Why We Invested in NephroPlus

By Sophia Friedman and Anna Reilly

There has been a significant increase in both the number and severity of end stage renal disease (ESRD) and chronic kidney disease (CKD) cases in India over the past several decades. Of the estimated 1.3M individuals requiring access to dialysis services in India, only ~20% are receiving those services at the recommended frequency. This gap is primarily due to: 1) affordability as the average cost per session is price prohibitive to most; and, 2) supply side constraints given there is a significant gap in supply of dialysis machines, clinicians, and centers. Additionally, geographic location continues to serve as a barrier to access for individuals living in tier II or III cities versus tier I cities. While a number of private dialysis companies have been founded in India, few have been able to scale high-quality, affordable services across high-need areas. Similar challenges exist more broadly outside of India. In The Philippines and Uzbekistan, the number of individuals with kidney diseases continues to grow and the demand for services in these countries has far outpaced supply.

Solution

NephroPlus enables individuals suffering from kidney diseases to resume normal functioning of life through high-quality, cost effective dialysis treatments and services. NephroPlus is Asia’s largest chain of dialysis clinics with ~450 centers across 250+ towns in India, Uzbekistan, and The Philippines. The company offers services through both standalone centers and outsourced dialysis centers located in hospitals within tier I, II, and III cities, and through public-private partnerships. NephroPlus has an in-house dialysis staff training program, which both addresses supply side challenges and ensures high-quality delivery of services. During the last 10 years, more than 1,000 students have been trained and placed successfully at NephroPlus clinics. NephroPlus is well-positioned to serve the large and growing number of individuals with a need for high-quality, affordable dialysis services in India, The Philippines, Uzbekistan, and additional countries in Asia.

Why We Invested

The prevalence and severity of kidney disease cases continues to increase around the world, particularly across Southeast Asia. In India, The Philippines, and Uzbekistan, where NephroPlus operates, there is a significant supply-demand gap in terms of dialysis machines, centers, and clinicians required to care for individuals suffering from renal disease. To combat this discrepancy, the Indian government launched the Pradhan Mantri National Dialysis Programme, which partners with private providers to increase the number of centers, machines, and clinicians offering dialysis services in the country. The governments within The Philippines and Uzbekistan are also offering universal health coverage for these services through government partnerships. However, public programs alone will not be enough to overcome the gap in the number of needed machines. Further, these countries also struggle to properly recruit and train the number of nurses and technicians needed to provide care.

Given the need for machines, centers, and clinicians, NephroPlus is well-positioned to become a market leading provider of dialysis services across Asia. As a single specialty, multi-site provider of high-quality, cost effective dialysis services, NephroPlus will be capable of partnering with governments and outsourcing dialysis services for hospital and center partners. The NephroPlus founding team has extensive experience in the dialysis industry, including effectively scaling the company to ~450 centers since its foundation in 2010. Founder and CEO Vikram Vuppala founded NephroPlus with a clear objective to redefine and transform healthcare in India. Further, NephroPlus’s most significant investor, Quadria Capital, is committed to working together with the company to professionalize and optimize the business as NephroPlus continues to scale throughout Asia. The NephroPlus and Quadria Capital teams share a similar mission to build Asia’s largest network of dialysis centers offering high-quality, cost-effective services in countries with a significant need. 

Impact

NephroPlus addresses all three barriers to services: accessibility, quality, and affordability. The company plans to add hundreds of additional centers across tier I, II, and III cities with the majority of centers added in tier III cities, where there is currently limited access to dialysis services. NephroPlus maintains a highly-qualified clinical board and ensures cohesive standard operating procedures lowering infection rates across centers and markets. Additionally, NephroPlus recently announced the publication of a research study in The Lancet Regional Health - Southeast Asia establishing the first national benchmark for survival amongst dialysis patients in India. The company has partnered with the governments in both The Philippines and Uzbekistan to ensure public coverage for services. Within India, while the company provides the majority of services through government models, either through PPP or offering services under government healthcare schemes, while the rest of services are either private insurance or self pay. NephroPlus intends to continue to partner with the Indian government to provide services through public-private partnership models.

