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Main article: Health

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Apple Watch’s ECG feature is already proving its worth

21:28 | 8 December

When Apple announced its latest Series 4 Watch with electrocardiogram features, my mom took a sigh of relief, and then proceeded to set a reminder to order one for my dad. That’s because we found out last year, by chance, that he has atrial fibrillation. Atrial fibrillation is an irregular heartbeat, often times rapid heart rate that can increase your risk of stroke, heart failure and other heart-related issues.

The ECG feature, which monitors your heart rhythm and can detect AFib,* went live just two days ago. Already, at least one person has benefited from it.

Yesterday, a person on Reddit shared how their Apple Watch notified them of an abnormal heart rate. From there, they ran the ECG app and found out it was AFib. They went to urgent care and saw a doctor who they say said, “You should buy Apple stock. This probably saved you. I read about this last night and thought we would see an upswing this week. I didn’t expect it first thing this morning.”

The patient says they proceeded to go to a cardiologist the next day, who did an exam and confirmed the AFib diagnosis.

“I’m scheduled to go back in a week for some additional tests to start looking at the cause… blood, thyroid, etc…,” they wrote. “He also scheduled me with a partner who specializes more in the electrical side of things to have it looked from that angle as well.”

As one of the first more widely-owned ECG monitors, this could make a huge difference in the number of people who have at least some transparency into their heart health. But to be clear, once you enable the new feature, the watch is still not constantly looking for AFib. When the heart rhythm monitor detects something is off — a skipped or rapid heartbeat, for example — it will send a notification to your wrist.

That’s when you open up the ECG app, rest your arm on your lap or table, and then hold your finger to the crown for 30 seconds. From there, the watch will tell you if there are signs of atrial fibrillation.

If you want to learn more about the features, check out my colleague Brian Heater’s piece below.



The Apple Watch’s ECG feature goes live today

17:00 | 6 December

ECG/EKG was easily the new Apple Watch’s most lauded feature. It’s also been the most delayed. Of course, this kind of serious health feature is the sort of thing you need to get exactly right, for reasons that ought to be pretty obvious on their face.

Electrocardiogram finally goes live today for Series 4 owners as part of the watchOS 5.1.2 update. It’s an important feature — and one that will go a ways toward helping establish the wearable as a more serious health monitor.

The new feature builds on a hardware upgrade built into the Series 4: a pair of electrodes built into the larger back crystal on the rear of the watch and the digital crown. Once enabled, the new feature is checking for a couple of key bits of heart health: irregular heart rhythms, which the watch will passively monitor in the background, and ECG, which requires the user to actively engage with by completing the circuit with a finger tip placed on the edge of the watch’s digital crown.

Of course, getting all of this isn’t as simple as just installing a software update. There is, understandably, a pretty long opt-in here. The on-boarding process is several pages long for both of the new features, as Apple collects some vital information and repeatedly reminds you of some important information — like the fact that the watch can’t detect a heart attack. If you feel like you might be having one, call the emergency services.

The Apple Watch isn’t meant to replace a doctor either, of course. Really, it’s just a way to monitor for complications. If the smartwatch can be regarded as a potential lifesaver or even peripheral medical device, it’s due to the fact that it features a kind of always-on monitoring. After all, outside of the proliferation of these sorts of wearables, most of us won’t experience something like constant ECG monitoring until under the care of a doctor. If this feature is capable of isolating that information ahead of time, it could go a ways toward addressing complications before they turn into major issues.

The sign-up process airs on the side of caution, while attempting to not overwhelm the end user with information. It’s a tricky balance, and if TOS have taught us anything, it’s that too much information upfront will ultimately result in the user’s eyes glazing over. In the case of this information, that could potentially lead to serious consequences if not properly adhered to.

Some of the key takeaways:

  • It cannot detect a heart attack (see a doctor)
  • It cannot detect blood clots or a stroke (see a doctor)
  • It cannot detect other heart-related conditions (see a doctor)
  • [It] is not constantly looking for AFib

That last one is particularly important when distinguishing between the new features. While heart rhythm detection is a feature, the Watch isn’t regularly looking for atrial fibrillation. That’s where the ECG app and the finger detection come in. The feature is intended to be used when the heart rhythm monitor detects that something is off — like a skipped or rapid heartbeat. In which case, it will send a notification right to your wrist.

