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This article is part of Inc42’s Startup Watchlist annual series where we list the top startups to watch for 2018 from industries like AI, Logistics, HealthTech etc. Explore all the stories from ‘Startup Watchlist’ series here. You can also explore the Healthtech Startups Watchlist 2019 here. In May 2016, a Forbes article written by VC Dave Chase stated 98% digital health startups (globally) to be walking dead and synonymous with Zombies. He feared that these startups are unable to go beyond angel funding and lack resources to scale ahead. Fast forward to 2017, one can easily witness the change in the scenario. As per an August 2017 CB insights report, globally, the sector attracted over $10 Bn funding with the market moving closer to consolidations, indicating the rise of big powers. Another report reveals that since 2016, $4.3 Bn has been invested in Asia HealthTech across 296 deals up to and including Q3 2017.ace. Traditionally, Healthtech startups were associated with those providing diagnostic, enterprise, medicine delivery solutions, etc. However, a new breed of startups has emerged trying to solve issues on the root causes such as the consumer lifestyle, mental stress, early diagnosis of genetic disorders and even reducing the after effects of painful processes such as chemotherapy in the recent years. These startups are not only bridging the gaps between the doctors and the patients but are also creating an ecosystem to facilitate a better and faster healthcare environment. How The HealthTech Sector Fared In India According to a recent PWC report, India ranks among the top 10 global growth markets for nutritional food and beverages. Further, the Indian healthcare market, which is worth $100 Bn, is likely to grow at 23% CAGR to reach $280 Bn by 2020, as per a Deloitte 2016 report. A rising middle-class, state-of-the-art healthcare facilities, expert physicians, and increased dependency on technology to facilitate healthcare at the prevention stage are driving the growth of the industry in India, thereby expecting the industry to attain double-digit growth. According to a United Nations Population Fund report, the number of people aged 60+ in India will increase from 100 Mn in 2011 to 300 Mn by 2050. And of these 300 Mn, 200 Mn will suffer from chronic ailments such as cancer, cardiovascular diseases, diabetes and more. Another report reveals that at present the average medical expenditure of Indians in a private hospital comes to around INR 32,375. Moreover, if we talk about life-threatening diseases such as cancer, then, according to a 2004 research, the spend in a home increases 36-44% more than in other households with similar demographics. Thus, opening up doors of opportunities for healthtech startups trying to disrupt untapped niche sectors in this space. As per Inc42 DataLabs, in 2017, Indian healthtech startups raised about $346 Mn across 111 deals. A significant contribution here is although made by online pharmacy startups such as Netmeds which secured $14 Mn funding. In addition, the other startups who are already leading the brigade of Indian healthtech ecosystem include 1mg, Medfinder, Curefit, Practo, Curofy, Portea Medical, Medgenome among others. As we will soon be stepping into another year, let’s have a look at 11 healthtech startups (raised less than $30 Mn funding), handpicked by Inc42 DataLabs team, which showcase the similar promise to grow and keep their flags flying high in 2018. Indian HealthTech Startups To Watch Out For In 2018 Consure Medical Founded in 2012, Consure Medical is a medical device company focused on developing medical devices for the management of critical care and long-term care patients. This product emerged from the Stanford Biodesign program. It is fundamentally catering to the $7 Bn fecal incontinence market with a differentiated product and aims to innovate a technology platform that would augment the way infection control and wound care was being approached in hospitals and in homes. Fecal incontinence (FI) is the inability to control bowel movement, leading to the involuntary and untimely release of feces or flatus. As mentioned on the startup’s website, hospitals lose millions of dollars in poor clinical outcomes, withheld Medicare reimbursements, and missed quality targets due to fecal contamination. Although FI is a benign condition, its clinical complications such as bed sores and cross-infections are often devastating to both patient and the care provider. As claimed by the founders, they have a unique distinction of being one of the few emerging market medical device companies to have both US FDA clearance and granted patents in all important markets including USPTO. Its first flagship product is Qora, which is a stool management kit specifically for bedridden diarrhoea patients. After raising an undisclosed amount of Series B funding in May 2016 from investors such as Accel Partners, Indian Angel Network, India Innovation Fund, and India Venture Partners, the startup is paving its way ahead into the international markets such as Japan and the US. There are more products in the pipeline that the company plans to launch in the next one to three years. With an initial focus on patients in