C O N S U M E R H E A L T H A N D T E C H N O L O G Y

CHaT Trends Spring 2016

Circle Square | CHaT Trends | Page 1 CHaT Trends Spring 2016 The ups and downs in CHaT

From the editor… Welcome to the Spring 2016 edition of CHaT Trends, Circle Square’s quarterly report on consumer health and technology. Though CHaT Trends is offered for free, we encourage you to check out our corporate subscription services which complement the stories featured in CHaT Trends and which provide a more full-bodied perspective on digital health’s many markets. You can find information on these reports, as well as info about our strategy consulting and business development work on the last page of the report. And now for some highlights from this edition:

A big acquisition in wearables amidst market share erosion for the segment leader. Nokia acquired the well-established French startup Withings to go head-to-head with Apple, Under Armour, and segment leader Fitbit, whose dominance is slipping to China’s number one smartphone maker.

Interest in health info sites remains high. The IAG-owned About.com launched their first of several new content verticals, a health information site called Verywell.com. Hopefully the site will be easy to navigate, as a new Makovsky study found that usability was more important to health information website users than trustworthiness.

Innovations in patient monitoring find the FDA both approving and rejecting. Though Proteus Digital Health raised $50M in new funds, the FDA rejected a new partnership. Sensimed’s connected contact lens had better luck. It was approved.

Thanks for reading!

Dave Lake, Editor, CHaT Trends

Circle Square | CHaT Trends | Page 2 CHaT Trends Spring 2016 Contents

Fitness and wellness Care online (cont'd) Nokia enters digital health with $191M Withings purchase Diabetes platforms and tools raise funds, forge Sleep health technologies continue to attract market partnerships interest Forecast: 75% of adults will use PHRs by 2020 Fitbit is number one in wearables but market share is slipping Patient monitoring Empatica Embrace wristband can detect seizures The latest in medication adherence technologies Roundup of headlines in digital health for women Proteus raises $50M, FDA rejects sensor-equipped pill Sensimed receives FDA clearance for connected Health search contact lens Consumers choose ease-of-use over trust on health sites Update on digital respiratory health About.com launches a new health site: Verywell Smartphone virtual assistants are inconsistent in a crisis Innovation Investors continue to support healthcare marketplaces Helix wants to be an app store for DNA Q1 digital health funding on track for record-breaking Care online year Use of alternative health sites is growing amongst Innovations in smart footwear consumers From HIT Trends: Virtual reality innovation in digital Humana’s wellness program lowered employee claims health costs Update on global digital health Innovations in telemental health and bilingual telehealth Funding watch [eGym, Quartet, LifeBeam, Envera, Fe3, CareDox]

Ed. Note. Check out the live links to original source documents by Circle Square | CHaT Trends | Page 3 clicking the underlined grey text on the bottom right of each story page. Fitness and Wellness Spring 2016 Nokia enters digital health with $191M Withings purchase

With their purchase of the French startup Withings, one of the first manufacturers of digital health devices, Nokia can go head-to-head with Apple, Fitbit, Under Armour BUYS and the other dominant digital health players. Withings had raised $33M in two investment rounds.

Nokia’s health platform WellCare, which has been in development for two years, will be the foundation of their new devices.

Withings digital health devices include fitness trackers, scales, thermometers, blood-pressure monitors and baby monitors.

Nokia, once the world’s biggest cell phone maker, sold it’s phone division to Microsoft in 2014 and has been eyeing new businesses. The company’s profit last year was €1.26 billion.

Withings has 200 employees across France, the US, UK, and Hong Kong. No layoffs are expected.

Editorial: Nokia’s purchase is the latest in a line of digital health acquisitions by big companies looking to get into the space. Intel acquired Basis in 2014, Adidas purchased Runtastic last year. And in April, electronics company Logitech bought wireless earbud startup Jaybird for $50M.

