Digital biomarkers are healthcare’s next frontier

Blood pressure, body temperature, hemoglobin A1c levels and other biomarkers have been used for decades to track disease. While this information is essential for chronic condition management, these and many other physiological measurements are typically captured only periodically, making it difficult to reliably detect early meaningful changes.

Moreover, biomarkers extracted from blood require uncomfortable blood draws, can be expensive to analyze, and again, are not always timely.

Historically, continuous tracking of an individual’s vital signs meant they had to be in a hospital. But that’s not true anymore. Digital biomarkers, collected from wearable sensors or through a device, offer healthcare providers an abundance of traditional and new data to precisely monitor and even predict a patient’s disease trajectory.

With cloud-based servers and sophisticated, yet inexpensive, sensors both on the body and off, patients can be monitored at home more effectively than in a hospital, especially when the sensor data is analyzed with artificial intelligence (AI) and machine-learning technology.

Opportunities for digital biomarkers

A major opportunity for digital biomarkers is in addressing neurodegenerative diseases such as mild cognitive impairment, Alzheimer’s disease and Parkinson’s disease.

Neurodegenerative disease is a major target for digital biomarker development due to a lack of easily accessible indicators that can help providers diagnose and manage these conditions. A definitive diagnosis for Alzheimer’s disease today, for example, generally requires positron emission tomography (PET), magnetic resonance imaging (MRI) or other imaging studies, which are often expensive and not always accurate or reliable.

Cost savings and other benefits

Digital biomarkers have the potential to unlock significant value for healthcare providers, companies and, most importantly, patients and families, by detecting and slowing the development of these diseases.

AI’s role is poised to change monumentally in 2022 and beyond

The latest developments in technology make it clear that we are on the precipice of a monumental shift in how artificial intelligence (AI) is employed in our lives and businesses.

First, let me address the misconception that AI is synonymous with algorithms and automation. This misconception exists because of marketing. Think about it: When was the last time you previewed a new SaaS or tech product that wasn’t “fueled by” AI? This term is becoming something like “all-natural” on food packaging: ever-present and practically meaningless.

Real AI, however, is foundational to supporting the future of how businesses and individuals function in the world, and a huge advance in AI frameworks is accelerating progress.

As a product manager in the deep learning space, I know that current commercial and business uses of AI don’t come close to representing its full or future potential. In fact, I contend that we’ve only scratched the surface.

Ambient computing

The next generation of AI products will extend the applications for ambient computing.

  • Ambient = in your environment.
  • Computing = computational processes.

We’ve all grown accustomed to asking Siri for directions or having Alexa manage our calendar notifications, and these systems can also be used to automate tasks or settings. That is probably the most accessible illustration of a form of ambient computing.

Ambient computing involves a device performing tasks without direct commands — hence the “ambient,” or the concept of it being “in the background.” In ambient computing, the gap between human intelligence and artificial intelligence narrows considerably. Some of the technologies used to achieve this include motion tracking, wearables, speech-recognition software and gesture recognition. All of this serves to create an experience in which humans wish and machines execute.

The Internet of Things (IoT) has unlocked continuous connectivity and data transference, meaning devices and systems can communicate with each other. With a network of connected devices, it’s easy to envision a future in which human experiences are effortlessly supported by machines at every turn.

But ambient computing is not nearly as useful without AI, which provides the patterning, helping software “learn” the norms and trends well enough to anticipate our routines and accomplish tasks that support our daily lives.

On an individual level, this is interesting and makes life easier. But as professionals and entrepreneurs, it’s important to see the broader market realities of how ambient computing and AI will support future innovation.

3 things to remember when diversifying your startup’s cap table

Making purposeful decisions on diversity and inclusion in the workplace goes beyond simply building your team.

As a minority female entrepreneur and co-founder of a women’s health startup, ensuring diversity within our cap table has been a must — and has proven instrumental to our success. Breaking down your cap table to diversify your investors based on a variety of criteria will provide far more value than funding alone.

I have spent the last 10 years working in women’s health, and the lack of diversity in investors and leadership baffles me. From the inception of my company until now, diversifying our cap table has been a top priority that will continue to serve as a key factor when bringing in investment.

Prioritizing diversity will bring a wealth of knowledge, perspective and expertise to the table. We knew that to make this happen, we had to focus on building a product and team that people wanted to invest in. Many startups talk about wanting to adding diversity to their cap table, but how should you go about it?

