Opportunities for Impact: Building & Investing in Digital Platforms for Mental & Behavioral Health, Chronic Disease, & More | LSI Europe '23

Transcription

Imran Hamid  0:06  
Good afternoon, everyone. Thank you for joining us, at the session, I understand it's just post lunch. So hopefully we'll keep the energy high and keep you entertained and enthralled by the conversation it's going to follow. And in the absence of that, you might hopefully have some questions for us at the end of the session. So I'll do my brief introduction, then hand over to my esteemed panelists to introduce themselves. Thank you, Henry. As you will know, my name is Imran Hamid one of the senior investment principles at life arc ventures. We're a UK based venture fund operating underneath a large medical sciences charity, we invest across the full spectrum of Life Sciences, Biotherapeutics health tech devices digital and I myself am a board member of two companies in the space Affects Therapeutics based in the US that specializes in substance use disorder management, and surgery hero who offer services to optimize people's journey through their surgical care. And with that, perhaps I'll hand over to Heather.

Heather Roxborough  1:04  
Hi, everyone. So I'm Heather Roxborough. I'm partner at OSE, so I lead our healthtech vertical. We are a venture builder and a series a two series D investor and the health tech space. We've got a billion dollars under management and have been on the go for about seven years with 10 portfolio companies, a number of which are in the mental health space.

Imran Hamid  1:29  
Thank you very much

Jordi Ferrer  1:31  
Hi everyone. Thank you for attending the session. My name is Jordi Ferrer, I'm investment director at chip two ventures ship to be is an impact venture capital fund based out of here out of Barcelona. Basically, we provide an impact angle to healthcare investments. This means that we are technology agnostic and pathology agnostic we are we have identified three vulnerable communities which are elderly people, people with chronic diseases and people with impairments and we invest in solutions that improve quality of life of this these communities. In an early stage, so we are basically are just getting investors from series seed to Series A.

Guillem Masferrer  2:12  
Hello, hi hello. Guillem Masferrer, partner Asabys Partners, probably you have heard about Asabys during the morning. Early stage VC based in Barcelona started in 2018. With the idea of investing in human health innovation across technologies across stages, across reputed carriers, we have a pretty agnostic mindset. And the idea is to find solutions that in a way can help patients feel better. We are managing close to 200 million euros across two funds. We're currently fundraising our second fund. And from our first fund, we have several investments that relate to today's topic, a couple of them in the mental health space, some others in the chronic care space. One of them actually, an Asabys company that we're going to be probably discussing a little bit in the coming minutes. Yep, pleasure to be here.

Xavier Palomer  3:06  
Good afternoon. I'm Xavier Palomer. I'm the founder of Amelia Vitual Care. Although today I'm representing XRHealth because we just matched with a US based company. Which, you know, coming from Amelia going from Spain, Barcelona, I think is one of the success stories on the digital health environment in Europe, definitely in the south part of Europe. We have built the virtual reality tool for mental health professionals. We have customers in more than 50 countries, very solid, go to market strategy, of course, science, clinical validation, etc. And we were lucky enough to partner with some of the funds that are represented here today. And they helped us grow the company all the way to become one of the leaders in the world, and making sure and helping us managing with his US based company. And today we can I think we can proudly say that thanks to all of us. We are the largest Victoria it therapeutic platform in the world with a goal of really growing to grow very, very fast in the coming months. And hopefully, you know, making our investors happy very, very soon.

Imran Hamid  4:23  
So thank you for the introductions and first question to get us started. I'd love to get your reflections on. What do you personally look for in potential companies in this space, in terms of things that excite you things that you think may help differentiate businesses you may be investing or operating? And do you think there's opportunities to do more than just having a single technological approach, for example, combining technological approaches? Heather, perhaps if you'd like to start?

