Technology to Improve Maternal Health: Technology Panel

Technology to Improve Maternal Health: Technology Panel

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And now I'm going to start our technology panel. I would like to introduce Dr. Gandini from Accel Diagnostics, who will be the moderator for our technology panel and will start off by introducing all our panelists. Dr. Gandini. Hello everybody.

I'd like to start with thank you to NIH for organizing the workshop, the panelists, and of course all the participants. My pleasure to introduce the member of the panels. Dr. Steve Xu, is a physician engineering, and health regulatory policy ASPER. He's a medical director of the center for bio integrated electronic in Northwestern.

He has over a hundred peer review publication and numerous patents, and grant. Some of most interest work is on wireless monitoring, both for pregnant women and neonatal. Alicia Chong, she's the founder and CEO of Bloomer Tech. She has a degree in electrical engineering and computer science, as well as an integrated design management from MIT.

She has made a mission of her life to reduce the disparity in healthcare diseases in women, and with her company they are developing electronic, it can be embedded, integrated into the fabric to provide increased access to critical physiological data. Kate Ryder, she's the founder and CEO of Maven. Maven is the US unicorn in women health, female and healthcare sector. It's a platform that's try to increase critical support for women across the spectrum from fertility, pregnancy, adoption, parenting and pediatrics.

Tony Ma, is the co-founder of Benten Technology. It's a digital therapeutic company that focus on addressing healthcare disparity. Tony has a very interesting narrative life story that shape his life and work mission, and I hope he will touch upon that. Elizabeth Bay, she is the managing director of Rhia Venture. A women led impact venture capital firm that invest in reproductive and material health landscape. In her role, she has supported some very interesting startup in this space, and her career she has manager a rich portfolio of startup with successful exit.

Can you get to the next slide please? Before I let the panel their time, just brief introduction about what the work we're doing at Accel Diagnostic. I'm the CEO and co-founder of Accel Diagnostic. It was starter company that we founded in Carnegie Mellon University almost 10 years ago. The mission is to develop a point of care testing that can be used anytime, anywhere from a single finger prick of drop of blood.

Testing at the point of care, at a home setting, doctor's office, and use the smartphone technology to be able to transfer that information and be able to do a more proactive monitor for various diseases. In the context, we work in many diseases but in the context of women health the project that we have currently on, one is developing a blood diagnostic test for preeclampsia to enable women to self test in the comfort of their home, and be able to eventually predict if there is an increased risk of developing preeclampsia. The other is actually a COVID test antibody test, COVID antibody test level in pregnant women to monitor how the antibody may change during the course of pregnancy. And that I'd like to just give the floor to the panels so they can give their presentation. Thank you. The first one would be Steve Xu.

Hello, good morning. Thanks for the kind introduction. My name is Steve Xu. I'm the medical director at the Querrey Simpson Institute, I'm also an entrepreneur and I just wanna make sure that the disclosure is clear, I do have a financial and venture and royalty interest in a company called Cybil that is commercializing these devices. Next slide.

So I think that Dr. Howell gave a wonderful introduction, and I'll basically kind of convey that again is, fundamentally we can do better in maternal health and actually in 2017, the only two countries in the entire world that actually saw an increase in maternal deaths, that was US and the Dominican Republic. I think the CDC also emphasized that about two thirds of these maternal deaths are actually preventable. And we also obviously know that women of color are far more likely to die compared to white women. And the things that really drive these preventable maternal deaths are proceeded by vital signs changes that are consistent with things like hemorrhage, eclampsia and sepsis, things that we can measure and things that hopefully by measuring it and preferably a continuous way, the naturalistic way, can lead to an effective early interventions that reduce maternal mortality. Next slide.

So our work both as an academic group, which is my primary focus, but also towards commercial translation in scale, is focused on how we take what we do in the ICU, continuous monitoring, high fidelity, high quality data-driven decisions and bring it everywhere. And for us as a group, rather than focusing on cardiology or other things, we believe where the greatest needs for this technology is in maternal and neonatal health. So we publish works in science, nature medicine, and most recently the Proceedings of the National Academy of Sciences, describing how these soft, flexible, low costs wearable sensors can recapitulate what happens in the ICU, but be as wearable as your Fitbit.

Next slide. And so this is our vision. Today, if we wanna monitor a woman, a pregnant woman from her vital signs that are critically important to her well-being as well as of her fetus, you kinda need all the things on the left. A blood pressure cuff, a tocodynamometer, two pucks basically strapped to the wires, pulse oximeter, ECG, to be able to kind of create that sort of high acuity care.

Now our vision is to replace those with soft flexible band-aids that she can apply herself, wear them anywhere, whether that's in the intrapartum setting, antepartum setting or the postpartum setting, to not only replace one or two things, but everything. And we think that that's important because through a comprehensive view of maternal health would be better able to develop algorithms and prediction to hopefully reduce maternal mortality. I think there was a mention about some of the technologies being used in the global health and low and middle income settings where actually the burden of maternal mortality is the greatest. We've actually partnered with the Bill and Melinda Gates Foundation and the University of North Carolina, our system has actually now been deployed in more than 6,000 pregnant women and four sites and three LMICs collecting data through an intrapartum setting to predict for bad outcomes for both mother and baby.

