IAC’s NurseFly rebrands to Vivian Health as it expands its healthcare jobs marketplace

NurseFly, the healthcare jobs marketplace owned by IAC, has rebranded to Vivian Health as it expands its range of services. Originally launched for traveling nurses (or nurses willing to travel for short-term positions), Vivian Health now includes listings for permanent positions, per diem shifts and local openings. It also added employer reviews and a pay database that uses information gathered from the 1.7 million jobs that have come through its system.

Founded in 2017, NurseFly was acquired by IAC in August 2019. It is used by providers like AMN Healthcare, Cross Country Healthcare, Host Healthcare, Trinity Health, SSM Health and Honor Health. During the pandemic, Vivian Health quadrupled its employee headcount in order to meet demand, founder and chief executive officer Parth Bhakta told TechCrunch in an email.

“Over the past year, we’ve grown to fill nearly 10% of all travel nursing positions across the United States, oftentimes helping fill a crisis position in a matter of hours rather than weeks,” Bhakta said. During that time, the platform heard from major health systems “that their challenges around hiring for permanent roles were oftentimes even more dire than filling their travel positions,” he added. “Permanent roles at health systems were taking months to fill, costing tens of thousands of dollars to hire, and leading to short-staffed facilities in the meantime.”

As a result of these conversations, Vivian Health’s team spent three months rebuilding the platform to serve a wider range of healthcare providers and employers. Its rebranding and expansion comes at a time when many healthcare professionals are reporting burnout as a result of the pandemic.

In a study of 1,300 respondents published earlier this month, Vivian Health found that 83% said their mental health had been affected by working in healthcare over the past year. About 43% said they had considered quitting the profession.

One of the main reasons for burnout is working overtime, with 86% of their respondents reporting that their facilities are short-staffed, even as demand for healthcare professionals accelerates. According to the Bureau of Labor Statistics (BLS), about 17.3 million people were employed in the heatlhcare sector in 2018, and that number is expected to increase 15% to 19.9 million by 2028, making it one of the fastest growing sectors.

“Crisis-level staffing shortages” are compounded by the amount of time, sometimes up to 120 days, it can take to hire a permanent employee. Shortening the amount of time it takes to fill positions has a ripple effect because clinicians need to work less overtime. Meanwhile, recruiters can focus on the right leads. Bhakta said employers have been able to use Vivian Health to fill permanent positions in as little as one week, and are typically able to do so within 30 days.

Vivian Heath built a proprietary dataset of healthcare industry information through the 1.7 million jobs that have come through its systems and asks all of its staffing agency partners to include pay rates in their listings. As a result, job seekers are able to see how a position’s compensation compares against the market, while employers can quickly adjust their rates to be more competitive.

Bhakta said Vivian Health added pay information because “our business is built on transparency, which we believe is a crucial element in solving the healthcare hiring crisis.”

The health data transparency movement is birthing a new generation of startups

In the early 2000s, Jeff Bezos gave a seminal TED Talk titled “The Electricity Metaphor for the Web’s Future.” In it, he argued that the internet will enable innovation on the same scale that electricity did.

We are at a similar inflection point in healthcare, with the recent movement toward data transparency birthing a new generation of innovation and startups.

Those who follow the space closely may have noticed that there are twin struggles taking place: a push for more transparency on provider and payer data, including anonymous patient data, and another for strict privacy protection for personal patient data. What’s the main difference?

This sector is still somewhat nascent — we are in the first wave of innovation, with much more to come.

Anonymized data is much more freely available, while personal data is being locked even tighter (as it should be) due to regulations like GDPR, CCPA and their equivalents around the world.

The former trend is enabling a host of new vendors and services that will ultimately make healthcare better and more transparent for all of us.

These new companies could not have existed five years ago. The Affordable Care Act was the first step toward making anonymized data more available. It required healthcare institutions (such as hospitals and healthcare systems) to publish data on costs and outcomes. This included the release of detailed data on providers.

Later legislation required biotech and pharma companies to disclose monies paid to research partners. And every physician in the U.S. is now required to be in the National Practitioner Identifier (NPI), a comprehensive public database of providers.

All of this allowed the creation of new types of companies that give both patients and providers more control over their data. Here are some key examples of how.

Allowing patients to access all their own health data in one place

This is a key capability of patients’ newly found access to health data. Think of how often, as a patient, providers aren’t aware of treatment or a test you’ve had elsewhere. Often you end up repeating a test because a provider doesn’t have a record of a test conducted elsewhere.

Healthcare is the next wave of data liberation

Why can we see all our bank, credit card and brokerage data on our phones instantaneously in one app, yet walk into a doctor’s office blind to our healthcare records, diagnoses and prescriptions? Our health status should be as accessible as our checking account balance.

The liberation of financial data enabled by startups like Plaid is beginning to happen with healthcare data, which will have an even more profound impact on society; it will save and extend lives. This accessibility is quickly approaching.

As early investors in Quovo and PatientPing, two pioneering companies in financial and healthcare data, respectively, it’s evident to us the winners of the healthcare data transformation will look different than they did with financial data, even as we head toward a similar end state.

For over a decade, government agencies and consumers have pushed for this liberation.

In 2009, the Health Information Technology for Economic and Clinical Health Act (HITECH) gave the first big industry push, catalyzing a wave of digitization through electronic health records (EHR). Today, over 98% of medical records are digitized. This market is dominated by multi‐billion‐dollar vendors like Epic, Cerner and Allscripts, which control 70% of patient records. However, these giant vendors have yet to make these records easily accessible.

A second wave of regulation has begun to address the problem of trapped data to make EHRs more interoperable and valuable. Agencies within the Department of Health and Human Services have mandated data sharing among payers and providers using a common standard, the Fast Healthcare Interoperability Resources (FHIR) protocol.

Image Credits: F-Prime Capital

This push for greater data liquidity coincides with demand from consumers for better information about cost and quality. Employers have been steadily shifting a greater share of healthcare expenses to consumers through high-deductible health plans – from 30% in 2012 to 51% in 2018. As consumers pay for more of the costs, they care more about the value of different health options, yet are unable to make those decisions without real-time access to cost and clinical data.

