Tag: telehealth

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Telehealth startup Cerebral shared millions of patients’ data with advertisers

Cerebral has revealed it shared the private health information, including mental health assessments, of more than 3.1 million patients in the United States with advertisers and social media giants like Facebook, Google, and TikTok.

The telehealth startup, which exploded in popularity during the COVID-19 pandemic after rolling lockdowns and a surge in online-only virtual health services, disclosed the security lapse in a filing with the federal government that it shared patients’ personal and health information who used the app to search for therapy or other mental health care services.

Cerebral said that it collected and shared names, phone numbers, email addresses, dates of birth, IP addresses and other demographics, as well as data collected from Cerebral’s online mental health self-assessment, which may have also included the services that the patient selected, assessment responses, and other associated health information.

The full disclosure follows:

If an individual created a Cerebral account, the information disclosed may have included name, phone number, email address, date of birth, IP address, Cerebral client ID number, and other demographic or information. If, in addition to creating a Cerebral account, an individual also completed any portion of Cerebral’s online mental health self-assessment, the information disclosed may also have included the service the individual selected, assessment responses, and certain associated health information.

If, in addition to creating a Cerebral account and completing Cerebral’s online mental health self-assessment, an individual also purchased a subscription plan from Cerebral, the information disclosed may also have included subscription plan type, appointment dates and other booking information, treatment, and other clinical information, health insurance/pharmacy benefit information (for example, plan name and group/member numbers), and insurance co-pay amount.

Cerebral was sharing patients’ data with tech giants in real-time by way of trackers and other data-collecting code that the startup embedded within its apps. Tech companies and advertisers, like Google, Facebook, and TikTok, allow developers to include snippets of their custom-built code, which allows the developers to share information about their app users’ activity with the tech giants, often under the guise of analytics but also for advertising.

But users often have no idea that they are opting-in to this tracking simply by accepting the app’s terms of use and privacy policies, which many people don’t read.

Cerebral said in its notice to customers — buried at the bottom of its website — that the data collection and sharing has been going on since October 2019 when the startup was founded. The startup said it has removed the tracking code from its apps. While not mentioned, the tech giants are under no obligations to delete the data that Cerebral shared with them.

Because Cerebral is a telehealth startup and handles confidential patient data, it’s considered a company covered under the U.S. health privacy law known as HIPAA. According to a list of health-related security lapses under investigation by the U.S. Department of Health and Human Services, which oversees and enforces HIPAA, Cerebral’s data lapse is the second-largest breach of health data in 2023.

News of Cerebral’s years-long data lapse comes just weeks after the U.S. Federal Trade Commission slapped GoodRx with a $1.5 million fine and ordered to stop sharing patients’ health data with advertisers, and BetterHelp was ordered to pay customers $8.5 million for mishandling users’ data.

If you were wondering why startups today should terrify you, Cerebral is just the latest example.

Today’s startups should terrify you

Telehealth startup Cerebral shared millions of patients’ data with advertisers by Zack Whittaker originally published on TechCrunch

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BetterHelp owes customers $7.8M after FTC alleges data mishandling

The Federal Trade Commission (FTC) is requiring online therapy company BetterHelp to pay $7.8 million to consumers in a settlement over alleged data mishandling between 2017 and 2020. This marks the first proposed FTC order that would compensate consumers whose health data was compromised.

According to the FTC, BetterHelp assured customers that it would not share their health data except for the purpose of providing counseling. But the FTC alleged that BetterHelp shared customer emails, IP addresses and health questionnaire responses with advertisers like Facebook, Snapchat and Pinterest.

“The FTC alleged we used limited, encrypted information to optimize the effectiveness of our advertising campaigns so we could deliver more relevant ads and reach people who may be interested in our services,” BetterHelp wrote in a statement. “This industry-standard practice is routinely used by some of the largest health providers, health systems, and healthcare brands.”

Customers who used BetterHelp between August 1, 2017 and December 31, 2020, when these advertising practices were in effect, will be eligible for partial refunds.

