While the U.S. is often hailed as the capital of innovation, digital health hubs are sprouting up all over the world. To the north, Canadian health tech companies are beginning to emerge.
In 2020, Toronto saw 19 digital health deals, coming to a total of $282 million, according to a Startup Health report. This made the city the fifth largest non-U.S. digital health funding hub in the world.
But many of these digital health companies aren’t staying put in Canada. Several have taken the leap into the U.S., with sights set on a larger market. However, going into a large new market isn’t always easy. The notoriously complex U.S. healthcare market can be difficult to break into.
There are examples of companies making the jump. For example, in 2018 Canadian digital employee health benefits company League scored $47.4 million to expand into the U.S. and Europe.
The Canadian government is looking to help young companies expand their geographical footprint. The Canadian Trade Commission has set up a Canadian Tech Accelerator (CTA) program that guides tech companies with everything from finding their feet in the industry to gaining funding.
“Companies come here, and we help them understand the local environment," Serban Georgescu, Trade Commissioner at the Canadian Technology Accelerator, told MobiHealthNews. "They find their strategy, find their niche. They are mentored. We provide a team of mentors, most of whom are actually Canadian expats who have lived here for many years, and they volunteered and are happy to help young Canadian startups become successful.”
Georgescu, who works at the Boston CTA said this accelerator is open to all sectors, but being in a healthcare hub the program typically has a higher percentage of life science and medtech companies. The trade commission is turning its sights specifically on the digital health world.
“This year we have also developed a CTA focused on digital health, which is a multi-city program between Boston, New York and SF, the leading centers for digital health companies in the U.S.”
According to Georgescu, the companies have already been selected and are just starting the program. While this may be the first digital-health-focused initiative for the trade commission, health tech companies have gone through the accelerator and evolved in the past.
“At the beginning it’s a little bit of a learning curve. The best example is Pomelo Health. Pomelo, a very successful company. When they came [to the U.S.], they felt like they had been able to grow in Canada. They had millions of dollars in revenue there, and they thought it's going to be easy in Boston. Then they hit a wall. Then they had to learn some things, but they grew," Georgescu said.
"They were very open minded. The mentors helped a lot, as did the consulate. Then at some point they said the best thing for them was changing their frame of mind. Now we can do much more. Our ceiling is much higher than when we were in Canada. So technologies are not that different in the end. You still have the patient in front of you. … Companies are quick to adapt, and learn the U.S. system, and become successful.”
Read on for a list of five Canadian digital health companies making it in Canada and expanding into the U.S.
Pomelo got its start in Canada tackling the issue of wait times in urgent care and emergency rooms. The technology allowed patients to register at home and go into a virtual waiting room. When the doctor was ready to see them, they got a text and could go to the clinic.
“And it was a huge success in Canada for obvious reasons. And the patient would pay three bucks, and people are super happy to do so, because you could just wait and watch Netflix, instead of being in the hospital with sick people,” Remi Richards, president of Pomelo Health said.
“This product led to a full-on patient engagement suite. So basically we are really between the doctor and the patient, and we do everything that's communication related, appointment access to care related intakes, telemedicine.”
Richard looked to the south and saw a big market for a tool like Pomelo. When the company came to the U.S., they were able to team up with a care integrator, which had connections to the bulk of EMR companies in the country. This allowed Pomelo to distribute its software across the states.
The company also changed its model to bill health systems or urgent care centers instead of patients. But this wasn’t the only recent pivot. COVID-19 also forced the company to evolve.
“So this year has been really interesting for us, because we adopted software from just regular appointments or patient engagement to [COVID-19] testing and ... vaccinations.”
“I would say to fellow Canadian entrepreneurs to be more aggressive. So if you want to go into the U.S., you better be prepared to face more competition and bring your A game,” Richard said. “But if you do, the rewards are absolutely huge. So it's absolutely worth it. It's a once-in-a-lifetime opportunity, maybe twice, or two or three times for some people, but it takes a lot of energy.”
Founded in 2014, Genxys is a Vancouver company that created a precision-prescribing software. The company uses a software tool and genetics to help doctors determine if a drug is right for a particular patient and what the dosage should be. The company started out in the pharmacogenetics world.
“In the simplest layman's term is the science of how we as individuals and our genetics metabolize different medications,” Karl Pringle, CEO of Genxys said. “So the three of us could all be given the same dose of the same drug for whatever condition it is. And it may be that for one of us it's the perfect dose. For another one of us, maybe we need half the dose.”
Pringle said that today three emerging areas for pharmacogenetics are mental health, cardiac care and chronic pain. The company has pivoted to more of a software company than a pure pharmacogenetics startup.
Like Pomelo, the startup has its eyes on the U.S. market and has worked with the CTA.
“So our vision is that every prescription globally is powered by our software. And the reason for that is a number of factors. But fundamentally, it's to increase patient safety,” Pringle said. “It's to improve population health, and it's to reduce the cost of health care. In Canada, adverse drug reactions are the fourth largest cause of death. In the United States, they are at the top.