So a lot of the things that are happening, although this technology is applicable for both low cost and high resource settings, we can imagine how this could be useful in high resource settings, such as the United States. Next slide. So we believe that technology enables this. So we have our chest sensor that gives you essentially continuous cardiopulmonary monitoring.

Next slide. The limb sensor, which gives you oxygenation, together the chest and limb sensor gives you continuous blood pressure without a cuff. Abdominal sensor gives you doppler as well as uterine contraction, and all of this works with your iPad, your iPhone, as well as a smart watch. Next slide.

So if you can mute the video, I'll just talk through it, but this is just an example of the system in action. We're demonstrating, if you press play on the video, you can illustrate the fact that this system in its full streaming mode, is really giving you something very similar to what you would see in an ICU. Full sort of maternal monitoring, may not be something you need on a stress test or a prenatal visit, but illustrating the full capabilities of the system in case you wanna be able to do high acuity care in our RPM setting, but as a demonstration of what it can do. Next slide. Well we've gone on to develop further versions of this technology where we have a fetal ECG system that actually provides 18 channels of monitoring. So it automatically measures fetal ECG, uterine contraction.

I think uterine physiology is actually one of the most poorly understood areas of physiology. How does a uterus keep pace? How does preterm labor initiate? These are all important scientific questions I think are enabled by technology such as ours. So this is an up and coming technology that is integrated within our system that works with our continuous maternal model.

Next slide. You can skip the video, yeah. For speed.

All of this is data wherever you are. So when you think about a healthcare administrator, a busy OB-GYN with multiple patients, and the ability to link all that data directly to the cloud in near real time. So as long as you have internet access, you can look. We actually can monitor all of our clinical sites, both in Zambia, Ghana and India, all virtually through the cloud and managing that data in a way that makes it useful and accessible no matter where you are. Next slide. But I think ultimately it's the insights, not the measurements that are most important.

And that requires a lot of data cleaned, clinically labeled with outcomes. And that's exactly what we're doing in our large cohort of pregnant women, which is not only to measure these things and provide information for actionable activities by OB-GYNs, but the ability for the system to identify patterns beyond just heart rate. Looking at advanced metrics like heart rate variability, continuous blood pressure changes, autonomic changes, and what ultimately happens in terms of maternal or neonatal morbidity mortality. That's active work for us using these ICU great data to let people know when they might actually give birth, whether there's a risk of C-section or hemorrhage or blood pressure going out of control.

So that's sort of the ultimate vision. Next slide. And these are examples of the data outputs.

Those that you would sort of see in an ICU offering clinicians, providers, the ability to create wave forms, not only just point measurements for continuous or episodic monitoring. Next slide. And I think one thing that's kind of under-appreciated, that pregnancy is a completely different physiological state.

Your blood volume changes, your body position creates an amazingly difference in how your vital signs look, can swing your blood pressure 20, 30 millimeters mercury. So our system actually offers the ability to quantify vital signs based on body position relevant to pregnancy. So these are things that are important for insights, for AI, for machine learning, where understanding the unique things that are happening in pregnancy are critically important to develop the insights that ultimately reduce death. Next slide.

We believe that the future of patient monitoring is not only ICU great data but that that is accessible, equitable and low cost. So next slide. So we've incorporated an ecosystem of traditional sensors. We have a wireless glucometer, a weight scale, proper weight gain during pregnancy has profound impact on both maternal and neonatal outcomes.

So we have a weight scale that's integrated, a traditional blood pressure cuff for more episodic measurement, all of it integrated with a single software stack that we'll shoot it from. Next slide. And lastly, we believe in costs above all.

So we think that it's important that our system is able to reduce the cost making affordability available for everyone. Our centers are rechargeable, re-usable, waterproof, so it dramatically lowers the daily costs compared to existing systems, eliminates costly consumables that increase medical waste and likely will exacerbate equity issues. So we really believe in lower costs, not only for low middle income countries, but also underserved populations here in the United States. Next slide. And I think lastly I just wanna convey our appreciation to the NIH and federal funding.

It has been absolutely critical to the growth of our company. This is work that we're doing with NICHD around using our system potentially predict for preterm labor, still a major conundrum and syndrome that is poorly understood in our field, and again, love to take any questions, appreciate everyone's attention. Thank you.

Hello, I'm Alicia, I'm the founder and CEO at Bloomer Tech. I have to disclose that I have a financial interest in the company as well. I wanted to share with you a little bit about my background. My background is in electrical engineering and computer science, and back when I was doing my graduate studies at MIT, I was part of the computational cardiovascular research group, and I had access to huge data sets. Realizing that women were one of the largest subgroups underrepresented in these datasets was really eyeopening for me. And I was talking to my now co-founders, Osiel Halabi and Monica Arca about these data gaps that we were seeing, and it was interesting because we were able to connect these data gaps with our own lives.

In my case, I have my grandma, who's also called Alicia, I'm called after her, I admire her a lot because she became an OB-GYN in Peru back in a time when women were rarely allowed to obtain medical degrees, and she had died suddenly from a heart attack when I was only 13 years old. And in Monica's case, it was one day when she was waiting at school for her mom to pick her up and that just didn't happen because her mom who was a 44 year old physician had suddenly passed away from stroke. For us realizing that 15 years later after these incidents, there was a lot of new evidence about sex differences but most of the medical devices that exist today have not been designed around women's physiology with a woman's centric design was eye opening. And I will share a little bit more about how we came to be to design these patented advanced fabrics sensor technology that you see here on this image, that we're using to integrate into women's everyday bras and adapt them discreetly into her her life so that we can augment valuable data collection, right? And we use these data to generate non-invasive digital biomarkers for women's health.