Heather Roxborough  4:52  
Yeah, I'm happy to. I think for us, what we're really looking for is not just the technology but Have a clear understanding of what the value proposition and the commercial model is. I think oftentimes, we are not good at doing that at a seed stage. So I think for coming to really stands out, they think without from the from the start, I think personally, I'm also keen to understand what they're good at market is not just in the UK in Europe, but also US. I think the US market is much bigger, and we're seeing companies thrive there. And some doesn't see that Amelia has also gone there as well for that for that reason. So I think that's the second element. And I think the the third is, we're trying to avoid point solutions. So we've seen, I think the first wave in digital health was very much point solution based. And I think by the customers looking for platforms, as platforms that will succeed. So we're looking to see opportunities that have the potential to extend across multiple use cases and give a platform position.

Imran Hamid  5:55  
Thank you. 

Jordi Ferrer  5:57  
Yeah, from from our side, very similar, I would say that we mainly look at two things. And both are equally important. And kind of contradictory. First of all, you have strong clinical validation. And these, of course, he's expansive, the other part of it is good commercial traction, or at least some commercial traction. And this probably the most difficult part because it's kind of a gray area, there's the market access, you know, so it's not so clear. And we are seeing nowadays, some companies that are not succeeding their business model so so we only look for these companies that are able to succeed in both probably the more successful ones, or the ones that are either able to prove good evidence by as a standalone by themselves. But we are finding also many of them that can be also coated in with other existing drugs.

Imran Hamid  6:59  
Thank you. And Guillem.

Guillem Masferrer  7:02  
Just trying to extend a little bit the I mean, I definitely agree with with both of them, probably, I mean, at least the way of doing things that we that we have at Asabys, we basically, we always try to ground our investment decisions on this really needs to be a real impact on patients. So the evidence, the clinical and medical evidence, it's fundamental for us. However, it's true that with the different, you know, range of technologies currently available, there might be different ways of making therapies accessible for patients. And this is something that we always try to find, which would be the best mix of the evidence that is out there in the market, or the the evidence that the scientific teams in our companies are doing together in finding a way in making this real solution that it's actionable for patients, for professionals and to get inside the whole complicated healthcare ecosystem in a way that it's obviously at the end, turning into summary financial results for finance investors, no. So it's a complicated mix. It's many, many things that that come together. But yeah, that's what we are most interested in.

Imran Hamid  8:12  
And Guillem a follow up question, if I may, there are a number of different solutions that have already hit this sort of space over the years. Do you think there's room for new companies? Or do you think it's the case of companies that exist now proving they have the ability to scale?

Guillem Masferrer  8:23  
That's a great question. I mean, you know, all of us, as investors receive many, many new opportunities constantly, we see a lot of things that are kind of a copycat or try to replicate some other, you know, more or less successful solution that has happened, for instance, in one geography and replicate in another. We see this all the time. It's true that the larger the largest players, currently, the ones that have a platform with different products, let's say across therapeutic areas, or across indications are the ones that might be from economies of scale point of view, easier for them to get successful, but so that sometimes just focusing into developing one product, the right way, might be able to make that team capable of creating the best solution out there. And so I think it's a combination to be opening to new technologies, point solution technologies, but always having the mindset that probably without the platform, it's very complicated to scale.

Imran Hamid  9:20  
Great. Thank you. And Xavier, your thoughts on that space? And how you achieve that? Obviously, as the only operator on the panel.

Xavier Palomer  9:28  
Yeah, I think, you know, healthcare is a very complicated market. You need to do the clinical validation, as they said, you go to you need to go through the regulatory aspect. Without users have the development phase right then then you need to go to the market and convince providers to somehow use or prescribe your brother, whatever you want. And finally patients to use it right? So it's a four, if you want, to simplify the four step process. It's very, very are complicated and you need to be successful in all of them, you cannot fail in any, right. So it's you know, but at the end, the the end goal is to actually help patients and to help patients, you will need to have everything but having a very solid go to market, right. So from an operator perspective into thing, think on the platform and point different ways on approaching the problem. But you need to have in mind also that you need to be successful in these four stages, right. And when you talk to investors, you need to make sure that this is somehow explained easily, because as they said, they look a lot of deaths, that the eggs with a son needs to be good, it needs to be simplified and explained very, very easily to make sure that everyone is on the same page.