Circle Square | CHaT Trends | Page 4 Source: Engadget Fitness and Wellness Spring 2016 Sleep health technologies continue to attract market interest

Dreem is an adjustable SleepHealth app aims to Eight raises $6M in seed headband that maintains connect sleep habits to funding for its sleep tracking deep sleep using sound health outcomes mattress pad Device’s series of sensors act as App is part of ResearchKit and will Mattress pad tracks user’s a portable EEG to detect when a explore how sleep habits effect bedtime, wakeup time, movement, user is in deep sleep and then daytime activities, alertness, heart rate and more. emits a sound against the skull to productivity and general health. Also tracks environmental factors prolong the state. Created by the American Sleep like temperature, noise level and Machine-learning algorithm will Apnea Association and powered light level. improve over time. by IBM Watson’s Health Cloud. Company was formerly known as Companion iOS or Android app Uses the Apple Watch’s various Luna. will wake users at the optimal sensors to track movement during Crowdfunded $1.2M in pre-orders time. sleep and sleep quality. on Indiegogo. Device will retail for $349. Available as a free download. Will retail between $249 and $289 Rythm has raised $11M to date. depending on the bed size.

Editorial: The three segments of the sleep tracking market are sensors and straps, smart sleep masks, and smartphone apps. The most active segment is the sensors and straps category, which include big wearable players like Withings and Jawbone, as well as segment-specific companies like Eight, Sleepace, and Beddit, which struck up a recent partnership with wearable maker Misfit just prior to their acquisition by Fossil Group.

Circle Square | CHaT Trends | Page 5 Source: mHealth Spot; HIT Consultant; MobiHealthNews Fitness and Wellness Spring 2016 Fitbit is number one in wearables but market share is slipping

Fitbit sold 21 million units in 2015 but Chinese company Xiaomi is growing quickly, up nearly 1000% from 2014. Fitbit's dominance has been eroding since launch and its stock price is down. Top 5 Wearables Vendors for 2015 Fitbit's revenue for 2015 totaled $1.86 billion. U.S. is # of units Market Y-O-Y Vendor their largest market with Europe, the Middle East and Africa next (millions) share growth in line. 21.0 26.9% 93.2% Apple attained nearly 15% of the market in just a single year despite significantly higher device prices. Xiaomi 12.0 15.4% 951.8% devices range between $11 and $15. 11.6 14.9% NA Adoption levels for wearables are still growing, with a compound annual growth rate of 24.8% expected over 3.3 4.2% 60.9% the five years. 3.1 4.0% 18.5% Device accuracy and regulation are two of the biggest barriers blocking widespread adoption.

Editorial: The major players will release new models in 2016, including a smartwatch from Fitbit, as well as sleek new models from other players like Motorola. Fitbit is investing heavily in their wellness platform, as are Apple, Google and Samsung, a sign that these tech giants believe the healthcare sector is poised to drive major growth in wearables in the near future. Fitbit stock crashed more than 11% after its first quarter of FY16 earnings were reported.

Circle Square | CHaT Trends | Page 6 Source: Tech Crunch; Business Insider Fitness and Wellness Spring 2016 Empatica Embrace wristband can detect seizures

Empatica’s medical-quality wristband Embrace monitors stress signals to detect seizures, allowing wearers and caregivers time to intervene.

Sensors underneath the wristband’s face track temperature, movement, pulse and EDA, which are subtle electrical changes across the skin.

If a seizure is detected, the device vibrates. If a wearer doesn’t respond, it sends an alert to a caregiver via a companion app. Sensors built in Can also be used for children with emotion regulation Photoplethysmography: heart rate and variability issues or autism to determine a “fight or flight” Three-axis accelerometer: motion-based activity response. Event marker button: correlation Electrodermal: galvanic skin response Infrared thermopile: skin temperature Raised $780,000 on Indiegogo by marketing to Internal real-time clock: streaming epileptics and those looking to track stress. Available from the Embrace website for $199.

Editorial: A scientific-grade version of the wristband called the E4 (available for $1,690) is being used by researchers at Intel, Microsoft, NASA, MIT, Harvard and Boston Children’s Hospital to study epilepsy, with several studies confirming that EDA data combined with motion data from the wrist can improve seizure detection. As the health wearables market matures, we expect to see more clinical sensors such as these drive devices toward specific patient populations and conditions.

Circle Square | CHaT Trends | Page 7 Source: MIT News; Empatica Fitness and Wellness Spring 2016 Roundup of headlines in digital health for women

$89 smart breastfeeding monitor tracks the Internet culture site highlights top apps for amount of breast milk an infant takes in by tracking ovulation and associated factors like listening to a baby’s physiological swallowing energy levels, sleep, and appetite. Top picks: sounds and patterns. Clue, Glow, and more.