So next slide. Our huge goal is to be able to obtain, in a very discreet way, all of these missing data, because we realized that this is a problem that was huge, especially in a day and age where we're using a lot of data for the next generation of digital health tools. There is a lot of lack of data, missing data from underrepresented subgroups and we have seen it in clinical outcomes and in how we are seeing the worsening of health disparities, that there is a huge need to increase the collection of valuable lifesaving data. And next slide.

So we set up out on a mission to prevent deadly and often overlooked medical challenges with a discreet comfort of advanced fabrics and the precision of digital biomarkers. Next slide. And then when we talk about women's health from the perspective of pregnancy and postpartum in terms of cardiovascular health, it is very interesting, right? Because women's bodies, as we all know are fascinating and pregnancy can actually be nature stress test on the heart.

It is a natural stress test with all of the hemodynamic changes that her body undergoes both during pregnancy and after pregnancy. We know that adverse pregnancy outcomes are associated with increased maternal risk for cardiovascular disease that it increases the risk over five times for hypertension and 1.5 times for coronary heart disease, and there's also a three times increased risk for cardiovascular death when these complications occur. And it's interesting because this can actually serve as a tool to predict how her life could develop and develop a new set of preventative tools throughout her life because we now know through these natural stress test over the next years how her heart could raise several complications. In terms of these huge unmet needs in this space, one of the most neglected stages so far is still the postpartum period. Currently the guidelines recommend a visit within six weeks of postpartum after an adverse pregnancy outcome like hypertensive disorders or diabetes or preterm birth, right? And it's interesting because in recent studies most of the postpartum maternal deaths occur 42 days to 365 days after birth.

So this is a space where there needs to be a lot more information and more ambulatory monitoring could be useful to prevent this from happening. 'Cause right now if you think about it from the perspective of the value of biomarkers, if you just go to one time visit, you get that one snapshot in time, you don't get to see the progress and the evolution of the changes in her body that are going on, which is why using our discrete sensors, if you go to the next slide please, that are hidden in the comfort of her everyday bra, these can be very seamlessly integrated into a maternity bra and you can just wear your bras you would any other bra, and now collect very valuable data that work more like a video to generate and even predict future health outcomes and be very well-communicated with your care coordinator and physician, right? These can ensure that you know how to, how the patient is metabolizing drugs, how she's reacting to treatment and to have very, a well documented analytics and reports around the changes that her body is undergoing. So we're trying to kind of cover this huge unmet need to make it safe when the patient is outside of the hospital in a way that it's comfortable and completely changes the way that most medical devices look like today. So I wanted to share with you that we're really excited to be partnering with, and building collaborations with people that are currently doing a lot of women's health studies, and that we're on the verge of generating novel digital biomarkers with them. So if you're interested in doing this next generation of how we use data that is from the point of the data collection, the most, the less noisy, the most equipped to be collecting good data acquisition from her physiology, and it can in the comfort of her home, I invite you to join us and take on to this next revolution of women's centric platforms that can really advance and generate the new algorithms that are going to be the digital health toolbox of the future.

Thank you. Hi everybody. It is such a privilege to be here today, and I'm so excited to also just have the chance to learn from my fellow panelists.

Well, and then of course not only learn but then share a little bit about Maven Clinic and our mission to build a better health care experience for every woman and every family everywhere. So if we go to the next slide, a little bit about who we are. Maven's a digital health platform that helps people build healthy families. So starting with preconception and fertility support, going through pregnancy and postpartum care and into early pediatric support.

And since our earliest days, we have taken the position that the single most important challenge to solve for in health care is one of access. Access means a lot of different things to us, access to whole person healthcare whenever, wherever a member needs it, access to providers who speak your language or share your lived experience, access to a broad range of clinical and subclinical services and resources in the app in the community or in a traditional health care facility, access to health care that's affordable. The transparent appointment pricing and our direct to consumer product is in most cases less than a copay or even free, which we're able to do by partnering with employers and health plans and increasingly providers that we work with. And they turn to us because they see that women's and family health is uniquely underserved, and they see the high costs, pregnancy and childbirth is the number one reason for hospitalization, which is greater than the next six categories combined.

They see poor outcomes, so I think we've heard a lot about that today. The US is one of the only of its peer nations with rising annual rates of maternal mortality and morbidity, and we heard Dr. Howell talk about how 60% of that is preventable. We have poor physical access, where 50% of US counties lack an OB and 7 million women live in maternity care deserts. And then of course, the deeply rooted inequity we see within communities of color, the LGBTQ community and for low income patients.

And so at Maven it's our mission to help change all of that by building a more personal and patient centered experience for women and families through a platform of offering care, that's the right size to and your unique needs. So regardless of where you live or what you look like or what kind of family journey that you're on. So we'd go to the next side, please.

So our ability to do that is the result of our unique combination of breadth and depth. Our providers represent more than 30 specialties and more than 350 subspecialties from mental health providers, who specialize in infertility and miscarriage, to pelvic floor therapists, to pediatric sleep coaches, to OBs and midwives and doulas, we're supporting all of our different patient populations with their unique approach to maternal health. They're all on Maven, they're all accessible within just a few clicks, and most often on the same day a member needs support. And at the same time we also offer the one-on-one continuous longitudinal care advocacy and navigation.

