Mango Sciences: Ensuring access to innovative, life-saving cancer care for everyone.
For a digital native like myself, contact with the Health Care system feels like going back in time (or sometimes getting shocked with a cattle prod). It is not just the ubiquitous circa 1980 user interface design, it is the stunning lack of modern information technology across all aspects of our Health Care system. Why, in 2021, am I still handed a clipboard full of paper forms when I go to the doctor? Why no personalized medicine? Why is health care so hard to access, especially new treatments? Where are the innovators? It is all very Orwellian with innovators screaming into a void of faceless, endless bureaucracy while patients and doctors trudge along in mindless conformity.
As an investor, I have been on the lookout for pure software innovation in Health Care that can thread the needle between Monopoly/Oligopoly malaise/control and regulatory capture/suppression. By focusing on software that delivers immediate value and doesn’t require regulatory approval I have seen start-ups side-step the Orwellian black hole. At Incisive Ventures, we aim to invest in companies that can get revenue traction and product-market fit in 6-18 months with a couple of million raised versus the > $100M and 5-10 year path for regulatory approval of devices, drugs, procedures, etc.
There are so many areas where Health Care innovation is shockingly behind what we have in our daily consumer lives. Big Tech knows more about me than my wife, but my doctor hands me a clipboard of paper? Another shocker for me is the stunning absence of real-world data or personalization to target treatment options. Medical treatments go through expensive studies (86% caucasian) with relatively small numbers of patients to later be prescribed to millions with no data coming back as to how the treatment performs in the real world. In America, HIPAA regulations, vendor compatibility, and competitive pressures make sharing medical records at scale for data analysis incredibly difficult. Despite being over a decade into the implementation of “electronic medical records” I still get the clipboard, tons of PDF files (data not in a database), and the doctors/hospitals silo the data from each other and me. Modern “big data” analytics cannot be applied to this structurally fragmented data set in the US. This has always struck me as a huge missed opportunity for America, a self-inflicted wound.
Internationally there are more progressive views around medical records as an asset for building a better health care system. Turns out, India in particular has a regulatory environment friendly to this kind of data-driven innovation. That is where I found Mango Sciences with over 35M patient records and a commanding CEO in Mohit Misra. Mango Sciences is using intelligence mined from years of patient records as a platform to drive multiple innovations in healthcare. The first product to be built on the platform was SaaS access for providers and pharma to assist with treatment and drug discovery. The second product to be built on the platform is risk-based financing for (initially) advanced cancer therapeutics in partnership with global pharma. Turns out, a drug that gained approval being tested on a caucasian patient base in the west, may perform differently in the real world of a far more mixed patient environment. Mango’s AI can “underwrite” the efficacy of a treatment for a specific patient based on the real-world outcomes for similar patients in the local market. Not only does this enable payment over time for high probability patients, but for the first time, the price can also vary based on outcomes.
I first met CEO Mohit Misra late in 2020 during the depths of the pandemic. Despite the complications of the pandemic, he became super animated as he told me the “Why” story behind Mango Sciences. Just after becoming a doctor in the UK, Mohit Misra’s grandmother passed away in India from pancreatic cancer. She had not received the same standard of care as she would have in the UK since 86% of cancer care in India is out of pocket and many treatments were unavailable due to costs or regulations. This was compounded over the years as stories streamed in from his extended family of lack of access to cancer drugs (specifically breast cancer) that were the standard of care he was using every day in the UK. Mohit decided to do something about it. He started Mango Sciences. “I fundamentally believe that medical advances should be available for all and there can be sustainable commercial models to do so…this is my personal passion for Mango. If we can make a dent in the inequality of healthcare access across the globe, I will be content in my old age,” he told me.