Set your investor criteria from the beginning

My co-founders and I were all in agreement that we would select our investors based on a variety of factors, such as type of investor (VC, angel, family office, etc.), gender, race, expertise and a deep passion for our mission. While arriving at these criteria, my co-founders and I wrote down reasons why each factor was important to us.

Breaking down your cap table to diversify your investors based on a variety of criteria will provide far more value than funding alone.

As a startup tackling a problem that affects women globally, it was particularly important for us to have women investors, racially diverse investors and industry professionals who understood the magnitude of the problem we were trying to solve.

Recent studies have shown that women and people of color disproportionately experience medical gaslighting. Seeking out investors who fit this profile was critical to onboarding people who we felt would share our passion for our work and be supportive along the way.

When setting your criteria, you should define your goals clearly and identify the value each investor will bring to the table. As a team, think about what you would want if you could have it your way and why.

For better or for worse: Managing founder-CEO tension inside a startup

“Are you gonna hire a bunch of useless salespeople like they have at Oracle?”

This was the first of many memorable interactions I had with Eliot Horowitz. Eliot was the founder and CTO of MongoDB, and in late 2010, I was interviewing to come aboard as president. Product-led growth was far from the common buzzword it is today, but the founding team at MongoDB had built a product that developers loved — the very developer love that would drive much of the company’s rapid growth.

My topic today isn’t product-led growth, but the relationship between a founder, such as Eliot, and a hired CEO and the key factors necessary for that relationship to succeed. That dynamic was always important, but focusing on it is critical in today’s more volatile, fast-changing technology markets.

On the surface, Eliot’s question was about business models and sales hiring. But it went much deeper: Our discussion was a live experiment on how we would work together, getting to the heart of a startup’s decisive partnership between a CEO and a founder. The territory we covered that day included:

  • Was I open to unorthodox thinking?
  • Could I justify my plans on first principles?
  • Was I willing to engage with a young technical founder on business issues?
  • Did discovering that the founders wanted to challenge the established way of doing things make me excited to join — or want to run for the hills?
  • Could I make a business decision contrary to the founder’s views and have us both feel good about the process?

All of those are valid questions and examples of potential tension points between a technical founder and a new leader brought in from the outside. How a founder and a CEO work through these points of tension could help determine the ultimate success of a company.

Beyond product-market fit

Lots can go wrong with a startup, but to succeed, two things have to go right: First, the product must fit the market well, which is almost always the domain of the founder(s), and second, the company has to execute successfully, which is sometimes the domain of a hired CEO.

In almost every case, the initial product and market vision come from founders. They started the company because they had an insight that something could be done better and an idea of how to do it better. When that idea resonates with a broad audience, you have the kernel of product and market fit. Without that, there is no company.

But that initial product-market fit isn’t nearly enough. A company needs funding, a team, and, ultimately, it needs to execute on engineering, sales, customer success and marketing. In some cases, a founder is interested in and has shown an initial aptitude for leading all these areas. In other instances, they don’t, and in these cases, they need a partner to lead the company’s operations.

The four years I spent at MongoDB — first as president, then as CEO — were a great experience. The company grew explosively and changed the market for databases and how developers built web applications. Perhaps more importantly, we laid some of the foundations for what would later become a hugely successful cloud business that transformed how enterprises delivered and consumed infrastructure software.

We wouldn’t have been able to do that without a strong partnership between the founders and me, particularly with Eliot and Dwight Merriman (founder and initial CEO, who eventually became chairman). Decisions didn’t neatly divide into categories of product for them and operational for me.

Dear Sophie: Can I do anything to speed up the EAD renewal process?

Here’s another edition of “Dear Sophie,” the advice column that answers immigration-related questions about working at technology companies.

“Your questions are vital to the spread of knowledge that allows people all over the world to rise above borders and pursue their dreams,” says Sophie Alcorn, a Silicon Valley immigration attorney. “Whether you’re in people ops, a founder or seeking a job in Silicon Valley, I would love to answer your questions in my next column.”

TechCrunch+ members receive access to weekly “Dear Sophie” columns; use promo code ALCORN to purchase a one- or two-year subscription for 50% off.


Dear Sophie,

I’m on an L-2 visa as a dependent spouse to my husband’s L-1A.

My EAD (work permit) is expiring in May — we filed for the extension of both my visa and EAD a few months ago. How long is the current process?

Might there be anything I can do so my employment isn’t affected?