If a member needs help finding, for instance, a reliable childcare provider in their town or if a member doesn't yet have an in-person OB and we actually find that 30% of our members don't, we take care of it, working both within their benefits from their employer or directly with their health plan, whether that's Medicaid, whether that's a fully insured, planed through an insurer, or again, whether it's through an employer. And we help them find the best option for their specific needs. We also look to steer members to hospitals and clinics that score highly on metrics that also relate directly to the quality of patient experience, and so, work that will only be helped by the Biden Administration's directive on birthing friendly hospitals, which was announced this past December, which we're really thrilled to see. And so it's this combination of services and support all under one proverbial roof that allows us to serve members across all family journeys and wherever, whenever they need care. So we go to the next slide, please. Our approach has helped countless patients through the experience of starting and raising a family, and so with every person who turns to us, we aspire to meet them where they are.

And building relationships and empowering their experience is really what enables us to drive a sustained engagement with our service and of course this engagement is what drives outcomes. And then these are ultimately the kind of outcomes that can make a real difference at the system level. So you might over the course of pregnancy see your provider 12 or 14 times for about 15 minutes each visit and if we're doing our job right, you're visiting Maven every day. And the average member, for instance, receives 130 touchpoints during the course of their membership in the maternity program, and it's how across clinical and business objectives that we're able to reduce, for instance, the need for ER visits, given that more than 30% of Maven appointments occur outside of typical business hours, including through the night, we staff 24/7. And then we also work because we're bringing the full power of the healthcare system to the individual, not forcing the individual to find their own way.

And I think that also from a NICU reduction, C-section reduction, this is an area where working with that 24/7 care team, having virtual birth planning appointments and just always being available with the right providers, there's a direct correlation between that always on access, our care management through our care advocates and then the outcomes that you see. Then finally, just mental health is a really, really critical component of our model and a third of our patients actually are seeing mental health providers on Maven and reporting that they have improved their experience and made them healthier. And so really incorporating mental health into the prenatal care model is also really critical as well to even driving some of the more, the outcomes that really affect direct costs. If we'd go to the next slide. One of the things that I wanted to specifically call out is Maven's work around care matching.

This owes a deep debt to the pioneering work being done by Dr. Rachel Hardiman and her team at the University of Minnesota. Our view at Maven is that anything we can do to make accessing care feel easier, safer and more possible, that's what we wanna do and so, this includes things like staffing to make sure that wait times are short, and so on average our care advocates are available within 30 minutes of when a message is being sent. I think it also includes the breadth and depth of our networks. So, the hour long birth planning sessions, the weekly new parent meetups, all of the different ways in which you can engage with provider, with other patients like you, are really critical.

And then when it comes to the diversity of the provider workforce, we've made a really concerted effort to build a network that looks like the patients we serve. We all know the stats, black women are two to three times more likely to die in childbirth than white women. A black mother with a college education is 60% more likely to die from a maternal health related cause than a white woman with a high school education.

And so beyond those headline numbers, we see again and again that patients of color feel unheard at the doctor's office or have their concerns discounted or even themselves need to feel kind of unreliable consortiums of their own wellbeing. And so that's one of the fundamental things we're trying to improve with Maven is, if you can actually connect a patient on their preferred terms to a doctor that they feel comfortable with rather than even forcing the patient to come get their care where it happens to be offered, that actually also fundamentally results in improved outcomes. And so, that's an area that we at Maven are continuing to lean in on, not only this year but over many, many years.

I think this is one of the great promises of digital health, is this idea of digital inclusion. Now, if you can go to the next slide, just taking a step back since Maven began in 2014, we've been able to grow and serve some of the most prominent global companies along with thoughtful equity oriented payers across the country. We've achieved some major milestones in our journey, and so we serve more than 10 million women and families over these years, we have members in more than 175 countries around the world, but there is so much more to be done. I always feel like we're only like 5% of the way through our product roadmap and we're only just getting started. So I'm so proud to be part of a growing team that truly feels the same way with mission driven technologists and product experts coming together to really focus on every aspect of the care experience and with the exceptional clinical leadership in Neil Shaw, Dr. Neil Shaw, who I know is a friend to many of you here. And so, if we go to the next slide, ultimately where majority member experiences, Time is up, please wrap up.

Sorry. Oh, okay, great. We're just, we're driven by the member experience in making it exceptional. So you can just see here some member stories, and so we're also always looking to learn from others.

So please reach out if you're interested in what we're doing, and we look forward to talking to you. So thank you again so much for the opportunity to share a little bit here. Hi, good afternoon everyone. I wanna first thank NIBIB, as well as NIDA and other NIH institutes and centers for putting together this great workshop on the technology improve maternal health outcomes. It's been a great learning experience, and I hope that we can share a little bit of our unique perspective and experience as well.

I am Tony Ma, I am co-founder of Benten Technologies, a social impact company. I'm also recovering management consultant. As far as disclosure, we do have a financial interest in Benten and the commercialization of these grant funded solutions. I'm here to talk to you about building a comprehensive prenatal and postpartum platform leveraging grant funding.

The vision of our platform is to improve care, the care journey, as well as ultimately improve maternal child health. For us the focus, the number one issue is to really create a comprehensive, coordinated as well as personalized care for mother and child. Next slide please. Here in the US there's about 3.7 million pregnancies annually.

