By Sebastian Seiguer, Co-Founder & CEO of Scene Health
We recently announced big news — the completion of a $17.7M financing round led by ABS Capital Partners with participation from existing investors Claritas Health Ventures, as well as Healthworx, the innovation and investment arm of CareFirst BlueCross BlueShield, PTX Capital, and Kapor Capital.
This is an incredible opportunity for Scene Health (formerly emocha Health), and it comes with a very serious obligation to use these funds to impact many more people’s lives than we do today. With this funding, we’ll be able to drastically scale our impact to support millions of people who struggle with chronic and infectious conditions and continue our work to solve the $500B problem of medication nonadherence and prevent unnecessary hospitalizations and deaths.
As we celebrate this development, I can’t help but reflect on our journey to this point and the foundational attributes we’ve honed along the way.
We’re Tackling Medication Nonadherence, the Most Insidious Cause of Mortality and Cost in Our Healthcare System
Medication nonadherence is an entrenched, decades-old issue that kills thousands every year and leads to the steady worsening of deadly chronic conditions. If it were only a matter of correcting behavior, it would have been solved long ago — but this is not the case. Medication regimens can be complex, and there are gaps in patient understanding of how to administer them. Socioeconomic factors (the ability to afford medications, transportation issues, and access to care to name a few) clearly hinder success.
We work to solve the nonadherence problem by partnering with Medicaid and Medicare managed care plans, public health departments, pharmaceutical companies, and clinical research organizations to help people succeed on life-saving medication regimens by scaling and enhancing Directly Observed Therapy (DOT) with video technology.
The rest of the healthcare system is slowly coming around. Just last month, the CDC recognized that video Directly Observed Therapy (video DOT) — part of what we do at Scene — is equivalent to in-person DOT. The announcement received little fanfare because the update primarily affects public health departments and their patients. However, it is the first-ever example of an asynchronous video visit achieving official equivalence to an in-person appointment. This parity is not just for billing purposes — clinical efficacy and patient-centricity of asynchronous video are at the heart of the change.
There are big implications for all conditions in which medication is critical to outcomes. At Scene, we envision a world where the standard of care for chronic conditions includes at least some video DOT. A great example is medications for kids with solid organ transplants. To this point, we announced a $1.6M grant award to support work with the University of Florida and Florida State University heart transplant experts last week. Thanks to funding from the NIH, every child with a heart transplant in Florida will have access to Scene, and we’ll continue building our library of peer-reviewed journal articles reflecting on the success of our program.
We Have Roots in Public Health Research
DOT, the model of care that is the gold standard for medication adherence support, involves a meeting of the patient and healthcare provider at every dose to secure adherence and mitigate problems such as side effects. Every single dose administered in the clinical setting (hospitals, urgent care, etc.) is administered using DOT. In the outpatient setting, the standard has been considered too expensive to implement and has therefore been reserved for two conditions that are considered matters of serious public health concern: tuberculosis and addiction therapy.
All of that changed in the early 2000s when a team of Johns Hopkins infectious disease researchers launched global research efforts in Africa, India, and Latin America. To help in these efforts, the team at the Hopkins Center for Clinical Global Health Education ideated a mobile platform to support healthcare workers caring for patients with an infectious disease far afield. They named the platform eMocha: electronic mobile comprehensive health application. In 2008 the first application of eMocha was successfully launched for an HIV project in rural Uganda despite a challenging setting — no internet connectivity and limited cellular availability. The project's success led to a series of high-impact studies across the globe by 2013, with implementations in Bolivia, Colombia, Tanzania, Uganda, and India.
Co-founder Morad Elmi and I met Dr. Bob Bollinger, Jane McKenzie-White, Dr. Larry Chang, and Miquel Sitjar in 2013, introduced by the Johns Hopkins Technology Ventures group and identified an opportunity to use the technology to revolutionize DOT. But first, we needed to solve three major issues to take DOT to scale.
We’re Scaling All Aspects of Directly Observed Therapy
The first issue was obviously geography — bringing a patient and provider to the same location is expensive, and patients often lack transportation. This issue could easily be solved with secure video. The next issue was less obvious, but the key to scale: synchronicity. Those with limited financial resources often have complicated lives that do not match the hours of operation of our healthcare providers for routine care. How could you have a video visit with someone working all day in the fields with little to no internet access for such a call? Even if you could somehow technically support a daily video visit, scheduling was complex for short visits, and no-shows or late shows would limit the scale. The answer was asynchronous video, in which each party to the visit would record their part. The final issue was tricky to quantify. In public health departments, DOT is not just about “observation” - it’s a model of care that relies on compassion and person-to-person support to help the patient complete a brutal six to nine-month regimen with their life at stake. No matter what, the public health ethos of accompaniment and support would have to be woven into every aspect of our company and platform (to see what I mean by this latter point, watch Bending the Arc, a documentary about Paul Farmer and his team at Partners in Health).
