Silicon Valley Bank report on Consumer Digital Health

1. Consumer Digital
Health
How Market Shift Is Leading to
New Opportunities
Steve Allan CFA
Head of SVB Analytics
sallan@svb.com
Scott Winder
Director
swinder@svb.com
Alex Lee
Manager
klee@svb.com
Emily Wengel
Associate
ewengel@svb.com
Written by SVB Analytics:

2. Table of Contents
2
3 Consumer Digital Health: Introduction & Financing Trends Overview
9 Healthcare Consumers: Fundamental Needs of the User
13 Financing Trends: Shift Toward Clinically Driven Consumer Health
17 Fitness/Wellness: Adapting to the Market
22 Disease Management: Growth Opportunities
28 Market Outlook: Assessing Consumer Health Opportunities
30 About the Authors
31 About Silicon Valley Bank and SVB Analytics
Consumer Digital Health

3. Consumer Digital Health: Market Shifts to Focus on
Engagement and Improved Patient Outcomes
Consumer Digital Health 3
Consumer Digital
Health Companies
address the needs
of patients and
healthcare
consumers
Investment trends in digital health are shifting from consumer
wellness applications to clinically driven solutions that drive
better health outcomes at lower costs.
This next wave of financing focuses on encouraging consumers
and patients to change health-related behaviors, underscoring
the greater opportunities for companies with solutions that
create value for payers, providers, employers and consumers.
This is the second in a series of reports from SVB Analytics examining Digital Health.
In this report we:
• Analyze broad consumer health trends and business models
• Examine the shift in investments from consumer wellness to clinically focused solutions
• Describe adaptation strategies of consumer wellness and wearables companies
• Explore potential areas of opportunity in disease management

4. Digital Health Landscape
Consumer Digital Health 4
Patients / Consumers
In our first report, we provided a framework that landscaped the digital health sector. In this report, we
focus on consumer digital health investment trends.
FocusonHealthOutcomes
Employers / Payers
Life Science / Other Systems / Healthcare Professionals
FocusonHealthcareCosts
Enterprise Wellness
Risk Adjustment / Payer
Administration
Value Based Care
Enterprise Health
Management
Data Driven PayersPatient Engagement /
Benefits
R&D
Operational
Patient /
Professional
Interaction
Clinical Operations
Patient Surveillance
Image Management /
Analytics
Electronic Medical Records
Decision Support & Analytics /
Predictive Medicine
Marketing / Customer
Experience
Networking /
Education
Care Coordination /
Communication
Population Health Management Practice Management &
Operational Workflows
Professional Search Insurance SearchSocial SupportGenetic Screening
Disease / Medication
Management
Education Fitness / Wellness /
Wearables / Tracking
TelemedicineRemote
Monitoring
Patient-Clinician
Communication
Digital Therapeutics /
Pill Plus

5. Focus on Consumer Health: Categorizations
Consumer Digital Health
Patients / Consumers
5
TelemedicineRemote
Monitoring
Patient-Clinician
Communication
Digital Therapeutics /
Pill Plus
Patient /
Professional
Interaction
• Disease Management
Disease/Medication Management
Digital Therapeutics
• Monitoring
Remote Monitoring
• Communications
Telemedicine
Patient-Clinician Communication
Clinical Enablement
• Fitness / Wellness
Fitness
Wellness
Wearables
Tracking
Consumer Activation
• Medical Education
Education
Social Support
Genetic Screening
• Provider Search
Professional Search
• Insurance
Insurance Search
Education and Transparency
Less Clinically
Focused
More Clinically
Focused
For our analysis, we looked at
three key themes: clinical
enablement, consumer activation
and education and transparency.
We also grouped consumer digital
health into seven categories, and
focused on fitness/wellness and
disease management.
Professional Search Insurance SearchSocial SupportGenetic Screening
Disease / Medication
Management
Fitness / Wellness /
Wearables / Tracking
Education

