Hollo (Digi-ACT)

Healthcare services are necessary for sustaining and improving human well-being, yet they have contributed hugely to environmental crises. According to the global supply-chain database, the healthcare sector causes a substantial share of the world's emissions of greenhouse gasses (4.4%) and harmful particulates (2.8%). A significant portion of carbon emissions can be traced to energy use in healthcare facilities for heating, cooling, ventilation and hot water. Along with its contributions to greenhouse gasses and air pollutants, the healthcare industry uses about 1.5% of water in the world annually, suggesting that the healthcare sector is one of the major contributors to harmful emissions and waste. Needless to say, the manufacturing, delivery, consumption and disposal of products and services, as well as numerous disposable medical items, such as surgical equipment and bed linen, has added up to tons of environmental footprint globally. These emitted greenhouse gasses not only result in global warming, but also worsen a range of health conditions. 

Among the emitted greenhouse gasses, airborne particulate matter and toxic fluorinated gasses are generally considered non-genetic factors that increase the risk of rare diseases (RD). With 1 in 2000 individuals suffering from RD in the world, it has been estimated that around 10% of the world population is affected by RDs. As RDs are often chronic, progressive, and debilitating, patients are forced to undergo costly and endless treatments. Most importantly, the heterogeneity, complexity, and rarity of RD make them difficult to diagnose and mostly inefficient to treat, which can lead to significant morbidity and mortality. Despite increasing access to RD care in highly developed regions, the difficulties faced by patients with RDs remain an issue in low- and middle-income countries and cities. 

Long diagnostic odyssey, lifelong disabilities, lack of compensatory support, and few but costly effective treatments fail to meet the needs that plague the lives of RD patients, and lead patients to feel uncertainty about the future. The feeling of uncertainty causes 69% of RD patients to report depression and 82% to experience anxiety and stress, compared with a combined rate of approximately 17% for the general population. Such psychological impact often reduces patient medication adherence and increases the frequency of A&E visits for patients. Unfortunately, even in highly developed cities such as Hong Kong, the accessibility of mental health services is quite low, with only 4.5 psychiatrists per 100,000 people compared to the general population. This shows a lack of access to and integration of psychological services, extending this issue to the RD patient population. The scale of the problem is large, and there are no clear services or comprehensive solutions for comorbidities of mental health problems in RD for people with depression, which results in a higher Cost of Care for the healthcare system, ultimately compromises the environment, and so the vicious cycle is reinforced. 

We cannot lead healthy lives if we live in an ailing world, hence, there is an urgent need to seek a sustainable solution that reduces our carbon footprint while centering RD healthcare.

Hollo is developing a pipeline of clinically validated technology that focuses on improving the detection, diagnosis, and treatment of mental health issues in modern, multimorbid patients through automated digital therapy. Through our innovative approach, we enable clinicians to increase the accuracy and regularity of treatment adherence while increasing the accessibility, compliance and transparency of digital health, enabling remote diagnosis and care, and reducing emergency visits.

Hollo Screening Technology relies on AI to assist clinicians diagnose and monitor mental health conditions remotely. Our technology integrates advanced Machine Learning and Deep Learning models to detect patients' digital biomarkers through multi-layered patient profiles, including a cohort of clinical indexes, AI-generated cognitive and behavioral biomarkers from video interviews and mobile/wearable sensors. Utilizing models in Computer Vision, Audio Processing, Semantics, Digital Phenotypes, and Biofeedback to identify underlying characteristics that define cognitive activity/behavior, allows an inclusive, linear, and more accurate diagnostic result, which reduces inequalities and inefficiency in the diagnostic process. Our ultimate goal is to migrate our models towards a HiTOP framework, which focuses on the comorbidity between physical and mental illnesses. This shift in the diagnosis paradigm has the potential to revolutionize the industry. 

The screening technology not only enables us to collaborate with front-line suppliers to apply actionable data and achieve meaningful outcomes for their service models but also allows us to provide a unique and effective treatment plan for each patient. Our therapeutic products are digital versions of evidence-based interventions that consist of a blend of educational content, gamified training, and exercises aimed at improving patients' quality of life and alleviating symptoms of depression and anxiety, ultimately reducing the waste of healthcare resources by reducing treatment time. Hollo DigiACT takes a digital spin on Acceptance and Commitment Therapy (ACT), which guides patients to set mindfulness and valued living goals, focus on positive aspects of their lives, and connect with others in their communities. ACT is widely applicable and considered 'trans-diagnostic,' allowing it to be used for alleviating depression and anxiety in general populations, comorbid chronic populations, and rare diseases. 