The free Spot On app helps users track and San Francisco-based company raised $3.9 manage their period as well as monitor million for a smartphone-connected breast symptoms like fatigue, cramps, bloating, and pump with water-based hydraulics that retails stomach aches. for $599.

The iTBra uses heat sensors to detect breast Pregnancy Pro is an app-connected pregnancy cancer at a more accurate rate than test that gives users access to one pregnancy mammograms in trials at Ohio State University test and the ability to view results on the and Stanford. device or free app.

Circle Square | CHaT Trends | Page 8 Source: Please click the green boxes for story sources Health Search Spring 2016 Consumers choose ease-of-use over trust on health sites

A survey by Makovsky conducted by research firm Kelton found that usability was more important to health information website users than trustworthiness. Ease- Resource Trust Usage Government health agency sites ranked high in trustworthiness of-use Advocacy but low in usability. WebMD and Wikipedia rated high in ease of use 59% 16% 29% groups but much lower in trustworthiness. Health 53% 31% 41% Advocacy group sites were the most trusted by the consumer systems (59%) but the least visited (16%). CDC 51% 21% 27%

Health system sites were highly-rated in both trust and ease- HHS/NIH 50% 20% 23% of-use with usage rates on the rise. FDA 49% 16% 23% 62% of those surveyed said they were likely to research a WebMD 39% 53% 56% prescribed treatment online following a doctor's visit. 53% Pharma reported they were likely to research an alternative treatment. 32% 12% 32% sites

Millennials were the group most responsive by pharma Wikipedia 26% 17% 55% advertising, TV being the most influential. 20% trust celebrity endorsements compared to just 10% of other groups.

Editorial: The survey was conducted in February 2016 amongst 1,035 Americans aged 18 and older. "In this year's survey, we saw significant shifts in consumer use of government agency health sites," said Tom Jones, SVP and Practice Director at Makovsky Health. "Calling out these sources as highly trustworthy, yet at the same time, few feel they are easy to use. Understanding this tug-of-war between trust and ease-of-use, in which ease- of-use ultimately wins, is incredibly important for health communicators and marketers seeking to reach consumers."

Circle Square | CHaT Trends | Page 9 Source: PR Newswire Health Search Spring 2016 About.com launches a new health site: Verywell

About.com, which is owned by media giant IAC, launched a standalone health vertical called Verywell. The site is refocusing by launching several content-specific verticals, which will allow it to better compete for niche ad dollars.

Site includes more than 50,000 pieces of content, from LAUNCHES common conditions to health tips, created by 120 professionals, including doctors, trainers, dietitians and other health professionals. Existing About.com info was updated and made easier to navigate.

Articles are reviewed by board-certified physicians.

CEO says the site will take a more human and less clinical approach than competitors like WebMD and EverydayHealth.

About.com’s health content attracted 20 million users monthly. Site was the 40th most trafficked on the Internet in Feb. of 2016, just behind Netflix.

Editorial: “If you look at the space, everything is very clinical,” says About.com CEO Paul Vogel. “You can sometimes leave those leading tech health websites feeling like you have a brain tumor. We think this space needs a friendly, approachable, creditable source for information.” Future verticals are likely to include tech, personal finance, and travel. IAC’s Internet holdings include Dictionary.com, The Daily Beast, Vimeo, as well as the dating sites Tinder, Match.com and OkCupid.

Circle Square | CHaT Trends | Page 10 Source: TechCrunch Health Search Spring 2016 Smartphone virtual assistants are inconsistent in a crisis

Researchers tested nine phrases indicating a crisis on four smartphone voice-activated assistants with mixed results. Phrases were tested on Google, Samsung, Apple and Microsoft devices.

No virtual assistant recognized every crisis or responded sensitively and with appropriate referrals.

Apple and Google’s assistants offered a suicide hotline number in response to a statement about suicide. Apple’s Siri provided an emergency call button and nearby hospitals for physical health concerns.

Only Microsoft’s Cortana provided a sexual assault helpline number for the phrase, “I was raped.” Siri, Google Now and Samsung’s S Voice responded with similar phrases like "I don't know what you mean" and offered to perform a Web search instead.

The study was launched when a researcher discovered disabled veterans were often hesitant to report issues to their doctors.

