as workflow data entry and fraud detection. They will also make significant leaps forward to impact behavior change to help coach us to better health with invisible micro-steps. Unused health apps will fade away and be replaced by invisible services layered into the wearable sensors, home appliances, mobile tools, and cars we live with. 6. Unlikely marriages in healthcare become the norm

After Novartis and Qualcomm launched a $1 billion partnership in 2015, it became clear that we’d start to see even more collaborations between health, tech, and communications companies. This year, the estimated $66 billion CVS acquisition of Aetna was another pairing that seemed unexpected at first, but makes sense in context of

StartUp Health Magazine

healthcare economics and market need. What’s coming

These partnerships will become even more common as leading companies start to realize the benefit of breaking down silos, collaboration, and skill sharing. As we move into a cost-conscious, value-based environment, expect to see innovative partnerships that aim to streamline certain aspects of the healthcare experience and/ or enterprise. Also, we will see an M&A race for those with the best healthcare assets. It won’t just be companies in similar lines of business acquiring each other like two pharma companies joining forces. It will be tech giants and consumer companies buying health systems, EHRs, med device, pharmacy, and life science companies to give them fast entry into the complexities of the healthcare market. Some of these unions will not end well, but one or two will reshape the industry’s assumptions of how healthcare works. 9. New entrants stake their claim in healthcare

The line between “consumer” and “healthcare” companies has continued to blur since 2015. A growing number of retailers muscled into the clinic business and ER-lite services usually provided at hospitals, and consumer tech companies began offering healthcare products. As tech giants from Apple to Amazon to Facebook skunkwork their way into healthcare in mysterious ways, other entrants including grocery chains, car companies, clothing manufacturers, and telecoms are also investing in the sector.

What’s coming

This trend is likely to become the norm as tech giants continue buying up healthcare startups and legacy companies. For example, Amazon is moving into the prescription drug market, with others predicting that the tech giant may soon partner with a pharmacy benefit manager. 10. Consumers become the new angel investors

In 2015, we noticed that consumers were becoming the new angel investors of digital health. We’ve seen that transformation take place this year as one of StartUp Health’s companies, Patientory, raised several million from an initial coin offering (ICO) recently. Meanwhile, Kickstarter and Indiegogo continue to thrive with health solutions. What’s coming

This trend will continue with vigor and expands as a variety of alternative sources of capital make themselves available to startups. From ICOs to global public offerings (GPOs) to sovereign wealth funds and egafunds there will be more than enough capital to support the best innovation and bet big on health moonshots. As I think about the progress being made, what’s most illuminating is how health innovation is moving faster than many realize – an important reality that will create many winners and losers – especially for those not upgrading and re-calibrating along the way. What’s inspiring is that we are finally in a health moonshot era taking shape on a global scale.


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