6. $0
$500
$1,000
$1,500
$2,000
$2,500
$3,000
$3,500
0%
10%
20%
30%
40%
50%
60%
70%
2011 2012 2013 2014 2015 2016 (E)
TotalFunding($M)
PercentageofTotalFunding
$
(Consumer)
Consumer
Funding (%)
Consumer Digital Health Financing Trends Overview
Consumer Digital Health 6
Source: Rock Health Database;2011-2016Q2
SVB Analytics Analysis
2016(E) is extrapolatedbased on 2016HY
About 55% of all digital health investments since 2011 have been in companies whose technologies
interface with the consumer in some manner. This reflects the convergence of technologies to drive and
measure improved health outcomes and cost savings, and funding is following.
Investments in Consumer Health Companies as a
Percentage of Total Digital Health Investments
(2011 to Q2 2016)

7. 0%
10%
20%
30%
40%
50%
60%
$0
$500
$1,000
$1,500
$2,000
$2,500
$3,000
2011 2012 2013 2014 2015 2016 (E)
TotalFunding($M)
Crossover Investments
Financings without Strategic Investor
Financings with Strategic Investor
% of Deal Count with Strategic Investors
Strategic Investors Actively Investing in Consumer
Digital Health
Consumer Digital Health 7
Consumer Digital Health Investments
(2011 to Q2 2016)
* Crossover investmentsrepresentinvestment rounds greaterthan $100M that are led by a crossover investor
Source: Rock Health Database;2011-2016Q2
SVB Analytics Analysis
2016(E) is extrapolatedbased on 2016HY
Top Strategic Investors
Focused on Consumer Health
The number of deals with strategic investors participating has slowly increased over time, as tech, life
science, healthcare and insurance companies seek to partner and collaborate with startups.
1
2
3
4
5
6
7
8

8. 0%
10%
20%
30%
40%
50%
$0
$200
$400
$600
$800
$1,000
$1,200
$1,400
$1,600
$1,800
$2,000
2011 2012 2013 2014 2015 2016
(E)
TotalFunding($M)
Crossover Investments
Financings without Strategic Investors
Financings with Strategic Investors
% of Dollar Investments with Strategic Investors
0%
10%
20%
30%
40%
50%
$0
$200
$400
$600
$800
$1,000
$1,200
$1,400
$1,600
$1,800
$2,000
2011 2012 2013 2014 2015 2016
(E)
TotalFunding($M)
Crossover Investments
Financings without Strategic Investors
Financings with Strategic Investors
% of Dollar Investments with Strategic Investors
Strategic Investors Shift to More Clinically Focused
Investments
Consumer Digital Health 8
Other Consumer Digital Health Investments*
(2011 to Q2 2016)
Clinically Focused Consumer Digital Health
Investments* (2011 to Q2 2016)
Strategic investors have recently shifted their attention to clinically focused startups as they begin to
see how technologies designed to affect patient behavior can generate better health outcomes and
cost savings.
* Crossover investmentsrepresentinvestment rounds greaterthan $100M that are led by a crossover investor
Source: Rock Health Database;2011-2016Q2
SVB Analytics Analysis
2016(E) is extrapolatedbased on 2016HY
*IncludesClinical EnablementCompanies *IncludesConsumer Activation and Educationand Transparency Companies

9. Consumer Digital Health 9
Healthcare
Consumers:
Fundamental Needs of the User

10. Challenge Fundamental Need Solution
Lack of choice and
price transparency
Consumer-
Friendliness
Improve consumers' access to healthcare
and their user experience by making
healthcare easier to use
Poor health literacy Knowledge Create access to education and relevant and
personalized health information
Lack of tools to manage
health and wellness Engagement
Engage and affect behavioral change in
healthcare consumers to better manage
their own health
Consumer Digital Health 10
Overview:
Empowering Patients
Is Key to Fixing
Healthcare System

11. Consumer Digital Health Framework
Consumer Digital Health 11
Knowledge Engagement
Fitness / Wellness /
Wearables/ Tracking
(for leisure)
Disease / Medication
Management
(incl. Fitness/Wellness)
Professional
Search
Insurance
Search
Remote Monitoring
Social
Support
Genetic
Screening
Education
Digital
Therapeutics /
Pill Plus
Consumer-Friendliness
Challenge:
Lack of choice and
price transparency
Solution:
Improve consumers' access to
healthcare and their user experience
by making healthcare easier to use
Knowledge
Challenge:
Poor health literacy
Solution:
Create access to education and
relevant and personalized health
information
Engagement
Challenge:
Lack of tools to manage health and
wellness
Solution:
Engage and affect behavioral change in
healthcare consumers to better
manage their own health
Consumer-Friendliness
Patient-Clinician
Communication
(incl. Telemedicine)