If that happens, fire up the ECG app, rest your arm on your lap or a table and hold your finger to the crown for 30 seconds. Apple will display a real-time graph of your heart rhythm while you wait. It’s strangely soothing, honestly, though Apple doesn’t recommend using the feature with much regularity, unless you have cause to.

Using it just now, I got a “This ECG does not show signs of atrial fibrillation” note, meaning the reading falls within the parameters of a sinus rhythm.

Here’s your old friends at WebMD:

Your heart’s job is to pump blood to your body. When it’s working the way it should, it pumps to a regular, steady beat. This is called a normal sinus rhythm. When it’s not, you could have an irregular heartbeat called AFib.

So, good. No need to call the doctor. If you’re still feeling unwell, however, there’s a quick link to dial emergency services on the screen. There’s also a spot for adding any symptoms you might be having if you’re feeling less than 100 percent. And while Apple promises not to share any of the info collected on-device, you can always export your findings to a PDF for your doctor to take a gander at.

Along with the new feature comes a new White Paper, detailing the technology. It’s an usual bit of transparency from Apple, but the company understandably wants to be as upfront about the technology as possible. The paper details a lot of what went into bringing the feature up to speed for general availability.

Apple started with a pre-clinical study of 2,000 subjects, including ~15 percent who have been diagnosed with heart arrhythmia. Six-hundred subjects were then involved with the clinical trial to validate the AFib.

Per Apple, “Rhythm classification of a 12-lead ECG by a cardiologist was compared to the rhythm classification of a simultaneously collected ECG from the ECG app. The ECG app demonstrated 98.3% sensitivity in classifying AFib and 99.6% specificity in classifying sinus rhythm in classifiable recordings.”

The company employed similar methods to validate the Irregular Rhythm notifications. “Of the participants that wore an Apple Watch and ECG patch at the same time,” the company writes, “almost 80 percent received the notification and showed AFib on the ECG patch, and 98 percent received the notification and showed other clinically relevant arrhythmias on the ECG patch.”

In addition to that testing, the company has also employed a number of medical doctors to help ensure the product meets the sort of exacting standards one would hope from a product like this.

More information on the research can be found in this Stanford partnered paper published earlier this month.



Apple puts third-party screen time apps on notice

23:57 | 5 December

A number of app developers building third-party screen time trackers and parental control applications are worried that Apple’s increased scrutiny of their apps in recent weeks is not a coincidence. With Apple’s launch of iOS 12, the company has implemented its own built-in screen time tracking tools and controls. Not long after, developers’ third-party screen time apps came under increased review from Apple, and, in some cases, rejections and removals from the App Store.

The impacted developers have been using a variety of methods to track screen time, as there has not been any official means of tracking this data. This included the use of background location, VPNs, and MDM-based solutions, and sometimes a combination of methods.

A small crowd of a half-dozen or so developers began to discuss their troubles amongst themselves over the past couple months. But not all wanted to go on record. After all, publicly criticizing Apple is not something many developers feel comfortable doing, especially when their business is at risk.

However, a few did take to their company blogs to report their troubles when they thought they had reached the end of the road.

In October, for example, the digital detox app called Mute publicly announced its removal from the App Store around the same time that many other screen time tracking apps had been put on notice.

Then three-year old screen time app Space did the same after its removal from the App Store in November.

They were not alone. Several others, who did not want to be quoted, were also facing rejections.

Some of the developers, we understand, were told they were in violation of App Store developer guideline 2.5.4, which specifies when multitasking apps are allowed to use background location. Specifically, developers were told they were “misusing background location mode for purposes other than location-related features.”

Others were told their app violated developer guideline 2.5.1, which references using public APIs in an unapproved manner.

And others, still, were told the way they’ve implemented screen time and parental controls was no longer permitted.

Above: Space on iOS

In an odd turn of events, after Space and Mute published on their public company blogs to complain, they received a call from Apple and had their apps reinstated on the App Store.

The Apple reps asked the companies about how they handled data privacy, and reminded them they have to have a customer-facing feature that requires location-based services in order to legitimize their use of such an approach, they reported.

“We are of course hugely grateful that Apple has chosen to continue to allow our business to operate,” said Space CEO Georgina Powell.

