Evidation Health Is
Santa Barbara’s Latest
America’s Largest Digital Health Network Started Around a Kitchen Table on Voluntario Street
By Tyler Hayden | April 15, 2021
Imagine an app that pays you to exercise. That can detect the hidden beginnings of Alzheimer’s disease or the early warning signs of a stroke long before it strikes. That allows researchers to conduct large-scale clinical studies much faster and cheaper and gives pharmaceutical companies the knowledge they need to make better drugs.
Imagine an app that harnesses the power of mass data and machine learning, not to optimize Facebook ads for a quick buck but to build a superhighway of information that flows between individuals, doctors, and scientists so the world becomes a healthier place.
Evidation Health ― a Santa Barbara startup born nine years ago around a kitchen table on Voluntario Street ― and its accompanying app, called Achievement, is the means by which those dreams will be realized. At least that’s what some of the country’s biggest and most respected institutions and philanthropists believe.
Late last month, Evidation announced it raised $153 million in venture capital from Kaiser Permanente and a private equity firm. That’s on top of a previous infusion of $106 million and existing working partnerships with Johnson & Johnson, the American College of Cardiology, the Bill and Melinda Gates Foundation, and others.
Today, Evidation is the largest digital health network in the United States, with more than 4.5 million people using Achievement to track and share their steps, heart rhythms, sleeping patterns, and other health indicators via wearable devices like Fitbits and Apple Watches. Participants receive reward points that they can convert into cash or donations to charities of their choosing. They can also opt into anonymous studies or answer questionnaires for even more rewards.
But it was this latest round of funding that officially metamorphosed Evidation into a “unicorn” ― that rare breed of private company valued at $1 billion or more. It got a write-up in Bloomberg. European wire services picked up the news. People far and wide took notice. Especially locally. Only a handful of South Coast businesses ― Procore, AppFolio, Apeel, and a few others ― have achieved such coveted status.
To learn more about this rising tech giant in our midst, we spoke with its creators, a pair of computer prodigies from Europe who could have lived and worked anywhere in the world but chose to make Santa Barbara their home. In fact, they say, the city has been critical to their success. They employ 50 people out of their recently renovated office on Figueroa Street, and with the new capital, they are looking to hire 50 more.
Coding Before It Was Cool
Luca Foschini and Alessio Signorini were born just a few days apart in 1982 but on opposite sides of Italy.
Foschini grew up on a farm outside Bologna, where Bolognese sauce gets its name. (“They just call it sauce,” he said.) The farm produced apples and pears and was one of the first in the region to plant kiwis. Foschini’s father was an innovator. “He was always tinkering,” Foschini said. He even built a produce-moving machine that caught the eye of engineers with Lamborghini, which also makes farming equipment.
One day, Foschini’s dad brought home one of the earliest computers to come on the market. His son was hooked. But he wasn’t satisfied with just playing the one game the tiny hard drive held, Gorillas, where two big apes took turns flinging bananas at each other. Foschini wanted to do some tinkering of his own. So he figured out how to modify the game’s source code, which allowed him to manipulate its design and physics and opened a world of infinite possibilities.
Foschini never lost that fascination with the power and potential of programming. “To me, the computer is like a painter’s canvas,” he said. “My passion is not typing on the keyboard. It’s thinking of something in my mind and figuring out how to make the computer do it.”
Gorillas, it turns out, is also what opened the digital gates for 8-year-old Signorini. Except he didn’t own the computer he’d eventually master. It belonged to the elderly couple in the apartment below his, who ran an IKEA-like store and used the loud and bulky machine to track inventory. The deal was that Signorini could use the computer during the store’s off-hours, and “as long as I didn’t break it,” he explained.
Signorini remembers the painstaking process of translating the English user’s manual into Italian. “I couldn’t pronounce anything, but little by little I figured out what every word meant,” he said. “That’s how I learned.” Gorillas was fun, but what really captured his imagination was creating. He’d change a number here, add a line of code there, and marvel as his keystrokes came alive on the screen.
Like Foschini, Signorini has never stopped making things. Even today, in his limited free time, he’s building a network of climate-control sensors for his home. At Evidation’s original office on Mission Street, Foschini put together a small outdoor hydroponics system, where Signorini would find him munching on vegetables.
It was their formal education in “informatics” ― the European term for what we call computer science ― that brought the pair together when they were 18-year-old high school students. By this point, they’d both gotten so good at programming they were selected to represent their country at the annual International Mathematical Olympiad.
They trained together for a month for the competition, during which teams are presented with three unsolvable “problems” and given a certain amount of time and disc space “to write the best possible program that approximates as best possible the solution,” Foschini explained. The preparation was intense, but the friendships they formed with like-minded teenage coders ― way before coding was hip ― was life-changing.
Eventually, Foschini and Signorini started seeing the world in terms of “problems” and “solutions.” They’d walk around their Olympiad host cities in China and Finland and talk about how to improve stoplights or “anything else we saw that we thought we could make better,” Signorini remembered. Little did they know, America’s bloated and broken health-care system would eventually become the biggest problem they would try to solve.