— Career Centered

Dear Centered,

I’ve got fantastic news for you and other L-1 spouses — and your employers! As long as your visa remains valid, you are no longer at risk of having your employment interrupted due to delays in getting your Employment Authorization Document (EAD).

Thanks to a policy change by U.S. Citizenship and Immigration Services (USCIS), getting work authorization is now easier for L-2 spouses of L-1 visa holders as well as a few other categories. As Elon Musk said this week, for anybody who wants to work hard in the U.S., immigration should be a “no-brainer.”

Soaring processing times

During the past two years, processing times for EADs soared due to a combination of backlogs prompted by the pandemic, funding issues and paper-based USCIS processing procedures.

Depending on which USCIS service center processed the EAD renewal application (Form I-765), timing ranged from about 90 days to more than a year. Interesting to note, it can take anywhere from 7.5 to 14.5 months to process EADs at the California Service Center. At the Texas Service Center, it can take two to 13 months.

A composite image of immigration law attorney Sophie Alcorn in front of a background with a TechCrunch logo.

Image Credits: Joanna Buniak / Sophie Alcorn (opens in a new window)

Lawsuit prompts big policy changes

Last September, a group of spouse-dependent visa holders filed a class-action lawsuit against the Secretary of Homeland Security, who oversees USCIS. The suit was filed on behalf of dependent spouses of H-1B and L-1 visa holders, many of whom had been forced to stop working when USCIS failed to approve and send out new EADs before the current ones expired due to substantial processing delays.

The situation was compounded by the fact that EAD renewals can’t be filed more than six months in advance of their expiration date.

Starting up remotely? Keep these labor laws and tax guidelines in mind

When it comes to remote employment, employees and employers both face a plethora of benefits and pitfalls. While the cultural pros and cons have been covered, considerations from a setup and maintenance standpoint largely haven’t been addressed. There are important legal and tax implications to keep in mind when it comes to a remote workforce.

Virtual teams existed well before COVID-19, but over the last two years, employees turned not being able to go into an office into a benefit by moving out of their employer’s state. For startups, hiring out-of-state employees became common, as remote-first businesses were created from scratch and talent was vastly more critical than location.

Should your startup start or go remote, keep the following in mind.

Tax implications

Remote workforces have tax implications for their companies. Specifically, there is a state payroll withholding tax. This is generally required for the state where an employee works or provides services, regardless of an employer’s location. This means your startup may need to register and withhold income taxes in several states.

These are complicated issues, and often, the best approach is to engage an expert early.

Here are the questions we ask clients:

  1. What are your sales and revenue by state?
  2. Where are your employees located?
  3. Where is your office located, as well as any other property?

Dollar amounts and property locations matter because each state has a different threshold when it comes to defining whether a nexus (more on that in a moment) has been established or not.

This isn’t something you can ignore. States do pay attention. When you register with a government agency, the state receives your tax ID number and other identifying information. This means you’ve got a presence in that state, and your business will be monitored and pursued for any resulting tax liabilities.

For example, one of our clients was stalled during an acquisition last year because they were discovered to be out of compliance with their remote workforce. So, it’s critical to register in each state where you have employees.

Considering the “nexus”

How to evolve your DTC startup’s data strategy and identify critical metrics

Direct-to-consumer companies generate a wealth of raw transactional data that needs to be refined into metrics and dimensions that founders and operators can interpret on a dashboard.

If you’re the founder of an e-commerce startup, there’s a pretty good chance you’re using a platform like Shopify, BigCommerce or WooCommerce, and one of the dozens of analytics extensions like RetentionX, Sensai metrics or ProfitWell that provide off-the-shelf reporting.

At a high level, these tools are excellent for helping you understand what’s happening in your business. But in our experience, we’ve learned that you’ll inevitably find yourself asking questions that your off-the-shelf extensions simply can’t answer.

We’re generally big fans of plug-and-play business intelligence tools, but they won’t scale with your business. Don’t rely on them after you’ve outgrown them.

Here are a couple of common problems that you or your data team may encounter with off-the-shelf dashboards:

  • Charts are typically based on a few standard dimensions and don’t provide enough flexibility to examine a certain segment from different angles to fully understand them.
  • Dashboards have calculation errors that are impossible to fix. It’s not uncommon for such dashboards to report the pre-discounted retail amount for orders in which a customer used a promo code at checkout. In the worst cases, this can lead founders to drastically overestimate their customer lifetime value (LTV) and overspend on marketing campaigns.

Even when founders are fully aware of the shortcomings of their data, they can find it difficult to take decisive action with confidence.

