Disease-related risk management is now a thing, and this young startup is at the forefront
Charity Dean has been in the national spotlight lately because she was among a group of doctors, scientists and tech entrepreneurs who sounded the pandemic alarm early last year and who are featured in a new book by Michael Lewis about the U.S. response, called The Premonition.
It’s no wonder the press — and, seemingly moviemakers, too — are interested in Dean. Surgery is her first love, but she also studied tropical diseases and not only applied what she knows about outbreaks on the front lines last year, but also came to appreciate an opportunity that only someone in her position could see. Indeed, after the pandemic laid bare just how few tools were available to help the U.S. government to track how the virus was moving and mutating, she helped develop a model that has since been turned into subscription software to (hopefully) prevent, detect, and contain costly disease outbreaks in the future.
It’s tech that companies with global operations might want to understand better. It has also attracted $8 million in seed funding Venrock, Alphabet’s Verily unit, and Sweat Equity Ventures. We talked late last week with Dean about her now 20-person outfit, called The Public Health Company, and why she thinks disease-focused risk management will be as crucial for companies going forward as cybersecurity software. Our chat has been edited for length; you can also listen to our longer conversation here.
TC: You went to medical school but you also have a master’s degree in public health and tropical medicine. Why was the latter an area of interest for you?
CD: Neither of my parents had college degrees. I grew up in a very modest setting in rural Oregon. We were poor and by the grace of a full ride scholarship to college I got to be premed. When I was a little girl some missionaries came to our church and talked about disease outbreaks in Africa. I was seven years old, and driving home that evening with my parents, I said, ‘I’m going to be a doctor, and I’m going to study disease.’ It was outrageous because I didn’t know a single person with a college degree. But . . my heart was set on that, and it never deviated from it.
TC: How did you wind up at the Santa Barbara County Public Health Department, instead of in private practice?
CD: It’s funny, when I was finishing up my residency — which I started doing general surgery, then I pivoted into internal medicine — I had a number of different doctors’ private practices come to me and try to recruit me because of the shortage of women physicians.
[At the same time] the medical director from the county public health department came and found me and he said, ‘Hey, I hear you have a master’s in tropical medicine.’ And he said, ‘Would you consider coming to work as the deputy health officer, and communicable disease controller, and tuberculosis controller, and [oversee the] HIV clinic and homeless clinic?’ And . . . it was, for me, a fairly easy choice.
TC: Because there was so little attention being paid to all of these other issues?
CD: What caught my attention is when he said communicable disease controller and tuberculosis controller. I had lived in Africa [for a time] and learned a lot about HIV, AIDS, tuberculosis, vaccine-preventable diseases — things you don’t see in the United States. [And the job] was so in lockstep with who I was because it’s the safety net. [These afflicted individuals] don’t have health insurance. Many are undocumented. Many have nowhere else to go for health care, and the county clinic truly serves the communities that I cared about, and that’s where I wanted to be.
TC: In that role — and later at the California Department of Public Health — you developed expertise in multi-drug-resistant tuberculosis. Was your understanding of how it is transmitted — and how the symptoms present differently — what made you attuned to what was headed for the U.S. early last year?
CD: It was probably the single biggest contributor to my thinking. When we have a novel pathogen as a doctor, or as a communicable disease controller, our minds think in terms of buckets of pathogen: some are airborne, some are spread on surfaces, some are spread through fecal material or through water. In January [of last year], as I was watching the news reports emerge out of China, it became clear to me that this was potentially a perfect pathogen. What does that mean? It would mean it had some of the attributes of things like tuberculosis or measles or influenza — that it had the ability to spread from person to person, likely through the air, that it made people sick enough that China was standing up hospitals in two weeks, and that it moved fast enough through the population to grow exponentially.
TC: You are credited with helping to convince California Governor Gavin Newsom to issue lock-down orders when he did.
CD: Everything I’ve done is as part of a team. In March, some amazing heroes parachuted in from the private sector, including [former U.S Chief Technology Officer] Todd Park, [famed data scientist] DJ Patil, [and Venrock’s] Bob Kocher, to help the state of California develop a modeling effort that would actually show, through computer-generated models, in what direction the pandemic was headed.
TC: How did those efforts and thinking lead you to form The Public Health Company last August?
CD: What we are doing at The Public Health Company is incorporating the genomic variant analysis — or the fingerprint of the virus of COVID virus as it mutates and as it moves through a population — with epidemiology investigations and [porting these with] the kind of traditional data you might have from a local public health officer into a platform to make those tools readily available and easy to use to inform decision makers. You don’t have to have a mathematician and a data scientist and an infectious disease doctor standing next to you to make a decision; we make those tools automated and readily available.
TC: Who are your customers? The U.S. government? Foreign governments?
