The digital health space continues cooking on gas: Berlin-based Ada Health has closed a $90M Series B round of funding led by Leaps by Bayer, the impact investment arm of the German multinational pharma giant, Bayer AG. Other investors in the round include Samsung Catalyst Fund, Vitruvian Partners, Inteligo Bank, F4 and Mutschler Ventures.

The startup last raised around four years’ ago, reporting a $47M Series A round in 2017. But don’t be fooled by the low lettering of these rounds: Ada Health has been working on its symptom assessment tech for around a decade at this point — relying, in the first several years of its mission, on private funding from high net worth individuals in Germany and elsewhere in Europe.

Initially it was also focused on building a decision support tool for doctors before pivoting to directly addressing patients via an AI-driven symptom assessment app.

It’s not alone in offering this type of tool. Others in the space include Babylon, Buoy, K Health, Mediktor, Symptomate, WebMD and Your.MD — but Ada claims its app is the most used and highest rated by users. It can also point to a peer reviewed study it led, which was published in the BMJ, and compared the condition coverage, accuracy and safety of eight competitors. The study found its app led the pack on all fronts.

One reason for that edge is that Ada Health’s medical knowledge base covers around 30,000 ICD-10 codes (aka the alphanumeric codes used by doctors to represent different diagnoses) at this point — which co-founder and CEO, Daniel Nathrath, tells us is “by far the largest coverage of any of the systems in this space”.

The Ada Health app, which launched in late 2016 — and remains free to use — has been downloaded by more than 11 million people across 150 countries so far. Users have completed some 23M assessments using the tool which he likens to having “24/7 access to your trusted family doctor”.

Currently, the app has support for 10 languages. But the goal with the funding is to push for truly massive scale.

“The idea is to help as many people as possible get better access to healthcare around the world,” Nathrath tells TechCrunch. “Our ambition is, in a few years, that a billion people instead of 11M people will be using out technology. In order to get there we think that working with the right investors can help us accelerate that growth path and give more people the benefit of our technology faster.”

“With 11M app downloads I believe we are the most used AI symptom assessment technology that I know of in the world,” he goes on. “We are also the most rated and reviewed app in the medical category of the App Store and Google Play Store ever — after, what, just four years. With about 300,000 ratings and reviews, most of them five-star. So… we have gained some users but we think it’s just the beginning.

“Digital health — with all the things you see going on — is at an inflection point where it’s being realized not only by the users who have already been using our technology but also by health systems, governments, and payers, insurers, and life sciences companies — I think everyone has realized digital health is here to stay.”

As well as putting its symptom assessment app directly in the hands of patients, Ada Health offers a suite of enterprise solutions where partners pay it to be able to embed and deeply integrate its triage technology into their websites and digital services. That means they can use it to offer an entry point for their users — to help direct them to the correct service and provide administrative support by arming clinicians with health information provided by patient via the Ada interface (and the AI’s own assessment) ahead of the appointment.

One publicly disclosed customer for Ada’s enterprise offering is Sutter Health, in the Bay Area.

“They have integrated Ada into their own homepage and into their app so people can use it as a digital front door to the entire service of Sutter,” says Nathrath, explaining that the difference vs the version of the app that patients can download is “people don’t just get generic advice”. “It’s fully integrated. So if it says — for instance — you need to go to the emergency room… then you can go straight into appointment booking.

“And not only that; when you book the appointment the outcome of the Ada pre-assessment can then be shared with the health professional who will then look at you so the doctor doesn’t start from a blank sheet of paper but is already pre-briefed and gets decision support in terms of ‘this is constellation of symptoms the patient is reporting’ and ‘based on that these could be the most likely diagnosis and these should be the tests, examinations or investigations I should consider next to get to the confirmed diagnosis’.”

The added advantage for Ada’s enterprise partners is that patient data arrives with the doctor that sees them already structured so — after a few confirmations — they can easily import it into their documentation, saying precious minutes per patient, per Nathrath. “[If] you save a few minutes with each patient that means you have more time for the patients who really need you and not the patients who maybe has a cold and shows up in the emergency room, which unfortunately is a reality,” he adds.

With this enterprise strand of its business Ada is continuing to provide support for doctors. Nathrath suggests its patient-facing app is also being used for some informal decision support for doctors too.

More and more doctors are using the app “together with their patients”, he tells us, or else recommending it to their patients —  asking them “so what did Ada say?”.

The role of AI in healthcare will be a core one, Nathrath predicts — given that demand for healthcare professionals is always going to outstrip supply.

He argues that’s true even with rising use of telehealth platforms which can certainly make more efficient use of doctors’ time.

Ada did, at one point, offer a telehealth service itself — before deciding to fully focus its efforts on AI — so it’s approach now is to partner and integrate with other healthcare and health data providers throughout the care ecosystem.

“We think there’s a place for telehealth, obviously. It adds convenience. During the pandemic I guess it had a special role where for many it was almost the only way to interact with a doctor,” he says. “So we do see a place for telehealth but we also see an issue with telehealth in that it doesn’t address the structural issue in healthcare — that simply there aren’t enough doctors to serve the entire population of the world.”

“We’re building Ada as a multi-sided platform,” he adds. “We’ll be computing different sources of input data — which is sensor data, wearables data, lab data, genetic testing data — that’s on the input side — and then on the more downstream, on the next step after Ada, we can partner with any telehealth company in the world. And we’re seeing enormous interest from literally all corners of the world where telehealth companies approach us. And insurance companies and governments — where they say yes there is a use-case for telehealth but we basically need something before that, that filters people to the right next step.”

Whatever that right next step is in a patient’s care journey, “Ada is like the gatekeeper at the beginning of the journey that then sends you on your way,” is how Nathrath puts it.

The overarching vision is that Ada becomes not just an app in your pocket but an omnipresent “personal health companion” — or what it describes as “a personal operating system for health” — which is powerful enough to deliver preventative healthcare by being able to aggregate all sorts of data and spot health issues sooner so as to enable earlier and less costly interventions.

“What we’re building is really much more than a symptom assessment technology,” he tells TechCrunch. “Where you would also take into account lab results which can now be done much more direct to consumer than was previously possible, sensors and wearables data — and you probably say that Samsung is one of our investors but we’re obviously talking to all the large players in the space about this; how we can integrate that data best — and all the way to genetic testing and even the full genome sequence.

“When you take all these different sources of health information and compute them against each other on a continuous basis you’ll have something like an early warning system for your health — which, again, from a population health and system level perspective should be desirable for anyone who’s in charge of providing healthcare or paying for healthcare because you can catch the problem when it’s still a £100 problem and not yet a £100,000 a year problem.”

Given that ambition it’s interesting that big pharma is investing in Ada. (And its PR notes that it’s also in talks with Bayer on a potential strategic partnership.) But Nathrath suggests that the industry is well aware of the shifts being driven by digital health — and keen to avoid it’s own ‘Kodak moment’, i.e. by not adapting to the coming changes in a timely enough manner.

If AI-powered health interventions end up being so successful that they can shrink drug bills through earlier intervention and more preventative care then it makes good business sense for big pharma to be plugged into the cutting edge of digital health.

At the same time this type of tech might end up driving demand for medicines — exactly because of its scalability and because it can present a higher dimension view of more people’s health — meaning there’s more opportunity for increased prescription. So there’s not really a downside for pharma to get involved here.

“We’re really excited about the possibilities we can find by working together [with pharmaceutical companies] to really deliver a better healthcare experience to patients,” says Nathrath. “If you look at Bayer they have a consumer health business, they also have a pharmaceutical business and if you look at the cases within Ada if you look at the top ten most common ones it’s very comparable to what a GP would see all the time and a lot of those basically can end up in the recommendation towards healthcare where oftentimes an over the counter drug will be enough to address the issue. One area where Bayer has a lot of offerings, of course. But then their spectrum goes all the way towards rare diseases — where we’re also particularly strong. Where they have some drugs that help patients with very rare conditions.”

There are also potentially major research riches to be derived from the health data generated via Ada’s app which could also be interesting to pharma companies doing drug discovery.

Although Nathrath emphasizes that app users’ data is never used for research purpose without explicit consent from the individual (as is required under Europe’s General Data Protection Act).