By January 2014, we went live with emocha Mobile Health Inc. through the Dreamit Health accelerator program in Baltimore. We found a brave physician-scientist in Dr. Maunank Shah, from Johns Hopkins, who was running and still runs the Baltimore City Health Department’s Tuberculosis Control program. Dr. Shah was convinced that removing geography and scheduling barriers using asynchronous video would work for his patients, most of whom were non-English speaking immigrants working hourly jobs. By April 2014, we were using our version 1 mobile application to help the parents of a 4-year-old complete video DOT without having to take her to the health department every day. It worked! By September 2014, we were operational in Harris County, Texas, the country’s third-largest county, spanning more than 1,700 square miles and including one of the largest tuberculosis populations in the country. By early 2015 we had proven to Harris County that they could save millions of dollars while maintaining a standard of care.
We’re Evidence-based, with no Compromises on Scientific Rigor
In 2017, early adopters of our video DOT platform were proving that adherence rates using Scene were just as high as those secured with traditional, in-person DOT. Evidence was critical — the infectious disease academic community relies on peer-reviewed poster presentations and publications to make changes to the standard of care. Using asynchronous video was very controversial, as a lot was at stake. Tuberculosis remains a major killer outside of the United States, and efforts from 1970-2000 have dramatically reduced the scale of the disease. DOT was a major part of the disease elimination strategy, and it worked. At the same time, it’s very hard to change a routine, and the mobile app approach insulted many who believed in-person support alone drove adherence rates. They were right and wrong. Technology cannot replace care, support, and evidence-based practice. But it can amplify people’s efforts and overcome logistical barriers such as distance and time. In 2017 CDC publications issued within a week demonstrated that Scene Health helped public health officials secure extremely high adherence rates in the most challenging situations — one during Hurricane Harvey in Texas, another showing the effective stop of a TB outbreak in a mental health facility in Puerto Rico. Finally, Dr. Shah and his team at Johns Hopkins published one of the landmark papers in this area, demonstrating comparability between video DOT and in-person DOT and cost-effectiveness.
Since then, we’ve had 19 peer-reviewed publications demonstrating that we can help people across chronic and infectious conditions. We have gone to great lengths to study the acceptability, feasibility, and adherence impact of applying our technology-enabled gold standard of care to people with other conditions. Today, we’re proud to support patients across multiple chronic and infectious diseases, including diabetes, asthma, cholesterol, opioid use disorder, hepatitis C, tuberculosis, hypertension, solid organ transplants, and sickle cell disease. We are proud that more than 25 completed, ongoing, or planned independent clinical research studies and trials are using our platform to support adherence.
The latest is a new qualitative study published in Addiction Science & Clinical Practice showing that Scene’s video DOT platform (as emocha Health) can help those suffering from Opioid Use Disorder avoid the challenges of continuing treatment by removing the timing requirements, travel burden, and stigma associated with in-person care.
We’re Focused on Health Equity
At our founding, we were very clear in our focus. Our mission is to help those that need the most help to succeed on medication regimens. It is no coincidence that every single peer-reviewed publication you will find involving Scene Health documents an attempt to improve the lives of people facing the most challenging conditions and circumstances.
It’s been a constant in our work from our origins in Uganda to our efforts supporting public health departments and now our work with under-resourced Medicaid populations. When asked how Scene Health addresses health equity, the answer is that the company’s mission is to have the greatest possible impact on the lives of others, with an exclusive focus on those who need the most help first. It’s in our DNA.
We Have a Holistic Approach
Our differentiator is our combination of world-class, novel technology with a compassionate virtual care team of pharmacists, nurses, and health coaches, combined under an evidence-based model of care. Taken all together, our people, science, and technology represent a holistic approach to supporting medication adherence that we call Panorama.
Panorama is more than just DOT. Over the years, we’ve enhanced DOT, adding pharmacist interventions such as Comprehensive Medication Reviews (CMRs), small financial incentives, motivational interviewing techniques, and the power of human connection. For payers and providers, it’s a window into the home, and for patients, it’s personalized coaching and support.
Altogether, our approach improves true adherence (not just the refill rate), achieves better outcomes, and identifies and addresses social determinants of health at the root of medication challenges.
We’re Backed by Great Investors, and We Have a Clear Path Forward
Along with our clinical validation and real-world success, our recent wins are proof that what we’re doing is working. We have been fortunate to work with excellent investors who believe in the Scene Health vision and back us with capital and know-how. I’m excited to partner with ABS Capital for the next chapter of growth.
At Scene, we’re uncompromising in realizing our vision for a world where people have the support they need to successfully take every dose of their medication, and billions of dollars of preventable hospitalizations and countless deaths are history.
This funding will fuel our journey to getting there.