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June 25, 2019
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Biofourmis raises $35M to develop smarter treatments for chronic diseases

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Biofourmis, a Singapore-based startup pioneering a distinctly tech-based approach to the treatment of chronic conditions, has raised a $35 million Series B round for expansion.

The round was led by Sequoia India and MassMutual Ventures, the VC fund from Massachusetts Mutual Life Insurance Company. Other investors who put in include EDBI, the corporate investment arm of Singapore’s Economic Development Board, China-based healthcare platform Jianke and existing investors Openspace Ventures, Aviva Ventures and SGInnovate, a Singapore government initiative for deep tech startups. The round takes Biofourmis to $41.6 million raised to date, according to Crunchbase.

This isn’t your typical TechCrunch funding story.

Biofourmis CEO Kuldeep Singh Rajput moved to Singapore to start a PhD, but he dropped out to start the business with co-founder Wendou Niu in 2015 because he saw the potential to “predict disease before it happens,” he told TechCrunch in an interview.

AI-powered specialist post-discharge care

There are a number of layers to Biofourmis’ work, but essentially it uses a combination of data collected from patients and an AI-based system to customize treatments for post-discharge patients. The company is focused on a range of therapeutics, but its most advanced is cardiac, so patients who have been discharged after heart failure or other heart-related conditions.

With that segment of patients, the Biofourmis platform uses a combination of data from sensors — medical sensors rather than consumer wearables, which are worn 24/7 — and its tech to monitor patient health, detect problems ahead of time and prescribe an optimum treatment course. That information is disseminated through companion mobile apps for patients and caregivers.

Bioformis uses a mobile app as a touch point to give patients tailored care and drug prescriptions after they are discharged from hospital

That’s to say that medicine works differently on different people, so by collecting and monitoring data and crunching numbers, Biofourmis can provide the best drug to help optimize a patient’s health through what it calls a ‘digital pill.’ That’s not Matrix-style futurology, it’s more like a digital prescription that evolves based on the needs of a patient in real-time. It plans to use a network of medical delivery platforms, including Amazon-owned PillPack, to get the drugs to patients within hours.

Yes, that’s future tense because Biofourmis is waiting on FDA approval to commercialize its service. That’s expected to come by the end of this year, Singh Rajput told TechCrunch. But he’s optimistic given clinical trials, which have covered some 5,000 patients across 20 different sites.

On the tech side, Singh Rajput said Biofourmis has seen impressive results with its predictions. He cited tests in the U.S. which enabled the company to “predict heart failure 14 days in advance” with around 90 percent sensitivity. That was achieved using standard medical wearables at the cost of hundreds of dollars, rather than thousands with advanced kit such as Heartlogic from Boston Scientific — although the latter has a longer window for predictions.

The type of disruption that Biofourmis might appear to upset the applecart for pharma companies, but Singh Rajput maintains that the industry is moving towards a more qualitative approach to healthcare because it has been hard to evaluate the performance of drugs and price them accordingly.

“Today, insurance companies are blinded not having transparency on how to price drugs,” he said. “But there are already 50 drugs in the market paying based on outcomes so the market is moving in that direction.”

Outcome-based payments mean insurance firms reimburse all outcomes based on the performance of the drugs, in other words how well patients recover. The rates vary, but a lack of reduction in remission rates can see insurers lower their payouts because drugs aren’t working as well as expected.

Singh Rajput believes Biofourmis can level the playing field and added more granular transparency in terms of drug performance. He believes pharma companies are keen to show their products perform better than others, so over the long-term that’s the model Biofourmis wants to encourage.

Indeed, the confidence is such that Biofourmis intends to initially go to market via pharma companies, who will sell the package into clinics bundled with their drugs, before moving to work with insurance firms once traction is gained. While the Biofourmis is likely to be bundled with initial medication, the company will take a commission of 5-10 percent on the recommended drugs sold through its digital pill.

