 Good afternoon. My name is Michael Brownrig. I have the privilege of moderating this panel this afternoon on health and medical care in the palm of your hand, the M Health Revolution. My firm Total Impact is a merchant bank for social enterprise, so we look for great opportunities around the world that are going to be game changing and profit making. And it's our pleasure and really my distinct pleasure to introduce three great panelists who cover both ends of the spectrum. So you're going to hear from two fantastic entrepreneurs in the mobile health space and one fantastic investor. And I've been coming to SoCAP for a long time. I love SoCAP. I think it's a fantastic conference. But I think it's really helpful to hear both sides of the equation, both on the entrepreneur side and on the investor side as we think about how to grow a business into something that scales and meaning. When we think about M Health as a general matter, you know, here at SoCAP and in our own business we're always talking about the intersection of profit and purpose or money and meaning. And I don't think anything gets more into that cross-section than healthcare. If you look globally, we're 500 days or so away from the Millennium Challenge goals. Maternal health since 1990, the deaths of maternal health have fallen by 45%. But that still means that in 2013, 300,000 women around the world died from either complications in pregnancy or childbirth. Of the interventions that are being tracked, about a quarter of them are, to try to bring that number down, about a quarter of them are technology related. So clearly, technology can play a big role in trying to improve healthcare for everybody. I'm going to ask our panel to introduce themselves to you. But briefly, I'll just do a quick overview. Ann DeGeest is the chairwoman of HealthTech Capital, one of the leading Silicon Valley groups of angel investors in health technology. A really remarkable group of about 100 individuals committed to making angel investments. And for those of us who live in the valley, we know that angel capital has become more precious than ever. As fund sizes grow bigger and bigger, and the interest in health funds to invest in early-stage companies becomes less and less. So Ann will talk, and in addition to which, Ann is an investor in a number of companies whose primary markets are in the developing world. Amit Safir is with Mobile OCT, a really remarkable technology to improve the diagnosis of cervical cancer overseas in the developing world. And Abner Mason is the CEO of Consejo Sano, a company that brings health and wellness to Latinos in the undocumented here in the United States. And so with that, I'd like to let each of you introduce yourselves and your businesses in a little more depth to our audience. Ann, if I could start with you. Yeah, thank you. And so for clarification, I'm not, oh no. Oh sorry, I'm so sorry. Ann is exactly right. So initially, Anna Schellikens, who is a remarkable individual and entrepreneur who's helped build a company called Farm Access into one of the leading providers of medical technology in Africa, and microfinance for clinics in Africa, and an old friend of our firm was going to be here, but was detained in Europe for business reasons and so couldn't join us. So Ann De Geest is a remarkable step in, and thank you very much for being here, Ann. Thank you. And there'll be a quiz at the end on how you spell my name. So if you do get it, you'll get a free ticket to my conference. So my name is Ann De Geest. I've been a serial entrepreneur and now investors in the space. I define as health tech. And I coined that word because I wanted to differentiate it from medtech and biotech, which are very different. So those products that usually have the regulated, a lot of product risk. And really what we're talking about here is changing markets, is changing behaviors, which is something in health care we never did before. We were really developing products for the physicians, got for the FDA, and then the physician told the patients, you know, to do whatever they tell them to do, which doesn't always work. And so I started several companies in this space for the last 25 years. I was kind of a black sheep. Several of these companies went public. I had the pleasure of working with companies who have saved now six minutes of life. And I think people ask me, why do I do this? And I think because of the global impact that this technology have had on people's life. And so I got really frustrated because all these companies, one after another, you know, would be pulse oximetry that some of you may know. This is the device you put that in your finger that measured the percent of oxygen and hemoglobin in your blood, as well as VZQ, which was really the first medicine in the space there. All these companies became massive, massive winners, but you could never raise the seed in series A. Because I will go to my medical VC friends and they say, well, what's the mechanism of action? What do you mean? There is no technology. There's no IP, my gosh. So I started this group called Health Tech Capital. It was the idea four years ago that you need three sets of expertise to succeed in this space. The first one is understanding health care. And that means the clinical workflows, what are the clinical needs, the FDA, reimbursement, depending on the countries, and really all the complexity in that time, the absurdity on how we deliver health care. The second aspect is how to use technology not to put something over a phone, but use phone to change the business model. And the third aspect, which is the biggest one that people always underestimate, which is we have to change somebody's behavior. Historically, we never did that. And so in this case, we may have to change the behavior of a patient, a nurse, a caregiver, or somebody. So the group has 100 investors, a third of them are physicians. So we have deep clinical expertise. What's unusual with the group is that we venture capitalists, some of the biggest firms in the valley, as well as the industry, a company like Johnson & Johnson, Philips, Genentech, and Merck. And again, it shows that they're really trying to change health care delivery. And I got so frustrated three years ago by some of these demo day conferences there where people showing there for their 59 seconds of fame, and I had 55 questions that we can expand more later about what does it take to succeed, that we start our own conference called the Health Tech Conference, which is going to be on October 14 and 15 in San Mateo, where we really focus in