CD: Are the tools that we are developing useful for government? Absolutely. We’re engaged in a number of different partnerships where this is of incredible service to governments. But they are as useful, if not even more useful, to the private sector because they haven’t had these tools. They don’t have a disease control capability at their fingertips and many of them have had to essentially stand up their own internal public health department, and figure it out on the fly, and the feedback that we’re seeing from private sector businesses has been incredible.
TC: I could see hedge funds and insurance companies gravitating quickly to this. What are some customers or types of customers that might surprise readers?
CD: One bucket that might not occur to people is in the risk management space of a large enterprise that has global operations like a warehouse or a factory in different places. The risk management of COVID-19 is going to look very different in each one of those locations based on: how the virus is mutating in that location, the demographics of their employees, the type of activities they’re doing, [and] the ventilation system in their facility. Trying to grapple with all of those different factors . . .is something that we can do for them through a combination of our tech-enabled service, the expertise we have, the modeling, and the genetic analysis.
I don’t know that risk management in terms of disease control has been a big part of private sector conversations, [but] we think of it similar to cyber security in that after a number of high-profile cyber security attacks, it became clear to every insurance agency or private sector business that risk management had to include cyber security they had to stand up. We very much believe that disease control in risk management for continuity of operations is going to be incredibly important moving forward in a way that I couldn’t have explained before COVID. They see it now and they understand it’s an existential threat.
Elderly caretech platform Birdie gets $11.5M Series A led by Index
SaaS-maker Birdie has closed an $11.5 million Series A round of funding led by Index Ventures. Existing investor Kamet Ventures also participated.
The UK-based caretech startup has raised a total of $22.9M since being founded back in 2017 (a 2018 raise that was called a Series A at the time is now being classed as a seed expansion). It’s focused on building tools for social care providers to drive efficiencies in a chronically under resourced sector.
Birdie isn’t a care provider itself (so it’s not a direct competitor to a startup like Lifted); rather it aims to support care providers with a suite of digital tools intended to reduce admin costs and makes it easier to manage the care being provided to individuals — doing away with the need for paper-based records, and enabling real-time visibility such as via carer check-ins and medication-related notifications.
The wider mission is for the platform to support care providers to offer more co-ordinated, personalized and — the hope is — preventative care so that older adults can be supported to live for longer in their own homes.
“Technology can completely transform the way we look after the elderly and help them to age at home much longer, healthier and happier,” says CEO and co-founder Max Parmentier, explaining the founding premise. “We position ourselves as a solution to uniquely offer a full support for the elderly to age at home… So we started off with the people closest to the elderly and caring for the elderly which are the care providers. And when we look at how these providers are operating they are extraordinary committed, and very much involved in their work, but the care delivered is very uncoordinated, reactive and sometimes very generic.
“We felt that we could go way beyond — in terms of technology — becoming the operating system to be much more efficient in the way they deliver care but also to significantly increase the quality of the care delivered.”
What’s the draw for VCs to invest in such an under-resourced market? “There’s macro trends which are unavoidable. I agree with you that it’s vastly underfunded but it’s just unsustainable,” he argues. “There is clearly an argument to say that whether VCs or investors are interested in this industry or not it’s going to get bigger. And one way or another we’ll have to find some funding mechanism to pay for it.”
“Today already we hear horrible stories about older people not being taken care of properly. I think what got particular Index excited is really the opportunity to [tell a positive story],” he goes on. “I’m quite an optimistic person. I do believe that actually you could very much craft a much happier path in terms of ageing which is actually more affordable — because it doesn’t cost as much because you really lower the healthcare costs if you really tailor these packages better and tailor the care much better. And you can also use technology to make it more personalized, more preventative.”
By simplifying and streamlining data capture around elderly care via a digital platform, information about the care being delivered can be structured in a way that helps reduce errors (such as from handwritten notes leading to administering the wrong medication) and allows for problems to be spotted early when an intervention may be highly beneficial, is the contention.
Parmentier gives the example of early signs of a urinary tract infection which, if picked up on — by spotting telltale signs in the data — can be treated simply at home with antibiotics. But if not an elderly person may end up in hospital, with all the associated risks of a far worse outcome.
Birdie can also supply connected hardware like motion sensors to its care provider customers so that its platform can monitor frail elderly adults who may be at risk of falling. Although Parmentier emphasizes that such hardware is an optional component of the platform — and is only installed with the full knowledge and consent of the care recipient.
The business is focused on “serving the interests and the rights of these older adults and no one else”, he says, confirming that care recipients’ data is not shared with any third parties unless it’s directly related to the delivery of their care.
Having a digital platform-level view into an individual’s care obviously offers increased visibility vs paper-based records. It also means real-time data can be shared — such as with close family members who may want the reassurance of knowing when their loved one has received a visit or taken their medication, and so on. (Again, though, only with the proper consents.)
