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In 2013, Colombian businessman David Velez decided to reinvent the Brazilian banking system. He didn’t speak Portuguese, nor was he an engineer or a banker, but he did have the conviction that the system was broken and that he could fix it. And as a former Sequoia VC, he also had access to capital.
His gut instinct and market analysis were right. Today, Nubank announced a $750 million extension to its Series G (which rang in at $400 million this past January), bringing the round to a total of $1.15 billion and their valuation to $30 billion — $5 billion more than when we covered them in January.
The extension funding was led by Berkshire Hathaway, which put in $500 million, and a number of other investors.
Velez and his team decided now was a good time to raise again, because, “We saw a great opportunity in terms of growth rate and we’re very tiny when compared to the incumbents,” he told TechCrunch.”
Nubank is the biggest digital bank in the world by number of customers: 40 million. The company started as a tech company in Brazil that offered only a fee-free credit card with a line of credit of R$50 (about USD$10).
It now offers a variety of financial products, including a digital bank account, a debit card, insurance, P2P payment via Pix (the Brazilian equivalent of Zelle), loans, rewards, life insurance and an account and credit card for small business owners.
Nubank serves unbanked or underserviced citizens in Brazil — about 30% of the population — and this approach can be extremely profitable because there are many more clients available.
The banking system in Brazil is one of the few bureaucracies in the country that is actually quite skillful, but the customer service remains unbearable, and banks charge exorbitant fees for any little transaction.
Traditionally, the banking industry has been dominated by five major traditional banks: Itaú Unibanco, Banco do Brasil, Bradesco, Santander and Caixa Economica Federal.
While Brazil remains Nubank’s primary market, the company also offers services in Colombia and Mexico (services launched in Mexico in 2018). The company still only offers the credit card in both countries.
“The momentum we’re seeing in Mexico is terrific. Our Mexican credit card net promoter score (NPS) is 93, which is the highest we’ve had in Nubank history. In Brazil the highest we’ve had was 88,” Velez said.
The company has been on a hiring spree in the last few months, and brought on two heavyweight executives. Matt Swann replaced Ed Wible (the original CTO and co-founder). Wible continues to be an important player in the company, but more in a software developer capacity. Swann previously served as CTO at Bookings.com and StubHub, and as CIO of the Global Consumer Bank at Citi, so he brings years of experience of scaling tech businesses, which is what Nubank is focused on now, though Velez wouldn’t confirm which countries are next.
The other major hire, Arturo Nunez, fills the new role of chief marketing officer. Nunez was head of marketing for Apple Latin America, amongst other roles with Nike and the NBA.
It may sound a little odd for a tech company not to have had a head of marketing, but Nubank takes pride in having a $0 cost of acquisition (CAC). Instead of spending money on marketing, they spend it on customer service and then rely on word of mouth to get the word out.
Since we last spoke with Velez in January regarding the $400 million Series G, the company went from having 34 million customers to now having 40 million in a span of roughly 6 months. The funds will be used to grow the business, including hiring more people.
“We’ve seen the entire market go digital, especially people who never thought they would,” Velez said. “There is really now an avalanche of all backgrounds [of people] who are getting into digital banking.”
Here in the U.S. the concept of using driver’s data to decide the cost of auto insurance premiums is not a new one.
But in markets like Brazil, the idea is still considered relatively novel. A new startup called Justos claims it will be the first Brazilian insurer to use drivers’ data to reward those who drive safely by offering “fairer” prices.
And now Justos has raised about $2.8 million in a seed round led by Kaszek, one of the largest and most active VC firms in Latin America. Big Bets also participated in the round along with the CEOs of seven unicorns including Assaf Wand, CEO and co-founder of Hippo Insurance; David Velez, founder and CEO of Nubank; Carlos Garcia, founder and CEO Kavak; Sergio Furio, founder and CEO of Creditas; Patrick Sigris, founder of iFood and Fritz Lanman, CEO of ClassPass. Senior executives from Robinhood, Stripe, Wise, Carta and Capital One also put money in the round.
Serial entrepreneurs Dhaval Chadha, Jorge Soto Moreno and Antonio Molins co-founded Justos, having most recently worked at various Silicon Valley-based companies including ClassPass, Netflix and Airbnb.
“While we have been friends for a while, it was a coincidence that all three of us were thinking about building something new in Latin America,” Chadha said. “We spent two months studying possible paths, talking to people and investors in the United States, Brazil and Mexico, until we came up with the idea of creating an insurance company that can modernize the sector, starting with auto insurance.”
Ultimately, the trio decided that the auto insurance market would be an ideal sector considering that in Brazil, an estimated more than 70% of cars are not insured.
The process to get insurance in the country, by any accounts, is a slow one. It takes up to 72 hours to receive initial coverage and two weeks to receive the final insurance policy. Insurers also take their time in resolving claims related to car damages and loss due to accidents, the entrepreneurs say. They also charge that pricing is often not fair or transparent.
Justos aims to improve the whole auto insurance process in Brazil by measuring the way people drive to help price their insurance policies. Similar to Root here in the U.S., Justos intends to collect users’ data through their mobile phones so that it can “more accurately and assertively price different types of risk.” This way, the startup claims it can offer plans that are up to 30% cheaper than traditional plans, and grant discounts each month, according to the driving patterns of the previous month of each customer.
“We measure how safely people drive using the sensors on their cell phones,” Chadha said. “This allows us to offer cheaper insurance to users who drive well, thereby reducing biases that are inherent in the pricing models used by traditional insurance companies.”
Justos also plans to use artificial intelligence and computerized vision to analyze and process claims more quickly and machine learning for image analysis and to create bots that help accelerate claims processing.
“We are building a design driven, mobile first and customer experience that aims to revolutionize insurance in Brazil, similar to what Nubank did with banking,” Chadha told TechCrunch. “We will be eliminating any hidden fees, a lot of the small text and insurance specific jargon that is very confusing for customers.”
Justos will offer its product directly to its customers as well as through distribution channels like banks and brokers.
“By going direct to consumer, we are able to acquire users cheaper than our competitors and give back the savings to our users in the form of cheaper prices,” Chadha said.
Customers will be able to buy insurance through Justos’ app, website, or even WhatsApp. For now, the company is only adding potential customers to a waitlist but plans to begin selling policies later this year..
During the pandemic, the auto insurance sector in Brazil declined by 1%, according to Chadha, who believes that indicates “there is latent demand rearing to go once things open up again.”
Justos has a social good component as well. Justos intends to cap its profits and give any leftover revenue back to nonprofit organizations.
The company also has an ambitious goal: to help make insurance become universally accessible around the world and the roads safer in general.
“People will face everyday risks with a greater sense of safety and adventure. Road accidents will reduce drastically as a result of incentives for safer driving, and the streets will be safer,” Chadha said. “People, rather than profits, will become the focus of the insurance industry.”
Justos plans to use its new capital to set up operations, such as forming partnerships with reinsurers and an insurance company for fronting, since it is starting as an MGA (managing general agent).
It’s also working on building out its products such as apps, its back end and internal operations tools as well as designing all its processes for underwriting, claims and finance. Justos’ data science team is also building out its own pricing model.
The startup will be focused on Brazil, with plans to eventually expand within Latin America, then Iberia and Asia.
Kaszek’s Andy Young said his firm was impressed by the team’s previous experience and passion for what they’re building.
“It’s a huge space, ripe for innovation and this is the type of team that can take it to the next level,” Young told TechCrunch. “The team has taken an approach to building an insurance platform that blends being consumer centric and data driven to produce something that is not only cheaper and rewards safety but as the brand implies in Portuguese, is fairer.”
Obie, which has developed an insurtech platform for landlords, has raised $10.7 million in a Series A funding round led by Battery Ventures.
Thomvest Ventures, Funders Club, MetaProp and Second Century Ventures also participated in the financing.
If this sounds like a niche offering, that’s because it is. Obie’s software specifically targets small-to-medium size apartment landlords who own single-family rentals and/or larger apartment buildings.
Chicago-based Obie — which also went through the Y Combinator program — says its platform stands out because it offers instant quotes (by instant, they mean in about three to five minutes). The company also claims to save policyholders up to 25-30% compared to other insurance premiums. Over the past year, Obie has secured insurance for over $3 billion worth of property.
Obie co-founders (and brothers) Aaron and Ryan Letzeiser have taken their respective backgrounds in insurance and real estate private equity to build out the Obie platform. They are operating under the premise that despite being the largest class of real estate investors in the U.S, this group of landlords “is significantly underserved.”
“Generally SMB landlords have been ignored in the market, and there’s 11 million of them,” Aaron said. “And we beat target premiums, on average, by 31.7%.”
The demand appears to be there. According to the pair, Obie saw its premiums climb to about $1 million in its first 12 months of being in business. Over the last 12 months, that number has climbed to about $10 million.
In conjunction with its funding announcement, Obie also announced today the extension of its property and casualty insurance to all 50 states.
Image Credits: Obie
So, how does it work? Landlords and investors answer a series of questions on Obie’s site. The platform extracts a few data points from client responses, which its technology then combines with public and private data points such as the proximity of the landlord to the property. (This can be an indicator of how quickly a landlord can conduct proactive and preventative maintenance and general attentiveness to tenant issues.)
Once Obie runs its analysis, the platform uses a “proprietary” algorithm to match an application to carriers based on what they describe as “risk-appetite” profiles. For example, some carriers don’t want to cover properties built before a certain year. The platform then provides the landlords and property owners with a quote. If they’re OK with the quote, landlords can be “immediately underwritten,” according to the company.
At its core, said Ryan, the brothers want to make Obie “the easiest way for landlords to get the insurance that they need.”
The company plans to use its new capital to expand upon its product and “really try to own the entire vertical.”
