Digital Health Startups Need to Build a Research Flywheel

Those who are at a digital health startup face a challenge other types of software companies rarely face — they have to prove their software actually works.

Other software may launch with a minimally viable product that sort of works, but those who want to sell into healthcare need to convince experts the app delivers expected benefits. For instance, a sleep app would be expected to have data it improves sleep or a weight-loss app have data showing users lose weight.

My company, BrainHQ, makes a brain training app. To create growth, we needed studies showing our app improves brain performance and health.

The ability to make strong claims is critical for a startup that hopes its product will be used, recommended or even paid for by the pillars of our healthcare system (healthcare providers, hospital systems, insurers).

Strong study results enable a business to make strong marketing claims. There’s a huge difference between a digital health app with and without evidence. Only after we’d shown it in studies could we adopt our current tagline: “Think faster, focus better, and remember more.” Apps without studies offer weaker claims, like “engages memory” or “designed by scientists.”

Running a gold-standard study takes a lot of time and money. At BrainHQ, there are now hundreds of published scientific papers, supporting a broad array of claims. That allows us to partner with dozens of Medicare Advantage plans that have made our program available to millions of users. We did it by building a flywheel of scientific validation — it started slowly, but now spins out many papers every year.

For those unfamiliar with the term, a “flywheel” is a heavy wheel used to store mechanical energy in the form of rotational movement (as in a potter’s wheel). As a business metaphor, it’s come to mean small wins that build on each other — eventually gaining so much momentum that growth almost seems to happen by itself.

Based on our experience, here’s how to build a research flywheel:

Make the flywheel: Businesses should approach researchers in their field; describe their science to university-based scientists to see if they’d be interested in learning more and might consider joining the startup’s Scientific Advisory Board.

Start the flywheel: Studies need academic partners, for access to patients and credibility. Just asking academic researchers to run a study on a cool new product is not productive — researchers have their own priorities and their time is consumed by existing projects. Instead, businesses can become part of their research by collaborating on a grant. Federal Small Business Innovation Research grants (and similar small business grants) are made by all the institutes that form the National Institutes of Health (and other agencies), and only go to qualified small businesses. They’re not nearly as competitive as the grants academic scientists apply for. SBIRs allow businesses to fund research by their academic partner at their university — a win for both parties.

Accelerate the flywheel: After a few publications, researchers started asking if they could use our product in their own studies. We responded by developing an Investigator-Initiated Research Program to provide strong scientific support to university-based researchers.

Keep spinning: As a business’s publications grow, academic scientists with discoveries may approach it to become their commercialization partner. Businesses should not view academic researchers as competitors (after all, it’s hard to start a company), but as potential product map contributors. They want their discoveries to make the world better — and to be brought to market by people who appreciate good science. Becoming that partner can accelerate the startup’s innovation.

Digital health is a new field we need to develop on solid ground. Businesses need to build out their science so their interventions will be taken seriously — just like new developments in pharmaceuticals and medical devices.

Henry Mahncke got his Ph.D. in neuroscience at the University of California, San Francisco in the lab that discovered the brain remains “plastic” — capable of chemical, structural and functional change — at any age. He then joined Posit Science, the company that makes BrainHQ, to put that science to work, with a remit to create a scientific flywheel. He is now CEO.