how do we build a business that's sustainable. And I think at the end of the day, you may want to try to have an impact, but you have to get a revenue generating company there, you know, to basically get the capital and hopefully at some time earnings to justify the investments there. And so the team of the conference is that we put together the entrepreneurs with the Big Dodge Corporation to develop partnerships with the investors of Angel and Venture Capital, the payers and the providers all together, we lock them up for a day and a half. And by the end of the conference, everybody has a deal. I'm just kidding. So that's my short story. Thank you. Thank you. Thank you, Anne. Amy, please tell us about mobile OCT. And Amy, it has a couple of visuals that will go with it. Sure. Thank you very much, Michael, and thank you very much for the opportunity to be speaking at this amazing conference. I'll take your word on that conference, hoping I can get out of there with a big investment. I'll give you a discount. So mobile OCT is a technology that can help them start up, aiming to bring powerful diagnostic technology to improve cancer screening in developing areas. Currently, cancer kills over quarter million women in the world. Unfortunately, most of them come from low resource settings. And what's the most cancer is that if you can catch cervical cancer in the first five years since it begins developing, the treatment takes 10 minutes and the patient can go home totally safe. But in cervical cancer is a silent disease and signs do not appear and patients do not start, do not see these signs after 10 or 20 years after the cancer developed and bleeding begins, that's too late already and the results are fatal. So what MobiloCity is doing is using the technology that's based on a mobile phone, five billion of these mobile phones are actually currently around the world and the number is just increasing and increasing. There's barely a place around the world where you cannot find a mobile phone and smartphones are moving and replacing all the regular phones. What the core of MobiloCity is on biophotonics and what we're building is a multimodal imaging technology platform that allows any clinical healthcare worker that is located on the field to use a mobile phone to attach it, to attach a set of lenses, use an LED light and to get really clear images and be able to identify structural changes on the tissue as well as the contents in that tissue. These we believe will increase the specificity of the screening technique from 15% to above 80%. But anyways, that's our long-term goal and biophotonics is something that we're still testing on our clinical trials. We have five clinical trials running around the world. What we notice when we started speaking about MobiloCity with experts and with people that are actually in the field is the need for a device that will basically be able to record these images, send these images, save these images in a platform and then allow experts that are located anywhere else around the world. It can be Boston, it can be Buenos Aires, London. These people can actually review these images, give their opinions, and continue the mentoring to all these healthcare workers that are in the field that probably receive training once or twice a year and after that they don't see their mentors and they're not sure if the work they're doing is the right work. They're making a decision based on their eyes and on what their eyes see and on a technique called visual inspection with acidic acid. The result of this is a huge level of overtreatment. Five out of six women that are treated for cervical cancer in the field should not get this treatment. They do not have cancer. So we believe that the resources that are being spent for treating cervical cancer could be used for screening more women and save more women's life. Thank you. Thank you very much, Amit. That was terrific. Before I turn to Abner Mason with Kinseo, I want to give the audience fair warning, which is my view of the best panels are when you're engaged and we're going to have a conversation up here and maybe even ask one another questions, but I hope very much to turn quickly to the audience and let you also participate in a dialogue because I think that's the best way to make sure we address the questions that are on your minds. But with that, Abner, tell us about what Kinseo Hosano is doing. Okay, great. Thanks. Thanks, Michael. Do you want to put up the first slide? There we go. Okay. Well, Kinseo Hosano is a mobile application and online platform providing health and wellness services to Hispanics. We're launching the services fall, we're targeting Hispanics in the U.S., and the reason for the service, the need for it, is that the U.S. healthcare system simply has not caught up with the explosive exponential growth of the Hispanic community in the U.S. About 10% of the U.S. population speaks Spanish as their primary language. In California, 40% of Californians speak Spanish as their primary language. In 2050, the U.S. will be the largest Spanish-speaking country in the world, and about 70% of Hispanics speak Spanish in the home now. What's interesting about the Hispanic market in the U.S. is that although it's a huge number of people, 52 million people, 22 million employees, it's not evenly spread across the country in terms of where people live, where Hispanics live. They actually are focused in five states, Texas, California, Texas, Florida, New York, and Illinois. 65% of all Hispanics live in five states. What that means is that the pressure on those states and the health systems in those states is intense, and it's getting much worse. It also means that there's an enormous opportunity in terms of new revenue because of healthcare reform for health insurance companies in those states if they can find a way to meet the needs of Hispanics. The point is the healthcare system in the U.S. is just not prepared. An example is in California, 40% of California is Hispanic. That's about 14 million people, but only 5% of doctors speak Spanish, 5% speak Spanish, but 40% of the population is Hispanic, and about 30% of that group only speak Spanish, so it gives you a sense of the kind of needs that we have in the U.S. There are market trends that we've designed, can say, has on to respond to. One is that this group, Hispanics, is just growing. In about 25 years, this group will represent 30% of the U.S. population. Governments and insurers have started to figure out that they need new strategies, both to serve this group, but also to attract them if you're