“Historically, we’ve been an agency-based business but we are in the process of putting together our own product that is slated to roll out right at the end of the second quarter,” said Aaron. “Very similar to Lemonade and Hippo, and we’re doing it with a large insurer that’s backing us.”
In other words, Obie believes it has validated its brokerage model in the market and is now planning to use the data it’s been able to gather to become its own carrier. The company expects the rollout to take time, so until it gets approval in all 50 states, it will partner with other carriers.
“Our goal at the end of the day is to go from agency to eventually carrier,” said Ryan. “This is a tried and true path. Next has done it. Hippo has done it. Lemonade has done it.”
The brothers believe their backgrounds allow them “to speak the same language” to their clients.
“We have lived the pain points of our clients so we can understand how the price of the premium of coverage experience plays into the overall business strategy,” Aaron said.
Battery Ventures’ Michael Brown, who has taken a seat on Obie’s board, agrees the embedded nature of the startup’s offering gives them a competitive advantage.
“Allowing their end customers to buy professional liability or general liability or commercial auto right from the vertical software that is servicing their business is really interesting and a great distribution channel for Obie,” Brown told TechCrunch. “Landlords can go direct or through their channel partners.”
Brown says Battery — as long-term investors in the insurance sector — was also attracted to the fact that Obie is focused on commercial lines rather than personal because the firm believes “they are larger markets, less competitive and can probably drive higher value just given the overall size of the premiums involved.”
When disaster strikes, costs pile up quickly. Flood waters can wipe out the foundation of a home or building, just as much as wildfires can burn down the walls or the entire structure. For residents and business owners, rebuilding and rebuilding quickly is crucial: they ultimately need some place to live and offer services, and they often can’t afford to be shut out for extended periods of time.
Of course, the need for speed among consumers hits the brick wall that is the insurance industry and government’s timeline for dispersing post-disaster insurance claims and aid. It’s not uncommon for federal aid to take months or even years to arrive, and insurance companies can often take months as well to process claims, particularly after large disasters like hurricanes where thousands of claims arrive simultaneously.
Dorothy is a startup that is aiming to bridge the gap by offering, well, gap loans to users who already have existing private insurance or federal flood insurance policies. The idea is to extend cash as quickly as possible after qualification, and then Dorothy gets paid back when a claim is later processed. Much like other advance cash startups in other sectors, Dorothy takes a fee based on the size of the loan.
The company’s underwriting model assesses the likelihood that a claim will be approved given the details of a particular disaster and the user’s insurance policy.
Arianna Armelli and Claudio Angrigiani founded the company last year in the midst of the COVID-19 pandemic, naming it for the character from the Wizard of Oz who repeatedly said “there’s no place like home.” They met each other in graduate school at the University of Pennsylvania and explored different ways to solve the challenges of disaster finance.
Armelli, for her part, had experienced these challenges firsthand in the wake of Hurricane Sandy in 2012. She was an architect, and her office in Manhattan had to be evacuated. She returned a few days later, but over time, realized that many of her friends still couldn’t return to their homes even weeks after the hurricane had passed. She volunteered with recovery efforts, and I “went house to house in the Rockaways to remove drywall from their basements,” she said.
She continued her career, spending nearly six years as an architect and urban planner, and that training drove some of her early ideas about how to improve post-disaster recovery. “I thought the answer to these problems was designing better infrastructure and long-term sustainable solutions with planning,” she said. “After six years in planning, [I] realized these were 40-year projects.”
After meeting Angrigiani, the two explored ways to make the insurance system better for end users. They began by investigating how better flood data could help insurance companies underwrite better policies and process claims faster. They realized over time though that the insurance industry was quite sclerotic, and that a third-party provider of better flood predictive data wasn’t going to have a large impact on outcomes.
As COVID bared down on the world, they then explored business interruption insurance. Using their technology for disaster prediction, they saw an opportunity to offer “a financial supplementary product for businesses,” essentially a “credit line product that is offered to commercial business owners similar to a credit card,” Armelli said. That idea eventually morphed into the company’s current product offering targeting property owners, both businesses and individuals, with the same sort of gap loan to solve immediate cash-flow problems.
Dorothy participated in the latest cohort of Urban-X and closed a pre-seed round this past February. The company has raised a $250,000 debt facility to further test out its gap loan product, and it has 25 qualified customers in its pipeline. It’s early days, but an interesting new bet on how to make insurance actually useful when people face some of the toughest moments of their lives.
It’s just one of a new crop of startups that are building new offerings in a world increasingly filled with massive disasters.
When Art Agrawal was growing up in India, a car ride was a rare treat, and car ownership was a dream. When he moved to the U.S. and bought his first car, he was shocked by how much it cost and how difficult it was to maintain a car.
In 2012, he co-founded a company called YourMechanic (and won TechCrunch’s Disrupt that year) that provides on-demand automotive mobile maintenance and repair services. Over the years, the challenge of helping consumers more easily find car insurance was in the back of his mind. So in 2017, he teamed up with Lina Zhang and Musawir Shah to found Jerry, a mobile-first car ownership “super app.” The Palo Alto-based startup launched a car insurance comparison service using artificial intelligence and machine learning in January 2019. It has quietly since amassed nearly 1 million customers across the United States as a licensed insurance broker.
“Today as a consumer, you have to go to multiple different places to deal with different things,” Agrawal said. “Jerry is out to change that.”
And now today, Jerry is announcing that it has raised more than $57 million in funding, including a new $28 million Series B round led by Goodwater Capital. A group of angel investors also participated in the round include Greenlight president Johnson Cook and Greenlight CEO Timothy Sheehan; Tekion CEO Jay Vijayan; Jon McNeill, CEO of DVx Ventures and former president of Tesla and ex-COO of Lyft; Brandon Krieg, CEO of Stash and Ed Robinson, co-founder and president of Stash.
CEO Argawal says Jerry is different from other auto-related marketplaces out there in that it aims to help consumers with various aspects of car ownership (from repair to maintenance to insurance to warranties), rather than just one. Although for now it is mostly focused on insurance, it plans to use its new capital to move into other categories of car ownership.
The company also believes it is set apart from competitors in that it doesn’t refer a consumer to an insurance carrier’s site so that they still have to do the work of signing up with them separately, for example. Rather, Jerry uses automation to give consumers customized quotes from more than 45 insurance carriers “in 45 seconds.” The consumers can then sign on to the new carrier via Jerry, which would even cancel former policies on their behalf.
Image Credits: Jerry
“With Jerry, you can complete the whole transaction in our app,” Argawal said. “We don’t send you to another site. You don’t have to fill out a bunch of forms. You just give us some information, and we’ll instantly provide you with quotes.”
Its customers save on average about $800 a year on car insurance, the company claims. Jerry also offers a similar offering for home insurance but its focus is on car ownership.
The company must be doing something right. In 2020, Jerry saw its revenue surge by “10x.”
For some context, Jerry sold a few million dollars of insurance in 2019, according to Agrawal. This year, he said, the company is on track to do “three to four times” more than last year’s numbers.
“There’s no other automated way to compare and buy car insurance, because all the APIs are not easily accessible,” he said. “What we have done is we have automated the end to end journey for the consumer using our infrastructure, which will only scale over time.”
Jerry makes recurring revenue from earning a percentage of the premium when a consumer purchases a policy on its site from carriers such as Progressive.
“A lot of the marketplaces are lead-gen. A very small percent of their revenue is reoccurring,” Agrawal said. “For us, it’s 100% of our revenues.”
Goodwater Capital’s Chi-Hua Chien notes that the insurance space has historically been a very challenging category from a customer experience perspective.
“They took something that has historically been painful, intimidating and difficult for the customer and made it effortless,” he told TechCrunch. “That experience will more broadly over time apply to comparison shopping and maintenance, too.”
Chien said he was also drawn to the category itself.
“This is a competitive category because 100% of drivers need to have auto insurance 100% of the time,” he said. “That’s a large market that’s not going to go away. And since Jerry is powered by AI, it will only serve customers better over time, and just grow faster.”
The small firm has been working with clients to build up their community efforts, and its team will now be tasked with building up some of the newsletter company’s upstart efforts for writers in its network.
In a blog post, Substack co-founder Hamish McKenzie said that the company had previously used the People & Co. team to consult on their fellowship and mentorship programs and that members of the team would now be working on a variety of new efforts, from scaling programs to help writers with legal support and health insurance to community-guided projects like workshops and meetups to help crowdsource insights.
“These people are the best in the world at what they do, and now they’re not only working for Substack, but they’re also working for you,” McKenzie wrote.
Beyond Substack, previous partners with People & Company include Porsche AG, Nike and Surfrider.
Substack has been blazing ahead in recent months, adding new partners and raising cash as it aims to bring on more and more subscribers to its network. The firm shared back in late March that it had raised a $65 million round at a reported valuation around $650 million, according to earlier reporting by Axios.
Once the uncool sibling of a flourishing fintech sector, insurtech is now one of the hottest areas of a buoyant venture market. Zego’s $150 million round at unicorn valuation in March, a rumored giant incoming round for WeFox, and a slew of IPOs and SPACs in the U.S. are all testament to this.
It’s not difficult to see why. The insurance market is enormous, but the sector has suffered from notoriously poor customer experience and major incumbents have been slow to adapt. Fintech has set a precedent for the explosive growth that can be achieved with superior customer experience underpinned by modern technology. And the pandemic has cast the spotlight on high-potential categories, including health, mobility and cybersecurity.
Fintech has set a precedent for the explosive growth that can be achieved with superior customer experience underpinned by modern technology.
This has begun to brew a perfect storm of conditions for big European insurtech exits. Here are four trends to look out for as the industry powers toward several European IPOs and a red-hot M&A market in the next few years.