12. Knowledge Engagement
Consumer-Friendliness
Consumer Digital Health Framework
Consumer Digital Health 12
Consumer-Friendliness
Challenge:
Lack of choice and
price transparency
Solution:
Improve consumers' access to
healthcare and their user experience
by making healthcare easier to use
Knowledge
Challenge:
Poor health literacy
Solution:
Create access to education and
relevant and personalized health
information
Engagement
Challenge:
Lack of tools to manage health and
wellness
Solution:
Engage and affect behavioral change in
healthcare consumers to better
manage their own health

13. Consumer Digital Health 13
Financing Trends:
Shift Toward Clinically Driven
Consumer Health

14. $0
$500
$1,000
$1,500
$2,000
$2,500
$3,000
2011 2012 2013 2014 2015 2016 (E)
TotalCapitalInvested($M)
Disease
Management
Remote Monitoring
Communications
Fitness / Wellness
Medical Education
Provider Search
Insurance
Total Capital Invested by Category
(2011 – Q2 2016)
Financing Trends: Historic Investment Trends Weighted
Toward Wellness
Consumer Digital Health 14
The advent of the quantified self movement in the early 2010s attracted significant capital, especially
in the fitness and wellness category.
Source: Rock Health Database Q2 2016, Pitchbook,2011-2016 Q2;
SVB Analytics Analysis
2016(E) is extrapolatedbased on 1H 2016
More
Clinically
Focused
Less
Clinically
Focused
Disease Management
Remote Monitoring
Communications
Medical Education
Provider Search
Insurance Search
Fitness / Wellness
Clinical
Enablement
Education and
Transparency
Consumer
Activation

15. Financing Trends: Rise of Clinically Driven
Consumer Health
Consumer Digital Health 15
Percentage of Total Deal Count Over Time
by Category (2011 – Q2 2016)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2011 2012 2013 2014 2015 2016 (E)
Disease
Management
Remote Monitoring
Communications
Fitness / Wellness
Medical Education
Provider Search
Insurance
There has been a gradual shift toward increased investment activity in the more clinically focused
categories of disease management, remote monitoring and communications.
Source: Rock Health Database Q2 2016, Pitchbook,2011-2016 Q2;
SVB Analytics Analysis
2016(E) is extrapolatedbased on 1H 2016
More
Clinically
Focused
Less
Clinically
Focused
Disease Management
Remote Monitoring
Communications
Medical Education
Provider Search
Insurance Search
Fitness / Wellness
Clinical
Enablement
Education and
Transparency
More
Consumer
Focused

16. Financing Trends: More Clinically Focused
Companies Receiving Early-Stage Funding
Consumer Digital Health 16
Investment Amount by Stage of Development (2011 – Q2 2016)
0
10
20
30
40
50
60
70
80
90
100
$0
$200
$400
$600
$800
$1,000
$1,200
2011 2012 2013 2014 2015 2016
(E)
Funding($M)
Early Mid
Late Total Deal Count
0
10
20
30
40
50
60
70
80
90
100
$0
$200
$400
$600
$800
$1,000
$1,200
2011 2012 2013 2014 2015 2016
(E)
Funding($M)
Early Mid
Late Total Deal Count
0
10
20
30
40
50
60
70
80
90
100
$0
$200
$400
$600
$800
$1,000
$1,200
2011 2012 2013 2014 2015 2016
(E)
Funding($M)
Early Mid
Late Total Deal Count
The clinically focused areas of disease management and patient-provider communications are
seeing an increase in early-stage funding, indicating new startup formation; consumer activation
and education and transparency companies are maturing, with fewer early-stage rounds raised.
Source: Rock Health Database Q2 2016, Pitchbook,2011-2016 Q2;
SVB Analytics Analysis
2016(E) is extrapolatedbased on 1H 2016
Early – Seed and Series A, Mid – Series B and C, Late – Series D and later
Clinical Enablement
Disease Management
Monitoring
Communications
Consumer Activation
Fitness/Wellness
Education and Transparency
Medical Education
Provider Search
Insurance Search