These products are designed to be patient-centric and accessible to patients from all walks of life, regardless of location or socioeconomic status. Currently, the products are undergoing clinical trials under the regulatory bodies, FDA and CE, to validate their efficacy. Digitization of diagnostic and treatment processes shifts resource-intensive clinical settings to networked lower-cost settings and the home, which minimizes energy and materials used in healthcare services and ensures more efficient use of scarce resources. Through our innovative approach to digital mental health interventions, we aim to provide high-quality treatment to everyone in need, while achieving sustainability by reducing the carbon footprint emitted by the healthcare industry.

Our company's flagship product is specifically designed to support cancer patients who require pain management and experience depression and anxiety. We are based in Hong Kong and are recently working with hospitals and private clinics serving the cancer population in the region to conduct proof of concept and pilot service testing of our technology.

Cancer patients, like those with chronic and rare diseases, require comprehensive and continuous medical care to manage their conditions and improve treatment outcomes. This leads to an increase in their hospitalizations, additional resources for treatment by healthcare professionals, frequent monitoring, and thus increasing the carbon footprint of the healthcare industry. In Hong Kong, the energy use of the healthcare sector was over 5,000 terajoules and emitted about annually, mainly from electricity, transport and heating to operate hospitals and clinics. In addition to medical treatment, cancer patients also need mental support to help them deal with the physical, emotional, and financial challenges that often accompany the disease. However, due to the stigma attached to mental health in Asian cultural contexts, mental health tends to be a low priority in healthcare delivery. Lack of psychological support can lead to poor medication adherence and prolonged recovery. While the healthcare sector currently emits 9.2 million tons of greenhouse gasses, prolonged hospitalization, additional monitoring and care were expected to add an additional 16% to total emissions.

Our mission is to increase accessibility to care, improve the efficiency of healthcare systems, and promote sustainable care. We believe that by providing a scalable, autonomous, inclusive, and clinically validated solution for mental health management and treatment, we can make a lasting impact on communities with limited resources. Our innovative approach combines objective digital biomarker data with digital intervention to enable remote preventative care that is scalable and can target larger populations while reducing clinic visit frequency and transportation-related carbon emissions. By using appropriate diagnostics and triage, we can redistribute care and reduce stress on healthcare systems, ensuring efficient management of medical resources. This approach offers numerous benefits to patients, including improved mental health and increased disease treatment adherence, resulting in reduced treatment time and healthcare waste. Healthcare providers can also engage with patients in real time through this digital solution, thereby strengthening the doctor-patient relationship. When the doctor-patient relationship changes from typical paper and face-to-face interaction, substituting electronic messages can potentially reduce paper consumption, greenhouse gas emissions and waste generated from general practice, e.g. disposable nitrile gloves. Our technology is designed to address challenges such as the performance of smart devices, and the burden on frontline healthcare workers in a sustainable manner, by adopting green cloud computing and environmentally conscious computational technologies, for example, tinyML and compact AI. Through our efforts, we aim to create long-lasting improvements to healthcare structures that will benefit patients, healthcare systems and the environment simultaneously. We are committed to leveraging technology to improve healthcare outcomes, and we believe our approach sets the standard for the sustainable use of digital health solutions in the healthcare industry.

Hollo’s founding members consist of myself (Cameron), Duncan, and Imogen (our cognitive scientists). We are all from Hong Kong, but have spent time overseas for some part of our education. We all have both first hand experience with Mental health issues, mental healthcare itself and chronic patient care in the local area, handling it in both English, and Chinese.