Several early insurtech success stories started life as managing general agents (MGAs). Unlike brokers, MGAs manage claims and underwriting, but unlike a traditional insurer, pass risk off their balance sheet to third-party insurers or reinsurers. MGAs have provided a great way for new brands to acquire customers and underwrite policies without actually needing a fully fledged balance sheet. But it’s a business model with thin margins, so MGAs increasingly are trying to internalize risk exposure by verticalizing into a “full-stack” insurer in the hope of improving their unit economics.
This structure has been prevalent in the U.S., with some of the bigger recent U.S. insurtech IPO successes (Lemonade and Root), SPACs (Clover and MetroMile), and more upcoming listings (Hippo and Next) pointing to the prizes available to those who can successfully execute this expensive growth strategy.
Electronic health records (EHR) have long held promise as a means of unlocking new superpowers for caregiving and patients in the medical industry, but while they’ve been a thing for a long time, actually accessing and using them hasn’t been as quick to become a reality. That’s where Medchart comes in, providing access to health information between businesses, complete with informed patient consent, for using said data at scale. The startup just raised $17 million across Series A and seed rounds, led by Crosslink Capital and Golden Ventures, and including funding from Stanford Law School, rapper Nas and others.
Medchart originally started out as more of a DTC play for healthcare data, providing access and portability to digital health information directly to patients. It sprung from the personal experience of co-founders James Bateman and Derrick Chow, who both faced personal challenges accessing and transferring health record information for relatives and loved ones during crucial healthcare crisis moments. Bateman, Medchart’s CEO, explained that their experience early on revealed that what was actually needed for the model to scale and work effectively was more of a B2B approach, with informed patient consent as the crucial component.
“We’re really focused on that patient consent and authorization component of letting you allow your data to be used and shared for various purposes,” Bateman said in an interview. “And then building that platform that lets you take that data and then put it to use for those businesses and services, that we’re classifying as ‘beyond care.’ Whether those are our core areas, which would be with your, your lawyer, or with an insurance provider, or clinical researcher — or beyond that, looking at a future vision of this really being a platform to power innovation, and all sorts of different apps and services that you could imagine that are typically outside that realm of direct care and treatment.”
Bateman explained that one of the main challenges in making patient health data actually work for these businesses that surround, but aren’t necessarily a core part of a care paradigm, is delivering data in a way that it’s actually useful to the receiving party. Traditionally, this has required a lot of painstaking manual work, like paralegals poring over paper documents to find information that isn’t necessarily consistently formatted or located.
“One of the things that we’ve been really focused on is understanding those business processes,” Bateman said. “That way, when we work with these businesses that are using this data — all permissioned by the patient — that we’re delivering what we call ‘the information,’ and not just the data. So what are the business decision points that you’re trying to make with this data?”
To accomplish this, Medchart makes use of AI and machine learning to create a deeper understanding of the data set in order to be able to intelligently answer the specific questions that data requesters have of the information. Therein lies their longterm value, since once that understanding is established, they can query the data much more easily to answer different questions depending on different business needs, without needing to re-parse the data every single time.
“Where we’re building these systems of intelligence on top of aggregate data, they are fully transferable to making decisions around policies for, for example, life insurance underwriting, or with pharmaceutical companies on real world evidence for their phase three, phase four clinical trials, and helping those teams to understand, you know, the the overall indicators and the preexisting conditions and what the outcomes are of the drugs under development or whatever they’re measuring in their study,” Bateman said.”
According to Ameet Shah, Partner at co-lead investor for the Series A Golden Ventures, this is the key ingredient in what Medchart is offering that makes the company’s offering so attractive in terms of long-term potential.
“What you want is you both depth and breadth, and you need predictability — you need to know that you’re actually getting like the full data set back,” Shah said in an interview. “There’s all these point solutions, depending on the type of clinic you’re looking at, and the type of record you’re accessing, and that’s not helpful to the requester. Right now, you’re putting the burden on them, and when we looked at it, we were just like ‘Oh, this is just a whole bunch of undifferentiated heavy lifting that the entire health tech ecosystem is trying to like solve for. So if [Medchart] can just commoditize that and drive the cost down as low as possible, you can unlock all these other new use cases that never could have been done before.”
One recent development that positions Medchart to facilitate even more novel use cases of patient data is the 21st Century Cures Act, which just went into effect on April 5, provides patients with immediate access, without charge, to all the health information in their electronic medical records. That sets up a huge potential opportunity in terms of portability, with informed consent, of patient data, and Bateman suggests it will greatly speed up innovation built upon the type of information access Medchart enables.
“I think there’s just going to be an absolute explosion in this space over the next two to three years,” Bateman said. “And at Medchart, we’ve already built all the infrastructure with connections to these large information systems. We’re already plugged in and providing the data and the value to the end users and the customers, and I think now you’re going to see this acceleration and adoption and growth in this area that we’re super well-positioned to be able to deliver on.”
A French startup that set out to bring a new approach to driver education and road safety, and then used that foothold to expand into the related area of car insurance, is today announcing a big round of funding to continue building its service across Europe.
Ornikar, which prepares people for driving tests by providing online drivers education courses, lets those users organize in-person lessons with driving instructors, provides a booking system for taking their written and practical examinations, and finally provides them with competitive rates for getting car insurance as new drivers, has raised €100 million ($120 million).
The company intends to use the funding to expand its business. Drivers education services are live today in France and Spain, while insurance is offered today only in France: the plan will be to expand both of those to more markets.
The Series C is being led by KKR, with previous investors Idinvest, BPI, Elaia, Brighteye, and H14 also participating. Benjamin Gaignault, Ornikar’s CEO who co-founded the company with Flavien LeRendu (who also jointly holds the title of CEO), said the startup is not disclosing its valuation, but we understand from a source that it is around $750 million. The company has raised $175 million to date.
Ornikar has been around since 2013 and was founded, in Gaignault’s words, “to disrupt driving education.”
Coming into the market at a time when most of the process of organizing, learning and booking your driving education was not only very fragmented but completely offline, Ornikar’s internet-based offering represented a step change in how French people learned to drive: the process not only became easier, but on average about 40% cheaper to arrange.
Ornikar’s driving education business today includes not just online course materials and booking services, but a network of instructors across 1,000 towns and cities in France, and a business that launched last year in Spain, under the Onroad brand. Some 1.5 million people have taken Ornikar’s driving education courses to date, with another 2 million using its driving school, with growth accelerating: 420,000 new customers signed up with Ornikar in the last year alone.
Last year was a tricky one for companies in the business of transportation. People were generally staying put and not traveling anywhere, but when they were getting around, they wanted plenty of their own space to do so.
Translating that to markets like France and Spain where many towns will have solid public transportation and taxi services, people might have opted to use these less, looking instead to private vehicles in their place. And translating that to Ornikar, Gaignault said that people being at home more, and looking to use the time productively with a view to driving more in the future, the startup saw business growing by 30% each month last year.
Interestingly, it was in the middle of the pandemic that Ornikar launched its car insurance product, which came out of the same impetus as the driver education services: it was built to fill a hole in the market rethought with Ornikar’s users in mind.
Car insurance in France — a €17 billion ($20 billion) market annually — is dominated by big players, and when it comes to first-time drivers and looking for competitive rates, “the bigger companies are not comfortable with user experience,” said Gaignault. “It’s pretty poor and not aligned with expectations of the customers.”
The car insurance product — sold as Ornikar Assurance — is now on track to hit some 20,000 users by August (when it will have been in the market for a year).
While it accounts today for a small fraction of Ornikar’s revenues compared to its driver education platform, that take up — not just from alums of Ornikar’s drivers ed, but from those who had never used an Ornikar service before — is a good sign that it’s on to something big, Gaignault said.
“In October we noticed that 80% of our new insurance customers were not coming from Ornikar but from social media, Google ads and other outside sources,” he said. “That’s why we decided to create a new business unit and explore a business as an insuretech.”
But, he added, that will not be at the expense of the driving education: the two go hand in hand for a common goal of improving how people drive and improving road safety. Indeed, Gaignault said he envisions a time when one will feed into the other: not only will the driving school serve as a way of bringing in new insurance customers, but insurance rates can be impacted by how many driving courses a person takes to keep their knowledge of the driving code and best practices fresh.
“Ornikar has done a tremendous job creating a great experience for students and driving instructors through engaging online education courses and a well-designed marketplace,” said Patrick Devine, director at KKR and member of the Next Generation Technology Growth investment team. “We are thrilled to invest behind Benjamin, Flavien, and their talented team as they expand internationally and accelerate their insurance offering following the successful launches of Onroad in Spain and Ornikar Assurance.”
Level, a startup that aims to give companies a more flexible way to offer benefits to employees, has raised $27 million in a Series A funding round led by Khosla Ventures and Lightspeed Venture Partners.
Operator Collective and leading angels also participated in the financing, along with previous backers First Round Capital and Homebrew. The round was raised at a “nine-figure” valuation, according to founder and CEO Paul Aaron, who declined to be more specific.
Founded in 2018, New York City-based Level says it’s “rebuilding insurance from the ground up” via flexible networks and real-time claims with the goal of helping employers and employees get the most out of their benefit dollars.
Employers can customize plans to do things like offer 100% coverage across treatments. The company also touts the ability to process claims in four hours.
“That’s lightning fast when compared to 30- to 60-day claims often processed by traditional payers,” said Aaron, who as one of the first employees at Square, led the network team at Oscar Health and is an inventor of several patents in the payments space.
Level first launched employer-sponsored dental benefits in the summer of 2019 and started serving its first beta customers that fall. It also now offers vision plans. The company has more than 10,000 members from companies such as Intercom, Udemy, KeepTruckin and Thistle that have paid for care via its platform.
“Insurance is confusing and often feels unfair. Networks restrict where you can go, billing takes weeks and you always seem to owe more than you expect,” Aaron said. “We believe paying with insurance should be as easy as any other purchase.”