But he also notes that Ada is able to do some interesting studies based on aggregated user data, too — giving an example of how it looked at kids mental health during COVID-19 lockdowns, comparing areas where schools had been shut vs those where they had remained open. “You could really compare what happened in different countries,” he says, noting that rates of depression in kids in Germany where schools and pre-schools were closed went up by over 100%, whereas in Switzerland where schools remained opened throughout there was no rise and even a slight improvement in children’s mental health.

In another example, involving aggregated data from usage of the app in US, he says it was able to show that it could have spotted a measles epidemic via the cases in the app slightly sooner than the CDC’s official announcement of an epidemic.

“If you think about the potential of that, in terms of spotting outbreaks earlier, that can be quite significant,” he suggests.

“We think there’s really a long list of ways we can work together [with researchers, policymakers and pharma companies] for the benefit of patients,” he adds. “The mission of all the people I spoke to at Bayer was really similar to ours — which is to help people, basically… That’s why we’re really happy to work with them.”

Commenting on the funding in a statement, Dr. Jürgen Eckhardt, head of Leaps by Bayer, added: “Investing in breakthrough technologies that drive digital change in healthcare is one of the strategic imperatives for Leaps by Bayer and for the entire field of healthcare. Ada’s truly transformative technology, combining powerful artificial intelligence with an emphasis on medical rigor and high levels of clinical accuracy will lead the way in helping more patients and consumers in achieving better health outcomes sooner by intervening earlier in their healthcare journey.”

Since the pandemic began last year, nearly 61% of adults in the United States gained weight, with the average adult surveyed gaining 15 pounds, according to a report from the American Psychological Association. Likely as a result of that rise in girths, Noom witnessed a surge of demand for its weight-loss app, generating $400 million in revenues in 2020 — almost twice the $237 million it made the year before.

Following on the heels of a banner year, and to fuel expansion into new categories and new countries around the globe, Noom announced this morning it had raised a $540 million Series F round led by Silver Lake. Other investors who participated in the round included Oak HC/FT, Temasek, Novo Holdings, Sequoia Capital, RRE, and Samsung Ventures.

“Most people want to eat healthier, exercise more, be less stressed, and get better sleep, but it’s not easy to change these behaviors,” said Saeju Jeong, co-founder and CEO of Noom in a statement. “This strategic round of funding reflects our investors’ confidence in the immense opportunity we have in building a business around helping as many people as possible live healthier lives through behavior change.”

Noom also announced the addition of two new board members, Silver Lake managing director Adam Karol, and former TaskRabbit CEO Stacy Brown-Philpot.

The Noom app may be a success now with 45 million downloads to date in 100 countries including the U.S., UK, Canada, Australia, Ireland, and New Zealand, but cofounders Jeong and Artem Petakov officially founded their startup in 2007 as a different venture entirely, experimenting with a connected bike and calorie-counting app. It had some early success, but it wasn’t until 2017, when Jeong and Petakov released a customer-focused and weight-loss-oriented app that the startup finally hit its stride, resonating with legions of people who longed to shed the weight they’d gained. The company raised $58 million of funding in mid-2019 led by Sequoia.

“If you go and you say, ‘Hey, I can solve hypertension for you, nobody cares,” explains Noom president and co-founder Artem Petakov. “So we put our heads together, and thought, ‘how do you make it work with consumers?’ Well, weight loss is a human value proposition that’s working. Can we double-down on that?”

Though the Noom app enables users to count the number of calories they consume each day — a feature that other apps like MyFitnessPal, LoseIt!, and MyPlate Calorie Counter share — Noom says the key to its users keeping the weight off in the medium-to-long term lies in its use of Cognitive Behavioral Therapy, a goal-oriented psychotherapy treatment that helps people understand and combat the things that trigger negative thoughts, compulsive actions, and unwelcome consequences.

Whether Noom can maintain its momentum remains to be seen. According to a Bloomberg report last week, the startup has reportedly met with potential advisers to gear up for an IPO later this year or early next year with a targeted valuation of nearly $10 billion.

Heaven knows what will happen to the mental health of children who’ve gone through this past year but if there’s one thing we need right now it’s mental health provision for young people that can scale. And as much as some of us can’t bear the thought of another video call, a UK startup reckons it’s come up with the magic formula for online therapy for children.

Now, Healios has raised a £7 million ($10M) Series A round to expand its platform across the UK. If the roll-out is successful, the startup is looking at expanding internationally. The round was led by InHealth Ventures with participation from existing investors AlbionVC.

Healios will use the funding to expand its AI, machine learning, and data science expertise, as well as add to the team. Healios says its platform digitises the clinical pathway, enabling children, adults, and their family members to use clinical services at home.

According to UK government statistics, one in eight (12.8%) five to 19-year-olds in the UK have a mental health disorder but two-thirds are unable to access NHS care because of soaring demands. And the Covid-19 pandemic has made things worse.

Launched in 2013, Healios says it has now worked with 65% of NHS Mental Health Trusts, with 70,000 specialized clinical sessions delivered, which is a high success rate for a startup, considering how hard it is to get NHS approval.

The online, family-focused therapy program for young people zeros in on psychosis and schizophrenia. Healios says that studies have shown involving family members from the start can reduce suicide by as much as 90%. It also covers anxiety, low mood, autism and ADHD, as well as support to their families.

Unlike some startups in the area of mental health, Healios is not a marketplace of advisers but is an end-to-end provider of these services.

InHealth Ventures and InHealth Group Chair, Richard Bradford, will be joining the Healios board, alongside Cat McDonald of AlbionVC.

Rich Andrews, Founder, and CEO of Healios, said: “This funding will help us reach more families in need and enable us to develop further sector-leading interventions and therapies. By bringing together clinical experts and giving them the tools to reach their patients regardless of where they are, we are closing the access gap which has plagued mental health provision for far too long.”

Andrews also told me: “A young person will have an initial mental health assessment with us. If needed, we’ll make a diagnosis and then they’ll move on to other interventions with us, so this is a seamless experience.”

Dr Ben Evans, Managing Director of InHealth Ventures, said: “Healios is a standard-bearer for healthcare innovation. They bring together clinical excellence with digital expertise, working in partnership with the NHS to address a critical, but complex area of care delivery. Healios’ work to date speaks for itself; their holistic approach to diagnosis and treatment has had a substantive impact on clinical outcomes and patient experience.”

Cat McDonald, Investor at AlbionVC, added: “Covid has engendered a pace of innovation previously unseen in healthcare. In particular, we have seen that remote care not only works, but often works much better than traditional alternatives. The option to receive care remotely, at home and in a family-centric setting is the strong preference of most kids suffering from poor mental health.”

Mental health has been put into the spotlight in a big way in recent times. For many of us, our lives and lifestyles have changed massively in the last year, and alongside that, we’re collectively facing pandemic-fueled mortality on a global scale in a way that hasn’t existed for generations, a perfect storm of sorts that has inevitably had an impact on our state of mind and our moods.

Today a startup that has built a platform to help people think about and respond to this situation is announcing a big round of growth funding, specifically to help address all of this and how it plays out in one of the more stress-inducing aspects of our life — our workplaces.

Unmind — a London startup that has built a mental health app for the workplace — has raised $47 million, a Series B that it will be using to continue investing in its research and development and also to expand its business reach. The funding is being led by EQT Ventures –- a very active investor at the moment in UK growth rounds — with participation also from Sapphire Ventures and previous backers Project A, Felix Capital, and True.

The core of Unmind’s service is an app built around a set of questions to help employees explore their own states of mental health, which could include depression, anxiety, insomnia, and a host of other manifestations. It provides advice and content to begin addressing the results of that — exercises, advice, podcasts, links for further reading, and links to seeing further help from professionals (not more machine interfaces, but humans). It also provides a service to the employers, sharing anonymized data from the app with them so that they, too, can consider how better to respond to their employees’ needs.

The app has seen some notable traction especially in the last year, a time when the conversation about mental health has become much more commonplace and critical, given the environment we’ve been living in.

Unmind does not disclose user numbers, nor how they have grown, but it tells me that uptake and adoption of its app ranges from 15% to over 60% of an organization’s workforce (this varies by size, and the emphasis that the organization itself puts on using the app, among other things). It said that of those employees who are using Unmind, 88% have said they experience an improvement in mental wellbeing, work, or relationships, while 92% report higher confidence, awareness, and understanding of mental health.