“There is a positive narrative which is that ageing is actually great,” Parmentier suggests. “If you’re in good health this part of your life is probably one of the most exciting. And this is really the spin we should give in terms of story but also we should empower these older adults with the right support to take that happy path.”
To date, Birdie has partnered with almost 500 providers across the U.K. — and currently its platform is being used to support the care of more than 20,000 older people every week.
Growth has been 8x over the past 12 months, per Parmentier, as the coronavirus pandemic has accelerated demand for in-home elderly care. The new funding will go on accelerating growth in the U.K., though he also says it has its eye on other geographies and sees potential to expand internationally.
“Phase one [of the business] is how can we empower these care providers to be better at what they do?” he says. “Because I really believe that there’s am army of care givers who are so committed and if we can help them be better at what they do that’s beautiful.”
Having structured data on elderly care provides a foundation for conducting research that could further the ‘preventative’ care component of the mission — and Birdie is taking some tentative steps in that direction via some project partnerships.
Such as one into polypharmacy (i.e. concurrent use of medications which can have negative clinical consequences) with U.K.-based AI company Faculty.
“There’s very little known as to what impact medication has on older adults health. If you think about it we just have pharma companies doing trials and then flagging secondary symptoms up when they arise and then doctors prescribe that. The reality is for elderly people — because usually they combine different medications — the symptoms and the damage to health can be greater,” he explains.
“What we’ve done with Faculty is to look at what is the medication treatment of an older adult and what is the clinical observations from carers following these medication treatments. So do we see that typically there’s less appetite to eat or drink, or complaints about pains and so on. And do we see correlations with the actual medication treatment prescribed?”
The polypharmacy research is at an early stage but he says the hope is they will be able to build an AI model that can generate warnings for a prescribing clinician if a particular medication regime has been linked to outcomes that may damage health or otherwise hamper healthy caring for an individual.
On the research side, Birdie’s website notes that it’s using “anonymized” data in these exploratory efforts — which is a claim that merits scrutiny given that medical data is both very sensitive and notoriously difficult to robustly (irreversibly) anonymize.
Asked about this, Parmentier says that for the moment its research efforts entail correlating data on different older adults from different care providers, and that the data being pooled is limited to specifically relevant info (i.e. depending on the research project) — removing “all the un-needed data”, as he puts it.
He says it is not, for example, currently combining any of the data it holds with National Health Service (NHS) patient data — which he acknowledges could pose a major risk of re-identification. But he also says Birdie does want to go there because it believes that combining more data-sets could help it further preventative care research.
“The risk is when you pool your data with any third party data-set such as the NHS for instance. That is really risky… because there’s always a way to tie it back. So we’ve been keeping away from that for the moment,” he tells TechCrunch.
“I think it can really improve our preventative models but we need to do that only under very strict conditions that the anonymization is bullet-proof,” he adds. “We haven’t done that yet and we’re exploring ways to do it. But we’re going to very cautious about it. So for the moment there’s no risk really because we’re not mixing data-sets of the same patient. But if we were to integrate with third parties’ systems the risk will rise — and we’ll need to address it very clearly.”
Parmentier also offers a glimpse of an ambitious potential second phase of the business — where Birdie believes it will be able to coach older adults themselves (and/or their family members who are acting as care givers), i.e. enabled by its platform-level view of best practice (and by being able to fold in data-fuelled research into preventative care AI models).
To get there will require not, just a lot of data, but a sectoral shift toward a model of care delivery focused on “value-based healthcare”; where the provider is billed not for hours of care given but on health/quality of life outcomes. So the transformative vision of highly scalable, data-enabled elderly home care is certainly not going to arrive overnight.
In the meanwhile Birdie’s business remains firmly in phase one: Building support tools to drive efficiency and quality for an under-resourced sector.
“We see the same problem everywhere,” adds Parmentier. “Today already we don’t look after our elderly properly… Today they cost us about 60% of our healthcare costs. Tomorrow is going to be much worse. We need to channel more investment into this industry — in terms of new ways of operating, technology, and really innovation is key to move towards better models where it’s more preventative, more personalized, more outcome based — because that’s the solution. It’s going to lower the cost base, it’s going to improve the health outcomes.”
Commenting in a statement, Stephane Kurgan, venture partner at Index Ventures, added: “Our ageing society and increasing healthcare costs require us to rethink the way we care for frailer populations like the elderly. Technology gives us the tools, as the care sector has remained widely paper-based and is ripe for disruption.
“By investing in caretech with Birdie, we are investing in solving the daily challenges of the care community. We firmly believe in Birdie’s vision to make care more personalised and more preventative so that older people can age at home longer, healthier and happier. We’ve been impressed by Birdie’s traction and the calibre of its team, and are very excited to embark on this journey with them.”
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