Level says it is taking a full-stack approach and building end-to-end tools, from automated underwriting to real-time benefit analytics.
It plans to launch a new insurance product aimed at “helping smaller businesses offer bigger benefits” that typically only enterprises have the ability to offer. The company also aims to help employers get money back for any unused benefits after paying a fixed amount each month. Ultimately, the goal is to be able to offer a full suite of products that will allow companies of all sizes — from two employees to 20,000 — provide better benefits for their teams.
Level claims that its self-insured dental and vision products let companies offer more coverage to their teams while often cutting nearly 20% from their benefits budget.
“Employers already spend so much money on benefits, and neither they nor their teams get enough out of it,” said Jana Messerschmidt from Lightspeed Venture Partners, in a written statement. “Businesses of all sizes need to compete for talent with innovative benefits that help people get more from their paychecks. Level offers a far superior employee experience, and you’re getting bang for your buck.”
Meanwhile, Khosla’s Samir Kaul said he believes Level can do for insurance and benefits “what Square Cash did for person-to-person payments.”
For a continent with such stark inequality, Africa has seen limited innovation to increase access to healthcare and reduce healthcare delivery costs. Over the years, there has been continued investment in traditional care models despite the overwhelming evidence of inefficiency and escalating costs. The pandemic also laid these problems bare, exposing the vulnerabilities of the continent’s healthcare system.
Health tech startup Quro Medical is trying to scale alternative models for African healthcare starting from its home country, South Africa. The company, which provides services to manage ill patients in the comfort of their homes, is emerging from stealth to announce the close of its $1.1 million round. The round was led by Kenya-based Enza Capital and South African VC firm Mohau Equity Partners.
Quro Medical was founded by Dr Vuyane Mhlomi, Zikho Pali and Rob Cornish in 2018. CEO Mhlomi understood the pressing need for South African healthcare innovation from his own experience before and after he became a doctor.
It is known that hospitals in Africa experience excessive demands, which places strain on bed capacity. At the same time, it hinders effective patient treatment and recovery. Raised in Cape Town by his parents, Mhlomi experienced this firsthand. His parents suffered from chronic health conditions and he had to spend hours in clinics and hospitals waiting to see doctors.
Later, an opportunity to study medicine took him to the University of Oxford. Upon completion, he returned to South Africa where he knew the problem he faced previously was one to solve, hence Quro Medical.
“We were connected by our belief that the private healthcare sector can and should be doing more to shoulder the burden of healthcare provision in this country and on the continent generally,” Mhlomi told TechCrunch. “These escalating costs are the primary barrier to accessing healthcare in the private sector, leaving an overwhelming burden on our public health system.”
The CEO argues that acute patient care at home leads to better clinical outcomes and improved patient experience. This is the principle on which Quro Medical is established. In the long run, it wants to build the largest virtual hospital ward in Africa, with superior clinical outcomes to conventional care at a lower cost.
Unlike hospitals, getting healthcare at home can feel safer, which is an extra proposition for Quro Medical. According to COO Pali, apart from hospitals’ high costs, patients are at risk of getting hospital-acquired infections. But while it might appear that Quro Medical is offering the same old traditional home care with a mix of telemedicine service, that’s not precisely the case. Pali says the company incorporates clinical data and remote healthcare monitoring to provide real-time, data-driven clinical interventions. “We are focused on saving lives and enhancing patient care. The technology is the enabler, making all of this possible,” adds Mhlomi.
Patients are admitted into the company’s care in lieu of a general ward hospital admission. Then Quro Medical makes revenue from filing a claim with medical aid and insurance companies paid via reimbursement. The healthtech startup also collects out-of-pocket payments from patients.
The pandemic reinforced the company’s importance in offering remote patient monitoring services, a significant aspect of its business that garnered a check from Enza Capital.
“As our collective healthcare systems struggle to care for patients beyond the walls of a hospital, which we’ve seen exacerbated with the onset of the COVID-19 pandemic, remote patient monitoring and healthcare delivery will undoubtedly form a core part of the lasting solution,” said Mike Mompi, partner and CEO at the firm.
Nevertheless, this period has seen health tech startups offering out-of-hospital services struggle to have their services reimbursed. So how has Quro fared? Pretty well, apparently. The company claims to successfully convert most of its major medical schemes (health insurance) in South Africa as clients. They account for more than 90% of the total medical scheme market in the country.
Quro Medical has grown to work with about 150 doctors. Mhlomi believes his company is a first mover in Africa, meaning that he expects other players’ arrival in line with the trends in other markets. The company that has grown to work with 150 doctors now has plans to accelerate its hospital-at-home services and scale its operations across the country to meet its growing client base’s demands. It also wants to attract and retain talent and extend into other African markets.
Speaking on the investment for Mohau Equity Partners, CEO Dr Penny Moumakwa said, “We are very excited to be invested in Quro, they are a dynamic management team, building out a global medical solution, that will showcase the ability of entrepreneurs on the African continent in advanced digital healthcare.”
Risk and compliance startup LogicGate has confirmed a data breach. But unless you’re a customer, you probably didn’t hear about it.
An email sent by LogicGate to customers earlier this month said on February 23 an unauthorized third-party obtained credentials to its Amazon Web Services-hosted cloud storage servers storing customer backup files for its flagship platform Risk Cloud, which helps companies to identify and manage their risk and compliance with data protection and security standards. LogicGate says its Risk Cloud can also help find security vulnerabilities before they are exploited by malicious hackers.
The credentials “appear to have been used by an unauthorized third party to decrypt particular files stored in AWS S3 buckets in the LogicGate Risk Cloud backup environment,” the email read.
“Only data uploaded to your Risk Cloud environment on or prior to February 23, 2021, would have been included in that backup file. Further, to the extent you have stored attachments in the Risk Cloud, we did not identify decrypt events associated with such attachments,” it added.
LogicGate did not say how the AWS credentials were compromised. An email update sent by LogicGate last Friday said the company anticipates finding the root cause of the incident by this week.
But LogicGate has not made any public statement about the breach. It’s also not clear if LogicGate contacted all of its customers or only those whose data was accessed. LogicGate counts Capco, SoFi, and Blue Cross Blue Shield of Kansas City as customers.
We sent a list of questions, including how many customers were affected and if the company has alerted U.S. state authorities as required by state data breach notification laws. When reached, LogicGate chief executive Matt Kunkel confirmed the breach but declined to comment citing an ongoing investigation. “We believe it’s best to communicate developers directly to our customers,” he said.
Kunkel would not say, when asked, if the attacker also exfiltrated the decrypted customer data from its servers.
Data breach notification laws vary by state, but companies that fail to report security incidents can face heavy fines. Under Europe’s GDPR rules, companies can face fines of up to 4% of their annual turnover for violations.
In December, LogicGate secured $8.75 million in fresh funding, totaling more than $40 million since it launched in 2015.
Are you a LogicGate customer? Send tips securely over Signal and WhatsApp to +1 646-755-8849. You can also send files or documents using our SecureDrop. Learn more.
The Zebra, an Austin-based company that operates an insurance comparison site, has raised $150 million in a Series D round that propels it into unicorn territory.
Both the round size and valuation are a substantial bump from the $38.5 million Series C that Austin-based The Zebra raised in February of 2020. (The company would not disclose its valuation at that time, saying now only that its new valuation of over $1 billion is a “nice step up.”)
The Zebra also would not disclose the name of the firm that led its Series D round, but sources familiar with the deal said it was London-based Hedosophia. Existing backers Weatherford Capital and Accel also participated in the funding event.
The round size also is bigger than all of The Zebra’s prior rounds combined, bringing the company’s total raised to $261.5 million since its 2012 inception. Previous backers also include Silverton Partners, Ballast Point Ventures, Daher Capital, Floodgate Fund, The Zebra CEO Keith Melnick, KDT and others.
According to Melnick, the round was all primary, and included no debt or secondary.
The Zebra started out as a site for people looking for auto insurance via its real-time quote comparison tool. The company partners with the top 10 auto insurance carriers in the U.S. Over time, it’s also “naturally” evolved to offer homeowners insurance with the goal of eventually branching out into renters and life insurance. It recently launched a dedicated home and auto bundled product, although much of its recent growth still revolves around its core auto offering, according to Melnick.
Like many other financial services companies, The Zebra has benefited from the big consumer shift to digital services since the beginning of the COVID-19 pandemic.
And we know this because the company is one of the few that are refreshingly open about their financials. The Zebra doubled its net revenue in 2020 to $79 million compared to $37 million in 2019, according to Melnick, who is former president of travel metasearch engine Kayak. March marked the company’s highest-performing month ever, he said, with revenue totaling $12.5 million — putting the company on track to achieve an annual run rate of $150 million this year. For some context, that’s up from $8 million in September of 2020 and $6 million in May of 2020.
Also, its revenue per applicant has grown at a clip of 100% year over year, according to Melnick. And The Zebra has increased its headcount to over 325, compared to about 200 in early 2020.
“We’ve definitely improved our relationships with carriers and seen more carrier participation as they continue to embrace our model,” Melnick said. “And we’ve leaned more into brand marketing efforts.”
The Zebra CEO Keith Melnick. Image courtesy of The Zebra
The company was even profitable for a couple of months last year, somewhat “unintentionally,” according to Melnick.
“We’re not highly unprofitable or burning through money like crazy,” he told TechCrunch. “This new raise wasn’t to fund operations. It’s more about accelerating growth and some of our product plans. We’re pulling forward things that were planned for later in time. We still had a nice chunk of money sitting on our balance sheet.”
The company also plans to use its new capital to do more hiring and focus strongly on continuing to build The Zebra’s brand, according to Melnick. Some of the things the company is planning include a national advertising campaign and adding tools and information so it can serve as an “insurance advisor,” and not just a site that refers people to carriers. It’s also planning to create more “personalized experiences and results” via machine learning.