Why We Invested in Mae Health

By Sophia Friedman

The United States is facing a maternal mortality crisis. Maternal mortality rates in the US exceed rates in other high income countries (by more than ten times in some cases, such as compared to Australia, Japan and Spain). Specifically, Black women are most negatively impacted and are 3-4x more likely to die from pregnancy-related complications. Further, 15% of Black births are premature, 35% of Black births are via c-section, and Black women are twice as likely to experience pregnancy-related complications. Various factors drive this inequity in care including access to care, social determinants of health (SDoH), and structural racism. Notably, structural issues such as implicit biases of caregivers and a lack of cultural competency materially contribute to these outcomes. 

Solution

Mae Health is a culturally competent digital health platform connecting Black expectant mothers with critical resources to elevate the standard of care for Black women, with a focus on improving maternal health outcomes. Mae works in concert with healthcare payers and states to address the significant disparities in maternal health outcomes for Black mothers across the country by pairing a community-based model of doula support with best-in-class digital interventions.

Mae’s core offerings include continuous digital engagement and culturally aligned support. The continuous digital engagement provides multi-modal touchpoints such as culturally aligned content, virtual, small group ‘Mae Momma classes’ that offer programming on specific topics, SDoH monitoring, care flags to identify risks early and track data, and analytics to share with healthcare providers and payors. Mae’s culturally-aligned support offers virtual or in-person perinatal support from credentialed doulas. Mae connects expectant mothers with doula networks for the provision of care and also provides various levels of support to doulas including a client management interface, workflow tools, and billings and claims submission support.

Why We Invested

We believe that Mae’s approach is unique as it is entirely focused on reaching Black expectant mothers, and their sales traction to date has been 100% with Medicaid payors (though the company does have D2C users who can access free content). Some competitors have avoided contracting with Medicaid payors because of the complex reimbursement dynamics that vary by state, and inherent challenges to engaging these patient populations, but Mae has tackled this head-on and is a first mover in this space. Mae has proven a  strong value proposition to payors by clearly mapping the cost savings of providing doula support and has seen great success with signing and launching new Medicaid payor contracts in recent months.

Further, the doula-centric approach is also unique, and Mae has made progress ahead of other players in building out a bench of doula talent. While there are several players in the maternal health market broadly, Mae’s approach is unique in its focus on optimizing doula benefits for Medicaid populations. Doula support has been directly linked to improved health outcomes as women who give birth with a doula present have a 22% lower risk of undergoing a c-section. By employing this model, there is significant impact potential in a market that not many companies have been willing to focus on. Lastly, the team is extremely impact motivated and brings relevant lived experience to the platform. Founder and CEO Maya Hardigan has prior experience on the innovation team at Pfizer and as the mother of three young girls, she has personally experienced the inequities that she is trying to address.  

Impact

Mae aims to elevate the standard of maternal health care for Black women, with a focus on improving maternal health outcomes. Believing that many of the disparities Black women face are driven by biases in care, its model prioritizes on-the-ground support from community-based doulas who are known to improve pregnancy experiences and outcomes. Mae has already begun to demonstrate improvements, and its solution is linked to reduction in maternity cost of care, improvements in health performance metrics (HEDIS metrics), and enhanced member literacy, satisfaction and engagement.  From an access perspective, at the time of investment, Mae’s enterprise users were 100% Medicaid patients, and several quantitative measures suggest that the approach is driving positive health outcomes amongst this population. Specifically, Mae has shown a 31% reduction in c-section rates and a 58% reduction in preterm birth rates amongst its users. 

While not specific to Mae, many of the tactics Mae is employing have demonstrated a direct link to an improvement in clinical outcomes. For instance: women who attend a childbirth education classes are 26% more likely to have a vaginal delivery than those who do not; women who have a birth plan are 98% more likely to have a vaginal delivery than those who do not; and, mothers who use a lactation consultant are almost 71% more likely to exclusively breastfeed within the first month of the baby’s life. Thus, with time, Mae expects to collect additional data to prove its positive impact on health outcomes.

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Our investment in Mae Health was part of a fundraising round led by Jumpstart Nova.

