According to the World Health Organization, cardiovascular diseases (CVDs) are the leading cause of death worldwide. 80% of cardiovascular diseases can be prevented by addressing behaviour risk factors as early as possible. Digital biomarkers can provide vital data measurement that is relevant for preventive personalized cardiovascular care. Together with Matthias Puls, CEO of Kenkou, a Berlin-based health-tech company, we dive into how their software development kit (SDK) offering for apps is revolutionizing heartbeat measurement, the company’s business model and commercial strategy, as well as the future of data-driven precision medicine and the trends that shape this space.
More than 17 million people die each year from cardiovascular diseases, representing 32% of all deaths globally (WHO). CVDs are one of the costliest burdens on economic and healthcare systems.
Accurate real-world evidence data is key to improve population’s wellbeing. Health tech companies foster innovation and play an important role in data-driven precision medicine and preventive care. Everyday smartphones and smartwatches, along with wearables and implanted sensors are transformed into powerful diagnostic tools. Leveraging strategically cardiovascular biomarker SDK integrations / APIs can facilitate more developers / market players enrich their solutions with vital signs, connect with different apps and medical systems at the point of care, accelerate time to market, significantly rise a solution user engagement, deliver unique value quicker.
Digital biomarkers unlock the power of individual essential health data in real-time to detect potential indicators of a disease and empower people with data-driven customized insights to reduce behaviour risk factors and take charge of their health. Personalized continuous cardiovascular vital signs data also provides healthcare givers with evidence-based clinical decision support and assists them in health maintenance and better management of the illness, thus improving population outcomes at scale. (We invite you to take a look at R2G’s market insights on What are the four main reasons of why digital biomarkers are hot?)
To dive a bit deeper in this fascinating space, we recently talked to Matthias Puls, CEO of Kenkou, about the role the company plays in the data-driven population ecosystem and how they enhance other digital health solutions with its cardiovascular biomarker SDK, as well as what are the market opportunities within the digital preventive health care and what challenges tech giants like Amazon, Google, might face in the digital health space.
Enjoy the interview!
Research2Guidance: Can you please introduce Kenkou and your service offering?
Matthias Puls: Originally, and what Kenkou is our B2B2C solution ‘KENKOU Stress Guide’ for stress management and burnout prevention, predominantly used by health insurances. In our app, the user puts his / her finger on the smartphone camera, and we can measure the pulse wave in ECG quality to measure stress levels. Afterwards, users gain access to meditations, mindfulness and breathing exercises. Very important, we don’t need any additional wearables and the app is certified as a medical device (EU-MDR).
What we are mainly detecting through the smartphone camera is the scientific biomarker called HRV (heart rate variability) which stands for body strain and stress. The analysis of HRV originally comes from space research, and it has made its way to high-performance sports and medicine. It is for example used in treatments of posttraumatic stress disorder (PTSD), as well as among all Cognitive Behavioural Therapies (CBTs). There are scientifically proven relationships between low HRV and worsening of chronic diseases, such as depression, anxiety but also cancer and diabetes.
However, our focus at Kenkou is our mission to
revolutionize heartbeat measurement by transforming a smartphone into a real-time cardio diagnostic tool to measure vital signs, analyze personal results and get an in-depth look into the body’s current state.
Therefore we offer our technology in the form of a software development kit (SDK) to all digital health applications to lift their solutions to the next level. Through the seamless integration of our SDK health providers gain valuable insights and relevant data to actually be able to individualize their offerings, support diagnosis and to even monitor the positive effect of their interventions/programs.
Research2Guidance: Interesting about your SDK business shift. Can you share a bit more? And do you also see this trend towards hyper individualization in the healthcare space?
Matthias Puls: Yes, sure. We see a mega trend to (hyper) individualization in the fields of digital health where all the solutions out there, including DiGAs, must become more effective, so that patient A receives a different treatment from patient B. Otherwise you do not differ yourself massively from a one-size-fits all meditation app. But in order to be able to do this one must generate more vital signs and biomarkers. In a nutshell, we support precision medicine.