“We are accelerating our efforts to make The Zebra a household name,” Melnick said. “And we want a deeper connection with our users.” It also aims to be there for a consumer through their lifecycle — as they move from being renters to homeowners, for example.
And while an IPO is not out of the question, he emphasizes that it’s not the company’s main objective at this time.
“I definitely try not to get locked on to a particular exit strategy. I just want to make sure we continue to build the best company we can. And then, I think the exit will make itself apparent,” Melnick said. “I’m not blind and am very aware that public market valuations are strong right now and that may be the right decision for us, but for now, that’s not the ultimate goal for me.”
To the CEO, there’s still plenty of runway.
“This is a big milestone, but I do feel like for us that this is just the beginning,” he said. “We’ve just scratched the surface of it.”
Early investor Mark Cuban believes the company is at an inflection point.
” ‘Startup’ isn’t the right word anymore,” he said in a written statement. “The Zebra is a full fledged tech company that is taking on – and solving – some of the biggest challenges in the $638B insurance industry.”
Accel Partner John Locke said the firm has tripled down on its investment in The Zebra because of its confidence in not only what the company is doing but also its potential.
“In an increasingly noisy insurance landscape that includes insurtechs and traditional carriers, giving consumers the ability to compare everything in one place is is more and more valuable,” he told TechCrunch. “I think The Zebra has really seized the mantle of becoming the go-to site for people to compare insurance and then that’s showing up in the numbers, referral traffic and fundraise interest.”
With the pandemic sending the planet indoors to workout, the at-home fitness market has boomed. It was only in October last year that three-year-old Future closed $24 million in Series B and Playbook (streaming for personal trainers) raised $9.3 million in a Series A. Into this market launched Moxie, a platform that allowed fitness instructors to broadcast live and recorded classes, access licensed music playlists and deploy a CRM and payment tools. Classes range from $5-$25 and various subscriptions and packages are offered.
Moxie has now raised a $6.3M ‘Seed+’ funding round led by Resolute Ventures with participation from Bessemer Ventures, Greycroft Ventures, Gokul Rajaram, and additional investors. With the $2.1M Seed round from last October, that means Moxie has now raised a total of $8.4M.
With the funding, Moxie now plans to better optimize the user experience with a curated selection of top Moxie classes; new tools that help connect users to instructors; and the ability to preview classes before attending.
The company claims to have experienced “exponential growth” because of its convenience in the pandemic era, with 8,000 classes and 1 million class-minutes completed in March. Moxie’s independent instructors set their own schedules and prices, and get to keep 85% of what they earn on the platform.
The company will also now launch ‘Moxie Benefits’ in partnership with Stride Health, provide instructors with access to health insurance, dental and vision plans, life insurance, and other benefits.
Also planned is ‘Moxie Teams’, enabling groups of instructors to join together to form small businesses on the platform, not unlike the way some Uber drivers form teams.
Jason Goldberg, CEO and founder said in a statement: “Moxie was born during the pandemic alongside thousands of independent fitness instructors who were forced out of gyms and studios and suddenly had to become entrepreneurs and navigate the new frontier of virtual fitness. Now we are seeing widespread adoption of online fitness into people’s lives, and Moxie’s growth proves that these shifts in consumer behavior have staying power. We know that 89% of Moxie users plan to continue virtual workouts post COVID — they love the convenience.”
Resolute Ventures Partner & Co-Founder Raanan Bar-Cohen said: “Our investment theory has always been to identify entrepreneurial founders solving for today’s problems. With Moxie, we saw an experienced operator in Jason, with a product that solved for the issues that instructors and consumers had experienced in the shift to online fitness, as well as a clear roadmap for continued success.”
So why has Moxie managed to cleave to the new virtual workout culture? Goldburg tells me it’s down to a range of factors.
For starters, it’s a two-sided fitness marketplace that has live interactive group fitness classes, unlike VOD apps, and, crucially, unlike Peloton. Additionally, any instructor can teach on Moxie, rather than wait to be picked as a ‘star’ by Peloton. Since 90% of classes are live group fitness classes, they are effectively replacing yoga studios and HIIT classes, rather than personal training. He says many top instructors are now earning $6-figures on the platform.
Certainly, Moxie has managed to capitalize on the fact that while gyms are closed, it’s easy to do virtual classes. Will they still stick around when the pandemic is over? Presumably many will find it more convenient than schlepping to the gym and less intimidating than joining classes in person. Additionally, users can switch classes as easily as switching TV channels.
As Goldberg told me via email: “Covid forced everyone to try virtual fitness for the first time. Guess what? People found it more convenient and more connected than going to offline gyms. And guess what? Peloton is not for everyone.”
Next Insurance recently announced that it has raised a $250 million round, valuing the SMB-focused insurance provider at $4 billion. The company last raised another $250 million in September 2020, at a valuation of $2 billion. This funding also comes after Next Insurance acquired Juniper Labs in December, and AP Intego more recently.
Next sells small-business coverage across a number of categories (workers’ comp, commercial auto, general liability, etc.) for different classes of workers. Think fitness companies, or construction concerns. Put together, Next’s bet is that its ability to price coverage across different categories and industries will allow it to scale its gross written premium (GWP) quickly by attracting myriad small businesses, and upselling them to other products over time.
Next Insurance’s new round and new valuation come at an interesting time for the insurtech space more broadly. Some air has come out of Lemonade’s share price, the rental-insurance unicorn being an early public debut for the broader tech-enabled, neo-insurance niche.
Since Lemonade’s debut, we’ve seen Root Insurance go public as well. The car insurance tech startup has struggled since its debut, losing value and attracting lawsuits despite besting investor growth expectations. MetroMile, another neo-insurance company focused on automotive that went public via a SPAC-led combination, has been slightly uneven since starting to trade. Hippo, which focuses on home insurance, intends to list via a SPAC itself at a $5 billion valuation.
Inside those numbers you can find optimism, and some lackluster trading results. How to parse the mix will depend on one’s perspective.
For Next Insurance’s backers, however, it’s all systems go. And there’s reason to believe that their enthusiasm is not misplaced, despite some chop in Next’s broader market.
Next says its GWP in the half-year after its last round. That makes its valuation doubling seem somewhat reasonable — if private investors were willing to pay for its shares at a certain GWP multiple, why not re-up at double the price and double the GWP while the company continues to scale?
Just how big is Next today? It reached a GWP run rate of $100 million back in February of 2020. And it reached a $200 million GWP run rate in February of this year. So, larger than that by a few months’ growth, exclusive of the AP Intego business, which had around $185 million in active premium around the time its deal with Next Insurance was announced.
To clarify the numbers, TechCrunch reached out to Next Insurance for detail on when it doubled its GWP, and when the AP Intego deal started to count toward its numbers. Per an email from CEO Guy Goldstein, the doubling metrics regarding GWP was “in relation to that 2020 figure and [was calculated] before the AP Intego acquisition.” So, we can presume that the firm is now well north of the $200 million GWP run rate that it had previously cited.
Finally, TechCrunch asked the company about the SPAC boom and if it intended to avoid that rapid path to the public markets. “We’re always evaluating our options, but right now, the main focus remains on growing the business,” Goldstein responded.
That’s a no.
Pie Insurance, a startup offering workers’ compensation insurance to small businesses, announced this morning that it has closed on $118 million in a Series C round of funding.
Allianz X — investment arm of German financial services giant Allianz — and Acrew Capital co-led the round, which brings the Washington, D.C.-based startup’s total equity funding raised to over $300 million since its 2017 inception. Pie declined to disclose the valuation at which its latest round was raised, other than to say it was “a significant increase.”
Return backers Greycroft, SVB Capital, SiriusPoint, Elefund and Moxley Holdings also participated in the Series C financing.
The startup, which uses data and analytics in its effort to offer SMBs a way to get insurance digitally and more affordably, has seen its revenues climb by 150% since it raised $127 million in a Series B extension last May. Its headcount too has risen — to 260 from 140 last year.
Pie began selling its insurance policies in March 2018. The company declined to give recent hard revenue numbers, saying it only has grown its gross written premium to over $100 million and partnered with over 1,000 agencies nationwide. Last year, execs told me that in the first quarter of 2020, the company had written nearly $19 million in premiums, up 150% from just under $7.5 million during the same period in 2019.
Like many other companies over the past year, Pie Insurance — with its internet-driven, cloud-based platform — has benefited from the increasing further adoption of digital technologies.
“We are riding that wave,” said Pie Insurance co-founder and CEO John Swigart. “We believe small businesses deserve better than they have historically gotten. And we think that technology can be the means by which that better experience, that more efficient process, and fundamentally, that lower price can be delivered to them.”
Pie’s customer base includes a range of small businesses including trades, contractors, landscapers, janitors, auto shops and restaurants. Pie sells its insurance directly through its website and also mostly through thousands of independent insurance agents.
Workers’ compensation insurance is the only commercial insurance mandated for every company in the United States, points out Lauren Kolodny, founding partner at Acrew Capital.
“Historically, it’s been extremely cumbersome to qualify, onboard and manage workers’ comp insurance — particularly for America’s small businesses which haven’t been prioritized by larger carriers,” she wrote via email.
Pie, Koldony said, is able to offer underwriting decisions “almost instantly,” digitally and more affordably than legacy insurance carriers.
“I have seen very few insurtech teams that come close,” she added.
Dr. Nazim Cetin, CEO of Allianz X, told TechCrunch via email that his firm believes Pie is operating in an “attractive and growing market that is ripe for digital disruption.”
The company, he said, leverages “excellent,” proprietary data and advanced analytics to be able to provide tailored underwriting and automation.
“We see some great collaboration opportunities with Allianz companies too,” he added.