Why We Invested in Vacuumschmelze

By Chris Wu and Aakash Dattani

A majority of the discussion, policy, and investment in the clean energy transition has been focused on renewable energy generation, storage, mobility, financing, consumer adoption, and related challenges. The underlying supply chain and enabling infrastructure needed to support this transition, given its scale, is less well understood, and underappreciated. The growing electrification of the global energy system, both in terms of generation, and final consumption relies on a commensurate growth in the supply of highly efficient electric motors and generators. High quality magnets are an essential component of both of these electrical devices. At present, China accounts for 87% of global permanent magnet production. Consequently, the global magnet supply chain, especially after COVID, is a source of significant risk for turbine manufacturers, electric vehicle OEMs (original equipment manufacturers), and the like, especially in the western world.

Solution

Vacuumschmelze (VAC) is an advanced magnetic materials and solutions company with a 100-year operating history. The company manufactures a variety of different products that play a key role in end markets driven by the energy transition including EVs, industrial efficiency, alternative energy, and electric flight through its soft magnet and permanent magnet segments. The company currently is the only Western manufacturer of significant scale producing permanent magnets, which is a mission-critical component that goes into EV motors, so they are uniquely positioned to serve as a key supplier for this high-value segment of the global magnetic materials market.

VAC has two operating segments: Hard Magnets (permanent magnets) and Soft Magnets (Temporary Magnets). The most common type of permanent magnets VAC produces are sintered NdFeB magnets and their associated assemblies. NdFeB sintered magnets are used in EV car motors to generate propulsion (rather than an internal combustion engine) and have the highest levels of magnetism of any known magnet. VAC also serves several market segments such as wind and solar energy, advanced manufacturing, and aerospace, in which it enjoys a large market share because of the superior performance, high customization, and advanced technology characteristics of its products.

Why We Invested

Almost all of VAC’s segments have differentiated products critical to the energy transition. Key end markets within the energy transition are expected to grow at double-digit CAGRs over the next five years. VAC has longstanding secure partnerships with many blue chip customers, which tend to be sticky on account of high switching costs, and the company’s customers have consistently demonstrated strong willingness to pay. VAC’s management team has extensive industry knowledge, each member of the management team brings 15+ years of relevant industry experience. The company’s R&D pipeline - supported by a demonstrated track record - generates innovative products with attractive, durable markets and opportunities for higher margins. Western auto OEMs are projected to drive demand for an additional 25,000 tons of permanent magnets per year by 2030, which VAC is well positioned to serve. At present, there are only three players in the advanced magnetics space that can take advantage of this massive opportunity and VAC is the only producer in North America or Europe and VAC is the only one who has signed an offtake contract with a Western OEM, General Motors. VAC is in the process of building a new North American facility to supply under this contract, which is likely to meaningfully scale the company’s operations, allowing it to play a greater role in supporting the energy transition. 

Impact

The company manufactures key products that are considered foundational components that go into EV motors as well as EV charging infrastructure. OEMs desperately need these components in order to meet the transportation sector’s goal of electrifying mobility. The transportation sector accounted for 27% of the US CO2 emissions in 2020, according to the EPA. As more electric vehicles are sold they will displace polluting internal combustion engine (ICE) vehicles. The greenhouse gas emissions associated with an electric vehicle over its lifetime are typically lower than those from an average gasoline-powered vehicle, even when accounting for manufacturing and mining of rare minerals.The International Energy Agency estimates that the lifecycle GHG emissions for a mid-size EV is ~53% lower than for gasoline-powered cars. VAC’s soft magnet products, such as closed loop sensors and common mode chokes, are mission critical components that are necessary for the continued rollout of solar energy. VAC’s permanent magnets are also a core component of wind turbines, where they are used in gearbox technology for offshore wind turbines and in direct drives for onshore wind turbines. By delivering more of these products to customers, the company will enable more solar and wind energy projects to come online, which ultimately will help decarbonize the grid by displacing GHG intensive fossil fuel-based energy generation.