an insurance company. That's 62 billion in new revenue goes to insurance companies if they can attract these users. It's an underinsured population. Hispanics are the most underinsured segment of the U.S. population, but it is very much an early adopter. In fact, within the U.S., Hispanics represent the number one early adopter of new technology. In fact, 72% use cell phones, but there is a problem that we face in the U.S. because despite the reform, which is going to bring 9 million Hispanics into having health insurance for the first time, which is huge. That's a big step forward. Healthcare reform has failed when it comes to undocumented people. It does not include them. There are 12 million people who are not eligible for health insurance, so we want to serve them as well. Finally, the explosive growth of telehealth. It's clear to us that the future of healthcare in the U.S. is going to be a significant segment of that future will be telehealth. What we've done is we've designed a product for the Hispanic market in the U.S. We provide access to a doctor 24 hours a day, seven days a week, linguistically relevant and culturally relevant. We also provide an opportunity to video chat with the doctor in Spanish 24 hours a day, seven days a week. We set the pricing so that we can meet the needs of people regardless of their income level. We also have a wide range of content, video material, blogs, and written materials designed to help people make better choices for themselves and their families. We've got a network we've built of providers around the country so that when someone calls our service and they can't be helped on the phone, we can direct them to a provider that can provide them help. That's also linguistically and culturally relevant. We have a mobile app and we have a website that we are in the service we're launching in the U.S., a direct-to-consumer part of our service in the fall. So that's Kensei Hosano. Terrific. That's a great overview. Thank you all very much. In a way, each of your companies are bringing health services to the underserved and I wonder was that what motivated you to start these businesses or did you see it as an opportunity or both? We believe at Mobile OCT that building bottoms up and starting and working with the people that need their technology the most is not only the right way to go but the only way for us to go. It's interesting because we are building for low-resourced settings but as we show this more and more to our advisors and to doctors that work in the U.S., that work in Europe, they see our device, they see the simplicity of it and they're engaged, they want to get one. We try to stay in focus and think only on low-resourced settings but that does not mean that the need is also on high-resourced settings. Thank you. Abner? I think it was definitely a driving force for us and for me at Consigna Hosano to try to make sure that put meaning behind this idea that healthcare is a right. I really do believe that healthcare is a right. I think just as a person, I feel that we have an obligation to figure out a way to make sure that people have access to certain basic things and healthcare is one of them but at the same time I know that there's an enormous cost involved so to me it's a personal, I think sometimes when there's a challenge you have to step up and meet it so on the one hand I believe that there should be a right to healthcare but on the other hand I know that if we do it the way we keep doing it that's never going to happen so it means that someone in this case I felt I could step up and make a difference. I felt we could figure out a way to do something really big and that is to make sure that not that every person who was a Latino in the U.S. had the option, the ability to talk to a doctor. It sounds like a big thing to me it's a little thing but I guess it's a big thing. I think we can do that and I think that we can use technology to do that and my goal with Consigna Hosano is to make sure that we get up to a point soon and I think if we achieve our goal we'll be there soon that we can say that there's not a Latino person in the U.S. undocumented or undocumented it doesn't have the ability when they feel sick and when their kid is sick or when they need help they can get someone on the phone who understands them who they can talk to who is sensitive to their needs and at least they can they can start the journey to get help. Thank you and a sort of a riff on that I guess and obviously you bring a hundred disparate investors together and you pointed out some of them are corporate some of them are venture guys. How much for them if you can characterize how much for them is the fact that they're investing in something that if it works is going to make people healthy how much of that that feel good as part of what drives it or is it all just bottom line in IRR? Well I think that in the U.S. as well as the rest of the world healthcare is being turned upside down and if you think about it from a picture point of view is that you have 17% of the GDP that's being transformed this is the biggest experiment we've ever done in the American economy. The rest of the world is also making change for different reasons that we can expand into it. So I think what's happening is that will it be a tech company like Samsung, Apple, LG, Intel, we never heard of in this space they all coming in because they see that we're totally changing healthcare and I can expand on that. If you think about it from a big picture point of view we are some of you are old enough like me is that in the old days we build a healthcare system because you had a big infection you had a heart attack and it was life and death acute care setting you get the best of the best technology. 