Imran Hamid  10:45  
And following up on Heather's comment talking about the merits of a platform based solution versus a more siloed approach. What were your thoughts when going through that sort of process, particularly the experience at Amelia Care? Were you conscious of that? And did you have a preferred view or a strong view that on one versus the other?

Xavier Palomer  11:05  
Since day one way bet on that platform approach. And actually, the match that we just did with XRHealth, it's also a validation of that right? To give you a short answer to that when you talk to a customer in a hospital or clinic or healthcare provider, and you come from the virtual reality space, if you have a solution, let's say they want to treat mental health, physical therapy, like different conditions or areas. If they need to treat if they want to treat all of these different conditions with virtual reality, and you don't have a platform approach, they will need to be dealing with like, let's say you have five benders, five harbors five headsets, flat five logins, flat five, invoices five, customer service, five, blah, blah, blah, that makes the life more complicated, right. And as a, as a technology or product provider, you don't want to make the life of customer more complicated, right? So following this, I think it makes, you know, makes a lot of sense to actually come to the provider to the end client, saying I'm a platform, and if you work with me, you are going to have a solution for ABCD, etc, right. But you need to keep in mind that focus, it's important. So you can not be everything but nothing. And also, although I think it's better for the customer, in our case, that healthcare provider, it's more complicated internally, right? Yeah. What's the what is the focus?

Imran Hamid  12:38  
And the Heather, just reflecting on that. Do you have a view on what looks good from a differentiation or defensibility perspective? In this space? As we said, there are a lot of companies that look very similar at face value, what sort of techniques? Or what sort of propositions have you seen that make you think, okay, that's a really unique approach and how to create that differentiation/defensibility?

Heather Roxborough  12:57  
Yeah, I think it's interesting question. So I think we're actually seeing a lot of Me Too's to the pan this point. So a lot of companies are focused on lower acuity, anxiety, a mild depression. And I think it's very hard to differentiate there, they have tried to differentiate around ways to get better therapists and platforms around some business models. But I think it's actually very challenging. I think where we're seeing differentiation is in the hierarchy building opportunity. So in severe mental illness, where the the need is very strong as a bit of white space, we're also seeing it in some what I would call more niche indication. So we have recently invested in a company focused on binge eating, which is, you know, might appear small, but actually is a chronic condition with 4 million sufferers in the in the US, but one actually, that's very poorly served. We're seeing at the CME in the rise in the autism space, and children's mental health. So I think there's opportunities to, to extend into areas where actually the very large, underserved markets, I think what we need to do is stay away know from the wellness, anxiety, lower acuity opportunities, which are just flooded as very hard to see how you can have something's differentiated. 

Imran Hamid  14:17  
Yeah, that makes sense. And surely just falling on for that comment. Certainly, I've seen companies who've got a mixture of technology. So it's not only just the healthcare service, but maybe they might have a digital therapeutic, possibly a medical device, they may prescribe sort of treatments. Do you have a view on whether that wave differentiation is helpful? Or do you think that just creates more noise in the market?

Jordi Ferrer  14:40  
I think differentiation is critical and is very connected to what Xavier was saying. So the fact of having a platform gives you the opportunity to leverage on this platform to be able to have specific products that differentiate with each other. For instance, we have a a portfolio company that is exclusively focused on psycho oncology, right? So it's focused on psychological symptoms for oncology patients. And this is a niche per se that provides huge benefit, therapeutic benefit to these type of patients. If you go to if you don't differentiate yourself, then you end up with more generic solutions that provide less value to specific conditions, you're not able to help them as much because you're not connected, as much as much to their real needs are their real pains.

