Scalable Business Models in Digital Healthy Longevity:

Lessons from Top-Funded Digital Health Companies in 2022

Wasu Mekniran

1,2 a

and Tobias Kowatsch

2,3,4 b

Centre for Digital Health Interventions (CDHI), Institute of Technology Management, University of St. Gallen,

Switzerland

CDHI Department of Management, Technology, and Economics, ETH Zurich, Switzerland

Institute for Implementation Science in Health Care, University of Zurich, Switzerland

School of Medicine, University of St. Gallen, Switzerland

Keywords: Scalable Business Models, Digital Therapeutics, Healthy Longevity, Companies, Demographic Impact,

Prevention, Treatment, Investment, Venture Capital.

Abstract: Digital health companies can address significant healthcare challenges and mitigate the demographic impact

on the health system. Healthcare value delivery becomes increasingly complex based on multiple health

problems, different treatment methods and payment schemes, various care methods, and payment schemes;

therefore, scaling up a healthcare solution is not trivial, especially for new companies. To explore the business

models of the top-funded digital health companies and analyze the respective scalable element of their value

creation and delivery processes, this study systematically used venture databases and a business model

framework to describe top-funded companies. Then, we performed literature and desk research to specify

which business model elements helped them scale up. As a result, we identified ten top-funded companies in

the field; our main findings suggest that these companies scaled up by developing a platform for a wide range

of users, in contrast to specific demography and disease. We recommend that new digital companies in healthy

longevity prioritize employers in customer acquisition and align incentives between patients and payers with

the help of digital health data to improve transparency on return on investment.

1 INTRODUCTION

In recent years, much research has focused on a

particular aspect of digital offerings on health

outcomes (Safavi et al. (2019), Salamanca-Sanabria

et al. (2022), Wang et al. (2021), Nebeker et al.

(2020)). Still, little work has been done from the

perspective of the business model. However, previous

studies have shown that business elements such as

cost-sharing schemes can affect patient engagement

and health outcomes (Kaplan & Milstein, 2019).

It remains to be seen how companies, especially

new private companies in digital health, should

deliver their healthcare services. A business model

can be a guide tool for creating and capturing values

sustainably in a rapidly changing landscape such as

digital health. To this end, we need to research and

discuss how innovation in business models could

https://orcid.org/0000-0001-5184-0438

https://orcid.org/0000-0001-5939-4145

create a new way to address longevity challenges,

namely preventive care for non-communicable

diseases (Winston et al., 2016). Therefore, companies

can ease the stress on our healthcare system by

reducing disease treatment costs. Moreover, at the

same time, it increases the effectiveness of digital

therapeutics on health outcomes.

Despite the rapid growth and widespread adoption

of the digital health industry, most offerings focus on

disease management rather than prevention (Cohen et

al., 2020). Furthermore, the health outcomes of digital

therapeutics with patients and its effectiveness should

be better studied (Safavi et al., 2019). Finally, digital

health interventions need a suitable ecosystem for

their introduction to become genuinely efficient

(Essén et al., 2022) and ultimately to increase the

chance of scaling up the business.

Mekniran, W. and Kowatsch, T.

Scalable Business Models in Digital Healthy Longevity: Lessons from Top-Funded Digital Health Companies in 2022.

DOI: 10.5220/0011778400003414

In Proceedings of the 16th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2023) - Volume 5: HEALTHINF, pages 609-615

ISBN: 978-989-758-631-6; ISSN: 2184-4305

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

609

Furthermore, trustworthiness in digital

therapeutics (De Santis et al., 2021) and cost-sharing

models of health plans (Kaplan & Milstein, 2019)

need to be addressed to increase user participation;

this further underscores the importance of suitable

business models for digital health (Grichnik & Hess,

2020), as they can significantly affect actual health

outcomes of the demography. Therefore, it is

necessary to research specific business models to

guide our current system toward healthy longevity.

The purpose of this study was to identify and

investigate private digital healthy longevity

companies worldwide as they successfully scaled up

and addressed concerns about healthcare delivery,

such as access to care and reimbursement of

treatments. Furthermore, this study will contribute to

any company that aims to innovate its business model

in order to build a sustainable revenue model.

Subsequently, this article describes the research

methodologies and frameworks used for analyzing

companies with digital offerings for healthy

longevity. Subsequently, the study results suggest

scalable business elements for each target company.

Specifically, our research asks: (1) What are the top-

funded companies offering healthy longevity DTx?

