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Naluri

Naluri helps people with chronic disease and mental illness

Malaysia
Market: Medicine, Artificial Intelligence
Stage of the project: Operating business

Date of last change: 15.09.2020
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Idea

Naluri is a human-driven, AI-augmented digital treatment program that delivers quantifiable health outcomes and helps healthcare payors save on avoidable healthcare costs ...

...through delivering a structured, multi-disciplinary, behavioral, and psychological coaching that helps people cope with chronic physical and mental health risks...

...in a way is that twice as effective as medication alone, ten times as cost-efficient and much more accessible

Current Status

We are currently serving 3 countries, Malaysia, Singapore and Indonesia.
We are intending to expand into the Phillipines and Thailand.

As of September 2020, we have achieved USD1mn ARR, and are growing between 4x-5x year on year.

FYE 2019: ~USD16k
FYE 2020: ~USD235k
FYE2021 (expected): ~USD852k
FYE2022 (forecast): ~USD2.8mn

Market

Our end users are predominantly chronic disease sufferers and those who have mental health issues, such as depression, anxiety and stress risks. With over 50% of adults at risk of chronic disease and/or mental health, this encompasses a large population that is growing every year.

We are predominantly a B2B company that serves 4 key groups of clients:
1. Corporates: Naluri helps corporates reduce escalating medical expenditure and improve productivity in the workplace
2. Insurers: Naluri helps keep policyholders healthy, reducing the risk and probability of payout, thus reducing the claims ratio.
3. Pharmaceutical Companies: Naluri augments the effectiveness of medication by improving medicine compliance and improving the lifestyle of patients
4. Healthcare Providers: Naluri helps close the loop of care by providing post-hospitalisation and out-of-hospital support to patients

Problem or Opportunity

Problem Statement:
Today, more people die from reversible chronic diseases than all infectious diseases combined. Similarly, more people die from suicide than all wars, terrorism and murders combined. While many are racing to address these crises of humanity, few see the connection between diabetes and depression, or heart disease and anxiety, or the value in addressing physical and mental health in an integrated manner.

There are 13 million adults at-risk of chronic disease and almost 7 million adults suffer from mental health problems in Malaysia today. Over 50% of the 10,000+ Malaysian white-collar employees enrolled and assessed in Naluri’s health programme have combined physical and mental health risks. Yet, these health issues are avoidable, and this need not be through expensive medication and hospitalisation. The economic impact of addressing this is large; preventing chronic disease for just one person could save up to RM 80,000 across a 10-year period. Employers are not only bearing the increasing financial burden associated with these diseases, but are also facing losses in employee productivity. We estimate that the productivity losses associated with absenteeism and presenteeism due to chronic disease are almost equal to the direct medical costs associated with chronic disease, presenting an even stronger case for change.

Limitations in current healthcare services:
• Reactive and transactional. Whether someone sees a doctor at a hospital or books a consultation session through a telemedicine platform, it is both reactive – they wait until they get sick and then reach out for help – and it is transactional. The doctor gives them advice and maybe a prescription – and expects them to manage their own health at home, until they come again for a follow-up consultation. But chronic diseases cannot be solved with a single consultation or prescription. Behaviour change and care beyond the hospital/clinic is needed to achieve health improvements.

• Activity-based instead of outcomes based. Healthcare is charged based on an activity, not whether someone actually gets healthier. A doctor is paid for the consultation, but not whether the patient improves their diabetes, hypertension or mental health. Similarly, there are many digital health apps out there that only track activities – e.g., number of steps, counting calories, amount of sleep – but does not deliver actual clinical health improvements.

• Siloed and not integrated. Hospital care tends to be siloed by specialisation. If one saw a cardiologist, she only focuses on the heart. A separate gastroenterologist focuses on gut health, a dietitian focuses on food, and a psychologist focuses on mental health. But care is not coordinated. Yet, chronic diseases are deeply inter-related and healthcare professionals need to work as a team, with the patient at the centre, rather than treating narrowly by each individual specialisation.

Solution (product or service)


Solution:
Here at Naluri, we aspire to disrupt how we care for Malaysians to help them live better, healthier and more fulfilling lives, while also improving their workplace productivity and saving their employers avoidable costs.

We do three things:

1) First, provide tailored intervention programs that goes beyond self-help tools, health trackers and planners, to specifically help those who are most at risk and need professional care to address the difficult challenges blocking them. Our Naluri Digital Coaching Program, leads to 2X outcomes vs. medication alone and 4X retention compared to targeted solutions such as wearables or diet programs.

2) Secondly, pioneer personalized, coordinated, multidisciplinary care for individuals in this region. Global innovations in integrated, out-of-hospital care has proven to reduce costs while improving outcomes.

3) Thirdly, create a step-change in healthcare professional productivity, moving from one-to-one matching to one-to-many matching, by leveraging the latest developments in artificial intelligence, machine learning and digital design - something that simple booking and telemedicine consultation models cannot do.

This allows us to deliver a market-leading intervention program that is able to achieve superior health outcomes in a way that is much more affordable. We have already served over 30 of the leading companies in Malaysia: corporates, insurers, healthcare providers and pharma; and our programs deliver an ROI of 5-8X within a year.

Competitors

The digital therapeutics market is very new; and therefore, there are a very few number of competitors in the space. Many play in certain areas of the service spectrum (e.g., mental health coaching, dietetics support, device monitoring, educational content, health screenings) but no player other than Naluri has integrated the entire spectrum.