Imran Hamid  15:38  
And again, just reflecting on that differentiation, you know, one of the key things we're looking for as investors is how to scale these builds businesses, I wonder, Guillem, have a view on what you've seen work well, to scale these businesses, and where there are preferred business models that you get more excited about are attracted to as an investor.

Guillem Masferrer  15:58  
So I think, again, it would depend on on the on the on the, on the vertical or the industry itself. No, at the end, I'm just reflecting a little bit on my my colleagues comments, I think it's really important to identify what's the real problem that you're trying to solve as a company, or as a product? I think, just focusing maybe on the on the mental health space No, in our current world, in which two out of three people or 60% of the global workforce suffers from some sort of mental health problem, being able to understand how can how can there be real therapies or real impact for those people suffering with technology or with products that might be out there in the market, I think that's critical finding a way of matching this gap or bridging this gap between supply and demand. For us, it's, we are all the time trying to find, trying to invest in companies that in a way, try to solve this kind of problems, not more of a you can get super creative in trying to find a very interesting or breakthrough business model or go to market strategy. But the reality proves that you can be able to place your solution into the final user or patient. That's what we are most interested about.

Imran Hamid  17:11  
Sure. I know some businesses, they typically tend to work directly, or compete against existing providers to try and get primary reimbursement from a payer. Others try to work with the provider and effectively help them to resell their services, do you have a view on whether one is better than the other or preference and sort of what approach might be more scalable.

Xavier Palomer  17:34  
And in obviously, just I mean, I'm investors are people coming from the traditional healthcare space reimbursement is such a milestone and in being able to get your solution directly reimbursed, and doctors to be able to prescribe without affecting the pocket of patients. This is this is obviously it is a grail. However, it's complicated. I'm not just thinking on the more digital solutions, the path, the regulatory path on the, let's say, the, the the clinical and regulatory development that companies need to do in order to get that it's still unclear. And we might be almost 8-10 years into this market. And nobody has been able to kind of crack the code. So again, it all depends on I mean, we like to think in a flexible way in this regard, trying to find a way that a solution is really available for patients, let's find a way to do that. But that will depend company on company, and maybe

Jordi Ferrer  18:29  
If I may, just to add some thoughts to it. So I do agree completely with Guillem. And I do agree that we are eight to 10 years, far from from getting this the sector established. But I always think of so we were just mentioning before the clinical evidence that we are requiring for these type of solutions. I'm talking digital now, where we you just mentioned staging, where we are in terms of getting reimbursement, as you said, it's great. But there's a huge difference compared to other sectors such as life sciences or molecules, which is patentability and protection, which digital. On one side, it's and unfortunately, it doesn't have it because it doesn't have this protection, therefore, you can not charge that much. On the other side, it's better, or you should be better for the patients because it provides equity and accessibility for patients. So the question I have a question here for you is that are we really going to see a reimbursement market for for these solutions? Or will we have new partnerships or new channels that are going to end up providing these solutions to patients? Because I really wonder, I wish

Xavier Palomer  19:43  
I knew the answer. I don't know. I again, I think it's what it's undeniable is that digital technologies have proven to improve the access to therapies for patients. I think this is something that all of us are seeing every day where This is gonna turn into something that could be patentable, reimbursable? I don't know, but I think that by proving that these technologies can really impact the health of people in the long term, this is going to count from one way or another. But I don't have an answer, unfortunately.

Imran Hamid  20:15  
And Xavier just reflecting on that same conversation? Are there things that you feel that you've done well, at immediate virtual care that in retrospect, you hadn't expected? You know, there were surprises to you on the journey? And in retrospect, are there things you might have done differently to get that reimbursement or commercial adoption more quickly? 