Looking ahead, the company plans to use its new capital to invest further in technology and automation, as well as to grow its core workers’ comp insurance business and “lay the groundwork for new business offerings in 2021 and beyond.”
Insuretech startup Counterpart, has raised $10 million in funding led by Valor Equity Partners. Also participating was Susa Ventures and Felicis Ventures. Counterpart works in the ‘management liability’ insurance market. Counterpart will also partner with Markel Specialty, a specialty insurance division of Markel Corporation, to offer its management liability insurance products.
Insuretech startups like Oscar, Lemonade, and Root have made incursions into personal insurance. What has been less prevalent, says Counterpart, is startups tackling the $300bn corporate insurance market.
Counterpart is competing with Next Insurance which has raised $631M, and which also provides small business liability insurance, as well as the big insurance carriers, from AIG to Berkshire Hathaway.
Counterpart is used by some wholesale brokers in the United States to allow small to medium businesses get insurance coverage, because it digitizes much of the process, from application submission, coverage selection, binding, claims management, and loss prevention. Counterpart says this market has become less attractive to insurance carriers because of the increasing claims costs and severity, and their lack of digitization of the process.
Tanner Hackett, founder, and CEO, said in a statement: “The $1.2tn insurance industry is going through a digital revolution.. We saw an outsized opportunity with management liability, a critical insurance line in which we have unique expertise.”
Valor Equity Partners partner and Counterpart board member Jon Shulkin said: “Counterpart’s platform goes beyond the scope of a traditional insurer, layering in insights, tools, and services to help business stakeholders navigate this extremely challenging operating environment.”
Valor was an early backer of Tesla, SpaceX, Addepar, and GoPuff. Susa has previously backed Robinhood, PolicyGenius, and Newfront Insurance. Felicis has funded Hippo, Plaid, and Credit Karma.
Healthcare tech startup Ro has raised $500 million to help fuel continued growth of its hybrid telehealth/in-home primary care platform, which also includes a growing pharmacy business as the company pursues a strategy of vertical integration to optimize delivery and reduce costs for clients. The company’s latest raise is a Series D round, and means it has now raised over $876 million since its 2017 founding.
That may seem like a lot of money, but as Ro fo-founder and CEO Zachariah Reitano told me in an interview, it’s actually “peanuts” when it comes to the healthcare industry – which is part of why they founded the company in the first place.
“Sometimes people talk about how great it is to be in the healthcare arena, in tech circles,” Reitano said. “They say, ‘Oh, healthcare is a $4 trillion market – it’s so massive.’ But that’s the worst thing in the entire world; it’s awful how large it is. And I think what we have the opportunity to cut it in half with technology.”
That’s what Reitano says will be the primary focus of this round of funding: Fueling its efforts around vertical integration of healthcare services and technology, to further the eventual end goal of reducing costs to patients through the efficiencies realized in that process.
“To me, what I’m really excited about is being able to continue to invest in that infrastructure and add even more,” Reitano told me. “We’ll continue to invest in telemedicine, we’ll continue to invest in our logistics and pharmacy, and continue to invest in in-home care, as well as the connection between the three, and then we’ll also invest in additional diagnostics, remote patient monitoring – so collecting and distributing devices to patients to go from reactive to proactive care.”
Ro’s model focuses on primary care delivered direct to consumer, without involving any payer or employer-funded and guided care programs. The idea is to reduce costs through vertical integration and other efficiency engineering efforts in order to get them to the point where they’re effectively on par with your out-of-pocket expense with co-pays anyway. Reitano explained that the insurance system as it exists in the U.S. now only effectively masks individual costs, making it less clear that much of what a person pays out in healthcare costs comes out of their pocket anyway, whether it’s through taxation, or employers allocating more of the funds they have available for compensation to healthcare, vs. take-home pay.
That’s what’s behind Ro’s recent push into operating its own pharmacies, and growing that footprint to include more all the time. Zeitano told me that the company will have 10 pharmacies by the end o this year, and 15 by the end of next, all placed strategically around the country to ensure that it can provide next-day shipping to patients at ground shipping rates pretty much anywhere in the U.S.
Doing that kind of vertical optimization has enabled Ro to offer 500 common drugs at $5 per month, including treatments for heart disease, anxiety, depression and diabetes — with a plan to ramp it to 1,000 drugs available at that price by year’s end. That’s roughly equal to the co-pay required for many insurers for the same treatments.
Meanwhile, Zeitano says Ro has seen big changes in the healthcare system generally that favor its model and accelerate its hybrid care plans owing to the COVID-19 pandemic.
“I would say that there are two most profound impacts of the pandemic on the healthcare system,” he said. “One is that it simultaneously shed light on all of the inequities for the entire country to see, right at the same time where we all cared about it. So those things were sort of known for the people impacted day to day — the geographic inequity, the financial inequity, the racial inequity. If someone felt that that inequity, then they would talk about it, but it wasn’t something everyone cared about at the same time. So this massive spotlight was shed on the healthcare system. And the second was that everyone’s healthcare journey now starts online, even if it is going to end in person, it will still start online.”
Ro’s model all along has espoused this time of healthcare delivery, with remote care and telehealth appointments handling most day-to-day needs, and follow-up in person care delivered to the home when required. That obviously generate a lot of efficiencies, while ensuring that older patients and those with mobility issues also don’t need to leave the house and make a regular trip into their physician’s office for what amounts to a 15-minute visit that could’ve been handled over video.
According to most industry observers, Zeitano is likely right that healthcare probably won’t go back to the old, inefficient model of favoring primarily in-person care after the pandemic ends. One of the positive outcomes of the COVID-19 situation has been proving that telehealth is more than capable of handling a lot of the primary care needs of a lot of people, particularly when supplemented with remote monitoring and ongoing proactive health measures, too.
While Ro doesn’t work with insurance currently, Zeitano points out that he’s not against the concept entirely – he just says that health insurance as it exists now doesn’t actual work as intended, since it’s meant to pool risk against an, expensive, uncertain and rare outcome. Eventually, he believes there’s a place for insurance in the overall healthcare mix, but first the industry needs to face a reckoning wherein its incentive structure is realigned to its actual core customer – patients themselves.


text:
How To Stop Overeating
Summary The more prepared you are to
eat healthily, the less likely you are to overeat. Keep the fridge and pantry
stocked with healthy, filling foods.
23 Simple Things You Can Do to Stop Overeating
There are ways to improve eating habits. For example, you can try to track what you eat and choose more filling foods like proteins. Your doctor can recommend the best approach for you.
Eating too much in one sitting or taking in too many calories throughout the day are common habits that can be hard to break.
And while some people see these behaviors as habits that can be broken, they may indicate an eating disorder in others.
Over time, eating too much food can lead to weight gain and increase the risk of developing a chronic condition, such as diabetes or heart disease.
Regardless of whether you have an eating disorder, breaking the cycle of overeating can be challenging. However, some techniques can help.
Almost two-thirds of that $3.3 trillion cost – 64% – is paid for by American tax dollars, and that amount is growing. A study by the American Journal of Public Health predicts that taxpayers will shoulder 67.3% of the burden of healthcare costs by the year 2024, Physicians for a National Health Program
The 23 tips below provide a starting point to reduce overeating.
Whether it’s working through lunch in front of the computer or noshing on chips while catching up on your favorite TV show, eating while distracted is a common occurrence for most people.
While this habit might seem harmless, it can contribute to overeating.
A review of 24 studies found that being distracted during a meal led people to consume more calories at that meal. It also caused them to eat more food later in the day, compared with people who paid attention to their food while eating ( 1 ).
Summary Make an effort to turn off
or put away potential distractions like phones, computers, and magazines. Concentrating
on your meal during mealtime can help prevent overeating.
Pinpointing which foods can trigger overeating and avoiding them can help decrease the chances of overeating.
For example, if ice cream is likely to trigger a binge or episode of overeating, it’s a good idea to stop storing it in the freezer. The harder it is to access something, the less likely you might be to overeat that food.
Preparing healthy options like a sliced apple with peanut butter, hummus and veggies, or homemade trail mix can encourage better choices when snacking.
Another helpful tip is to keep unhealthy snack foods like chips, candy, and cookies out of sight so there’s no temptation to grab a handful when walking past them.
Summary Identify the unhealthy foods
that trigger overeating. Keep them out of the home or far out of sight, and
make healthy options easily accessible instead.
Restrictive eating patterns that eliminate many of your favorite foods may cause you to feel deprived, potentially leading you to binge on forbidden treats.
Diets that concentrate on whole, unprocessed foods are always best, but making room for an occasional treat is perfectly healthy.
Swearing to never have a scoop of ice cream, slice of pizza, or piece of chocolate again is not realistic for most people.
That said, in the case of food addiction, a person may need to permanently abstain from trigger foods. In this case, it’s a good idea to find healthy substitutes that are satisfying.
Focus on providing your body with mostly healthy, nutritious food while giving yourself the freedom to truly enjoy a treat here and there.
Summary Eating patterns that are too
restrictive may drive binges. The key to a sustainable, healthy diet is to
concentrate on eating whole, unprocessed foods most of the time while allowing for
a treat here and there.
Volumetrics is a way to eat that focuses on filling up on low calorie, high fiber foods like non-starchy vegetables.
Consuming foods that are low in calories and high in fiber and water before meals can help you feel full, which might decrease overeating.
Examples of volumetrics-friendly foods include grapefruit, salad greens, broccoli, beans, tomatoes, and low-sodium broth.
Eating a large salad or bowl of low-sodium, broth-based soup before lunch and dinner may be an effective way to prevent overeating.
Summary Use the volumetrics method
of eating — fill up on healthy, low-calorie, high-fiber foods to help promote feeling
Eating chips out of the bag, ice cream out of the carton, or takeout straight from the box can lead to consuming more food than is recommended as a serving size.
