The Longevity

Designing a Lifestyle: The Future of Technology for Aging

The future of robots may not be all shiny plastic and smooth metal. In fact, it might be downright cute and cuddly:

Paro closes its watery eyes, tilts its head and emits a soft cry. The robotic harp seal — the world’s best-known therapeutic robot — is the creation of Japanese scientist Takanori Shibata, but its voice is made in Canada. Shibata recorded the baby harp seal, which became the voice of Paro, on Quebec’s Magdalen Islands. 

Paro, which has been used in Japan and through Europe since 2003, has helped demonstrate that technology can be used and embraced in previously-unheard-of ways for eldercare. The robot seal, which responds to touch and makes eye contact, has been found to reduce patient and caregiver stress, to stimulate interaction between patients and caregivers and to improve the socialization of patients. It has also been found to reduce the need for medication in some cases.

The World Congress of Gerontology and Geriatrics discussed the future of robotics and other technology in the service of elder care at their recent gathering in San Francisco. The event also included a pitch competition and “startup alley”:

Technological advances have made many new aging technologies possible, said William Kearns, president of the International Society for Gerontechnology. Robots have a particular appeal.

“A robot can be a far more persuasive way to get a person to behave in a certain way — such as exercising — than an iPad or a cellphone,” Kearns said.

Joseph Coughlin, founder of AgeLab at MIT, predicted smart homes, robots and more will change the way people live and age.

“It is not about reminding me to take my meds, it is about having overall wellbeing and enabling me to do things, to improve the quality of life, not simply to extend it,” he said. “We should understand we are designing a lifestyle.”

Coughlin expects that baby boomers and younger generations of digital natives will see this technology as a given, rather than a perk or a perplexing extravagance:

“Are you going to be as polite as your parents?” he asked. “No, you are going to expect a pill, a product or a policy to insure you live longer better because you have seen it your whole life. 

But even those comfortable with smart devices may have questions and apprehensions about how this technology can affect their autonomy as they age:

Beyond nanny cams installed by concerned family members to watch elders is a future in which implanted tracking devices become more common. That raises new questions, said Coughlin.

Coughlin asked, “Where is privacy and dignity in all of this? How far do I push your dignity in order to ensure your safety?”

“The home environment has always been the domain in the individual, the space where you can be free from the observation of others. The introduction of surveillance technology breaks that boundary, and this is significant.”

Startups Addressing Social Determinants of Health

According to the World Health Organization, social elements in our lives have an impact on our overall health:

"To a large extent, factors such as where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family all have considerable impacts on health, whereas the more commonly considered factors such as access and use of health care services often have less of an impact."

Business Insider reports that some startups are trying to close this gap in access to resources:

Now, a crop of companies is trying to addressing the "social determinants of health" — the external factors like your environment or socioeconomic status — that can impact your health, and they're getting some backing from venture capitalists. 

These companies are trying to do for the poor or the elderly what many of us take for granted — like making sure people make regular doctors appointments and have a way to get to them. And lately, they're ginning up interest from venture capital investors. 

But can providing these services be good for business, as well as for those they help? Lisa Suennen thinks so:

Making money here means providing social services, and tapping funds for Medicaid and Medicare. 

"Turning these traditional charity, social things into companies and figuring out how to get business models built around them is a very current, trendy thing," Lisa Suennen, senior managing director of healthcare at GE Ventures told Business Insider. That's a good thing, she said. 

Suennen gave two examples of startups that got funding just in July:

- Healthify announced on July 11 that they had raised $6.5 million. Healthify works with people on Medicaid and Medicare in 30 states. The company uses technology to identify the social determinants of health that might be hindering someone's ability to be healthy, and then connects patients to everything from housing and food to day care and transportation to improve their overall health.

- Circulation, a company that drives people to appointments, raised $10.5 million

Ultimately, the pitch is that this kind of help could make healthcare less expensive. If you can treat people earlier, when they have a better chance to recover, it'll keep people from putting off visits and ending up in the emergency room. 

"I'm optimistic about the profit opportunity here, she said. "Because if something like 60-70% of all health costs have a social component to them, either mental health or otherwise, and if you can tackle those there's a lot of money to be saved and that way you can take money out of savings and get them reimbursed from that."