Guillem Masferrer  20:35  
That's the question, right? I mean, what we've seen lately, and you've seen that different IPOs that we've seen in the space lately, the go to market, I mean, you can get the reimbursement that you can get the code, you can get whatever formality you want. But that's not the end goal, you have a long path, and we've seen companies, you know, failing, loads of resources, failing in that stage, right. So digital health, I think we still need to find our way, you know, and reimbursement is what has been there forever. And eventually, this will evolve for digital digital health, right? I think, you know, if you prove that you have a therapeutic value, so you can improve that the patient, whatever. Somehow, this has a value, right? How do we pay for it? Because at the end of the day, we are for profit organizations, startup is a business. So we need to we need to generate revenue, we need to generate profit, right? Is reimbursement the only path? Well, today, yes. Is it working? Well, a lot of question marks that, in our case, we've been, you know, trying to do this reimbursement path forever, in a lot of different ways. Bottom up, top down, bottom up, creating your own codes, talking to whatever you need to talk to create your own code, using existing codes to get paid or to get out to allow our customers, therapists to get paid when using our tool. It has been easy, no. It's just more the it's the it's a solid path that is going to work for everyone in the future. I don't think so. Is the only thing that we have today? I think so as well. So I think in digital health, we really need to have any mental health specifically, you know, strong focus on how to build businesses out of a digital solution. Right? When you ask for that, what's the difference? Or how do you differentiate your product company from other out there? I think today Honestly, the only answer I don't think it's IP, don't think it's technology. Think it is having a solid go to market. No one has proved in the world to have a solid go to market and digital health. Right. So the first one that kind of achieve that somehow. I think that's going to be a game changer. Right? We've seen a lot of monetary reimbursement, like paper value based care, like different ways. Right. But I think in the future 1 2 3 10 years, I don't know. But the difference, the real difference is going to be the go to market. Right. Yeah. 

Imran Hamid  23:23  
Heather, I see you reaching for your microphones. Looks like you've got something to add there. 

Heather Roxborough  23:27  
Yeah, no, I think it's really important point. Right. So I think it's actually no cookie cutter approach to market access for for digital health products in the US. And so we see a reimbursement one route, it's a really tough one that companies are struggling with. So with with payer, and Achille and others, it is not easily. We're seeing actually quite a bit of creativity and innovation in the business models. We're seeing some companies thinking about being selling to self insured employers as a health tech service, rather than as a product. We're seeing others going on as a pseudo providers and network provider, selling to, again to payers, and it just seems to be that the companies in this space, there's not whenever you ask like what what is the the key? What was the best approach, there is no one best approach. And I think it depends on what your product is, who your customer is. And then you just have to innovate around it. And for some of the companies, actually they have two or three different commercial models that are actually running in parallel. Because they can't, you know, figure that out, either. So I think it's going to be an interesting one. But somehow I suspect that reimbursement is one of the toughest paths. 

Imran Hamid  24:38  
Yeah. And this wasn't mentioned in the introduction, but I know in your previous life, you're at Optum. And I'm curious from that perspective, when you think about exit or strategic interest from potential acquirers. At what stage do you think companies become attractive on how do they optimize that sort of ability to look attractive for an exit?

Heather Roxborough  24:57  
Yeah, so I think it depends on who they, who they are exitting to. So if it's to a not US health insurer, I think it's really clear, you just have to have very strong ROI data to show that you can significantly reduce the total cost of care in a population that they really care about. So if it's a big cost burden to the insurer, and you have a path to actually reduce that cost, that's the driver. I think it's very different. If it's, if it's pharma, as a acquirer, or or medtech. We're seeing some provider acquisitions, but but less of those, I think most of the big exits we have seen, actually in the US in the digital health space has primarily been, if not IPO, but to US insurers based on that ROI data.

Imran Hamid  25:44  
And do you think there's an opportunity? Question for anyone on the panel that there might be a roll up sort of play here whereby it's not natural that necessary insurers are provided themselves are acquiring and but secondary growth funds or private equity funds will step in this space to do consolidation? Do you? Do you feel that's a possibility or any signs that they may be happening? Jordi.