(2) What services are companies offering? (3) To

whom are companies offering services? (4) How do

these companies scale their services?

2 RELATED WORKS

2.1 Demographic Health Impact

Life expectancy is now nearly double the average of

100 years before. Considering 150,000 years of

human history, our longevity today is nothing less

than extraordinary (K. M. Murphy & Topel, 2006).

Our healthcare technologies and practices enable us

to reduce medical risk and treat acute diseases more

efficiently (Fleisch et al., 2021). However, this led to

a cost that our generation may not have considered, a

cost to stay alive. The healthcare system is now at risk

of system failure due to increased healthcare costs

and longer duration of care due to newly achieved

longevity(A. Murphy et al., 2020).

Evidently, one major factor that puts our

healthcare system under severe stress is the high cost

of health management for non-communicable

diseases (NCDs) and common mental disorders (A.

Murphy et al., 2020). The Prospective Urban and

Rural Epidemiology Study (PURE) with data from 18

high-, middle-, and low-income countries indicated

that NCD households spent their effective income on

healthcare significantly more than non-NCD

households, for example, 16% vs. 6% in China. To

make matters worse, as the population ages, they are

prone to suffer from multiple NCDs, and this

comorbidity can alter disease severity drastically

(Wallace & Lemke, 1991). Therefore, healthcare

costs can increase exponentially with multiple NCDs

(Hajat & Stein, 2018).

As eminent concerns rise, WHO declared that a

decade from 2021-2030 will be a decade of healthy

ageing (World Health Organization, 2020). This

initiative aims to address the issues of the ageing

population around the world. Furthermore, it

recognized an urgent need to reform the healthcare

system and promote a better life for a rapidly growing

senior population (World Health Organization,

2020).

To achieve these goals collaboratively and

address functional abilities, WHO set priority action

areas as follows: change how we think, feel, and act

toward age and ageing, ensure that communities

foster older people's abilities, deliver person-centered

integrated care and services that respond to older

people's needs, and provide access to long-term care

for older people who need it.

2.2 Digital Therapeutics (DTx)

As information and communication technologies

advance, it is apparent that digital therapeutics can

contribute to a healthy, long-lasting society (Digital

Therapeutics Alliance (2022), Fleisch et al. (2021),

Jaconson et al. (2022)). Even though the

technological benefits are well received, the current

implementation of digital therapeutics needs to be

personalized to utilize its full potential. Furthermore,

more studies are required on evidence-based DTx

(Kowatsch & Fleisch, 2021). However, it is

commonly agreed that current regulations on DTx are

inappropriate and must be addressed to accommodate

further development and use in a large population

(Ryll, 2021). Here, some countries, such as Germany,

are at the forefront, and some are lacking behind

(Essén et al., 2022).

However, the development and use of digital

biomarkers for DTx is necessary for system

improvement. Digital biomarkers are objective and

quantifiable physiological and behavioural data

derived from digital devices, which can be used to

analyze, change or predict health outcomes (Coravos

et al., 2019). DTx can leverage these digital

biomarkers to enable patients to care for their health.

An essential contribution of DTx is that it allows

users to become healthier as they know the factors

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that influence their health outcomes. In summary, the

development and integration of DTx can play an

essential role in providing more sustainable

healthcare.

2.3 Digital Health Business Models

In a time of rapid technological change, DTx needs a

suitable ecosystem to become genuinely efficient

(Essén et al., 2022). Healthcare practices should value

the health outcomes of patients by collaborating with

multiple stakeholders, such as payers, healthcare

providers, and patients themselves. This requires a

reformation of our healthcare value delivery and

capture models.

We observe novel business models for DTx.

Taking the example of digital mental health

companies and their DTx offerings, we can see that it

is a winner-takes-it-all landscape (Salamanca-

Sanabria et al., 2022). Therefore, DTx companies can

adapt their business model to accommodate

established platforms and bring healthcare providers

and payers together, such as employers and health

insurers, instead of launching their DTx.

Different target customers imply different ways

to deliver and capture value. Therefore, to ensure the

effectiveness of the DTx offerings in healthy

longevity, especially for those hard-to-reach

populations, such as patients with low socioeconomic

status (Mackenbach et al., 2008), the monetary aspect

of healthcare must be closely integrated. In this study,

we will explore such implications concerning the

scalability of business models.