“When a person struggling with mental health issues reaches out for help, they do so in a moment of vulnerability and with an expectation that professional counseling services will protect their privacy,” said Samuel Levine, director of the FTC’s Bureau of Consumer Protection, in a statement. “Instead, BetterHelp betrayed consumers’ most personal health information for profit.”

BetterHelp said it has never received payment from any third parties for information about its customers.

The FTC’s proposed order also requires BetterHelp to limit how long it can retain customer data and ask third parties to delete consumer health data that they shared. BetterHelp is also ordered to obtain express consent before disclosing customer health information to third parties, and to develop a more comprehensive privacy program.

“This settlement, which is no admission of wrongdoing, allows us to continue to focus on our mission to help millions of people around the world get access to quality therapy,” BetterHelp wrote in its statement.

‘Self-therapy’ startups are blooming in the ‘moderate mental health’ space

 

BetterHelp owes customers $7.8M after FTC alleges data mishandling by Amanda Silberling originally published on TechCrunch

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With a focus on patients with chronic illness, Nourish hopes to help Americans eat better

Many of us would feel better if we ate better. But for patients with chronic diseases, the issue is more pressing: Fixing their diet is often key to keeping their condition under control.

According to the CDC, six in 10 adults in the U.S. have a chronic disease such as diabetes or heart conditions. Millions of these could benefit from professional nutrition guidance but don’t always have the time or means to seek care.

Enter Nourish, a U.S. startup that connects users with a registered dietitian (RD) via telehealth and helps them get their consultations covered by health insurance.

Telehealth is part of the appeal, both for patients and for nutritionists, but the RD qualification is an important point too.

“All registered dietitians are nutritionists — but not all nutritionists are registered dietitians,” the Academy of Nutrition and Dietetics warns. Unless you seek an RD or RDN (registered dietitian nutritionist), you won’t be sure that your nutritionist is properly qualified for the job — and your insurance will not cover it.

Insurance coverage is a big part of Nourish’s value add. The startup’s CEO, Aidan Dewar, told TechCrunch that “94% of our patients are fully covered by insurance and pay nothing out of pocket. Most of the rest just have a small co-pay.”

That’s because since 2002, medical nutrition therapy has fallen under the scope of Medicare under certain criteria, a move that led major private insurers to follow suit.

On paper, qualified patients who are aware of this could get reimbursed after seeing an outpatient RD, whether online or off. But as often with healthcare in the U.S., the process is cumbersome for practitioners, and many end up not accepting insurance.

In contrast, Nourish’s RDs are employed by the company, which took care of closing partnerships with Medicare and major U.S. healthcare companies Aetna, BCBS, Cigna, Humana and United Healthcare in exchange for a fee.

Nourish currently employs 50 RDs but has a waitlist of over 400 RDs interested in joining its team, Dewar said. Having launched in November 2021, the startup is pacing itself but already reports “millions in revenue” from “thousands of patients seeing dietitians each month.” And by the end of the year, it plans to employ 200 RDs and grow its non-RD team from 18 to around 30.

Nourish’s growth plans will be funded by a recent $8 million seed round that brought its total funding to $9.3 million. Led by Thrive Capital, it had participation from Susa Ventures, Operator Partners, Box Group and Y Combinator, whose accelerator the startup graduated from in 2021.

Dewar also highlighted that several of Nourish’s angel investors built exciting healthcare companies, such as Alto Pharmacy (Jamie Karraker), Headway (Andrew Adams), Rightway Healthcare (Jordan Feldman) and Spring Health (April Koh).

“Nutrition has largely been excluded from the healthcare system, despite its importance and connection to people’s health. We love that Nourish is changing that by bringing consumers, registered dietitians, and insurance companies together to build a more affordable and complete nutrition program,” Thrive Capital general partner Kareem Zaki said.

Expanding nutrition therapy

Nourish has big goals: By helping people to eat well, the startup is hoping to contribute to solving the American healthcare crisis. “More than half of Americans have a chronic condition related to what they eat, which has contributed to healthcare costs going up and quality-adjusted life expectancy going down,” its founders said.