Biofourmis CEO and co-founder Kuldeep Singh Rajput dropped out of his PhD course to start the company in 2015

Doubling down on the US

With its new money, Biofourmis is doubling down on that imminent commercialization by relocating its headquarters to Boston. It will retain its presence in Singapore, where it has 45 people who handle software and product development, but the new U.S. office is slated to grow from 14 staff right now to up to 120 by the end of the year.

“The U.S. has been a major market focus since day one,” Singh Rajput said. “Being closer to customers and attracting the clinical data science pool is critical.”

While he praised Singapore and said the company remains committed to the country — adding EDBI to its investors is certainly a sign — he admitted that Boston, where he once studied, is a key market for finding “data scientists with core clinical capabilities.”

That expansion is not only to bring the cardio product to market, but also to prepare products to cover other therapeutics. Right now, it has six trials in place that cover pain, orthopedics and oncology. There are also plans to expand in other markets outside of the U.S, and in particular Singapore and China, where Biofourmis plans to lead on Jianke.

Not lacking in confidence, Singh Rajput told TechCrunch that the company is on course to reach a $1 billion valuation when it next raises funding, that’s estimated as 18 months away and the company isn’t saying how much it is worth today.

Singh Rajput did confirm, however, that the round was heavily oversubscribed, and that the startup rebuffed investment offers from pharma companies in order to “avoid a conflict of interest and stay neutral.”

He is also eying a future IPO, which is tentatively set for 2023 — although by then, Singh Rajput said, Biofourmis would need at least two products in the market.

There’s a long way to go before then, but this round has certainly put Biofourmis and its digital pill approach on the map within the tech industry.

Dear Hollywood, here are 5 female founders to showcase instead of Elizabeth Holmes

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There’s a seemingly insatiable demand for Theranos content. John Carreyrou’s best-selling book, “Bad Blood,” has already inspired an HBO documentary, The Inventor; an ABC podcast called The Dropout, a prestige limited series starring SNL’s Kate McKinnon, was just announced; and Jennifer Lawrence is reportedly going to star in the feature film version of this tawdry “true crime meets tech” tale. That’s before getting started on the various and sundry cover stories and think pieces about her fraud.

I think it’s fair to say the Theranos story has been sufficiently well-documented, and I’m worried that this negative perception may be reinforced now that uBiome founder Jessica Richman has been placed on administrative leave. While it’s hard to pass on a chance to stoke startup schadenfreude, perhaps we could focus less on these rare, unrepresentative and dispiriting examples? Instead, Hollywood could put the spotlight on women who pioneered the bleeding edge of tech and actually produced billion-dollar successes. Here are a few candidates ready for their close-ups:

Judith Faulkner, founder and chief executive officer, Epic Systems

Judith Faulkner – Founder/CEO, Epic Systems

In the late 1970s, the picture of a working woman in Wisconsin was likely Laverne or Shirley. Little did anyone know that in the basement of a Victorian manse in Madison, the future of healthcare was being coded by Judith Faulkner, the founder and CEO of what would become Epic Systems. Epic is arguably the most impactful startup in the history of health software, and Faulkner was building medical scheduling software before most people could even picture a PC. Her efforts established the Electronic Medical Records market as we know it and today. Her company manages records for more than 200 million people, employs nearly 10,000 and generates around $2.7 billion per year in revenue — not bad for a math graduate who never raised any venture capital.

One might argue that the origins of medical software are too tepid to make for exciting TV, but something tells me the kind of CEO who hires Disney alums to design her corporate campus and dresses up like a wizard to address her employees might make for a compelling subject.

SANTA BARBARA, CA – FEBRUARY 09: Lynda Weinman speaks onstage (Photo by Rebecca Sapp/Getty Images for SBIFF)

Lynda Weinman – Founder/CEO, Lynda.com

Lynda Weinman might have the most esoteric path to becoming a billion-dollar entrepreneur in history. After getting a humanities degree from Evergreen College, where she was classmates with “Simpsons” creator Matt Groenig, Lynda opened a pair of punk rock fashion boutiques on LA’s Sunset Strip.