Cameron: I have several layers of proximity to mental healthcare and chronic care due to my own battle with depression, I have witnessed how my personal experience as an Asthma patient has interacted with my mental health, particularly in how circular my breathing difficulty and anxiety can be, as well as anxiety/depression affecting how I complete activities that may benefit my asthma (medication taking, exercise, etc.). As I’ve grown up, I have also played the role of care-taker for my Mom and Dad, with aging parents and the reality of their Cancers developing. Luckily, my parents have not been terminal cases, my mother has faced 3 forms of Cancer: ovarian, thyroid and lung, whilst my dad faced skin cancer and was diagnosed with COPD during the height of COVID. Being the caretaker for my parents has given me firsthand experience in going through their hospital visits, listening to doctors and nurses interact with them and see the inefficiencies and inaccessibilities. Often spending lengths of time personally explaining their disease or treatment options to them, since I was privileged enough to complete a biotech degree. 

Duncan: I was inspired to pursue mental health research by his Grandmother’s Alziemers, but as I completed my degrees and my family aged, I have also played the role of caretaker for family members with Cancer. Most recently, my mother has faced a mixed bag of diagnoses from different oncologists regarding a potential tumor. I found and felt frustration towards the different systems of doctors in Shanghai vs. Hong Kong and Taiwan (my family sought second and third opinions in different cities). Witnessing this I found that there are many opportunities to innovate and create cross disciplinary solutions that I can positively contribute to through my privileged position. 

Imogen: Having witnessed my grandmother’s battle with lung cancer and the psychosocial stress it inflicted upon my grandfather and mother, I understand firsthand the importance of including caretakers and other key stakeholders when developing adept healthcare solutions, regardless of the condition at hand. This realization became particularly salient when one of my cousins was recently hospitalized for depression, which stemmed from various chronic health issues. Conversations with my cousin and her primary caretakers have reiterated the importance of developing solutions that are designed and developed with the patient’s ecosystem in mind, i.e., their immediate environment, relationship with their physician, availability of caretakers, integrability of the solution etc. As someone with moderate eczema as well, I routinely engage in patient advocacy work in Hong Kong to ensure that the community’s input and agendas are streamlined and taken into consideration for future research work.

The grant will provide capital aid to commercialise and scale up the impact solution our business offers. This grant used to fund-match our own capital to achieve business growth and target impact for the next two years in the following areas:

1. 40%: Marketing and educational content pipeline: required to train doctors, nurses and providers how to use and integrate our services into their businesses. Part of the marketing will be used for patient interest, support from Non profit and non government organizations, in pursuit of product trials, exploring partnership projects and supporting the marketing channels in both online and offline fashion. We foresee webinar series, offline roadshows and launching door to door marketing efforts with Oncology professionals and larger medical groups organizations.

1. 30% Talent Acquisition & Retention: We recognize that one of our team’s weaknesses is a lack of internal software team needed to manage and launch fixes/updates to our app. The team is critical to our success, and we aim to attract and retain top talent to support our product roadmap and scale our impact. We will allocate a portion of the grant to talent acquisition efforts, such as hiring bonuses and professional development opportunities, to attract and retain top talent. 

1. 30%: Clinical Product Pipeline (R&D and Commercialization): We aim to continue building our pipeline of products, including further targeting other NCDs, new AI models for digital biomarkers, and building outcome-based business models with our unique diagnostic processes. This portion of the grant goes towards funding our next phase of clinical trials to ensure our products are safe, effective, and evidence-based. We already are operating a trial to establish how efficacious our treatment is to alleviate symptoms of depression. But to increase competitiveness, we need greater insights on the translation into care, explore delivery models, as well as provide a dynamic study design that allows for UX/UI Updates during the trial, whilst managing multiple study arms. Main costs include patient recruitment, site management, and ethical approvals.

At the systemic level, we aim to serve > 5,000 cancer patients from hospitals, medical groups, and clinics in Asia by 2025. As one of the fore-runners for digital health solutions, we look to establish ground rules with hospital partners and care providers.We plan to achieve this significant impact through our product pipeline, which focuses on addressing unmet medical needs in cancer care. Our short-term milestones include completing the product design, conducting a pilot RCT test, and obtaining basic clinical data to demonstrate the efficacy of the product. Our long-term milestones include building a pipeline of products that serve healthcare providers and organizations to allow for clear impact measurement and connectivity to patient groups; large scale product clinical trials; and exploring regulatory approvals locally and within Asia. The ultimate goal is to scale our impact and sustain it beyond the two years covered by exploring adjacent market expansion, operating clinical trials/tests with foreign hospitals and clinics, establishing clear partnerships with Insurance providers and pharmaceutical companies for growth and scale.