The company also said that revenues grew by more than 3x in the last 12 months. Meanwhile, its customers include major retailers like John Lewis and M&S, high street bank TSB, Uber, Samsung, Virgin Media, British Airways and Asos — a list of companies that have strong degrees of customer service around them, have been greatly impacted by the lockdowns, and you can imagine must have a lot of people working in them pretty stressed out as a result of being on the front lines of interfacing with a stressed-out wider population of consumers.

The company was co-founded by Dr Nick Taylor, who previously had been a clinical psychologist and worked for years in mental health care (and before that was a classically-trained singer), who said he came up with the idea after feeling like he was seeing too many people only for the first time at a stage when their issues were already very advanced.

“I kept encountering the same frustration time and again: I wish I’d met this person six months ago,” Taylor said in an interview.

As with all kinds of preventative healthcare, it’s always better to identify and work on issues before they grow big and more urgent, and so he set out to think about how one might approach the concept of a preventative check-up and check-in for mental health.

The workplace is not a bad place to base that effort. Not only is it often a source of stress for people, but it’s a regular place for them to be every day so creating a way of assessing mental health through that implicitly creates a kind of routine to the effort. It also potentially means a closer connection to the employer to work on issues more collectively when and if they emerge, in a way that the employer might not do (or ever discover) through other means.

The connection between work and mental health is a longstanding one but has perhaps been proven out more than ever before in the last year.

“I didn’t know what would happen with mental health during Covid,” Taylor recalled. “I actually wondered if it would be demoted,” given all of the other conflicting priorities. “But the prevalence of mental illness has escalated. It’s out of control. And in the workplace, it’s a leading cause of absenteeism and turnover.” And given how full-on everything has become, including likely more hours spent working since now it all has merged with our home lives, we all know (and may well be among) many people who are feeling incredibly burned out right now.

Taylor said that in fact quite the opposite has happened to his early skepticism: mental health has become front of mind, “and the shackles of stigma are falling away.”

This is part of what has really caught the eye of investors: technology that is not just effective, but very relevant to right now. “It is now universally recognized that our Mental Health is as important if not more important than our physical health – but has long been neglected. That is now changing rapidly,” said Alastair Mitchell, a partner at EQT Ventures. “As a result there has been a massive rise in the popularity of consumer mental health apps which is now being matched by surging demand from employers and employees for the same in the workplace. Unmind is the leading mental health app for the enterprise and we are so excited to work with Dr Nick and the team to support their scaling globally.” EQT is also a strategic investor, not just a financial one: it’s rolling out Unmind across its own workplace and its many portfolio companies.

Unmind, it should be noted, is not the only company that has identified this “opportunity,” if you could call it that. They include other startups like SF-based Ginger — which has also built a platform that partners with employers, but also healthcare providers and other stakeholders, to help people identify and manage their state of mind. Ginger has been well-capitalised over the years. Others in the same space include Welbot in New York, Spill also out of London and a host of others providing different aspects of mental wellness like Calm and Headspace, the meditation apps.

I’m inclined to think that, given the size of the problem and that mental health should not be a bunfight but something that takes a village to address, the key will be in how each company approaches its remit, and how people respond to it, and whether what people do ultimately use results in better bridges for employees to getting the help and peace they need, whether it’s from the app or a professional.

“We have a responsibility to connect with our mental health in the same way that we do when it comes to healthcare,” Taylor said, likening the effort to how it takes a number of skill sets sometimes to work on the complexities of a health issue. “Great healthcare integrates across a number of systems.”

While much of the world eagerly watches to see if the vaccination rollout helps curb and eventually stamp out Covid-19, one of the companies that has been helping to manage the spread of the virus is announcing a big round of funding on the heels for strong demand for its technology.

Huma, which combines data from biomarkers with predictive algorithms both to help monitor patients, and uses the same technology to help researchers and pharmaceutical companies run clinical trials, has closed an equity round of $130 million, a Series C that the company can extend to $200 million by way of a $70 million debt line if it chooses.

Huma can pick up data that patients contribute via smartphones, or by way of diagnostic devices that measure glucose, blood pressure or oxygen saturation, and the plan will be to use the funding to augment that in a couple of ways: to continue investing in R&D to both expand the kinds of biomarkers that Huma can measure and to work on more research and trials; to continue expanding London-based Huma’s business particularly in newer geographies like the US, alongside a strong wave of business it’s been seeing in Europe, specifically the UK and the DACH region.

The funding includes a number of high-profile strategic and financial backers that speak to some of the opportunities coming down the pike. Co-led by Leaps by Bayer, the VC division of the pharmaceutical and life sciences giant, and Hitachi Ventures, it also includes Samsung Next, Sony Innovation Fund by IGV (one of Sony’s investment funds), Unilever Ventures and HAT Technology & Innovation Fund, Nikesh Arora (the former president of SoftBank and ex-Google exec) and Michael Diekmann (Chairman of Allianz) all in the round. Bayer also led Huma’s $25 million Series B in 2019, when the startup was still called Medopad.

Medopad rebranded to Huma last year in April, just as the Covid-19 pandemic was really taking hold across the world. In the year since, CEO and founder Dan Vahdat said that the company has been on a growth tear, working hard across the spectrum of areas where its technology could prove useful, since it provides a bridge to monitoring patients remotely, at a time when it’s been significantly more challenging to see people in person.

“Last year when the pandemic first hit, it made everyone’s lives miserable not just from the health aspect but also research aspect,” he said. “The whole idea is how to decentralize care and research.”

Its work has included partnering with the NHS early on to ship some 1 million oxygen saturation devices to monitor how patients’ levels were faring, since that was early on discovered to be a leading indicator of whether a patient would need urgent medical care: this was essential way to triage people remotely at a time when hospitals were quickly getting overwhelmed with people. Vahdat said this directly helped reduce readmissions by one-third.

It is also playing a role in helping to monitor all the many patients who had been due to have operations but found those postponed. In the UK alone, there were 4.8 million people waiting as a result for their procedures, “a shocking number,” Vahdat said. How to handle that queue? The idea here, he said, is that when you are a patient at home waiting for cardiac surgery, your condition might deteriorate quickly. Or it may not. Huma set up a system to provide diagnostics for those patients to monitor how they were doing: signs that they were not doing well meant they would get moved up and brought in to be seen by a specialist before they deteriorated and became urgent rather than managed cases.

Alongside this clinical work, Huma has also been working on a number of trials and research, including a phase 4 study on one of the Covid-19 vaccines that has been getting distributed under emergency authorization (this is a regulatory process that comes in the wake of that authorization).

It’s also been continuing to contribute essential data to ongoing medical research. One that the company can disclose that is not directly related to Covid-19 is a heart study for Bayer; and one that is related to Covid-19 — finding better biomarkers (specifically in looking at digital phenotypes) to detect Covid-19 infections earlier — called the Cambridge Fenland study.

This long list of work has meant that Huma still has much of its Series B in the bank, and so it’s also been turning its attention to humanitarian work, donating resources to India and other countries still in the throes of their own Covid-19 crises.

Although startups that bridge the worlds of medicine and technology can be very long plays, the last year has shown not just how vital it is to invest in the smartest of these to see out their ambitions for the greater good of all of us, but that, when they do have their breakthroughs, it can prove to be a huge thing for the companies and investors. BioNTech’s last year has been nothing short of a stratospheric turnaround, going from a loss-making business to one producing more than $1 billion in profit in the last quarter on the back of its Covid-19 vaccine research and work with Pfizer.

It’s for that reason that so many investors are keen to continue supporting the likes of Huma and the insights it provides.

“Aligned with the vision of Leaps by Bayer, Huma’s expertise and technology will help drive a global paradigm shift towards prevention and care and may boost research efforts using data and digital technology,” said Juergen Eckhardt, Head of Leaps by Bayer, in a statement. “We invest into the most disruptive technologies of our time that have the potential to change the world for the better. As an early investor into Huma we know how perfectly the company fits into that frame as one of the leading digital innovators in healthcare and life sciences.”

“Huma has built a comprehensive remote patient monitoring platform and established a strong track-record and we are excited to be working with Huma to bring its world-leading health technology to new markets in Asia. We believe that together we can advance new digital health products to power better care and research for all,” added Keiji Kojima, EVP of Hitachi’s Smart Life division.

SaaS-maker Birdie has closed an $11.5 million Series A round of funding led by Index Ventures. Existing investor Kamet Ventures also participated.