Instead, portion out a single serving size on a plate or in a bowl to help control the number of calories you consume in one sitting.
Use measuring tools to train your eye on what a normal portion should look like for different types of foods.
Summary Instead of eating food
straight from the package, portion it into a dish. Try measuring out
appropriate serving sizes to help train your eye to identify how much food is recommended
as an average portion.
Stress can lead to overeating, so it’s important to find ways to reduce the amount of stress in your daily life.
Chronic stress drives up levels of cortisol, a hormone that increases appetite. Studies have shown that being stressed can lead to overeating, increased hunger, binge eating, and weight gain ( 2 ).
There are many simple ways to reduce your everyday stress levels. Consider listening to music, gardening, exercising, or practicing yoga, meditation, or breathing techniques.
Summary Stress can lead to
overeating, so reducing the stress in your everyday life is one important step
to reduce overeating.
Choosing foods that are rich in fiber, such as beans, vegetables, oats, and fruit, can help keep your body feeling satisfied longer and reduce the urge to overeat.
For example, one study found that people who ate fiber-rich oatmeal for breakfast felt fuller and ate less at lunch than those who consumed cornflakes for breakfast ( 4 ).
Snacking on nuts, adding beans to your salad, and eating vegetables at every meal may help reduce the amount of food you consume.
Summary Add fiber-rich foods to your
diet to keep your body feeling satisfied longer. Studies show this may help
reduce the urge to overeat.
When attempting to lose weight, many people cut out meals in hopes that it will decrease the number of calories they take in.
While this may work in some instances, such as intermittent fasting, restricting meals may cause you to eat more later in the day.
Studies have demonstrated that eating more frequently throughout the day may decrease hunger and overall food intake ( 5 ).
For example, some people may skip lunch to restrict calories, only to find themselves overeating at dinner. However, eating a balanced lunch may help reduce the chances of eating too much later in the day ( 6 ).
Summary Skipping meals may cause you
to eat more later in the day. Instead, focus on keeping your body feeling
satisfied by eating balanced meals made with whole foods.
Keeping track of what you eat in a food diary or mobile app may help reduce overeating.
Many studies have shown that using self-monitoring techniques like keeping a food diary may aid weight loss ( 7 ).
Plus, using a food journal can help identify situations and emotional triggers that contribute to overeating, as well as foods that are likely to provoke binge eating.
Summary Studies have shown that
tracking your food intake may help you lose weight. It will also help you become
more aware of your habits.
The food choices of your dining companions may have a greater effect on your food intake than you realize.
Numerous studies have found that people’s food choices are heavily influenced by the people they eat with.
People may tend to eat portions similar to those of their dining companions, so dining out with friends who overeat may cause them to overeat as well ( 8 ).
Plus, studies have shown that a person is more inclined to order unhealthy options if their dining partner does ( 9 ).
Choosing to eat with family and friends who have similar health goals can help you stay on track and reduce your chances of overeating.
Summary With whom you choose to eat
may majorly impact your food choices. Try to dine with people who also want to
eat healthy meals in moderate portions.
Protein helps keep your body full throughout the day and can decrease the desire to overeat.
For example, eating a high protein breakfast has been shown to reduce hunger and snacking later in the day ( 10 ).
Choosing a protein-rich breakfast like eggs tends to lower levels of ghrelin, a hormone that stimulates hunger ( 11 ).
Adding higher protein snacks like Greek yogurt to your routine can also help you eat less throughout the day and keep hunger under control ( 12 ).
Summary Eating protein-rich foods
may help stave off hunger and cravings. Starting the day with a high protein
breakfast can also help fight hunger later in the day.
Eating white bread, cookies, candy, and other carbs with high glycemic indexes will likely cause blood sugar levels to spike, then fall quickly.
This rapid blood sugar fluctuation has been shown to promote hunger and can lead to overeating ( 13 ).
Choosing foods with lower glycemic indexes will help prevent blood sugar spikes and may reduce overeating. Beans, oats, and brown rice are all great options.
Summary Eat foods that help keep blood
sugar levels constant. High-glycemic foods like candy and white bread can make
blood sugar spike then drop, which may lead to overeating. Instead, choose
foods like beans, oats, and brown rice.
Eating too quickly may cause overeating and lead to weight gain over time.
Slower-paced eating is associated with increased fullness and decreased hunger and can serve as a useful tool for controlling overeating ( 14 ).
Taking the time to thoroughly chew food has also been shown to reduce overall food intake and increase feelings of fullness ( 15 ).
Summary Focusing on eating more
slowly and chewing food thoroughly may help you recognize signs of fullness and
Drinking alcohol may cause overeating by lowering your inhibitions and stimulating appetite ( 16 , 17 ).
While having a drink or two with a meal generally won’t have a huge effect, having several drinks in one sitting may lead to increased levels of hunger.
One study found that college students who drank four to five drinks at a time more than once per week were more likely to overeat after drinking, compared with students who drank one to two drinks at a time ( 18 ).
Cutting back on drinking alcohol may be a good way to minimize overeating.
Summary Studies show that drinking
several drinks in one sitting may lead to overeating. Instead, stick to just
one or two drinks, or forgo drinking alcohol entirely.
Being unprepared when hunger strikes can make it more likely that you’ll make poor food choices that can lead to overeating.
Purchasing meals and snacks at the last minute from restaurants or delis increases the likelihood of making unhealthy choices and eating more.
Instead, keep healthy snacks on hand, pack home-cooked lunches, and stock the fridge with healthy options to prepare dinner at home.
These strategies can help decrease overeating. Plus, making more meals at home can save money and time.
Summary The more prepared you are to
eat healthily, the less likely you are to overeat. Keep the fridge and pantry
stocked with healthy, filling foods.
Drinking sugary beverages like soda and juice could lead to weight gain and increase the risk of certain diseases like diabetes ( 19 ).
Studies have shown that consuming sweetened drinks with meals may be linked to overeating as well.
A review of 17 studies found that adults who drank sugar-sweetened beverages with meals consumed 7.8% more food than adults who consumed water with meals ( 20 ).
Choosing water or unsweetened seltzer over sweetened beverages may help reduce overeating.
Summary Avoid sugary beverages.
They’ve been linked to an increased risk of diabetes and other diseases and may
be linked to overeating. Drink water instead.
Overeating in the absence of hunger could be a sign that something deeper is going on.
Depression and boredom are two common issues that have been linked to the urge to overeat ( 21 , 22 ).
Fortunately, taking certain actions can help. For example, try taking on a new activity that’s enjoyable. It may help prevent boredom and distract from the urge to nibble.
Also, spending some time thinking about what triggers overeating can help determine the type of help to seek. If depression and anxiety are contributors, getting proper treatment from a mental health professional might assist with reducing overeating.
Every person is different, so it’s important to find the right treatment plan for your needs.
Summary Think about the feelings
during episodes of overeating and seek help to address the issues behind the
behavior. Depression and boredom are two common reasons. A mental health
professional can provide guidance.
Fad diets probably won’t help you stop overeating in the long run. Short-term, restrictive diets may lead to rapid weight loss, but they are often unsustainable and can set you up for failure.
Instead, make long-term lifestyle changes that promote health and wellness. It’s the best way to create a balanced relationship with food and prevent habits like overeating.
Summary Instead of going on fad
diets to curb overeating, find a sustainable way of eating that nourishes your
body and helps it reach optimal health.
Habits can be hard to break, especially when they involve food.
Many people get into comfortable routines, like eating dinner in front of the TV or having a bowl of ice cream every night.
It may take time to identify unhealthy behaviors that lead to overeating and replace them with new, healthy habits, but it’s well worth the effort.
For example, make it a point to eat at the dinner table instead of in front of the TV, or replace a nightly bowl of ice cream with a hot cup of tea. These replacements will become healthy habits over time.
Summary Identify unhealthy habits
and gradually replace them with new, more positive behaviors.
Although high fat foods are often associated with weight gain and overeating, choosing foods rich in healthy fats can help you eat less.
Several studies have shown that adults who consume high fat, low carb diets are less hungry 3–4 hours after meals and lose more weight over time, compared with people who consume diets high in carbs and low in fat ( 23 , 24 ).
Adding healthy fats like avocados, nuts, seeds, nut butters, and olive oil to your diet may help you feel more satisfied after meals and reduce overeating.
Summary Try adding more healthy fats
to your diet. Studies have shown doing so may help you feel fuller after meals
and lose weight over time.
Setting short- and long-term goals and referring to them often may help you stay on track and reduce the urge to overeat.
Knowing the reason for overcoming overeating and how overeating is preventing you from reaching your health and wellness goals can motivate you to work toward establishing new eating patterns.
Jotting down motivational quotes and hanging them in prominent places around your living space can help inspire you to stick to a plan throughout the day.
Summary Identify specific short- and
long-term eating goals and refer to them often. It can even be helpful to place
motivational quotes around your home.
It’s important to distinguish overeating from binge eating disorder (BED).
Binge eating disorder (BED) is recognized by the Diagnostic and Statistical Manual of Mental Disorders(DSM-5) as a psychiatric disorder. This means someone who has BED will likely need treatment from a team of medical professionals to overcome it.
BED is characterized by ongoing episodes of eating a large amount of food very quickly to the point of discomfort, despite not being hungry. After a binge, a person might feel shame or guilt surrounding the behavior.
It affects millions of people worldwide and is the most common eating disorder in the United States ( 25 ).
If you feel that you might have BED, it’s important to get help. Speak with your healthcare provider about treatment options.
Summary If you regularly binge on
large quantities of food, lack control, and experience feelings of guilt, you
may have binge eating disorder and should seek professional help.
Adopting mindful eating techniques is one of the best ways to prevent overeating.