As a developed country, we have one of the highest mortality as well as morbidity rates of any developed nation. The poor maternal mortality rates you've heard especially affect our underserved population. Also our morbidity rates are also poor in the US, where we have an estimated over 60,000 cases of severe maternal morbidity annually.

Prenatally, severe maternal morbidity cases include preeclampsia, hypertension, and gestational diabetes. In the postpartum period, the severe maternal morbidity cases include sepsis and depression. So why me? Asian guy.

This journey is personal to me. You see, my mom almost died giving birth to me. She had undiagnosed hypertension and went into an eclamptic seizure while giving birth to me in rural Vietnam, almost taking both of our lives. We came to the US as both refugees, as well as myself as a sickly child with adverse child experiences from the war, living in section eight housing and experiencing many of the challenges of seeking healthcare for my health condition in the early '80s. (Tony clears throat) We have made a lot of progress, I do wanna acknowledge that.

And some of the cases, it's better than other lower middle income countries and others it's not. However, we still have barriers today. Those include fragmented systems, as well as processes, lack of access to care, especially in our rural communities, lack of continuity of care, as well as culturally competent care amongst our melting pot of population.

There's also further racism, discrimination and stigma itself. Newer barriers also include unfunded government mandate as well as with the M-health technologies, just technological barriers, including app overload. There's thousands of apps out there and multiple apps as well as a lack of evidence-based content itself. Next slide please. Our mission is to really move forward with building a prenatal and postpartum digital health platform to provide comprehensive, coordinated, and continuous care for mothers and child from conception to two years postpartum. The solution that we're looking at to create is a one-stop shop for mothers.

It's a comprehensive, culturally relevant and personalized app for the mom and child to support them continuously from the prenatal to postpartum. Think of it as the intersection between Netflix, with all the health content, Google with its AI and Amazon for service delivery. We really wanna look towards that high customer service for the mom. So those are the intersection and that's what we base our development. Foundational is that, integration, as well as an integrated care platform for providers and support to provide that continuity of care, so moms aren't switching between multiple apps and multiple systems.

We believe care coordination is key to that. Next slide please. We wanna first thank NIH, as well as the various institutes and centers along with other federal agencies and foundations for supporting our vision and mission. That includes NIDA, NIMHD, NIAAA and NICHD. As a result of their support, we have started our development journey. We focus from preconception to early childhood that supports both the mothers and child.

We have attained mostly phase one funding to build this out, that includes universal screening to address discrimination and stigmatization, but we're also looking at very comprehensive plan of safe care that provides various customized plans to support mother and child based on the cultural relevance. We've also been supported to build out lactation support, both from a SBAR as well as other research grant, to target very specific populations including African-American and black, as well as Hispanic, where there's the disparity. As part of this we're also engaging in other areas and incorporating different areas around the research, including gestational diabetes, prenatal communication and care, postpartum depression, postpartum returner, monitoring for sepsis.

This is looking as you can see as attached shifting because WHO has stated that in the next 20 to 30 years there'll be a shortage of about 18 million healthcare workers globally. Finally, our solution has won some awards, including we were the grand prize winner of the HRSA Maternal Child Health Bureau challenge, being the final winner of that. So we're really excited. That helped us to build out our telehealth platform. Next slide please.

And we wanna say that we took a unique position, it really does take a village. As social entrepreneurs we have leverage and I pinch myself every morning being able to wake up and work with great minds from academic and research collaborators, as well as clinical collaborators, as well as other state and community partners. We've formed a multidisciplinary teams with multiple collaborations and clinical partners, to develop evidence-based solutions as well as content, we're leveraging AI from computer vision NLP to predictive models and leveraging a wearable solution. Examples of that research and collaboration include our work with CristianaCare, as well as Thomas Jefferson University over in India where we successfully looked at global health to reduce breastfeeding rates from a nine month study were able to increase the breastfeeding rates exclusively from 36% to over 60%. So that was exciting as well.

Leveraging coordinated specific care education for the moms and using Asher workers as well. Our solution is gaining a lot of traction. We have several states interested in our platform, including Delaware, New Mexico, Ohio and Pennsylvania. So we're really excited. We're still in the early stages of this and looking forward to see where this go with our phase two in the coming year.

Next slide please. We've brought together a strong team who share a common value. As I mentioned my why but I won't get into everyone's why, but each one of the individuals here have their why and their common value. We are a mission driven organization, and we leverage three pillars that are based on leveraging time, technology and education to democratize healthcare, create health products, with this grand vision of impacting a billion lives.

We believe in global health, being immigrant and an immigrant nation, I do believe that not only can we leverage the solutions here in the US but globally, in other parts of the world leveraging low cost solutions. Each one of my team members, as I mentioned, has a personal story, and we're excited to where this has taken. Myself included, we've successfully, my history includes launching and being part of a team that launched the My Healthy Vet, where in its early days, where we grew it from zero to 800,000 users. And that's really kind of where we are.

And really excited about the platform. As we move forward, as I mentioned, we are in the early stages. For those that are interested in learning about non dilutive funding, next slide please, you can feel free to contact me. We've been able to leverage various non dilutive or grant funding, as well as foundation to really kind of build out this vision of ours. So if there's any questions, please feel free to contact me.

So thank you so much. Good afternoon everyone. I really wanna start by thanking the NIH for convening this workshop.