The UK-based caretech startup has raised a total of $22.9M since being founded back in 2017 (a 2018 raise that was called a Series A at the time is now being classed as a seed expansion). It’s focused on building tools for social care providers to drive efficiencies in a chronically under resourced sector.

Birdie isn’t a care provider itself (so it’s not a direct competitor to a startup like Lifted); rather it aims to support care providers with a suite of digital tools intended to reduce admin costs and makes it easier to manage the care being provided to individuals — doing away with the need for paper-based records, and enabling real-time visibility such as via carer check-ins and medication-related notifications.

The wider mission is for the platform to support care providers to offer more co-ordinated, personalized and — the hope is — preventative care so that older adults can be supported to live for longer in their own homes.

“Technology can completely transform the way we look after the elderly and help them to age at home much longer, healthier and happier,” says CEO and co-founder Max Parmentier, explaining the founding premise. “We position ourselves as a solution to uniquely offer a full support for the elderly to age at home… So we started off with the people closest to the elderly and caring for the elderly which are the care providers. And when we look at how these providers are operating they are extraordinary committed, and very much involved in their work, but the care delivered is very uncoordinated, reactive and sometimes very generic.

“We felt that we could go way beyond — in terms of technology — becoming the operating system to be much more efficient in the way they deliver care but also to significantly increase the quality of the care delivered.”

What’s the draw for VCs to invest in such an under-resourced market? “There’s macro trends which are unavoidable. I agree with you that it’s vastly underfunded but it’s just unsustainable,” he argues. “There is clearly an argument to say that whether VCs or investors are interested in this industry or not it’s going to get bigger. And one way or another we’ll have to find some funding mechanism to pay for it.”

“Today already we hear horrible stories about older people not being taken care of properly. I think what got particular Index excited is really the opportunity to [tell a positive story],” he goes on. “I’m quite an optimistic person. I do believe that actually you could very much craft a much happier path in terms of ageing which is actually more affordable — because it doesn’t cost as much because you really lower the healthcare costs if you really tailor these packages better and tailor the care much better. And you can also use technology to make it more personalized, more preventative.”

By simplifying and streamlining data capture around elderly care via a digital platform, information about the care being delivered can be structured in a way that helps reduce errors (such as from handwritten notes leading to administering the wrong medication) and allows for problems to be spotted early when an intervention may be highly beneficial, is the contention.

Parmentier gives the example of early signs of a urinary tract infection which, if picked up on — by spotting telltale signs in the data — can be treated simply at home with antibiotics. But if not an elderly person may end up in hospital, with all the associated risks of a far worse outcome.

Birdie can also supply connected hardware like motion sensors to its care provider customers so that its platform can monitor frail elderly adults who may be at risk of falling. Although Parmentier emphasizes that such hardware is an optional component of the platform — and is only installed with the full knowledge and consent of the care recipient.

The business is focused on “serving the interests and the rights of these older adults and no one else”, he says, confirming that care recipients’ data is not shared with any third parties unless it’s directly related to the delivery of their care.

Birdie’s team (Image credits: Birdie)

Having a digital platform-level view into an individual’s care obviously offers increased visibility vs paper-based records. It also means real-time data can be shared — such as with close family members who may want the reassurance of knowing when their loved one has received a visit or taken their medication, and so on. (Again, though, only with the proper consents.)

“There is a positive narrative which is that ageing is actually great,” Parmentier suggests. “If you’re in good health this part of your life is probably one of the most exciting. And this is really the spin we should give in terms of story but also we should empower these older adults with the right support to take that happy path.”

To date, Birdie has partnered with almost 500 providers across the U.K. — and currently its platform is being used to support the care of more than 20,000 older people every week.

Growth has been 8x over the past 12 months, per Parmentier, as the coronavirus pandemic has accelerated demand for in-home elderly care. The new funding will go on accelerating growth in the U.K., though he also says it has its eye on other geographies and sees potential to expand internationally.

“Phase one [of the business] is how can we empower these care providers to be better at what they do?” he says. “Because I really believe that there’s am army of care givers who are so committed and if we can help them be better at what they do that’s beautiful.”

Having structured data on elderly care provides a foundation for conducting research that could further the ‘preventative’ care component of the mission — and Birdie is taking some tentative steps in that direction via some project partnerships.

Such as one into polypharmacy (i.e. concurrent use of medications which can have negative clinical consequences) with U.K.-based AI company Faculty.

“There’s very little known as to what impact medication has on older adults health. If you think about it we just have pharma companies doing trials and then flagging secondary symptoms up when they arise and then doctors prescribe that. The reality is for elderly people — because usually they combine different medications — the symptoms and the damage to health can be greater,” he explains.

“What we’ve done with Faculty is to look at what is the medication treatment of an older adult and what is the clinical observations from carers following these medication treatments. So do we see that typically there’s less appetite to eat or drink, or complaints about pains and so on. And do we see correlations with the actual medication treatment prescribed?”

The polypharmacy research is at an early stage but he says the hope is they will be able to build an AI model that can generate warnings for a prescribing clinician if a particular medication regime has been linked to outcomes that may damage health or otherwise hamper healthy caring for an individual.

On the research side, Birdie’s website notes that it’s using “anonymized” data in these exploratory efforts — which is a claim that merits scrutiny given that medical data is both very sensitive and notoriously difficult to robustly (irreversibly) anonymize.

Asked about this, Parmentier says that for the moment its research efforts entail correlating data on different older adults from different care providers, and that the data being pooled is limited to specifically relevant info (i.e. depending on the research project) — removing “all the un-needed data”, as he puts it. 

He says it is not, for example, currently combining any of the data it holds with National Health Service (NHS) patient data — which he acknowledges could pose a major risk of re-identification. But he also says Birdie does want to go there because it believes that combining more data-sets could help it further preventative care research.

“The risk is when you pool your data with any third party data-set such as the NHS for instance. That is really risky… because there’s always a way to tie it back. So we’ve been keeping away from that for the moment,” he tells TechCrunch.

“I think it can really improve our preventative models but we need to do that only under very strict conditions that the anonymization is bullet-proof,” he adds. “We haven’t done that yet and we’re exploring ways to do it. But we’re going to very cautious about it. So for the moment there’s no risk really because we’re not mixing data-sets of the same patient. But if we were to integrate with third parties’ systems the risk will rise — and we’ll need to address it very clearly.”

Parmentier also offers a glimpse of an ambitious potential second phase of the business — where Birdie believes it will be able to coach older adults themselves (and/or their family members who are acting as care givers), i.e. enabled by its platform-level view of best practice (and by being able to fold in data-fuelled research into preventative care AI models).

To get there will require not, just a lot of data, but a sectoral shift toward a model of care delivery focused on “value-based healthcare”; where the provider is billed not for hours of care given but on health/quality of life outcomes. So the transformative vision of highly scalable, data-enabled elderly home care is certainly not going to arrive overnight.

In the meanwhile Birdie’s business remains firmly in phase one: Building support tools to drive efficiency and quality for an under-resourced sector.

“We see the same problem everywhere,” adds Parmentier. “Today already we don’t look after our elderly properly… Today they cost us about 60% of our healthcare costs. Tomorrow is going to be much worse. We need to channel more investment into this industry — in terms of new ways of operating, technology, and really innovation is key to move towards better models where it’s more preventative, more personalized, more outcome based — because that’s the solution. It’s going to lower the cost base, it’s going to improve the health outcomes.”

Commenting in a statement, Stephane Kurgan, venture partner at Index Ventures, added: “Our ageing society and increasing healthcare costs require us to rethink the way we care for frailer populations like the elderly. Technology gives us the tools, as the care sector has remained widely paper-based and is ripe for disruption.

“By investing in caretech with Birdie, we are investing in solving the daily challenges of the care community. We firmly believe in Birdie’s vision to make care more personalised and more preventative so that older people can age at home longer, healthier and happier. We’ve been impressed by Birdie’s traction and the calibre of its team, and are very excited to embark on this journey with them.”

The pandemic forced many employees to begin working from home, and, in doing so, may have changed the way we think about work. While some businesses have slowly returned to the office, depending on where you live and what you do, many information workers remain at home.

That could change in the coming months as more people get vaccinated and the infection rate begins to drop in the U.S.

