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April 21, 2019
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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.”

News Source = techcrunch.com

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.

News Source = techcrunch.com

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.”

News Source = techcrunch.com

Two former Qualcomm engineers are using AI to fix China’s healthcare problem

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Artificial intelligence is widely heralded as something that could disrupt the jobs market across the board — potentially eating into careers as varied as accountants, advertising agents, reporters and more — but there are some industries in dire need of assistance where AI could make a wholly positive impact, a core one being healthcare.

Despite being the world’s second-largest economy, China is still coping with a serious shortage of medical resources. In 2015, the country had 1.8 physicians per 1,000 citizens, according to data compiled by the Organization for Economic Cooperation and Development. That figure puts China behind the U.S. at 2.6 and was well below the OECD average of 3.4.

The undersupply means a nation of overworked doctors who constantly struggle to finish screening patient scans. Misdiagnoses inevitably follow. Spotting the demand, forward-thinking engineers and healthcare professionals move to get deep learning into analyzing medical images. Research firm IDC estimates that the market for AI-aided medical diagnosis and treatment in China crossed 183 million yuan ($27 million) in 2017 and is expected to reach 5.88 billion yuan ($870 million) by 2022.

One up-and-comer in the sector is 12 Sigma, a San Diego-based startup founded by two former Qualcomm engineers with research teams in China. The company is competing against Yitu, Infervision and a handful of other well-funded Chinese startups that help doctors detect cancerous cells from medical scans. Between January and May last year alone, more than 10 Chinese companies with such a focus scored fundings of over 10 million yuan ($1.48 million), according to startup data provider Iyiou. 12 Sigma itself racked up a 200 million yuan Series B round at the end of 2017 and is mulling a new funding round as it looks to ramp up its sales team and develop new products, the company told TechCrunch.

“2015 to artificial intelligence is like 1995 to the Internet. It was the dawn of a revolution,” recalled Zhong Xin, who quit his management role at Qualcomm and went on to launch 12 Sigma in 2015. At the time, AI was cereping into virtually all facets of life, from public security, autonomous driving, agriculture, education to finance. Zhong took a bet on health care.

“For most industries, the AI technology might be available, but there isn’t really a pressing problem to solve. You are creating new demand there. But with healthcare, there is a clear problem, that is, how to more efficiently spot diseases from a single image,” the chief executive added.

An engineer named Gao Dashan who had worked closely with Zhong at Qualcomm’s U.S. office on computer vision and deep learning soon joined as the startup’s technology head. The pair both attended China’s prestigious Tsinghua University, another experience that boosted their sense of camaraderie.

Aside from the potential financial rewards, the founders also felt an urge to start something on their own as they entered their 40s. “We were too young to join the Internet boom. If we don’t create something now for the AI era, it will be too late for us to be entrepreneurs,” admitted Zhong who, with age, also started to recognize the vulnerability of life. “We see friends and relatives with cancers get diagnosed too late and end up  The more I see this happen, the more strongly I feel about getting involved in healthcare to give back to society.”

A three-tier playbook

12 Sigma and its peers may be powering ahead with their advanced imaging algorithms, but the real challenge is how to get China’s tangled mix of healthcare facilities to pay for novel technologies. Infervision, which TechCrunch wrote about earlier, stations programmers and sales teams at hospitals to mingle with doctors and learn their needs. 12 Sigma deploys the same on-the-ground strategy to crack the intricate network.

Zhong Xin, Co-founder and CEO of 12 Sigma / Photo source: 12 Sigma

“Social dynamics vary from region to region. We have to build trust with local doctors. That’s why we recruit sales persons locally. That’s the foundation. Then we begin by tackling the tertiary hospitals. If we manage to enter these hospitals,” said Zhong, referring to the top public hospitals in China’s three-tier medical system. “Those partnerships will boost our brand and give us greater bargaining power to go after the smaller ones.”

For that reason, the tertiary hospitals are crowded with earnest startups like 12 Sigma as well as tech giants like Tencent, which has a dedicated medical imaging unit called Miying. None of these providers is charging the top boys for using their image processors because “they could easily switch over to another brand,” suggested Gao.