Mohit’s personal experience with challenges accessing advanced care in emerging markets is, unfortunately, all too common. Over 1 Billion people will be added to the middle class in Emerging Markets over the next decade. While global Pharma expects 31% of all pharma revenue to come from Emerging Markets by 2025, there remains a huge affordability gap as > 90% of health care is Out of Pocket due to lack of insurance coverage. Big data analytics and artificial intelligence promises to help bridge this gap by giving the industry the ability to predict and track clinical outcomes with high probability.
Mango Sciences has built the world’s first and largest Emerging Market database of health data and Real World Outcomes for Global Life Sciences Companies. The platform covers over 35M patient records (and growing) and over 400 providers across India and other Emerging Markets. There are over 1.2M proprietary Oncology-specific records. The platform has been under development for 7 years and started commercialization in 2020. Mango has executed partnership agreements to embed its platform with some of the most recognizable cancer care brands and clinics across India and MENA.
Based on this deep data platform, Mango is pioneering risk-based financing agreements – patients pay for treatments only if they work, by bringing health data and financing together, enabling access to health care for the large and growing middle-class population across India, South-East Asia & North Africa.
For patients, this brings access to treatments otherwise out of reach due to high price points and ensures full price of payment only if the drug has the desired clinical outcome. For Pharma companies, this brings many more patients on novel treatments which grows revenues. We are pioneering the use of clinical data with financial credit scores to bring the best cancer treatments to people who struggle to access life saving care. As this FT article explains, this area is of particular interest to big pharma.
In addition to Mohit, Mango is founded by repeat entrepreneurs and its leadership team includes Doctors, Statisticians, and Technologists who have held advisory/board positions in advocacy bodies and governments including NICE, HIMSS, HL7, and held leadership positions in organizations like Novartis, Merck, Aetion, Religare, Philips, and Premier.
Why I am Investing
Most healthcare investments are not great early-stage investments for individual investors or small funds. Confusing over-regulation, patent minefields, concentrated slow-to-act buyers, meddling governments, anti-competitive practices at every level, drugs and devices cost hundreds of millions before have any idea if they work; count me out. Healthcare has been an industry racked by costly, sluggish companies and products for most of its existence. So how does an investor find innovators that can succeed in this oppressive environment? At Incisive Ventures, we have found over time that there are certain characteristics successful healthcare software innovators share including:
- Operates a software Platform.
- Significantly reduces market friction.
- Run by proven technology leaders.
- Rapid time to market, low/no regulatory burden.
- Creates a product category.
We are investing in Mango Sciences because they are exemplary on all fronts. Lets dig in:
Operates a software Platform .
Mango Sciences has built the world’s first and largest Emerging Market database of health data and Real World Outcomes for Global Life Sciences Companies. This database is embedded with over 400 providers adding more records every eyar. The company is currently monetizing this database through SAAS contracts with providers/Pharma and is delivering its second monetization (risk-based contracts for oncology) in Q1 ’22. They have identified two other products to monetize the database that are in development later next year.
The flywheel of data + AI Analytics = products is working and starting to spin faster. The value of the platform grows over time as they connect more providers, pharma and patients.
Significantly reduces market friction.
Great technology innovation significantly reduces friction in a huge market. How painful was it to get a ride before Uber? Remember when you had to get in a car to buy something? How much more consumption is in the world because of Credit Cards?
The healthcare market is riddled with friction. Lack of real-world data on drug/treatment outcomes. Small, limited demographic clinical trials. Regulations at all levels, especially privacy. Expensive drug discovery process. High-cost products. Opaque pricing. No guarantees of performance. Limited or lacking insurance coverage. To name a few.
Mango Sciences database and applications significantly reduce friction to healthcare in Emerging markets today by:
- Giving providers and global pharma access to real-world outcome data on treatments specific to Emerging Markets. This would be very difficult in the West due to privacy regulations among other friction.
- Improving selection and screening for clinical trials with Emerging Market patients. Most drugs today were developed for and using data from the 1 billion people living in the West which represents 16% of the world’s population, 86% of drug trials are on Caucasian patients, leading to a blind spot of friction.