But these were not isolated incidents. Across the third-party screen time app industry, apps were coming under review – in some cases, after operating for years without incident.

Above: Moment app on iOS

But at the same time, some apps were getting a pass – as if Apple is making its decisions on a one-off basis.

For example, an app called Moment – which TechCrunch has covered a few times over the past four years and has been featured by Apple – also received a call from Apple, we learned.

Apple had some questions for Moment, which they answered to Apple’s satisfaction. The app was not removed or threatened.

Asked if they were concerned at all about the increased scrutiny, Moment’s creator Kevin Holesh responded, “I do feel confident about Moment’s future after talking to Apple.” But he added he’s now “mostly watching to see how things play out with this issue going forward.”

The makers of the screen time app solution and hardware device, Circle with Disney, is also unaffected, we were told. (But then, imagine the consumer backlash if your $99 home network device just stopped working.)

Though not all apps were getting the boot, it seemed, Apple did seem to have a problem with screen time apps that took advantage of mobile device management (MDM) and/or VPNs to operate.

For example, the developer behind Kidslox had implemented a combination of MDM and a VPN for screen time and parental controls. The app tracks the time the device is connected to the VPN for screen time, which Apple said it could no longer do.

Kidslox CEO Viktor Yevpak tried to explain a VPN was necessary for more than just screen time. The app also includes a feature that checks websites against a blacklist to allow for kids to safely browse when they were connected through the VPN.

“I said, there has to be a middle ground, because you’re pretty much killing the entire company,” Yevpak told TechCrunch, recalling his conversations with Apple’s app review. “We have over 30 people working on it, and you’re us telling us to shut down,” he had told them.

After several rejections of updates to Kidslox’ year-old app, the developer finally took to the company blog to also call out Apple for what it believed was the “systematic destruction” of the third-party screen time management industry.

Like many we spoke to, he’s highly suspicious about the timing of Apple’s review, given that iOS 12’s screen time feature has just launched.

Kidslox remains available on the App Store today but its updates are not being approved. Yevpak says the company has been discussing ways to pivot the business, as it seems its time is up.

Apple, of course, never intended for VPNs to be used for screen time tracking or parental controls, nor did it want the enterprise-focused MDM technology to be implemented in consumer-based apps. And by permitting its use to date in apps like these, Apple had given up control over how its devices can be used by consumers.

But its policies have not matched up with its App Store approvals. Apple has greenlit – and it has been directly aware of – screen time apps using MDM in ways that violated its guidelines for years.

Above: OurPact’s app rules allow parents to block apps

One case in point app is OurPact (specifically, its OurPact Jr. product), an app which leverages MDM technology to allow parents to control if and when kids can use certain apps on their phone, block texting, filter the web, and much more. Its apps – one designed for the parent and the other for the child – have been live for four years. OurPact now says that Apple will no longer allow the company to use MDM for its purposes.

“Our team has received confirmation from Apple that managing application access and content outside of iOS Screen Time will not be permitted in the Apple device ecosystem,” says Amir Moussavian, OurPact parent company Eturi Corp., in a statement provided to TechCrunch. “It’s incredibly disappointing that Apple is choosing to dissolve the iOS parental control market at a time when childhood and adolescent screen time management is finally being understood as a necessity.”

The company says its OurPact Jr. app, the app designed for the child’s device, is impacted by the change. But its parent app will continue to operate.

Apple’s permissiveness to allow these “rule-breaking” apps signaled to developers entering the screen time space anew that MDM was being tacitly approved in these scenarios, even if Apple’s own terms and agreements said otherwise.

Developer Andrew Armour of ACTIVATE Fitness, said he decided to implement MDM for a screen time management solution for iOS after seeing many other developers already had been the same thing for years, he told TechCrunch.

“I have sunk my entire life savings into the development of this mobile application to provide families with a solution to better regulate and manage screen time and at the same time promote physical activity,” Armour said, speaking about his app’s App Store rejection.”After two years of hard work and determination, my entrepreneurial journey to introduce ACTIVATE Fitness to the world has come to an end due to an Apple rejection in a flawed and unfair review process,” he lamented.

Apple could choose to release an official Screen Time API or carve out exceptions for screen time apps that use MDM or other technologies. Its decision to instead put the entire third-party industry on notice after rolling out its own screen time solution, however, seems to indicate it now wants to control the experience of monitoring screen time usage on iOS, and not leave it up to these third parties.

