Sonde Raises $19M for Voice-Based Screening

Sonde Health puts a few unique spins on the hard problem of early disease detection, but its core tech is built around doing one thing extremely well: flagging patients at risk for health conditions using short voice clips.

Now, after landing a string of new partnerships and $19.25M in Series B funding, Sonde is turning its sights to global expansion.

Sonde’s AI-enabled platform analyzes vocal biomarkers like smoothness, pitch, and clarity to gain insight into a patient’s mental state. It also measures breath cadence and vocal capacity to gauge their respiratory health.

  • This data isn’t positioned as a standalone solution for diagnosing medical conditions, but as a way to improve the clinical workflows of physicians / therapists, the patient stratification of RPM programs, and the value of call center audio.
  • Sonde’s platform can be embedded directly onto device chipsets for passive health monitoring, a feature that’s already being explored within Qualcomm’s smartphone chips and GN Group’s hearing products.
  • This technology also produces a treasure trove of every healthcare startup’s favorite asset – data. Sonde claims to have the largest and most diverse health-labeled voice dataset, with over 1.2M voice clips from 85k users across four continents.

The latest funding will help Sonde expand into Asia, where it’s reportedly seen high demand for its existing solutions, and support the addition of more health conditions to its platform.

  • A validation study of Sonde’s mental health tools is underway at McMaster University, and research on new focus areas is in development at Cambridge University (cystic fibrosis) and the Albert Einstein College of Medicine (dementia).
  • A partnership with Korean telecom giant KT corporation should also streamline the international expansion by bringing Sonde into its call centers and telehealth solutions.

The Takeaway

Although voice-tech is a relatively new healthcare arena, the prospect of passively diagnosing conditions has attracted plenty of competition from startups like Kintsugi ($20M Series A in March) and Eleos ($20M Series A in April), and it’s definitely on the radar of larger players like Microsoft (Nuance) and Amazon (Alexa).

As these companies begin to refine the AI models supporting voice diagnosis, access to proprietary data sets for training the algorithms will become increasingly important for gaining an edge, and Sonde’s funding announcement makes it clear that it plans on turning its dataset into its biggest competitive advantage as quickly as possible.

CB Insights Digital Health 150 Report 2022

CB Insights released its annual Digital Health 150 rankings of the most promising private digital health startups, and it was interesting to see how dramatically the landscape evolved over the past year.

Methodology (maybe more of a Disclaimer): The startups that made the final cut were selected from a pool of 13k applicants based on “proprietary Mosaic scores,” company business models, funding, investor profiles, competitive positioning, tech novelty, and plenty of other metrics. Getting your company to purchase CB Insights’ data products wasn’t listed as one of them, although it probably wouldn’t hurt your chances.

With that out of the way, let’s dive into some of the biggest trends that emerged in the Digital Health 150 pictured above (here’s a high-res version).

  • Early-stage innovation: This year’s Digital Health 150 included a huge share of high flying up-and-comers, with nearly half of the list at Series A or earlier in their growth. These players included Equum Medical (acute care telehealth), Vori Health (hybrid MSK treatment), Playback Health (mixed media patient-provider communications), and Homeward (rural healthcare provider).
  • Diagnostics focus: The screening, monitoring, & diagnostics category led with 29 startups (25%), including Babyscripts (virtual maternity care), Ixlayer (precision health testing), and Enlitic (medical imaging AI). That category was followed by interoperability & data (12%), virtual care (11%), and patient engagement (11%). These categories clearly have a ton of momentum, but growing success leads to growing saturation.
  • Mental health momentum: Although the treatment indications took some time to sort out manually, we counted 24 startups building mental health solutions, a big step up from the 10 that were included last year. It would have been more surprising if it were any other area.
  • Few repeat showings: Around 90% of this year’s cohort wasn’t on last year’s list, which was apparently due to record M&A activity and public exits in 2021. Repeat showings included names that are tough to argue with like Xealth, Redox, and Maven Clinic.
  • Top investors: General Catalyst was the most active investor in this year’s cohort, backing 13 of the companies since 2017 (Ex. Equip, Casana, SWORD Health). Insight Partners was a close second (10), followed by 7wire (6), and Plug and Play (6).