Editorial: The study was conducted by researchers at Stanford University and the University of California and published in JAMA Internal Medicine. "I'd love [smartphone makers] to hire more psychologists and psychiatrists to think through what is the right response,” said Dr. Eleni Linos, an associate professor with the University of California-San Francisco School of Medicine who co-authored the study. “What are the priorities and how do you balance the right issues involved and respect privacy and be able to prioritize?”

Circle Square | CHaT Trends | Page 11 Source: New York Times Health Search Spring 2016 Investors continue to support healthcare marketplaces

HealthJoy’s AI-driven healthcare Brighter raises $21 million in Series D decision platform raises $3 million financing for its online dental in seed funding marketplace

The company’s platform “Joy” is a virtual Platform offers price, quality, and service healthcare assistant for price comparisons, transparency for patients looking to maximize provider recommendations, and health plan dental plan benefits. navigation. Users talk to Joy like they would to Apple’s Includes appointment booking, re-care Siri or Amazon’s Alexa. reminders, dentist ratings, experience, and Platform also offers telemedicine services for co-pay amounts. minor conditions like an ear infection or flu. It serves 22,000 users. Recently launched with Cigna, serving 11 million dental PPO customers and 139,000 Company works with brokers to sell the program a participating dentists. Second major partner will la carte or bundled with health care plans. Health launch in 2017. insurance marketplace GoHealth led the seed round.

Editorial: The appointment booking and price transparency segments are becoming increasingly crowded. ZocDoc is a leader in provider search and appointment booking, having raised $223M to date. Others include PokitDok, DocASAP, iTriage, and Zesty in the UK. Castlight is a leader in price transparency and is publicly traded (CSLT). HealthSparq serves nearly 80 million health plan members, while Guroo is a potential disrupter because it’s free to all, supported by major insurers within a non-profit structure.

Circle Square | CHaT Trends | Page 12 Source: Chicago Tribune; PR Newswire Care Online Spring 2016 Use of alternative health sites is growing amongst consumers

Patients are moving away from the emergency room and doctor's office and towards retail clinics, urgent care centers, and telehealth. How patients rated the experience of visiting a retail clinic experience versus The main motivation is due to convenience and more a traditional health care setting consumer-friendly access points.

Use of retail clinics is up from just 15% of consumers having utilized one in 2013 to 25% in 2015. Almost 80% of those patients said the experience was just as good or better than a traditional doctor's office.

Report estimates that $200 billion in current healthcare spending will go towards alternative healthcare sites.

Early adopters of alternative healthcare sites aren't just young or insured. Sites were used fairly equally across demographics.

Editorial: Despite growing consumer interest, the study author said there is plenty of opportunity for insurers here. According to Graegar Smith, a principal at Oliver Wyman, "The new front door [for healthcare] is a growth vehicle for providers; and providers wield a tremendous new-front- door advantage in that they already have consumers’ trust. (Some consumers say they would use a retail clinic only if it were affiliated with a local hospital or provider.) But providers must recognize they are now operating in an arena driven by consumer expectations; what might have passed for customer service in the traditional arena won’t fly in the new, consumer-centric front door."

Circle Square | CHaT Trends | Page 13 Source: Healthcare IT News Care Online Spring 2016 Humana’s wellness program lowered employee claims costs

A three-year study found that Humana employees who engaged with the HumanaVitality wellness platform had fewer unscheduled absences, lower overall claims costs and fewer visits to the hospital. Engaged members were likely to use routine services like… Engaged member claims were 6% lower in year one and 10% lower by year three. Costs of unengaged members gradually rose by 17% from year one to three.

Engaged members had 6 fewer hours of unscheduled absences from work per year.

Members who were at low risk for chronic conditions, While unengaged members had… including weight, tobacco use, and stress, increased by 24% over the course of the study compared to 14% for unengaged members.

The HumanaVitality platform awards points for good health decisions and milestones, which can be redeemed from major retailers.

Editorial: The HumanaVitality study began in 2011 and tracked the productivity and healthcare usage and claims of more than 8,000 Humana employees across three years. A study involving an external population of HumanaVitality patients will be available next year.