The practice of mindful eating stresses the importance of focusing on the moment and being aware of thoughts, emotions, and senses while consuming food.
Many studies have shown that mindful eating is an effective way to reduce binge eating behaviors, overeating, and emotional eating ( 3 ).
Eating more slowly, taking small bites, chewing thoroughly, being aware of your senses, and appreciating food are all simple mindfulness practices to incorporate into a daily routine.
Summary The practice of mindful
eating has been shown to help reduce binge eating behaviors. Mindful eating
focuses on being aware of your thoughts and senses while eating.
Many people struggle with overeating.
Fortunately, there are ways to improve eating habits and overcome eating disorders.
Healthcare professionals like psychologists, doctors, or registered dietitians can also provide counseling and guidance to help you get back on track.
Overeating can be a hard habit to break, but you can do it. Use these tips as a starting point to help establish a new, healthy routine, and make sure to seek professional help if you need it.
Editor’s note: This piece was originally published on April 16, 2018. Its current publication date reflects an update, which includes a medical review by Timothy J. Legg, PhD, PsyD.
How we reviewed this article:
Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.
Overeating, or eating even after you’re full, is fairly common. We overeat at parties, family gatherings and holidays. But overeating can also contribute to obesity and the development of eating disorders.
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What is overeating?
Overeating is eating past the point of fullness. When we overeat, we eat even though we aren’t hungry. If it becomes a habit, overeating can lead to weight gain and eating disorders. But overeating isn’t binge eating disorder.
Overeating is very common, and it’s biological. When you’re stressed, your body makes more of a hormone called cortisol. Increased cortisol is a fight-or-flight response that, among other things, tells you it’s time to find food. It can make you crave foods high in sugar, fat or salt.
There are other factors at play here, too. How fast you eat, what you eat, when you eat and what you’re doing while you eat can all contribute to overeating.
Occasional overeating can cause stomach pain and indigestion, alter how your body regulates hunger and contribute to weight gain.
Symptoms and Causes
What are the symptoms of overeating?
When you overeat, you may feel:
You may also have these symptoms for other reasons, not just overeating. If these symptoms last more than a day or so, they may not be related to overeating. If they get worse or last for a week, contact a healthcare provider.
How long will the symptoms last?
The discomfort from overeating should start to get better a few hours later. Getting some exercise and drinking water may help you feel better faster.
How do you know when you’ve overeaten?
Overeating is eating past the point of fullness. But while you’re eating, it can be hard to tell when to stop, especially if you eat quickly or are busy with other things.
Typically, your body regulates hunger with hormonal signals. If it’s been a while since you last ate, your levels of a hormone called ghrelin rise, which makes you hungry. After you eat, the hormone leptin tells you you’re full.
Overeating overrides these signals. This disrupts the balance of the hormones that regulate our hunger and makes us more likely to eat for pleasure instead of energy.
You might not notice you’ve been overeating for about 20 minutes or so after you stop eating. Then, you may feel tired or have an upset stomach.
What causes overeating?
There are many causes of overeating, some related to the foods themselves, and others related to why or when we’re eating. Causes of overeating include:
- Emotional eating. You’re more likely to eat in times of stress, or if you’re in a bad mood, tired, bored or sad. Eating causes your brain to release endorphins, which are feel-good hormones. So, eating feels good for a lot of people. It’s something we can do when we feel overwhelmed or burnt out. When we eat because it feels good, and not necessarily because we’re hungry, we’re more likely to overeat.
- Preferred foods. It can be hard to stop eating foods you love. Foods like French fries, pizza, chocolate and ice cream are common foods to overeat.
- Highly processed foods. Processing and added flavors encourage you to eat for pleasure and to keep eating even when you’re not hungry.
- Time of day. Overeating is common in the evenings when you’re more likely to eat because it feels good and not just because your body needs the energy.
- Social situations. We gather around food a lot — on holidays, for sporting events and to connect with family and friends. In social situations, you may be more distracted, nervous or feel pressure to eat while everyone else is eating, even if you’re no longer hungry.
- Large portions. When you’re at a restaurant or eating buffet- or family-style, you’re more likely to eat larger portions.
- Certain medications can make you less likely to know when you’re full. Talk with your healthcare provider if you notice overeating after a medication change.
- Medical conditions. Some medical conditions can contribute to overeating, including premenstrual syndrome, atypical depression, anxiety, Prader-Willi syndrome (PWS) and Kleine-Levin syndrome.
Management and Treatment
What should I do after overeating?
If you overeat, feeling shame or blaming yourself won’t help you feel better. Remember that overeating is common. You might feel bad for a few hours and it’s important to be kind to yourself while your digestive system works. There are some things you can do to help your body digest your meal and get you back on track. For example:
- Take a walk. Getting moderate exercise can help reduce gas and regulate your blood sugar.
- Stay hydrated. Your digestive system will need more water to process the extra load.
- Herbal teas, like peppermint, chamomile and ginger can help with digestion and reduce gas.
- Taking an over-the-counter antacid may help relieve heartburn or indigestion.
Complications/side effects of antacids
Possible side effects of antacids include:
- Changes in the color of your poop.
- Stomach cramps.
How can I avoid overeating?
Although occasional overeating is common, it can change how your body regulates hunger and lead to unwanted weight gain. One of the main reasons we overeat is because it feels good. So, doing more things that make you feel good that aren’t eating may help. Practice good self-care: Move your body, get enough (but not too much) sleep and limit social media.
Other things that may help you stop overeating include:
- Limit alcohol consumption. We eat more when we’re drinking. Cutting back may help.
- Avoid salty foods, which can increase your desire for sweets.
- Fill your plate with vegetables, which contain more fiber and will slow down your eating.
- Manage your stress levels. Stress hormones can override hunger and fullness hormones.
- Eat slowly. If you take your time, you may notice you’re full before you finish your plate.
- Eat mindfully. Know your triggers and motives for eating.
- Get regular exercise. Exercise is an alternative source of endorphins.
- Plan your holiday celebrations earlier in the day, when you’re less likely to overeat.
Frequently Asked Questions
Can overeating make you sick?
Yes, overeating can lead to nausea and vomiting.
Will overeating cause weight gain?
Overeating once or twice a year shouldn’t cause lasting weight gain. But if overeating becomes a pattern, then it will. When you feel discomfort from overeating, be gentle with yourself. Get some light exercise and drink some water. And don’t drastically reduce your caloric intake the next day. Eat — mindfully — when you’re hungry.
Why does overeating make you feel tired?
Overeating makes your body work harder and redirects blood flow away from other organs to your busy digestive system. This can make you feel tired or sluggish. The foods we’re more likely to overeat also tend to be higher in carbohydrates, which can cause a sugar rush followed by a sugar crash.
When should I contact my healthcare provider?
If you find yourself overeating more than once per week for a few months, it might help to discuss your symptoms and eating behaviors with a healthcare provider.
A note from Cleveland Clinic
Everyone overeats from time to time. Be kind to yourself. It may help to understand why you eat and what happens in your body when you eat (and overeat). Getting some exercise and drinking water should help relieve the discomfort. While occasional overeating is OK, if you overeat more often, you may gain weight or develop chronic conditions. If you find yourself overeating regularly, reach out to a healthcare provider.
Last reviewed by a Cleveland Clinic medical professional on 02/07/2023.
- American Academy of Family Physicians. Antacids and Acid Reducers: OTC Relief for Heartburn and Acid Reflux. (https://familydoctor.org/antacids-and-acid-reducers-otc-relief-for-heartburn-and-acid-reflux/) Accessed 2/7/2023.
- American College of Gastroenterology. Acid reflux. (https://gi.org/topics/acid-reflux/) Accessed 2/7/2023.
- Chamorro R, Kannenberg S, Wilms B, et al. Meal Timing and Macronutrient Composition Modulate Human Metabolism and Reward-Related Drive to Eat. (https://pubmed.ncbi.nlm.nih.gov/35276920/) Nutrients. 2022 Jan 27;14(3):562. Accessed 2/7/2023.
- Felonis CR, Boyajian L, Fan S, et al . Changes in affect from non-eating activity engagement as predictors of loss of control eating: an ecological momentary assessment study. (https://pubmed.ncbi.nlm.nih.gov/34846722/) Eat Weight Disord. 2022 Aug;27(6):2229-2235. Accessed 2/7/2023.
- Flatus & Bloating. In: Papadakis MA, McPhee SJ, Bernstein J, eds. Quick Medical Diagnosis & Treatment 2022. McGraw Hill; 2022.
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- Kelly NR, Cotter EW, Williamson G, et al. Loss of control may uniquely predict negative affect among the disinhibited eating experiences of high-risk young men. (https://pubmed.ncbi.nlm.nih.gov/36240577/) Eat Behav. 2022 Dec;47:101674. Accessed 2/7/2023.
- Neumann NJ, Fasshauer M. Added flavors: potential contributors to body weight gain and obesity. (https://pubmed.ncbi.nlm.nih.gov/36319974/) BMC Medicine. 2022;417.
- Peitz D, Warschburger P. Taking a closer look at mindful eating: incremental validity and importance of subfacets. (https://pubmed.ncbi.nlm.nih.gov/35301692/) Eat Weight Disord. 2022 Oct;27(7):2507-2514. Accessed 2/7/2023.
- Schulte EM, Avena NM, Gearhardt AN. Which foods may be addictive? The roles of processing, fat content, and glycemic load. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334652/) PLoS One. 2015 Feb 18;10(2):e0117959. Accessed 2/7/2023.
- Unick JL, Dunsiger SI, Shira I, et al. Randomized Trial Examining the Effect of a 12-wk Exercise Program on Hedonic Eating. (https://pubmed.ncbi.nlm.nih.gov/34261994/) Med Sci Sports Exerc. 2021 Aug;42(8):1638-1647. Accessed 2/7/2023.

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