80% of the reason why you died today is because of chronic diseases. So the way we have built a healthcare system which unfortunately is rigid it was basically based on an emergency situation there antibiotics and a lot of the new technology cardiac and heart attack have gone down smoking fangar is going down but you know most of these are chronic diseases and so what's happening right now is that the government that we like it or not they basically blown up all the resistance to change and so suddenly you have everybody in the private to say we have 17% of the GDP we're going to take a piece of it and since we're simplistic we say well one percent is big let's go for that so what you're seeing is people coming to say we're going to deliver care anywhere you are in particular in your home in your office and in a mall the role of the primary care provider is being turned upside down we're not going to wait for you to come with a symptom of your stomach hurting and I don't care about the rest of your body because I'm a gastroenterologist I'm going to basically go to you I mean because I think you're here too long and I think you need to wash them off and I'm just kidding this is a joke this is Belgium humor if you've messed up so the point is that we're going to be proactive we're going to do population management we're going to try to change people's behavior call it chronic disease management or hellness so as a result of that people are doing this because it's not they can make a quick buck because if you have ever done a quick buck in this space you must be the only one I know it's really a long treacherous road we all have scars trying to change these markets and I think people are doing it they're doing it because at three o'clock in the morning when you wake up and your spouse is saying what the hell are you doing you have to be able to see because and the because is that I'm trying to change people's life I'm trying to have an impact it's not just the money you will not survive the journey if you do it for the money that that is those are great words um yes please I mean I would like to add something um we feel that um the dream of bringing a computer or bringing uh bring a computer or a laptop into every classroom all over the world or into uh into every clinic into every satellite clinic anywhere in the world uh is a dream that just right now with the introduction of smartphones is being achieved um this it never happened really that every classroom or around the world or every hospital around the world had a computer that could use uh so this is a huge advantage um when you get these devices all over around the world um and you get connection um it's not it's not a coincidence to see um all of the big companies like like samsung like google like uh facebook trying to uh push for that uh trying to work they're bringing down the prices of the phones this phone is 120 dollars next generation is being announced uh I think tomorrow the day after it's gonna cost a hundred dollars uh so there's no it's not a coincidence for that and I think that it's a great opportunity for impact investors and impact startups and social projects to take advantage of it and actually make a difference well the fundamental revolution that has happened is that in the past we were B2B business we basically were selling very complex surgical diagnostic or drugs to a physician who basically told you what to do with it the big change that's happening right now is retail medicine retail medicine that means I don't have to go to each of you and convince you to first use my insurance number two use my doctors and number three change behaviors and and so this is something we've never done before which is why you see a lot of the you know direct to consumer experts coming into the space and and we have a the medical device industry and the farm industry is being commoditized and and what's happening is the role of drugs and and and devices are less than they used to be part of that because I know if you know how many physicians do you think are working now for as an employee how many people think it's 30 percent come on come on wake up wake up 50 percent 75 percent okay it's between 50 to 75 percent depending on a profession that is changing all the games and so technology like like our two partners here presenting there is enabling you all of you would it be old or wealthy or sick or poor to finally take care of the only thing you have when you die which is your body and really take charge of that up to now you really never had the technology or the knowledge I mean what is technology and what is knowledge there and I think what's missing is probably what I'm talking about which is the whole solution is healthcare delivery which is taking that information to make it actionable so you change behavior we have something to capture with your new devices so that we can do earlier and save money so that's that's an interesting segue so recognizing that this next question could lead to probably you know phd uh dissertations but we have a very international panel here so Amid is from Israel and you work in Africa Abner has started his business in Mexico City and brought it back and obviously is from Brussels and works around the world how do you think that changing um help the globalization of healthcare if you will leads to innovation elsewhere in other words I think the U.S. has had a very U.S. centric view of healthcare and we are in this rigid system that we invented but that's not true around the world and and sometimes it may be a disadvantage if you don't have the mobile networks for your system to work but on another way and I saw this in China with telecom where they didn't have an installed landline basis and they went to mobile like that you can leapfrog so talk to us a little bit about the global situation and is innovation is innovation happening elsewhere are we missing it by focusing always on Silicon Valley uh I'll talk from my personal experience um what we found when I was doing work in Mexico was that there were innovations in Mexico that weren't here in the U.S. um and one in particular was telehealth it's grown much more quickly in Mexico um it's really in a in huge ways and in the U.S. it's been very it's been very slow and even with reform it's so we have this moment that you're talking about that we're in where it's the whole system is turned upside down telehealth has still moved slowly and I think it's because going to your point Michael this is an example of in Mexico they didn't have the legacy of state boards of medicine so in the U.S. medicine is regulated in every state differently so you know there's no national there's no one policy fits all and you didn't have the strong uh sort of medical associations that are very protective of their turf not that I'm against doctors love doctors but they're very protective of their turf and so when it comes to a new technology it's very difficult in the U.S. and even now we're struggling everybody if you ask everybody in medicine they'll say telehealth is the future but is the future now no and it's because of turf it's because of tradition it's because of state boards not being willing to defer to a national policy uh whereas in Mexico they didn't have that they they they didn't have those legacy sort of structures and so they were able to leapfrog and surpass the U.S. so I think in my personal