Extending on our team's previous answer to the proximate leadership roles, our team is uniquely positioned to be part of one of the world's leading medical universities, where we are encouraged to bring innovation and translate it into care. 

Imogen is an incoming PhD candidate at HKU Psychology where her primary aim and research surrounds the gaps in how mental health (depression, anxiety, etc.) are diagnosed. Her focus is in heiarchical diagnoses of mental health issues through the HITOP research vertical as well as the biomarker signals through brain, cognitive, and behavioural datapoints. Her direct connection to the University allows our team to operate quick academic studies in collaboration with great research departments to ensure our technology is safe, validated, and effective at doing its job. 

Duncan's work at Hollo focuses on the therapeutic angle, particularly our DigiACT product to begin with. His role at one of the largest mental health NGOs in Hong Kong (Mind HK), primarily reinforced his learning of ACT practices as a practitioner; and allowed him direct clinical hours with patients young and old. His Master's education at UCL provided great foundation in both research and application, which has led to his passion towards contributing to the chronic and rare disease patients of the world. 

Cameron's direct connection to the Biotech department at HKU enabled him to envision how to translate research being done around the world and identify a key gap through his personal connection with mental health and chronic illness. By being a great connector, Cameron has been able to continue to facilitate unlikely collaborations (since most research is in 'Silos' in HK), and bring about impact to the community. He has done several projects with NGOs in the past and has great networks in the social impact and entrepreneurship space in Hong Kong, allowing us easy partnerships to address these key issues. 

Our advisory panel directly contributes to how we control our product and its clinical efficacy, our business sustainability as well as our innovation. They help provide the network, credibility and edge to keep our team on our toes and push the team to hold our standards to a high degree, even as a startup. For example, our Oncology advisors give us a direct communication channel with patients at both public and private hospitals in Hong Kong - where we see a range of patients from different backgrounds and socioeconomic backgrounds. 

Our solutions are innovative and sustainable because they address many of the challenges faced by healthcare providers in Asia. 

• Digitalizing the clinical processes lowers carbon footprint and waste, which gives significant environmental benefits. Our digital psychiatry platform prevents unnecessary travel, as patients are asked to do pre-assigned mental training and wellness exercises via app at home. It also prevents unnecessary hospitalization, in a resource-intensive facility, as patients’ vital biomarkers are remotely monitored, and clinicians identify those most in need of immediate intervention.

• Multiple digital health solutions are unilateral - focused on impact for providers and not patient centric; monomorbid - focused on singular disease management; and poorly integrated with existing healthcare infrastructure. 

  • Hollo Targets these issues with the core of our technology; product focus; and blended design approach considering clinical, user-centric, and software agile frameworks into our development model. 

• Asia has limited Digital therapeutic and diagnostic models being curated due to the lagging healthcare systems and poor integration of startups and software into these communities. We are able to spark this initiative within Hong Kong, collaborate with first movers in this space (Singapore, Taiwan, etc.) and bring these models to collaborate with organizations in regions with poor access to healthcare resources. With our Asian focused design lenses and quick startup agility; we are able to localize (in language and more importantly, culture) and contextualize our findings quickly to new systems and easily adapt with local teams on an international scale. Solutions from Western research and companies may not be able to connect well with target communities, and particularly will not be able to integrate themselves well with the clinical systems and practices in Asia.

• Majority (96%) of mental health solutions do not seek clinical validation of their solutions. Hollo looks to validate every part of our AI, Software and treatment models through multiple bodies of authority. Our clinical validation model seeks approval from the FDA, allowing access and monitoring of our development, which is adaptable to the majority of Asian Medical device regulators.

• Our sustainable software design reduces the consumption of physical IT hardware and the energy consumption in the healthcare industry. Our web-based Gateway Portal aggregates data from multiple sources and integrates with the hospital systems, so that clinicians get the data they need with context. Leveraging on cloud computing, it reduces the power usage effectiveness of the average 1.7 (hospital data center) to 1.2 (Hollo’s cloud platform), as well as a 15-ton reduction in carbon dioxide emissions from remote cloud service rather than onsite installation. This helps our medical partners lower their operational costs and environmental impact.

