Nicolette: A Patient Empowerment Company — A Startup Research Report by Aneri Patel

Meet the new kind of company — a patient empowerment company. Nicolette strives to build interactive, visual displays of individualized medical data and research to enable patients to understand their health easily and quickly, so that they can serve as their own healthcare advocate. Founded in 2016 and headquartered in Long Beach, CA, Nicolette currently has a team of 5 employees and has raised $260,000 in funding through seed and angel investing rounds. Their principal investors are GAN Ventures and Backstage Capital.

Team

Phil Martie is the Chief Executive Officer and founder of Nicolette. He founded Nicolette based on his experience with premature twins in 2014 when he had difficulty understanding the medical data that he was being presented with by medical professionals. Martie wanted to be able to understand the numbers himself, without depending entirely on the word of the doctor. He believes that if he had been better able to understand the data on his premature twins, he would have been able to save the life of his daughter, Nicolette– the company’s namesake. His goal has always been to empower patients who are fighting acute health battles to be their own competent advocates by making medical info consumable to the layperson. Prior to founding Nicolette, Martie was VP of Operations at Canon’s Business Process Services division, working in Business Process Outsourcing (BPO). His other areas of experience include operational delivery, analytics, and sales. For one year, he attended Georgia State University to study Film and Television Production, before he left to launch his first startup. He later completed a BS in Business Administration from Kaplan University.

Dr. Michel Mikhael, MD is Nicolette’s co-founder and Chief Medical Officer. He joined Martie in creating this company, because he was passionate about minimizing the worry behind premature babies and improving communication between doctors and patients in the healthcare industry. Mikhael is a board-certified pediatrician and neonatologist by the American Academy of Pediatrics. He splits his time between working at Nicolette, as an assistant professor of clinical pediatrics at UC Irvine, and practicing medicine at the Children’s Hospital of Orange County. He completed medical school in Cairo and completed his fellowship at the University of Texas Southwestern Medical Center in Dallas.

Tynan Szvetecz is the Chief Technical Officer for Nicolette, but serves more as a technical advisor to the company. He believes that the future of patient engagement (equal access to information and informed consent) can only be developed through companies like Nicolette. Over the last 16 years, he has founded and developed a technology consultancy firm — CKD Technology Partners — which builds web-based software, specifically in the health arena. Consultants from this firm are hired to build the software that Nicolette needs, resulting in a constantly accessible team of programmers to help the company. Additionally, Szvetecz is an advisor for multiple healthcare accelerators and incubators across the country, and has deployed digital healthcare solutions into DaVita, University of Texas’s Medical Branch, US Oncology, and Allscripts. Szvetecz has a partial degree in Computer Science from Wesleyan University.

Product

Nicolette’s first (and currently only) product is called NicoBoard. NicoBoard is a parent-facing, HIPAA-compliant app that provides parents with easy to understand data about their children from the neonatal intensive care unit (NICU). By creating visuals from their child’s electronic health record (EHR), parents can feel more competent in their child’s journey to wellness. Currently, NicoBoard can provide color-coded graphs of a patient’s oxygen saturation, carbon-dioxide levels, bradycardia episodes, and apnea episode history.

Although creating graphs is the main focus of NicoBoard, the product provides many other features as well. For example, NicoBoard curates research articles and papers about their child’s medical conditions, so parents can feel well-informed about the latest scientific developments and the best options they can take for their baby. Other features include a directory of a patient’s healthcare team at the hospital, remote physician communication, and a diary feature where procedures and developments can be tracked in a calendar format.

As for how NicoBoard will be used in everyday application, the founders’ goal is that hospitals will provide parents with a tablet, provided by Nicolette, that contains the app, so parents can get real time health updates on their child in the NICU as their tests get uploaded to their EHR. Parents would also be able to download the app to their mobile device or access an online version through their laptop.

To address common privacy concerns that surface with dealing with very personal data, NicoBoard utilizes secure sockets layer (SSL) encryption. Additionally, there will be an authentication step during the login process to the app.