experience is it's it's an example it's an interesting example of where a country like Mexico has leapfrog the U.S. has demonstrated this works the people love it and now you know we're trying to introduce it into the U.S. so I think you're exactly right so you're saying that our physicians are saying about telemedicine that it's the technology of the future and they hope it always will be exactly right the future is not now and never should come I mean what's your perspective sitting in Israel uh well you like to make a point you mentioned the challenge that it is setting up a network and working with a network I believe that it's not too far from today that there will be internet coverage all over the planet there's not a reason why this will not happen if the prices of devices are going down and the big big companies are pushing for that I am sure the same way as cell phones leapfrogged line phones in Africa I think that satellite communication or high speed networks will leapfrog DSL or any other uh networking thanks I have two comments uh coming from Europe I have to say something about that uh there's really two countries to follow one is the Netherlands and also Denmark uh what's nice about these countries is that they've been pushing patient engagement for a long time they've had the patient data longitudinal data for 23 years of your life because everything is centralized and the government is proactively trying to get the population because the population is older than here to take charge of their life so if you look about some of the basic innovation in Europe they're ahead of the US in a lot of the aging at home the telemedicine the patient population analytics and all of that and the other comment I'd like to say is that we invest in a company called pharmacy cure and what's interesting about pharmacy cure is that they're selling uh there's technologies in India and in Nigeria is the fact that in some of this country up to 30 percent of the drugs are faked or they have a lower dose which is even worse because if if you have malaria the worst thing you can do to somebody is to get a lower dose because then you build resistance and I think what was nice about some of those countries is that um in the case of India is that it turns out they were fake drugs made in other countries in Asia that will stay nameless uh that were saying made in India and being shipped to Europe so the big problem was not necessarily the population getting the wrong drugs but the fact that the emerging uh Indian pharmaceutical industry was being totally destroyed in credibility so the government stepped in and they made a decision to say is effective immediately certain drugs will have an authentication code that the patient when they get it uh because the whole supply chain was contaminated you can text it because everybody has access to a text doesn't have to be a smart phone a dumb you know phone and you can authenticate that drugs and they're now doing billions of those drugs uh authentication on a yearly basis there so the power of those countries is the fact that if the government steps in they can change the needle really really fast where I think the power of the US is that we're so fragmented with like you said all the issues of the state and each of the specialty there it's extremely very difficult to change fundamentally the system so I'm going to give the audience a warning I'm going to ask another question and then I want to turn it over to you so uh start thinking but the question I have it's kind of a related one and that is um legal liability so you know we live for better or for worse in a very litigious society and that drives decisions how much does it drive your business decisions um is there anything government could do to make life easier for m health and bring these benefits uh to the respective populations you serve more quickly or and from your point of view uh you know more generally the the the sort of regulatory slash legal situation are the ways that we could improve things and bring innovation bring this innovation to market more quickly so I'll start and me do you want to kick it off sure um I think there's uh infinite uh bad things that you can hear from people about the FDA and about how hard it is to pass the FDA um we at Mobile OCD are uh not looking right now at FDA we're looking at CE which is a much easier process and uh we're not interested in getting into the American market so quickly uh one thing I do have to say one good thing about the FDA is that uh the decision that the FDA made not to regulate mobile phones uh probably because they don't want that headache right now and they don't want to start regulating every single version of mobile phone that comes out uh it's a very welcome decision by us and uh we're happy that uh decision was made uh I think that there are so there are some definitely challenges um I'll I'll speak to the U.S. uh and uh it's a big problem that that uh medicine is regulated in the U.S. by this by state it really is a huge problem I think it's always been a problem but it had it it it's increasingly becoming very very difficult to have solutions that take into account new technologies so uh is there something the government can do with your question yeah we need to have a federal law that uh that comes up with one standard for uh uh medical registration so that it's not 50 different policies in 50 different states um I think that's that's one really important thing we need to do and there has been some legislation but it has and is bipartisan which is very rare but it's never gotten to the floor of either House or Senate so I think that's a really important thing but as you might imagine there's turf there are people who are defending their turf I think so I think that's a really important step the U.S. could take that would really uh open the floodgates for uh for for telehealth for example another thing I think that we that the U.S. could do and this may have more to do with the medical associations um than the government but maybe the government at some point um and it goes to our personal product the product that we're building this is an interesting example there are people in the U.S. 12 million who are undocumented they typically don't have insurance they're fairly low income they're working but they don't have a lot of money um the idea that we would connect them with a doctor in Mexico there are people in the U.S. in health care in government who would prefer that they have no option rather than talk to a licensed doctor in Mexico and if you think about