Purpose: Coherence Health brings health and wellness to every person everywhere.
Vision: A Coherence platform in every home, helping people stay healthy and well by partnering with them for the long-term, meeting them where they are in an engaging and hassle-free manner.
One-line Company Summary
We have created a wellness platform, which is initially targeting medication adherence, consisting of an integrated smart connected (IOT) device and an AI-based behavioral coaching and analytics platform to advance home healthcare by providing a patient-centered, hassle-free delivery of medication and patient personalized patient engagement.
The Problem
Medication adherence is hard and only 55% of patients take their medication as prescribed. While this leads to hundreds of thousands of preventable deaths and costs the US healthcare system approximately 300-500 billion dollars every year. Reasons for poor adherence include memory impairment (most common), side effects, and poor health literacy. Poor adherence is responsible for 10% of all ER visits in the over-65 age group, making it one of the most common causes of an ER visit. While problems affect the entire prescription medication population, some 160 million people in the USA alone, are particularly seen in assisted living and independent living spaces. This occurs because half of these patients are polypharmacy (take 5 or more medications) and 85% requirement assistant with medication management. Worse still, even with supervised medication taking, the error rate in assisted living facilities can exceed 42%.8 This is an urgent problem as expressed by both the CDC and WHO.9,10
The Market
The Assisted living market consists of 1.2 million residents and is expected to grow significantly as the baby boomer generation ages. The market size is expected to crease from 92 billion dollars today to 140 billion in the next 7 years.11 The consumer market, which would be a natural adjacent market extension is even larger with 160 million medication users in the US alone and approximately 26.5 million polypharmacy patients over the age of 65. Currently, the cost of poor compliance is estimated to be 300-500 billion per year in the US which results in half a million ER visits each year.12,3 An additional adjacent future market is the decentralized clinical trial space for biotech and the Pharmaceutical industry.
The Solution
The platform consists of fully integrates smart connected IOT hardware and AI-enabled software secured cloud platform. The hardware consists of a medication dispensing unit, which seamlessly integrates with delivered medication packages in a single-click manner for easy loading and minimal hassle for the patient. The hardware also contains multiple monitoring systems which are powered by an advanced AI that detects adherence without relying on the patient. The engaging software also contains an AI-powered dynamic behavioral coaching system, which uses the high-quality adherence data stream (derived from the connected device) to help engage patients in maintaining a high level of medication adherence by personally optimizing advanced behavioral, psychological, and design elements. This is coupled with an analytical platform that provides patients, physicians, and clinical teams with data and insights to help intervene in adherence and improve long-term adherence in a sustainable manner.
Current State and Road Map
The team has successfully completed a working prototype (2.0 device) for deployment in assisted living facilities.
Specifically, the integrated smart connected hardware functions as is the basic AI behavioral coaching and analytics platform.
The team has leveraged strong offshoring capabilities.
Commercially, we have an initial pilot partner assisted living facility in the US, which would become our initial customer post the pilot.
We are currently raising seed money in order to complete the development of our next-generation device (3.0), complete the FDA application to enable commercial sales, and develop a founder-led sales team to enable an additional 10 pilots (of 10 patients) with 10 assisted living facilities to be completed with the majority of these becoming paying customers.
We would plan a series A in the future to help with scaling our sales and marketing team and develop tooling and custom-made electronics to drive down hardware costs to enable mass scaling of our platform.
In the future, we would be looking to work with insurance companies and governments to obtain reimbursement for the platform, as improved adherence has been well documented as a way to reduce healthcare costs.
Business Model
Currently, the platform would be a subscription-based service with a monthly subscription fee.
The first year (12 months) would be paid upfront (after a successful pilot). The discount would be given for longer commitments (24 and 36 months).
There would also be up-sale options for additional services, such as fall detection, physiotherapy, etc.
Team
President/Chairman
Professor Justin Moore MD. Justin is an active neurosurgeon with expertise in medicine and health, behavior, law, business, and data science. Justin has studied and taught at some of the world's leading organizations including Stanford, Harvard, MIT, Oxford, Monash, and Melbourne Universities, and has an MBA at MIT.
CEO
Ram Konduru. Ram is a serial global entrepreneur who has successfully bootstrapped multiple tech start-ups. He has a background in engineering and consulting and completed his MBA at MIT. He has expertise in tech, offshoring, and business.
Chief Signals/AI engineer
Haris Brkic: Haris has expertise in high-accuracy radio frequency-based localization and motion systems. He completed his undergraduate and graduate training at MIT.
Chief Systems Engineer
Daniel Johnson: Daniel has led high-performance multi-disciplinary teams to develop world-class automated testing systems. He has expertise in mechanical engineering and product building.
Other members of the team
Behavioral Psychologists, Software engineers, Med Tech designer engineers.
Company Story
During his tenure at Stanford University, Neurosurgeon Dr. Justin Moore, inspired by the Stanford Biodesign course 2016, discovered that there was a significant number of patients, who had suffered recurrent stroke, despite having been prescribed preventative medication. After moving to Boston in 2017 and starting at Harvard Medical School as an academic surgeon, who urgently removes clots from patients suffering an acute stroke, he continued to see this trend. He dived further into this problem while participating in the Harvard Biodesign course and realized – patients were simply not taking their medicine.
While the underlying behavior could be seen, customer discovery revealed that the root causes were complex and unique to each patient. It became clear that taking medications was hard work. Seeing the impact of these strokes on his patients, he was compelled to act. His mission took him to the Massachusetts Institute of Technology (MIT) where, while undertaking an MBA focused on innovation and entrepreneurship, he met Ram Kndouru a former tech consulted who had become a tech entrepreneur. Ram connected with the idea, and Coherence was born. The company then began to assemble a group of engineers from MIT and across the globe to build an initial prototype. The first prototype was completed in early 2022. A second iteration with full software capability and behavioral coaching functionality is now being completed. Coherence Health is on target to begin field testing in January 2023.