Why We Invested in Cloverly

By Chris Wu

The Role of Carbon Removal and Voluntary Carbon Markets

Carbon removal technologies are likely to play a crucial role in limiting warming to 1.5°C. In its April 2022 report on mitigating climate change, the Intergovernmental Panel on Climate Change (IPCC) highlighted the need to rapidly deploy carbon removal technologies to counterbalance hard-to-abate residual emissions and meet net-zero targets at a global scale. High-quality carbon credits are necessary in order to scale-up the deployment and operation of carbon removal technologies. Carbon credits enable businesses to make earlier and more ambitious climate commitments by allowing them to reduce their current emissions through offsets. Further, an active market for high-quality carbon credits is necessary in order to catalyze the flow of investments for deploying existing carbon removal technologies and developing new technologies. Voluntary carbon markets (VCMs) allow carbon emitters to offset their unavoidable emissions by purchasing carbon credits generated by projects targeted at removing or reducing greenhouse gasses (GHG) from the atmosphere. Each credit – which corresponds to one metric ton of reduced, avoided or removed CO2 or equivalent – can be used by a company or an individual to compensate for the emission of one ton of CO2 or equivalent gasses. A high-quality carbon credit represents real, quantifiable, additional, leakage-proof, and permanent GHG emission reductions or removals. VCMs represent an important mechanism to scale high-quality carbon credits from $2 billion in 2021 up to $40 billion by 2030. 

Solution

Cloverly is an API-first marketplace for high-quality carbon credits, enabling businesses to meet their climate goals by offering seamless access to high-quality carbon removal credits from across the globe. While Cloverly is a marketplace for businesses of all sizes looking to offset their emissions voluntarily, it has seen strong traction in the enterprise segment, with customers across industries from logistics to financial services. Cloverly offers an API that matches any transaction with a carbon offset in real-time. Their API calculates the amount of carbon emissions generated by a particular activity and then purchases an offset instrument that pays for avoiding or sequestering the same amount of carbon elsewhere in the environment. Cloverly’s focus on project quality ensures that every carbon credit meets their criteria for additionality, permanence, leakage and other indicators. All projects listed on the marketplace undergo a rigorous quality evaluation process by climate science experts that look at 60+ quality indicators to pick the best projects in the voluntary carbon market. As a result, only 10% of carbon credits pass through their screening process and are deemed high-quality and eligible to be on their marketplace. Cloverly’s marketplace allows customers to buy both spot and forward credits in one click. That means they can purchase and build an inventory of credits that can be retired when needed to help them manage carbon credit price volatility.

Why We Invested

Our investment and impact thesis are premised on the catalytic role that VCMs are likely to play in the coming years. Active and efficient carbon markets will be necessary in order to create the right set of incentives for the deployment of projects offering high-quality carbon credits and the development of new carbon removal technologies. The rapid development and deployment of carbon removal technologies is imperative to the achievement of global climate goals, it’s estimated that 10 gigatons of CO2 will need to be removed from the atmosphere annually by 2050. As governments and corporations set ambitious climate targets that entail more than just reducing their emissions, the relevance of VCMs will increase. With the use of carbon capture technologies set to increase 13x, driven by the provisions of the IRA, VCM transaction volumes are likely to register exponential growth.

While today’s VCM is growing at a breakneck pace, it lacks some of the fundamental elements required to drive meaningful impact at scale. Cloverly has been addressing these problems surrounding access, ease, trust, and transparency since its inception as the first API in the world for carbon credits. On the demand-side, Cloverly’s approach is characterized by a focus on the enterprise segment, a recent change in strategy for which there is already clear evidence of success. Cloverly has seen strong growth in transaction volumes and customer acquisition, and has signed key partnerships with Visa, American Express, Redwood Logistics, Ecolytiq, and Salesforce. On the supply-side, what sets Cloverly apart is its ability to provide customers access to a vast and diverse, high-quality portfolio of both nature-based and technology-based carbon offset projects from across the globe. Its focus on high-quality offsets and sourcing and verification processes are key, and this was critical to us (and, we believe, to its customers), given the significant challenges associated with tracking and verifying project credentials and performance. Lastly, we believe the team, led by CEO Jason Rubottom, has a strong understanding of the problem and the market, as well as a clear and compelling vision for the company. 

Impact

We believe that Cloverly’s marketplace enables both SMBs and large enterprises to effectively offset their emissions through the purchase of high-quality offsets. Purchasing high-quality carbon credits, in addition to eliminating avoidable emissions, plays a critical role in accelerating the transition to net-zero emissions. Making and achieving credible decarbonisation commitments is challenging for businesses, particularly in emissions-intensive sectors. Credits allow businesses to reduce their emissions now through offsets, while taking cost-effective action to reduce future emissions through asset turnover and evolution of their business models. In the longer term, credits have an essential role in offsetting hard-to-abate emissions from products which lack low or zero emissions options. At scale, the carbon removal purchases that transact on Cloverly’s platform can improve the economic viability of emerging carbon capture technologies, thereby catalyzing the flow of capital to that sector. In the case of high quality nature-based offsets, which promote the preservation of natural ecosystems, they direct private financing to climate-action projects that would not otherwise get off the ground. These projects may also offer additional co-benefits in terms of biodiversity protection, pollution prevention, public-health improvements, and local job creation.