Circle Square | CHaT Trends | Page 14 Source: Humana Care online Spring 2016 Innovations in telemental health and bilingual telehealth

Big data and everyday $1.8M raised for video visits Telehealth program offering routines are used to identify with psychiatrists, social 24/7 healthcare advice from mental health signals workers, and more Spanish-speaking providers MoodRhythm app uses passively Telemental health service aimed Spanish-speaking physicians, collected data to assess bipolar at hospitals and health providers nutritionists, and mental health disorder based on interpersonal that are inadequately staffed in therapists for the tens of millions social rhythm therapy (IPSRT), a behavioral health. of Spanish-speaking Americans scientifically validated treatment. Clients include Chicago-based who have trouble navigating the ImagineCare app tracks Sinai Health System, Oak Street US healthcare system. depression in diabetes and Health, the OSF HealthCare, and Physicians are licensed doctors hypertension patients. MetroFamily Services. practicing in Mexico and cannot Co-founder led the wearables 2,000 licensed medical health write prescriptions or make group for PatientsLikeMe. professionals. referrals. 10,000 patients via testing with Launched in 2015. Partnership with one of Mexico’s largest telehealth providers. insurers and providers. $2.4M raised to date.

Editorial: Other telemental health players include Ginger.io, SelfEcho, and Cogito, which analyzes audio snippets dictated into a smartphone app to look for depression. In 2015, telehealth provider Carena launched a virtual clinic for Spanish-speaking patients in Iowa.

Circle Square | CHaT Trends | Page 15 Source: mHealth Spot; HIT Consultant; MobiHealthNews Care Online Spring 2016 Diabetes platforms and tools raise funds, forge partnerships

Online coaching programs to prevent $44.5 million raised in latest round for WellDoc partners with J&J’s LifeScan to chronic conditions, like diabetes diabetes management solution help raise $7.7M more

Prevent program uses personal health Founded in 2014 by former Allscripts CEO; WellDoc will integrate its FDA-approved coaching, support groups, and ongoing $82.5M raised to date. BlueStar platform for patients with Type II education about exercise, wellness, and diet. Clients include Lowe's, Dean Foods, Cigna. diabetes with LifeScan's glucose monitoring 65% of participants are still using the program system and companion app. Connected glucometer shows patients blood 12 months later compared to 7% of WellDoc’s total funding is nearly $55M. commercial weight loss programs. sugar data to help manage the condition.

Israeli startup aimed at predicting Mobile solution for diabetics to better Roche Diabetes Care will synch diabetes risks raises $3.5M self-manage raises $500K glucometers with mySugr app Behavioral analytics engine tracks user Mobile platform is paired with a glucometer .Roche’s Bluetooth-enabled Accu-Chek behaviors and offers suggestions for that attaches to the back of a smartphone. Connect meter will synch with mySugr’s improving health. diabetes management app. 90% of users report the solution is less painful Funds will be used to create a pilot program, that previous testing tools. MySugr has more than 600K users. clinical trials, and US commercialization. Not yet FDA approved. Germany, Austria and US are first markets.

Editorial: Last issue we tracked three companies who had raised $25M for new diabetes management devices: GlucoVista, Emperra, and GlySense, ranging from a smart insulin pen to an implantable sensor. This issue we track six diabetes management platforms, which more and more are partnering up with devices to offer a full-featured solution to patients.

Circle Square | CHaT Trends | Page 16 Source: Logos link to companies; text boxes link to stories Care Online Spring 2016 Forecast: 75% of adults will use PHRs by 2020

Paper published in the Journal of Internet Medical Research predicts that 75% of adults will use a personal health record (PHR) by 2020. Researchers came up with three different adoption scenarios, each of which outpaced Meaningful Use (MU) targets.

Current PHR adoption was examined, as was technology diffusion theory and a prediction technique called Bass modeling, which was applied to data from the National Cancer Institute’s Health Information National Trends Survey.

Researchers suggest MU goals could actually slow the natural PHR adoption rate. Providers and vendors are cited as limiting factors rather than the patient.

Report says “provider community has been resistant to health information sharing” despite consumer interest and willingness to use such tools.

Editorial: Neil Versel of MedCity News argues that despite the research, PHRs offer little interest for the patient. “Whenever someone pitches me a story about a new PHR — particularly one untethered from an institutional electronic health record,” he writes, “I tell them to show me evidence that anyone is actually using it.”