Image Credits: F-Prime Capital

Tech startups have an opportunity to ease the transmission of healthcare data and address the push of regulation and consumer demands. The lessons from fintech make it tempting to assume that a Plaid for healthcare data would be enough to address all of the challenges within healthcare, but it is not the right model. Plaid’s aggregator model benefited from a relatively high concentration of banks, a limited number of data types and low barriers to data access.

By contrast, healthcare data is scattered across tens of thousands of healthcare providers, stored in multiple data formats and systems per provider, and is rarely accessed by patients directly. Many people log into their bank apps frequently, but few log into their healthcare provider portals, if they even know one exists.

HIPPA regulations and strict patient consent requirements also meaningfully increase friction to data access and sharing. Financial data serves mostly one-to-one use cases, while healthcare data is a many-to-many problem. A single patient’s data is spread across many doctors and facilities and is needed by just as many for care coordination.

Because of this landscape, winning healthcare technology companies will need to build around four propositions:

Kaia Health grabs $75M on surging interest in its virtual therapies for chronic pain and COPD

New York headquartered Kaia Health, which offers AI-assisted digital therapies via a mobile app for chronic pain related to musculoskeletal (MSK) disorders and for Chronic Obstructive Pulmonary Disease (COPD), has raised a $75 million Series C.

The round was led by an unnamed leading growth equity fund with support from existing investors, including Optum Ventures, Eurazeo, 3VC, Balderton Capital, Heartcore Capital, Symphony Ventures (golfer Rory McIlroy’s investment vehicle), and A Round Capital.

The funding fast-follows a $26M Series B closed last summer. The pandemic has accelerated the uptake of telemedicine, generally — and Kaia has, unsurprisingly, seen a particular surge of interest in its virtual treatments.

After all, DIY home working set-ups are unlikely to have done much good for the average information worker’s back in the pandemic-struck year. Kaia’s real-time feedback generating motion coach is also able to offer treatment for neck, hip, knee, shoulder, hand/wrist, and foot/ankle pain.

A digital health solution may have been the only lockdown-friendly option for treating conditions considered ‘elective care’ during COVID-19 — meaning suffers of chronic pain may have faced restrictions on accessing physical healthcare provision like in-person physiotherapy. Kaia says it grew its business book 600% in 2020.

Given the U.S. healthcare sales cycle is heavily focused on January onboarding of new medical benefits by employers — who are key customers for Kaia in the market, where it now has around 50 employer and health plan clients — it’s expecting another big onboarding bump next January. And while it hadn’t been looking to raise again so soon after the Series B, doing so was “a very easy process”, says co-founder and CEO Konstantin Mehl.

“We actually planned to start the raise in the end of this year and then the pandemic happened and of course we had a huge boost because the healthcare system was pretty much shut down for in person elected treatments and chronic diseases are considered to be elected treatments which I think is a bit of a mistake.

“The thing is that the big b2b partners they are really scared that they will have this big backlog of surgical interventions that are very expensive… Pre-pandemic I think 20% of employers in the US were even interested in offering a digital therapy and then that changed to 100% immediately. So that was a big boost,” he goes on. “The other thing is that our market got really hot. We don’t really need the money right now but we met these investors and it was a very easy process.”

Kaia says that globally its digital MSK platform is accessible to 60M patients — which it claims makes it by far the biggest player in the space in terms of covered lives. (Other startups in the space include Hinge Health and Sword Health which are both also focused on MSK; and Physera, a virtual physical therapy provider that was acquired by Omada last year.)

The plan for Kaia’s (unexpectedly rapid) funding boost is “to be much more aggressive in building out our commercial team”, Mehl tells TechCrunch. “We are very proud of being a product focused company but it also gets a bit stupid at the point where you just need to bring the product in front of the relevant customer so we are investing a lot in that and also in computer vision because it’s still our USP.”

Kaia’s digital therapies rely on using computer vision to digitize proven treatments so they can be delivered outside traditional healthcare environments, with the app helping patients perform exercises correctly by themselves.

The user only needs a smartphone or tablet with a camera for the app to do real-time, posture-tracking and provide feedback. No wearables are required. Although Kaia is researching how 3D data from depth-sensing cameras which are now being embedded in higher end mobile devices may further feed the accuracy of its body tracking models.

“We basically can have the same correction functionality in your home that you have can have with a PT [personal trainer],” says Mehl. “We want to invest a lot more in computer vision and build out that team so we can also do that more aggressively now [with the Series C funding] which is cool.”

Kaia has started to use motion-tracking in another way in its patient-facing chronic pain app — as a way to track progress. So as well as asking patients to quantify their pain (which is a subjective measure) it can have an objective biomarker alongside patients’ pain assessments by getting them to do regular tests that track their body movements.

“We started to use motion-tracking besides the correction-tracking functionality also as a biomarker. So we basically can measure your body functionality. Now we can, for example, see which body parts are less flexible and that’s how we can measure the disease progression, instead of asking you how is the pain level today,” he explains. “Pain is the number one cause for work disability and the reason is because your body functionality decreases so if we can measure that correctly then we can also escalate it to the right speciality doctor, for example.”

Kaia can also quantify the progress of COPD patients in a similar way — by tracking them performing a sit-down, stand-up test.

Care for COPD has had a particular imperative during the pandemic as people with the chronic inflammatory lung disease who catch COVID-19 have the highest mortality rate among COVID-19-infected patients, per Mehl.

At the same time, pulmonary rehabilitation centers have been shut down during the pandemic because of the risk of infection to patients. So, once again, Kaia’s app has provided an alternative for suffers of chronic conditions to continue their rehab at home.

In the US Kaia focuses on activation rate as a percentage of the employer population — and Mehl says this stands between 5%-10%, depending on how the app is communicated to potential users. “We also had a company that had 15% of their population active it one year but you always have these outliers,” he adds.

Looking ahead to the coming 12 months, he says he expects to be able to grow revenue 5x-10x as a number of bigger partnerships kick in.

In Germany, where Kaia plans to start prescribing its app (via doctors), he’s hopeful they’ll be able to get 10,000 prescriptions done over the same period, once it has approval to do so under a national reimbursement system.

Plugging Kaia into wider healthcare provision

Integrating into a wider care pathway by being able to loop in healthcare providers where appropriate has been a big recent focus for Kaia.