Competitors
While there are no direct competitors, there are multiple companies doing some of the jobs the Coherence platform covers.
Nurses: The vast majority of assisted living facilities use nursing staff to ensure that patient takes their medications. However, there is a significant limitation with this model. Nursing staff can be expensive. This is particularly the case at the moment, with the sector going through a labor crisis. It is forecast that the labor crisis will continue well into the future. Even using nurses, there is a 40% error rate. Half of these errors are in timing, 7% were considered serious and could significantly harm the patient. Most errors go unnoticed in practice.
Pill Dispensers (Spencer and Hero): Spencer is the closest competitor and is focused on consumers and the clinical trial market. Currently, they offer a simple pouch base dispensing system. However, there are significant limitations, including that they are not able to confirm if the medications were actually taken, they cannot prevent double dosing, they lack sophisticated behavioral coaching, the dispensing can be hard for certain patients as it requires manual opening (therefore dexterity and hand strength) of pouches, there is essentially no travel system, and the technology is not able to pick up context (what happened post dispensing).
Other devices such as Hero have some traction in the consumer market, their limitations include cumbersome manual loading and programming requirements and lack of adherence verification means they have not been used in clinical trials.
Alarms/Diaries; are perhaps the most common method patient use for medication administration assistance. There is no verification mechanism, it's cumbersome and there is no coaching platform. Large studies have found that these simple interventions (and also basic smart caps) don’t actually improve adherence.
Behavioural Apps (Perx, Noom): These Apps harness behavioral modification techniques to try and help patients improve their habits around general problems such as weight and exercise (Noom) and adherence (Perx). Again these are limited in medication adherence as they rely on the patients providing self-reported data, which is known to be inaccurate. Noom is focused on exercise and weight loss.
Coherence Health Competitive Advantages:
High-quality data: Our smart connected hardware will offer unprecedented accuracy on adherence, enabling equally high-quality decisions to be made regarding adherence patterns, enrolment, and site performance. The system looks for actual adherence not merely that a medication was dispensed. As such it is also able to prevent double dosing.
Behavioral Coaching: We have a sophisticated dynamic AI-enabled behavioral coaching platform that has been developed using advanced behavioral economic, psychological, gamification, and design principles, which fully integrates and leverages the high-quality data generated by the platform to continually enhance and maintain adherence.
End-to-End Coverage: Adherence is complex and our system is the only platform to offer end-to-end support for the patient journey, thus we are able to support the patients for each step of the journey. Specifically, it oversaw easy dispensing, so that even those with disabilities are able to easily use the system. Our competitors usually solve only a single problem for the patient, but this is limited as there are often multiple obstacles to patient adherence for any patient.
Context Analysis and Closing the Loop: In order to identify and overcome obstacles in the patient adherence journey, not only is it important to have high-quality data and analytics, but our platform ten closes the loop using the behavioral coaching system.
Data to Value time: Our solution enables real-time, real-world review of adherence data, thus enabling critical decisions to be made in real-time based on high-quality data.
Adherence Intervention: Our platform leverages its high-quality data and real-time analytics to enable real-time intervention by clinical teams to monitor and improve adherence. Furthermore, the behavioral coaching elements aim to engage patients to improve adherence, therefore taking the workloads off clinicians.
Platform Built for Patients and their Carers: Our platform has been built from the ground up for patients and their clinical teams. It has sophisticated software to track side effects, patient-reported outcomes, and adverse events in addition to extremely high-quality adherence data. The platform is also built to perform in changing conditions including power outages, loss of Wi-Fi, etc so that it can be deployed in more remote settings (where many clinical trial candidates reside).
References
1Kristy Iglay 1, Shannon E Cartier, Virginia M Rosen, Victoria Zarotsky, Swapnil N Rajpathak, Larry Radican, Kaan Tunceli. A systematic literature review was conducted to identify articles published in English over the last 10 years evaluating the use of OAHAs for the treatment of T2DM. Curr Med Res Opin. 2015;31(7):1283-96. doi 10.1185/03007995.2015.1053048. Epub 2015 Jun 18.
3Watanabe JH, McInnis T, Hirsch JD. Cost of Prescription Drug-Related Morbidity and Mortality
4Truven Health Analytics;
ID 913707. Conducted by Truven Health Analytics Survey period June 1 to 15, 2017 Region(s) United States Number of respondents 3,003
5Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare cost. Med Care. 2005;43 (6):521-530.
6Resnick B, Galik E, Boltz M, Holmes S, Fix S, Vigne E, Zhu S, Lewis R. Polypharmacy in Assisted Living and Impact on Clinical Outcomes. Consult Pharm. 2018 Jun 1;33(6):321-330. doi: 10.4140/TCP.n.2018.321. PMID: 29880094; PMCID: PMC6311411.
7https://www.seniorcare.com/assisted-living/resources/services-provided/medication-management/
8Zimmerman S, Love K, Sloane PD, Cohen LW, Reed D, Carder PC; Center for Excellence in Assisted Living-University of North Carolina Collaborative. Medication administration errors in assisted living: scope
9Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc. 2011;86(4):304-314.
12Heaton PC, Tundia NL, Luder HR. U.S. emergency departments visits resulting from poor medication adherence: 2005-07. J Am Pharm Assoc (2003). 2013;53(5):513-519.