The approaching “silver tsunami” of aging Baby Boomers will mean a growing number of people with the increasing medical needs that come with getting older. Providing solutions that save money in health care costs is a business opportunity that VCs may want to pay attention to.

Survey: What Unpaid Family Caregivers Really Want from Digital Solutions

Taking a cue from the 2015 AARP and National Alliance for Caregiving study on the nearly 43.7 million Americans providing unpaid caregiving to another child or adult, the Massachusetts eHealth Institute (MeHI) recently took to take a closer look at what those caregivers desire from digital health tools.

Caregiving entrepreneurs take note: MeHI just released key findings and the full report on the results of their survey of 700 non-professional Massachusetts caregivers. This is free market research that could provide invaluable insights on potential customers.

Qmed provides a summary of background and the findings.

Non-professional caregivers represent a huge market for medtech companies. In 2015, AARP and the National Alliance for Caregiving estimated that around 43.7 million people in the United States provide unpaid care to an adult or child. To put that in perspective, it’s almost as much as the number of people in the country living with diabetes (29 million in 2014, according to the U.S. Centers for Disease Control and Prevention) and cancer (14.7 million, according to the National Cancer Institute) combined. What’s more, with an aging population, longer life expectancy, and Medicaid cuts possibly on the horizon, the number of non-paid caregivers is expected to climb in the coming years.

Anyone who has cared for a family member knows it’s not easy. A recent survey by the Massachusetts eHelath Institute of 700 non-professional caregivers in the state showed that in addition to giving medicine, attending to wounds, and providing other medical or nursing care, caregivers are often performing daily tasks like grocery shopping, transportation, housework, meal preparation, and financial management. Around three-quarters of survey respondents said caregiving is one of the most significant or the most significant aspects of their life right now, and two-thirds said they never, rarely, or only sometimes can take a break from caregiving if they needed it. Not surprisingly, this leads many caregivers to feel stressed, overwhelmed, burned out, depressed, and isolated.

Digital tools exist to help with many if not all these tasks, but the first notable finding of the survey is that these unpaid caregivers more often than not simply do not know they exist.

More than a quarter [of these unprofessional caregivers] said they don’t use tools like smartphones, tablets, apps, and computer programs to provide and coordinate care, according to the “Caregivers and Digital Health” survey. Many (58%) said they’re simply unaware of the technologies available to help, but 56% said they haven’t found a tool that addresses their specific needs.

What do the caregivers say they could really use in a digital health tool? Here are some of the key findings:

- Provide access to test results and other medical records in one place (57%)

- Help me find out reliable information about the needs and conditions of the people I care for (52%)

- Allow me to share information directly with doctors and other service providers (51%)

- Allow me to communicate with everyone responsible for coordinating care (51%)

- Help me understand insurance benefits and navigate the insurance claims system (49%)

- Help me organize and manage many aspects of care, rather than just one or two, in one place (48%)

- Help me balance everyday life with my responsibilities as a caregiver (44%)

- Remind the people I care for to take their medicine or eat a meal (44%)

- Help me discover and learn about caregiver products and services (44%)

- Connecting me with caregivers who could fill in when needed (36%)

- Help me connect to other caregivers for support or conversation (35%)

- Help me feel less alone and/or guilty (35%)

- Provide a support network of other caregivers in similar situations (34%)

4 Veterans of FinTech “Company Building” Launch Lab for Digital Health Startups

The four founders of the new Berlin-based Heartbeat Labs aim to build “pioneering healthtech companies,” according to its website.

[The] new company builder by HitFox Group…will launch up to five digital startups a year.

It will back three to five startups working on health tech solutions with seed funding between €500,000 and €5 million. It will launch its first company by the end of August.

Heartbeat Labs was founded by Jan Beckers, Hendrik Krawinkel, and Eckhardt Weber, who previously founded the fintech company builder FinLeap, which raised €39 million earlier this week.

“While medical therapies are advancing steadily, not enough progress has been made in making healthcare more data-driven, efficient and affordable,” said Jan Beckers, managing director, on the decision to establish the new company builder.

