How a mobile app delivers digital therapeutics to enhance behaviour health and empower kids throughout their chronic condition journey – Interview with Dr. Haljas, CEO of Triumf Health

Digital health care and digital therapeutics providers lead a new chapter in healthcare by utilizing technology to enhance patient care. Personalized patient management programs with novel therapies and services aimed at changing behaviour and influence disease can play a prominent role in assisting patients in a wide range of chronic conditions. 60% of chronically ill children are at risk of developing psychological problems in addition to their underlying condition. Triumf Health is on a mission to support mental well-being of children with chronic illness by delivering digital therapeutics to enhance behaviour health through a personalized health game journey.

The global healthcare market offers thousands of digital health solutions designed to support adult patients suffering from non-communicable diseases (diabetes, COPD & Asthma, obesity, cancer, etc.) and their caregivers. Patients’ testimonials and clinical trials have shown the positive impact digital health care services and digital therapeutics have on disease prevention and management, behaviour change and related outcomes to improve one’s health. However, the market for digital therapeutics and behaviour change for kids with chronic condition is still untapped. Novel solutions designed specifically for this target group have the potential to enhance the behaviour health of pediatric patients and increase the reach of interventions more effectively outside the hospital and doctor’s office, transforming also mental health care in a very personalized way.

We talked to Dr. Kadri Haljas about the importance of the mental wellbeing of children with chronic conditions, Triumf Health’s business model and how their solution is enhancing the behaviour health of pediatric patients, as well as the challenges the company is facing and market trends in the behaviour and mental health space for pediatric patients.

Enjoy the interview!

Research2Guidance: As a short introduction, could you please share Triumf Health’s story

Dr. Kadri Haljas: Triumf Health is a digital health company that is delivering digital therapeutics through an award winning mobile game to enhance the behavioural health of pediatric patients. Designed by domain experts, Triumf health game combines evidence-based clinical research and psychological techniques to assess well-being, encourage treatment adherence and to induce the creation of healthy habits through gameplay.

Triumf solution focuses on the mental wellbeing of children. Currently, one in four children battle with chronic illness and almost every third child is overweight, thus at risk of developing lifestyle associated illnesses.

Although these conditions can be very different in their symptoms and treatment, these conditions are all mentally burdening for children. Evidence suggests that up to 60% of patients with an underlying chronic illness are at risk of developing psychological problems, partly due to unmet health needs. This in turn can lead to decreased quality of life, treatment complications and increased healthcare expenditures. Triumf Health aims to prevent that by providing children with comprehensive supportive care through a medium that is familiar and safe for them – a game environment.

The need for such solution came from personal experience and the lack of solutions in the digital therapeutics sector for pediatric patients. I have both clinical and research expertise in the field of health psychology and started the company in 2017 to address pediatric patients’ unmet needs by utilizing technology.

Since the start of Triumf Health, we’ve come a long way to create an effective and impactful solution that is loved by children and valuable for the care teams. In 2019 we were named as TOP 2 digital health company in Europe by the European Institute of Innovation and Technology (EIT Health) and TOP 20 startup across all industries in Europe by the Startup Lighthouse programme.

Research2Guidance: What is your value proposition and how do you differentiate it from other similar solutions on the market?

Dr. Kadri Haljas: To help children with chronic illness, we need to focus on many aspects: their mental health and treatment adherence, we need to give them health-related information, support their general health, and at the same time empower them and give a sense of success. These components – necessary to induce behavioural change – work only when these are delivered in a way that kids love. And don’t they just love playing games?

We’ve placed a strong emphasis on the narrative of the game, where children need to save the Triumfland city from a Disease Monster, who has spread an illness to the city. By helping Triumfland citizens stay healthy, children are learning more about their illness and healthy behaviours, get personalised psychological support from a virtual friend based on their profile and get rewarded for completing various health-related mini-games and activity-based learning tasks.

Competition & Key Differentiators …
Considering other solutions on the market, we provide the only product that offers an end-to-end solution by combining research-based approach with machine learning, engaging game environment and data analytics. By offering appropriate on-time care and supporting patients in managing their own health we can shift the focus on prevention. Our visual dashboard that can be linked with existing medical information system helps with treatment monitoring, improves medical visit effectiveness and care team communication.

Furthermore, we are launching an application for parents with the aim to give parents information about their child’s health and wellbeing and support their own self-efficacy.

Our innovation is especially valuable because once patients develop mental health disorders in addition to their underlying chronic illness, healthcare expenditures double. At the same time, there is a profound mismatch between the burden of the comorbidities of mental health conditions and chronic illnesses and the number of trained professionals to manage or prevent those conditions.

We aim to relieve the significant issue of vastly increasing expenditures in healthcare in a generally understaffed medical practice.