Why We Invested In Pear Suite

By Sophia Friedman

Community Health Workers (CHWs) are frontline public health workers who typically share ethnicity, language, socioeconomic status, and life experiences with the community members they serve. CHWs have been identified as a valuable resource that can deliver services around the healthcare journey in a culturally sensitive way, thus leading to positive health outcomes. While the market for care navigation and care coordination is crowded, there is tremendous potential to leverage CHWs as a resource on a larger scale to drive improved health outcomes for underserved communities. The US Department of Health and Human Services’ recently announced of the availability of $226.5M in American Rescue Plan Funding to launch a Community Health Worker Training Program, and there have been (and are expected to be more) shifts in Medicaid funding for the development of community health centers and reimbursement for services provided by CHWs that were not previously reimbursed, therefore creating new opportunities for innovative CHW models. 

Solution

Pear Suite aims to be a trusted care navigator to guide otherwise underserved populations through their health journey. Pear Suite empowers CHWs to support older adults and individuals in underserved communities by providing culturally sensitive, empathetic care navigation. CHWs are lay members of the community who typically work in association with the local health care system in both urban and rural environments. CHWs typically share ethnicity, language, socioeconomic status and life experiences with the communities they serve (NIH). Pear Suite leverages CHWs to connect people to resources (vaccination resources, food access, transportation, housing support, economic support) and also helps them to get onboarded to digital health programs or telehealth to support their health journey.

Pear Suite’s platform allows the CHW user to build custom care journeys to automate patient support and facilitate person-centered interactions; achieve higher activation rates through personalized recommendations and goal tracking; engage patients using omni-channel communication tools; and track real-time metrics to evaluate impact and drive actionable solutions.  Pear Suite has both SaaS and tech-enabled services lines of business: the SaaS product is used by Pear Suite’s clients for their CHWs and the services product provides outsourced CHWs employed by Pear Suite to supplement the clients’ teams. 

Why We Invested

Pear Suite transforms social determinants of health data into actionable solutions and empowers community health workers to provide culturally sensitive care navigation. Without actionable data, healthcare organizations struggle to address the social drivers of health at scale. Researchers estimate that a lack of data and inaction prevents 20M adults from living at home and costs billions annually.  Pear Suite's cloud-based platform enables anyone to leverage data to better assess and address the social drivers of health in a scalable, cost-effective, and person-centered way. Pear Suite’s Cofounder and CEO, Colby Takeda, is mission driven and has a strong impact orientation to maximize the CHW as a valuable community resource to drive improved health outcomes by addressing often overlooked sociocultural factors that have a strong impact on health. 

Pear Suite has traction with several different customer types. While sales to date have focused on government agencies, Pear Suite is expanding to focus its sales on healthcare organizations and startups as well as payor clients. Pear Suite has developed both a strong SaaS platform as well as a services business to address the multiple facets related to operating in the CHW market. We believe that Pear Suite is differentiated via its focus on CHWs as a key stakeholder in the patient journey with ability to drive impact both in terms of improved outcomes for patients and improved socioeconomic opportunities for the CHWs themselves.

Impact

Pear Suite was founded to address the lack of focus on social factors within healthcare. More specifically, there are many solutions in the healthcare space that aggregate healthcare data, but few are focused on translating social determinants of health (SDoH) data into actions to help individuals address their needs. Existing solutions do not lead to an action on behalf of the member, as solutions typically focus on what the data means to payors or providers. Therefore, Pear Suite seeks to leverage data to assess what actions can support long term outcomes for patients.

Community health workers are uniquely positioned to drive impact as frontline public health workers who typically share ethnicity, language, socioeconomic status, and life experiences with the community members they serve. As a result, they understand the sociocultural needs of that community and can effectively drive better health outcomes. The platform provides resources such as better understanding local food resources, support in accessing SNAP benefits, understanding affordable senior housing options, enrolling in virtual physical activity classes, connecting users to technology classes so that they can better leverage tech to manage their health and so on. 