After those folded in the early 1980s, she taught herself enough computer graphics to become a freelance animator on movies like “Bill & Ted’s Excellent Adventure,” which in turn led to her becoming a teacher at the prestigious Art Center College of Design. Her academic pedigree provided the launching pad to write an influential textbook; that, in turn, gave her the star power to strike out on her own as one of the first web celebrities.

Keep in mind; this dramatic arc only covers the time before she started the eponymous Lynda.com, and bootstrapped it to a $1.5 billion exit in edtech — an industry most VCs and entrepreneurs fear to tread. In terms of material for a memoir, Hannah Horvath has nothing on Lynda Weinman.

FRAMINGHAM, MA – MAY 30: Shira Goodman, former chief executive at Staples, poses for a portrait in Framingham, MA on May 30, 2017 (Photo by Suzanne Kreiter/The Boston Globe via Getty Images)

Shira Goodman – CEO, Staples.com

Shira Goodman has arguably done more for online shopping in the U.S. than anyone not named Bezos. She didn’t found Staples, but she did start and scale its “delivery business,” as she humbly calls it, to the point where it became the fourth largest e-commerce company in the U.S.

At a time when more nimble startups were disrupting big-box retailers, Shira did what few of her contemporaries could do — rapidly shifted a multi-billion-dollar legacy company in an ancient industry into the future, and eventually became CEO of the entire enterprise. She did this while also raising three children and supporting her husband when he decided to change careers and go to Rabbinical school. Sitcoms have been premised on less, and since two versions of “The Office” have captivated audiences, perhaps it’s time to provide the perspective from the CEO of Dunder-Mifflin HQ?

Helen Greiner, co-founder, iRobot

Helen Greiner – Co-founder, iRobot

From C. A. Rotwang in “Metropolis” to Tony Stark in the Marvel movies, there have been plenty of cinematic explorations of robot builders, but the story of iRobot co-founder Helen Greiner might be more interesting than anything yet committed to celluloid. As a recent grad from MIT, Greiner spent a substantial chunk of the 1990s applying her mechanical genius to everything from a mechatronic dinosaur for Disney to a store cleaning robot with the potential for mass destruction for SC Johnson.

Far from an ivory-tower academic, Grenier helped the government deploy search and rescue efforts at Ground Zero after 9/11 and cave-clearing ‘bots in Afghanistan, and the bomb-disposing Packbot she developed has saved the lives of thousands of service members. Grenier, at age 38, took her company public and made the Jetson’s vision of a robot housekeeper a reality in the form of the Roomba.

CAMBRIDGE, MA – MARCH 15: Kelsey Wirth, who has a grassroots organization called Mothers Out Front: Mobilizing For A Livable Climate (Photo by Essdras M Suarez/The Boston Globe via Getty Images)

Kelsey Wirth – Co-founder, Align Technologies

While the original startup bros were inflating the tech bubble in the late 1990s, Kelsey Wirth was pioneering 3D printing, which at the time was as fantastical as anything Theranos promised. Wirth’s story as the co-founder of Align Technology is especially compelling in the way it shares some surface similarities with Holmes’ narrative. Prominent skeptics of Invisalign cast doubts on the company in its early days, noting that the startup’s PR had outstripped its clinical validation. Wirth had to solve seemingly intractable technical challenges, including scanning misaligned incisors, developing algorithms to overcome underbites, pioneering new manufacturing process, convincing the FDA to clear the product and then selling it across the country — armed only with an English lit degree and an MBA. Despite the long odds of curing crossbites with software, Wirth started what has become a publicly traded business that is currently worth more than 20 billion dollars.


Most of these founders faced setbacks, including external obstacles and those of their own making. There were layoffs, bad deals and few of these stories had perfectly happy endings. Still, while a contemporary startup can earn plaudits for simply repackaging CBD and pushing it on Facebook, these entrepreneurs demonstrated a level of ambition rarely seen among modern upstarts.