The Takeaway

Lists like these usually get some pushback because of the methodology or glaring company exclusions, but this year’s Digital Health 150 cohort feels pretty well aligned with the high momentum names that keep popping up in our own coverage. For what it’s worth, here were some of social media’s most commonly mentioned exclusions: Ada Health, Awell, Cityblock, Innovaccer, Memora, Ribbon, Turquoise, TytoCare, and Zus.

care.ai Raises $27M for Ambient Monitoring

“Non-clinical workflow” companies continue to lead the pack in terms of digital health funding, and ambient monitoring startup care.ai just added $27M to the segment’s Q4 total following its latest raise.

care.ai’s Smart Care Facility Platform uses ambient sensors spread within care facilities to monitor patients and their caregivers, informing real-time clinical and operational insights.

  • The platform records data such as patient bed exits and falls, while also reducing manual tracking in EHRs by enabling contactless check-ins and screenings.
  • The ambient nature of the solution means that patients aren’t required to wear any RPM device for it to be effective, removing a big source of friction for many virtual nursing or virtual sitting programs.

The fresh funding will help care.ai expand to more hospitals, skilled nursing facilities, and assisted living facilities, building on the 1,500 locations already using its technology.

  • care.ai points to the continued prevalence of staff shortages and burnout as key demand drivers for its solutions, which aims to improve the lives of overworked staff by automating away manual workflows.
  • Other products from GE, ADT Health, or even Amazon’s Alexa fall detection feature compete at least somewhat within the same arena, but care.ai is focused on creating the first truly care site-agnostic solution to the problem of ambient patient monitoring.

The Takeaway
care.ai is setting out to automate away the manual processes causing higher burnout and operational costs for the organizations attempting to deliver optimal care. It’s a tough promise to live up to, but the company’s leadership has done it before. care.ai founder and CEO Chakri Toleti sold his previous patient engagement startup HealthGrid to Allscripts for $60M, and prior to that was putting his motion sensor expertise to work while filming what look to be some pretty epic Bollywood action movies.

The Biggest Company in the World

Venture capital giant Andreessen Horowitz (a16z) got right to the point in a recent blog post that made a huge splash across health tech social media: “We think the biggest company in the world will be a consumer health tech company.”

a16z lays out two paths that could let a healthcare company leapfrog over massive consumer icons like Google, Apple, Facebook, and Amazon to become the world’s most valuable company (Fun fact: the $4T US healthcare market is 5x the size of the global advertising industry).

Path 1 involves creating a vertically integrated “payvidor” that grows to own most care. Picture a company that looks something like if “UnitedHealth Group and Apple had a baby,” with the business model of UHG but the sleek consumer experience of Apple.

  • a16z believes that these companies will need to become big enough to cover most specialties, and also own a health plan that encourages patients to stay within the same care ecosystem (similar to Apple’s tech lineup).
  • Combining both components is essential so that the reimbursement arm can serve as a distribution channel for the care delivery services.

Path 2 centers around building a horizontal marketplace similar to Amazon where healthcare services are aggregated alongside trusted reviews and comparison data. 

  • According to a16z, the key to success for healthcare marketplaces is to serve as an acquisition channel for established players, in addition to being their own acquisition channel.
  • These companies will need to crack the code on how to direct patients to relevant services, while also leveraging the traditional healthcare system for both provider listings and patients.

The Takeaway

Some of the biggest companies in the world are consumer companies that were built in relatively small industries, and the US healthcare market is so big that it can support plenty of success stories with both vertical and horizontal models. That said, packaging something as complicated as healthcare into a consumer experience as simple as Amazon isn’t exactly an easy task, which is why a16z believes that the biggest company in the world will be the one that pulls it off.

HLTH 2022 Recap and Major Announcements

HLTH 2022 is officially a wrap, and we’re sending lots of good energy to the vendors currently breaking down their booths after spending a full week in Vegas.

Hats off to HLTH for putting together a stellar 9,000 person event with awesome attendees, a great speaking track, and the best lunch menu in the industry.

If you weren’t able to make it in person, we’ve got you covered with a roundup of some of the biggest announcements that were showcased in the exhibit hall.