3 METHODS

This article established a three-step process to

approach a systematic business model analysis

similar to the previous work by Salamanca-Sanabria

et al. (2022), as shown in Figure 2. First, the authors

specified a business model analysis framework

throughout the study to avoid putting unnecessary

weight on ideation. This leads to conclusions about

the elements of the scalable business model of the

top-funded digital healthy longevity companies. The

first step is a screening process for top-funded

companies. The second is a business model analysis.

And third is a discussion of findings and insights from

the perspective of a contribution to healthy longevity.

Figure 1: Three-step analysis approach.

3.1 Definitions

Our research defines companies that offer healthy

digital longevity as companies that use digital health

interventions according to the FDA definition as a

tool to contribute to WHO priority action areas; see

Figure 1. The U.S. Food and Drug Administration

(FDA) interprets digital health as a digital tool that

can accurately diagnose and treat disease and improve

health care delivery to the individual, including

mobile health, health information technology,

wearable devices, telehealth, and telemedicine (FDA,

2020). At the same time, the World Health

Organization (2020) defined 'Healthy Ageing' as a

process of developing and maintaining the functional

ability that enables well-being in older age. More

specifically, the ability to meet one's basic needs,

learn, grow, make decisions, move, build, maintain

relationships, and contribute to society.

In this paper, we extend the 'ageing' to 'longevity'

by including offerings that cater not only to the

elderly but also to the total population.

3.2 Inclusion Criteria

Define search categories and terms used in the

Crunchbase venture database to extract related

companies for healthy digital longevity. Keywords

are digital health, longevity, ageing, fitness, elder

care, biological age, health care, and biotechnology.

Our research excluded pre-seed and seed funding

rounds. Additionally, since the business model is

dynamic and considers its environment (Steinhöfel et

al., 2016), our research restricted the analysis to

companies with full commercial track records.

Another reason is to ease the hype effect of immature

technologies (Linden & Fenn, 2003).

3.3 Data Extraction

The authors extracted data related to our research

questions from two venture databases: Crunchbase

and PitchBook. Below are the overall coding logic

and data points captured from the venture capital

database for our private pre-IPO company selection

process on 14 November 2022.

Top-funded

companies

selection

Business model

analysis

Performance

mapping and

impact evaluation

Scalable Business Models in Digital Healthy Longevity: Lessons from Top-Funded Digital Health Companies in 2022

611

3.3.1 Data Coding

This study uses resources, definitions, and analysis

methods to establish a systematic framework.

- Data source: Crunchbase and Pitchbook, as these

venture databases are among the most accepted

by researchers (Retterath & Braun, 2020).

- Categorization: FDA and WHO definitions

- Model analysis: Established business model

analysis framework (Gassmann et al., 2020)

3.3.2 Data Points

Table 1 indicates the data point and its source. For

total funding, we compared two venture databases to

ensure validity.

Table 1: Data points from venture databases.

Data point Source

Company name Crunchbase

Location Crunchbase

Employees Crunchbase

Year founded Crunchbase

Total funding Crunchbase, PitchBook

3.4 Business Model Analysis

Framework

We used the Business Model Navigator (BMN)

framework to systematically assess the top-funded

companies (Gassmann et al., 2020). This framework

was used in favour of others. Such as the Business

Model Canvas (Lima & Baudier, 2017) or the

integrated business model (Wirtz & Daiser, 2017),

because the assessment criteria focus on analyzing

existing models rather than new ideas for business

model innovation. To investigate each crucial

business element, we ask; What are the top-funded

companies offering? Who is the target customers?

How are services delivered? And how do these

companies achieve value?

The BMN framework focusses on recombining

business model patterns rather than inventing.

Initially, we analyze the environment to ensure the

external consistency of a specific business model

rather than focusing on ideation. This approach takes

a neutral role of an analyzer rather than an active

entrepreneur role in Wirtz (2013).

4 RESULTS

4.1 What Are the Top-Funded

Companies Offering Healthy

Longevity DTx?

In Table 2, we identified ten top-funded companies

that offer digital healthy longevity services based on

combined definitions from FDA and WHO. Table 2

also shows that all companies, except one, have over

100 employees and were all founded from 2008

onwards. In contrast to the fact that the venture

market in the USA is four times the size of other

leading markets (Teker et al., 2016), there are

interestingly five non-US companies out of 10

companies in the field of healthy longevity, namely

from India, France, Germany, the Isle of Man, and

Chile.

As the total funding volumes between PitchBook

and Crunchbase have a Pearson's correlation

coefficient of 0.906, which can be interpreted as a

very high positive correlation (Witz et al., 1990), we

then used Crunchbase values for a funding

representation.