Dewar and Nourish COO Sam Perkins are childhood friends and landed on Nourish’s mission after struggling with chronic conditions themselves (migraines and irritable bowel syndrome). After experiencing the positive impact of nutritional care, they co-founded their startup together with CTO Stephanie Liu, who had become close friends with Perkins at Princeton.

The founders knew firsthand that working with a dietitian was a long-term process, but this vision is also reinforced by the startup’s chief clinical officer, Adrien Paczosa. “We focus on a long-term, sustainable approach — truly a lifestyle change,” she said. “We will never put you on a fad diet that is impossible to maintain, tell you to only eat salad for every meal, make you track everything you eat, or give you some generic, one-size-fits-all meal plan.”

Because of this approach, the startup doesn’t see itself as directly competing with weight loss apps. However, it plans to use its seed round to launch an app of its own by the end of the quarter, but with different goals in mind.

“The mobile app will augment the core experience of seeing your dietitian, with features including high-quality nutrition content and resources, clinical outcome tracking, and features that help you acquire the food such as integrated grocery delivery (so your RD can prescribe you food in the same way an MD can prescribe medicine),” Nourish explained.

The app’s goal is to make sure that patients are achieving the desired outcomes. Indeed, Nourish has two priorities in 2023: growth and outcomes. This road map has to do with how Dewar and his team define success. “It’s [both] about how many people we help and how much we help them.”

There’s still plenty of room for Nourish to grow on both fronts: The vast majority of chronic illness patients who could benefit from seeing an RD currently don’t, and even when they do, eating well remains a struggle. Will an app help make their journey easier? Only time will tell.

With a focus on patients with chronic illness, Nourish hopes to help Americans eat better by Anna Heim originally published on TechCrunch

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This startup brings Southeast Asia’s vacant hospital rooms into the sharing economy

Uber and Airbnb have long been the poster children for the sharing economy. In other realms of society, entrepreneurs are also trying to match demand with untapped assets and services. HD, a startup based out of Bangkok, is applying the economic model to healthcare in Southeast Asia.

HD operates a platform that helps three parties meet: surgeons with private practice, patients looking to have their surgeries done more cheaply, and vacant surgery rooms at hospitals. The model might sound a bit counterintuitive to people in the West, but Southeast Asia’s medical system is built on very different patient-hospital dynamics.

Sheji Ho, co-founder and CEO of HD, conceived the idea when he saw surgeons in Thailand advertising on Facebook to attract private customers. Dual practice is “very common” for doctors in Southeast Asia, observed Ho, who previously co-founded the Southeast Asian e-commerce enabler aCommerce.

“They get the credential from working for top hospitals, but they are paid poorly, so they also work at private ones where they get the money,” he says in an interview.

In Southeast Asia, people go straight to the hospital when they get sick. The problem with public hospitals, Ho reckons, is they have very long queues, so doctors try to lure patients to the private institutions where they work. “Doctors [in the region] are kind of like merchants who operate across different platforms,” he says.

Forty percent of Southeast Asia’s health spending was paid out of pocket in 2018, according to World Health Organization, compared to 29.8% in Europe and 32.4% in the Americas. Since there’s no central platform providing cost transparency, patients often end up paying a steep price.

When the COVID-19 pandemic broke out, swathes of surgeon rooms suddenly got freed up as Thailand, a popular destination for medical tourism, lost international patients. The oversupply was exacerbated by the country’s hospital-building spree before the pandemic, Ho noted, as the government bet on an aging population and increased land value.

“Organically, hospitals wanted to use our platforms,” Ho says. And since HD is bringing customers to them, it can bargain for lower room rates. Patients getting surgeries such as thyroid, hemorrhoid, and orthopedic surgery through HD are paying 15-20% less than market prices.

Why not provide a meeting point for all these needs? Hence HD launched its HDcare private-label surgery service two months ago. The platform is now sitting on a supply of over 20 operating rooms across Thailand and Indonesia, according to Ho, with the potential to access more from 1,500 healthcare providers already on its platform, and has over 40 types of surgeries lined up. The plan is to scale the service to 200 surgeries performed per quarter by Q4 2023.