At the end of the day, the decision is bad for consumers because Apple’s solution doesn’t offer many of the features of the MDM-based solutions focused on parental controls. For example, parents using third-party screen time solutions can hide certain apps from kids’ homescreens and control when those apps function.

Apple declined to comment on the matter.

But sources familiar with Apple’s thinking dismissed this as being some sort of targeted crackdown against third-party screen time apps. Rather, the pushback developers received was part of Apple’s ongoing app review process, they said, and noted that the rules these apps violate have been in place for years.

That’s a fair point. Apple can opt to enforce its rules at any time, and building apps in violation of those rules is never a great idea – especially when developers are knowingly taking advantage of technologies in ways they had to know Apple never intended.

That being said, a decision to purge the App Store of third-party screen time and parental control apps is one that may come across to the impacted end users of these apps as being in poor taste.

In recent months, big tech companies – including the likes of Facebook and Google – have been made aware of the addictive nature of our devices and the apps we use and the negative effects on our mental health. They have all been rolling out solutions to counter this problem. For Apple to be seen as tamping down on the very apps that have been trying to battle these problems for years – before Silicon Valley took notice – is not a great look.



Birth control delivery startup Nurx now offers an at-home HPV testing kit

21:58 | 4 December

Telemedicine startup Nurx — once dubbed the “Uber for birth control” — has launched a direct-to-consumer Human papillomavirus (HPV) testing kit. The addition means its customers can test for the most common sexually transmitted infection in the U.S. and a cause of genital warts and cervical cancer in the comfort of their own homes.

The Y-Combinator graduate is backed with about $42 million in venture capital funding from Kleiner Perkins, Union Square Ventures, Lowercase Capital and others. It launched in 2015 to facilitate women’s access to birth control across the U.S. with a HIPAA-compliant web platform and mobile application that delivers contraceptives directly to customer’s doorsteps. Nurx’s telemedicine platform ensure its users can communicate with doctors and are provided the resources necessary in choosing the correct method of birth control.

The HPV test is free with insurance, aside from the $15 shipping and lab processing fee, and $69 for those without insurance. Beginning today, the kit is available to all current Nurx users and will be fully rolled out to new customers in 2019.

In addition to birth control and the HPV test, the company also ships PrEp, a once-daily pill that reduces the risk of getting HIV. Nurx’s expansion beyond birth control is part of the company’s goal of helping people take control of their health, especially the millions in the U.S. who live in “contraceptive deserts,” or areas where there is no reasonable access to a public clinic.

“Our mission here is to leverage telemedicine to change public healthcare,” Nurx co-founder and chief executive officer Hans Gangeskar told TechCrunch. “We are building a full-stack primary care telemedicine platform at an unparalleled cost.”

The HPV testing kit is only approved for women over 30 and is not a replacement for a Pap smear, which collects a sample of cells from the cervix to check for abnormalities. Still, the kit, which requires only a vaginal swab, is able to assess for 14 high-risks of HPV that lead to cervical cancer. The company says the test will be a game-changer for women who are not regularly able to get Pap smears or who have not had access to the HPV vaccine, like women who live in rural areas and those without health insurance.

Nurx raised a $36 million round with support from the Clinton Foundation in July. As part of the deal, Chelsea Clinton joined its board of directors. The company has used that investment to incorporate the HPV testing kit, as well as to expand into several new markets in 2018. 

Nurx is currently available in 22 states, including the District of Columbia.



Sleep tracking ring Oura raises $20 million from Michael Dell, Lance Armstrong and others

19:30 | 3 December

Oura Health, a sleep tracking and improvement platform, just raised $20 million in a funding round led by MSD Capital with participation from YouTube co-founder Steve Chen, Twitch co-founder Kevin Lin, Sunrise founder Dave Morin, JUMP founder Ryan Rzepecki and others. This round comes a couple of years after the Finnish company raised €5 million from MIT Media Lab Director Joi Ito and others.

Oura is a smart ring that tracks your sleep habits to help you achieve better sleep. It does this by measuring the blood volume pulse from your finger’s palmar arteries, detecting the direction and intensity of your body’s movements using a 3D accelerometer and gyroscope to detect the direction and by measuring your temperature through three NTC temperature sensors.