that it's nuts these are people 65 percent of whom are from Mexico because if you look at the U.S. Hispanic population 65 percent of Mexico so these are people who are saying we would rather you not talk to a licensed doctor in the country where you're from and the country where you frequently go and you have family we'd rather you have nothing than to talk to a doctor in Mexico there's a kind of uh uh tin ear-ness or you might say arrogance to to people taking that kind of position so I think part of what we need to do is to have a broader sense that it's a big world and people have solutions outside of the U.S. that can work very well and we need to be more open to those solutions so so I have two comments I mean one is that the VA which doesn't have to follow the state laws is the biggest user of telehealth they have done millions of telehealth consult it is effective it's saving them money it works the patient likes it it is kind of sad then one part of the government doesn't have to follow the other part of the government but uh my name is oh no um just kidding uh so the other comments I would have to say is the biggest part of the space is that you have to provide a solution that someone is willing to pay for and as a result of that the claims you're making for your product or your first solution is what's going to define the value that you bring that someone's going to pay for as soon as you start making claims like I can diagnose cancer I can basically do anything to do with your disease automatically you go under the FDA claims the challenge is the FDA is still thinking all peer reviewed articles a long-term studies and you know which takes five 10 15 years this space is changing on a monthly basis so there's a tall disconnect in the timelines and I think the FDA as you have seen is a 23 and me situation it's not convinced that you as a consumer can use that information and know what to do about it you can drive a car buy a car go 100 miles an hour and kid yourself but you you cannot find out you have a genetic mutation that can put you at risk maybe uh of a cardiac event and so so there's a lot of the culture change the problem is who uses and who pays for it and that defines your claims so I've seen some products which really worries me on the negative side because I went to a trade show at CES and I launched pulse oximeter a long time ago this guy had a pulse oximeter there he was selling and I put it on he was wrong by 20 beats now by 20 beats that normally your oxygen saturation would be between 95 to 97 percent he was at 75 percent I should be dead I mean this is as wrong as it was I have good heart rate my heart rate was tally off also by 20 points he was selling the damn thing and I told him he says did you go for the FDA and I said no we don't need that he's directed the consumer so it's a little bit of the wild west so I mean we still need some oversight and some claims it's also worrisome when people are trying to develop these tricorders and they say it's for informational use only well if it's three o'clock in the morning and your baby crying and you have no idea if you should go to the ear or not it's not informational use only I mean there's gonna be some consequences so so I think there's a lot of those you know fine line we're walking and honestly people don't know sorry uh so I would invite questions from the audience if there are any or otherwise we can continue our conversation but I did want to give you a chance yes please there's a microphone coming your way uh thank you um when you see a lot of new devices and uh applications being developed I would like you to comment on do you also see that there are ideas and entrepreneurs working in the space to connect that data in order to give a continuous care look for patients so for example with your app related to cervical cancer how do you see the rest of that being developed where you'd have doctors looking at these pictures and getting the information back and tracking the people over time what do you see going on in that space um I think that um on mobile OCT's uh uh core uh we do see uh not only a piece of technology but we do see um um a whole platform that evolves from using your mobile phone inside a mobile together with a photo that you can take from a mobile phone you can take geolocation you can ask for the healthcare worker to add more information uh these all this information can be collected uh and can be sent to any of the EMR solutions that you have around the world um and together with that we we see a pipeline of products uh that will be able to be used for um other diseases like skin cancer uh oral cancer so it is not just one uh one solution for what one problem but uh we are building a whole platform uh that will be able to connect and to speak with all of the um with all of the other uh technologies that you see being developed today let me give you an example for for for what's for cancer screening uh if we can give a mobile phone to every community healthcare worker in Africa um that's uh checking for cervical cancer and structural changes on certain the services that they check um and they can just by one click decide whether if they're gonna treat or they're not gonna treat that patient uh you have the geolocation of of that phone so you can know where exactly those focal points where HPV is uh prevailing and how is HPV remember that cervical cancer is uh um developed from HPV which is a sexual transmitted disease so it moves in vectors uh so by knowing those focal points and knowing how this is moving uh healthcare organizations can know where to move the resources and where they need to um where where they need to send uh either more tanks of liquid nitrogen which is what's used for treatment and where they need to send less where they need to send more uh healthcare workers and where they need less uh and that just one example uh moving to other types of cancers you can do similar similar things I hope I answered the question yes uh if you just wait for the microphone thank you do you find that adoption by consumers need relies on breaking down the barriers human health is not an exciting topic right when when as an everyday person I've got 50 million things pulling me in different ways and as a 35 year marketer I know that the way you get engagement is to make it a little bit more interesting it's not only news you can use but also can you make it appealing enough to me to be interested in it so that as technology becomes available that allows you to become healthier I actually have an interest in it uh and go