In February it kicked off a major integration of its patient-facing MSK therapy/pain-management app with a referral system that plugs into services offered by other healthcare providers — using an escalation algorithm and screening and triage system, which it calls Kaia Gateway — to identify patients at risk of needing more invasive or intense treatment than the digital therapies its app can provide. It’s working with a number of premium partners for this referral path (i.e. within an employer or health plan’s ecosystem).

Its partners can provide additional medical services to relevant patients, both general and specialty care solutions, including disease management programs, PT, telemedicine, care navigation, and expert medical opinion services. Partners also get access to detailed treatment history on referred patients from Kaia, including via APIs.

“Besides being just an app-based therapy we want to expand more down the treatment path,” explains Mehl. “And also work with external medical providers — doctors etc — and bring our users at the right point to the right doctor to prevent any deterioration in pain that we cannot treat in the app. I think that brings a lot of trust, also, to the app.

“Because I think what’s happening now is that there’s so many digital therapies popping up everywhere. And one thing that is happening in the beginning when you’re small, like us three years ago, we just offered this app and said we don’t really know what’s happening before or after… Now we really want to integrate.”

“We have some cool partnerships coming up in the U.S. — partner with bigger medical providers that have thousands of medical providers on their payroll,” he goes on. “And then integrate with them so we can optimize the full treatment path. Because then the patients can really feel safe and say hey they don’t keep me in the app-based therapy when they know I should actually see somebody else because it’s not the best care anymore.”

“We have this platform approach but then we saw now it really makes sense to go deeper in these two diseases,” Mehl adds. “We start with our chronic pain approach in the U.S. and say we really want to go down the treatment path. And because the main problem is if people then start to be frustrated in our app and say I need something else and then they get back to this, for example, pain killers, opioids, surgery, cycle, and then they’re back in the system where we actually wanted to help them getting out of it so that’s why we say it’s not really possible to not integrate with healthcare professionals.

“You need to integrate them. If not you cannot always offer best care and then the patients realize at one point this app is not enough — but I also don’t get directed to a medical professional who could offer a new diagnosis or a different prescription. And then your trust is lost.”

“The other point is when you think about different levels of chronification, because we’re so scalable we can catch people much earlier in their chronification journey when the disease is still reversible. And even if our app is still the best treatment it helps to get an additional medical professional involvement to validate a diagnosis — or to just talk with a patient so that they really know that they’re safe here. So just reassuring, motivation and also diagnosis, to really say okay just to be sure we should make this diagnosis just to be sure you are getting best care. So I think that’s a huge product task and operational task for us.”

Kaia is starting by doing case referrals manually in-house — by setting up a medical case review team, staffed by doctors and therapies it employs — aided by a triage system that automatically flags patients for the team to review. But Mehl hopes this process will be increasingly assisted by AI.

“We assume yellow flags from what they told us in the entry test or from their exercise feedback or therapy feedback. Or from the interactions they have with their motivational coaches,” he explains of how the case review system works now. “Then [the case review team] has a look at them and decides if they should see an external medical provider partner and at what time.”

“Over time this should get more and more automated,” he adds. “We hope that we can make this better and better with machine learning over time and show that we can optimize the treatment path much better than just having this manual oversight. And that’s a huge challenge. If you think about what you need to do to get there I think it will define our product roadmap for years… But that’s also where the most value is to increase the quality of care. If not you just have siloed solutions everywhere… and the patient suffers because the treatment path is torn apart and it doesn’t feel like one thing.

“We will always need this clinical oversight. But where we can use machine learning is to help these medical professionals to look at the right patients at the right time. Because they cannot look at everybody all the time so there needs to be some filtering. And I think that filtering — or that triage — that can be really done by machine learning.”

Would Kaia ever consider becoming a healthcare provider itself? Combining a telemedicine service with some digitally delivered treatments is something that Sweden’s Kry, for example, has done — launching online cognitive behavioral therapy (CBT) treatments in its home market back in 2018 while also offering a telehealth platform and running a full healthcare service in some markets.

Mehl suggests not, arguing that telemedicine companies are by necessity generalists, since they are catering to “the top of the funnel”, handling and filtering patients with all sorts of complaints — which he says makes them less suited to focus deeply on catering to specific disease.

While, for Kaia, it’s deeply focused on building tech to treat a few specific diseases — and so, likewise, isn’t best suited to general medical service delivery. Partnering with medical service providers is therefore the obvious choice.

“I think about the patient journey and for the telemedicine companies… they might have some treatment paths integrated but they’re never as good as completely owning one chronic disease as we can be,” he says. “Most of chronic disease patients they just want to start a treatment because they talked with so many doctors. They want to find something that helps them and then at the right moment talk to the right medical professional. So that’s a difference in how telemedicine companies are doing it.

“The other question is how much of the medical provider job of the treatment path do we want to internalize? And we really are a tech company. We’re not very keen on becoming a medical provider. And we see that there are so many amazing medical providers in the landscape here — in different countries — that during COVID-19 had to become more digital, so it’s easy to partner with them, and why would we want to learn how to run a hospital where there are all these people who did it for decades and are really good at it, and we are really good at tech.”

“It’s really cool for the patient in the end. They know they get the best of both worlds and it’s optimized and ideally these offline medical providers get data from us so they can make better decisions — so they can also have a higher quality of decision-making because they have more data than just talking with a patient for two minutes. They can see our complete dashboard and how the patient progressed over time and everything — so the quality of decision-making gets higher.”

The U.S. overtook Europe as Kaia’s biggest market in recent years so it’s inexorably been focusing a lot of energy on serving its growing number of U.S. customers. The size of the addressable market in the U.S. is also massive, with ~100M chronic pain patients in the country, or around a third of the population.

But Kaia continues to develop its proposition in a number of European markets, including Germany which was where the business started. Mehl says its team in Munich is looking at how to make a recent reimbursement law for app-based health treatments will work for it in practice. It hasn’t yet obtained the necessary reimbursement code for doctors there to start prescribing its tech to their patients but it’s taking steps to change that.

At the same time, Mehl concedes that learning how to make doctors want to prescribe its app is an “open challenge” in the market.