“I believe Oura has identified a challenge that faces us all, namely getting enough high-quality sleep,” Dell said in a statement. “Oura’s design and technology show tremendous craftsmanship, and now more consumers around the world will be able to get their own Oura ring.”

The star-studded funding group also includes Shaquille O’Neil, Lance Armstrong and Will Smith.

“We are thrilled to have such a talented group of builders, champions, and creators join us as investors,” Oura Health CEO Harpreet Rai siad in a statement. “It’s amazing to see how such a diverse group of investors all recognize the universal importance of sleep.”

To be clear, sleep tracking and improvement is an area many startups and large companies have tried. You may remember Basis Health, which eventually sold to Intel. And then there’s Fitbit, smart ring Motiv and other wearables that track your sleep.

We have yet to try this out, but we’ll report back if we do. Oura Health is currently shipping to over 100 countries and retails from $299 – $999, depending on the material you select. Meanwhile, Motiv retails for $199.



China’s Infervision is helping 280 hospitals worldwide detect cancers from images

18:22 | 30 November

Until recently, humans have relied on the trained eyes of doctors to diagnose diseases from medical images.

Beijing-based Infervision is among a handful of artificial intelligence startups around the world racing to improve medical imaging analysis through deep learning, the same technology that powers face recognition and autonomous driving.

The startup, which has to date raised $70 million from leading investors like Sequoia Capital China, began by picking out cancerous lung cells, a prevalent cause of death in China. At the Radiological Society of North America’s annual conference in Chicago this week, the three-year-old company announced extending its computer vision prowess to other chest-related conditions like cardiac calcification.

“By adding more scenarios under which our AI works, we are able to offer more help to doctors,” Chen Kuan, founder and chief executive officer of Infervision, told TechCrunch. While a doctor can spot dozens of diseases from one single image scan, AI needs to be taught how to identify multiple target objects in one go.

But Chen says machines already outstrip humans in other aspects. For one, they are much faster readers. It normally takes doctors 15 to 20 minutes to scrutinize one image, whereas Infervision’s AI can process the visuals and put together a report under 30 seconds.

AI also addresses the long-standing issue of misdiagnosis. Chinese clinical newspaper Medical Weekly reported that doctors with less than five years’ experience only got their answers right 44 percent of the time when diagnosing black lungs, a disease common among coal miners. A research from Zhejiang University that examined autopsies between 1950 to 2009 found that the total clinical misdiagnosis rate averaged 46 percent.

“Doctors work long hours and are constantly under tremendous stress, which can lead to errors,” suggested Chen.

The founder claimed that his company is able to improve the accuracy rate by 20 percent. AI can also fill in for doctors in remote hinterlands where healthcare provision falls short, which is often the case in China.

Winning the first client

infervision medical imaging

A report on bone fractures produced by Infervision’s medical imaging tool

Like any deep learning company, Infervision needs to keep training its algorithms with data from varied sources. As of this week, the startup is working with 280 hospitals – among which twenty are outside of China – and steadily adding a dozen new partners weekly. It also claims that 70 percent of China’s top-tier hospitals use its lung-specific AI tool.

But the firm has had a rough start.

Chen, a native of Shenzhen in south China, founded Infervision after dropping out of his doctoral program at the University of Chicago where he studied under Nobel-winning economist James Heckman. For the first six months of his entrepreneurial journey, Chen knocked on the doors of 40 hospitals across China — to no avail.

“Medical AI was still a novelty then. Hospitals are by nature conservative because they have to protect patients, which make them reluctant to partner with outsiders,” Chen recalled.

Eventually, Sichuan Provincial People’s Hospital gave Infervision a shot. Chen with his two founding members got hold of a small batch of image data, moved into a tiny apartment next to the hospital, and got the company underway.

“We observed how doctors work, explained to them how AI works, listened to their complaints, and iterated our product,” said Chen. Infervision’s product proved adept, and its name soon gathered steam among more healthcare professionals.

“Hospitals are risk-averse, but as soon as one of them likes us, it goes out to spread the word and other hospitals will soon find us. The medical industry is very tight-knit,” the founder said.

It also helps that AI has evolved from a fringe invention to a norm in healthcare over the past few years, and hospitals start actively seeking help from tech startups.