ahead I mean you're asking the perfect question I mean the challenge we've had historically we never really dealt with your feelings and your emotions and I think the biggest challenge is I see a lot of entrepreneurs coming up with really cool technology but that they just haven't dealt with the fact that somebody has to be engaged be acquired be engaged keep it change behavior be measured and continue to stick to it and and that has been we haven't figured that out I mean there has been a couple of interesting stories I invest in a company called omata health and omata health to the concept of alcoholic anonymous and and people doing um uh other type of treatment there which is it takes 12 weeks for the brains to reward itself initially the brain fight against you to change behavior and so what has worked in the past is personal coach and peer pressure and it's usually a group of 10 to 12 people there that basically says you ate a cookie again don't do it again and it's really that I mean I'm being cynical it's not necessarily knowing really what's happening to polyunsaturated fatty acid that goes into your brain and as a result of that that's not what people want to know people want to feel good they want to feel engaged they want to immediate feedback they want reinforcement and so my view is that I'm with you very very skeptical the Fitbits and all of those guys will accomplish that for you it's going to be technology enabled services which is going to be a combination of getting new data at the time you need it not overwhelm you with it give you an action that is easy to take and a quick reinforcement there for your peers and other means that you're doing good and continuously iterating that and so in pre-diabetes they're showing they can decrease by seven percent your body weight in 12 weeks and decrease by 50 percent of conversion to diabetes which is a big deal can if you you by all means can have a follow-up but let me just chime in as well um so I think this I think I'll share two quick stories with you from an insurance company point of view there's the same upheaval in the medical system creates an upheaval in the insurance system so in the old days the insurance companies were all about risk avoidance who's sick who can I figure out is sick and therefore how can I get them off my roles but that's not true anymore now it's about risk attraction who's healthy who can I get to my service so you're going to see as a consumer especially if you're a healthy one a lot more attention paid to what motivates you to come to the site to engage with this health platform or this health technology because people are going to be marketing to you in a way that you have not been marketed before erectile dysfunction notwithstanding they seem to get a lot of marketing but everyone else not so much um the other story though is with respect to sort of cultural affinity that I'll share is and I think too often we talk about the successes and not the failures but we looked very hard at a telehealth clinic in India and the notion was to bring telehealth services to really remote parts of India and on its face it made perfect sense here we're going to bring great medicine with great technology to um you know rural villages and the system ultimately failed not because the technology didn't work not because the doctors weren't great but because the fact was in those villages they were used to going to a medicine man and the medicine man would give them a pill and the fact is most illnesses resolve themselves most illnesses are not cervical cancer thank god and they resolve themselves and so the medicine men of these villages were deeply opposed to this and the villagers were not willing to take the chance of irritating that guy and so sooner or later we will have those systems in place but it is important I think to always understand the cultures in which we're working and technology is sometimes a bridge too far in some of these places but but you had a follow up I was going to say that because people I was talking to the Mayo Clinic right and they were saying we get everybody over 50 because they're feeling their years and they don't they want to avoid heart attacks and they're like okay 50 years old roll around I better get on the stick and start being healthy but it's more important that it's a lifestyle part of your lifestyle the whole way through right and there's so much ignorance and I say that respectfully lack of information about what that means and it's something that becomes a boring topic in any conversation right so I'm talking about where's the incentive and motivation to engage your mind body and soul and being healthy as an ongoing well I'm going to turn to Abner because I think the notion of trying to you know educate people in an entertaining way is a big part of your service but I will say that from you know this is both carrot and stick one is to try to get people to do the right things and then there's also the Mayor Bloomberg approach which is we're not going to let you big buy 64 ounce sodas anymore right so there's a little bit of both but Abner talk about can say yeah I think I actually want to follow up on your point and just reiterate it that we have it's only in the last say six months that the reality has hit the health care providers and particularly insurance companies and the big spenders that the world has changed for them and now they have to compete for customers they didn't they didn't have to compete before I don't want to insult anyone but if you go to an insurance company whether they're big or small the people there who were in marketing was not the 18 the people at Nike go to Nike or go to go to somebody who's selling you know go to Clorox go these people make Clorox interesting they make so I mean it's amazing what they can make interesting because they've been doing a long time and they knew that they had to get people to move and they figured out how to do it we've never had to do that in health care until basically January 1st 2014 and these companies do not know how to do it I've talked to large insurance companies some of the biggest in the in the in the country and I'm talking to them just about the Hispanic market so I think this holds true for the English speakers too but when it comes to the Hispanic market they're they're saying we have no idea we've never first of all we didn't care about this group very much before because not many of them we're going to be paying but now because of ACA health reform nine million new Hispanics are going to get insurance it's 62 billion dollars