Assembling the Dream Team
After the Olympiads, the Italian team parted ways but stayed in touch with some of the Internet’s very first email addresses. Yet Foschini and Signorini’s paths continued to crisscross, first at the University of Pisa, then at an early search-engine company, Ask Jeeves.
Signorini went on to get his PhD in artificial intelligence from the University of Iowa and worked for a software company that customized digital billboards based on who was looking at them and for how long. He also partnered with Kimbal Musk, Elon’s brother, to create a search engine specifically for social media sites.
Meanwhile, after stints at Google and CERN, Foschini was lured to UC Santa Barbara by the opportunity to work with fellow Italian Giovanni Vigna, a rock star of the cybersecurity world, who also taught him to surf.
The two old friends always knew they wanted to partner on a project together. With their credentials, they could have had nearly any Big Tech job they wanted (and with a handsome salary), but what they really craved was to create something of their own. They just needed the right idea.
It was Signorini who first planted the seed of Evidation while he was in New York. He also brought on board the company’s financial- and health-care-minded cofounders: Christine Lemke and Mikki Nasch, who remain with the business as its co-chief executive officer and president, and vice president of business development, respectively. But it was Foschini who convinced the three of them to grow the concept with him in Santa Barbara. The 72-degree February days helped his argument.
In 2012, the four rented a house on Voluntario Street and got to it. They originally considered building their own device before deciding on software. “The first year was a lot of heads down, just working,” said Signorini. “You don’t talk to anybody. You just work all the time.” There were distractions. Former colleagues, for instance, were retiring at 30 after striking it rich with algorithmic stock trading. There were moments of panic, too. What if they failed? “But we just pushed harder,” he said.
The home wasn’t the kind of grungy tech incubator you see in episodes of Silicon Valley, but it fostered the same kind of creative energy and camaraderie that gives rise to true innovation. Most of the meetings and coding sessions took place in the living room or around the kitchen table, oftentimes between bites of food.
At first, before they gained any kind of financial momentum, they paid the cash for redeemed user points straight out of their personal bank accounts. They heard a lot of “no”s from investors. Then the positive reviews started rolling in. Users said they were exercising for the first time in years. More than a few said they’d used the cash to buy new running shoes.
“It was wonderful to see,” said Foschini, “because we really believed in what we were doing.”
Do No Harm, and Don’t Break Things
While Evidation’s potential applications are vast, the basic philosophy behind its platform is relatively simple and builds on the longstanding technological concept of the “quantified self,” or “lifelogging” your body’s signals with wearable devices. Foschini palmed a grip-strength tester as he explained this.
What if that concept could be used as a preventative health tool to catch undiagnosed medical conditions before they became dire, the four wondered? Wouldn’t that save people a lot of pain, doctors a lot of work, insurance companies a lot of money, and on down the line?
“My worst fear is that one day I don’t feel great and the doctor tells me I have a tumor the size of a tennis ball in my abdomen that took a year and a half to grow,” Signorini said by way of example. “Could we have detected it when it was the size of a marble? My car has a sensor that tells me when the left front tire is low. Can’t we have something like that for our bodies?”
Evidation’s goal is to establish a baseline for users and create a “longitudinal context of health,” explained Foschini. That offers a much more complete picture of a person’s physiology compared to the brief snapshots one gets by sporadic trips to the doctor and blood tests every few months or years. For instance, it can be especially useful for sleep apnea studies, as wearing a device at home is likely to yield more accurate results than a fitful night at some clinic.
In one of its biggest undertakings, Evidation recently partnered with Johnson & Johnson and Apple for the Heartline Study to determine if Apple Watches can accurately detect atrial fibrillation (AFib), a leading cause of strokes in the United States. It will also reveal if the app ― with its incentive system that awards points for participation and delivers gently worded nudges and reminders at optimal times of the day ― is able to effectively encourage people to take their medications.
“Heartline is a study that has the potential to fundamentally change our understanding of how digital health tools could lead to earlier detection of AFib, helping patients understand and directly engage in their heart health, prompting potentially life-saving conversations with their doctors,” said Harvard Medical School’s Dr. C. Michael Gibson in a statement.
“My car has a sensor that tells me when the left front tire is low. Can’t we have something like that for our bodies?”
— Alessio Signorini
Just a few months ago, the American College of Cardiology (ACC) tapped Evidation for a similar quest to better understand heart failure by continuously tracking patients’ activity levels, sleep patterns, and blood pressure. One of ACC’s leaders, Dr. John S. Rumsfeld, said the combination of Evidation’s platform and ACC’s clinical and scientific expertise offered “groundbreaking opportunities.”
Earlier studies have already yielded important and eye-opening results. In one, the incentive system and its messaging ― referred to as “digital intervention” ― successfully motivated a cohort of people with diabetes to get their yearly flu shot. It showed how the same behavioral psychology tools and snappy user interfaces that companies like Netflix and Spotify use to attract ad-clicks can actually get people to engage with their health.