When you think about where innovation really happens and takes off, it's often at this intersection of medicine and community and technology and business, and so it's why these kinds of interdisciplinary conversations are so important, especially ones that are bringing together people who don't necessarily hang out together on a daily basis. Lana asked us to share a little bit about our personal story and in the interest of time, I'll keep mine really short, except to say that when I started in venture capital over 20 years ago, there were almost no co-investors and therefore decision-makers who looked like me or who even wanted to talk about my health issues or women's health issues more generally. So fast forward to the present day out of sheer frustration, I helped found an all women led fund that focuses only on women's health, so I don't need to be apologetic about that anymore. And for all those people who continue to say that women's health is a niche market, I wanna remind us that we are not only 50% of the population but we birth a hundred percent of the population. So our health really does matter, and we need to talk about it and we need to invest in it. Representation really does matter when we're deciding where to allocate funding and investment and other kinds of resources.

So whether you're in a lab or treating patients, building a technology company or, in my case, making investment decisions, we always need to make sure that we have the right voices at the table. Next slide please. So Rhia Ventures launched our venture capital fund in 2019 with a mission to advance reproductive and maternal health for the betterment of all women, while also delivering financial returns to investors.

We are an impact first fund, but we're not apologetic about the fact that we also wanna generate strong financial returns for our investors. We think that's important to ultimately help attract even more private investment into this space, which has historically been lacking. Next slide please. So one of our two investment, priority investment focus areas is maternal health, which is where about half of our portfolio sits today. We have four types of innovations that we look for as we think about investing in the future of maternal health.

We think there's a big opportunity to extend beyond traditional clinical settings. You've heard many, many solutions addressing that as well, whether it's into the home, into the community, COVID has obviously accelerated that, but we need the technologies and the business models to support that kind of expansion, which we know will expand access to so many more women when they need it. We made an investment in Bloom Life, which leverages machine learning and AI to enable remote pregnancy monitoring really from the basic non-stress test all the way to the ability to monitor high risk pregnancies and catch preterm labor. We also look for innovations that have the potential to really transform care and address some of the big unmet needs. As an example, we know that fetal heart rate monitoring is fraught with issues and actually being able to diagnose fetal distress. We've had some clinicians actually tell us that deciphering fetal heart rate readings is like reading tea leaves, so we know we can do better and when you look at the high C-section rates, which create their own set of problems, we made a bet in a new technology being developed by Raydiant Oximetry, which is developing a new non-invasive fetal oximeter that measures blood oxygen levels to diagnose fetal distress.

And it'll start as an adjunct technology, but we think could even become the standard of care longer term. We also look for companies that are currently serving or well-suited to serve the Medicaid market. So as, I think everyone here knows Medicaid accounts for almost half of all of births in the US, so the market is enormous, and if you're not serving Medicaid as a maternal health company, you're not only missing an opportunity to help millions of women and address major health problems among a big population, but you're also missing a big business opportunity. We invested in an Ovia Health, a digital health platform that since inception has served over 15 million users and on an annual basis touches about 40% of all births in the US.

When we invested, over a third of their freemium users on their apps were Medicaid and over time they've refined their offering to intentionally serve Medicaid and develop content and services that would best support the needs of those moms. And last but certainly not least, we invest in companies that prioritize equity and are working to reduce health disparities and address issues of racial and gender bias. So we have been hearing, just in the short time we've been together today, the abysmal statistics around health disparities and race in the US, but we need solutions that are tackling it head on instead of being an afterthought. And all of the great new technologies won't really matter if the system isn't working to meet the needs of marginalized and underserved communities.

We recently invested in a company called Mae, which is a services and tech company that's helping to realize the potential of culturally competent doula care starting with serving black birthing people. And again, the evidence the doula care can improve outcomes is already there, Mae is really working to help scale that model in a sustainable way. Next slide please. So lastly, I just wanna touch on some of the barriers that we're seeing in the maternal health startup ecosystem.

They're not probably gonna be very new to most people here, but I think worth mentioning 'cause I think there are opportunities to create a more conducive environment that's actually gonna get these innovations to scale and creating the kind of outcomes that we're looking for. So, currently there is limited funding specifically to de-risk innovation. So I'm not gonna belabor this, but later stage venture funds will only take on so much risk, so the more early stage investment, and I think it's both grants. We heard about one opportunity today, quite a sizable one in the diagnostic space, both grants and equity are critical to avoid that valley of death where we see a lot of innovation stall. We at Rhia Ventures are certainly trying to play a role in helping invest at an early stage to help with that de-risking process.

There's also a lack of technical assistance for first time founders. So the exciting thing that we've seen in our maternal health startup pipeline is that there are a lot of first-time entrepreneurs, and we think that that is a great trend and we want it to continue, but I think one of the things that venture hasn't done well is that we ask clinical and scientific founders to also be exceptional business people. And of course, many scientific founders do become great CEOs, but business is a different skill set and sometimes I think we're asking too much of the CEOs right off the bat. We need more programs to support first time entrepreneurs and help build a team around these entrepreneurs to compliment their skillsets versus asking them what I think we sometimes do, to be superhuman, and have all of those skillsets wrapped up in one person.