ICUs and general wards, Consure Medical plans to move to enhance care in step-down units, nursing homes, and at-home patients. Consure Medical is trying to tap an opportunity in one of the most niche sectors of healthtech industry and is filling the much-needed gap. The low-cost products developed by the company will certainly give the company an edge in both the local and global markets and it would be worth watching what other innovations this healthtech startup has in its kitty to create a hygienic environment for over 16 Mn Indian and 100 Mn global patients worldwide. DocTalk DocTalk is a mobile application that allows users to safely save all their medical files and history on the cloud so that they never have to carry their files again. A part of Y Combinator’s Winter 2017 batch, the startup aims to work on an AI-based, on-demand virtual assistant application to simplify the Indian healthcare ecosystem. Using the app, patients can also chat with their doctors and get prescriptions on-the-go. The platform also services doctors by preventing revenue leakage, while also assisting them in maintaining relationships with patients. As Co-founder Akshat Goenka shared in a blog post on Medium, “We started reading up on the Indian healthcare ecosystem and some of our most basic assumptions were proven drastically wrong. We quickly realised that there is a great opportunity to simplify problems but the deeper we looked, the greater the problems seemed.” Within a span of two years, the startup has now extended its presence in Delhi, Mumbai, and Hyderabad. DocTalk’s messaging platform has been availed by up to 500 doctors and more than 30,000 patients as of November 2017. Also, it has raised $5 Mn in a funding round led by Khosla Ventures and Matrix Partners India. A report by KPMG and the Organisation of Pharmaceutical Producers of India (OPPI) points out that more than 75% of India’s pharmacies, around 60% of hospitals and 80% of doctors are located in urban areas. As pointed out above, the startups like Doctalk are thus filling the much-needed gap and are trying to provide a better doctor to patient ratio in a densely populated country like India. Grow Fit According to the World Economic Forum, in India alone, over 6 Mn lives are lost every year due to lifestyle diseases. And the economic burden of lifestyle diseases has been estimated to be over $4.58 Tn by 2030. Launched in September 2015 by Jyotsna Pattabiraman, Grow Fit is trying to address this gap with its healthtech platform. It aims to help over 300 Mn Indians who are at risk of contracting lifestyle diseases, with its expert coaching, health foods and behavioral insights. The platform consists of a group of nutritionists, food technologists, counsellors, technologists, and product people who want to use the power of the mobile to make health a daily habit. It now offers its solutions on three fronts: the diet chart; a range of packaged foods that is available online; and, in Bengaluru, a central kitchen that makes and delivers food in the city. In September 2016, Grow Fit also entered the functional beverages field with the acquisition of Drink King to expand its offerings to areas including expert health advice, customised diet plans, therapeutic and functional foods, and nutritional beverages. As of June 2017, the company claims to have an 80% success rate. As per a company statement, the Grow Fit mobile app has been downloaded over a million times (Android and iOS) and delivers about 10,000 healthy meals a day in Bengaluru currently. The company uses data science and machine learning to identify and validate strategies for customer success. In its endeavour, Grow Fit has been joined by investors and mentors such as Manipal Education, Medical Group (MEMG), SAR Group, The Grover Trust, Krishnan Ganesh and Meena Ganesh of GrowthStory as well as Dr. Ranjan Pai, the MD & CEO of MEMG and Kris Gopalakrishnan, co-founder, Infosys. Moving ahead in 2018, we will be watching Grow Fit on three fronts - its novel approach, investment in R&D, and its technology platform. With Indians gradually getting concerned over their health and looking for convenient measures, the segment is expected to further expand only, thus opening up a number of opportunities for Grow Fit. Further, Grow Fit has the ability to address both national and international markets. iGenetics Launched by the trio from Actis PE, having over a decade of experience in healthcare investment, strategy and marketing areas, iGenetics is working in the area of bringing better tools in the hands of the future medical community. The startup offers clinically relevant differential diagnosis panels in addition to a highly accurate range of individual laboratory tests specifically in areas of critical care, oncology, gynaecology, and infertility. iGenetic is housed in an ICH, NABL, and CAP compliant laboratory with its central processing laboratory spread over a 10,000 sq ft facility in Mumbai with satellite labs across the country. According to a company statement, as of March 2017, the startup offers 1,400 tests, including advanced tests for cancer, infertility, and infectious diseases as well as routine laboratory tests. As claimed on the company’s LinkedIn Page, iGenetic has the capability to develop