Amazon for health services

HD’s surgery platform is a new addition to its established business, a marketplace for outpatient services. The model has proven successful in the massive healthcare market in neighboring China, where JD.com, Alibaba’s domestic archrival, runs a similar e-commerce operation selling third-party healthcare services like vaccinations, checkups, imaging sessions, and minor surgeries.

The absence of primary care in Southeast Asia means people either need to ask their friends for recommendations or do several rounds of hospital hopping before landing the right doctor and treatment.

That’s a contrast to the U.S., where 75% of adults had primary care physicians as of 2015 to treat common conditions and are referred to hospitals only for urgent and specialist treatment.

Like Airbnb, HD began onboarding hospitals and clinics through a lot of heavy lifting, like helping customers set up their product pages. “But that’s also our moat,” says Ho. “SaaS is still too early for Southeast Asia.”

HD takes a cut from transactions and charges a listing fee from healthcare providers, similar to how a conventional e-commerce platform monetizes. It also offers healthcare marketing solutions to providers on its platform, similar to how Amazon Ads and Tmall Ads enable brands to increase their reach and performance.

The liability of platform operators is an ongoing debate in the tech industry, and a business that could influence one’s health seems to make the matter even trickier. As a marketplace platform, HD doesn’t deal with disputes in general; in the beauty space where the experience may be more “subjective”, HD takes an approach similar to that of Amazon whereby it “puts patients first, refunds customers and deals with the providers directly,” says the founder.

“In general, HD prioritizes minimally invasive, short-stay, elective surgeries that have low output variation such as thyroid and hemorrhoid surgery, in addition to outpatient procedures.”

Since its founding four years ago, HD has served around 250,000 patients. It saw a 7x sales growth during the pandemic and aims to keep its growth rate at 2-3x growth in the post-COVID years.

Optimism in recession

While the pandemic is taking a toll on the global economy, Ho is optimistic about his own venture. “Whenever a recession started, we saw some businesses take off. They were leveraging excess supply. Groupon was leveraging the excess supply of restaurants, and for Airbnb, it was vacant homes,” he suggests.

“So, as we enter the recession, there is enough opportunity — hospitals sitting on excess rooms. We have a two to three-year window to rapidly grow that part of the business.”

Despite the encouraging signs of growth, HD’s fundraising was off to a rough start. As the pandemic swept across the world, investors turned to telemedicine startups as the default healthcare solution. Ho disagrees with the presumption.

“Telehealth works well in the Western market. Basically, you talk to the GP [general physician], you get a prescription, and you go to Walgreens to get your antibodies, which need a prescription,” he says.

“But in Thailand, Indonesia, and Vietnam, you can get that tier of medication at pharmacies [over the counter], removing the need for telehealth.”

Investors are now waking up to the potential of HD, which is enabling offline medical providers with digital platforms rather than competing with them. The startup recently closed a $6 million funding round from Partech Partners, M Venture Partners, AC Ventures, iSeed, and Orvel Ventures. It’s also part of a recent batch accepted into Google for Startups Accelerator’s Southeast Asia program.

Southeast Asia “omnichannel” health startup Doctor Anywhere gets $88M SGD

This startup brings Southeast Asia’s vacant hospital rooms into the sharing economy by Rita Liao originally published on TechCrunch

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After mothballing Amazon Care, Amazon reenters tele-health with Amazon Clinic, a marketplace for third-party virtual consultants

The ink is not yet dry on Amazon’s $4 billion acquisition of OneMedical, but in the meantime, the online services giant is making one more move into telehealth, and into medical services overall, on its own steam. The company today is taking the wraps off of Amazon Clinic, which Amazon describes as a virtual health “storefront”: users can search for, connect with, and pay for telehealth care, addressing variety of conditions that are some of the more popular for telehealth consultations today.

Amazon Clinic is initially launching in 32 states in the U.S.. It does not work with health insurance and this point, and overall pricing will vary depending on providers, conditions, and location. (One example, connecting with a clinic for acne treatment in Nevada will cost around $40, and you get a choice of two providers whose different offers are provided in a comparative table. Another example, for pink eye (conjunctivitis) in New Jersey, has a wider price gap of between $30 and $48 between the two providers listed.)