Research2Guidance: What is your business model?

Dr. Kadri Haljas: Our customers are hospitals (annual license fee to prescribe the game to patients and use the dashboard for monitoring) or health insurance funds (per patient cost with the possibility for the patient to use the solution for as long as needed with the recommendation of two months). We are now also transitioning into B2C model with our parental application. However, we strongly believe that the game needs to be free for patients.

Research2Guidance: How many users do you have?

Dr. Kadri Haljas: Since we have entered the market through research collaboration, at this stage, our user number is in hundreds.

Research2Guidance: What is your engagement strategy – how do you make sure that children will use it long enough to have the desired outcome behaviour change?

Dr. Kadri Haljas: Even though we have three psychologists in the team who either have clinical or research background, we consider the children to be the real experts. They are our partners not only from the perspective of the solution design but also from the perspective of their challenges. By involving stakeholders, we are able to pinpoint the universal issues that they are experiencing. And in our case, since we have involved patients from various countries with different cultural backgrounds, we could identify issues that were independent of the location.

Once we identified the unmet needs, we were able to utilize our own expert background in finding a way to support them. This collaborative process led to designing the solution together. It all started in 2016, before officially incorporating, and today, we are still collaborating with patient organizations in order to constantly improve our solution because we are doing it for ill children. And they are the real experts who need additional support during their treatment process, which is why they have been involved in the solution design process from the beginning.

Forming New Habits …
It takes time for the new habits to form, which is why we recommend kids to use the game for at least two months. Throughout the gameplay, we regularly evaluate whether the new habits are getting internalized. This is the underlying goal of the solution – that kids would take learnt behaviors with them after discontinuing to use the solution. Once the learnt behaviours are internalized, the game has reached its goal. In addition to the recommended dosage of daily gameplay for 60 days, we constantly collect feedback from patients regarding their usage of the Triumf solution.

The game also involves daily notifications – every morning the patients are welcomed to continue using the solution with a “Good morning” message, after which they respond how they slept at night.

Research2Guidance: Are human coaches part of your service?

Dr. Kadri Haljas: One of the benefits of our solution is the fact that it is completely an “algorithmic medicine”, it does not require any human interaction, the environment is safe and intuitive for kids and requires no external coaching. However, we provide training for care team members to give a better understanding of the content of the solution, its personalized path and benefits for patients. Since the solution can be linked with the dashboard for care teams, the majority of the training focuses on that – how the dashboard can be used for remote monitoring, inform the medical visit and improve the communication between the patient and the doctor.

Research2Guidance: Who are your partners?

Dr. Kadri Haljas: We are currently implemented in four hospitals – Tartu University Hospital, Tallinn Children’s Hospital, Helsinki University Hospital and the National University Hospital in Singapore. We have entered the hospitals through research collaboration with the aim to convert this collaboration into customer relationships after successful completion of the randomized controlled trials among various disease groups.

We cater to various disease groups:

• cancer,
• asthma,
• diabetes,
• surgical care,
• overweight/obesity and currently the studies involve hundreds of patients all together.

Additionally, our collaborating patient organizations can use the solution for free upon request until the solution becomes available in hospitals.

Research2Guidance: Do you have proof that behaviour change helps children with chronic illnesses to take better care of their health?

Dr. Kadri Haljas: Chronic illness management usually requires lifelong care and places a great mental burden on the patient. We have already published our research finding that showed the beneficial effects of the Triumf game as a digital intervention: the game was positively perceived by pediatric cancer patients, resulting in high usability and acceptability evaluations. To highlight, participants unanimously gave feedback where the game was described as being easy to use and engaging in terms of gamified activities, while also providing beneficial and trustworthy information. Furthermore, the findings indicated that psychological well-being of the participants improved after the intervention period.

We are currently running randomized controlled trials in Estonia, Finland and Singapore across various disease groups to evaluate the effect of the game as a digital intervention compared to the treatment as usual. At this stage, as the randomized studies in the aforementioned countries are about to end, we are starting a population-based study among overweight children in various European countries with the aim to reduce their risk of developing lifestyle associated diseases. Here one can see our research findings; additionally an award-winning master’s thesis for better theoretical overview and the impact on wellbeing.

Research2Guidance: What countries are you concentrating on and why?

Dr. Kadri Haljas: We have identified our target markets to be Europe and Southeast Asia. In Europe, we are making progress mainly in the UK with their National Health System (NHS). Our mission and outcomes match strongly with the ones laid out by the NHS long term plan, where the main priorities include the mental health of young people and general shift towards prevention. The innovation happening in health tech and digital health in the UK combined with a genuine interest from the system makes it a desirable market to enter. We’ve also scouted the suitability of our application by working together with local experts. We’re also really proud to have the safety and effectiveness of our solution evaluated by international app reviewer ORCHA. Being a top application for children on their platform has given us a lot of credibility and eased the process of negotiating with local hospitals.