As that happens, it is likely that more offices will reopen. We’ve already heard from major employers like Salesforce, which indicated it will be allowing a percentage of its workforce back to the office this month, starting with the company’s San Francisco headquarters. The CRM giant plans to move slow and follow the government’s lead, allowing 20% capacity at first and hoping to build to 70% over time.

Most companies aren’t the size of Salesforce, which boasts a worldwide workforce of more than 50,000 employees. These smaller companies often don’t control entire skyscrapers, as Salesforce does in San Francisco. That creates complicating factors, including managing people who aren’t willing to be vaccinated, dealing with social distancing and masking, and sharing buildings or floors with other companies.

Even more, many companies have discovered that their employees work just fine at home. And some workers don’t want to waste time stuck on congested highways or public transportation now that they’ve learned to work remotely. But other employees suffered in small spaces or with constant interruptions from family. Those folks may long to go back to the office.

On balance, it seems clear that whatever happens, for many companies, we probably aren’t going back whole-cloth to the prior model of commuting into the office five days a week.

Last August, we spoke to a number of tech company executives about what returning to the office could look like. We recently went back to most of those same executives, as well as a Rhode Island state official and a medical expert we spoke to then to revisit the idea and talk about what’s changed and what work could look like as move slowly toward the post-pandemic era.

The office will never be the same

While their approaches vary, all of the executives I spoke to said that they foresee adopting a hybrid model when they can return in earnest, although there were definitely different interpretations of what that means, and what the office structure will look like.

Disasters may not always be man-made, but they are always responded to by humans. There’s a whole panoply of skills and professions required today to respond to even the tiniest emergency, and that doesn’t even include the needs during pre-disaster planning and post-disaster recovery. It’s not a very remunerative industry for most and the mental health effects from stress can linger for decades, but the mission at the core of this work — to help people in the time of their greatest need — is what continues to attract many to partake in this never-ending battle anyway.

In the last three parts of this series on the future of technology and disaster response, I’ve focused on, well, technology, and specifically the sales cycle for new products, the sudden data deluge now that Internet of Things (IoT) is in full force, and the connectivity that allows that data to radiate all around. What we haven’t looked at enough so far is the human element: the people who actually respond to disasters as well as what challenges they face and how technology can help them.

So in this fourth and final part of the series, we’ll look at four areas where humans and technology intersect within disaster response and what future opportunities lie in this market: training and development, mental health, crowdsourced responses to disasters, and our doomsday future of hyper-complex emergencies.

Training in a hellfire

Most fields have linear approaches to training. To become a software engineer, students learn some computer science theory, add in some programming practice, and voilà (note: your mileage may vary). To become a medical doctor, aspiring physicians take an undergraduate curriculum teeming with biology and chemistry, head to medical school for two deadened years of core anatomy and other classes and then switch into clinical rotations, a residency, and maybe fellowships.

But how do you train someone to respond to emergencies?

From 911 call takers to EMTs and paramedics to emergency planning officials and the on-the-ground responders who are operating in the center of the storm as it were, there are large permutations in the skills required to do these jobs well. What’s necessary aren’t just specific hard skills like using call dispatch software or knowing how to upload video from a disaster site, but also critically-important softer skills as well: precisely communicating, having sangfroid, increasing agility, and balancing improvisation with consistency. The chaos element also can’t be overstated: every disaster is different, and these skills must be viscerally recombined and exercised under extreme pressure with frequently sparse information.

A whole range of what might be dubbed “edtech” products could serve these needs, and not just exclusively for emergency management.

Communications, for instance, isn’t just about team communications, but also communicating with many different constituencies. Aaron Clark-Ginsberg, a social scientist at RAND Corporation, said that “a lot of these skills are social skills — being able to work with different groups of people in culturally and socially appropriate ways.” He notes that the field of emergency management has heightened attention to these issues in recent years, and “the skillset we need is to work with those community structures” that already exist where a disaster strikes.

As we’ve seen in the tech industry the last few years, cross-cultural communication skills remain scarce. One can always learn this just through repeated experiences, but could we train people to develop empathy and understanding through software? Can we develop better and richer scenarios to train emergency responders — and all of us, really — on how to communicate effectively in widely diverging conditions? That’s a huge opportunity for a startup to tackle.

Emergency management is now a well-developed career path. “The history of the field is very fascinating, [it’s] been increasingly professionalized, with all these certifications,” Clark-Ginsberg said. That professionalization “standardizes emergency response so that you know what you are getting since they have all these certs, and you know what they know and what they don’t.” Certifications can indicate singular competence, but perhaps not holistic assessment, and it’s a market that offers opportunities for new startups to create better assessments.

Like many of us, responders get used to doing the same thing over and over again, and that can make training for new skills even more challenging. Michael Martin of emergency data management platform RapidSOS describes how 911 call takers get used to muscle memory, “so switching to a new system is very high-risk.” No matter how bad existing software interfaces are, changing them will very likely slow every single response down while increasing the risk of errors. That’s why the company offers “25,000 hours a year for training, support, integration.” There remains a huge and relatively fragmented market for training staff as well as transitioning them from one software stack to another.

Outside these somewhat narrow niches, there is a need for a massive renaissance in training in this whole area. My colleague Natasha Mascarenhas recently wrote an EC-1 on Duolingo, an app designed to gamify and entrance students interested in learning second languages. It’s a compelling product, and there is no comparative training system for engaging the full gamut of first responders.

Art delaCruz, COO and president of Team Rubicon, a non-profit which assembles teams of volunteer military veterans to respond to natural disasters, said that it’s an issue his organization is spending more time thinking about. “Part of resilience is education, and the ability to access information, and that is a gap that we continue to close on,” he said. “How do you present information that’s more simple than [a learning management system]?” He described the need for “knowledge bombs like flash cards” to regularly provide responders with new knowledge while testing existing ideas.

There’s also a need to scale up best practices rapidly across the world. Tom Cotter, director of emergency response and preparedness at Project Hope, a non-profit which empowers local healthcare workers in disaster-stricken and impoverished areas, said that in the context of COVID-19, “a lot of what was going to be needed [early on] was training — there were huge information gaps at the clinical level, how to communicate it at a community level.” The organization developed a curriculum with Brown University’s Watson Institute in the form of interactive PowerPoints that were ultimately used to train 100,000 healthcare workers on the new virus, according to Cotter.

When I look at the spectrum of edtech products existing today, one of the key peculiarities is just how narrow each seems to focus. There are apps for language learning and for learning math and developing literacy. There are flash card apps like Anki that are popular among medical students, and more interactive approaches like Labster for science experiments and Sketchy for learning anatomy.

Yet, for all the talk of boot camps in Silicon Valley, there is no edtech company that tries to completely transform a student in the way that a bona fide boot camp does. No startup wants to holistically develop their students, adding in hard skills while also advancing the ability to handle stress, the improvisation needed to confront rapidly-changing environments, and the skills needed to communicate with empathy.

Maybe that can’t be done with software. Maybe. Or perhaps, no founder has just had the ambition so far to go for broke — to really revolutionize how we think about training the next generation of emergency management professionals and everyone else in private industry who needs to handle stress or think on their feet just as much as frontline workers.

That’s the direction where Bryce Stirton, president and co-founder of public-safety company Responder Corp, has been thinking about. “Another area I am personally a fan of is the training space around VR,” he said. “It’s very difficult to synthesize these stressful environments,” in areas like firefighting, but new technologies have “the ability to pump the heart that you need to experience in training.” He concludes that “the VR world, it can have a large impact.”

Healing after disaster

When it comes to trauma, few fields face quite the challenge as emergency response. It’s work that almost by definition forces its personnel to confront some of the most harrowing scenes imaginable. Death and destruction are given, but what’s not always accounted for is the lack of agency in some of these contexts for first responders — the family that can’t be saved in time so a 911 call taker has to offer final solace, or the paramedics who don’t have the right equipment even as they are showing up on site.

Post-traumatic stress is perhaps the most well-known and common mental health condition facing first responders, although it is hardly the only one. How to ameliorate and potentially even cure these conditions represents a burgeoning area of investment and growth for a number of startups and investors.

Risk & Return, for instance, is a venture firm heavily focused on companies working on mental health as well as human performance more generally. In my profile of the firm a few weeks ago, managing director Jeff Eggers said that “We love that type of technology since it has that dual purpose: going to serve the first responder on the ground, but the community is also going to benefit.”