many in-house tests and products which are not available in the market today with several "first in the market" tests already commercialised. The company has so far raised $20.48 Mn, with major $19.5 Mn secured in March 2017 from CDC Group Plc, the financial institution run by the UK government, and the Manipal Education and Medical Group (MEMG), who have together pledged to invest $74 Mn in healthcare networks and service providers in India, Africa and South Asia. The future-ready generation is looking forward to solutions like these to cure genetic diseases. It will be worth watching how far iGenetic can take its innovations in the coming years. NIRAMAI The year 2017 has gone extremely well for NIRAMAI. In just one year, the startup has been selected to be a part of Google Launchpad Accelerator, Philips HealthWorks Accelerator Programme, and Axilor Accelerator Programme. Not only this, it also received a backing from Flipkart founder Binny Bansal, pi Ventures. Ankur Capital, Axilor Ventures, and 500 Startups. This startup, led by two women co-founders Dr. Geetha Manjunath and Nidhi Mathur, bundled in itself over 25 years of research and innovation expertise in areas such as data analytics, machine learning, cloud computing, semantic web as well as years of nurturing from serial entrepreneurship. NIRAMAI stands for Non-Invasive Risk Assessment with Machine Learning. It is working on a non-invasive, radiation-free, painless and low-cost, cancer-screening solution. As per facts, 95% of breast cancers are curable if detected early. Yet 76,000 women die in India alone and more than 700,000 globally, every year, as stated by the company in an official statement. NIRAMAI is thus on a mission to create a universal cancer screening method that can save lives by detecting breast cancer at an early stage. NIRAMAI uses artificial intelligence over thermal images to address the issues of early detection of breast cancer. The overall hardware-software solution is portable and uses big data analytics, artificial intelligence and machine learning for reliable, early and accurate breast cancer screening. Their method of screening is based on principles of Thermography that can detect tumours five years before mammography or a clinical exam can. As per a February 2017 report of CB Insights, globally deals with healthcare-focused AI startups went up from less than 20 in 2012 to nearly 70 in 2016. And like we said above, the incorporation of IoT, AI, and machine learning in the healthcare industry is further opening up doors for the startups like NIRAMAI to experiment and put forward innovative solutions for rare diseases. The recent recognition received by NIRAMAI in Amazon AI Awards further indicates the same. NeuroSynaptic Neurosynaptic offers proven ehealth and mhealth technology solutions that bring together products, partners, and processes in the healthcare delivery ecosystem. It develops a point-of-care diagnostic device capable of performing dry chemistry tests including biochemistry tests, electrolyte tests, HBA1c, etc. The company aims to enable access to affordable healthcare in rural and semi-urban areas, using its cloud-based telemedicine platform called ReMeDi (Remote Medical Diagnostics). The software claims to provide screening and primary diagnosis by connecting patients with doctors. As claimed by the founders, not only does ReMeDi connect the entire fragmented ecosystem for last-mile delivery, but it also offers several features like workflow configuration, and the latest sensor and wireless communication technologies. The startup raised an undisclosed amount of Series A funding round in October 2016 from Indian Angel Network (IAN), Healthquad, and Axilor Ventures to gain international certifications and to expand business in Africa and Southeast Asia. According to World Bank 2015 report, around 67.25% of Indian population still resides in rural areas. However, only 2% doctors are available to cater to their needs, making the availability of medical facilities at the right time a daunting task.ReMeDi digital health solutions aim to improve this situation and has successfully demonstrated scale on the ground. As shared by the Neurosynaptic team at the time of Series A funding, in near future the startup can bring on the platform products like SaaS-based, pay-per-use telemedicine and mhealth solution as well as ReMeDi-NOVA to revolutionise the last-mile healthcare access. OncoStem Diagnostics India is said to be the largest contributor of cancer-related deaths in the world with around 2.2 Mn people falling prey every year due to this deadly disease. As per doctors, 70% of the cancer patients take consultation at the terminal stage and of this maximum times, only 30% are curable. Also, there remain the chances of relapse. OncoStem Diagnostics is trying to fill in this gap by providing personalised cancer treatment planning through the development of tests that predict the chance of recurrence in patients. It also helps patients to stay away from the costly and painful treatment of chemotherapy and its toxic effects. Their lead product ‘CanAssist-Breast’ - ‘Morphometric ImmunoHistoChemistry’ (mIHC) test, can predict the risk of recurrence for HR+ breast cancer patients from Stage 1 up to Stage 