Amazon Clinic appeared to leak out about a week ago when users spotted a video on YouTube that was then quickly removed as media picked up on the attention. Now, it is launching officially, and at a critical moment.

It’s only been a few months since Amazon shut down Amazon Care, which had been a telehealth service that it created for its own employees before stepping up plans to launch it nationwide and to third-party companies. And more generally, the company is, like many others in tech, feeling the economic pinch. It is reportedly gearing up to make a big round of layoffs, potentially 10,000 jobs and possibly this week; and additionally to that it’s been downsizing and cutting a number of its operations.

Amazon Clinic is about the company taking another pass at the healthcare market, and positioning itself as a player in what is a perpetual problem in the U.S.: how to bridge the gap between people needing medical help for ailments that are more complicated that a trip to the drug store, but might not justify expensive and time-consuming trips to the doctor.

(Other conditions it will cover addition to acne and pink eye include asthma refills, birth control, cold sores, dandruff, eczema, erectile dysfunction, eyelash growth, genital herpes, gastroesophageal reflux disease (GERD), hayfever, hyperlipidemia refills, hypertension refills, hypothyroidism refills, men’s hair loss, migraines, sinusitis, smoking cessation, urinary tract infections (UTIs), yeast infections and so on.)

Clinic is very much built in the Amazon mold. It’s a marketplace where third parties can leverage Amazon’s platform and reach to find customers, and Amazon can leverage third parties to quickly scale what offers to its consumers. And it helps Amazon extend the business funnel for other Amazon operations — in this case Amazon Pharmacy, which can fulfill any prescriptions that come out of Clinic consultations, and has reportedly not been as big of a boom in business as expected. (Users can fill Amazon Clinic scripts in other pharmacies, too.)

We’ve asked Amazon if it plans to provide its own in-house (private label, in e-commerce parlance) telehealth consultancy utalongside third parties, and what the plans are for further states, whether there are international ambitions, and if it will accept health insurance for Clinic in the future. It may well be that this is laying the groundwork for Amazon to link up what it is building here with OneMedical when that acquisition closes.

The bigger picture for Amazon Clinic is that the service will sit within Amazon’s bigger ambitions in the healthcare market. The company already has an online chemists, Amazon Pharmacy, which fulfills subscriptions and lets users additional buy over-the-counter drugs via Prime memberships that ship the items within two days.

Amazon also believes its new telehealth service addresses a gap in the market for providing users with health consultations for more minor ailments. Some situations need more direct physician involvement, which might be covered with One Medical or one’s existing healthcare coverage; some situations might be addressable by visiting a pharmacy on one’s own steam.

“But we also know that sometimes you just need a quick interaction with a clinician for a common health concern that can be easily addressed virtually,” the company noted in its blog post announcing the service.

Amazon has been making inroads, and laying out its ambitions, in healthcare for a number of years. Amazon Pharmacy was launched off the back of its acquisition of PillPack. And it’s been exploring healthcare as an enterprise opportunity, with integrations of Alexa into healthcare environments.

But Amazon Care is not the only step back it’s taken in its longer journey. In 2018, it formed a JV with JP Morgan and Berkshire Hathaway to build an employee healthcare operation, appointing a high-profile doctor to lead it. That service never appeared to take shape as expected and shut up shop in 2021.

We’ll update this piece as we learn more.

After mothballing Amazon Care, Amazon reenters tele-health with Amazon Clinic, a marketplace for third-party virtual consultants by Ingrid Lunden originally published on TechCrunch

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Veterinary telehealth service Vetster launches in the UK, post expansion in the US

Vetster, a veterinary telehealth service which has raised $40M, is launching in the UK following expansion in the US.

Vetster connects licensed veterinarians with pet owners via video, voice and online chat.

It hopes to fill a yawning gap in provision. In the UK one in two veterinary clinics are overbooked and unable to take on more patients, according to research.

Vetster commissioned research through 3Gem with 150 vets in March 2022 and found vets are overwhelmed with pets, overbooked and unable to take on new patients. And many are looking to quit. So the Telehealth industry is probably arriving just in time.