Two examples of companies from its portfolio are useful here to explore as examples of different pathways in this category. The first is Alto Neuroscience, which is a stealthy startup founded by Amit Etkin, a multidisciplinary neuroscientist and psychiatrist at Stanford, to create new clinical treatments to post-traumatic stress and other conditions based on brainwave data. Given its therapeutic focus, it’s probably years before testing and regulatory approvals come through, but this sort of research is on the cutting-edge of innovation here.

The second company is NeuroFlow, which is a software startup using apps to guide patients to better mental health outcomes. Through persistent polling, testing, and collaboration with practitioners, the company’s tools allow for more active monitoring of mental health — looking for emerging symptoms or relapses in even the most complicated cases. NeuroFlow is more on the clinical side, but there are obviously a wealth of wellness startups that have percolated in recent years as well like Headspace and Calm.

Outside of therapeutics and software though, there are entirely new frontiers around mental health in areas like psychedelics. That was one of the trends I called out as a top five area for investment in the 2020s earlier this year, and I stand by that. We’ve also covered a startup called Osmind which is a clinical platform for managing patients with a psychedelic focus.

Risk & Return itself hasn’t made an investment in psychedelics yet, but Bob Kerrey, the firm’s board chairman and the former co-chair of the 9/11 Commission as well as former governor and senator of Nebraska, said that “it’s difficult to do this if you are the government, but easier to do this in the private sector.”

Similar to edtech, mental health startups might get their start in the first responder community, but they are hardly limited to this population. Post-traumatic stress and other mental health conditions affect wide swaths of the world’s population, and solutions that work in one community can often translate more broadly to others. It’s a massive, massive market, and one that could potentially transform the lives of millions of people for the better.

Before moving on, there’s one other area of interest here, and that is creating impactful communities for healing. First responders and military veterans experience a mission and camaraderie in their service that they often lack once they are in new jobs or on convalescence. DelaCruz of Team Rubicon says that one of the goals of bringing veterans to help in disaster regions is that the veterans themselves “reconnect with identity and community — we have these incredible assets in these men and women who have served.” It’s not enough to just find a single treatment per patient — we oftentimes need to zoom out to the wider population to see how mental health ripples out.

Helping people find purpose may not be the easiest challenge to solve as a startup, but it’s certainly a major challenge for many, and an area fermenting with new approaches now that the the social networking wave has reached its nadir.

Crowdsourcing disaster response

Decentralization has been all the rage in tech in recent years — just mention the word blockchain in a TechCrunch article to get at least 50 PR emails about the latest NFT for a toilet stain. While there is obviously a lot of noise, one area where substance may pan out well is in disaster response.

If the COVID-19 pandemic showed anything, it was the power of the internet to aggregate as well as verify data, build dashboards, and deliver highly-effective visualizations of complex information for professionals and laypeople alike. Those products were developed by people all around the world often from the comfort of their own homes, and they demonstrate how crowds can quickly draft serious labor to help respond to crises as they crop up.

Jonathan Sury, project director at the National Center for Disaster Preparedness at the Earth Institute at Columbia University, said that “COVID has really blown so much of what we think about out of the water.” With so many ways to collaborate online right now, “that’s what I would say is very exciting … and also practical and empowering.”

Clark-Ginsberg of RAND calls it the “next frontier of disaster management.” He argues that “if you can use technology to broaden the number of people who can participate in disaster management and respond to disasters,” then we might be reaching an entirely new paradigm for what effective disaster response will look like. “Formal structures [for professional frontline workers] have strengthened and that has saved lives and resources, but our ability to engage with everyday responders is still something to work on.”

Many of the tools that underpin these crowdsourced efforts don’t even focus on disasters. Sury pointed to Tableau and data visualization platform Flourish as examples of the kinds of tools that remote, lay first responders are using. There are now quite robust tools for tabular data, but we’re still relatively early in the development of tools for handling mapping data — obviously critical in the crisis context. Unfolded.ai, which I profiled earlier this year, is working on building scalable geospatial analytics in the browser. A lot more can be done here.

Oftentimes there are ways to coordinate the coordinators. Develop for Good, which I looked at late last year, is a non-profit designed to connect enterprising computer science students to software and data projects at non-profits and agencies that needed help during the pandemic. Sometimes these coordinators are non-profit orgs, and sometimes, just very active Twitter accounts. There’s a lot more experimentation possible on how to coordinate efforts in a decentralized way while still engaging with professional first responders and the public sector.

Speaking of decentralization, it’s even possible that blockchain could play a role in disaster and crisis response. Many of these opportunities rest on using blockchain for evidence collection or for identity. For example, earlier this week Leigh Cuen took a careful look at an at-home sexual assault evidence collection kit from Leda Health that uses the blockchain to establish a clear time for when a sample was collected.

There is a lot more potential to harness the power of crowdsourcing and decentralization, and many of these projects have applications far outside disaster management itself. These tools not only solve real problems — they provide real community to people who may not be related to the disaster itself, but are enthusiastic to do their part to help others.

The black swans of black swans

In terms of startups, the three markets I identified — better training, better mental health, and better crowdsourcing collaboration tools, particularly around data — collectively represent a very compelling set of markets that will not only be valuable for founders, but can rapidly improve lives.

In his book Normal Accidents, Charles Perrow talks about how an increasing level of complexity and coupledness in our modern technical systems all but guarantee disasters to occur. Add in a warming world as well as the intensity, frequency, and just plain unusualness of disasters arriving each year, and we are increasingly seeing entirely novel forms of emergencies we have never responded to before. Take most recently the ultra-frigid conditions in Texas that sapped power from its grid, leading to statewide blackouts for hours and days in some parts of the state.

Clark-Ginsberg said, “We are seeing these risks emerge that aren’t just typical wildfires — where we have a response structure that we can easily setup and manage the hazard, [we’re] very good at managing these typical disasters. There are more of these atypical disasters cropping up, and we have a very hard time setting up structures for this — the pandemic is a great example of that.”

He describes these challenges as “trans-boundary risk management,” disasters that cross bureaucratic lines, professions, societies, and means of action. “It takes a certain agility and the ability to move quickly and the ability to work in ways outside typical bureaucratic structures, and that is just challenging full stop,” he said.

Even as we begin to have better point solutions to the individual problems that disasters and their responses require, we can’t be remiss in neglecting the more systematic challenges that these emergencies are bringing to the fore. We have to start thinking about bringing humans together faster and in more novel ways to be the most effective, while coupling them flexibly and with agility to the best tools that meet their needs in the moment. That’s probably not literally “a startup,” but more a way of thinking about what it means to construct a disaster response fresh given the information available.

Amanda Levin, a policy analyst at the Natural Resources Defense Council, said that “even if we mitigate, there are huge pressures and huge impacts today from a warming world … even if we stop emissions today, [they] will still persist.” As one of my interviewees in government service who asked to go unnamed noted about disaster response, “You always are coming up short somewhere.” The problems are only getting harder, and we humans need much better tools to match the man-made trials we created for ourselves. That’s the challenge — and opportunity — for a tough century ahead.

Sensor data from smartphones and wearables can meaningfully predict an individual’s ‘biological age’ and resilience to stress, according to Gero AI.

The ‘longevity’ startup — which condenses its mission to the pithy goal of “hacking complex diseases and aging with Gero AI” — has developed an AI model to predict morbidity risk using ‘digital biomarkers’ that are based on identifying patterns in step-counter sensor data which tracks mobile users’ physical activity.

A simple measure of ‘steps’ isn’t nuanced enough on its own to predict individual health, is the contention. Gero’s AI has been trained on large amounts of biological data to spots patterns that can be linked to morbidity risk. It also measures how quickly a personal recovers from a biological stress — another biomarker that’s been linked to lifespan; i.e. the faster the body recovers from stress, the better the individual’s overall health prognosis.

A research paper Gero has had published in the peer-reviewed biomedical journal Aging explains how it trained deep neural networks to predict morbidity risk from mobile device sensor data — and was able to demonstrate that its biological age acceleration model was comparable to models based on blood test results.

Another paper, due to be published in the journal Nature Communications later this month, will go into detail on its device-derived measurement of biological resilience.

The Singapore-based startup, which has research roots in Russia — founded back in 2015 by a Russian scientist with a background in theoretical physics — has raised a total of $5 million in seed funding to date (in two tranches).