Infervision has stumbled in its foreign markets as well. In the US, for example, Infervision is restricted to visiting doctors only upon appointments, which slows down product iteration.

Chen also admitted that many western hospitals did not trust that a Chinese startup could provide state-of-the-art technology. But they welcomed Infervision in as soon as they found out what it’s able to achieve, which is in part thanks to its data treasure — up to 26,000 images a day.

“Regardless of their technological capability, Chinese startups are blessed with access to mountains of data that no startups elsewhere in the world could match. That’s an immediate advantage,” said Chen.

There’s no lack of rivalry in China’s massive medical industry. Yitu, a pivotal player that also applies its AI to surveillance and fintech, unveiled a cancer detection tool at the Chicago radiological conference this week.

Infervision, which generates revenues by charging fees for its AI solution as a service, says that down the road, it will prioritize product development for conditions that incur higher social costs, such as cerebrovascular and cardiovascular diseases.



Insurance startup Bright Health raises $200M at ~$950M valuation

03:33 | 30 November

A flurry of digital-first insurers are betting they can surpass industry incumbents with a little help from technology and a lot of help from venture capitalists.

The latest to land a massive check is Bright Health, a Minneapolis-headquartered provider of affordable individual, family and Medicare Advantage healthcare plans in Alabama, ArizonaColoradoNew York CityOhio and Tennessee. The company, founded by the former chief executive officer of UnitedHealthcare Bob Sheehy; Kyle Rolfing, the former CEO of UnitedHealth-acquired Definity Health; and Tom Valdivia, another former Definity Health executive, has brought in a $200 million Series C.

The funding values Bright Health at $950 million, according to PitchBook — more than double the $400 million valuation it garnered with its $160 million Series B in June 2017. Sheehy, Bright Health’s CEO, declined to comment on the valuation. New investors Declaration Partners and Meritech Capital participated in the round, with backing from Bessemer Venture Partners, Greycroft, NEA, Redpoint Ventures and others. Bright Health has raised a total of $440 million since early 2016.

VCs have deployed significantly more capital to the insurance technology (insurtech) space in recent years. Startups in the industry, long-known for a serious dearth of innovation, have raked in nearly $3 billion in private capital this year. U.S.-based insurtech startups have raised $2 billion in 2018, a record year for the sector and more than double last year’s total.

Deal count, meanwhile, is swelling. In 2016, there were 72 deals conducted in the space, followed by 86 in 2017 and 94 so far this year, again, according to PitchBook’s data.

Oscar Health, the health insurance provider led by Josh Kushner, is responsible for about 25 percent of the capital invested in U.S. insurtech startups this year. The company has raised a total of $540 million across two notable deals in 2018. The first saw Oscar pulling in $165 million at a $3 billion valuation and the second, announced in August, had Alphabet investing a whopping $375 million. Devoted Health, a Waltham, Mass.-based Medicare Advantage startup, followed up with a massive round of its own. The company nabbed $300 million and announced that it would begin enrolling members to its Medicare Advantage plan in eight Florida counties. Devoted is led by Todd Park, the co-founder of Athenahealth and Castlight Health.

Bright Health co-founders Bob Sheehy, CEO; Tom Valdivia, chief medical officer; and Kyle Rolfing, president

VC’s interest in insurtech isn’t limited to healthcare.

Hippo, which sells home insurance plans at lower premiums, officially launched in 2017 and has brought in $109 million to date. Earlier this month the company announced a $70 million Series C funding round led by Felicis Ventures and Lennar Corporation. Lemonade, which is similarly an insurer focused on homeowners, raised $120 million in a SoftBank-led round late last year. And Root Insurance, an app-based car insurance company founded in 2015, itself raised a $100 million Series D led by Tiger Global Management in August. The financing valued the company at $1 billion.

Together, these companies have raised well over $1 billion this year alone. Why? Because building a health insurance platform is incredibly cash-intensive and particularly difficult given the breadth of incumbents like Aetna or UnitedHealth. Sheehy, considering his 20-year tenure at UnitedHealthcare, may be especially well-positioned to disrupt the industry.

The opportunity here for investors and startups alike is huge; the health insurance market alone is forecasted to be worth more than $1 trillion by 2023. Companies that can leverage technology to create consumer-friendly, efficient and, most importantly, reasonably priced insurance options stand to win big.