Jordi Ferrer  26:06  
I personally think so. And we are already seeing it in certain fields. For instance, in imaging, diagnostic imaging, we are seeing already some consolidation probably more expected. And and going back to the beginning, right, if we're talking platforms, definitely, they will need to be consolidating.

Imran Hamid  26:24  
Yeah. Do you think there are cultural limitations, particularly in the mental health of chronic disease space that may make it harder to do those roll ups? Again, thinking about people's own perception of their disease? How that sits within them as an individual, that community society as a large Do you think there's, there might be some barriers there for mental health that make it hard to roll up across borders? I don't know, if anyone has experienced of companies operating across multiple jurisdictions where they've sent that or seen that bit language or cultural barriers. And anyone can answer that question.

Jordi Ferrer  26:59  
I think that's an outstanding question. I would tend to say, yes, of course, there are their natural barriers for these for these solutions. But

Heather Roxborough  27:11  
Yeah, I mean, it's a really interesting question, it made me pause to think. I've had a couple of portfolio companies that has gone from European markets to the US. And I've seen vice versa. And actually, the the core product is largely the same, because the core problems largely the same, there has to be some, you know, UX UI adaptation. But actually, the the problem experienced by the patient, I think, is the same across the board. And so if you can get that the user experience and engagement, I guess, adjusted for the cultural variation, then I think that's, that's fine.

Imran Hamid  27:48  
Yeah. Yeah. 

Heather Roxborough  27:49  
It's an interesting question. 

Imran Hamid  27:51  
Xavier or maybe,

Xavier Palomer  27:52  
Just to build on that, because I was thinking that it's, it's, it's a paradox that happens all the time in the healthcare space that sometimes, even if you prove that a solution can be really improving life of people, health of people, at the end of the day, being a company producing that solution does not depend merely on that in order to be successful, you need to get in through different complexity, across geographies with the different healthcare ecosystems, the different reimbursement schemes or payers, providers, hospitals. So at the end, you can even have the best product in the world and receive all the evidence supporting that this is the best thing that you can give to a patient. And it might not be enough now. So we live in this world, this is how we do. And we need to navigate each of these complexities every day, 

Guillem Masferrer  28:37  
I think to add to that, just remember, when Facebook Meta was created, right, they were they had no revenue, they had no business model at all. The goal, there was a common trend in the digital health in the digital world, like just reach this like massive market, and then you will figure out how to make money out of it, right? Maybe healthcare know what we are trying to do, like generate some kind of value. Because Facebook, Facebook had some value at the time we were all at Facebook, right? Maybe not today, but some days ago. So they had some value, right? And at the end, they found a way to monetize it, which delays like at publicity. Maybe healthcare is not a good example. Right. But at the end, what I'm trying to say that we know that we are generating value, right, for the patient, for the provider for the community for that. We don't really know how to monetize that. Right. And I think that the biggest challenge, right, and regarding the regulatory aspect on that it's difficult to build this value on different geographies with different regulatory landscapes healthcare systems. And try to create value everywhere with a no without a clear like monetization process go to market business model, as you mentioned, right. So I think we are kind of facing that situation today, especially in mental health, right? We've seen a big, big change in mental health in the last three years since COVID. But we're still way behind other like health care areas, right.

Imran Hamid  30:15  
Any questions for me? I've been asking you all the questions, do you turning time to turn the tables and seek your revenge? If you wish?

Heather Roxborough  30:23  
So what do you think the amount of the Optum business model digital health company should take?