just over the next eight years mostly in five states if you do the math it's just an enormous amount of new revenue so these companies are saying how do we do what you want them to do how do we make caring about your health interesting how do we make health insurance interesting companies in the US and around the world have figured out how to make some really uninteresting stuff interesting because they got great marketers doing it and I think you're right that it I'm actually optimistic about what is going to happen over the next 12 24 36 months as the best marketing minds are are sort of brought to bear on how do we get people to move how do we get them to be interested in their own bodies you can get people interested in tires you can get people interested in you know as I said Clorox there's a way to get people interested in their own health it's just that you need to have smart people who really get marketing who really get the demographics they're targeting to to involved at the back just just to add to that I'm a physician from Toronto Ontario Canada and there are a number of compliance aspects that can be built into those mobile platforms and in fact there's there's a number now in terms of compliance in in children with diabetes they they're reporting on a regular basis they get itune credits and things like that so and there's a aspects of gamification and things like that that you can also build in so I think to your point I think that the marketing aspect of it is really actually highly developed so I think it's a good thing thank you for that comment I appreciate it with the last couple of minutes I always know there's always entrepreneurs in the room and so what I'd like to do is turn this into an advice column for just a minute I'd like each of you you guys speaking personally from your roles as startup entrepreneurs and and from as somebody who has seen and seen a million companies and funded a hundred thousand or something what's the advice for the early stage entrepreneur what what what kernel can you give the folks in the room who are trying to be the next great health care in investment so there's really two very different I mean the first one every investor will tell you at the end of the day when you go back about which one did well at each one didn't do well it's always the same one the people the people the people it takes a village it doesn't take a person and so you have to really look at what the skill setting expertise in in the team typically when you start there's you and maybe another another sucker who followed you and sorry for the expression and you have to basically get yourself advisors board members other people are willing to work for you for sweat equity to really bring in the expertise you need the second one it's just tie on that not that you have the expertise you need to figure out what is the pain point you're solving I see too many people are in love with their technology the technology is just the enabler what you have to solve is a pain point and the problem of health care it's not just like the consumer market which is you know one seller one buyer it's complicated the user which is usually the patient is going to be different than the caregiver that's going to be different than the physician who writes the prescription who may be different than the person who pays for it which could be guess what the employer the providers nowadays with the acos the employers the family i mean we don't know and so the key is to really go back in defining the pain points understanding what's the unmet needs of all the stakeholders and then it will become obvious what your total solution is and the technology is the one that gets you there but really focus for the solution and get the right skill set and expertise to figure it out I think I'm here to take advice not to give um I don't think I am really on the stage where I can give advice one of the things I tell my peer entrepreneurs is uh basically there's so many startups today that do games and that do advertising and advertising platforms and the big data for you to tell you exactly in which page pages in Facebook you need to put your little picture so people will click on it when I hear those things and I know the amount of money because they're my friends that are doing that uh they're making it just drives me not drives me not and like the only thing that I try to tell people when I speak with them is try to do something every day and try to make sure that uh your startup your job is really changing the life of people and it's making the life better and it's not just moving money from one pocket to the other pocket uh I'm pretty sure that everyone uh everyone in this conference knows that because they wouldn't be in uh SoCAP but it's it's a message I try to uh to deliver just make sure that you're doing something that will change the life of people to better and not just move money from one pocket to the other last word uh I really agree with both both comments both both from Ann and Amit so I think those are really really wise words um so maybe I'll just be uh very kind uh it's something that I tell myself every day when I get up and it's a practical piece of advice so it's very much on the practical side but I think if someone said it to me and I followed it and it's been really helpful and it is that when you're an entrepreneur when you're doing this you have to be willing to ask people for stuff you have to be willing to ask for help you have to be willing to ask for advice you have to be willing to ask for money and you kind of have to lose your pride a bit and be a shameless asker and and it was hard for me because I was not brought up to ask people you know it just wasn't the way I was brought up and and it was a transition for me to learn that most of my job is about figuring out a way to ask people for stuff and and I know that a lot of the times probably the majority of times you're going to get a no so it does require you to develop a bit of uh toughness but my advice is you just have to every if you're not if you don't if you're not asking people for stuff every day you're not doing your job as an entrepreneur in my opinion you just got to be building building and building and building and let me do that uh unless you're a fabulously wealthy and you can use your own money for everything uh most of us aren't like that you've got to ask people for stuff so I would say just be shameless and ask um well thank you and I hope you'll join me in thanking the panel for a stimulating overview of mHealth and building a business