As for the other side of this product — the hospitals, Martie plans on sharing data between hospitals and healthcare providers that use NicoBoard on how they “rank against” each other in certain engagement benchmarks. This data would mostly be demographic user statistics, with the aim of helping improve parent engagement in the NICU. By creating a sense of competition and transparency between hospitals, Martie hopes to improve parent involvement in their child’s health, at least in their ability to be a knowledgeable advocate for their baby and not feel helpless.

At the time of publication, there are no reports on new Nicolette products. Instead, they are currently focusing on launching NicoBoard to hospitals and perfecting the product to their consumers’ desires (both hospitals and parents).

Market Strategy

In July 2018, Nicolette was selected to be part of the Cedars-Sinai accelerator program, which they graduated from in October 2018. Soon after graduating, Nicolette released that will begin launching NicoBoard in Cedars-Sinai Hospital and the Children’s Hospital in Orange County and L.A. They are currently focusing on Nicoboard’s launch, making sure that the product is a right fit for hospitals and easy to use, tweaking it if necessary; after this is completed, then they will focus on expanding NicoBoard to other hospitals in the area and hopefully across America. Only after NicoBoard is successfully implemented does Nicolette see itself creating new “patient empowerment” products.

Martie believes that parents will be incentivized to use the product, because it will let them be more involved in their child’s health; meanwhile, hospitals will be willing to adopt NicoBoard, because it will improve their patient experience, helping their reputation in the long run.

Market Size

Each year 10–15% of babies born in the United States end up in the NICU, which is around 0.5 million children. So while it is possible to say that .5 million families have a need for a product like Nicoboard, Nicolette is a B2B company. Therefore, we must look at the number of hospitals in America — the true customers of NicoBoard.

The total number of hospitals in the United States is 5,534. Of these, only around 900 have NICUs (neonatal intensive care units). Therefore, in America the potential market size of NicoBoard would be 900 hospitals. Even if only 20% of hospitals with a NICU adopted this technology, then we could estimate a reasonable market to be 180 hospitals.

However, if the product can be tweaked to be applied to different medical situations and healthcare needs (for example, just generally letting patients visualize the results from their medical tests at hospitals), then potentially this product could be sold to around 5,000 hospitals.

Market Competition

Within the small niche that is parent-facing, NICU health information technology, there are accordingly only a few apps. When looking on the Apple App Store or Google Play Store, two loosely comparable apps to NicoBoard are MyPreemie and My NICU Baby. However, neither of them use data directly from an actively-hospitalized patient’s EHR.

MyPreemie offers easy-to-understand explanations of common health and developmental issues, equipment in the NICU, medical procedures, and descriptions of the specialists a parent would encounter when they have a child in the NICU. The app includes a daily journal that helps parents chronicle their preemie’s major events and milestones in text and photos. There are also customizable to-do lists and to-ask lists, helping parents become better informed and more engaged participants. The app also plots their baby’s daily recorded weight, length, and head size on a custom growth chart.

In comparison to NicoBoard, MyPreemie is similar in that it focuses on parent empowerment and advocacy through education. However, any displayed graphs are the result of parents manually inputting data into the app. The app is not automatically linked to the child’s EHR like it is in NicoBoard. Overall, it serves much more as a platform where parents can get general data about NICU procedures and vocabulary, not specific information about their child.

My NICU Baby is an app created by March of Dimes which provides a variety of services and informational resources. With this app, parents can get tips and videos on how to care for their baby while they are in the NICU, track breastfeeding sessions and their baby’s weight, take photos, connect with other families with similar experiences, and create a customizable checklist to make sure they are prepared to take their child home. Like myPreemie, My NICU Baby is mostly an educational tool for parents that also serves as a diary to track their child’s progress. The data found in My NICU Baby is quite standard (e.g. weight, hours slept, etc.) and is inputted by the parents themselves. In this way, NicoBoard again differentiates itself by creating a platform that displays up-to-date, personalized data straight from a patient’s electronic health records.