“Some startups started doing it but — at scale — I still think there have to be some learning to be made to really scale it up,” he says of the German app prescriptions, adding that it’s preparing to hand in its application in relation to its COPD app which it will be bringing to market in Europe with a pharma partner.

“We also closed a partnership with a pharma company for Germany, UK and France to distribute our app through the pulmonologists — which is pretty cool. So we’re launching that partnership now,” he adds. “That will be exciting to see where the prescriptions start.”

Mehl professes himself a fan of Germany’s approach to digital healthcare — saying that it makes it easy to obtain a general reimbursement code which then gives the app-maker a year to prove any cost savings and deliver the care they say they do — couching that as a compromise between the “really long” process of getting approval for a medicine and the data-driven needs of startups where founders need to be able to show traction to get investment to build and grow a business in the first place.

“Healthcare’s already tough because you have to do clinical trials and it’s already a bit slower. So a longer approval process makes it even more difficult to launch something useful and I can see the UK, France, the Nordics bringing out some similar legislation to facilitate that,” he adds.

“We expect in other European countries — and in other countries in generally, like Canada, Australia and in Asia too — that they update their regulation to cover digital therapies. And then that will be good because we will know how to get apps prescribed and we know the other way, like in the U.S., [i.e. without needing to go through a doctor first]… And so with our app being so scalable we could easily launch in these countries compared to other companies in the market that are more reliant on one specific healthcare system or on hardware or anything that limits the scalability.”

 

Vista Equity takes minority stake in Canada’s Vena with $242M investment

Vena, a Canadian company focused on the Corporate Performance Management (CPM) software space, has raised $242 million in Series C funding from Vista Equity Partners.

As part of the financing, Vista Equity is taking a minority stake in the company. The round follows $25 million in financing from CIBC Innovation Banking last September, and brings Vena’s total raised since its 2011 inception to over $363 million.

Vena declined to provide any financial metrics or the valuation at which the new capital was raised, saying only that its “consistent growth and…strong customer retention and satisfaction metrics created real demand” as it considered raising its C round.

The company was originally founded as a B2B provider of planning, budgeting and forecasting software. Over time, it’s evolved into what it describes as a “fully cloud-native, corporate performance management platform” that aims to empower finance, operations and business leaders to “Plan to Growtheir businesses. Its customers hail from a variety of industries, including banking, SaaS, manufacturing, healthcare, insurance and higher education. Among its over 900 customers are the Kansas City Chiefs, Coca-Cola Consolidated, World Vision International and ELF Cosmetics.

Vena CEO Hunter Madeley told TechCrunch the latest raise is “mostly an acceleration story for Vena, rather than charting new paths.”

The company plans to use its new funds to build out and enable its go-to-market efforts as well as invest in its product development roadmap. It’s not really looking to enter new markets, considering it’s seeing what it describes as “tremendous demand” in the markets it currently serves directly and through its partner network.

“While we support customers across the globe, we’ll stay focused on growing our North American, U.K. and European business in the near term,” Madeley said.

Vena says it leverages the “flexibility and familiarity” of an Excel interface within its “secure” Complete Planning platform. That platform, it adds, brings people, processes and systems into a single source solution to help organizations automate and streamline finance-led processes, accelerate complex business processes and “connect the dots between departments and plan with the power of unified data.”            

Early backers JMI Equity and Centana Growth Partners will remain active, partnering with Vista “to help support Vena’s continued momentum,” the company said. As part of the raise, Vista Equity Managing Director Kim Eaton and Marc Teillon, senior managing director and co-head of Vista’s Foundation Fund, will join the company’s board.

“The pandemic has emphasized the need for agile financial planning processes as companies respond to quickly-changing market conditions, and Vena is uniquely positioned to help businesses address the challenges required to scale their processes through this pandemic and beyond,” said Eaton in a written statement. 

Vena currently has more than 450 employees across the U.S., Canada and the U.K., up from 393 last year at this time.

Brazil’s Positive Ventures closes on $10M fund for impact investing

Positive Ventures, a Sao Paulo-based venture firm, has secured $10 million for its latest fund.

Positive Ventures has raised the capital from an impressive list of LPs including investor Luis Stuhlberger, founding partner of Verde Asset Management and Teresa and Cândido Bracher, who was the chairman of Itaú-Unibanco, Brazil’s largest bank.

The Brazilian venture firm’s self-described mission is to “invest in startups where every dollar of revenue is also delivering environmental or social impact.”

I spoke with co-founder and co-CEO Fabio Kestenbaum who emphasized the importance of such an investment strategy in a country like Brazil that has had its share of corruption over the years. (Kestenbaum co-founded the firm with Andrea Oliveira and Bruna Constantino).

Positive Ventures prides itself on being guided by the United Nations as part of its Global Compact initiative. It also has a top tier B Impact Score, meaning as a B Corp. that makes impact part of its core strategy, it’s doing pretty darn good.

The firm’s sweet spot is early-stage — Seed and Series A — ventures “that can deliver outsized impact and financial return,” according to Kestenbaum. Its average investment size is $500,000, but the firm can go up to $1.5 million in follow-on rounds. 

Positive Ventures seeks to back impact-oriented early-stage companies “building breakthrough solutions to tackle massive challenges related to inequality and climate change.”

Partner and CIO Murilo Johas Menezes is based out of the Bay Area and leads the firm’s offshore strategy and investments in companies.

Investments

Positive Ventures is sector agnostic but keeps three impact megatrends in mind when sourcing deals: 

  • Planetary Boundaries, such as recycling, carbon, sustainable systems
  • Social Resilience, such as financial services, credit, workforce upskilling and 
  • Institutional Voids, focused on emerging economies’ most pressing challenges such as education, health and rising technologies.

“If you want to bring private capital to the game to help address social and environmental challenges, we have to reward this capital,” Kestenbaum told me in a previous interview. “As such, we recognize that we have to invest in good businesses that can provide financial returns as well.”So far, Positive Ventures has backed five companies from its new fund.

One of its first investments, Labi Exames, went on to become a “yardstick for fighting Covid in Brazil,” Kestenbaum said, by delivering a fair-priced and quality alternative to test millions of uninsured low-income families in vulnerable communities.