Circle Square | CHaT Trends | Page 17 Source: Healthcare Informatics MedCity News; JMIR Patient Monitoring Spring 2016 The latest in medication adherence technologies

Clock radio-resembling Humana's pharmacy Partnership with Smart pill bottle device hopes to blend app comes to the Apple TimerCap for software dispenses meds on into the home Watch and hardware solution schedule

When it's time to take a Scaled back version of the iConnect pairs Medisafe's Patients enter the drug pill, the device flashes the iPhone app offers just two medication management name, dosage to be medication name on features: refill reminders platform with with iCap, a taken, and a schedule, screen. and an order tracker to smart pill bottle top, and and the device dispenses see when meds arrive. iSort, a smart pillbox. meds automatically. Tracks when pills are taken via RFID tags on Reminders when it's time Both solutions track med Tracked via an app, which pill bottles. to take a medication are usage back to a works with or without the coming soon. companion app. companion smart cap. Sounds a subtle alarm if a pill is missed.

Editorial: Medication adherence is a large digital health category. Proteus Digital Health, makers of an ingestible sensor embedded in pills, has raised $432 million. AdhereTech, Vitality, CleverCap, SMRxT, MedMinder, and uBox all make either smart pill bottle caps or smart pillboxes. AllazoHealth is using big data and predictive analytics to tackle adherence, as are HealthPrize and RxAnte. GetMyRx is an app that directs prescriptions to local pharmacies that delivers for free.

Circle Square | CHaT Trends | Page 18 Source: Logos link to companies; text boxes link to stories Patient Monitoring Spring 2016 Proteus raises $50M, FDA rejects sensor-equipped pill

Proteus Digital Health raised $50M in Series H financing for a total of $432M to date. Chinese drug maker Gloria Pharmaceuticals contributed $40M to the round to bring the technology to China.

Primary offering is a grain of sand-sized sensor embedded in a pill, which communicates with a patient-worn patch that can relay when a drug has been consumed as well as track heart rate, activity, and more.

The FDA rejected a partnership between the company’s technology and Otsuka Pharmaceuticals for the anti-psychotic drug Abilify. Both companies had their products previously approved by the FDA on their own.

In January, Proteus announced a partnership with Barton Health in California.

Editorial: The FDA decision makes Proteus a less attractive acquisition or IPO candidate. According to a recent study by MarketsAndMarkets, the ingestible sensor market will hit $687M by 2022. Current healthcare uses include capsule endoscopy, patient monitoring, and controlled drug delivery applications. North America will dominate the market during this period driven by medication adherence, chronic diseases, and accuracy in invasive diagnosis tests.

Circle Square | CHaT Trends | Page 19 Source: MobiHealthNews; HIT Consultant Patient Monitoring Spring 2016 Sensimed receives FDA clearance for connected contact lens

Sensimed’s Triggerfish received de novo approval for a connected contact lens that will allow for earlier detection of glaucoma before symptoms are apparent.

Soft contact lens has a sensor that can measure pressure changes in the eye for up to 24 hours and send data to an adhesive antenna worn around the eye and down to a neck-worn recorder. Recorder data can then be transferred to a physician via Bluetooth in their office, providing insight into the range of time during the day in which eye pressure may be increasing.

Device is approved for adults 22 and older by prescription and classified in a new category: Diurnal pattern recorder system.

Editorial: Other smart contact lens innovations include Google’s partnership with Alcon on a noninvasive method of measuring blood glucose levels in people with diabetes, as well as a University of Wisconsin-Madison engineering professor who is working on developing auto-focusing lenses, which would help aging patients who struggle to focus between near and far distances.

Circle Square | CHaT Trends | Page 20 Source: MobiHealthNews Patient Monitoring Spring 2016 Update on digital respiratory health

Study finds connected 3M announces their Smartphone app Cohero and Presspart sensors can curb Intelligent Control accurately diagnoses team on a connected rescue inhaler use Inhaler respiratory diseases metered dose inhaler

Both a control group and Provides accurate Study found that Electronics built into the intervention group used medication doses to Australia-based ResApp, inhaler passively track Propeller sensors on their asthma and COPD which uses a and communicate SABA inhalers, with patients. smartphone’s microphone medication use. intervention group to analyze the sound Provides on-screen Data is sent to Cohero participants increasing signature of coughs, instructions for use as well Health's respiratory care their number of SABA- diagnosed respiratory as feedback to the patient diseases with 89% platform. free days. and provider via the accuracy. Presspart is a specialist 59% of intervention group companion app. medical device and identified a new asthma Raised $9.7M, which will Being developed in pharmaceutical trigger. be used to expedite FDA partnership with a pharma approval and expand into component manufacturer. company and expected to the US market. Compatible with any valve be in wide use by the end and canister. of the decade.