The sensational focus on Elizabeth Holmes’ misdeeds steal focus from a group of landmark female entrepreneurs and waste a tremendous opportunity to inspire the next generation with heroic tales instead of fables of fabrication. None of these accounts have the black and white morality of the Theranos debacle, but these founders cleared hurdles both scientific and social. They flipped the script and made history; surely Hollywood can find some drama in that.

Thanks to Parul Singh, Elizabeth Condon and Alyssa Rosenzweig for reviewing drafts of this post.

Jio Health combines online and offline healthcare in Southeast Asia, starting in Vietnam

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The internet is often lauded for the potential to increase the impact of a range of primary services in emerging markets, including education, commerce, banking and healthcare. While many of those platforms are now being built, a few are finding that a hybrid approach combining online and offline is advantageous.

That’s exactly what Jio Health, a “full stack” (forgive the phrase) healthcare startup is bringing to consumers in Southeast Asia, starting in Vietnam.

The company started as a U.S.-based venture that worked with healthcare providers around the “Obamacare” initiative, before sensing the opportunity overseas and relocating to Vietnam, the Southeast Asian market of 95 million people and a fast-growing young population.

Today, it operates an online healthcare app and a physical facility in Saigon; it also has licenses for prescriptions and over the counter drug sales. The serviced launched nearly a year ago; already the company has some 130 staff, including 70 caregivers — including doctors — and a tech team of 30.

The idea is to offer services digitally, but also provide a physical location for when it is needed. Therein, the company ensures that “every element of that journey” is controlled and of the required standard; that’s in contrast to services that partner with hospitals or other care centers.

The scope of Jio Health’s services range from pediatrics to primary care, chronic disease management and ancillary services, which will soon cover areas like eye care, dermatology and cancer.

“Our initial research [before moving] found that healthcare in Vietnam was unlike the U.S.,” Raghu Rai, founder and CEO of Jio Health, told TechCrunch in an interview. “Spending is primarily driven by the consumer (out of pocket) and there’s no real digital infrastructure to speak of.”

Rai — a U.S. citizen — said doctors typically “have minutes per patient” and get through “hundreds” of consultations in every morning shift. That gave him an idea to make things more efficient.

“We can probably address north of 80 percent of consumers’ health needs,” he said of Jio Health,” but we also have referral partnerships with certain hospitals.”

Raghu Rai is CEO and founder of Jio Health

The process begins when a consumer downloads the Jio Health app and inputs primary information. A representative is then dispatched to visit the consumer in person, potentially within “hours” of the submission of information, according to Rai.

He believes that Jio Health can save its users money and time by using remote consultancy for many diagnoses. The company also works with health insurance companies for areas like annual checkups, and Rai said that McDonald’s and 7-Eleven are among the corporations that offer Jio Health among the providers for their staff; they’re not exclusive.

This week, Jio Health announced that it has closed a $5 million Series A funding from Southeast Asia’s Monk’s Hill Ventures . Rai said the company plans to use the capital for expansion. In particular, he said, the company is adding new care categories this month — including eye care and dermatology — and it is working toward expanding its brand through marketing.

Further down the line, Rai said the company hopes to expand to Hanoi before the end of this year. While there is interest in moving into other markets within Southeast Asia, that isn’t about to happen soon.

“We have begun to investigate other markets, but at this point feel the market in Vietnam is substantial in itself,” he told TechCrunch. “It’s very plausible that we’d be looking at international expansion plans in 2020… we’re going to be focused on Southeast Asia.”

CXA, a health-focused digital insurance startup, raises $25M

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CXA Group, a Singapore-based startup that helps make insurance more accessible and affordable, has raised $25 million for expansion in Asia and later into Europe and North America.

The startup takes a unique route to insurance. Rather than going to consumers directly, it taps corporations to offer their employees health flexible options. That’s to say that instead of rigid plans that force employees to use a certain gym or particular healthcare, a collection over 1,000 programs and options can be tailored to let employees pick what’s relevant or appealing to them. The ultimate goal is to bring value to employees to keep them healthier and lower the overall premiums for their employers.