We have started from local markets in Estonia and Finland that served as a gateway to the rest of Europe. Thus, in addition to Estonian, Finnish and UK market, we focus on the German and Israel market due to their innovative and welcoming approach towards accepting and implementing digital health solutions in their health care system. Moreover, we see a strong desire from these countries to support children and young people, as more and more focus shifts on their mental health and general health. Health care systems are starting to realise that intervening in childhood leads to happier and healthier adults later on, which is why they are keen for new solutions.

At the same time, we are also implemented in Singapore and we see that market also as the gateway to the rest of the Southeast Asian market.

Research2Guidance: What is your pricing model?

Dr. Kadri Haljas: Our pricing model varies across regions. In the local markets (Nordics), we offer the per patient fee around 100€ for health insurances that are reimbursing the usage of the game as a digital medicine to patients.

In some countries, we enter the market solely through hospitals as they are interested in improving their digital toolset to stay competitive. In such case, we provide the license fee that covers the game for patients and the dashboard for care teams. The annual license fee is of around 50 000€ (actual cost is calculated based on how many patients are treated in that department every year), which allows them to prescribe the game for patients and use the dashboard for remote monitoring.

Additionally, the game can be linked with our parental application that is currently under development, in such case the business model is B2C and applicable in various regions as the solution will be distributed through app stores for Android and iOS.

Research2Guidance: Who do you see as the key competitors?

Dr. Kadri Haljas: Whilst there are a lot of digital therapeutic solutions addressing the needs of adults, there aren’t many comprehensive solutions focussing on supporting the behavioural health of children. Nevertheless, it’s great to see companies using innovative mediums by which to reach children in need. For example, Akili Interactive has developed a science-based video game for ADHD and autism. Similarly, focusing on early intervention and the behavioural health of pediatric patients, Cognoa offers digital therapeutics for the treatment and diagnosis of autism.

Yet, to create healthier futures, there’s still a serious need for innovation to support the younger generations – not only their physical but also mental health and address developmental and behavioural needs.

The lack of available evidence-based solutions for pediatric patients’ places Triumf into a great position to become the global leader in digital therapeutics for pediatric patients. We’re the only solution addressing several chronic conditions through one platform whilst delivering personalised preventative care.

Research2Guidance: What challenges are you facing? Are there any international market specific differences?

Dr. Kadri Haljas: The key challenges are related to the market uptake of digital health innovations. The sales cycle is very long in the case of B2B or B2G models and requires significant stakeholder involvement to reach the set goals. And even in the case of strategic account-based marketing, there are many key decision makers that need to be all essentially sitting on the same side of the table with innovators for the solution to be implemented. Fortunately, at the same time, pediatric health is a highly important societal matter, which is why we have been able to work mainly under grant basis so far.

Research2Guidance: What trends do you see in your market?

Dr. Kadri Haljas: Whilst digital health continues to grow and develop, it was especially great to witness a significant surge in interest and investment to behavioural health, including mental health, in 2019. According to the latest research by Octopus Ventures and Big Health, the quality and volume of seed-stage mental health deals raised rapidly last year, and this trend is expected to continue. The commitment from investors side demonstrates the increased recognition and trust towards leveraging technology to tap into one of the most challenging biomedical areas – the mental health crisis.

In general, the digital health arena is moving towards a customer-centric mindset where the key values are shaped by the needs of patients. What is also interesting to note is that there’s increasing recognition among investors towards clinically-focussed digital health startups, next to fitness and wellness startups. As such, we see a high investment rate into monitoring, diagnosis and treatment of disease.

Research2Guidance: What is next for you? Where do you see the company in the near future?

Dr. Kadri Haljas: Our aim is to become the global leaders in digital therapeutics for pediatric patients. In the following months, we are finalizing our research collaboration, publish the findings and move further into tackling the global crisis of overweight and the health risks related to this condition. Essentially, while looking at the pediatric population size in Europe and Southeast Asia and the fact that every third kid is overweight, every fourth battling with chronic illness, then even if we are able to reach out to 1% of those at-risk children in our target markets, it results in 4 million users. And this is our goal – to provide comprehensive care to all children no matter where they are getting their treatment.

ABOUT Triumf Health
Triumf Health is an Estonian health technology start-up focusing on digital therapeutics for pediatric patients delivered through a mobile game. By using evidence based clinical research and psychological techniques, Triumf intervention assesses and supports well-being, encourages treatment adherence and induces the creation of healthy habits during gameplay. The data is also made available to parents and doctors. In 2019, EIT Health named Triumf Health as TOP digital health startup in Europe through the European Health Catapult programme. For more information, please visit: https://triumf.health/