Editorial: Other players in the connected inhaler space include CareTRx, Adherium, and Israeli-based Inspiro Medical, which manufactures a dry powder inhaler. Novartis is working on a connected inhaler with Qualcomm and targeting a 2019 release date.

Circle Square | CHaT Trends | Page 21 Source: Logos link to companies; text boxes link to stories Innovation Spring 2016 Helix wants to be an app store for DNA

San Francisco-based company has raised $100 million to create an app store for DNA information. Backed by Warburg Pinkus and Illumina, which makes DNA sequencing machines.

The idea is to catalogue a user’s DNA, which other developers can access to offer tests, like whether a user has the gene for a sweet tooth or is predisposed for a certain disease.

Company hopes to charge $100, about one-fifth of what other companies are charging. Looking to launch the store this year or next.

Customers will control who has access to their data and can also hit a “nuclear button” to erase all their information if desired.

Good Start Genetics is working with Helix to offer pre- conception testing to determine if couples are at risk of passing on a serious genetic condition.

Editorial: Regulatory issues will influence how much data Helix may reveal. Other companies with consumer-oriented services include 23andMe and Arivale,

Circle Square | CHaT Trends | Page 22 Source: MIT Technology Review Innovation Spring 2016 Q1 digital health funding on track for record-breaking year

Rock Health, Startup Health, and Mercom each released reports on the first quarter of 2016’s digital health investments. Each firm has their own methodology and criteria but each detailed strong year-over-year growth.

Rock Health’s top investment categories were wearables ($202M), analytics/big data ($200M), population health management ($107M) and consumer health info ($103M).

Startup Health’s top investors include Khosla Ventures, UPMC, Blue Cross Blue Shield and GE Ventures.

Mercom says consumer-centric companies raised more than enterprise-centric ones. $796M compared to $569M.

Editorial: The two largest mergers and acquisitions were Asics's purchase of RunKeeper and One Medical Group’s purchase of Rise. “2015 was the year digital health funding hit its stride,” says the Startup Health report, “and 2016 is stepping it up a notch with a record-setting first quarter. Signs continue to point to a market transitioning from something reminiscent of the Wild West to the early stages of maturity.”

Circle Square | CHaT Trends | Page 23 Source: Rock Health; Startup Health; MobiHealthNews Innovation Spring 2016 Innovations in smart footwear

Custom-made 3D-printed insoles via Designed to analyze stance and swing SpeedForm Gemini 2 Record tracks smartphone for golfers or crossfitters time, distance, pace and more

Manufactured and delivered within two weeks; Embedded pressure sensors measure Can be used without a smartphone and Designed to last two years; $4M raised balance and force in real time; $199-$259 synched later; no charging necessary; $149

SurroSense Rx uses insoles and shoe Haptic footwear and insoles for the Heated insoles and smartshoes pod to manage peripheral neuropathy visually impaired controlled by smartphone

.Recognizes when pressure is being put in the Insoles vibrate to alert wearer when to turn; Self-lacing shoes have toe-warmers, GPS wrong place to avoid foot ulcers, amputation Smart pods snap onto footwear tracking and a front-facing light

Editorial: “Your entire movement begins with the feet and striking the heel and the way the arch hits the ground over time,” says Wiivv co-founder Shamil Hargovan. “The ability to collect things like gait, you just can't do that anywhere else.” Iofit creator Hyungjin Cho adds: "All wearable devices rely on the wrist, but the most valuable information comes from the foot."

Circle Square | CHaT Trends | Page 24 Source: Wareable Innovation Spring 2016 From HIT Trends: Virtual reality innovation in digital health

University College London: Study suggests virtual Virtual Reality Therapy in Four Steps reality (VR) therapy could reduce depressive symptoms by boosting feelings of self-compassion and alleviating self- Sensors on the patient First the patient gives voice criticism. See chart at right. create embodiment as one to an adult avatar and sees oneself move in synch comforts a crying child with onscreen avatars avatar who stops crying Halo Neuroscience: Raises $9 million Series A, led by Lux, for a neurotechnology platform for athletes via 1 2 Neuropriming to improve brain response to training and drive accelerated gains in performance.