“Our purpose is to empower personalized choices for better living for employees,” CXA founder and CEO Rosaline Koo told TechCrunch in an interview. “We use data and tech to recommend better choices.”

The company is primarily focused on China, Hong Kong and Southeast Asia where it claims to works with 600 enterprises including Fortune 500 firms. The company has over 200 staff, and it has acquired two traditional insurance brokerages in China to help grow its footprint, gain requisite licenses and its logistics in areas such as health checkups.

We last wrote about CXA in 2017 when it raised a $25 million Series B, and this new Series C round takes it to $58 million from investors to date. Existing backers include B Capital, the BCG-backed fund from Facebook co-founder Eduardo Saverin, EDBI — the investment arm of the Singapore Economic Development Board — and early Go-Jek backer Openspace Ventures, and they are joined by a glut of big-name backers in this round.

Those new investors include a lot of corporates. There’s HSBC, Singtel Innov8 (of Singaporean telco Singtel), Telkom Indonesia MDI Ventures (of Indonesia telco Telkom), Sumitomo Corporation Equity Asia (Japanese trading firm) Muang Thai Fuchsia Ventures (Thailand-based insurance firm), Humanica (Thailand-based HR firm) and PE firm Heritas Venture Fund.

“There are additional insurance companies and strategic partners that we aren’t listing,” said Koo.

Rosaline Koo is founder and CEO of CXA Group

That’s a very deliberate selection of large corporates which is part of a new strategy to widen CXA audience.

The company had initially gone after massive firms — it claims to reach a collective 400,000 employees — but now the goal is to reach SMEs and non-Fortune 500 enterprises. To do that, it is using the reach and connections of larger service companies to reach their customers.

“We believe that banks and telcos can cross-sell insurance and banking services,” said Koo, who grew up in LA and counts benefits broker Mercer on her resume. “With demographic and work life event data, plus health data, we’re able to target the right banking and insurance services.

“We can help move them away from spamming,” she added. “Because we will have the right data to really target the right offering to the right person at the right time. No firm wants an agent sitting in their canteen bothering their staff, now it’s all digital and we’re moving insurance and banking into a new paradigm.”

The ultimate goal is to combat a health problem that Koo believes is only getting worse in the Asia Pacific region.

“Chronic disease comes here 10 years before anywhere else,” she said, citing an Emory research paper which concluded that chronic diseases in Asia are “rising at a rate that exceeds global increases.”

“There’s such a crying need for solutions, but companies can’t force the brokers to lower costs as employees are getting sick… double-digit increases are normal, but we think this approach can help drop them. We want to start changing the cost of healthcare in Asia, where it is an epidemic, using data and personalization at scale in a way to help the community,” Koo added.

Talking to Koo makes it very clear that she is focused on growing CXA’s reach in Asia this year, but further down the line, there are ambitions to expand to other parts of the world. Europe and North America, she said, may come in 2020.

Bill Gates-backed Vicarious Surgical adds a virtual reality twist to robots in the operating room

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In an operating room in rural Idaho, doctors prep a patient for surgery. They make a tiny, thumb-sized incision into the patient and insert a small robot while across the country a surgeon puts on a virtual reality headset, grabs their controllers and prepares to operate.

While this scene may seem like science fiction now, a Charlestown, Mass.-based startup called Vicarious Surgical is developing the technology to make that vision a reality.

The company’s co-founders, Adam Sachs and Sammy Khalifa, have been developing and refining the technology almost since they met at the Massachusetts Institute of Technology as undergraduates.

The 27-year-old Sachs said that he and Khalifa formally launched the company roughly five years ago when they graduated from MIT, and have been working on it ever since.

“We’ve been working on ways to miniaturize robotics and put all of the motion of surgery into the abdominal cavity,” says Sachs. “If you put all of the motion inside the abdominal cavity you are not confined to motion around the incision sites.”

What really set the founders’ brains buzzing was the potential for combining their miniature robots with the ability to see inside the body using virtual reality headsets like the Oculus Rift.