And I see our key role here, as we are delivering very relevant vital signs for transforming digital solutions in cardiovascular (heart) disease prevention and that is why we have decided to give out our technology to other digital health applications for the larger impact. In fact, we were initially approached by solution providers to share our health technology capabilities with them.
HRV measurements are not really new, as mentioned before many CBT treatments already leverage these biomarkers successfully in a rather clinical or ambulant environment with heavy devices. In most cases, there is no need for 24/7 measurements. You can measure it once a day – ideally in a similar timeframe. The HRV is measured for example in the morning for only one minute and reflects the status of your autonomic nervous system very well.
Research2Guidance: What is your business model and how do you ensure your commercial success?
Matthias Puls: With our SDK we run a fair license-based business model that reflects the number of measurements taken by users.
Our big advantage is that we can show the SDK in a live environment in our KENKOU Stress Guide App. So new clients can have an idea about the appealing user experience, the user onboarding, and results screens.
We are very excited about our current SDK path. To ensure our commercial success we felt it was much easier to put our technology into other parties’ backpacks. And we do not need any wearables and this I think is a big advantage in the market especially when you consider markets like India, South America or Africa where people very often can’t just afford wearables. In our case, one needs just their smartphone. Easy access and low barriers drive our product development.
Recently our SDK has been implemented in Beuer’s ‘Calm Down’ App and Vivy’s healthcare assistant App. As Beuer is one of Europe’s largest medical device producers and Vivy a 100% subsidiary of Allianz Global Insurance Group you see our SDK being used by users in more than 30 languages around the world already.
Research2Guidance: Today, digital health companies and pharma must show evidence that their solutions / drug therapies make a real difference in health outcomes outside a clinical setting to be reimbursed. Digital biomarkers are a hot topic. What role do you play in this data-driven population ecosystem?
Matthias Puls: We definitely see ourselves as the provider of very relevant cardiovascular biomarkers. Cardiovascular diseases (CVD) are the main cause of death and the largest cost driver globally and I believe that there is more and will be more demand in this space. The World Heart Federation is convinced that 80% of cardiovascular diseases can be avoided if cardiovascular risk factors were being monitored and evidence-based prevention would be established broadly. This challenge drives our vision!
And you are right. Healthcare stakeholders need to provide evidence that their solutions / drugs are effective, and one sees all these expensive trials and the trial outcome shows that this solution helps 65% of the population. And then you are “Ok great, Is this our expectation? Or is there much more to be done. What about the remaining 35%? What about among this 65%, could we have done something different to even make the outcome better!?“
And this goes more into the direction that we discussed at the beginning to customize even more each solution / service. I believe that DTx providers who are not interested in relevant vital signs and biomarkers will not survive in the market in the medium-term. Because we can already be so much better. And you see markets outside Europe that are already much more advanced in leveraging this data in digital health.
In addition, vital signs and biomarkers support users a lot and provide relevant transparency. Very often it is not about “I believe I am feeling better!”, it is about “Looking at my data, I can prove I am feeling better!“
Research2Guidance: What market opportunities and challenges do you see within digital preventive health care?
Matthias Puls: The opportunities and the challenges are the two sides of a coin.
The challenge is knowledge and how to leverage the data. We definitely aim to partially educate the market and help with a better understanding specifically in the European space, but also to bring more use cases everywhere.
The pandemic has transformed the healthcare industry. A lot of investors made serious moves into digital health, billions were invested and there is an increasing awareness of the importance of preventive care. I think for every entrepreneur it is about having a solution with clear verifiable benefit(s), finding a bit of space to implement it, making sure the user experience is personalized and smooth, and that all the technical perspectives are looked at.
Research2Guidance: Which markets are leading the advancement of preventive health care and precision medicine? And why?
Matthias Puls: I think in general there is a lot of interest from different markets. In this highly connected world, there is hardly a place that doesn’t think about preventive care and customization of healthcare. Especially in the developed countries.