• Our Theory of Change model allows our company to bring sustainable and lasting change to communities. (Detailed in later answers)

Our impact goals for the next year and the next five years focus on improving healthcare outcomes for patients with rare diseases in Asia. Here are some of our high level key goals:

1. Treat over 10 million patients in Asia in the next five years

2. Improve Health outcomes for patients 

3. Serve multiple Chronic Diseases and Rare Diseases and comorbid mental health conditions

4. Highly sensitive and selective AI models for detection and treatment of mental health according to disease classification

5. Support the Characteristic Diagnosis of mental health (RDOC and HiTOP Frameworks of diagnosis)

6. Transform both high and low income communities towards digital first health systems. Working with offline first healthcare frontline companies (like reach52 and others) to reach patients.

7.  Implement systems of radical transparency in healthcare for patient centric approaches.

8. Helps local hospitals and clinics transition to digitally transform and achieve sustainable development by reducing carbon emissions

We aim to achieve these by mitigating several go to market risks with digital health:

1. Proving Clinical Efficacy

2. Proving Technological Efficacy

3. Proving Market Need & Feasibility

4. Regulatory Pipeline

By showing clinical efficacy of our treatment and diagnosis modeling, we are enabling scientific and evidence based programs to reach the populations that require proven methodologies to adopt into their healthcare systems. There is a quality assurance behind publishing our findings in both reputable and open source journals and opening our doors to peer review. Without this angle, we cannot prove to stakeholders (both patient and healthcare orientated) that the solution is trustworthy and worth implementing. Furthermore, technological efficacy is important when it comes to User and Patient Centric Design and Service design. Without a clear roadmap, feedback loops, and security audits, products that attempt to go to market and serve multiple nationalities cannot thrive. We are implementing these steps as we co-develop our product closely with the target users. 

Latter risks such as market need and feasibility are addressing the different structures of healthcare systems and digital health in different communities. It is inevitable that different systems will be structured with alternative infrastructure. By enabling the technology and service model to have modular flexibility to adapt to these systems, we can work with local, frontline teams on making sure the solutions work in the communities that need it. Finally, in terms of a regulatory pipeline, to further ensure that not just the theory behind the technology is monitored, but the servicing and practicality of the system can be assessed and monitored by authoritative bodies like the FDA. This will overcome blockers for communities with higher regulation on medical devices, and be a seal of approval for those without much regulation as well.

By addressing these risks early and engaging in the processes early, companies like ours can bring the solution to communities around the world, enable inclusive design, and be a bastion for credible and scientific resources in the world. 

Hollo aims to contribute to the following UN SDG indicators, which align with our impact goals: 

3.4.1 Deaths due to heart disease, cancer, diabetes or chronic respiratory disease 

- Hollo helps reduce mortality by adhering to treatment and including mental health treatment 

3.4.2 Suicide death 

- Direct mental health treatment will attempt to reduce suicide rates 

3.8.1 Discussion of essential health services 

- Contribute to the accessibility and affordability of health care services, and work by enabling organizations to deliver supportive services in low-income communities. 

3.8.2 Proportion of capital expenditure at home on health care as a share of household income or total income

 - Supports this presentation with cost-effective solutions for low-income communities.

We plan to support these indicators by providing accessible and affordable healthcare services, enabling organizations in low-income communities to provide subsidized services, and partnering with them. We will target mental health treatment to reduce suicidality and improve mental health outcomes for patients with chronic illness. 

Hollo also found that digitalization of care as an opportunity to accelerate sustainable development, as digitalization is considered as one of the 6 key transformations needed to meet the UN SDG. Hence, we developed ambitious sustainability targets, to ensure the sustainable use of medical resources and energy, reduce emissions and achieve carbon neutrality. Some of our goals are:

1. Maintain carbon neutrality and use renewable energy in our operation, so as to reduce carbon dioxide emission, in line with the 1.5 °C global warming scenario.

2. All our products will fulfill the EU EcoDesign requirement by 2026.

3. Work with cloud servicing suppliers who use green energy, so as to reduce the environmental footprint of our supply chain in line with a 1.5 °C global warming scenario.