Instead, 12 Sigma has its eyes on the second-tier hospitals. As of last April, China had about 30,000 hospitals, out of which 2,427 were rated tertiary, according to a survey done by the National Health and Family Planning Commission. The second tier, serving a wider base in medium-sized cities, had a network of 8,529 hospitals. 12 Sigma believes these facilities are where it could achieve most of its sales by selling device kits and charging maintenance fees in the future.

The bottom tier had 10,135 primary hospitals, which tend to concentrate in small towns and lack the financial capacity to pay the one-off device fees. As such, 12 Sigma plans to monetize these regions with a pay-per-use model.

So far, the medical imaging startup has about 200 hospitals across China testing its devices — for free. It’s sold only 10 machines, generating several millions of yuan in revenue, while very few of its rivals have achieved any sales at all according to Gao. At this stage, the key is to glean enough data so the startup’s algorithms get good enough to convince hospital administrators the machines are worth the investment. The company is targeting 100 million yuan ($14.8 million) in sales for 2019 and aims to break even by 2020.

China’s relatively lax data protection policy means entrepreneurs have easier access to patient scans compared to their peers in the west. Working with American hospitals has proven “very difficult” due to the country’s privacy protection policies, said Gao. They also come with a different motive. While China seeks help from AI to solve its doctor shortage, American hospitals place a larger focus on AI’s economic returns.

“The healthcare system in the U.S. is much more market-driven. Though doctors could be more conservative about applying AI than those in China, as soon as we prove that our devices can boost profitability, reduce misdiagnoses and lower insurance expenditures, health companies are keen to give it a try,” said Gao.

News Source = techcrunch.com

Healthcare by 2028 will be doctor-directed, patient-owned and powered by visual technologies

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Visual assessment is critical to healthcare – whether that is a doctor peering down your throat as you say “ahhh” or an MRI of your brain. Since the X-ray was invented in 1895, medical imaging has evolved into many modalities that empower clinicians to see into and assess the human body.  Recent advances in visual sensors, computer vision and compute power are currently powering a new wave of innovation in legacy visual technologies(like the X-Ray and MRI) and sparking entirely new realms of medical practice, such as genomics.

Over the next 10 years, healthcare workflows will become mostly digitized, with wide swaths of personal data captured and computer vision, along with artificial intelligence, automating the analysis of that data for precision care. Much of the digitized data across healthcare will be visual and the technologies that capture and analyze it are visual technologies.

These visual technologies traverse a patient’s journey from diagnosis, to treatment, to continuing care and prevention.They capture, analyze, process, filter and manage any visual data from images, videos, thermal, x-ray’s, ultrasound, MRI, CT scans, 3D, and more. Computer vision and artificial intelligence are core to the journey.

Three powerful trends — including miniaturization of diagnostic imaging devices, next generation imaging to for the earliest stages of disease detection and virtual medicine — are shaping the ways in which visual technologies are poised to improve healthcare over the next decade.

Miniaturization of Hardware Along with Computer Vision and AI will allow Diagnostic Imaging to be Mobile

Medical imaging is dominated by large incumbents that are slow to innovate. Most imaging devices (e.g. MRI machines) have not changed substantially since the 1980s and still have major limitations:

  • Complex workflows: large, expensive machines that require expert operators and have limited compatibility in hospitals.

  • Strict patient requirements: such as lying still or holding their breath (a problem for cases such as pediatrics or elderly patients).

  • Expensive solutions: limited to large hospitals and imaging facilities.

But thanks to innovations in visual sensors and AI algorithms, “modern medical imaging is in the midst of a paradigm shift, from large carefully-calibrated machines to flexible, self-correcting, multi-sensor devices” says Daniel K. Sodickson, MD, PhD, NYU School of Medicine, Department of Radiology.

MRI glove-shaped detector proved capable of capturing images of moving fingers.  ©NYU Langone Health

Visual data capture will be done with smaller, easier to use devices, allowing imaging to move out of the radiology department and into the operating room, the pharmacy and your living room.

Smaller sensors and computer vision-enabled image capture will lead to imaging devices that are being redesigned a fraction of the size with:

  • Simpler imaging process: with quicker workflows and lower costs.