Mark Bordo, CEO and coFounder of Vetster. “Veterinarians  are facing tremendous pressure to provide services to millions of pet owners. Vetster’s virtual care platform connects pet owners with licensed UK veterinarians to provide support when their clinic is closed, to answer a non-urgent question, and to improve  the health outcomes of their pet and help ensure owners can care for their animals.”
 
The pet telehealth service has been live in North America for over two years.

Vetster raised $30M USD in its Series B funding in April 2022.

Competitors include Televet (raised $7M) ,Dutch ($25M), and Pawp ($17.5M), among others.

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This Yale alum wants to build a telemedicine platform expressly for Alzheimer’s disease

Nikhil Patel is the kind of founder who investors adore. He’s a brainiac who, before studying computer science at Yale, spent three years in high school working as a research associate at the University of Central Florida. “I started working there before I could drive, and it was the most embarrassing thing to get dropped off by my mom at the office,” he says with a laugh.

Patel also has a personal connection to the problem he is trying to solve, that of trying to diagnose and address Alzheimer’s disease as early as possible. Watching his grandmother lose ground to Alzheimer’s, and understanding, from a young age, that an early diagnosis and intervention can delay the onset of dementia, he centered his research on building Alzheimer’s-related computerized diagnostics — which wasn’t easy to pull off as a teenager.  (He says he finally found one professor who was willing to publish his findings under the auspices of the lab after more than 100 others turned him down.)

Patel did get a wee bit distracted. After graduating from college, he logged time at a “couple of different hedge funds” and at Goldman Sachs where he worked on trading algorithms. But by early last year, as another relative was diagnosed with Alzheimer’s, he returned to his earlier work, founding Craniometrix, which is today a three-person operation with sizable ambitions.

So far, the team has raised $6 million in seed funding for a HIPAA-compliant app that, according to Patel, can help identify Alzheimer’s disease — even years before symptoms appear — after just 10 minutes of gameplay on a cellphone. It’s not purely a tech offering. Patel says the results are given to an “actual physician” affiliated with Craniometrix who “reviews, verifies, and signs that diagnostic” and returns it back to a patient.

But the company’s backers —  including Quiet Capital, Defy.vc, Olive Tree Capital, Rebel Fund, J Ventures, Cathexis Ventures and Y Combinator — and really betting on Patel and his bigger vision to create a one-stop, direct-to-consumer tele-medicine platform that not only helps with early Alzheimer’s detection but that also provides ongoing support to patients and their caregivers.

It’s a concept that Neil Sequeira of Defy says he rallied around easily, given his firm’s interest in startups that use tech to improve upon legacy healthcare businesses. (Others of Defy’s bets include a cloud-based lab management startup called Genemod and Apploi, a healthcare hiring platform.)

But Sequeira suggests that he might back anything Patel worked on. In fact, he says he met Patel through another CEO whose stealth startup Defy has funded and who, when asked about the smartest person he has ever met, pointed to Patel.

Only time will tell whether those smarts will successfully bolster a big business, but unsurprisingly, Patel already has a roadmap.

While step one centers on people who are concerned about developing Alzheimer’s, want to self-screen at home, and will receive a doctor-reviewed diagnostic report from the company within 48 hours, Craniometrix expects to soon offer real-time doctor access to customers who may have questions and concerns after receiving their report.

Craniometrix also plans to create bundled monthly subscriptions that will include point-in-time screenings, access to live doctor assistance, and other tools to address symptom management and caregiver support.

It’s a big market, Patel argues. He asserts that caregivers today spend $3,000 a year out of pocket on the types of services that Craniometrix will eventually offer online. He also notes that while the direct-to-consumer market alone is a big opportunity, he is already having “interesting conversations” with health plans about using tools like those that Craniometrix is developing to cut down on unnecessary patient visits.

Says Patel, “a lot of today’s visits could easily be served by a chat service or an offline communication service.”

Ultimately, Patel says, the idea is to eliminate the need to go to a medical office. But it’s also to “keep people on better footing” when it comes to managing the disease.