Some competitors to note:
1. Glycoleap - focuses predominantly on diabetes and glucometer tracking
2. Thoughtfull - focuses predominantly on digital counselling, but uses counsellors instead of clinical psychologists
3. Safe space - similar to Thoughtfull
4. Mindfi - Focuses on self-help psychotherapy and educational content
5. intellect - similar to Mindfi
6. Walnut Wellness - initially focused on integrated digital therapeutics, but recently pivoted

Advantages or differentiators

Three things set us apart, especially from traditional players in the space. We are moving:

1. From Activities-Based to Outcomes-Based:
Many health and wellness applications focus on tracking activities (e.g, steps counting, calorie counting, amount of fluids drank or hours slept).

We focus on delivering quantifiable and clinically significant health outcomes:
0.5% HbA1c reduction
10% Total Cholesterol reduction
10 mmHg Blood Pressure reduction
5% Weight loss
Improvement in DASS-21 score (depression, anxiety and stress)

2. From Transactional & Reactive to Structured & Proactive:

Tele-health and live consultation sessions tend to be transactional.
However, chronic physical and mental health conditions cannot be solved through a single session or a single prescription. Lifestyle changes require structured, on-going support.
By moving away from live one-on-one sessions to asynchronous chat supported by real-time analytics and decision-support tools, we can ten-fold the productivity of human professional health coaching.

3. From Siloed and Fragmented Care to Coordinated, Integrated Care:

Traditional care is siloed with limited coordination between each healthcare professional: A psychologist or counsellors provides mental health support, a doctor focuses on physical care, and a dietitian focuses on nutrition.

Meaningful health improvements require addressing physical health and mental health together in a coordinated manner.

Finance

We have two primary products:

1. Digital Chronic Disease Management Programe (Malaysia pricing is roughly USD90 per member per programme; Singapore is roughly USD150 per member per programme; Indonesia is roughly USD50 per member per programme)

2. Mental Health Programmes (this is typically an annual programme with corporates, in Malaysia this is roughly USD25,000 per year; in Singapore it is roughly USD40,000 per year and in Indonesia it is roughly USD15,000 per year)

Our primary drivers for cost are Coaching Costs. The key here is what we call 'coach productivity' and using our back-end technology and decision-making support tools to augment the effectiveness of coaches. We are currently at a member-to-coach ratio of 250:1; and hope to get to 400:1 by 2023, which will greatly improve our profit margin from about 22% to over 50%.

Business model

We distribute our services to new clients in two different ways:

1. Direct to corporate:
- We take a systematic and data-driven sales process approach, mapping our leads across stages of the funnel. The sales team generates new leads independently and pitches to corporates to the point of closing. Historically, this has been a primary driver in obtaining new clients


2. Channel partners:
- We have started leveraging channel partners such as Third Party Administrators (TPAs), Insurance Brokers and Insurance Companies; who have been excited to offer a digital, evidence-based health solution to their corporate clients to control their escalating medical costs
- We expect this to be a large driver of new business over the next few years in obtaining new clients

Money will be spent on

Predominantly:

1. Investment into our product:
i. Improvement in the Chat Feature for both our Coaches and Users
ii. Improvement in the Food Journal's Image Recognition through Machine Learning
iii. Health Journal: the recording and visualisation of health data
iv. Connected devices: Expanding the support for bluetooth connectivity to more devices such as Glucometers and Blood Pressure Monitors
v. Educational Content: Expanding our modules and areas of expertise within chronic disease

2. Expanding the coaching team, hiring in Malaysia, Singapore and Indonesia:
i. Clinical Psychologists
ii. Clinical Dietitians
iii. Medical doctors with specific specialty in Diabetes (Endocrinology); Hypertension/Cardiac Failure (Cardiology); Cancer (Oncology)

Offer for investor

We are looking to raise a series A in Q4 2020, and have investors who are currently interested and are in the process of, or have completed, due diligence for this purpose.

We aim to raise ~USD3mn at a USD23mn-USD25mn pre-money valuation.
We hope the minimum cheque size to be USD500,000 from investors.

Risks

The biggest risk was the adoption of a novel, digital solution to provide healthcare support and coaching to individuals. Many clients, especially in this region, were previously skeptical about if a digital solution would be appropriate and timely for their employees.

However, since the onset of COVID19, three key things have happened.

1. Awareness about health has increased, especially as those who have a chronic disease are between 5x and 10x more likely to suffer a fatality due to covid19

2. Mental health has become increasingly important, with Circuit Breaker and and as Work From Home becomes the 'new norm'. Our data has shown that levels of depression, anxiety and stress during covid have increased 31%, 14% and 52% respectively. Now more than ever, people are need of psychological support

3. The digital delivery model for healthcare has been validated. Since COVID, it has become apparent that the entire world has shifted to an online working norm. Now, clients are looking for digital solutions to support their employees; those who were once skeptical of this delivery model are now supportive of this model.

Incubation/Acceleration programs accomplishment

Accelerators:
1. Stanford StartX Spring 2019 Cohort - United States
2. 500 Startups Launch 2020 Cohort - Singapore
3. APACMed MedTech Innovator - 2020 Asia Cohort
4. Zurich Innovation World Championship Startup Tournament
5. Global Acceleration & Innovation Network (GAIN)
6. PlatCOM Ventures HIP2 Grant Recipient
7. Crade CIP300 Grant Recipient

Won the competition and other awards

Winner of Zurich Innovation World Championship Startup Tournament

Invention/Patent

We have a patent for "A Method and System for Behavioural Guidance of a User"; which protects the Naluri approach of digital coaching to improve the health of a user.

Photos

Photo 1 - Naluri helps people with chronic disease and mental illness

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Idea
Current Status
Market
Problem or Opportunity
Solution (product or service)
Competitors
Advantages or differentiators
Finance
Invested in previous rounds, $
Business model
Money will be spent on
Offer for investor
Team or Management
Mentors & Advisors
Lead investor
Risks
Incubation/Acceleration programs accomplishment
Won the competition and other awards
Invention/Patent
Photos
Product Video