In yet another trial, Evidation and Lyft Healthcare proved how difficult it can be for poor and elderly individuals to secure transportation to and from their doctor’s offices. The companies are now exploring ways to improve ride availability among Medicare and Medicaid beneficiaries.
Regular brain exercises on the app may reveal the onset of Alzheimer’s or dementia. High blood pressure could be caught before it wreaks havoc. Migraines might be better managed. The possibilities seem endless. Athletes are also using Achievement to optimize their performance on the field, while citizen scientists enjoy contributing to a growing body of knowledge.
At the outset of any study, Achievement’s participants agree to share their data, and they are asked again for their consent when researchers decide they want to use it. Anonymity is guaranteed.
But the company isn’t reinventing the wheel when it comes to cybersecurity, Foschini stressed. It’s only recently that privacy has become a commodity. Evidation just abides by the same safeguards and procedures that clinical research has followed for the past 50 years, he said.
Successfully navigating the checks and balances of the healthcare industry has been no easy task, Signorini and Foschini readily acknowledge. There were major liability hurdles to overcome, and the company is still constantly being audited by potential partners and investors to ensure its software is properly encrypted and can accurately handle the gobs of data it collects, synthesizes, and distributes.
As a technology company, gaining the trust of the people within the medical establishment has also been a challenge. “It’s really a clash of two cultures,” Foschini explained. “In medicine, you have ‘Do no harm.’ But in tech, you have ‘Move fast and break things.’ Those two concepts don’t really play well together.” Right now, Foschini went on, America is experiencing the fallout of Big Tech moving way too fast and breaking far too many things, with data breaches and plagues of misinformation troubling regulators and alienating users.
Meanwhile, the country’s health-care system remains a structural mess, with its IT infrastructure in desperate need of upgrades. “Healthcare is generally behind other things,” said Foschini. “It has a lot to do with the regulations, which are obviously important but also very cumbersome. Even transferring small amounts of data between two hospitals, especially when you’re still using CDs, can be difficult.”
The two worlds need to find a way to meet in the middle, Foschini declared. “Technology needs to become more responsible in order to be appealing to the healthcare industry, and healthcare needs to finally listen and embrace the technologies that can truly save and improve lives.”
Making Grandma Proud
Evidation may have a serious jump on most of its competitors, but it’s not the only game around. In fact, Bloomberg recently reported that equity investments in digital health companies reached $26.5 billion globally in 2020, a 45 percent jump from the year before. And just this week, Microsoft announced it’s buying a company called Nuance Communications, which uses hand-free Siri technology to record doctor-patient conversations, for a whopping $19.6 billion.
But what Evidation has that many other companies lack is the continued die-hard dedication of its original founders, nine full years after they first got together. That’s nearly unheard of in the tech startup universe and is a testament to how driven they are by their mission, Signorini said.
He and Foschini are also particularly proud that half of their leadership team is female, another anomaly in their line of work.
“We sponsor local initiatives like Womxn/Hacks,” UCSB’s all womxn-identifying and nonbinary hackathon, Foschini explained, “and really care about making tech a more welcoming place for women and people with diverse backgrounds. … We’ve seen enough tech bros.”
In their early days, the pair had considered headquartering Evidation up in the Bay Area, where they now have a second office. But Santa Barbara, with its beaches and a steady stream of computer science hotshots coming out of UCSB, was too good to pass up. Signorini swears the company simply wouldn’t have survived if they didn’t have their choice of sunny days to get outside and blow off steam when they needed to. “With all the hours of grinding and all rejections, we absolutely would have burned out,” he said.
So what does it really mean for Signorini and Foschini to have a billion-dollar feather in their caps? Did they go out and buy Montecito villas and a couple of flashy Ferraris? “No, definitely not,” laughed Foschini, noting that both men still live within a block of each other on the Westside. “Our lives haven’t changed much. I still drive a 2005 Pontiac Sunbird with dents on every side. But it’s the best car for surfing.”
For his part, Signorini is content on his Vespa. “The money is for the company and will help us build what we want to build,” he said. “It’s not for us.” But it may help convince his grandma that he’s on the right track. “Until pretty recently, she used to ask me: ‘Alessio, when will you stop playing with computers? Come home and find a real job.’”
The duo have no plans to sell Evidation, either. At least, not anytime soon. That’s not what it’s about, they explained. “I like what I do,” Foschini said. “I know it sounds cheesy, but I care more about optimizing the journey. I don’t obsess about the destination.”
They do, however, want to get back to working shoulder to shoulder with their colleagues in their Figueroa Street space, and they’re counting the days until COVID finally blows over.
“One advantage of starting your own company is that you get to decide how it takes shape,” Signorini said. “We tended to hire people that we wanted to work with. Of course they’re smart and have skills, but fundamentally, they’re people we wanted to work with. I miss being with them.”