- Financing reduces friction to purchase anything. Most medical care is unable to be financed today due in large part to a lack of predictive outcome models with which to underwrite. Mango Sciences has built these models, signed financial and pharma partners, and will be launching them in Q1 (more below).
- Very few medical procedures come with any kind of guarantee of performance or outcome from treatment. Mango Sciences hopes to significantly reduce friction for all kinds of treatments through their highly accurate predictive outcome models. When patients can receive a personalized risk-adjusted prediction of how a certain treatment should work specifically for them, friction to purchase should be reduced.
Run by proven technology leaders.
Most health care companies are run by either doctors, researchers or drug/device specialists. Very few of these people understand or live at the pace of our best software technology leaders.
Mango is founded by repeat entrepreneurs and its leadership team includes deep pharma and healthcare experience, but also with great AI pioneers, Statisticians and Technologists. The team has held advisory/board positions in advocacy bodies and governments including NICE, HIMSS, HL7 and held leadership positions in organizations like Foundation AI, Booz & Co, Novartis, Merck, Aetion, Religare, Philips and Premier. The team is all multilingual with the CTO speaking 7 languages. The lead partner at Unlock Venture Partners has known the team for years and has seen them deliver similar complex databases and applications at other healthcare companies.
Rapid time to market, low/no regulatory burden.
While software products that provide medical diagnosis typically require regulatory approval, internal tools do not. Mango Sciences platform is an internal tool for targeting and underwriting.
Mango is in the market generating revenue less than a year after launching their first product. The company has spent 2020 lining up banking, cancer care providers, and global pharma partnerships for their risk-based financing contracts which they expect to launch in Q1 2022. This is very rapid time to market for the health care market.
Creates a product category.
Mango is pioneering a new product category with risk-based financing contracts for Oncology treatments. Consumption of novel drug treatments, especially cancer is significantly constrained in Emerging markets by lack of insurance coverage and/or financing. Underwriters have lacked confidence without a model. Due to expensive treatments and lack of insurance coverage, Emerging Market patients pay between 50-90% of healthcare Out of Pocket. 93% of cancer care in India is Out of Pocket. The market is currently approximately $5B and is projected to grow to $20B with the addition of financing.
Outcomes-based financing is a unique innovation enabled by the database which would be VERY hard for a competitor to copy, leaving the market to Mango Sciences. The innovation unlocks new market spend which would not happen without Mango.
Trends I am betting on
Growth of middle class in Emerging Markets. America is great, but Emerging Markets have more people, lower regulatory burden, and are growing faster. Over 1B people will join the middle class in the next decade across Emerging Markets. While in America the incumbents are very entrenched, in Emerging markets innovators have greater opportunity. Mango Sciences could not have built their solution in America. They have built it in a larger, faster growing market.
Personalized Medicine. Historically medical treatments have been tested on a very small number of patients with very limited real world feedback. As medical records get opened up and patients have a host of wearables, we will for first time be able to medical treatment efficacy across very large data sets. This will usher in an era of personalized medicine that promises to radically improve outcomes. Mango Sciences is on the leading edge in Oncology today.
Fintech for all. Fintech is a “hot” buzzword, but what is it really? It is new financial products that are enabled by technology. New ways to access credit and financial services which previously were not possible without the technology. Fintech grows the overall GDP pie by enabling people to buy goods and services they otherwise would not. One of the critical components of any financial product is a reliable underwriting model that assesses risk. In health care these models have been impossible without access to data at scale. By enabling patients to finance previously unfinanceable health care treatments, Mango Sciences is increasing patient access and delivering new revenue to the health care system.
Why this deal is Incisive
Mango Sciences ranks very highly in key areas of our Meta Themes.
We have great founders creating a novel software platform which is a disruptive innovation. Mango can create new categories of products. Mango can leverage the platform to create multiple products (fintech, drug discovery, patient care, etc.). We are investing alongside smart committed investors we know well. We are very excited to support the company as they increase access to healthcare through software.
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