4. Engage with stakeholders and organizations to drive sustainability efforts addressing the UN SDGs.

We aimed to develop standardized, validated methods and tools for healthcare environments to assist stakeholders to make informed decisions about reduction of carbon emissions from digital health interventions. Currently, our environmental commitment would be monitored existing environmental framework proposed by Health Technology Assessment, frameworks include:

- Life-Cycle Assessment

- Environmentally Extended Input-Output Analysis

- Comprehensive Environmental Assessment

The audits on our social and environmental commitments will be reviewed by the ISO certification organization annually. In addition to these indicators, Hollo will look directly at social impact goals through our conversion theory. Specific indicators we will measure are: 

- Number of patients served 

- Improved mental health 

- Ongoing psychiatric outcomes 

- Measurement of quality of life 

- Patient reported outcome measures (PROMs in health care) 

- Hollo treatment adherence - Medical Treatment Maintenance (Special Treatment)

 - User experience (UX) changes to ensure higher functionality 

- Net promoter score

We also track our progress on these indicators through our impact reports and contributions to any public reports on sustainability. These indicators will help us measure our progress towards our impact goals and ensure we are making a positive difference in the lives of patients with chronic diseases in Asia.

Through our Theory of Change model, we aim to create lasting impact on both community and policy levels. Patients and other stakeholders benefit from our products directly; these lead to larger social and environmental Outcomes, Primary Impacts and Long Term Impacts. In our big picture, Hollo’s aims to primarily support SDG Goal 3 - Good Health and Wellbeing; we additionally target green energy solutions, inclusive workforces, and lowering inequalities. We aim to achieve this by our Primary Impact Goals: (1) Improving autonomy and access to care, (2) reducing inequalities in healthcare, (3) ethical and clinical/scientific development of core technology that is inclusive of all backgrounds, (4) radical transparency and digitization of healthcare for all, (5) Sustainable technology and cloud computing.

Direct Outcomes from the use of our product’s public launch/distribution (post R&D, Clinical trials/studies) directly contribute to these Primary Impacts. (1) Lower cost barrier to mental healthcare, (2) Increased care accessibility from home, (3) increased safety and reduced risk from validated methodology, (4) improved mental health, (5) faster, empowered chronic condition recovery (having mental health needs addressed in their care), (6) increased transparency due to digital channels of access, (7) improved health literacy. These outcomes happen primarily on our community level. With this evidence in hand, it would be paramount for healthcare systems and professionals to recognize the need for change in their care - we aim to spearhead this with other industry leaders and non-profit organizations in the future. By collaborating with all stakeholders from insurers, providers, patients, and beyond; Hollo aims to create lasting impact through implementing and supporting digital infrastructure and systems in Asia. By ensuring we additionally support green energy in our suppliers for Cloud Computing services and ensuring we have inclusive workplace and recruitment policies, Hollo’s social and environmental impact stems beyond our products and looks inward at our own processes as well.

However, to ensure that we are measuring and reporting our Outcomes, Primary Impacts, and Outputs, Hollo will collaborate with our Impact Partners, Dream Impact Hong Kong to ensure we complete our Social Impact Audits to certify our impact on paper! 

Several milestones allow us to accomplish goals, these can be reflected in our further description of business goals. However, in brief, by continuing our Business Goals: R&D; publishing our findings; clinically trialing our technology; and subsequently launching our services; Hollo will be able to reach our beneficiaries and begin further work on collaborating with stakeholders to create our impact.

Hollo’s core technology is built around behavioural AI detection and automated digital therapy models delivered to our patients through mobile apps. 

We have several AI models in the background that allow us to analyze Digital Biomarkers on our patients. By combining deep learning and machine learning models, we aim to develop comprehensive profiles of our patients, enabling them to make AI-enhanced treatment choices. We focus on several key signals:
1. Video Interview Data (voice, facial action units, semantics); 
2. Clinical Indicies (psychological tools that are golden-standard in the industry); 
3. Wearable and Mobile Sensor data (GPS, Bluetooth proximity, gyroscopic data, environmental audio, screen on/off, phone use, app use, phone-calls, text frequency, etc.) 
4. Cognitive and Behavioural task response (we are developing key tasks that help us assess characteristics of mental health disorders).