3A. Currently, it is available in India, Sri Lanka and Bangladesh. It also claims to have helped close to 50% of patients to avoid the severe side-effects of unnecessary chemotherapy. Patients can update their details and request a test report, after paying the fees on its website itself. In addition to CanAssist-Breast, OncoStem will soon launch another test for patients suffering from Triple-Negative Breast Cancer (TNBC). Also, the startup is working to expand its presence in new markets in Asia as well as Europe. Also, it aims to deepen its R&D efforts, develop effective tests for oral, brain and colon cancer and automate these tests. Recently, the startup also received the much required financial thrust of $6 Mn from marquee investors such as Sequoia India and Artiman Ventures. Going ahead, the technology and pricing of OncoStem can fundamentally change patient access to such cutting-edge tests, which have been prohibitively expensive in most markets globally so far. Also, the biomarkers discovered through OncoStem’s predictive analysis of cancer recurrence will help pharma companies in developing new targeted drugs. The way OncoStem is leading its way to develop affordable and innovative tests to accurately predict the risk of cancer recurrence, it can become a crucial tool for doctors in the near future to lay their hands on an actionable blueprint for personalised treatments. PharmEasy PharmEasy stands for Pharmacy made easy. It not only helps patients and their care-takers connect with the local medicine shops but also offers free sample collection service for diagnostic tests by authorised phlebotomists. The startup claims to ensure that medicines are delivered within six hours of prescription validation by a licensed pharmacist. The app also has an in-built dosage reminder for users. Further, in case a patient does not have a prescription, the PharmEasy team connects with him/ her and provides a valid prescription. The firm has tied up with nearly 700 doctors across India. Since its launch in 2015, this Mumbai-based startup has expanded its presence to 700 cities and 2000 pincodes with over 150 partner vendors. As of April 2017, the company has a network of 100 offline retailers and various licensed pharmacies to deliver medicines, free of charge, on submission of a valid prescription. PharmEasy has also tied up with a number of diagnostic centres across Mumbai, Delhi, and Kolkata to provide diagnostic services. The startup claims that its partner retailers are compliant with FDA rules and regulations. The healthtech startup works on a commission-based model. And if all these internal traction numbers are not enough, have a look at this. Earlier this year in April 2017, the startup also raised $16 Mn from a clutch of investors including Bessemer Venture Partners, Orios Venture Partners, and Ascent Health And Wellness Solutions. Some media websites also reported that PharmEasy has raised an add-on funding round of $2 Mn over Series B led by Trifecta Capital and Astarc Ventures, taking the total funding raised so far to $23 Mn. Post raising the funds, PharmEasy also announced to expand to four more states such as Maharashtra, Karnataka, West Bengal and Tamil Nadu and enrol a total of 1 Cr families on its platform by the end of 2017. As per reports, the startup is currently serving 20 Lakh families with a team of 600 and plans to raise 200 more tech people in next three months. Within past few years, the startup has evolved from a pure transactional flow to now being heavy on educating the customers on the process, which will further improve the rejections and cancellations on the app. As shared by the founder in an earlier interaction with Inc42, there were over 35% rejections and cancellations at one point, which have now reduced to 25%. Earlier plagued by regulatory hurdles, the online pharmacy market which is worth $78 Mn - $93.6 Mn (INR 500 Cr- INR 600 Cr), is now paving its way towards a smoother road. Going ahead in 2018, we expect the Indian health ministry to further ease of the path for these startups. As of now, e-pharmacies have already got a mention into the Niti Aayog’s three-year roadmap and have also got validation in the draft pharmaceutical policy released by the government earlier this year. How well PharmEasy will be cashing upon these opportunities in the upcoming year, will be worth watching. SastaSundar SastaSundar.com is a digital network for managing healthcare, pharma, and wellness product supply chain. It acts as a channel for connecting doctors, diagnostic services, health care clinics, and health information services. The focus is on using knowledge and digital connectivity to reduce cost and make the availability of high-quality medicines convenient. The digital network of the platform is built on the O2O model of healthcare delivery and inventory-less service centre of the franchise called Healthbuddy. Launched in 2013 by BL Mittal, the startup recently raised $5 Mn funding from Japanese pharma company Rohto which will also assist the startup in scaling its operations across pan-India. As per a company statement for the year ended March 2017, the GMV of SastaSundar.com was $23.6 Mn (INR 153 Cr) and it claims to have delivered close to 1.7 Mn orders. The company claims