Labi helped support companies in reopening safely by continually testing their workforce. 

“This hybrid value proposition made Labi the most admired health tech in Brazil and resulted in MRR growth beyond 600%, accelerating their Series B, which will happen in the upcoming months,” Kestenbuam noted.

Another cornerstone investment for Positive Ventures was Slang, an AI-driven app to challenge the English illiteracy in Latin America backed by Chamath Palihapitiya of Social Capital and Mexico’s AllVP. 

“Less than 3% of Brazilians speak English with proficiency, and such a void hammers their chances to get a decent job and improve income,” Kestenbaum said. “The same happens in all LATAM’s countries.”

Positive Ventures recently went on to close its largest investment thus far — in Provi, a B-Certified fintech providing education-driven loans to enable upskilling and employability for LATAM’s workforce, starting in Brazil. The company’s mission is to revolutionize education by delivering hassle-free and impact-oriented credit.      

Provi has pioneered income-share agreements (ISAs) in the region and already generated over $30 million in credit, most of which will go toward technology and healthcare courses.

Next up for Positive Ventures is a $30 million growth fund.

Kry closes $312M Series D after use of its telehealth tools grows 100% yoy

Swedish digital health startup Kry, which offers a telehealth service (and software tools) to connect clinicians with patients for remote consultations, last raised just before the pandemic hit in Western Europe, netting a €140M Series C in January 2020.

Today it’s announcing an oversubscribed sequel: The Series D raise clocks in at $312M (€262M) and will be used to keep stepping on the growth gas in the region.

Investors in this latest round for the 2015-founded startup are a mix of old and new backers: The Series D is led by CPP Investments (aka, the Canadian Pension Plan Investment Board) and Fidelity Management & Research LLC, with participation from existing investors including The Ontario Teachers’ Pension Plan, as well as European-based VC firms Index Ventures, Accel, Creandum and Project A.

The need for people to socially distance during the coronavirus pandemic has given obvious uplift to the telehealth category, accelerating the rate of adoption of digital health tools that enable remote consultations by both patients and clinicians. Kry quickly stepped in to offer a free service for doctors to conduct web-based consultations last year, saying at the time that it felt a huge responsibility to help.

That agility in a time of public health crisis has clearly paid off. Kry’s year-over-year growth in 2020 was 100% — meaning that the ~1.6M digital doctors appointments it had served up a year ago now exceed 3M. Some 6,000 clinicians are also now using its telehealth platform and software tools. (It doesn’t break out registered patient numbers).

Yet co-founder and CEO, Johannes Schildt, says that, in some ways, it’s been a rather quiet 12 months for healthcare demand.

Sure the pandemic has driven specific demand, related to COVID-19 — including around testing for the disease (a service Kry offers in some of its markets) — but he says national lockdowns and coronavirus concerns have also dampened some of the usual demand for healthcare. So he’s confident that the 100% growth rate Kry has seen amid the COVID-19 public health crisis is just a taster of what’s to come — as healthcare provision shifts toward more digital delivery.

“Obviously we have been on the right side of a global pandemic. And if you look back the mega trend was obviously there long before the pandemic but the pandemic has accelerated the trend and it has served us and the industry well in terms of anchoring what we do. It’s now very well anchored across the globe — that telemedicine and digital healthcare is a crucial part of the healthcare systems moving forward,” Schildt tells TechCrunch.

“Demand has been increasing during the year, most obviously, but if you look at the broader picture of healthcare delivery — in most European markets — you actually have healthcare usage at an all time low. Because a lot of people are not as sick anymore given that you have tight restrictions. So it’s this rather strange dynamic. If you look at healthcare usage in general it’s actually at an all time low. But telemedicine is on an upward trend and we are operating on higher volumes… than we did before. And that is great, and we have been hiring a lot of great clinicians and been shipping a lot of great tools for clinicians to make the shift to digital.”

The free version of Kry’s tools for clinicians generated “big uplift” for the business, per Schildt, but he’s more excited about the wider service delivery shifts that are happening as the pandemic has accelerated uptake of digital health tools.

“For me the biggest thing has been that [telemedicine is] now very well established, it’s well anchored… There is still a different level of maturity between different European markets. Even [at the time of Kry’s Series C round last year] telemedicine was maybe not something that was a given — for us it’s always been of course; for me it’s always been crystal clear that this is the way of the future; it’s a necessity, you need to shift a lot of the healthcare delivery to digital. We just need to get there.”

The shift to digital is a necessary one, Schildt argues, in order to widen access to (inevitably) limited healthcare resources vs ever growing demand (current pandemic lockdown dampeners excepted). This is why Kry’s focus has always been on solving inefficiencies in healthcare delivery.

It seeks to do that in a variety of ways — including by offering support tools for clinicians working in public healthcare systems (for example, more than 60% of all the GPs in the UK market, where most healthcare is delivered via the taxpayer-funded NHS, is using Kry’s tools, per Schildt); as well as (in a few markets) running a full healthcare service itself where it combines telemedicine with a network of physical clinics where users can go when they need to be examined in person by a clinician. It also has partnerships with private healthcare providers in Europe.

In short, Kry is agnostic about how it helps deliver healthcare. That philosophy extends to the tech side — meaning video consultations are just one component of its telemedicine business which offers remote consultations for a range of medical issues, including infections, skin conditions, stomach problems and psychological disorders. (Obviously not every issue can be treated remotely but at the primary care level there are plenty of doctor-patient visits that don’t need to take place in person.)

Kry’s product roadmap — which is getting an investment boost with this new funding — involves expanding its patient-facing app to offer more digitally delivered treatments, such as Internet Cognitive Based Therapy (ICBT) and mental health self-assessment tools. It also plans to invest in digital healthcare tools to support chronic healthcare conditions — whether by developing more digital treatments itself (either by digitizing existing, proven treatments or coming up with novel approaches), and/or expanding its capabilities via acquisitions and strategic partnerships, according to Schildt.

Over the past five+ years, a growing number of startups have been digitizing proven treatment programs, such as for disorders like insomnia and anxiety, or musculoskeletal and chronic conditions that might otherwise require accessing a physiotherapist in person. Options for partners for Kry to work with on expanding its platform are certainly plentiful — although it’s developed the ICBT programs in house so isn’t afraid to tackle the digital treatment side itself.

