The digital health space continues cooking on gas: Berlin-based Ada Health has closed a $90 million Series B round of funding led by Leaps by Bayer, the impact investment arm of the German multinational pharma giant, Bayer AG. Other investors in the round include Samsung Catalyst Fund, Vitruvian Partners, Inteligo Bank, F4 and Mutschler Ventures.
The startup last raised around four years’ ago, reporting a $47 million Series A round in 2017. But don’t be fooled by the low lettering of these rounds: Ada Health has been working on its symptom assessment tech for around a decade at this point — relying, in the first several years of its mission, on private funding from high-net-worth individuals in Germany and elsewhere in Europe.
Initially it was also focused on building a decision support tool for doctors before pivoting to directly addressing patients via an AI-driven symptom assessment app.
It’s not alone in offering this type of tool. Others in the space include Babylon, Buoy, K Health, Mediktor, Symptomate, WebMD and Your.MD — but Ada claims its app is the most used and highest rated by users. It can also point to a peer-reviewed study it led, which was published in the BMJ, that compared the condition coverage, accuracy and safety of eight competitors. The study found its app led the pack on all fronts.
One reason for that edge is that Ada Health’s medical knowledge base covers around 30,000 ICD-10 codes (aka the alphanumeric codes used by doctors to represent different diagnoses) at this point — which co-founder and CEO, Daniel Nathrath, tells us is “by far the largest coverage of any of the systems in this space.”
The Ada Health app, which launched in late 2016 — and remains free to use — has been downloaded by more than 11 million people across 150 countries so far. Users have completed some 23 million assessments using the tool, which he likens to having “24/7 access to your trusted family doctor.”
Currently, the app has support for 10 languages. But the goal with the funding is to push for truly massive scale.
“The idea is to help as many people as possible get better access to healthcare around the world,” Nathrath tells TechCrunch. “Our ambition is, in a few years, that a billion people instead of 11 million people will be using our technology. In order to get there we think that working with the right investors can help us accelerate that growth path and give more people the benefit of our technology faster.”
“With 11 million app downloads I believe we are the most used AI symptom-assessment technology that I know of in the world,” he goes on. “We are also the most rated and reviewed app in the medical category of the App Store and Google Play Store ever — after, what, just four years. With about 300,000 ratings and reviews, most of them five star. So … we have gained some users but we think it’s just the beginning.
“Digital health — with all the things you see going on — is at an inflection point where it’s being realized not only by the users who have already been using our technology but also by health systems, governments, and payers, insurers, and life sciences companies — I think everyone has realized digital health is here to stay.”
As well as putting its symptom assessment app directly in the hands of patients, Ada Health offers a suite of enterprise solutions where partners pay it to be able to embed and deeply integrate its triage technology into their websites and digital services. That means they can use it to offer an entry point for their users — to help direct them to the correct service and provide administrative support by arming clinicians with health information provided by patients via the Ada interface (and the AI’s own assessment) ahead of the appointment.
One publicly disclosed customer for Ada’s enterprise offering is Sutter Health in the Bay Area.
“They have integrated Ada into their own homepage and into their app so people can use it as a digital front door to the entire service of Sutter,” says Nathrath, explaining that the difference versus the version of the app that patients can download is “people don’t just get generic advice. It’s fully integrated. So if it says — for instance — you need to go to the emergency room … then you can go straight into appointment booking.
“And not only that; when you book the appointment the outcome of the Ada pre-assessment can then be shared with the health professional who will then look at you so the doctor doesn’t start from a blank sheet of paper but is already pre-briefed and gets decision support in terms of ‘this is the constellation of symptoms the patient is reporting’ and ‘based on that this could be the most likely diagnosis and these should be the tests, examinations or investigations I should consider next to get to the confirmed diagnosis.'”
The added advantage for Ada’s enterprise partners is that patient data arrives with the doctor that sees them already structured so — after a few confirmations — they can easily import it into their documentation, saving precious minutes per patient, says Nathrath. “[If] you save a few minutes with each patient that means you have more time for the patients who really need you and not the patients who maybe has a cold and shows up in the emergency room, which unfortunately is a reality,” he adds.
With this enterprise strand of its business Ada is continuing to provide support for doctors. Nathrath suggests its patient-facing app is also being used for some informal decision support for doctors too.
More and more doctors are using the app “together with their patients,” he tells us, or else recommending it to their patients — asking them “so what did Ada say?”
The role of AI in healthcare will be a core one, Nathrath predicts — given that demand for healthcare professionals is always going to outstrip supply.
He argues that’s true even with the rising use of telehealth platforms that can certainly make more efficient use of doctors’ time.
Ada did, at one point, offer a telehealth service itself — before deciding to fully focus its efforts on AI — so its approach now is to partner and integrate with other healthcare and health data providers throughout the care ecosystem.