“We look forward to leveraging our expertise to support the digitization of existing healthcare players and to bringing new business models to this market.”

Eckhardt also believes this is the right moment to jump into the digital health sector in Europe.

The European digital health sector is starting to catch up with the US, said Eckhardt. “We believe this is the right time to invest in healthcare: Changing regulations in Europe is opening up the markets. Technological capabilities are developing quickly,” he said.

Heartbeat Labs will assist startups on a business and product development level and help them prepare for entering what is a heavily regulated market. The program is supported by a board of medical experts.

Before You Go in Search of Funding, Make Sure You Avoid These Three Red Flags

Mark Gilbert, founder and CEO of MBS Accounting Technology & Advisory, recently contributed a post to MedCity News on some of the pitfalls start-ups fall into which “send investors running”.

Many health tech startups blame the economy when fundraising efforts go awry. Yet more often than not their failed fundraising boils down to the basics of business. These digital health entrepreneurs are overlooking areas of their business that investors want to scrutinize.

 Investors are scared away when the books are a mess, even when a startup has a unique idea. As a result, many startups never get their ideas discovered or funded. Today’s private investors, seed funders and angel investors – want more detailed reporting. They’re more astute to burn rates and detailed projection models, relying less on tax statements.

Aside from a good business idea, says Gilbert, investors want to see solid financials and business practices.

Red Flag #1: Using Excel as an accounting system

My company works with many startups and we continually see their founders using Excel for accounting. Running financials on an Excel document is a tedious practice, inadvertently leading to basic human error; just one incorrect manual input leads to the distortion of numbers that are important in company decision-making.

Using error-prone spreadsheets communicates the wrong message to investors. This practice is viewed as unprofessional, especially since it is not compatible with scaling a business. When the company scales, founders will spend too much time focusing on manually updating and linking spreadsheets.

 As the company’s Excel accounting system becomes more complex over time, this knowledge is not easily shared with new employees, let alone investors. It is increasingly hard to understand how the system of spreadsheets fits together.

 There is a quick fix — invest in a professional accounting interface system. Programs like QuickBooks Online and Xero will prepare any health tech startup from day one. An accounting system is more efficient and allows a startup to scale more quickly.

Red Flag #2: No due diligence reporting

Here is why you need that accounting interface. It will help you quickly generate reports. As soon as a pitch is made to investors, they will want the startup to show due diligence. This validates that a startup has an organized business model and is ready for capital investment.

The best way for a startup to show due diligence is with financial data, yet most startups do not have anything on hand other than bank statements and spreadsheets. Investors want to see a bottom-up financial forecast and a detailed analysis of cash flows to back up projections.

Potential investors will want to see departmentalized sales reports, enhanced expense reports and salary reports. An operating expense plan based on actual numbers is not only more concrete but also more realistic, two traits investors are looking for. These documents will show investors that the startup has a real understanding of its cash flow, revenue and variable expense projections.

Red Flag #3: No competitive research

Most startups are internally-focused and do not check industry comparisons before heading to investors. A startup will fail to raise money if it does not have as much knowledge of main competitors as it does of itself. Albeit, a startup with a new concept may not likely have the advantage of competitive research but a disruptive startup without peer benchmarking is a red flag

All investors will do an industry comparison. They will analyze all competing firms on similar revenue lines and compare the projections of their potential investment to existing companies. Investors will check to see what competitors are paying for supplies; if a startup is off the charts on variable expenses compared to competitors, it will need to come into the meeting with an explanation.

For this reason, startups are expected to know what industry comparisons will show on items like sales, revenues and expenses. This information is readily available with software like Qvinci.

Disorderly books cause potential investors to lock up their wallets and throw away the key. It’s not just because it looks unprofessional; it’s because every piece of a business is entwined with finances. All health tech startups can better prepare themselves right now for successful fundraising by instituting professional accounting and competitive research.