“Given that we are in the fourth round of this massive change and transition in healthcare it makes a lot of sense for us to continue to invest in great tools for clinicians to deliver high quality care at great efficiency and deepening the experience from the patient side so we can continue to help even more people,” says Schildt.

“A lot of what we do we do is through video and text but that’s just one part of it. Now we’re investing a lot in our mental health plans and doing ICBT treatment plans. We’re going deeper into chronic treatments. We have great tools for clinicians to deliver high quality care at scale. Both digitally and physically because our platform supports both of it. And we have put a lot of effort during this year to link together our digital healthcare delivery with our physical healthcare delivery that we sometimes run ourselves and we sometimes do in partnerships. So the video itself is just one piece of the puzzle. And for us it’s always been about making sure we saw this from the end consumer’s perspective, from the patient’s perspective.”

“I’m a patient myself and still a lot of what we do is driven by my own frustration on how inefficient the system is structured in some areas,” he adds. “You do have a lot of great clinicians out there but there’s truly a lack of patient focus and in a lot of European markets there’s a clear access problem. And that has always been our starting point — how can we make sure that we solve this in a better way for the patients? And then obviously that involves us both building strong tools and front ends for patients so they can easily access care and manage their health, be pro-active about their health. It also involves us building great tools for clinicians that they can operate and work within — and there we’re putting way more effort as well.

“A lot of clinicians are using our tools to deliver digital care — not only clinicians that we run ourselves but ones we’re partnering with. So we do a lot of it in partnerships. And then also, given that we are a European provider, it involves us partnering with both public and private payers to make sure that the end consumer can actually access care.”

Another batch of startups in the digital healthcare delivery space talk a big game about ‘democratizing’ access to healthcare with the help of AI-fuelled triage or even diagnosis chatbots — with the idea that these tools can replace at least some of the work done by human doctors. The loudest on that front is probably Babylon Health.

Kry, by contrast, has avoided flashy AI hype, even though its tools do frequently incorporate machine learning technology, per Schildt. It also doesn’t offer a diagnosis chatbot. The reason for its different emphasis comes back to the choice of problem to focus on: Inefficiencies in healthcare delivery — with Schildt arguing that decision-making by doctors isn’t anywhere near the top of the list of service pain-points in the sector.

“We’re obviously using what would be considered AI or machine learning tools in all products that we’re building. I think sometimes personally I’m a bit annoyed at companies screaming and shouting about the technology itself and less about what problem you are solving with it,” he tells us. “On the decision-support [front], we don’t have the same sort of chatbot system that some other companies do, no. It’s obviously something that we could build really effortlessly. But I think — for me — it’s always about asking yourself what is the problem that you’re solving for? For the patient. And to be honest I don’t find it very useful.

“In many cases, especially in primary care, you have two categories. You have patients that already know why they need help, because you have a urinary tract infection; you had it before. You have an eye infection. You have a rash —  you know that it’s a rash, you need to see someone, you need to get help. Or you’re worried about your symptoms and you’re not really sure what it is — and you need comfort. And I think we’re not there yet where a chatbot would give you that sort of comfort, if this is something severe or not. You still want to talk to a human being. So I think it’s of limited use.

“Then on the decision side of it — sort of making sure that clinicians are making better decisions — we are obviously doing decision support for our clinicians. But if it’s one thing clinicians are really good at it’s actually making decisions. And if you look into the inefficiencies in healthcare the decision-making process is not the inefficiency. The matching side is an inefficiency side.”

He gives the example of how much the Swedish healthcare system spends on translators (circa €200M) as a “huge inefficiency” that could be reduced simply — by smarter matching of multilingual clinicians to patients.

“Most of our doctors are bilingual but they’re not there at the same time as the patient. So on the matching side you have a lot of inefficiency — and that’s where we have spent time on, for example. How can we sort that, how can we make sure that a patient that is seeking help with us ends up with the right level of care? If that is someone that speaks your native language so you can actually understand each other. Is this something that could be fully treated by a nurse? Or should it be directly to a psychologist?”

“With all technology it’s always about how do we use technology to solve a real problem, it’s less about the technology itself,” he adds.

Another ‘inefficiency’ that can affect healthcare provision in Europe relates to a problematic incentive to try to shrink costs (and, if it’s private healthcare, maximize an insurer’s profits) by making it harder for patients to access primary medical care — whether through complicated claims processes or by offering a bare minimum of information and support to access services (or indeed limiting appointment availability), making patients do the legwork of tracking down a relevant professional for their particular complaint and obtaining a coveted slot to see them.

It’s a maddening dynamic in a sector that should be focused on making as many people as healthy as they possibly can be in order that they avoid as much disease as possible — obviously as that outcome is better for the patients themselves. But also given the costs involved in treating really sick people (medical and societal). A wide range of chronic conditions, from type 2 diabetes to lower back pain, can be particularly costly to treat and yet may be entirely preventable with the right interventions.

Schildt sees a key role for digital healthcare tools to drive a much needed shift toward the kind of preventative healthcare that would be better all round, for both patients and for healthcare costs.

“That annoys me a lot,” he says. “That’s sometimes how healthcare systems are structured because it’s just costly for them to deliver healthcare so they try to make it as hard as possible for people to access healthcare — which is an absurdity and also one of the reasons why you now have increasing costs in healthcare systems in general, it’s exactly that. Because you have a lack of access in the first point of contact, with primary care. And what happens is you do have a spillover effect to secondary care.

“We see that in the data in all European markets. You have people ending up in emergency rooms that should have been treated in primary care but they can’t access primary care because there’s no access — you don’t know how to get in there, it’s long waiting times, it’s just triaged to different levels without getting any help and you have people with urinary tract infections ending up in emergency rooms. It’s super costly… when you have healthcare systems trying to fend people off. That’s not the right way doing it. You have to — and I think we will be able to play a crucial role in that in the coming ten years — push the whole system into being more preventative and proactive and access is a key part of that.

“We want to make it very, very simple for the patients — that they should be able to reach out to us and we will direct you to the right level of care.”