  • 98point6’s new OEM platform tailored for health systems signed Tacoma-based MultiCare Health System as its first partner, licensing the virtual care solution within its hybrid ambulatory care platform, Indigo Health.
  • Awell and Healthie are partnering to enable care organizations to build clinical workflows in Awell’s low-code platform and easily integrate them into Healthie’s API to automate routine clinical tasks and synchronize data between systems.
  • Carenostics joined Bayer G4A’s portfolio of Digital Health Partnerships, providing the AI startup with a €200k convertible loan and coaching from industry experts to help enable earlier clinical intervention through machine learning on EHR data.
  • Google and Epic are partnering to create a new offering that’ll allow Epic hospitals to run their EHR on Google Cloud, with New Jersey-based Hackensack Meridian Health set to be among the first users.
  • General Catalyst tripled its health system partner roster with 10 new logos that it will work with to co-build startups: Banner Health, Cincinnati Children’s, Hackensack Meridian Health, Health First, MetroHealth, OhioHealth, MUSC, UC Davis Health, UC Irvine Health, and Universal Health Services.
  • Health Gorilla was selected by MEDITECH as the technology platform for Traverse Exchange Canada, a new interoperability network designed to enable the seamless flow of health information between participating organizations across Canada.
  • Hello Heart added Dot-to-Dot capabilities to its digital heart health program, leveraging AI to help people draw connections between their lifestyle choices, such as minutes walked or medication adherence, and their heart health.
  • Included Health, the digital health powerhouse formed by the merger of Doctor on Demand and Grand Rounds, launched an All-Included Health hybrid care service to provide primary, specialty, and behavioral care with personalized care teams.
  • Maven Clinic entered the unicorn club with a $90M Series E raise that’ll help the virtual maternity and family health clinic expand its parenting, pediatrics, and menopause platform beyond the 175 countries it already serves.
  • Nomi Health unveiled its Connect fintech platform to power real-time healthcare payments, enabling health plans and third-party administrators to drastically speed up their processes while cutting down on administrative waste.
  • Roche unified its digital health portfolio under the navify brand, providing a range of solutions that help provide evidence about optimizing operational processes and clinical decision making.
  • SonderMind acquired neuroscience company Total Brain to enable patients to better understand their mental state outside of therapy while helping therapists implement measurement-based care techniques.

Welcome to all of our new readers that we met at HLTH, and stay tuned for deeper dives into many of these announcements in next week’s Digital Health Wire.

2022 Digital Health M&A Trends

One of the best reads of last week was Rock Health’s deep dive into the digital health M&A trends that have defined 2022 as the funding bubble lets some air out.

While big ticket acquisitions have taken up most of the spotlight, Rock Health makes the case that declining valuations, customer overwhelm, and an unfriendly IPO market are setting us up for a widespread upswing in M&A activity.

This year’s 144 M&A moves have been shaped in part by supply-side dynamics (harsh fundraising conditions make M&A look more appealing than a down round or shaky IPO), but the report lays out four acquirer archetypes that are likely to drive the next wave.

  • Consolidation for inorganic growth – Lets startups grow their customer base while building confidence from investors looking for growth. This approach is particularly useful as purse strings tighten and customer acquisition costs climb.
  • Enhancing core operations – These acquisitions ideally offset their cost with the internal efficiencies gained in areas such as data integration or analytics. Provider orgs are leaning into this approach, logging 11 transactions Q1-Q3 2022 (3x 2021’s total).
  • Buy-and-build – Acquiring complementary features that enable the acquirer to move along the care delivery value chain or into adjacent categories. Examples include Quest Diagnostics’ acquisition of Pack Health (pushed Quest beyond lab testing into patient engagement / condition management) and Advocate Aurora’s acquisition of MobileHelp (propelled the health system into in-home care).
  • Disruptive innovation – Transforms an acquirer’s existing services and positions them to create a new business model or drastically differentiate in the market (Ex. Amazon acquiring One Medical). Rock Health predicts that the most likely targets will have strong clinical evidence and user bases, but may be struggling with their business model.

The Takeaway

Rock Health makes a pretty convincing argument that digital health M&A is poised for an active year ahead, but also wraps up the report with a warning that acquisition announcements are rarely the end of the story.

“Successful M&A approaches are determined by important choices (e.g. how best to integrate tech stacks as well as cultures and operations, what to keep and where to cut bait, workforce strategy, etc.)… but assessing these frameworks alongside financial, cultural, and operational aspects of M&A is necessary to help organizations—both acquirer and target—maximize impact.”

Headspace Launches Unified Mental Health Platform

Headspace Health just took a massive step forward in delivering on the promise of last year’s $3B merger with Ginger, rolling out a new unified product experience that combines the services of both companies into a comprehensive mental health platform.

The integrated experience brings together Headspace’s meditation and mindfulness offerings with Ginger’s on-demand coaching, therapy, and psychiatry solutions – all within the Headspace app.

The Headspace Health overhaul is set to debut in January 2023, which should be welcome news to the employers and employees that have been calling for more mental health support as the pandemic drags on.

For employees, the new experience provides seamless navigation between Headpace’s wellness content and Ginger’s clinical services.