A Feel-Good Digital Health Story: CaringBridge Turns 20

Last month, Eagan, MN-based CaringBridge turned 20, and the celebration included lighting up the I-35W bridge in Minneapolis in shades of purple and orange. CaringBridge is a digital health company that was way ahead of its time—a social network tool that connected anyone going through a health event to their network of loved ones. It allowed them to tell their story and thereby promote social connection and support.

The site, created in 1997 by founder Sona Mehring [pictured above] as a way to help her friends share news when their daughter Brighid was born prematurely, has since supported more than 675,000 individual sites with more than 2.1 billion visits. 

What it has become in the intervening 20 years, however, is primarily a site for caregivers, according to Liwanag Ojala, CaringBridge CEO.

“Today, 65 percent of our new sites are created by caregivers,” Ojala said. “Over the years, we’ve become a way for caregivers to control the chaos in the messaging and to communicate the practical issues of a loved one’s health-care journey, but we’ve also grown into an important place for them to find support from the outside world. Digital has the opportunity to play a role in minimizing isolation and supporting the caregiver on the journey, and we understand that more than anyone.”

This shift in audience is one of the many changes that CaringBridge is celebrating in “20 Years One You,” an anniversary campaign designed to emphasize the nonprofit’s growth and development over the last two decades.

Founder and CEO Sona Mehring used the anniversary celebration as a moment to retire, a move that was well-thought out when Ojala was hired as COO in 2014, with the intent that she would take over as CEO when Mehring made her exit.

“At the beginning, this job was an interesting operations and digital challenge,” [Ojala] explained, “but quickly, as I started reading more public CaringBridge sites, I began to understand the value of the catharsis that comes from writing, the value of having people wanting to hear your stories and the impact of active listening on a community, of people stepping forward to help a person in need. This made the job feel significant.”

It didn’t take long for [her] to realize that at CaringBridge, even small coding changes had the power to help others. This was a great realization.

“Every single time you make an improvement at CaringBridge it makes a positive practical impact on people’s lives,” Ojala said. After years working in traditional online industry, this ability to foster lasting positive impact was particularly appealing.

“We need to use digital technology to produce more good in the world,” she said. “There is way too much negativity in society these days.”

A Plan for the Future of CaringBridge

“We want to keep thinking about new ways we can support caregivers and visitors,” Ojala said. “How can we serve them by suggesting things that they might do to help others in their health journey? How do we help visitors think about what to say? These are examples of things that we have in our program roadmap.”

One enhancement will likely be features that help users add more interactive elements to their posts, Ojala said.

“We’re enhancing our multimedia capabilities, making it possible for users to tell their story and share a message with voice and video and music. These are ways that people communicate now.” 

Already an established resource in many hospitals, mental illness is also an area where CaringBridge sees an unmet need and an opportunity to expand their services.

Ojala would like to build stronger connections with psychiatric hospitals, so that more patients and their families could see how the site could help them. People undergoing treatment for mental illness also need support, and Ojala believes that the site could help break down walls of silence built around family members and communities.  

“I do think that there is an opportunity for people to use a social network around mental illness,” Ojala said. “There could be a way to bring in the community and encourage participation and social support. This could reduce the stigma around mental illness that still exists after all these years.”

CaringBridge has also launched a partnership with the University of Minnesota to better understand their user population, particularly ways in which individuals may already be using it to deal with mental health crises—or longer journeys.

While CaringBridge has no hard data about the number of users who use the site to support someone struggling with mental illness, they are working with a group of University of Minnesota researchers to build a greater understanding of their user population. While Ojala knows that the site enhances many users’ mental health through indirect benefits, she also suspects that there is a significant number who may be already using the site to gain support during a mental health crisis.

“We started a year ago working with these researchers,” she said. “They are working hard to better understand our data set. How much of our users are acute illness? How much are chronic illness? How much are mental illness? We haven’t yet gotten to the answers. Research is a long and winding road.” 

Staying True to Its Founding Principles

CaringBridge may be older than Facebook or Google, but it has made a point to stay true to its founding principles. The “small-but-mighty” staff of 40 is still based in Eagan, focused on the basic concept that very first site was built around: helping people use the internet to get the support they need when they need it the most.

“It’s a pretty basic idea and it’s worked all these years,” Ojala said. “We want to activate communities in support for healing.”