17. Consumer Digital Health 17
Fitness/Wellness:
Adapting To The Market

18. Fitness/Wellness: Decline in Valuations and
Investment Size
Consumer Digital Health 18
Median Pre-Money Valuation of
Fitness/Wellness Companies
(2011 – Q2 2016)
Median Invested Capital of
Fitness/Wellness Companies
(2011 – Q2 2016)
$0
$5
$10
$15
$20
$25
$30
$35
$40
2011 2012 2013 2014 2015 1H 2016
MedianPre-MoneyValuation($M)
Valuations and financing round sizes have declined in 2016 due to increased competition and
shifting investor interest toward clinical applications, forcing wellness companies to adapt.
Source: Pitchbook, 2011-2016Q2;
SVB Analytics Analysis
Series BSeries ASeries Seed
$0
$2
$4
$6
$8
$10
$12
$14
$16
$18
$20
2011 2012 2013 2014 2015 1H 2016
MedianInvestedCapital($M)

19. Strategy Description Examples
Strategic Exit Sell business to strategic partners
Acquire
Acquire companies to build clinical
programs
Partner
Partner with academic institutions to
conduct clinical studies and provide
ancillary data
Develop
Develop features or pivot business
model in order to collect real world
data or gather clinical-grade data
Consumer Digital Health 19
Fitness/Wellness:
Companies Adapt to
Changing Marketplace
As investors move toward more clinically focused strategies, wearables and wellness companies are
executing different strategies to adapt to this shifting landscape.

20. 11/11/2015 $250M $64M 3.9x
3/25/2014 $100M $37M 2.7x
2/12/2016 $85M $16M 7.4x
8/5/2015 $235M NA NA
2/4/2015 $474M $18M 26.3x
2/4/2015 $85M $6M 13.7x
12/6/2013 $150M $24M 6.3
Fitness/Wellness: Exit to Sports and Fashion
Companies
Consumer Digital Health 20
“If you don’t have a brand, it is hard to be legit in this space.”
– Sonny Vu, Chief Executive and co-founder of Misfit
Acquirer Target Date
Deal Value
($M)
Invested
Capital (IC $M)
EV / IC
Multiple
SoftwareHardware
Source: Capital IQ
SVB Analytics Analysis
Wall StreetJournal - Fossil Group to Buy Misfit for $260 Million
Sports
Fitness
Apparel
Fashion
Tech
Facing declining investor interest, companies that are not adopting clinical strategies are instead
choosing to sell to sports and fashion retailers. Among those, software-focused firms are receiving
the highest exit multiples.

21. $6.5B IPO
Partnership: Study on weightlossand
breast cancer prevention
Announcement: 200 clinical studies
run on Fitbit / Fitabase App
Hire: VP Digital Health from Walgreens
Acquisition +
Personnel
2013 2014 2015 2016
Fitness/Wellness: Companies Partner, Acquire or
Develop Clinical Technologies
Consumer Digital Health 21
Source: Company Press Releases,Mobihealthnews,FastCompany,clinicaltrials.gov,Fitbit S-1
• Two 510k approvals
• Real-time patient monitoring on
physician smartphone
• CEO of Spectros becomes Chief
Medical Officer of Jawbone
Acquisition
Jawbone, Fitbit, and Scanadu started in consumer wellness and have made acquisitions, formed
partnerships and started internal developments to adapt to the changing marketplace.
Consumer Clinical
• Has “FDA approval… [and] understandshow
to run a clinical trial with hospitals and
wellnessproviders.”
• 87 patents, >500 trillion data points
• “Partnered…for diabetes prevention”
Regulatory:
Announces Plans for
510K Submission
• Forms clinical advisory board
• Announces plans for clinical
trials
$10.5M
Series A
Used for clinical development
and regulatory approval in
U.S. and China
$35M
Series B
Acquire
Partner
Develop Kickstarter:
Branded as DIY
Vital Signs Device

22. Consumer Digital Health 22
Disease Management:
Growth Opportunities

23. General Disease
Management and
Vitals Monitoring
Solutions that help
patients manage
any type of disease
Medication
Management
Solutions that help
patients adhere to
and manage their
medications
Disease Specific
Solutions that help
patients manage one
specific type of
disease or disorder
Disease Management: Approaches to Engaging
Patients
Consumer Digital Health 23
*Includesboth Disease Managementand RemoteMonitoringcompaniesand deals
Source: Rock Health Database Q2 2016, Pitchbook,2011-2016 Q2;
SVB Analytics Analysis
Percentage of Total Capital Invested by Category*
(2011 – Q2 2016)
30%
8%
62%
Disease management and remote monitoring companies are shifting to focus on a specific disease to
help patients and providers better manage the condition as opposed to providing general solutions
aimed at patients facing different diseases.