  • An onboarding survey helps Headspace get to know its members and create personalized care plans, then ongoing check-ins help scale the level of support to individual needs.
  • A sample program might include meditation, a mindfulness walk, and a Sleepcast, with easy escalation to text-based behavioral health coaching or therapy if warranted.

For employers, the single platform approach is designed to eliminate administrative burden, while providing high-level insights for understanding their employees’ mental health needs.

  • Employers can access joint enrollment and engagement trends, such as the percent of members using both Headspace and Ginger simultaneously, as well as aggregate outcomes data for each product.
  • An included Employee Assistance Program bolts on work-life services, critical incident support, workplace training, and manager consultations.

The Takeaway
As we enter the fourth year of the pandemic, most employers are making mental healthcare a top strategic priority, but they’re also trying to avoid cobbling together point solutions to make it happen. The new Headspace Health experience sets out to be the end-to-end solution employers are calling for, although their biggest competitor seems to have gotten the same memo. Headspace will be up against Calm’s new clinical mental health product that was announced last month.

Providers Double Down on Software Investment

A new 2022 Healthcare Provider IT Report from Bain & Company and KLAS Research drew a lot of coverage this week with a headline takeaway that served as a nice break from recent bleak healthcare forecasts:

  • Providers are doubling down on software investments, even in the face of macroeconomic turbulence.

The research includes plenty of interesting data that’s worth checking out if you have half an hour to absorb it all, but here are the highlights for the visual learners with 3 minutes to spare.

  • Over 75% of providers expect to make new software investments next year, and one-third plan to invest more than usual (Figure 1). This signals a turning point in the provider IT market as many orgs who have stayed on the sidelines are now looking to retool software roadmaps for a “new normal.”
  • Of those investing heavily, nearly 80% cite labor shortages, inflation concerns, or restructuring (M&A, change in leadership) as the top catalysts (Figure 2).
  • Providers are particularly interested in revenue cycle management, security, and patient intake solutions as they look to address rising margin pressure and improve the productivity of limited staff (Figure 3).

The other main point that the report drives home is that providers are feeling increasingly overwhelmed by their expanding tech stacks and the proliferation of new vendors.

  • Over half are struggling with the flood of offerings and 24% believe that their existing tech stack keeps them too busy to stay current on new solutions (Figure 4). 
  • As a result, providers are actively trying to streamline their bloated tech stacks, with 72% attempting to expand with existing vendors before considering new ones and 63% looking to cut back on third-party software solutions over the next year (Figure 5).

The Takeaway

The consensus among providers appears to be that falling behind on software investment isn’t the way to turn around struggling performance, and neither is overloading their staff with disjointed products. That seems like a telltale sign that we’re in for more consolidation, especially with the report concluding that software vendors should pursue bolt-on acquisitions and strategic partnerships to create sticky platform offerings in a crowded field.

2022 Trends Shaping the Health Economy

Trilliant Health just released its 2022 Trends Shaping the Health Economy Annual Report, providing a unique perspective on the healthcare market through the lens of supply and demand.

Even though these dynamics don’t play out in healthcare exactly how they would in an “ideal market,” the 147-page report does a good job turning the core principles into a framework for examining 13 different secular trends.   

Perhaps the biggest trend, at least on the demand side, is what looks to be a shrinking total addressable market. The share of Americans with commercial health coverage dropped 0.6 percentage points from 2020 to 2021.

  • On top of this, care forgone during the pandemic appears to be permanently lost rather than delayed. Pandemic-related care is driving the appearance of a rebound, but with COVID treatment and vaccination omitted, healthcare encounters are down 6.2%.
  • The widespread availability of virtual care options hasn’t saved the day either, with Trilliant’s data showing that half of telehealth users in 2021 only used the modality once.

At the same time as demand is contracting, a growing supply of new entrants like CVS, Walmart, and Amazon is making consumer loyalty harder to capture. 

  • Trilliant makes the case that these retailers are commoditizing low-acuity services, leveraging their scale and large customer bases to pressure established players. 
  • This is taking place against a backdrop of burnout among traditional providers, with 9.8% of physicians leaving the field between 2019 and 2022. When accounting for new physicians entering the industry, the U.S. saw a -2% reduction in the physician workforce during the same period.

The Takeaway

If the full report makes one thing clear, it’s that the health economy is quickly turning into a negative-sum game as the number of patients with commercial health coverage decreases and new entrants swarm the field. Even though Trilliant doesn’t set out to give a solution to this problem, its research is a solid tool to help each stakeholder make sure they’re at least asking the right questions.