In terms of advancement and service offerings, I definitely see the North American and parts of the APAC markets as the leaders.
However, there are also more progressive markets in Europe, like the Scandinavian markets, but of course, they are much smaller.
Research2Guidance: Tech giants, like Apple, Google, Microsoft, and Amazon, are continuing to make moves into digital health and expanding their target audiences. What are your thoughts on that? What are the challenges that they might face?
Matthias Puls: Yes, the tech giants have entered the digital health space and will leave their footprint. At present, the large tech giants play a role more in the North American market. The European market is protecting itself since we are dealing with very sensitive data.
When we speak about privately held companies, the challenge at the end of the day is also a question of funding. One sees this with players like Booking, a Dutch startup or Skype, was a Swedish one. Europe still partially lacks relevant funding and for all these tech giants it is just pocket money to take over or merge with companies. I think this is a challenge, however, these companies will always be there, and then questions are “How is the data used and where is the data stored, how can we make sure that the data is not exported?“
From my perspective, in the long-term the big players will own the large market shares. But who will be these big players?
Maybe there will be a bigger market consolidation and a different big health player will lead the market. Because what I could imagine is a system where you are linked to one provider that proves devices as well – more or less from birth to death.
You have your device (currently this is our smartphone), and this is a powerful tool. In terms of future holistic health services, we talk about prevention, telemedicine providers, booking your face-to-face meeting with a doctor, all the pharmacies can be linked and available to you, and even steer smart home devices, therefore even potential areas such as health-supporting light and aromatherapy at home with your device. And this continues until you have your last breath. What I have described is all linked to an ecosystem, and you have wearables connected to it, so let’s see where this goes.
Research2Guidance: Are there any trends in data-driven personalized virtual care space that excite you?
Matthias Puls: I think we have learned a lot from precision medicine in oncology, where you see the benefits of the “none fits all size” but seeing what is really helping and adding value.
In terms of data-driven approach, we are still in quite early days, because you need to learn, you must identify the patterns, etc. There are promising start-ups that are trying to tackle these cases. Yet, I think it will take a few more years because we need to learn. There could be a correlation or causality in data, for example, and we might not know yet that it exists. So, the connection of data must be researched, and I believe there is a big opportunity in front of universities and research entities to support that and crunch the big data and analyse it.
Research2Guidance: What is the future of data-driven precision medicine? What role do you see Pharma playing in this?
Matthias Puls: I think data-driven precision medicine will become a commodity. I think there will be no digital health without it. I believe data will play a big role – our bodies are all different to a certain extent and do not all function the same, and we react to different things. And digital health can offer customized services. So why should we offer less?!
I think Pharma will go more and more into this direction and it would be very interesting to see how Pharma will run their strategies in the future. It might be both the hybrid therapy to have an app as a digital companion for their drugs / pharmaceutical products and also strong interest in spaces where digital health is a substitute for drugs.
Research2Guidance: What is ahead of Kenkou?
Matthias Puls: In our core is to offer vital signs and biomarkers to transform digital solutions in cardiovascular disease (CVD) prevention. And more or less all chronic diseases end up with a form of CVD. That’s why our work and the data we provide is so relevant for our healthcare systems.
We aim at enabling more and more start-ups to get relevant data for the early prevention of chronic diseases through our measured data. And this is what drives us to get this tool out to as many people as possible – with easy access and no wearables needed. Thus, health prevention including smart risk-stratification can start much earlier and will extend lives across the globe as well as prevent patients from suffering from chronic diseases.
Research2Guidance: Matthias, thank you for sharing with us Kenkou’s story and your thoughts about the market. Wishing you and your team all the best and a lot of success!
Kenkou is a Berlin-based health-tech company, which has been operating in the field of digital health since 2014. The main product is a software development kit (SDK) that can be seamlessly integrated into any health, fitness, or wellbeing apps to measure and analyze cardiovascular vital signs and biomarkers via the smartphone camera in real-time. It’s a certified medical device with ECG quality and no wearables are needed. For more information, please visit: https://kenkou.io/