24. Consumer Digital Health
Source: Interviewwith TJ Parker, August 19, 2016
23
“I don’t think you can scale a
business in healthcare
without working directly
with the clinical entities like
payers and providers.”
– TJ Parker, CEO

25. How PillPack Is Taking on Medication Management:
An Interview with TJ Parker, CEO, PillPack
Consumer Digital Health 25
Online pharmacy that uses technology to help
people take medication in a timely manner
Key Success Factors for Consumer-Centric Disease Management:
Expertise in Both Healthcare and Technology | Patient-Centric Design
Operating in the Clinical Space
Consumer health companies need to develop sound business models because
the patient is not the only customer – the payer is also the customer.
“The healthcare system is moving towards a pay for performance model. Pharmacy should do the
same and no one is truly doing that today.”
Source: Interviewwith TJ Parker, August 19, 2016
Most EXPENSIVE patients take 5+
prescriptions / day and have trouble
coordinating their medication.
Advice to Entrepreneurs
• Spend time with your consumers: figure out their pain points and
understand their core problems. And whether you can solve their
problems with technology alone or if you need to become a provider.
• Know who your customers are and what they are willing to pay for.
Poor Adherence
ProblemSolution
Manage complexity for patients
• Automated sign up and refills
• Coordination with payers
• Staff available 24/7

26. 0
5
10
15
20
25
2011 2012 2013 2014 2015 2016 (E)
Disease Management: Increasing Focus on Behavioral
Change and Complex Disease Management
Consumer Digital Health 26
Number of Investments in Disease Management and Remote
Monitoring Sectors (2011 – Q2 2016)
There has been a steady rise in investments in companies aimed at behavioral change, while the
niche targeting complex diseases is more nascent.
Source: Rock Health Database Q2 2016, Pitchbook,2011-2016 Q2;
SVB Analytics Analysis
2016(E) is extrapolatedbased on 1H 2016
Behavioral Change
Psychiatry
Metabolic
Degenerative and
Complex Diseases
Orthopedic
Oncology
Neurology
“Remote Monitoring 1.0”
Cardiovascular
Respiratory

27. Disease Management: Opportunities in Complex
and Degenerative Diseases
Consumer Digital Health 27
Degenerative and complex diseases, which are difficult to manage and account for a significant
portion of U.S. medical expenditures, have received comparatively lower digital health investments,
signaling the space is ripe for disruption.
Source: Rock Health Database Q2 2016, Pitchbook,2011-2016 Q2;
SVB Analytics Analysis
AHRQ - Total Medical Expenditureby Conditionsin US, 2013
Total Medical Expenditure,
by Chronic Conditions in U.S.
2013 ($B)
Total Investments in Disease Management and Remote
Monitoring Sectors by Chronic Conditions in U.S.
2011-Q2 2016 ($M)
24%
9%
22%
11%
14%
10%
9%
$- $50 $100 $150 $200 $250
Metabolic
Psychiatric
Cardiovascular
Respiratory
Orthopedic
Oncology
Neurology
*
34%
15%
19%
12%
6%
2%
4%
$-$100$200$300$400$500
Metabolic
Psychiatric
Cardiovascular
Respiratory
Orthopedic
Oncology
Neurology
*
Behavioral Change
Psychiatry
Metabolic
Degenerative and
Complex Diseases
Orthopedic
Oncology
Neurology
“Remote Monitoring 1.0”
Cardiovascular
Respiratory
10%
6%
-3%
1%
-8%
-8%
-5%
Difference
*Excludes trauma or injury-related conditions