With so much still to do tackling the challenges of healthcare delivery in Europe, Kry isn’t in a hurry to expand its services geographically. Its main markets are Sweden, Norway, France, Germany and the UK, where it operates a healthcare service itself (not necessarily nationwide), though it notes that it offers a video consultation service to 30 regional markets.

“Right now we are very European focused,” says Schildt, when asked whether it has any plans for a U.S. launch. “I would never say that we would never go outside of Europe but for here and now we are extremely focused on Europe, we know those markets very, very well. We know how to manoeuvre in the European systems.

“It’s a very different payer infrastructure in Europe vs the US and then it’s also so that focus is always king and Europe is the mega market. Healthcare is 10% of the GDP in all European markets, we don’t have to go outside of Europe to build a very big business. But for the time being I think it makes a lot of sense for us to stay focused.”

 

Founders Factory Africa partners with Small Foundation to invest in 18 agritech startups

Johannesburg-based investment company Founders Factory Africa (FFA) today announced a partnership with Small Foundation that will see it select 18 agritech startups for an acceleration and incubation program.

Small Foundation is a Dublin-based philanthropic organization that focuses on the rural and agriculture sector in sub-Saharan Africa. With this partnership, Small Foundation is making an undisclosed investment in FFA to build and scale agritech startups on the continent.

“The partnership stands to make a significant impact across the continent by supporting agritech startups who can innovate and improve the delivery of a range of services to smallholder farmers and micro, small and medium-sized enterprises in the agricultural sector,” an excerpt in a statement read.

According to the South African-based venture development and investment company founded by Roo Rogers and Alina Truhina, early-stage founders will need to apply to join the Founders Factory Africa Venture Scale or Venture Build portfolios. These startups will have access to funding between $100,000 to $250,000 and hands-on technical support.

This is a change from when the company launched in 2018. FFA is an extension of the Founders Factory organisation that has invested in more than 130 companies globally. In 2018, FFA launched its first vertical in fintech when it partnered with the continent’s largest bank, Standard Bank, to invest in fintech startups. Some of the startups include Bwala, LipaLater, MVXchange and OkHi.

The following year, it took on a second investor in South African healthcare company Netcare Group and, via the partnership, invested in health-tech startups like RxAll, Redbird and Wellahealth.

Last year when we reported this partnership, startups in FFA’s Venture Scale accelerator program received a £30,000 cash investment and £220,000 in support services. Those in the Venture Build program received £60,000 cash and £100,000 toward support.   

For this third partnership, Truhina says FFA will be investing a total of $300,000 in cash and hands-on support for companies in its Venture Scale program. However, startups in Venture Build will be receiving up to $250,000 in funding.

The Venture Scale program involves providing support for existing startups operating in seed to pre-Series A stages. On the other hand, the Venture Build program is for founders wanting to launch a startup in Africa, who may or may not have a concept or an idea

Currently, there are 23 companies across FFA’s Scale and Build portfolios. These startups, mainly from Ghana, Kenya, Nigeria and South Africa, have collectively raised more than $7 million during and after the program. Truhina says FFA plans to increase this number to nearly 90 startups in total by 2024.

“We will build, scale and invest in 88 startups with current FFA investors (Standard Bank, Netcare and Small Foundation) until 2024. We plan to continue to take on new investors and continue to work on the continent indefinitely,” she said.

Founders Factory Africa

While FFA is dedicating a fund for agritech startups, it has invested in other startups with agritech solutions for instance Nigeria’s Foodlocker. The company forecasts foodstuff demand through machine learning and helps buyers procure goods from smallholder farmers. But despite this proposition, FFA classifies the startup as a fintech investment.

“Foodlocker was a company we selected and invested in under our Fintech portfolio, as the startup has a financial component. With Small Foundation, we are setting up a new dedicated agritech sector,” said Truhina. Small Foundation joins Standard Bank and Netcare in the peculiarity of assistance offered to FFA portfolio startups. From sector expertise and footprint across the continent to access to clients, POCs and pilots, these investors are trying to fill in the gap in sectors ripe for exponential growth.

But though fintech has caught on well with both local and international investors, the same cannot be said for health tech and agritech. According to Briter Bridges, fintech accounted for 31% of the total $1.3 billion raised by African startups. Health-tech startups accounted for 9%, while agritech startups represented just 7%.

Small Foundation wants to improve this number in its own little way, and concurrently has a plan to “end extreme poverty in sub-Saharan Africa by 2030.” Conor Brosnan, the CEO and chair of the foundation, holds that tackling the sector’s biggest issues with the FFA will bring the company toward achieving this objective.

“This is a pivotal time to invest in the growing area of agritech in Africa, which has transformative potential for local livelihoods. We are excited to see FFA’s highly skilled teamwork with immensely talented African entrepreneurs to deliver scaled solutions to some of the biggest challenges faced by the sector,” he said.

In three years, Founders Factory Africa has managed to enlist the services and finances of three influential partners. Yet, it has 55 more startups to invest in before 2024, so we should expect an increased investment activity and more partnerships to fund startups in other sectors.

The firm also has fresh capital in the works for its portfolio companies as it advances, though. It’s in the process of raising a $35 million “Africa Seed Fund” which will exist alongside FFA and execute follow-on capital in some portfolio companies.

Oath Care just raised $2 million to develop a social, health-focused app that groups expectant and new parents

Being an expectant mom can be frightening, as can mothering an infant or toddler. The answers don’t come automatically, and while there’s no shortage of books and websites (and advice from grandparents) about how to parent at every stage, finding satisfying information often proves a lot harder than imagined.

There are online social groups that deliver some of the social and emotional support that new parents need, no matter where they live. There are many dozens of mom communities on Facebook, for example. However, it’s because there’s room for improvement on this theme — big groups can feel isolating, bad information abounds —that Oath Care, a young, four-person San Francisco-based startup, just raised $2 million in seed funding from XYZ Ventures, General Catalyst, and Eros Resmini, former CMO of Discord and managing partner of the Mini Fund.

What is it building? Founder Camilla Hermann describes it as a subscription-based mobile app that’s focused on improving the lives of new mothers by combining parents with a whole lot in common with healthcare specialists and moderators who can guide them in group chats, as well as one-on-one video calls.

