Can you tell us more about Naluri?
Naluri is a Malay word that means ‘instinct’. We want to change people’s mindset and behaviours toward living a healthy life, to the point where it becomes so ingrained that it becomes instinctual.
The company is working on a digital chronic disease management program. We help people with chronic disease risks to get healthier through a multidisciplinary approach, by blending both the physical side of diseases together with mental health diseases, to help patients achieve outcomes that are superior to medication alone.
We started in Malaysia, but the goal is to be regional and help healthcare players across Southeast Asia manage their healthcare costs, as the delivery of chronic disease management outside hospitals and clinics are rather immature in this part of the world.
Why did you decide to found Naluri?
I’ve always been involved in healthcare. I studied medicine, worked as a doctor and later joined management consulting. Handling the Southeast Asian market at McKinsey, I worked with hospitals, insurance companies, clinics, Pharma and Medtech companies.
One thing that really influenced how I think about healthcare was the work that I did for health systems, which involved helping governments think about delivery structures, payments and sustainability of healthcare. With a lot of these large companies, there wasn’t enough momentum to capture innovations that could help solve issues. That’s when my co-founder and I were thinking about doing something together and decided to found Naluri.
Tell us more about your co-Founders.
My co-Founder Azran is a serial entrepreneur. I think this is his third start-up. He worked on a budget long-haul airline called Airasia X, bringing it from one plane to IPO, and another start-up called iFlix.
What was the start of Naluri like and where are you at today?
We started in early 2018 and at that point it was just an idea, a hope and a hypothesis. The people that we ended up working with took a massive leap of faith to be a part of this. We only worked together with a handful of companies that year and the focus was to proof the case and show that by thinking about digital chronic disease management in a different way, we could deliver good clinical outcomes at a much lower cost.
How do you do this?
We are building a multidisciplinary team of medical doctors, psychologists, dietitians, and fitness coaches because we each have our own personalised portfolio of health challenges. By addressing all of them concurrently, we can have a higher success rate in terms of changing behaviours and achieving better clinical outcomes.
We measure typical things such as BMI for obesity, HbA1C for diabetes, blood pressure for hypertension, cholesterol for hypocholesterolaemia, etc. All of these are what we call cardiometabolic diseases, representing the largest disease burdens that drive almost 80% of the annual health cost increases of companies.
Solutions such as managing primary care physicians, having gym memberships and creating step challenges have been rather inadequate. By measuring these markers before and after, and then comparing them to medication alone or other solutions that people have tried, we managed to show that Naluri can be 2-3 times more effective than other solutions.
We can deliver these interventions for companies that are struggling with healthcare costs, where some experienced a 10% year-on-year cost growth. That represents almost 3-4 times return on investment within the first year itself. With that value proposition we managed to grow.
In 2019, it was a lot about repeating the successes that we’ve had, to show that it wasn’t a fluke, and that the clinical outcomes can be replicated across different clients and situations. In 2020 we tried to show that we could be relevant regionally and started to expand to Singapore. That was also when Covid hit, and we suffered as that slowed things down considerably.
On the flip side, Covid really shed light on the topic of mental health and there was a big shift in terms of how corporates viewed it – from something that was stigmatised and not worth spending money on, to something that was hugely necessary. We ended up serving a lot more companies by doing digital quantitative mental health interventions remotely. So, it was a double-edged sword.
What are the plans for Naluri in 2021?
We are just closing our Series A fundraising, and the next step will be the Series B. We try to continue growing geographically by expanding into places like Singapore, Indonesia and Thailand. We also want to make sure that we continue to strengthen our clinical evidence, and that is why we are going to Luxembourg to do our clinical trials, for us to obtain government approval for a CE mark for our interventions.
How did Luxembourg happen? Would that be the start of expanding across Europe?
It was one of those serendipitous meetings. We were in Singapore as part of the 500 Startups global launch programme where I met someone from R3i Ventures. We got connected and she has been helping us to explore how to further these clinical trial partnerships and navigate the European landscape.
In terms of commercial expansion to Europe, I think it’s something that we’ll consider if we can get strong commercial anchor clients.
What drives you?
I’m deeply motivated to solve healthcare issues. One of it is our current healthcare systems that are too hospital centric. There are other proven and better ways to treat people with chronic diseases, where you get to treat patients at home as opposed to having them go repeatedly to the specialists in hospitals.
The second is that we have to treat patients in a multi-disciplinary way, as opposed to looking at things only through the lens of disease – including things like mental health, diet, fitness and social environment.
For example, in Malaysia, besides the healthcare professionals, we also equipped the individuals with an executive coach and a financial planner, because we know the stress at work and finances are two major sources of stress that impacts your ability to look after your own health.
That’s very easy to do in places like Europe, UK or the US where the supply of these professionals is much higher. The hospital infrastructure would be much better if you could stitch them together to treat these individuals in places like Malaysia and a lot of other emerging markets, where the entire system does not exist, or supply is constrained.
Apart from the issue of delivery and digitisation, the biggest problem with healthcare is “who’s going to pay for it?”. There are all these nice and sexy technologies in health tech and a lot of money has been poured into it, but the question after that is how we can make it affordable enough for the emerging markets.
We had to do things differently by equipping healthcare professionals with organisational tools, operational tools, decision-support tools and advanced analytics for them to do their jobs with increased productivity and affordability.
What are some of the biggest challenges you have faced in the first three years?
Digital therapeutics or outcomes-based healthcare is still quite new in the region. Typically, when people think about digital health, they think about doctor-booking platforms, telemedicine or step counters. I almost liken what we do to something between a consumer app and a biotech intervention with provable clinical evidence.
There has been a lot of need to educate people. We also work with healthcare infrastructures that are relatively immature and there aren’t existing health reimbursement structures that we could fit within. We have had to go to these people and convince them to pay for services.
The second part of is talking to investors in Southeast Asia, who are not as focused on healthcare investing as compared to places like the US. The depth of the bench of investors that you have with the right expertise and ability to fund is much slimmer. We looked for investors on a more global level very early on.
Due to the immaturity of the emerging markets, the price points at which we need to deliver our services has been another challenge, forcing us to consider different ways of doing things. Also, because East Asia is made up of very different countries, it’s insufficient to create one solution that works in Malaysia but unable to be scaled across Asia. So, we needed to think about higher volumes with lower prices, which led to a regional story from the start.
Best and worst part of what you do?
The best part is the ability to make a difference in people’s lives. Oftentimes, we get these really uplifting stories of people that completely changed their lives–from overweight engineers who were declared not-fit-to-work who had then lost more than 20kg with treatments, getting off the hypertensive medications and going back to work; to individuals that had latent suicidal ideation that we managed to pick up early on and managed to work with them to recover. I think that it’s the reason why Naluri exists.
The worst is that every day seems like a struggle. It’s about going through that grind and knowing that it’s part of the process and it’s going to be painful. But every time you look back six months or a year, you can appreciate the progress that you’ve made.
What are your hopes for Naluri?
The holy grail for Naluri is for us to change the conversation around and the structure of care delivery for chronic diseases and mental health in Southeast Asia. That would mean that solutions like ours would address mental health issues that are fully reimbursed by healthcare payers.
In the future, we would like to build up a level of evidence to the point where a doctor can prescribe an app.