As for Bright Health, the company plans to use its $200 million infusion to rapidly expand into new markets, planning to triple its geographic footprint in 2019.

“Bright Health has continued to execute at a fast pace towards our goal of disrupting the old health care model that places insurers at odds with providers,” Sheehy said in a statement. “[Its] current high re-enrollment rate shows that consumers are ready for this improved healthcare experience – especially when it is priced competitively.”



Spike Diabetes applies social pressure to keep patients safe

18:58 | 29 November

It can be tough for diabetes patients to keep a constant eye on their glucose levels. Spike Diabetes lets family and doctors lend a hand by sending them real-time alerts about the patient’s stats. And the app’s artificial intelligence features can even send helpful reminders or suggest the most diabetes-friendly meals when you walk into a restaurant.

Today onstage at the TechCrunch Disrupt Berlin Startup Battlefield, Spike Diabetes is launching its Guardian Portal so loved ones with permission can get a closer look at a patients’ data and coach them about staying healthy.

“Diabetes is an incurable chronic disease that forces diabetics to live a life of carb-counting and insulin injections. Since diabetics are forced to do those mundane tasks for the rest of their lives, they tend to fall off the tracks sometimes simply because of how demanding those tasks can be,” says Spike co-founder Ziad Alame. “As for guardians and parents, they are left in the dark about their loved ones.” With doctors often only getting data during quarterly or semi-annual checkups, patients are often left on their own. A lifetime of management is very stressful, especially if your life depends on it.”

The startup faces stiff competition from literally hundreds of apps claiming to help patients monitor their vitals. MySugr, Diabetes Connect and Health2Sync are amongst the most popular. But Alame says many require users to track their levels through complex spreadsheets. Spike offers customizable mobile charts, and will even read users their stats out loud to make staying safe an easier part of daily life. Spike is invite-only and just on iOS, but it also touts an Apple Watch app plus optimized engineering to minimize battery usage.

“Spike started off as a personal project to help myself adhere better to my medication after reaching critical times in my diabetic life,” Alame tells me. Now he’s bringing to the problem his experience as CTO of the GivingLoop charity platform, TeensWhoCode summer camp and Zoomal crowdfunding site for the Arab world. Alame has assembled a team of diabetics, engineers and PhDs, plus $200,000 in seed funding from MEVP, Cedar Mundi and Phoenician Funds. They hope to see the premium paid version of Spike’s freemium app overtake longstanding competition through word-of-mouth triggered by bringing loved ones and doctors into the loop.

One of the app’s most interesting features is the proactive info it delivers. “For example, you walk into McDonald’s around 2 PM. Spike would automatically know it’s lunch time for you and suggest the top three options you can have with approximate carb counts,” Alame tells me. “After some time (~25 minutes) Spike automatically reminds you of your insulin and syncs with your diabetic devices to log all the details. With time, as the app gets to know the diabetic’s taste more, Spike would be able to suggest small behavioral tweaks to enhance lifestyle such as walking routes suggestions or new places similar to the diabetic’s taste but with a lower insulin consumption rate.”

Alame jokes that “The biggest risk [to Spike] is the best thing that can happen — which is finding a cure for diabetes.” But even if that happens, he believes Spike’s app for tracking and actively coaching users could be relevant to other diseases, as well. For now, though, it will have to convince users that an app could make managing diabetes simpler rather than more complex.



Insurance app Lemonade prepares for European expansion

18:47 | 29 November

Lemonade this morning revealed plans to expand into the European market. The news marks the first international expansion for the AI-powered insurance app, which launched in New York City, back in 2016.

The official announcement issued by the company is extremely light on detail, with the promise to reveal more pertinent information — namely which country will be the first on its list — “shortly.” Instead, the news is a bit of flag planting from the company, as it navigates the tricky international insurance waters.

It also notably comes a few months after the startup dropped a short-lived lawsuit alleging that German company WeFox had essentially reverse engineered the Lemonade model for ONE Insurance. “We intend to defend ourselves vigorously,” Wefox’s founder told TechCrunch at the time. “This lawsuit appears to be an attempt to bait the media into covering a non-issue.” Court filings showed that the suit was unceremoniously dropped.