And I think it's critically important to do this because if we wanna bring new voices and new faces to entrepreneurship, we need to create the right environment for them to succeed. So we also need to find more ways to connect startups to community and clinical organizations again to make sure those voices are part of the innovation process. And we Rhia Ventures had to change the question. We were asking from where are your community partnerships to actually, how can we help you connect with community organizations and clinical organizations that'll improve your business? So I think things that facilitate that are gonna be quite important.

And then a couple of, sort of other elephants in the room are the uncertain and complicated regulatory path for maternal health companies and low Medicaid reimbursement. So we certainly don't have the answers for those, but we obviously need to make progress there to help these companies and new technologies get to market and grow in a sustainable way. And turn it back over to Alberto.

Thank you so much. Hello, thank you everyone for a really interesting panel, and we have few question. If anybody else want to give us a question, they can raise their hand. If the NIH can help me with figuring out who's asking and who's raising their hand we can give them the floor to ask their question. In the meantime, there is some questions that has been asked early on through the chat. So I'll start with that in the meantime.

The question one, I think is an interesting question is for Steve Xu. The question is, "if you're able to pass the HIPAA compliance "and data security issue "when you're working with cloud system "for remote monitoring." I think that's a very important aspect obviously, of developing IT technology. Yeah, sure. I mean I think that, obviously HIPAA and cybersecurity is really, really important, but unfortunately there's a wide range of standards and cloud services that are HIPAA compliant high-trust certified, follow encryption like we do for our system.

Our system is FDA cleared, so there's a lot of sort of underlying kind of protections around data security, et cetera, as long as you're following those standards, yeah. Okay, great. Thank you so much.

Another question that came on is for Alicia. They're asking if some of these devices you guys are developing have been proven in a large cohort and if you can elaborate a little bit more about the current study you guys are doing. Yes, hello. So these devices we've done early feasibility studies at the MIT Clinical Research Center, and we've been basically developing from a woman centric perspective so that we can meet all of the requirements of woman's physiology. We discovered through both the development of algorithms and the development of the device during the studies, the comparison of how different things in the body can make a big difference in the quality of the signal that you collect. A big example here is a breast tissue.

Most of the devices we use today to collect, for example, electrocardiogram data, have not been designed around the diverse breast tissue sizes, and this inputs a lot of noise to the signal, which makes them sub-optimal for the wearer in terms of the availability of using these data, especially when you're using them then as inputs for algorithms. Then we got further evidence through our thesis at MIT, that when you're building mixed models with these type of data instead of sex specific models, that the models are performing a lot lower because thresholds are different. So we're programming a lot of these tools with thresholds that are primarily from evidence that we have from a male cohorts or if the male cohort is significantly larger in the datasets, they predominate the outcome of the algorithm. So when you, even if the dataset is smaller, when you train an algorithm with sex specific data, you have increasingly better outcomes in terms of the predictive and the AUC of the model.

Thank you so much. Then a question came in for Kate Ryder about if Maven does support women with diabetic during the pregnancy. Hi there.

I actually answered those in the chat. Yeah, I saw in the chat but if you can elaborate a bit more for everybody they may not have missed the chat. Yeah. Feel free to have a little bit more of a time to elaborate.

Okay, great, thanks. So the first question was, do we have dieticians as part of our platform? And we do. We have 30 different types of providers and specifically with dieticians and nutritionists, whether it's managing diabetes or actually having, managing specific diets and whatnot, we find them definitely one of the top five providers used by a lot of our pregnant patients and then the diabetes support. So the way that Mavin works is that when we're doing an intake, we restratify into low, medium, low rising and high risk. If somebody enters our platform with diabetes going into a pregnancy, they would be put in our high risk track, and they would have a different type of care team, including kind of high-risk coaches that help manage diabetes, they'd have a different care advocate who is trained in helping support someone with diabetes and who's managing a high risk pregnancy.

We have a maternal fetal medicine specialist as well that work in the platform. So, high-risk care management is definitely one of the cornerstones of our maternity program. Thank you, thank you so much.

Let me ask now a question to Elizabeth, I think obviously reproductive women health is a very challenging topic in the US and not just in the US, and maybe you can give a little bit more advise to both entrepreneur as well as scientists that work in this field of the challenges they may face if they actually have intent to work in this field and maybe even start a company and so on, 'cause definitely it's a very challenging space. (chimes) Yeah. I mean I think for anyone and the entrepreneurs on the panel are probably better suited to answer that question than anyone that, it's a long, hard journey, not for the faint of heart, but I think, I guess I'll go back to something I mentioned earlier which is, innovation really happens at this intersection of healthcare and technology and business.

And so, finding people with complimentary skillsets to work together and one of the things that we see a lot from the companies that we talk to and entrepreneurs we talk to is that they're sort of busy soldiering on alone. I think collaboration is key, it's not typically what venture often will encourage, so I think finding the right clinical partners, making sure that the voices of the patients you wanna serve are right alongside with you. You're not testing something on them and then going away and developing something but you really co-create these solutions alongside the patients and the people that you're trying to serve.

And I think when I think of the entrepreneurs that we've worked with that have been successful, it is through lots of different kinds of partnerships, the patient, the voice of the customer and the patient is in the room with them all the time. They themselves have diverse teams, so diverse perspectives represented, and you gotta be really persistent 'cause they're gonna be a lot of things that go wrong. And this is, I would say, maternal health is a more complicated space for some of the things that I mentioned, but incredibly important work. So I'll stop there. They know, thank you very much. Definitely.