28. Consumer Digital Health 28
Market Outlook:
Assessing Consumer Health
Opportunities

29. Progression to Clinically Driven
Consumer Health Solutions
Consumer Digital Health 29
Exits
Remote
Monitoring 1.0
2010–14
Fitness/
Wellness
2012–16
Disease
Management
2014–18
Digital
Therapeutics
2016–20
• Led by the medtech sector
• Point solutions
• Rely on traditional
reimbursement
• Rise of quantified self
movement
• Tech investors galvanize
market with investments
into consumer hardware
and software
• Focused on fitness and
wellness
• User-friendly
cloud/mobile solutions,
clinical-grade devices
and data analytics
• Engage patients to
actively manage their
health
• Target financiers
focused on controlling
health benefit cost and
improving outcomes
• Predictive and
personalized clinical
intervention
• FDA-regulated, provider-
prescribed, combination
solutions
• Demonstrate clinically
proven efficacy and cost
savings
High-Flyers
We have seen the sector's focus move from traditional devices aimed at a specific solution to consumer
devices. Now, the focus is on digital solutions for disease management. Going forward, clinically
proven software and hardware will be integrated to drive better health outcomes and cost savings.
Source: Pitchbook, Company websites
SVB Analytics analysis

30. About the Authors
Consumer Digital Health 30
Steve Allan, CFA
Steve Allan is the Head of SVB Analytics, responsible for the
three areas of information services provided to the
innovation economy: Strategic Advisory Services,
Compliance Valuations, and Insights. Strategic Advisory
Services provides consultative guidance around valuations,
benchmarking and inorganic growth strategies. Compliance
Valuations issues valuation opinions for private companies.
Insight focuses on studying trends and opportunities in the
private venture-backed innovation ecosystem. Steve brings
a strong financial background and passion for
entrepreneurship to his role at SVB Analytics.
Steve earned a master’s in business administration
from Duke University's Fuqua School of Business and a
bachelor's degree in finance from the University of
Notre Dame.
Head of Analytics
sallan@svb.com
Emily Wengel
Emily Wengel is a Valuation Associate with SVB Analytics,
responsible for conducting due diligence and financial analysis
on valuation engagements for early-stage, venture-backed life
sciences companies.
Prior to joining SVB Analytics, Emily worked as a business analyst
at BioMotiv, an early stage biotech accelerator. Emily graduated
cum laude from University of Pennsylvania, where she earned a
bachelor of science in economics and a bachelor of arts in
biology.
Associate
ewengel@svb.com
Alex Lee
Alex Lee is a Valuation Manager at SVB Analytics,
responsible for conducting due diligence and financial
analysis on valuation engagements for venture-backed
companies in the Life Science sectors.
Prior to joining SVB Analytics, Alex worked as a consultant
for biopharmaceutical companies, diagnostic companies
and medical research institutions, assisting in corporate
development, product commercialization and strategic
advisory activities. Alex holds a master’s of bioscience
degree from Keck Graduate Institute and a bachelor’s of
science degree in biochemistry from the University of
Nebraska-Lincoln.
Manager
klee@svb.com
Scott Winder
Scott Winder is a Director at SVB Analytics, responsible for
managing client valuation assignments and issuing valuation
opinions. Prior to joining SVB Analytics, Scott was a manager in
the Business Valuation practice of Deloitte Financial Advisory
Services LLP based in San Francisco. While at Deloitte, Scott
provided financial advisory services related to mergers and
acquisitions, accounting compliance, tax reporting and strategic
planning for clients in the technology and life sciences industries,
with particular experience in the biotechnology and
biopharmaceutical industry segments.
Scott holds a master's degree in business administration from
the Haas School of Business (University of California at Berkeley),
and a bachelor’s degree in human biology from Occidental
College.
Director
swinder@svb.com

31. About Silicon Valley Bank
For more than 30 years, Silicon Valley Bank has helped
innovative companies and their investors move bold ideas
forward, fast. SVB provides targeted financial services and
expertise through its offices in innovation centers around the
world. With commercial, international and private banking
services, SVB helps address the unique needs of innovators.
Consumer Digital Health 31
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information from third-party sourcesthat we believeto be reliable,but which have not been independentlyverifiedby us and for this reason we do not represent
that the information is accurate or complete.The information should not be viewed as tax, investment,legal or other advice nor is it to be reliedon in making an
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