Imran Hamid  30:28  
I think, you know, it's, it's almost a repeat of what you said, I think, you know, it's interesting, right? You've got people who have been very focused in getting employer coverage through insurers, etc, trying to sell through employee benefits. And you've seen some people do that pretty well, I think quit genius are one of the first who really got in under the radar of doing smoking cessation, using CBT, and an app and they got some great traction. And they, I think they dodged the bullet of a lot of people taking a very convoluted and complex approach to the market, the prescription digital therapeutic route, so that that serves this routes, with very quick coverage and reimbursement through employers, I think was a quite a good, good way of going about it. I don't know if that lends to natural scale, though, because actually, some of you may have noticed, they've rebranded to Pelago. And they're now going to the substance use disorder space, broadening out trying to get reimbursement direct from payers. So I think that's almost your example of they've tried one commercial route, they've got to a scale, and now they're trying to get into even greater scale by flipping into a broader, broader space. The other dynamic I've seen is management companies who've had experience as bricks and mortar providers coming out of that setting, saying we're going to do something in digital, right. So they know all the operating standards, they know the governance that's required, they know how to get state by state licensing, and they've got all the payer relationships, and they know the pain points the payers have. And I think that's quite a smart move. There are a few companies out there that are doing that, and have got what looks like quite formidable traction, I may or may not be an investor in one of them. So that's something I've seen. And the people I think I'm most worried about, and I think this came up in the panel previously is, a lot of the people doing very cool it low level, consumer grade anxiety, depression management, where there's just not enough substance or depth. And they're the ones I think are going to probably burn out of this space, and probably not have a great future ahead of them. So I think, you know, it comes down to those who are forging their way to get the deepest possible links into the healthcare system through payer reimbursement, and working alongside providers so that the example I was alluding to, they've gotten a position where the payers that they have coverage with and now using them as the primary point of triage for all their patients. So they do the triage, they hold on to the patients they can serve. And if they can't eventually pass them on to other providers, the typical very high acuity patients who need inpatient care, I think that's quite a smart way of doing that. But yeah, that was my, my own personal experience, others may have see something else.

Heather Roxborough  33:08  
I have another question. 

Imran Hamid  33:09  
Oh, god, okay. I'm gonna regret this. But okay.

Heather Roxborough  33:11  
I'm just curious what the what the panel thinks around the markets to go to scale. So I flagged that for us, we typically look to prove, prove out in our home market, the UK and then look to the US to scale, but we're seeing some of the changes in Germany, some of the changes might be brought in France and Belgium. Is that changing the panelists thinking? It's making me pause? And I consider I was just curious for everybody else.

Guillem Masferrer  33:38  
Maybe you can speak to that we have one of our portfolio companies is actually a listed company, we're about to be finally set in the reimbursement scheme in Germany. So a company called CardiaCare, developing a digital IPS treatment. And it's interesting how I mean, first of all, how this whole market has evolved in the last three, four years. And even with the availability of these reimbursement schemes for these kind of products, that they really prove that they can have an impact on patients. prescribers are not so keen on making available this kind of therapies that might even complement some pharmacological treatments are available to patients. It's something that it's still kind of obviously need some some time probably too, for everybody to adopt it. But I think it's good that this kind of political decisions or strategies happen across Europe. But at the end of the day, companies with an aim of scale, they still look at the US as the principal market to go to, for I would say, ROI, probably of investment in scaling, and the capacity of just by taking one model it can help you in Get into many, many different patients or users No. So it's complicated. I would like to see a bit more of effort, political efforts in this regard than to try and to kind of find ways to make things a bit more widely spread within Europe and more synergistic. But I think we still some years from that to happen.