Table 2: Ten top-funded companies.

No.

Company

Name

Location Employees Year

Funding

(millions)

1Noo

New York, USA 1001-5000 2008 $ 657

2 Cult.fit Karnataka, India 101-250 2016 $ 624.6

3Ala

Paris, France 501-1000 2016 $ 558.2

4 Omada Healt

California, USA 501-1000 2011 $ 448.5

5 Human Longevit

California, USA 101-250 2013 $ 330

6 Livongo California, USA 251-500 2008 $ 235

7 Juvenescence Douglas, Isle of Ma

11-50 2016 $ 219.2

8Betterfl

Santiago, Chile 101-250 2018 $ 204.5

9Lar

California, USA 251-500 2011 $ 195.7

10 Ada Healt

Berlin, German

101-250 2011 $ 189.5

4.2 What Services Are the Companies

Offering?

The service categories are listed in Table 3, we

observed that each company offers more than one

type of product and service. Digital health companies

made an effort to reduce the barrier to access to the

healthcare they provide by generating multiple

offerings to cover a variety of use cases. For example,

Cult.fit extends its offering from offline gym

membership to digital online fitness courses, covering

mental health consultation and home test analytics.

A closer inspection of Table 3 shows that although

the main category may vary across the list, most

companies personalize their product and tend to offer

telemedicine or personal consulting services. It is a

somewhat expected result, but worth mentioning that,

in addition to Human Longevity, all companies are

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incorporating the mHealth app into their offering,

mainly to communicate privately with users.

Table 3: Services categorization.

No.

Company Name Service Category

1 Noom Consumer Engagement, mHealth App

2 Cult.fit Care coordination, telemedicine, mHealth App

3 Alan Payer Administration, Telemedicine, mHealth App

4 Omada Health Health Management, Telemedicine, mHealth App

5 Human Longevity Analytics, Telemedicine

6 Livongo Digital Medical Devices, Personal Health Tools, mHealth App

7 Juvenescence Personal Health Tools, Analytics, mHealth App

8 Betterfly Consumer Engagement, Payer Administration, mHealth App

9 Lark Health Management, Telemedicine, mHealth App

10 Ada Health Analytics, mHealth App

4.3 To Whom Are the Companies

Offering Services?

Table 4 reveals an interesting aspect: nine out of ten

companies approach corporate customers, whether an

employer, health insurers, government bodies, or

healthcare facilities. So even when your offering aims

at end users who are patients, the service is packaged

so that the company can introduce and integrate it into

their healthcare practices.

Table 4: Target customers.

No.

Company Name Target Customers

1 Noom Patients, Employers, Payers

2 Cult.fit Patients, Employers, Providers

3 Ala

Patients, Employers, Providers

4 Omada Healt

Patients, Employers, Payers

5 Human Longevit

Patients

6 Livongo Patients, Employers, Payers

7 Juvenescence Patients, Providers

8 Betterfl

Patients, Employers, Payers

9 Lar

Patients, Employers, Payers

10 Ada Healt

Patients, Providers

In particular, companies with healthy digital

longevity are targeting human resources to introduce

benefits to improve the organization's brand image

and increase talent retention rate. Alan, Omada

Health, and Lark specify return-on-investment

indicators to illustrate gains for the companies. The

following typical target customer is a payer, such as

health plans; in such cases, digital health companies

aim to integrate them into their customer channel so

that care is effortless from the beginning to the

reimbursement.

4.4 How Do These Companies Scale

Their Services?

Table 5 lists a delivery model of each company. We

follow the classification and summarize our top-

funded companies based on the model classification

in digital health for diabetes from Kikuchi et al.

(2021).

The analysis results can be correlated to the

offerings, where half of the companies act as an

intermediate platform where one stakeholder is

participating in delivering the product's value. Three

companies are substituting previous solutions; for

example, Ada Health offers diagnosis through self-

report questionnaires and replaces the traditional

search method for relevant medical information

online. Human longevity aims to substitute general

disease prediction by collecting diagnostic facilities

in one place, including blood tests, magnetic

resonance imaging, and Whole Genome Sequencing

(WGS).

Table 5: Delivery models.