“It wasn’t a ‘Eureka!’ moment, but more like two-or-three weeks as the vision came together,” says Sachs. “We can make robotics more human-like and virtual reality would give you that presence in the body.”

The two founders initially bootstrapped their startup and then raised a small seed round, then began steadily closing larger tranches of a rolling round from luminaries like Bill Gates through his Gates Frontier fund, Khosla Ventures, Eric Schmidt’s Innovation Endeavors, AME Cloud Ventures (investment firm from Yahoo founder Jerry Yang), Singularity Holdings investor Neil Devani and Salesforce founder Marc Benioff.

In all, the company has raised some $31.8 million to support the development of its technology.

For Sachs and Khalifa, even though the technology was broadly applicable in areas that would yield faster results than healthcare, tackling the health market first was important, Sachs says.

A lot of people pointed out that our technology has a lot of applications. [But] healthcare for all of the reasons that people talk about really is meaningful to us,” says Sachs. “I have the luxury of being able to work on a project that’s fascinating from a technology standpoint and meaningful from a social good aspect.”

Vicarious Surgical chief medical officer Dr. Barry Greene (left), chief executive, Adam Sachs (middle), and chief technology officer, Sammy Khalifa (right)

Science and entrepreneurship runs in the Sachs family. Adam’s father, Eli Sachs, is a professor at MIT and one of the co-founders of the revolutionary 3D-printing company, Desktop Metal .

According to Sachs, a number of innovations in robotics has led the company to develop what Sachs calls tiny humanoid robots. 

Picture a very robotic version of two human arms and a human head,” says Sachs. “Two robotic arms that have the same degrees of freedom and proportions of a human arms and a camera that is placed above the shoulders of the robot… it’s a few inches across.”

Using the motorized robot a surgeon can remotely control the robot’s movements to operate on a patient. “They can be in another room or they can be hundreds of miles away (with an excellent internet connection,” says Sachs. 

For surgeons using Vicarious’ technology, the primary feedback is virtual, Sachs says. They look through the “eyes” of the robot and can look down and see the robot’s arms. “We track the surgeon’s arm motion and mimics their arms and hands. The primary feedback is to create the impression of presence of the surgeon as if they’d been shrunk down.”

The mission of Vicarious Surgical’s founders and its investors is to drive down both the cost of higher impact surgeries and access to the best surgeons through remote technologies.

The market for medical robots is highly lucrative. Earlier today, Johnson & Johnson announced the $3.4 billion acquisition of Auris Health — a maker of robotic diagnostics and surgical tools. In all, estimates put the robotic surgery market at somewhere around $90 billion, according to a report from Allied Market Research.

“We like to invest in things that if they work they truly change the industry. Minimally invasive surgeries and surgical robotics is definitely the future and it’s just getting started,” says Dror Berman, a managing director with Innovation Endeavors.

There were 900,000 surgeries done using surgical robotics out of a total of 313 million surgical procedures. It’s a low percentage and it’s very expensive to buy those… In general that’s not offered to the vast majority of patients. Vicarious is about democratizing that access… if it works it will open a huge market for people who can use much better procedures for much better surgeries,” Berman says. 

“One of the problems with that is that smaller hospitals can’t afford these $2 million robots,” says Sachs. “By making the devices tiny and fitting the motion inside a patient we can expand access long-term and in smaller hospitals where a surgeon might be able to start a procedure.”

Later, as Vicarious is able to build up taxonomies of different surgical practices and methods, the hospitals could begin to automate more aspects of the procedures to the point where many of these surgeries may just be handled by the robot.

The company is currently testing its miniature robots in laboratories and would not comment on whether it was using animal subjects. Vicarious is also modeling the human abdomen and conducting as many virtual tests as possible.

The new funding, Sachs says, will take the company through its applications for the Food and Drug Administration.

“A lot of our long-term vision is about growing and scaling our technology to the point where it’s accessible not just to big cities and major hospitals in the U.S. and also the small cities and towns in the rural U.S. and around the world as well,” says Sachs. “Long-term it’s about the democratization of surgery that can come from surgical robotics.”

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