Considering that Alzheimer’s currently afflicts 6 million Americans alone and that those numbers are growing fast as the overall population ages, the company could well be one to watch. Stay tuned.

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Robinhood’s hangover, YC’s reduction and Uber’s return to form

Hello and welcome back to Equity, a podcast about the business of startups, where we unpack the numbers and nuance behind the headlines.

Alex, Natasha and Mary Ann got together with Maggie this week for our weekly roundup show, and per usual, there was a lot to talk about, including the fact that there were even more topics than usual to pick from as the summer slowdown seems to be fading away. 

What else did we get into? The following:

  • To kick off our Deals of the Week, we discussed the fact that a startup which focuses on depression, suicidality and related mental health conditions is buying a company called KetaMD in an effort to extend its telehealth prowess and, in particular, to expand its tech-facilitated ketamine-based treatments. Don’t know what ketamine is? You’re not alone.
  • From there, it was time to talk about a new $100 million fund, which boasts some high-profile LPs and partners, that is out to invest exclusively in Latino(a) startup founders. We then dug into the hows and whys of a fintech company that aims to get consumers to deduct everyday expenses directly from their paycheck – a concept that took us a bit to wrap our heads around.
  • We then moved on to Robinhood and the news that the retail investment behemoth had laid off 23% of its staff – just 3 months after letting go of 9% of its workforce. The three of us had thoughts on CEO Vlad Tenev’s acceptance of responsibility for the layoffs, and of course, on just how much dang news has surrounded the company in the past 18 months or so.

  • Next up? We chatted about Y Combinator’s somewhat surprising decision to shrink its cohort by 40% – what that could mean for the early-stage venture scene. We also get into its increased check size and in-person return. So many variables! Only one experiment!
  • Lastly, we riffed about Uber and how the company both reported positive free cash flow and yet was deeply unprofitable in the second quarter (thanks to Alex breaking that down for us). 

And we had a blast to boot! See you next time!

Equity drops every Monday at 7 a.m. PDT and Wednesday and Friday at 6 a.m. PDT, so subscribe to us on Apple Podcasts, Overcast, Spotify and all the casts.

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This startup just raised $320M to make long-term care inside hospitals obsolete

Cera, a U.K. provider of healthcare inside people’s homes augmented by a platform that allows carers to monitor a patient’s health and potentially flag problems, has raised $320 million (£260 million) in an equity and debt financing round, split roughly 50/50.

The equity side of the funding round was led by Cera’s existing investor Kairos HQ, alongside the Vanderbilt University Endowment, Schroders Capital, Jane Street Capital, Yabeo Capital, Squarepoint Capital, Guinness Asset Management, Oltre Impact, 8090 Partners, technology investor Robin Klein (of LocalGlobe fame) and others. Cera declined to name it’s debt partner.

The company now plans to expand from servicing 15,000 patients to up 100,000 each day. Ironically, 15,000 patients is the bed capacity roughly equivalent to the 40 NHS hospitals promised more than two years ago by Britain’s ruling Conservative Party, which have yet to be delivered.

The statistic is indicative of how in-home patient care is being radicalized by tech startups that either use remote monitoring, or employ carers to manually enter patient data into apps. Eventually it is likely to make long-term care inside hospitals obsolete, as the home can be just as efficient a place to deliver care.

More than 88% of hospitals and health orgs in the U.S. are estimated to be investing in remote patient monitoring technologies. U.S.-based startups in the sector include GYANT, which has raised $23 million, Neteera ($8.5 million) and Binah.ai ($13.5 million).

Cera’s proprietary system is less tech-heavy, but all the same is clearly on the path toward greater automation, in the same way that Uber and Lyft drivers may one day be replaced by driverless taxis.

The company, which also operates in Germany, delivers care, nursing, telehealth and prescription delivery services in the home, and claims it is 10-times cheaper than servicing a patient in hospital. Staff collect patient symptoms and health data in the home, which is then used to predict deteriorations in conditions before they occur, triggering medical interventions. The company claims this can reduce hospitalization rates by over 50%, and has other benefits, such as reducing patient falls, infections and improving medication and prescription compliance.