DHW Q&A: The New Staffing Landscape With connectRN

With Ted Jeanloz
connectRN, CEO

Nurse staffing and burnout issues existed long before the pandemic, but they’ve taken center stage as nursing becomes more challenging as a profession. 

In this Digital Health Wire Q&A, we sat down with connectRN CEO Ted Jeanloz to discuss technology’s role in solving these problems and the new ways that human-centered design can help support healthcare staff.

Let’s kick things off with some background. Can you tell us a little bit about yourself and connectRN’s overall strategy?

Since our early days in 2018, our hypothesis has been that nurses were being squeezed out of the profession because of the rigidity of their schedules. They might be going back to school and need to make time for exams, or they might have a child and need more time for them. What they all have in common is that they need schedules built around their lives, not around work.

We initially thought maybe 10% of nurses would fall in that category of really wanting more flexibility. And with 6.5 million nurses and CNAs in the country, 10% of those would be a solid total addressable market. 

We quickly learned that our assumption that only 10% of nurses want flexibility was way off base. It turns out that 100% of nurses want flexibility. Back in 2019 we just weren’t programmed to realize it was possible, but the pandemic helped show us that flexibility and productivity aren’t mutually exclusive.

That’s at the core of what drives connectRN.

Can you share more about the platform? What are some of the ways that you create this flexibility?

As far as creating flexibility, there’s a bedside component and a virtual component. As far as in-person care we bring flexibility to that part of the equation by first and foremost giving nurses the ability to choose their shifts – timing, care setting, and anything in between.

They can also use the social component of our platform to elect to work with friends. They can say “these are the people I like working with,” coordinate with them on the details, then make the shift happen. That’s been working really well for a lot of our nurses.

We’re also moving towards a world where more care is delivered outside of facilities through things like RPM or telephone triage. If a nurse doesn’t have time for a full shift on Saturday, now they can do a home health visit for someone in their community. We have nurses licensed in all 50 states, so we’ll effectively be able to create an environment where nurses can contribute wherever the system needs them.

It seems like the platform is designed around the nurses in many ways outside of shift matching. Can you talk us through some of that?

One of the key ways that we’re focused on building around the nurses themselves is by facilitating their education. We have a ton of data coming in from both the supply side with the nurses and the demand side with the facilities. This gives us a lot of visibility into what the market is calling for and where there’s a gap.

That allows us to cross-check the skills that are needed with what’s in short supply, then give our nurses a list of next-step credentials that might immediately help their career. If a nurse has a certain set of shifts available to them based on their current qualifications, we can show them exactly how much their opportunity set would expand if they added what’s often a single certification.

By helping nurses get a little bit of training, we can hopefully increase their value in the market, increase the talent pool for providers, and if we can get all that aligned then it’ll move us to a place where nurses are truly better off.

Burnout is one of the bigger themes we cover, and adding more flexibility to the system probably helps with that. What are your views on if there’s a long term solution?

One of the problems with burnout is that there was this big pandemic shock, and it shocked us into a spiral that’s going to be really hard to get out of. It led to short staffing and a lot of nurses getting burnt out, so they ended up leaving, so there’s even fewer people, which creates more burnout and a pretty brutal cycle.

Our perspective is that giving nurses more options for how they work is a way that we can really help. Almost every nurse we talk to, when you ask them why they chose nursing, they all love their job. They all love patient care. It’s universal, but many of them say, “I love it, but I just can’t do it anymore.”

If there’s a long term solution, part of it is creating a way to keep them contributing but at a different scale. If we can let them pick their hours, pick their facilities, and pick how much they work, then they’re going to be happier when they’re there and be able to deliver better care.

That seems like a better mental health place for everybody and I think we can get there.

If you look back on connectRN’s growth, was there a secret sauce that you could share with other founders?

I really think it’s the team that we put together. Phenomenal companies are built by teams of phenomenally hardworking, phenomenally smart people. 

To have a successful startup, I think the first thing you need is a great problem to solve. Once you have that, you need to put together a great team to go after it. The third thing that helps is great investors, and we’ve had the support of really world class investors that have been there for us all along the way.

If you have those three things I think you can consistently succeed as a startup, but if we’re being 100% honest there’s also an element of luck. You absolutely make your own luck in some cases, but having the right solution at the right time is important.

For connectRN, the key has been to keep the flexibility and the nurses at the center of everything we do. We’re not optimizing for a full time schedule, we’re optimizing to help nurses build their careers.

For more on connectRN’s platform, head over to their website.

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