Home Caregiver Platform CellTrak Raises $11M

Eleven years after launch, Schaumburg, Illinois-based CellTrak has raised a round of funding to expand its sales and user support team, hoping to take advantage of market trends as the shift to value-based care takes hold.

CellTrak, an early entrant into the mobile health space that focuses on connecting home caregivers, has raised $11 million. Boathouse Capital led the round with participation from existing investor MK Capital. This brings the company's total funding to $23 million.

CEO Mark Battaglia told MobiHealthNews via email that there are a number of reasons the company decided to raise money now. For one, the company has seen a boost in business over the last year, owing partly to new integration with Epic. They've added Adventist, Aspirus, Childrens Mercy Hospital, Maine Health, Halifax Health, and St Joseph’s in Liverpool, New York, as well as some larger, undisclosed systems.

"We expect to see even more rapid growth in next few years due to 21st Century Cures Act and its requirement for Electronic Visit Verification in the Medicaid market (that drives demand for our mobile apps, which use the GPS capabilities of the mobile device)," Battaglia said.

"The shift to value-based models across all segments means that providers and payers in all segments (and all countries) want more information from the point-of-care. That both drives demand for our current software as well as a desire to expand our platform."

MobiHealthNews profiled [CellTrak] way back in 2010, at which time they had already secured 50 customers and over 50,000 users.

Today, the company has more than 200 customers and offers a device-agnostic care delivery management platform that connects home caregivers with their home offices, with extended care teams, and with other technologies including electronic health records.

"CellTrak is unique in the industry with its focus on the full scope of care delivery management," Battaglia said in a statement. "Today, we offer agencies proven real-time interoperability; secure connections that enable collaboration across the extended care team; and the ability to use data in smart ways, including to meet Electronic Visit Verification regulations that fight fraud, to improve point-of-care responsiveness, to optimize care delivery, and to better manage the people who deliver care.”

The company plans to use the funding to innovate its platform, hire more sales and support staff, and to support future acquisitions. CellTrak has already made at least one acquisition: Canadian clinical decision support and care documentation tool MedShare, which CellTrak purchased in 2011.

Diabetes Management App Glooko Secures $35M Series C

Mountain View, California-based Glooko, which offers a suite of services for diabetes management, continues to show strong market traction and has just closed a $35 million Series C round. Diabetes affects over 9% of the US population but over 25% of the 65 and older population.

Glooko’s goal with the new funding [which added Mayo Clinic and other new investors] is to deepen expertise in data analytics and continue to fuel commercialization in markets outside the U.S.

Toronto-based investor Georgian Partners, with a focus on machine learning, led the round, according to a news release. Diabetes medical device business Insulet Corp., another new investor, joined existing investors Canaan Partners, Social Capital, Medtronic and Samsung NEXT in the round.

The company also plans to use the funding to support commercialization in France, Germany, the UK, Asia and the Middle East.

The company has also proven itself to be effective at developing strategic partnerships and technical integrations as well.

[They have] inked deals with medical device and pharma partners such as Roche to integrate data from connected devices like Roche’s Bluetooth Low Energy blood-glucose meter ACCU-CHECK Connect. It is part of Glooko’s strategy to aggregate data from blood-glucose meters and insulin pumps to help diabetes patients and caregivers view that data in the context of activity and diet data collected from other apps.

Through its partnership with Novo Nordisk earlier this year, Glooko will provide access to consumer-focused technology platforms to the drug developer. In return, Glooko has gained access to the pharma company’s extensive customer base and library of educational content, some of which will be integrated into Glooko’s app. Glooko’s deal with Novo Nordisk involves co-developing products to enable personalized support for people with diabetes.

Glooko also partnered with Ascensia Diabetes Care, which Panasonic Healthcare Holdings acquired from Bayer last year. Ascensia received FDA 510(k) clearance for its blood glucose monitor Contour Next One. The deal is intended to give Ascensia broader access to Glooko’s health system partners. In April, Glooko and Fit4D announced a collaboration to provide its network of certified diabetes educators to Glooko’s customers.  Last year, Diasend merged with Glooko to open up the European market for the U.S. business.