With hospitals under strain after the worst of the pandemic, and staff at a premium, it’s likely that these technology-augmented services will take off amongst healthcare providers.

Dr Ben Maruthappu MBE, who launched the startup in 2016, told me: “What we are doing is just mirroring what has happened in other industries, such as ride-hailing or other services that come straight to your door. Most healthcare tech is now graduating to healthcare in the home. We have started with older people as they have a high frequency of care visitors.”

He said that Brexit had a negative impact on healthcare in the U.K., given that as much as 7% of NHS staff are from the EU, but claimed that Cera is able to retrain people from other industries fairly rapidly into healthcare roles. “Over 60% of people we are hiring are from outside healthcare. It’s like when ride-sharing had a breakthrough when it became more accessible to non-taxi drivers,” he said.

Maruthappu added that the company intends to eventually move toward a SAAS model, where it would allow other tech and care providers to use its services.

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This cardiac care startup just landed $20M for virtual rehab services

Moving Analytics (Movn), a virtual at-home intervention program for high-risk cardiac patients, claims to be “the most clinically validated” cardiac rehabilitation program on the market. Though other online-based programs exist, others either address other international markets, like Heart2Heart, or work only with very specific current insurance partners, like Henry Ford Health.

Moving Analytics founders and undergraduate friends Harsh Vathsangam and Shuo Qiao met their third co-founder, Ade Adesanya, at the University of Southern California. The trio had all immigrated to the United States with the hopes of becoming engineers, but soon after, their goal turned into having a “data-driven approach to making a dent in healthcare.”

Moving Analytics founders outside their Irvine office. Left to right: Joe Villanueva, Ade Adesanya, Harsh Vathsangam, Shuo Qiao. Image Credits: Moving Analytics

The Irvine-based company is looking to provide recovering heart attack and heart disease patients an at-home alternative to care with guided support over a 12-week course.

“A big part of the program is … we provide empathy to those patients around ‘Hey, we know this is a major event that’s happened to you, this is not the end of your world and there’s a lot of things you can do if you follow our guidance to actually get a stronger heart,’” Adesanya said.

Every patient is provided a cellular enabled scale, an American Heart Association information book, exercise bands, a Bodytrace blood pressure cuff and a Garmin fitness tracker to help monitor and track their progress throughout the course.

The company is set up as a healthcare provider and contracts with various insurance partners — Kaiser Permanente, Allegheny Health Network, CDPHP to name a few — and currently runs operations in 14 states with approximately 4,000 patients. If a cardiac patient opts for at-home care, they are then referred to the Movn team.

Nationally, heart disease is the leading cause of death in the country, which accounts for about 25% of deaths. Fewer than 20% of eligible cardiac rehab patients enroll in a program.

Additionally, patients who also engage in cardiac rehab reduce the risk of dying from a heart attack, according to a study published in the Journal of the American College of Cardiology.

According to figures provided to TechCrunch, the company claims to have seen an increase in enrollment and program completion rates across some of their partners. At Kaiser, for example, figures show prior completion rates were at 14% and are now at 88%. Similar figures are shown at other partners.

“I think that for us we just feel a sense of responsibility with this opportunity that we have to make sure that we can make the world just a little bit more better,” Adesanya said “And, you know, essentially, in terms of just work and healthcare, innovation, we can make it a little bit more inclusive, too.”

The company declined to say how much their program cost but claimed to offer a “cheaper” alternative to traditional in-person sessions. The average cost of an in-person session is approximately $240, according to a study published in the National Library of Medicine.

Co-founders Ade Adesanya (left) and Shuo Qiao (right) discussing business expansions in the Moving Analytics office. Image Credits: Moving Analytics

Movn has been able to convince investors as they have secured $20 million in a Series A funding round led by Wellington Access Ventures and Seae Ventures, with participation from Philips Ventures. According to the company, the investment is coming in the form of all equity — though they declined to share at what valuation.

In total, the company has raised $30 million and will use the new funds to expand their coverage across all 50 states, hire staff and begin implementing bilingual programming to better serve marginalized communities.