“We think there’s a place for telehealth, obviously. It adds convenience. During the pandemic I guess it had a special role where for many it was almost the only way to interact with a doctor,” he says. “So we do see a place for telehealth but we also see an issue with telehealth in that it doesn’t address the structural issue in healthcare — that simply there aren’t enough doctors to serve the entire population of the world.”
“We’re building Ada as a multisided platform,” he adds. “We’ll be computing different sources of input data — which is sensor data, wearables data, lab data, genetic testing data — that’s on the input side — and then on the more downstream, on the next step after Ada, we can partner with any telehealth company in the world. We’re seeing enormous interest from literally all corners of the world where telehealth companies approach us. And insurance companies and governments — where they say yes there is a use case for telehealth but we basically need something before that, that filters people to the right next step.”
Whatever that right next step is in a patient’s care journey, “Ada is like the gatekeeper at the beginning of the journey that then sends you on your way,” is how Nathrath puts it.
The overarching vision is that Ada becomes not just an app in your pocket but an omnipresent “personal health companion” — or what it describes as “a personal operating system for health” — which is powerful enough to deliver preventative healthcare by being able to aggregate all sorts of data and spot health issues sooner so as to enable earlier and less costly interventions.
“What we’re building is really much more than a symptom assessment technology,” he tells TechCrunch. “Where you would also take into account lab results that can now be done much more direct to consumer than was previously possible, sensors and wearables data — and you probably say that Samsung is one of our investors but we’re obviously talking to all the large players in the space about this; how we can integrate that data best — and all the way to genetic testing and even the full genome sequence.
“When you take all these different sources of health information and compute them against each other on a continuous basis you’ll have something like an early warning system for your health — which, again, from a population health and system level perspective should be desirable for anyone who’s in charge of providing healthcare or paying for healthcare because you can catch the problem when it’s still a £100 problem and not yet a £100,000-a-year problem.”
Given that ambition it’s interesting that big pharma is investing in Ada. (Its PR notes that it’s also in talks with Bayer on a potential strategic partnership.) But Nathrath suggests that the industry is well aware of the shifts being driven by digital health — and keen to avoid its own “Kodak moment,” i.e., by not adapting to the coming changes in a timely enough manner.
If AI-powered health interventions end up being so successful that they can shrink drug bills through earlier intervention and more preventative care then it makes good business sense for Big Pharma to be plugged into the cutting edge of digital health.
At the same time this type of tech might end up driving demand for medicines — exactly because of its scalability and because it can present a higher dimension view of more people’s health — meaning there’s more opportunity for increased prescription. So there’s not really a downside for pharma to get involved here.
“We’re really excited about the possibilities we can find by working together [with pharmaceutical companies] to really deliver a better healthcare experience to patients,” says Nathrath. “If you look at Bayer they have a consumer health business, they also have a pharmaceutical business and if you look at the cases within Ada, if you look at the top 10 most common ones, it’s very comparable to what a GP would see all the time and a lot of those basically can end up in the recommendation toward healthcare where oftentimes an over-the-counter drug will be enough to address the issue. One area where Bayer has a lot of offerings, of course. But then their spectrum goes all the way toward rare diseases — where we’re also particularly strong. Where they have some drugs that help patients with very rare conditions.”
There are also potentially major research riches to be derived from the health data generated via Ada’s app that could also be interesting to pharma companies doing drug discovery.
Although Nathrath emphasizes that app users’ data is never used for research purposes without explicit consent from the individual (as is required under Europe’s General Data Protection Act).
But he also notes that Ada is able to do some interesting studies based on aggregated user data, too — giving an example of how it looked at kids’ mental health during COVID-19 lockdowns, comparing areas where schools had been shut versus those where they had remained open. “You could really compare what happened in different countries,” he says, noting that rates of depression in kids in Germany where schools and preschools were closed went up by over 100%, whereas in Switzerland where schools remained opened throughout there was no rise and even a slight improvement in children’s mental health.
In another example, involving aggregated data from usage of the app in the U.S., he says it was able to show that it could have spotted a measles epidemic via the cases in the app slightly sooner than the CDC’s official announcement of an epidemic.
“If you think about the potential of that, in terms of spotting outbreaks earlier, that can be quite significant,” he suggests.
“We think there’s really a long list of ways we can work together [with researchers, policymakers and pharma companies] for the benefit of patients,” he adds. “The mission of all the people I spoke to at Bayer was really similar to ours — which is to help people, basically … That’s why we’re really happy to work with them.”
Commenting on the funding in a statement, Dr. Jürgen Eckhardt, head of Leaps by Bayer, added: “Investing in breakthrough technologies that drive digital change in healthcare is one of the strategic imperatives for Leaps by Bayer and for the entire field of healthcare. Ada’s truly transformative technology, combining powerful artificial intelligence with an emphasis on medical rigor and high levels of clinical accuracy will lead the way in helping more patients and consumers in achieving better health outcomes sooner by intervening earlier in their healthcare journey.”