to have about 178 Healthbuddy stores with 440K registered customers. Currently operational only in West Bengal, this Kolkata based startup gearing towards a $100 Mn national expansion plan in next two-three years. Also, the platform aims to have around 250 Healthbuddy stores in West Bengal and 50 Healthbuddy stores in Delhi by March 2018. The expansion to other cities will be dependent upon the response it will receive post the rollout of its services in New Delhi. SigTuple Launched in 2015, SigTuple aims to create a data-driven, machine learned, cloud-based solution for detection of abnormalities and trends in medical data for disease diagnosis. The startup looks to revolutionise the global medical diagnostic space through data-driven intelligence. SigTuple has developed a continuous learning platform powered by AI for healthcare, ‘Manthana’. It allows SigTuple to ingest visual medical data from different devices and to train, validate and execute AI and ML powered models to classify various objects of interest, detect diseases and compute the metrics for reporting. Currently, SigTuple is using Manthana to provide solutions for automated analysis of peripheral blood smear, urine and semen sample, retinal scans and chest x-rays. Another solution by SigTuple, Shonit™, has already undergone three clinical trials. It will soon be available for user adoption. Other solutions are in advanced stages of development. According to a company statement, SigTuple’s solutions will allow labs and hospitals to scale by implementing a hub and spoke model, where the medical experts can operate from the hub and devices, can be installed in spokes. Also, the initial focus is on the solutions for the screening tests so that the startup can positively impact a larger population not only in India but globally as well. In February 2017, the startup also raised $5.8 Mn in Series A funding round led by Accel Partners, raising the total funds raised so far to $6.54 Mn. Not only this, recently during the Global Entrepreneurship Summit being held in Hyderabad in November 2017, SigTuple also showcased its product before PM Narendra Modi and guest of honour Ivanka Trump under the most innovative startup's category. It is a DIPP recognised startup and has also been part of Google Launchpad Accelerator’s fourth batch selected in May 2017. The Indian diagnostic market is expected to be worth $32 Bn by 2022. However, the market is still very fragmented and lacks proper guidelines and regulations specifically for upcoming new age healthtech startups. But, now that startups like SigTuple are being recognised by the government, there seems wider opportunities to grow in near future. SigTuple is using innovative technologies such as deep learning and neural networks to predict any future illness in a person and has showcased a good average revenue run rate so far, which in long run can provide an edge to the startup amidst its fellow competitors. Tricog In India alone, 5 Mn people suffer heart attacks every year and 3 Mn of them don’t survive. Forget rural areas, the average time it takes to diagnose a heart attack even in urban India is 360 minutes. The chance of survival with this delay is a mere 20%. If this delay were reduced to 90 mins, the survival probability jumps to 80%. Founded by Dr. Charit Bhograj, an interventional cardiologist with over 16 years of experience, Tricog is an attempt to achieve the same. The Tricog team has built a cloud-based ECG machine, and appointed a team of doctors who can sit at a centrally-located hub 24×7 in Bengaluru. The idea was to allow any doctor at any remote location to take the ECG data of the patient using this machine and send it via the cloud to the Tricog team of doctors. The product and the services are offered on a pay-per-use model, so it also solves affordability issues for even small general practitioners. Also, the business model enabled Tricog to scale and reach even the remotest of locations. The Tricog team began with Karnataka and is now slowly expanding to Andhra Pradesh, Telangana, Tamil Nadu, Kerala, Maharashtra, and Delhi. It also raised an undisclosed amount in Series A funding from Inventus Capital Partners, Blume Ventures and other angel investors in August 2016. In September 2016, it also became the first startup to be selected by GE Healthcare’s accelerator, five.eight. Healthcare diagnosis was historically a major problem due to the costs involved in procuring the diagnostic hardware. But in the age of cloud-based service provision, healthcare has the potential to go through a paradigm shift for the better. The innovators in this field have been working on similar issues, but the ones which are able to provide the most cost-effective solution will most likely prosper in a developing country like India. And we believe, Tricog to be one such startup. While these were the Indian Healthtech startups to watch out in 2018, stay tuned for next edition of Startup Watchlist, where we will be featuring Indian Media & Entertainment startups to watch out in 2018, click here for more stories! [The startups mentioned above have been selected on editorial discretion, our interactions with the startups and other industry veterans.]

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