FDA Commissioner Announces Pilot for Expediting Approval of Digital Health Products

Just a few weeks into his role as the US Food and Drug (FDA) Commissioner, Scott Gottlieb has announced that providing clear guidance on digital health regulation--and expediting approval for low-risk digital health products and services--is a priority for the agency. (Read his original letter on FDA's blog).

[Late last week], Gottlieb...announced an upcoming pilot program that would create a third-party certification program under which lower-risk digital health products could be marketed without FDA premarket review and higher-risk products could be marketed with a streamlined FDA review.

The pilot, part of a new approach to regulating digital health tools, would help to certify, according to Gottlieb, whether a company "consistently and reliably engages in high quality software design and testing (validation) and ongoing maintenance of its software products. Employing a unique pre-certification program for software as a medical device (SaMD) could reduce the time and cost of market entry for digital health technologies."

This effort to provide clearer guidelines and expedited processes for digital health products is all part of FDA's implementation of the 21st Century CURES Act that was passed in December at the tail end of the Obama Administration. The Cures Act, passed with an overwhelming majority in both the House and the Senate, aims to "boost funding for medical research, ease the development and approval of experimental treatments and reform federal policy on mental health care," according to a Washington Post article at the time.

"...FDA will provide new guidance on other technologies that, although not addressed in the 21st Century Cures Act, present low enough risks that FDA does not intend to subject them to certain pre-market regulatory requirements," Gottlieb wrote in FDA’s Voice Blog.

FDA also will provide guidance clarifying its stance on products that contain multiple software functions and which currently fall outside FDA regulations.

The push into digital health comes as Bakul Patel, ‎associate center director for digital health at FDA, recently told conference attendees that guidance related to software as a medical device, and a new dedicated unit to digital health are coming to FDA’s Center for Devices and Radiological Health (CDRH). 

(See our coverage of FDA's new digital health unit here).

Gottleib also touted the role of a universal method for collecting post-market data on digital health products and using that data in turn to expedite new or evolving product functions.

"For example, product developers could leverage real-world data gathered through the National Evaluation System for health Technology (NEST) to expedite market entry and subsequent expansion of indications more efficiently ... The Medical Device Innovation Consortium (MDIC), a 501(c)(3) public-private partnership, is serving as an independent coordinating center that operates NEST. In the coming weeks, MDIC will announce the establishment of a Governing Committee for the NEST Coordinating Center comprised of stakeholder representatives of the ecosystem, such as patients, health care professionals, health care organizations, payers, industry, and government," Gottlieb wrote.

NEST’s fully operational system is expected to come by the end of 2019.

New App Curatio Looks to be the Tinder of Social Support for the Ill

Curatio is not setting out to help manage chronic illness or coordinate care. But it is looking to improve patient outcomes by combatting the social isolation that often comes with the diagnosis of a chronic or even terminal condition.

The social app company first launched through a startup competition in 2013 and revamped in past weeks to serve 10 different health communities. The app acts like an online dating app to connect you with people who have similar health experiences, down to exactly which symptoms they're experiencing. Then, anyone you connect with becomes part of your network to create a news feed that's like a HIPAA-compliant version of Facebook. 

Since health information is involved, privacy is key. Anything you share only goes to people you've approved to see it. And you can't be totally anonymous, but you don't have to use your real identity. 

There's also an AI concierge to answer questions about health information and a section for personal disease management and health tracking. Curatio also licenses its technology to other health providers and communities for their own social tools. 

The platform can cover a wide variety of conditions, and even has a section for caregivers.

Current groups include menopause, traumatic brain injury, heart disease, the blood disease Thalassemia, Crohn's disease and colitis, Type 1 diabetes, and a community for caregivers. 

Shirley Weir founded the Facebook group Menopause Chicks, which transferred their community over to Curatio. 

"If somebody comes to my community [on Facebook] and says, 'I'm losing hair,' I can give them information on experts or books," Weir said. "It's different to say, 'Talk to these four women who also experienced hair loss.'"

Ganzert-Brown declined to provider user metrics, but said Curatio users are now in 31 countries.