We have two questions from the audience that I'd like to ask. They're both for Steve and Alicia, so maybe Steve can go first, Alicia after, but both of you please answer the question. It says that besides acquiring valuable physiological data, can you share your thoughts on the current ability to remote monitor devices to predict varying disease and medical condition? That's obviously a very important question about prediction, just not monitor, but actually can we do something about it for the future? Thank you. Yeah, that's a great question.

I mean, I think that's sort of like the holy grail, right? It's the ability to not just recapitulate vital signs and measurements that are clinically used right now, but to sort of predict outcomes that actually matter and we're trying to do that with preterm labor and it's a big challenge. Things like predicting for when someone's gonna be pre-eclamptic, too eclamptic, I mean these things are still not solved. I think that if I had a crystal ball my feeling is that we're actually still in the early stage of this broader field where we still have to deploy these kinds of technologies to a certain level of scale, and then be able to clinically label them in a way that is accurate, accounts for the tremendous amounts of variability in care, in interventions to get to that final point. So I would sort of concede that we're really not there yet in a very meaningful way and I think that what you see with companies like InView, that just got FDA clearance for sort of a home monitoring, I mean it is still very much limited in its sort of utility to predict outcomes.

I think that we'll get there but I sort of kind of agree with that critique. I mean, I think certainly in other areas of medicine with machine learning and AI, we've gotten farther. Those are typically more static diagnoses, like you see it in imaging for breast cancer, we're seeing it for retinopathy and sort of eye issues and these kinds of things, but when you think about things as complex as hypertension in pregnancy, diabetes in pregnancy, it's biased psychosocial. It's not just the measurement itself.

So, I think ultimately it's gonna take a kind of national, international level kind of scope to get there, to be able to achieve those outcomes. That's my 2 cents, did I make sense? Hope so. (Steve chuckles) Alicia.

Yeah, I think I have to agree with Steve that we're in the early stages of seeing how this is going to revolutionize a lot of the things that, how we practice medicine today. I think it's very exciting how with genomics we were very pushed forward in terms of precision medicine and to really understand what triggers our genes and how our body reacts. We really need to understand our lifestyle and environment data, right? And this is what sensors like the ones we're building are going to achieve from a long-term perspective, that's why the wearability, the comfort, the usefulness of them is so valuable that we create them from the perspective of the wearer, even though, as we know in healthcare, that there's multiple stakeholders and how we're going to ultimately use the data for clinical decision-making and making the most optimal decisions for each individual patient, right? That takes us all the way to that uniqueness of her own body. Women's bodies are- (audio echoes) Are amazing. So we are really excited to be able to collect a lot of information that currently is missing and that we will be able to generate that next generation of digital health biomarkers with all of this information. A lot of things that we do today is somewhat, I hope that in the future we remember it old school or cumbersome way compared to things that we think about the past today, right? Like having to, I don't know, for IVF treatments, I think they were mentioned before, that you have to get blood work almost every day or every two days, right? Things that with long-term monitoring, we could potentially use digital biomarkers in terms, instead of these more, I would say analog biomarkers or traditional biomarkers.

So there's a lot of very exciting things that are coming our way in how we can develop and use all of these platforms that are coming out. Yeah. If I can give in my 2 cents on that is to the ability to monitor, even if we don't yet know how to use this data is obviously very important.

I'm coming from a background in physics where first most of everything, we just measure things, and then we try to figure out what they really mean. So to be able to really come up with devices that can provide a lot of data, a lot of data, even if not all the data may have a meaning right now, one day somebody will figure out they have a value. So I think the work you guys are doing is very, very important. I have another question, that was to ask earlier by David Weimer, and I'd like to ask to pass it on Tony Ma. I think Tony that's something that you probably have a lot of experience with with working with larger group.

And the question is that David expressed some sort of frustration with the health record system. They often don't talk to each other and especially when you go from provider to provider, and so the question is, what can a company, like private company like yours or a company in this space can do to reduce some of this problem and make things sort of better with this application talk from provider to provider? Thank you. So yes, one of the biggest challenge and that's one of our key focuses, how do you make various systems talk to each other? So full disclosure, I come from a management consulting background where integration is really one of the most difficult challenges in the care. You have issues and different organizations, state level, trying to coordinate data communication.

My previous background actually helped lend itself to that. So as we move forward, always looking at data standardization, looking at data integration, those components are really important. So you do look at platforms, even existing things like middleware platform, I know there's a platform called Redox, there's other open source platform that also look at that.

And then, for us, we're tackling the problem from a small perspective. What's the minimum set of data that can be shared across. So part of our comprehensive care coordination, because we don't have millions and millions in funding, we're leveraging grant funding, we're looking at what are the key things to kinda move the mom and child from the various, from preconception all the way to postpartum care and those things, and how does it connect the various platforms itself. So that's the approach that we're taking and in some cases where we can leverage commercial, it does take a village. So again, there are solutions out there, both from an open source perspective to other commercial platforms that allow for some sharing across various EMRs and other systems. And then you also have state systems.

You have others. I know Elizabeth talked about, working with the Medicaid population where there's, a lot of times there's different state systems and others that are also involved. So there's multiple types of coordination and integration beyond just the EMR system, the different case management, other platforms. So that's something to be mindful of, but there are definitely solutions out there to look to integrate. Thank you very much. Yeah, there's a question that

2022-02-17 10:47

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