Pringle said it was a no brainer when looking at where to put its efforts.
“Well, the U.S. looks pretty good there. They're right next to us. They speak the same language, OK? They've got a slightly different health system,” he said.
“The drugs that are available to prescribers and patients, pretty darn similar. And you know what? They also happen to be the [biggest] subscribers on the planet, and also their drug costs are the biggest on the planet. And then you overlay on that healthy dose of litigation, and it looks to me like a pretty good recipe for success.”
The CTA was able to help the company make introductions and understand the layout of the U.S. healthcare system. It also gave them time with stakeholders like UMass Medical.
“Start with who would be the most outlandish person [who] you would have or company [has] that would endorse your products in the U.S. And that's the first one. And just be bold and go for that. The second one is to take every offer of help that you can possibly get, whether it's through the formal Canadian channels like the CTA and being a small health innovator in the Canadian market."
Bio Conscious is focused on helping people manage their glucose by predicting future needs.
"The current standard of care, even continuous glucose monitoring, shows you the value that corresponds to what you have done in the past 30 minutes," Amir Hayeri, chief executive officer of Bio Conscious, said. "Our technology is the first that takes that input into account and predicts what is going to happen in the future.
"It's the immediate future, like what is going to happen in the next 60 minutes or hours. We honed in on the problem, but putting my science hat on, despite what everyone says this is a diabetes problem, it's not a diabetes problem. Diabetes is just the tip of the iceberg. It's the first condition we've identified as a glucose problem, but there is a very silent glucose epidemic ongoing. You have a lot of people with type 1."
The tool has different interfaces to meet the needs of providers and patients.
“Think of our work as a crystal ball. So we use machine learning. It's able to predict future states. So we have a crystal ball that we train, and out of it we create two diabetes products for [the patients] and Enodobits is for [their] doctor to monitor [them] and see how [they are] doing.”
Hayeri said that a move to the U.S. is inevitable. Currently the company is talking to U.S. investors and other startups to collaborate. A graduate of the CTA, he said on his trips to America he was able to figure out some of the market and the difference in approach.
Hayeri said that pitching your startup in Canada is different from how it is in the U.S. He remembers lessons learned from his first pitch.
“We were just being way too realistic with the company. We talked about risk assessment, if you will. In Canada, if you put that in front of me, you are a straight shooter, … but in the U.S., it doesn't work that way. When you start up with that kind of presentation, the investor gets turned off.”
360Medlink pitches itself as a digital therapeutic software. Its first product is called Tavie, a coaching tool that helps guide patients through their care.
"The system itself is more about digital solutions. And those solutions now are a series of platforms that we have and are customized for patient needs, essentially a treatment companion which was clinically validated," Jean Manasse Theagene, CEO and president of 360Medlink, said. "And recently we also filed for a CE mark for a healthcare professional device to help in neuroscience, [in] acute pain management for patients."
The program was designed to be culturally responsive. The coach can be tailored by “therapy, language, culture and ethnic preference.”
“So I instantly was looking at the overseas market also, where I have more interaction because of my years in pharma,” Theagene said. “We're working with the global teams ... Whether they were with Novartis or with Celgene, some of the successful biotech and pharma companies offer implementations with them on one side, and [on] the other side working with the U.S. government. The state of Rhode Island was the first patient-focused implementation of that view, which came out to be a big success.”
Since then, the bulk of 360 MedLink’s business has been in the U.S.
“What I would say from experience is just to be open to that, you know, the plan, that you have solid ideas. Maybe you don't know where technology is going next month, and what new things that are coming. So you have to be open to grab opportunities where they still remain in a focused way.”
Focused on MSK care, the company has created a medical device and digital system called the KneeKG, which can assess how knee joints are functioning. It’s similar to an EKG for the knee.
The tool is able to perform a 3-D assessment of the joint function. Patients are asked to walk for 45 seconds wearing the company’s exoskeleton system. The system’s algorithms can then analyze the data and “identify evidence-based mechanical biomarkers.” The tool was designed to help get to the root of the patient’s issues and help clinicians come up with a personalized care plan.
“There was an automated report. As we said, we use artificial intelligence that automatically interprets these recordings into meaningful data to the doctor,” Michelle Laflamme, CEO of Emovi, said.
“It's printed, and then sent to the doctor. So the patient will receive, you know, exactly what causes the pain and why. And with a visual, then the mechanism can explain what's happening and why it's causing pain or symptoms, and what we're going to do to address this problem.”
The company started working in the U.S. in 2017 in Philadelphia. Like the others, she worked with the CTA. Through it she was able to get endorsements.
She said finding support, such as that from the consulate, is key when entering a big market like the U.S.
“The way to proceed is different. The way to build your value proposition, the reimbursement pattern ...you need to find a way to make it happen, to present your data, to accumulate your data,” Laflamme said.