Backers come from both the biotech and the AI fields, per co-founder Peter Fedichev. Its investors include Belarus-based AI-focused early stage fund, Bulba Ventures (Yury Melnichek). On the pharma side, it has backing from some (unnamed) private individuals with links to Russian drug development firm, Valenta. (The pharma company itself is not an investor).

Fedichev is a theoretical physicist by training who, after his PhD and some ten years in academia, moved into biotech to work on molecular modelling and machine learning for drug discovery — where he got interested in the problem of ageing and decided to start the company.

As well as conducting its own biological research into longevity (studying mice and nematodes), it’s focused on developing an AI model for predicting the biological age and resilience to stress of humans — via sensor data captured by mobile devices.

“Health of course is much more than one number,” emphasizes Fedichev. “We should not have illusions about that. But if you are going to condense human health to one number then, for a lot of people, the biological age is the best number. It tells you — essentially — how toxic is your lifestyle… The more biological age you have relative to your chronological age years — that’s called biological acceleration — the more are your chances to get chronic disease, to get seasonal infectious diseases or also develop complications from those seasonal diseases.”

Gero has recently launched a (paid, for now) API, called GeroSense, that’s aimed at health and fitness apps so they can tap up its AI modelling to offer their users an individual assessment of biological age and resilience (aka recovery rate from stress back to that individual’s baseline).

Early partners are other longevity-focused companies, AgelessRx and Humanity Inc. But the idea is to get the model widely embedded into fitness apps where it will be able to send a steady stream of longitudinal activity data back to Gero, to further feed its AI’s predictive capabilities and support the wider research mission — where it hopes to progress anti-ageing drug discovery, working in partnerships with pharmaceutical companies.

The carrot for the fitness providers to embed the API is to offer their users a fun and potentially valuable feature: A personalized health measurement so they can track positive (or negative) biological changes — helping them quantify the value of whatever fitness service they’re using.

“Every health and wellness provider — maybe even a gym — can put into their app for example… and this thing can rank all their classes in the gym, all their systems in the gym, for their value for different kinds of users,” explains Fedichev.

“We developed these capabilities because we need to understand how ageing works in humans, not in mice. Once we developed it we’re using it in our sophisticated genetic research in order to find genes — we are testing them in the laboratory — but, this technology, the measurement of ageing from continuous signals like wearable devices, is a good trick on its own. So that’s why we announced this GeroSense project,” he goes on.

“Ageing is this gradual decline of your functional abilities which is bad but you can go to the gym and potentially improve them. But the problem is you’re losing this resilience. Which means that when you’re [biologically] stressed you cannot get back to the norm as quickly as possible. So we report this resilience. So when people start losing this resilience it means that they’re not robust anymore and the same level of stress as in their 20s would get them [knocked off] the rails.

“We believe this loss of resilience is one of the key ageing phenotypes because it tells you that you’re vulnerable for future diseases even before those diseases set in.”

“In-house everything is ageing. We are totally committed to ageing: Measurement and intervention,” adds Fedichev. “We want to building something like an operating system for longevity and wellness.”

Gero is also generating some revenue from two pilots with “top range” insurance companies — which Fedichev says it’s essentially running as a proof of business model at this stage. He also mentions an early pilot with Pepsi Co.

He sketches a link between how it hopes to work with insurance companies in the area of health outcomes with how Elon Musk is offering insurance products to owners of its sensor-laden Teslas, based on what it knows about how they drive — because both are putting sensor data in the driving seat, if you’ll pardon the pun. (“Essentially we are trying to do to humans what Elon Musk is trying to do to cars,” is how he puts it.)

But the nearer term plan is to raise more funding — and potentially switch to offering the API for free to really scale up the data capture potential.

Zooming out for a little context, it’s been almost a decade since Google-backed Calico launched with the moonshot mission of ‘fixing death’. Since then a small but growing field of ‘longevity’ startups has sprung up, conducting research into extending (in the first instance) human lifespan. (Ending death is, clearly, the moonshot atop the moonshot.) 

Death is still with us, of course, but the business of identifying possible drugs and therapeutics to stave off the grim reaper’s knock continues picking up pace — attracting a growing volume of investor dollars.

The trend is being fuelled by health and biological data becoming ever more plentiful and accessible, thanks to open research data initiatives and the proliferation of digital devices and services for tracking health, set alongside promising developments in the fast-evolving field of machine learning in areas like predictive healthcare and drug discovery.

Longevity has also seen a bit of an upsurge in interest in recent times as the coronavirus pandemic has concentrated minds on health and wellness, generally — and, well, mortality specifically.

Nonetheless, it remains a complex, multi-disciplinary business. Some of these biotech moonshots are focused on bioengineering and gene-editing — pushing for disease diagnosis and/or drug discovery.

Plenty are also — like Gero —  trying to use AI and big data analysis to better understand and counteract biological ageing, bringing together experts in physics, maths and biological science to hunt for biomarkers to further research aimed at combating age-related disease and deterioration.

Another recent example is AI startup Deep Longevity, which came out of stealth last summer — as a spinout from AI drug discovery startup Insilico Medicine — touting an AI ‘longevity as a service’ system which it claims can predict an individual’s biological age “significantly more accurately than conventional methods” (and which it also hopes will help scientists to unpick which “biological culprits drive aging-related diseases”, as it put it).

Gero AI is taking a different tack toward the same overarching goal — by honing in on data generated by activity sensors embedded into the everyday mobile devices people carry with them (or wear) as a proxy signal for studying their biology.

The advantage being that it doesn’t require a person to undergo regular (invasive) blood tests to get an ongoing measure of their own health. Instead our personal device can generate proxy signals for biological study passively — at vast scale and low cost. So the promise of Gero’s ‘digital biomarkers’ is they could democratize access to individual health prediction.

And while billionaires like Peter Thiel can afford to shell out for bespoke medical monitoring and interventions to try to stay one step ahead of death, such high end services simply won’t scale to the rest of us.

If its digital biomarkers live up to Gero’s claims, its approach could, at the least, help steer millions towards healthier lifestyles, while also generating rich data for longevity R&D — and to support the development of drugs that could extend human lifespan (albeit what such life-extending pills might cost is a whole other matter).

The insurance industry is naturally interested — with the potential for such tools to be used to nudge individuals towards healthier lifestyles and thereby reduce payout costs.

For individuals who are motivated to improve their health themselves, Fedichev says the issue now is it’s extremely hard for people to know exactly which lifestyle changes or interventions are best suited to their particular biology.

For example fasting has been shown in some studies to help combat biological ageing. But he notes that the approach may not be effective for everyone. The same may be true of other activities that are accepted to be generally beneficial for health (like exercise or eating or avoiding certain foods).

Again those rules of thumb may have a lot of nuance, depending on an individual’s particular biology. And scientific research is, inevitably, limited by access to funding. (Research can thus tend to focus on certain groups to the exclusion of others — e.g. men rather than women; or the young rather than middle aged.)

This is why Fedichev believes there’s a lot of value in creating a measure than can address health-related knowledge gaps at essentially no individual cost.

Gero has used longitudinal data from the UK’s biobank, one of its research partners, to verify its model’s measurements of biological age and resilience. But of course it hopes to go further — as it ingests more data. 

“Technically it’s not properly different what we are doing — it just happens that we can do it now because there are such efforts like UK biobank. Government money and also some industry sponsors money, maybe for the first time in the history of humanity, we have this situation where we have electronic medical records, genetics, wearable devices from hundreds of thousands of people, so it just became possible. It’s the convergence of several developments — technological but also what I would call ‘social technologies’ [like the UK biobank],” he tells TechCrunch.

“Imagine that for every diet, for every training routine, meditation… in order to make sure that we can actually optimize lifestyles — understand which things work, which do not [for each person] or maybe some experimental drugs which are already proved [to] extend lifespan in animals are working, maybe we can do something different.”

“When we will have 1M tracks [half a year’s worth of data on 1M individuals] we will combine that with genetics and solve ageing,” he adds, with entrepreneurial flourish. “The ambitious version of this plan is we’ll get this million tracks by the end of the year.”

Fitness and health apps are an obvious target partner for data-loving longevity researchers — but you can imagine it’ll be a mutual attraction. One side can bring the users, the other a halo of credibility comprised of deep tech and hard science.