No. Company Name Delivery Model

1Noo

Direct-to-Custome

2 Cult.fit Substitute

3Ala

Intermediar

4 Omada Healt

Intermediar

5 Human Longevit

Substitute

6 Livongo Intermediar

7 Juvenescence Direct-to-Custome

8Betterfl

Intermediar

9Lar

Intermediar

10 Ada Healt

Substitute

Table 6 is quite revealing in several ways. A

striking observation from the analysis was the major

trend of incentive alignment for payers. Furthermore,

unlike other companies that focus on cost reduction,

Betterfly offers psychological value while providing

benefits for life insurance (payer). Finally, it is worth

mentioning that Betterfly exchanges the digital token

"SweatCoin" as a symbol of contribution, which has

no medical function.

Table 6: Advantages of scaling up

No. Company Name Competitive Advantages

1 Noom Collaboration between providers and payers

2 Cult.fit Physical and digital blending at home offerings

3 Alan The health plan bundle of providers and payers

4 Omada Health Regulation certification and ROI incentive for payers

5 Human Longevity Unique specialization in DNA longevity sciences

6 Livongo Bundle physical and digital with IoT smart devices

7 Juvenescence Research teams on anti-ageing drug

8 Betterfly Societal motivation through a virtual coin exchange

9 Lark Regulation certification and ROI incentive for payers

10 Ada Health High clinical diagnostic accuracy with the A.I. algorithm

To underline the revenue model, it is

commonplace to find that healthy longevity

companies offer corporates a subscription package.

Most services are designed to use subscription plans

to differentiate the population segment and manage

payment for different types of digital health

intervention. An example of a Livongo is the

separation between smart device purchase and

analytic consultation.

Scalable Business Models in Digital Healthy Longevity: Lessons from Top-Funded Digital Health Companies in 2022

613

5 DISCUSSION

The findings of this study clearly show that our top-

funded companies tend to target a whole demographic

rather than a specific type of patient, as they use

advantageous high accessibility of digital offerings.

Furthermore, by using widely adopted

communication technology such as the web or mobile

applications as a channel, companies successfully

reached users with a lower socioeconomic status who

are the most vulnerable to NCDs and common mental

disorders.

One explanation for such a delivery model is that

a digital platform bundles digital and physical

offerings and provides more personalized care. They

have developed multiple key partner relationships

throughout their value chain; some act as a

marketplace to address a broader range of health

continuum; this was also suggested in Feld Birnbaum

et al. (2015) work. Ultimately, this approach reduces

the burden of receiving care and increases adherence

to the care routine.

Capturing value is conventional as a fee-for-

service mor value-based subscription model where

incentives are addressed for patients and payers. In

addition, low-barrier payment methods such as

packages and subscription models are prevalent on all

platforms. A greater variety of payment options also

addresses the concern about access to healthcare care

for users with a lower socioeconomic status.

6 CONCLUSIONS

We identified and analyzed ten top-funded digital

health companies that received 1.730 billion USD in

funding for healthy longevity offerings. According to

our findings, leading digital health companies that

promote healthy longevity successfully scale their

business by offering personalized care to a wide range

of populations and striving to become a one-stop-

service platform for their members.

From a value-delivery perspective, our findings

underline the importance of the direct patient-care

provider network and the low-burden health

interventions set up with existing adopted

technology. In addition, companies that aim to

provide their services to business counterparts made

an apparent effort to increase transparency on return

on investment, especially for payers, with the help of

digital health data.

Although the finite number of evaluated

companies limited this study, it can suggest a more

scalable business model that affects the population's

health outcomes on a large scale; digital companies

offering DTx for healthy longevity may consider

aligning profits of both patients and payers through

scalable DTx—for example, using digital

biomarkers, as a result, tracking and interpreting them

as financial impacts for organizations. In future work,

a detailed analysis of evidence-based health outcomes

should be studied. Additionally, the validity of

implementation in a certain location or a specific

setup should be considered.

CONFLICTS OF INTEREST

WM and T.K. are affiliated with the Centre for Digital

Health Interventions (CDHI), a joint initiative of the

Institute for Implementation Science in Health Care,

University of Zurich; the Department of

Management, Technology, and Economics at Swiss

Federal Institute of Technology in Zürich; and the

Institute of Technology Management and School of

Medicine at the University of St Gallen. CDHI is

funded in part by the Swiss health insurer CSS. CSS

was not involved in the design, data collection,

analysis, or interpretation of the results of this study.

TK is also a co-founder of Pathmate Technologies, a

university spin-off company that creates and delivers

digital clinical pathways. However, Pathmate

Technologies was not involved in this study.

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