More specifically, she says, for $20 per month, Oath matches pregnant and postpartum moms in circles of up to 10  based on factors like stage of pregnancy, age of child, location, and career so they can ask questions of each other, with the help of a trained moderator (who is sometimes a mother with older children).

Oath also pushes curriculum that Oath’s team is developing in-house to members based on each group’s specific needs. Not last, every group is given collective access to medical specialists who can answer general questions as part of the members’ subscription and who are also available for consultations when individualized help is needed.

Hermann says the pricing of these 15-minute-long consultations is still being developed, but that the medical experts with whom it’s already working see the app as a form of lead generation.

It’s an interesting concept, one that could be taken in a host of directions, acknowledges Hermann who says she was inspired to cofound the company based on earlier work developing a contact tracing technology created to track outbreaks like Ebola in real time.

As she said yesterday during a Zoom call with TechCrunch and her cofounder, Michelle Stephens, a pediatric clinician and research scientist: “We’ve fundamentally misunderstand something really important about health in the West; we think that [changes] happen to one person at a time or one part of the body at a time, but it always happens in interconnected systems both inside and outside the body, which fundamentally means that it is always happening in community.”

For her part, Stephens — who was introduced to Hermann at a dinner years ago — says her motivation in cofounding Oath was born out of research into childhood stress, and that by “better equipping parents to be those positive consistent caregivers in their child’s life,” Oath aims to help enable stronger, more intimate child-parent bonds.

It might sound grand for a mobile app, but it also sounds like a smart starting point. Though the idea is to match mothers in similar situations at the outset to help bolster theirs and their children’s health, it’s easy to imagine the platform evolving in a way that brings together parents in numerous groups based on interests, from preschool applications to autism to same-sex parenting. It’s easy to see the platform helping to sell products that parents need. It’s easy to imagine the company amassing a lot of valuable information.

Indeed, says Hermann, the longer-term vision for Oath is to create rich datasets that it hopes can be used to improve health outcomes, including by identifying health issues earlier. Relatedly, it also hopes to build relationships with health systems and payers in order to increase access to its products.

For now, Oath is mostly just trying to keep up with demand. Hermann says the “small and scrappy” company found its first 50 users through Facebook ads, and that this base quickly tripled organically before Oath was forced to create a growing waitlist for what has been a closed beta until now. (Oath is “anticipating a full launch in late summer,” says Stephens.)

That’s not to say the company isn’t thinking at all about next steps.

While right now it is “laser focused on building out the most exceptional experience for this specific cohort of users in this specific period of time of their lives,” says Hermann, once it builds out many more communities of small trusted groups with “high engagement and high trust,” there is “a lot you can layer on top of that. It’s virtually limitless.”

‘Conscience laws’ endanger patients and contradict health tech’s core values

Recent laws allowing healthcare providers to refuse care because of conscientious beliefs and denying care to transgender individuals might not seem like an issue for the tech industry at first blush, but these types of legislation directly contradict the core values of health tech.

Arkansas Governor Asa Hutchinson last month signed into law S.B. 289, known as the “Medical Ethics and Diversity Act,” which allows anyone who provides healthcare services — not just doctors — to refuse to give non-emergency care if they believe the care goes against their conscience.

Arkansas is one of several states in the U.S. that have been pushing laws like this over the past several years. These “conscience laws” are harmful to all patients — particularly LGBTQ individuals, women and rural citizens — especially because over 40% of available hospital beds are controlled by Catholic institutions in some states.

While disguised as a safeguard that prevents doctors from having to participate in medical services that are at odds with their religious beliefs, these laws go far beyond that and should be repealed.

While disguised as a safeguard that prevents doctors from having to participate in medical services that are at odds with their religious beliefs, these laws go far beyond that and should be repealed.

“Non-emergency” service is open to interpretation

The Arkansas legislation is one giant slippery slope. Even beyond the direct effects that the law would have on reproductive rights and the LGBTQ community, it leaves open questions about the many different services that medical professionals could decline simply by saying it goes against their conscience.

Broadly letting healthcare providers decide which services they will perform based on religion, ethics or conscience essentially eliminates protections patients have under federal anti-discrimination regulations.

What constitutes an “emergency” to one doctor or EMT may be deemed a “non-emergency” by another. By allowing medical professionals to avoid performing some services, the bill can be interpreted as allowing anyone involved in the provision of healthcare services to avoid performing any kind of service, as long as they say they believed it wasn’t an emergency at the time.

The law also allows individuals to refuse to refer patients to someone who would provide the desired service for them. This places an undue burden on patients with physical or mental health issues and causes delays in treatment as the patient searches for an alternate provider. In cases of health and life-threatening issues, for example, women have been refused treatment at Catholic medical institutions and forced to ride to the closest emergency care center.

The health tech community is working to improve the health of all

The Arkansas law runs counter to the values of the businesses that are working hard to develop and improve medical technologies. Health tech startups at their core are fighting to provide more and better services to more patients — whether it’s by building platforms to make healthcare accessible to all, developing specific medical devices to improve the quality of service or researching new treatments and vaccines.

Imagine developing a vaccine for a global pandemic and then allowing doctors the right to refuse to administer it because it’s open to interpretation whether the virus represents an emergency to specific people. Or imagine a hospital pharmacist who deliberately tries to spoil hundreds of vaccine doses because of the conspiracy theories he believes. Laws like the one in Arkansas open up the healthcare system to abuse by conspiracy theorists, and it is already the case that many wellness providers are basing their advice and services on QAnon falsehoods.

The health tech community is not just developing medications and devices for patients whose beliefs are similar to their own. Equally, medical professionals should not be making it harder for people to get needed medical care based on personal feelings. On the contrary, the ultimate goal of health tech businesses and healthcare providers alike should be a singular focus on improving the quality of care for all.

“Medical ethics” and anti-LGBTQ laws are unethical

As the health tech community continues to work tirelessly to bring new solutions to the marketplace to improve the health of everyone, it must also stand against laws like this, which threaten to eradicate the important gains that have been made in enhancing the lives and health of patients.

The Arkansas law — and others like it — place the burden of finding appropriate care on the patient instead of on the medical community, where it belongs. These laws must be repealed.