“We expect that these [apps] will get lots of people and we will be able to analyze those people for them as a fun feature first, for their users. But in the background we will build the best model of human ageing,” Fedichev continues, predicting that scoring the effect of different fitness and wellness treatments will be “the next frontier” for wellness and health (Or, more pithily: “Wellness and health has to become digital and quantitive.”)

“What we are doing is we are bringing physicists into the analysis of human data. Since recently we have lots of biobanks, we have lots of signals — including from available devices which produce something like a few years’ long windows on the human ageing process. So it’s a dynamical system — like weather prediction or financial market predictions,” he also tells us.

“We cannot own the treatments because we cannot patent them but maybe we can own the personalization — the AI that personalized those treatments for you.”

From a startup perspective, one thing looks crystal clear: Personalization is here for the long haul.

If the pandemic has been good for anything it’s been good for the therapy business and for startups targeting mental health, with VCs kept very busy signing checks. To wit, here’s another one: Madrid-based ifeel has bagged €5.5 million (~$6.6M) in Series A funding, led by Nauta Capital.

The startup was founded back in 2017 — initially as a consumer-focused therapy platform — but last year it pivoted to a hybrid business model, tapping into demand from businesses to offer staff emotional support during the public health crisis. So it’s available both to individuals via monthly subscription or as part of employer’s or insurance provider’s cover

It says that pandemic pivot has resulted in 1,000% growth in its b2b business.

Companies it’s signed up to offer its platform to their staff include AXA Partners, Glovo and Gympass.

“We have a total of 400K users on the platform (b2c and b2b),” says co-founder Amir Kaplan. “We have 100,000 eligible covered who have access to ifeel as a benefit (through our insurance and wellness partners or direct with ifeel).

“The 100K grew 10x from September 2020 and is the largest trend we are experiencing these days. Employees of 100 companies use ifeel on a weekly basis.”

ifeel’s platform delivers both live therapy sessions with licensed psychologists but also provides users with self-care tool such as daily mood trackers, recommended exercises and activities to expand the support available.

“By combining self-care and guided therapies, ifeel maximises engagement and retention of its users — with 90% reporting improved emotional and mental well-being after using ifeel,” it claims.

The startup is using AI technology in the self-care portion of its platform — to recommend “the most relevant” content or exercise to its users, per Kaplan. But he also says it’s looking at using the tech to assist the therapist practice by developing dedicated tools inside the platform.

ifeel has an international founding team, hailing from three countries (Israel, Italy and Mexico), and says its main markets so far are Spain, France, Brazil and Mexico. While its b2b and insurance network coverage extends to 20 countries and four languages (English, Spanish, French and Portuguese).

With so much competition in the mental health tools space — from mindfulness apps, to internet-delivered CBT programs, to therapy platforms — how does ifeel see itself standing out?

Kaplan suggests it has an advantage of being “global from day one”, and also flags a “strong technology integration focus” which he says has allowed it to plug into insurance companies and wellness players — to become a “main service provider”.

“Very early we partnered with global leading companies and we support them in many countries (compared to specific country players like in Germany and UK,” he tells TechCrunch. “The platform approach is different from ‘online therapy’ companies or ‘mindfulness apps’.

“We want our users to manage their emotional well being on our platform no matter the need. In this way we create millions of engagement events that are customized to the user’s needs and allow users over time to use different parts of our platform in different life situations.”

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.”

Mental health, and how it is getting addressed, has been one of the major leitmotifs of the past year of pandemic living. Covid-19 not only has led to a lot of people getting ill or worse; it has increased isolation, economic uncertainty, and led to a lot of other kinds of disappointments, and that all has had a knock-on effect on our collective and individual state of mind.

Today a startup called Headway, which has been working on building a better way for people to attend to themselves — by way of a three-sided marketplace of sorts, by helping a person to find and afford a therapist via a free-to-use portal, by making it possible for those therapists to accept a wider range of insurance plans, and by helping those insurance plans facilitate more therapy appointments for their patient networks — is announcing a major round of funding on the heels of strong growth.

The startup has raised $70 million, money that it will be using to continue expanding its platform with more partnerships, more hiring for its team (it wants to have 300 people this year) and opening up in new regions, aiming to be nationwide this year in the U.S.. This round, a Series B, has a number of big names attached to it: it is being led by Andreessen Horowitz, with Thrive, GV and Accel also participating. (The latter three are repeat investors: Thrive and GV led its Series A, while Accel led its seed.) This Series B is coming in at a $750 million valuation.

The rapid pace of funding, the backers, and that valuation all underscore the timeliness of the concept, and also the traction that Headway is getting for its approach.

When we last covered Headway — it raised $26 million just last November, six months ago — it said it had registered some 1,800 therapists on its platform in the New York metro area, where it is based. Now that number is up to over 3,000 with its network now covering not just NYC, but also New Jersey, Florida, North Carolina, Texas, Georgia, Michigan, Virginia, Washington, Illinois and Colorado. It has over 2,000 patients joining the platform each month and has so far helped facilitate 300,000 appointments, with a current average of 30,000 appointments each month. Revenues have in the last year, menawhile, grown nine-fold.

The approach that Headway is taking — creating not just a vertical search portal for therapists, but building a back-end system to help those therapists grow their business by making it easier for them to accept insurance coverage — comes directly out of the experiences faced by one of the startup’s co-founders.

Andrew Adams, the CEO of Headway, told me last year he came up with the idea after he moved to New York from California several years ago to take a job. In seeking a therapist, he found most unwilling to accept his insurance plan as payment, making getting therapy unaffordable.

This is a very typical problem, he said. Some 70% of therapists do not accept insurance today because it’s too complicated for them to integrate, since about 85% of all therapists happen to be solo practitioners. So something that should be accessible to everyone becomes something typically only used by those who can afford it, or have entered into social care programs that might provide it. But that leaves a massive gap in the middle.

“This is the defining problem in the space,” he said at the time. “Health insurance is built around a medical world dominated by billers and admins, but therapists are small practitioners and don’t have the bandwidth to handle that, so they don’t. So we thought if we could make it easier for them to, they would, and they have.”

And indeed, if you are needing to see a therapist, the very last thing you need or want to be doing is spending your time trying to work out the economics of doing so: you need to be focused on finding someone who you feel you can talk to; someone who can help you.

The problem is a huge one. In the U.S. alone it’s estimated that there are some 82 million people who have treatable health conditions. Headway was founded on the premise that most of them currently do not seek that treatment because of cost or accessibility.

A lot of therapy has traditionally been about seeing people in person — and arguably the fact that we’ve had so much reduced contact with people has contributed to mental health issues this past year — but in the event, Headway has definitely adapted to the current climate.

The company says that some 89% of its appointments at the moment are being carried out remotely. This is down from 97% at the peak of the pandemic in the U.S., and has been slowly starting to taper off, the company said. Some of the increased volume, meanwhile, is a direct result of therapists working remotely: they can fit more people in to a daily schedule as a result.

In terms of insurers, the company currently works with Aetna, Cigna, United Healthcare, Oscar and Oxford and says the list will be growing. On interesting detail is that Headway has not only built out a bigger funnel for these insurers in terms of the practitioners that they work with and individuals who can subsequently use insurance to pay for therapy, but conversely has served to be a conduit for those insurance groups in bringing more patients through to those therapists, who are now a part of their networks, by way of Headway’s platform.

Headway says that using its system can help a patient get an appointment within 5 days, versus the the 30-day average you typically face when using an insurance directory.

It’s the kind of scale and “software eating the world” efficiency that has attracted Andreessen Horowitz to backing companies before, with the added detail of this being particular relevant to the time we are living in.

“By getting the mental health provider community on the same page with insurance companies for the first time, Headway unlocks affordable mental healthcare for millions of Americans,” said Scott Kupor, managing partner at Andreessen Horowitz. “We’re incredibly excited to work alongside the Headway team.” Kupor is also joining Headway’s board with this round.

Cherry Miao, a former Partner at Accel and Headway’s lead seed investor, is also joining as Head of Finance & Data.

“I’ve been fortunate to work with some of the world’s most influential startups, and know that being part of Headway’s meaningful mission, robust business model, and incredibly talented team is a once-in-a-lifetime opportunity,” she said. “I’m thrilled to be helping rebuild America’s mental healthcare system for access and affordability.”