We’re generally big fans of plug-and-play business intelligence tools, but they won’t scale with your business. Don’t rely on them after you’ve outgrown them.

Evolving your startup’s data strategy

Building a data stack costs much less than it did a decade ago. As a result, many businesses are building one and harnessing the compounding value of these insights earlier in their journey.

But it’s no trivial task. For early-stage founders, the opportunity cost of any big project is immense. Many early-stage companies find themselves in an uncomfortable situation — they feel paralyzed by a lack of high-fidelity data. They need better business intelligence (BI) to become data driven, but they don’t have the resources to manage and execute the project.

This leaves founders with a few options:

  • Hire a seasoned data leader.
  • Hire a junior data professional and supplement them with experienced consultants.
  • Hire and manage experienced consultants directly.

All of these options have merits and drawbacks, and any of them can be executed well or poorly. Many companies delay building a data warehouse because of the cost of getting it right — or the fear of messing it up. Both are valid concerns!

Start by identifying your critical metrics

Start up solo, or bring on a co-founder? 4 factors to consider

Every journey to entrepreneurship is unique. I find the world of startups fascinating because the desire to address a problem or need — often one you’ve struggled with yourself — is just too tempting to resist.

Taking on that problem on your own as a solo founder can be daunting, but it can also be freeing. Alternatively, starting up a company with co-founders can be productive yet could have its own challenges.

When I started DocSend, I never had to consider whether or not I wanted a co-founder, because I knew I wanted to build a company with two specific people that I liked personally and respected professionally. But for many entrepreneurs, the question of whether you can take on that challenge by yourself or want a co-founder by your side isn’t an easy one. It’s understandable why.

Going solo can give you more control and freedom to lead the company the way you see fit. It also means you’re the only one responsible for pitching VCs, running board meetings, staffing a team, and making major decisions.

While a solo founder can bring on executives and managers to help with this work and these decisions, co-founders can balance out the leadership team. They can bring different areas of expertise, their own professional networks, and share responsibility.

While the data show solo founders raise more funding, a holistic approach to understanding your gaps and how to fill them is imperative.

If you are starting up a company or currently running your startup all by yourself, here are four things to consider when bringing in a co-founder (or not).

Expertise

Every entrepreneur should objectively assess their skills and determine if their capabilities are well-rounded enough to run a business alone. If you’re not technical and you are starting a tech company, you may need to find a co-founder who fills that gap, or at the very least a strong engineer to lead product development.

Even if you’re technical and can begin coding from day one, you need to consider other key business areas and decide if bringing on a co-founder with expertise in those areas will allow you to get to a viable product, market traction and revenue faster.

I reached out to my network to see how they felt about the decision. I recently spoke with Aneto Okonkwo, co-founder and CEO of Chatdesk, about why he decided to bring in multiple co-founders, and he said that different areas of expertise are a big driver.

“I thought about the different functions needed to make Chatdesk successful. Since we bring together tech and personalized, human support, it was important to establish three functions: technical, operations, and sales. I knew if each person could own an area, it would ensure we would achieve our mission,” he said.

The number of founders on your team may also impact your fundraising success. Our analysis found that solo founders had the most fundraising success, securing an average of 42 investor meetings and raising an average of $3.22 million, compared to companies with four or more founders, which secured an average of 30 meetings and raised an average of $1.7 million.

While the data show solo founders raise more funding, a holistic approach to understanding your gaps and how to fill them is imperative.

Founding employee versus co-founder

5 lessons from ‘Star Wars’ that can transform startup managers’ strategies and tactics

As leader of the Jedi council in the “Star Wars” universe, Yoda was essentially their CEO.

It was his job to see the future, a talent specifically honed by the visionary warrior monks, and yet he consistently allowed his vision to be clouded by the dark side of the Force. Despite his power, experience, authority and wisdom, Yoda was shockingly bad at understanding what was happening around him until it was too late.

Over a period of a decade, the Jedi Grand Master worked directly with the Dark Lord of the Sith, Darth Sidious, who was hiding right under Yoda’s nose as the Supreme Chancellor of the Galactic Republic. Yoda’s failure to recognize changes as they were happening resulted in the rise of Palpatine’s empire and the overhaul of an entire culture’s way of life.

When faced with confusing facts and suspicious clues, what did Yoda do? He retreated to his chambers to meditate, but he did not take action.

Yes, Yoda got Kodaked.

Unfortunately this is all too common among the leadership of incumbent corporations. Many executives act as though they believe good times will never end or as if they don’t care if it does.