In addition to the impact in terms of improving health outcomes for the patients that Pear Suite will reach, the company can also create better economic outcomes for CHWs. The CHW role provides a potential path for upward mobility for individuals within a community. CHWs often move on to work as clinicians, nurse practitioners or in government agencies. Therefore, this role provides a meaningful starting point from which to kickstart workers’ careers. 

Why We Invested in LearnLux

By Rahul Bhide

It’s clear that financial wellness is becoming a table-stakes benefit, and the current offerings are no longer enough. Only 22% of Americans feel that they are ‘financially well’. Fiduciary planning and other financial wellness solutions could play a big role in bridging that gap for the other 78% of Americans. It’s not a coincidence that only 16% of Americans use plans built with a financial professional, a similar share to those that consider themselves financially well. Financial planning has long been focused on high-net-worth individuals, and many of the current solutions for low- and middle-income individuals are heavily focused on budgeting tools.

Employers have also identified financial wellness as a key focus area for employee benefits to address the impact on productivity from financial stress, but also to differentiate themselves and retain talent in the wake of the Great Resignation. Surveys done by Bank of America and TIAA demonstrate these trends, with results showing that 95% of employers feel a sense of responsibility for the financial wellness of their employees, up from 81% in 2015. Furthermore, more than 8 in 10 employers agree that financial wellness programs result in greater productivity and more satisfied employees.

Solution

LearnLux is a workplace financial wellbeing provider that blends fiduciary digital planning with access to one-on-one guidance from Certified Financial Planner™ (CFP) professionals. LearnLux's program equips employees with a financial plan to guide them through key decision points across all life events. On the tech platform, employees can complete a quick financial checkup, set goals, and get an individualized financial plan. If employees need more support, they can book a free video call with a CFP. Employees usually start with a check-up to establish a baseline and identify blind spots and priorities. Subsequently, the platform gets into personalized elements such as health insurance and retirement planning.

Once a strong foundation is in place, the platform addresses more sophisticated elements such as savings for real estate, managing education loans and tax optimization. The platform also enables employers to speed up their onboarding process by helping new hires make benefit decisions, communicate the economic value of the benefits they are providing to differentiate themselves from other employers, and drive retention.

Why We Invested

We’ve been really impressed with the founders, the sister-brother duo of Rebecca Liebman (CEO) and Michael Liebman (COO). Both have focused on financial inclusion in different ways throughout their careers so far. LearnLux is serving people across income brackets, and the product was designed from the beginning for both blue collar employees and executives alike, giving LearnLux a differentiated positioning in the market and strengthening the impact potential. So far, customers of LearnLux have been similarly impressed, with all choosing to grow their relationship with LearnLux from year to year. Lastly, we see significant tailwinds as employers prioritize the financial wellness of their employees to reduce stress, improve productivity and retention, and differentiate themselves from other employers.

Impact

LearnLux enables the 78% of Americans that don’t have financial planning support to access unbiased financial planning and advice. We expect LearnLux to drive important results including reduction in financial stress for employees, greater use of pretax products, on-time retirement, and healthcare savings. LearnLux is inclusive across all ages, income levels, and job types; and the employee base it serves includes traditionally hard to reach populations like manufacturing, construction, retail and hourly workers.

Why We Invested in Twentyeight Health

By Sophia Friedman

There are significant barriers to accessing healthcare for low-income women and specifically for women of color. Some figures make clear these challenges: 45% of 18-29 year olds do not have a primary care physician; one in three doctors don’t accept new Medicaid patients; and, there are at least 72M women of reproductive age in the United States.

Specifically, access to quality sexual and reproductive healthcare is critical for the health and wellbeing of women, yet many women in the United States struggle to access quality and timely care. As a result, unintended pregnancy rates are 3x higher and maternal mortality is 2x higher for low-income women. While the gaps in access to care are clear, few solutions within the women’s health space cater specifically to underserved women, and as a result, many women struggle to access essential health services.