Jordi Ferrer  35:22  
So I completely agree with with Guillem. But as I found we try to, we have our vision is that the healthcare sector of 10 years from now, is completely different than from what we're seeing today. And we have DEGA, we have brought in France, many countries in the UK, there's already some some regulation for digital solutions us as well. They are trying and it's good. And they might not have the attraction expected they will improve for sure, they will iterate. But I'm sure I mean, the the guys who are going to have our constant monitoring through our watches through the way we write emails, or the way we post images are other guys that we're not contemplating. And these are the tech guys these are these are the ones that are going are already have our digital biomarkers. And these guys are going to redefine healthcare in a way that we just don't imagine yet. And I think we're going to talk about just speaking of mental health, now we have an image of mental health, from the clinical point of view, right from the diagnose, you know, illness that can be diagnosed, such as depression, anxiety, or if you want cognitive or other cognitive disease. But we're going to see other new disease that might not need a doctor involved, which are social isolation, for example, which is a huge, a huge illness. And as a matter of an example, social isolation, someone over 50 years old, with social isolations, has four times more likely to likelihood to have a stroke than a healthy person. This is exactly the same increase as someone who smokes 15 cigarettes. So it's a it's a huge disease, we're just not recognizing it from the formal healthcare point of view. So answering back to your question, or which market are we looking we of course, we are, in the very short term, we are very, we are looking very closely those markets that are trying to implement whatever is closer to reimbursement. But we don't think that this will be the final solution. So we are looking at traction at longitudinal data at companies that are able to capture patients that are treated like consumers rather than just patients.

Imran Hamid  37:58  
Yeah. Great. Well, look, thank you so much for all of your insights and being so candid in the discussion. And we have time for a question from the audience. That's a fantastic question. And for those who didn't hear the question was about how, how do you reduce attrition effectively in the use of apps, people are very quick to download and play with them, but not necessarily keep engaging? I don't know Heather whether you're because you're at right, Guillem, Xavier, perhaps?

Heather Roxborough  38:23  
No, I think that's a fantastic question. And the even more important, because it's one of the business models, when I seeing coming through, you only get paid per engaged user. And so of being able to have a UX UI that is really appealing and to hook patients is super important. What we're seeing now is companies taking some of the, I guess, the the new home from Apple, and other consumer companies, and actually applying that to the whole product experience. And that's what's driving the engagement. But it is, I think it's really hard for companies that have come from this from a really clinical perspective, because they feel they've got a product that works clinically in a clinical trial settling. But when it goes into the real world, you know, it's just not what a patient wants to do every day. And so jumping that chasm between a, I guess a clinical trial product, and to a consumer facing product is one I think it drives success. But it's not, it's not easy to do. 

Xavier Palomer  39:23  
And to add to that, you have a clinical validation based on product A, society evolves, UX or user experience or whatever evolves as well. So then the clinical trial that you conducted with product day is different on eBay, because you have evolved the UI. So you need to go through all the, it's an infinite cycle so an excellent question. I don't think I don't have an answer this, but it's definitely an excellent question. But by the way, we've seen that in pharma companies as well, that didn't just call it didn't in pharmacological right? In digital products, we see the same, right. So it's not just that our problem, I'd say is a product is a problem across that all different places. Right?

Imran Hamid  40:13  
Fantastic. I don't know if we have time for more questions. Gentleman at the front. Yeah, please feel free to ask questions. So the question for those who didn't hear was whether there's room for innovation around the treatment of addiction.

Guillem Masferrer  40:26  
I think now's the time to sell XRHealth.

Xavier Palomer  40:31  
So it's a very good question. Addiction is a very complex problem, right? And you need to face it a lot of different ways. For example, virtual reality is a good very good technology to actually help on on craving, right? Addiction is not just now I have a problem is like once I have that need of, no?, Virtual Reality is a very good example that, but addiction is a very complex problem is not just that the problem, the addiction problem is also your environment, right? Friends, family, whatever. So we need to target that from a lot of different aspects. Specifically in digital health, I think, you know, we all have smartphones in our pockets, right? So I think digital can help you in a lot of different ways. on a very regular basis, you will have it in your pocket help, some kind of a help, right? And going to what my lead investor asked me to do, I think virtual reality is a very good, a very good solution for craving, which is one of that process that you need to follow, right. But it's a very, very complicated problem. And it needs to be targeted from a lot of different aspects, social, behavioral, a lot of different aspects.

Imran Hamid  41:46  
Great. So finally, thank you very much for all your engagement, both the audience and the panel, and we'll hand over to the LSI team. Thanks very much.