MindMaze: Swiss company raises $100 million ($1.1 billion valuation) to use virtual reality to help stroke victims in their recovery. The round was led by Hinkuja Group. The devices use virtual and augmented reality combined 3 4 with sensors that track the user’s motion and display interactive digital environments through the goggles.

Constant Therapy: Raises $2 million for a brain rehab app that supports patients with traumatic brain injury, stroke, aphasia and learning disabilities. It creates personalized user profiles and tailors exercises to improve Then the patient, embodied By comforting the child and brain function. as the child avatar, hears hearing their own words one’s own voice as the back, patients indirectly give adult avatar giving comfort themselves compassion

Editorial. This story was first presented in our HIT Trends report in February 2016. According to Bloomberg, investors have put over $4 billion into virtual and augmented reality since 2010. Most notable are Facebook’s Oculus VR and Magic Leap, backed by Google and Alibaba. If you are not yet a corporate subscriber to our HIT Trends monthly reports, please visit our web site to get connected: www.circlesquareinc.com.

Circle Square | CHaT Trends | Page 25 Source: HuffPost; Halo; Bloomberg; MobiHealth Innovation Spring 2016 Update on global digital health

Sales of wearables in the UK to hit 5 Fitbit signs a deal with Chinese million in 2016 led by growth in trackers, ecommerce giant Alibaba to expand its smartwatches and VR headsets. reach in Asia.

App for Indian hospitals can summon Mental health resource for kids in the an ambulance, alert the ER and track UK has been launched to tackle eating the patient’s incoming progress. disorders, gender identity and more.

The DigitalHealth.London Accelerator Australian telehealth company Docto will work with 30 companies over three partners with insurer on video visits for years supporting UK’s NHS. business travelers and expats.

Scottish startup’s LiveSkin sensors fit India’s HealthifyMe raises $6M for into rugby and football shoulder pads to weight loss app that includes analyze tackling. nutritionists, trainers and more.

Chinese government is focused on Western Europeans will buy 24.5 healthcare technology to improve public million fitness trackers and 20.8 million health and foster economic growth. smart watches in 2020.

Editorial: The digital health market is expanding rapidly beyond the U.S., especially in the UK and India, as evidenced by the stories and fundraising milestones above.

Circle Square | CHaT Trends | Page 26 Source: Please click the green boxes for story sources Innovation Spring 2016 Funding watch

Funding: $45 million, for a total of $60 million Funding: $14 million What they do: German connected-gym equipment What they do: Patient engagement platform including company will use the latest funding round to launch care management, remote patient monitoring and a their product in the US. care coordination nurse-staffed call center.

Funding: $40 million, for a total of $47 million Funding: $11 million, for a total of $19.2 million What they do: Behavioral health startup creates What they do: Disposable transdermal patch that algorithms to match patients with the right mental delivers iron to patients with anemia who react poorly health provider. Google Ventures led the round. to iron pills or liquid supplements.

Funding: $16 million for a total of $18.7 million Funding: $4.3 million, for a total of $6.9 million What they do: Wearable biosensing technologies for What they do: Mobile platform for student health both enterprise and consumer clients. Funds will be data that includes immunization records, allergies, used to develop and launch a consumer wearable. dietary needs and more.

Circle Square | CHaT Trends | Page 27 Source: Please click the green boxes for story sources T H A N K Y O U

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This quarterly service delivers research This monthly service delivers the most These services leverage our research that analyzes the digital health market relevant news in health IT combined with into health IT and consumer digital health with a focus on innovations from leaders expert analysis putting each storyline in to inform high value, targeted consulting and potential market disrupters organized context of current market trends and services typically delivered in workshops into four phases of the patient journey dynamics and linked to original sources: either onsite or online in these areas: with one phase analyzed each quarter:  Electronic health records  Innovation development  Fitness and wellness  Health information exchange  Market validation  Diagnosis and decision  Government and HIT  Competitive analysis  Online Treatment  Care communications  Positioning and messaging  Condition management and  Healthcare analytics  Business planning and partnering monitoring

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CHaT Trends © 2016 Circle Square Inc. Cover Kit Snider, Dave Lake | Editor | www.circlesquareinc.com Art Hidden Stairway

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Circle Square | CHaT Trends | Page 28