In addition to these two apps, there are a whole slew of apps that solely provide information. Some examples include Parent Educator: NICU Knowledge, NICU Parent, and NICU Thrive. These apps have short videos and lessons that help answer parents’ frequently asked questions. They also contain information on different levels of NICU monitoring, staff roles, and equipment in the NICU. These apps serve as a platform to consolidate basic knowledge about premature babies and are solely intended to be used for educational purposes. NicoBoard provides this same general education about NICUs and preemies as one of the features of the platform.

Metrics

Nicolette’s web traffic according to SimilarWeb is 870 web visitors/month.

Nicolette wants the app to be free to parents. To earn revenue, the founders hope to charge hospitals around $10,000 a month to offer the service. They believe that hospitals will be more than willing to pay this sum considering that, if they adopt NicoBoard, the hospital will be able to provide better care and service, a better patient and family experience, and will result in babies going home sooner.

If we assume that 20% of NICUs in America will eventually adopt NicoBoard, then at this price of $10,000/month, Nicolette could make a revenue of $21.6 million.

  • $10,000/mo x 12 months x 180 NICUs = $21.6 million

Final Thoughts

While I wholeheartedly support their mission of patients better understanding their health and their treatment options, Nicolette is still in its very beginning stage of development, and it certainly shows. It’s first product, NicoBoard, still hasn’t been finalized, while their MVP for NicoBoard is just starting to be tested in hospitals — 2 years after it was first created. While I believe that the product itself if quite unique, useful, and easy-to-use, the fundamental flaw that I see with the company is that the people that would benefit the most from NicoBoard — the parents — are not the ones that having to purchase the product. While the parents can influence the purchasing decision, the hospitals are the ones making the final call. Therefore, I think they have structured their company incorrectly and targeted the wrong audience. I don’t think that hospitals would be willing to spend $10,000 per month just for parent convenience and providing better service, especially when it could potentially result in patients showering their doctor with questions or even resisting certain treatments and recommending new ones.

In an Entrepreneur report about Nicolette, a NICU nurse was interviewed on whether she thought NicoBoard would be useful to hospitals. She believed that most hospitals, especially those that are not-for-profit, wouldn’t have the money to spend on this costly of a service. Additionally, she points out that different hospitals have different systems for their EHR, and NicoBoard would have to be compatible with each one. This would significantly increase product development costs and the risk for bugs in the program.

While NicoBoard is probably the best of all the NICU apps that are currently on the market, because it does what the other apps do (journal, education, and research consolidation) and more (displaying data in visually understandable ways from patient’s EHR), I have strong doubts on whether hospitals would be willing to pay for such a product.

As of now, I wouldn’t say that I would invest in this company just yet. I would have to see how NicoBoard was implemented in Cedars-Sinai and the Children’s Hospitals, to what extent it was successful, and where Nicolette plans on going in terms of future products in this realm of patient empowerment. However, I definitely agree that this is a whole category of potential products that have yet to be created — products that increasingly involve the patient in their medical visits and treatments.

The team seems extremely passionate about their mission and quite knowledgeable about medical technology. They also have a great blend of people with tech, business, and medical backgrounds, which I believe will get them far in pushing NicoBoard into hospitals and promoting Nicolette’s mission. Therefore, with a little more information on future products and perhaps a unique shift in strategy, I would be willing to consider investing in this extremely early-stage startup.

One recommendation that I have for Nicolette right now is to form an advisory board made up of ex-board members of children’s hospitals as they could provide valuable guidance in shaping the product vision of NicoBoard and Nicolette’s overall corporate strategy.

Originally published December 2019.

More about Aneri: Aneri is a rising second-year at UCLA, majoring in Business Economics with minors in Entrepreneurship and Bioinformatics. Currently BV’s Co-Director of Marketing, Aneri is involved in all aspects of the club — from the club’s image, to recruitment, to social media engagement. In addition to her involvement in many entrepreneurship organizations on campus, she has interned at fin-tech companies, a boutique VC firm, and a journalism startup.

Disclaimer: All information in this report has been aggregated through numerous, public news reports/articles or Nicolette’s website itself. Any misrepresentation of the company is purely accidental. BV is more than willing to correct any mistakes.

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