Whether the example is the CEO of Kodak dismissing digital photography or the CEO of Blockbuster infamously downplaying the threat of Netflix, it seems there is always another market leader blissfully ignoring the winds of change.

‘I have a bad feeling about this’ are words leaders should live by, because the joke shows awareness and proactivity.

In contrast to Yoda, Jedi Knight Obi-Wan Kenobi combined insight and action to preserve hope for the future.

Seeing the future is also the goal of startup founders, corporate leaders and venture capitalists. With that in mind, here are five lessons from the heroic actions of Obi-Wan Kenobi, and how corporate and startup executives alike can apply these ideas to devise transformational strategies and tactics:

Find trouble before it starts by gathering street-level data

When the Sith criticize the Jedi for arrogance, their argument is justified because the Jedi’s leader Yoda is out of touch. The Jedi Council sits in a literal ivory tower, sending Obi-Wan Kenobi on missions. As one of the Jedi’s top field agents, he is able to gather firsthand information to help understand what’s happening across the republic. It is Kenobi who first learns that Darth Tyranus is actually Count Dooku during the Clone Wars, and he continues to pull on the threads of each clue he finds, always in a quest to learn more. Similarly, it is Kenobi who travels to Kamino in Episode II to unravel the mystery of the clone army.

The lesson for innovators is that you can’t meditate your way to organizational change. The “Star Wars” refrain, “I have a bad feeling about this,” might equate to Intel co-founder Andy Grove’s Only the Paranoid Survive. Grove’s definition of paranoia can be interpreted to mean that it’s important to pay attention at all times. This implies being unsatisfied with lack of clarity and investigating to acquire “street level” information about markets, customers and the state of everyone else’s capabilities.

At a practical level, street level data means that corporations should meet lots of potentially disruptive startups, and startups should meet with potentially complementary or competitive corporations. Each should meet with as many customers and prospective customers as possible.

Be bold and decisive

Obi-Wan tracks down General Grievous on Utapau in Episode III. While the Separatist cyborg leader has killed dozens of Jedi, the vastly outnumbered Kenobi realizes he must take the risk of confronting Grievous. He leaps from above in the midst of dozens of enemy droids, delivering a line that has become meme fodder, “Hello, there.”

To win insurtech 2.0, focus on underwriting before growth

Like many legacy markets poised for change, the insurance industry has already seen its first wave of innovation.

Similar in many ways to the initial novelty of opening a bank account online, insurtech 1.0 brought a centuries-old product into the digital era by giving customers a way to apply for insurance online. Customer excitement translated into investor excitement, and everybody rode off into the sunset.

Well, not quite. It seems some might have flown a little too close to the sun instead: Focusing on customer experience on the front end leads to rapid growth indeed, but failing to focus on underwriting on the back end can lead to a very large number of claims, very quickly.

That’s because insurance, fundamentally, is about risk. It follows that digital insurance innovation should primarily focus on digital underwriting innovation — in essence, using technology to correctly assess and price risk in real time.

The truly magical (and most misunderstood) fact is that everything else can simply flow from that innovative underwriting foundation: an instant, digital customer experience, sustainable growth unburdened by excessive claims and the ability to embed insurance in other digital journeys, creating better experiences for consumer, partners and insurtechs alike.

By focusing first on growth and then on underwriting, the insurtech 1.0 wave essentially flowed in the wrong direction. But there is plenty of time to reverse the tide — consumers’ enormous appetite for convenient, modern insurance products has only been whet.

Insurtech companies need to keep pace with the demand they have created through sustainable unit economics and wise risk management.

So what does focusing on next-generation underwriting really look like, and how should you build upon it? Here’s our five-step playbook for winning in the insurtech 2.0 era.

Realign your business around underwriting excellence

Refocusing on underwriting innovation starts with refocusing your business.

Ask yourself the following questions:

  • Do your primary KPIs include ways to measure underwriting outcomes alongside traditional growth metrics?
  • Do a majority of your employees work on underwriting directly or indirectly?
  • Do your company goals include explicit underwriting goals?
  • Can all your employees articulate how/why underwriting is a differentiator at your company?

If you’ve answered no to one or more questions, it might be worth rethinking your goals, metrics and organizational structure.

Prove your models

Nobody likes to qualify growth, but in insurtech, smart growth is the name of the game. Resist the urge to rapidly scale acquisition before you’ve built confidence in your underwriting engine. But how do you do that?