Solution

Twentyeight Health is a women's health platform focused on increasing access to reproductive and sexual health care for underserved communities.  Twentyeight targets a large, underserved market as there are 38M underserved women in need of women’s health access. Medicaid alone spends over $200B on healthcare for women of reproductive age. Twentyeight’s vision is to become the digital healthcare home for women, building trust early and providing care throughout a woman’s lifetime via telemedicine, medication delivery and ongoing care. Twentyeight provides medically accurate, accessible, convenient healthcare and currently offers various methods of contraception, emergency contraception, prenatal vitamins, and STD treatments, amongst other services. Twentyeight is available today in 34 states and in Washington DC. In 2021, Twentyeight launched full Spanish language telehealth services for their healthcare offerings to cater to Spanish speakers, a largely underserved population as a Health Affairs study published in 2021 shows that Spanish speakers receive approximately one-third less care than other Americans.  

Twentyeight has been strategic in its go to market strategy by initially offering contraceptive care to underserved women via its direct-to-consumer approach. As a result, Twentyeight developed strong relationships with thousands of women as a trusted healthcare provider while also gathering meaningful data around underserved women and their habits and health needs. Because Twentyeight builds long term relationships with their users by providing subscription-based access to birth control, the company is uniquely positioned to provide care coordination when users want to pause birth control and may be thinking about conception (or already pregnant). This fills a significant gap for health plans who want to proactively offer additional services to women at appropriate times to improve maternal outcomes and reduce costs but often cannot due so because of the lack of member engagement and accurate data. Now that Twentyeight has developed a strong foothold via its initial product offerings, it has expanded its healthcare offerings, such as herpes treatments, prenatal vitamins and emergency contraception. Twentyeight developed its own proprietary platform to easily engage with users, their provider network and their pharmacy partners. Additionally, the scalable platform will allow them to easily add additional healthcare offerings to the business.

Why We Invested

Twentyeight is specifically focused on reaching historically underserved populations via its platform and increasing access to health products and services for low income women. We found Twentyeight to be differentiated from other players offering digital health solutions to address women’s health for two main reasons:

1. Many women’s health solutions are point solutions - solutions that address and deliver on one specific need, often in isolation. However, while point solutions can target specific parts of the patient journey, it is important to keep in mind the holistic health of the woman in order to drive outcomes. Therefore, we are excited about Twentyeight’s approach to building a women’s health platform because we believe that winners will be solutions that address the woman’s whole health and/or integrate with other solutions to support various social and medical factors that may affect a woman’s health throughout various phases of her life.

2. A majority of the women’s health solutions currently in the market are offered as direct to consumer products that women pay for out of pocket. As a result, these solutions are often price prohibitive to underserved populations and therefore cater predominately to middle and high income populations. Therefore, low income women are typically unable to access these solutions. While Twentyeight has both direct to consumer and B2B business models, the services Twentyeight is offering are mostly fully reimbursed and so women do not pay out of pocket to access Twentyeight. Therefore, Twentyeight is reaching a population that has historically struggled to access these types of healthcare services. 

Beyond reproductive health, Twentyeight seeks to increase women’s access to healthcare more broadly. The company aims to empower individuals with information, affordable access and convenience for their reproductive and sexual health. Twentyeight is comprised of doctors, public health experts, designers, engineers and builders who are committed to changing the face of healthcare for underserved communities. 

Impact

We believe that Twentyeight can reach populations that have historically struggled to interact with the health system to improve health outcomes for women. Twentyeight’s user demographics indicate their success in engaging underserved populations: of Twentyeight’s users, 58% identify as BIPOC, 59% live in non-urban areas and 55% of users are on Medicaid.  63% of Twentyeight’s users report that they did not have access to birth control prior to joining Twentyeight.  Overall, Twentyeight has impact on various levels: the company can reach populations that have historically been left out of the health system (underserved, low income women), help to prevent unintended pregnancies, and bring women into the health system for regular visits and preventive care to identify conditions or illnesses at an earlier stage to improve outcomes and lower costs.

Why We Invested in Perfect Power

By Chris Wu

The electric grid is transitioning from a centralized system, to one that is more distributed, renewable and accessible. New regulations, renewable energy mandates, tighter environmental regulations, the electrical grid’s evolving load profile, as well as the increased intermittency of our energy supply as more renewable energy comes online all serve to usher in a paradigm shift in the 100 year old energy grid. 

The US Inflation Reduction Act (IRA) will dramatically reshape the makeup of electricity production in the US in the coming decades. The new law is a game changer for renewable energy development and energy storage installations; it is estimated that the IRA will more than triple US clean energy production and result in 40% of the country’s energy coming from renewable sources. In order to achieve this rapid transformation an additional 550 GW of electricity must be generated via renewable sources in less than 10 years time. In other words, meeting the emissions reduction goals of the IRA will hinge on the US’ ability to at least double the rate of renewable installations over the record levels observed in 2020 and 2021. 