For its part, Lemonade is positioning its global expansion among the list of some of tech’s most successful names in recent years.

“Whether in Chicago, Paris, or Singapore, today’s consumers listen to music on Spotify, ride with Uber, and stay with Airbnb. Great digital brands don’t stop at the water’s edge,” Lemonade CEO Daniel Schreiber said in a press release. “That’s why going global feels so natural for us: consumers are increasingly cosmopolitan, socially aware, and tech-native – everything Lemonade was built to be.”

The age of the digital startup has certainly afforded companies a more rapid path to international success, though the list of companies cited does, perhaps unintentionally point to some of the difficulties dealing with local regulations. And healthcare has enough complex nuances to put even song publishing to shame.



Loro’s mounted wheelchair assistant puts high tech to work for people with disabilities

15:24 | 29 November

A person with physical disabilities can’t interact with the world the same way as the able, but there’s no reason we can’t use tech to close that gap. Loro is a device that mounts to a wheelchair and offers its occupant the ability to see and interact with the people and things around them in powerful ways.

Loro’s camera and app work together to let the user see farther, read or translate writing, identify people, gesture with a laser pointer and more. They demonstrated their tech onstage today during Startup Battlefield at TechCrunch Disrupt Berlin.

Invented by a team of mostly students who gathered at Harvard’s Innovation Lab, Loro began as a simple camera for disabled people to more easily view their surroundings.

“We started this project for our friend Steve,” said Loro co-founder and creative director, Johae Song. A designer like her and others in their friend group, he was diagnosed with Amyotrophic Lateral Sclerosis, or ALS, a degenerative neural disease that paralyzes the muscles of the afflicted. “So we decided to come up with ideas of how to help people with mobility challenges.”

“We started with just the idea of a camera attached to the wheelchair, to give people a panoramic view so they can navigate easily,” explained co-founder David Hojah. “We developed from that idea after talking with mentors and experts; we did a lot of iterations, and came up with the idea to be smarter, and now it’s this platform that can do all these things.”

It’s not simple to design responsibly for a population like ALS sufferers and others with motor problems. The problems they may have in everyday life aren’t necessarily what one would think, nor are the solutions always obvious. So the Loro team determined to consult many sources and expend a great deal of time in simple observation.

“Very basic observation — just sit and watch,” Hojah said. “From that you can get ideas of what people need without even asking them specific questions.”

Others would voice specific concerns without suggesting solutions, such as a flashlight the user can direct through the camera interface.

“People didn’t say, ‘I want a flashlight,’ they said ‘I can’t get around in the dark.’ So we brainstormed and came up with the flashlight,” he said. An obvious solution in some ways, but only through observation and understanding can it be implemented well.

The focus is always on communication and independence, Song said, and users are the ones who determine what gets included.

“We brainstorm together and then go out and user test. We realize some features work, others don’t. We try to just let them play with it and see what features people use the most.”

There are assistive devices for motor-impaired people out there already, Song and Hojah acknowledged, but they’re generally expensive, unwieldy and poorly designed. Hojah’s background is in medical device design, so he knows of what he speaks.

Consequently, Loro has been designed to be as accessible as possible, with a tablet interface that can be navigated using gaze tracking (via a Tobii camera setup) or other inputs like joysticks and sip-and-puff tubes.

The camera can be directed to, for example, look behind the wheelchair so the user can safely back up. Or it can zoom in on a menu that’s difficult to see from the user’s perspective and read the items off. The laser pointer allows a user with no ability to point or gesture to signal in ways we take for granted, such as choosing a pastry from a case. Text to speech is built right in, so users don’t have to use a separate app to speak out loud.

The camera also tracks faces and can recognize them from a personal (though for now, cloud-hosted) database for people who need help tracking those with whom they interact. The best of us can lose a name or fail to place a face — honestly, I wouldn’t mind having a Loro on my shoulder during some of our events.

Right now the team is focused on finalizing the hardware; the app and capabilities are mostly finalized but the enclosure and so on need to be made production-ready. The company itself is very early-stage — they just incorporated a few months ago and worked with $100,000 in pre-seed funding to create the prototype. Next up is doing a seed round to get ready to manufacture.

“The whole team, we’re really passionate about empowering these people to be really independent, not just waiting for help from others,” Hojah said. Their driving force, he made clear, is compassion.


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