  • Lower expertise requirements: less complexity will move imaging from the radiology department to anywhere the patient is.

  • Live imaging via ingestible cameras: innovation includes powering ingestibles via stomach acid, using bacteria for chemical detection and will be feasible in a wider range of cases.

“The use of synthetic neural network-based implementations of human perceptual learning enables an entire class of low-cost imaging hardware and can accelerate and improve existing technologies,” says Matthew Rosen, PhD, MGH/Martinos Center at Harvard Medical School.

©Matthew Rosen and his colleagues at the Martinos Center for Biomedical Imaging in Boston want liberate the MRI.

Next Generation Sequencing, Phenotyping and Molecular Imaging Will Diagnose Disease Before Symptoms are Presented

Genomics, the sequencing of DNA, has grown at a 200% CAGR since 2015, propelled by Next Generation Sequencing (NGS) which uses optical signals to read DNA, like our LDV portfolio company Geniachip which was acquired by Roche. These techniques are helping genomics become a mainstream tool for practitioners, and will hopefully make carrier screening part of routine patient care by 2028.

Identifying the genetic makeup of a disease via liquid biopsies, where blood, urine or saliva is tested for tumor DNA or RNA, are poised to take a prime role in early cancer screening. The company GRAIL, for instance, raised $1B for a cancer blood test that uses NGS and deep learning to detect circulating tumor DNA before a lesion is identified.

Phenomics, the analysis of observable traits (phenotypes) that result from interactions between genes and their environment, will also contribute to earlier disease detection. Phenotypes are expressed physiologically and most will require imaging to be detected and analyzed.

Next Generation Phenotyping (NGP) uses computer vision and deep learning to analyze physiological data, understand particular phenotype patterns, then it correlates those patterns to genes. For example, FDNA’s Face2Gene technology can identify 300-400 disorders with 90%+ accuracy using images of a patient’s face. Additional data (images or videos of hands, feet, ears, eyes) can allow NGP to detect a wide range of disorders, earlier than ever before.

Molecular imaging uses DNA nanotech probes to quantitatively visualize chemicals inside of cells, thus measuring the chemical signature of diseases. This approach may enable early detection of neurodegenerative diseases such as Alzheimer’s, Parkinson’s and dementia.

Telemedicine to Overtake Brick-and-Mortar Doctors Visits

By 2028 it will be more common to visit the doctor via video over your phone or computer than it will be to go to an office.

Telemedicine will make medical practitioners more accessible and easier to communicate with. It will create an all digitized health record of visits for a patient’s profile and it will reduce the costs of logistics and regional gaps in specific medical expertise. An example being the telemedicine services rendered for 1.9M injured in the war in Syria.4

The integration of telemedicine into ambulances has led to stroke patients being treated twice as fast.  Doctors will increasingly call in their colleagues and specialists in real time.

Screening technologies will be integrated into telemedicine so it won’t just be about video calling a doctor. Pre-screening your vitals via remote cameras will deliver extensive efficiencies and hopefully health benefits.

“The biggest opportunity in visual technology in telemedicine is in solving specific use cases. Whether it be detecting your pulse, blood pressure or eye problems, visual technology will be key to collecting data,” says Jeff Nadler, Teldoc health.

Remote patient monitoring (RPM) will be a major factor in the growth of telemedicine and the overall personalization of care. RPM devices, like we are seeing with the Apple Watch, will be a primary source of real-time patient data used to make medical decisions that take into account everyday health and lifestyle factors. This personal data will be collected and owned by patients themselves and provided to doctors.

Visual Tech Will Power the Transformation of Healthcare Over the Next Decade

Visual technologies have deep implications for the future of personalized healthcare and will hopefully improve the health of people worldwide. It represents unique investment opportunities and we at LDV Capital have reviewed over 100 research papers from BCC Research, CBInsights, Frost & Sullivan, McKinsey, Wired, IEEE Spectrum and many more to compile our 2018 LDV Capital Insights report. This report highlights the sectors that power to improve healthcare based on the transformative nature of the technology in the sector, projected growth and business opportunity.

There are tremendous investment opportunities in visual technologies across diagnosis, treatment and continuing care & prevention that will help make people healthier across the globe.

News Source = techcrunch.com

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