Perfect Power strives to be a next-generation, clean-focused project developer, and is well positioned to serve the electric grid during this critical point in the clean energy transition. Perfect Power’s mission is to acquire, develop, and opportunistically own and operate, a differentiated portfolio of dispatchable low-carbon generating assets which accelerate the transition of the power grid to a faster, safer, more reliable, and lower carbon future.

Solution

Perfect Power acquires, develops or redevelops, owns, and operates electric power generation assets. The company is focused solely on assets that enable the decarbonization of the electrical grid, specifically renewable energy generation and battery energy storage. Perfect Power finds attractive locations to build large solar or battery projects, takes control of those sites, and performs all the development work needed in order to get that project to a point where it has achieved its full “Notice to Proceed” (NTP) milestone and has the green light to proceed with construction/installation. At that point, Perfect Power has the option to either sell that project at a markup to a strategic or larger developer who would then proceed to invest the money necessary to build and operate the solar or energy storage project, or they have the option to build and operate the asset themselves. The buyer would be acquiring an asset that has had the development risk removed and is ready to immediately begin construction or installation.

The company looks to develop a geographically diverse portfolio in markets that are accessible, liquid, tradeable and compensatory such as ERCOT (in Texas) and CAISO (in California). Perfect Power develops utility scale front of the meter assets that have transmission or distribution system interconnection points. It can also opportunistically pursue commercial and industrial (C&I) projects in select markets that require dispatch to obtain payments, as well as distributed front of the meter assets interconnected to participate in the wholesale electric generation market. Perfect Power is able to aggregate and build a portfolio of energy storage projects at a significantly lower entry price and with relatively low overhead expenses given its business model and personnel’s expertise. Perfect Power currently owns, or has exclusivity, on a wide variety of development-stage projects including a pipeline of up to 200 MW of distributed energy storage projects, 300 MW of utility-scale solar projects & 250 MW of utility-scale energy storage projects in ERCOT, as well as a pipeline of up to 325 MW distributed energy storage projects in CAISO.

Why We Invested

Perfect Power has a proven team with deep expertise in power generation, renewable energy and energy storage in key markets, as well as a proven track record of asset development and management. Perfect Power was formed and is wholly owned by SER Capital, who handpicked the company’s leadership team. In addition, the SER Capital team has over 100 years of private equity experience in this space as well as senior executive level operating experience at both private and public companies in the energy industry that will be invaluable as they partner with management to help the company scale and grow. 

We were impressed by Perfect Power’s ability to aggregate and build a sizable portfolio of energy storage and solar projects at a significantly lower entry price and with much lower overhead expenses than it would cost to acquire an established platform. We see an opportunity for Perfect Power’s platform to develop a differentiated portfolio of dispatchable low carbon generating assets which accelerate the transition of the power grid to a faster, safer, more reliable, and lower carbon future. As the electric grid is transitioning from high carbon intensity (e.g. coal-fired power plants) to a low carbon intensity; batteries will enable the integration of renewable energy and other resources based on demand instead of simply dispatching when the resources are available. We also were attracted to the flexibility of Perfect Power’s platform to either sell or build its projects, which gives it a distinct advantage. 

Impact

In order to achieve the greenhouse gas reductions (GHG) needed to limit global warming to 1.5 degrees Celsius above pre-industrial levels and avoid the worst effects of climate change, we must scale up renewable energy capacity at a rapid pace. Today electricity production makes up about 25% of the United State’s total GHG emissions given that approximately 60% of our electricity still comes from burning fossil fuels - primarily coal and natural gas. Perfect Power’s platform will enable more than 1 GW of renewable energy generation, energy storage, and efficiency improvements to be built and come online, which will help decarbonize the grid by displacing GHG intensive forms of energy generation such as combined cycle gas or coal plants. The environmental impacts of solar generation are immediate and material as a true zero-carbon source of energy. Energy storage plays a critical role in integrating intermittent renewable energy into the grid. Together battery energy storage paired with solar generation forms a strong combination that provides reliable and clean power at scale for the energy grid.