These key markers play a role in identifying signatures or signals of mental health issues that were not possible in the past without the technology. What we are capable of doing is identifying large samples of data from disordered populations and create sliding scales of diagnosis information about patients. This contributes to the network and hierarchical modelling that is now becoming more a more well known and more effective model in Psychology. 

We believe that this positively contributes to our patient profiles, allowing for better diagnosis, prognosis, and treatment procurement. This enables more accurate treatment, at the better time and allowing it to be more inclusive and creates solutions to systemic racism and classism inherit to the mental health diagnostic structures. We are excited to action on this in Asia and definitely interested in other countries/regions. 

Our digital therapeutics takes active evidence based programs that are designed for different populations and work with psychology professionals to curate modules of games, exercises, lectures and activities to ensure that patients have a variety to learn psychological practices and skills to overcome their symptoms. Currently, most solutions are one size fits all, however we believe by providing better characteristic identification, we are capable of curating more accurate and personalised treatment options by fitting modules to patient needs. 

In the near future, we plan to incorporate IoT devices such as wearable watches, rings, or earphones to collect basic biometric and digital phenotype data about our patients. We believe the implementation of this service model in low-income communities can be achieved through other networks.

It should be noted that Hollo’s technology is designed to be scalable and adaptable to healthcare contexts and needs. Leveraging the latest advances in AI and IoT, we aim to deliver innovative, flexible healthcare solutions that improve patient outcomes and enhance the overall healthcare experience.

Majority of our current development focuses on patient's needs and patient journey, however something of note that we would be focused on in the future would be care-taker tool kits; as well as tools that connect our work and signal identification into clinical decision support tools for providers.

Within the spectrum of rare diseases, studies looking at over 300 participants with 79 varying rare diseases have found that around 42% of participants had shown signs of depression and anxiety (N. Uhlenbusch, et al., 2019). Whether it be symptoms inhibiting a patient's day to day functioning, treatment side effects, or even dealing with one’s mortality, the relationship between rare disease and common mental disorders are often complicated and incorporate multiple aspects of the patient journey. This section explores acceptance and commitment therapy (ACT).

ACT is an evidence-based intervention formally falling under the “third wave” of cognitive behavioral therapy (CBT; Hayes, 2009). It incorporates elements of acceptance, mindfulness, and behavior-change activities to increase psychological flexibility (Luoma, Hayes, & Walser, 2007). Unlike second wave CBT, which identifies and targets maladaptive thoughts, emotions, and behaviors, ACT aims to accept these aversive elements and to encourage individuals to lead a value-driven life.

ACT is built on relational frame theory (RFT; Barne-Homes, Hayes, & Roche, 2001). RFT is a psychological theory that explains the arbitrary relations our cognitions, emotions, sensations, and behaviors make as a result of our language. ACT has shown to be effective in treating chronic diseases, pain, and mental health (Graham, Gouick, Krahé, & Gillanders, 2016). Due to limited research, we can look at ACT's impact on Cancer populations., as many symptoms are highly similar. According to a meta-analysis performed by Zhao et al. (2021), ACT had a large effect size (Hedge’s g = .88) on reducing psychological distress (stress, anxiety, depression, etc.) for individuals with unspecified cancer. This is sizable when compared to mindfulness-based interventions (Hedge’s g =.40; Cillessan, Johannsen, Speckens, & Zachariae, 2019) and CBT (Cohen’s d = .31; Tatrow & Montgomery, 2006) for other forms of cancer. 

In terms of our diagnostic work, Hollo's proprietary models explore an expansion on other literature that highlights key signals in Facial, Audio and Semantic markers to identify depression and anxiety. 

Affective computing research has underlined the facial and speech-related markers to identify depression. For example, prior studies have found that depressed individuals exhibit reduced facial expressivity; by fewer emotional expressions and smiles, and lessened duration / intensity of such smiles (Cohn et al., 2015). Researchers have posited psychomotor impairment and social withdrawal theories to explain observed differences in depressed populations, with the decrease in affiliative facial expressions as evidence for the latter theory (Girard et al., 2014). In terms of speech alterations, depressed individuals exhibit a narrower pitch range and reduced pitch variability, displaying fewer verbal activity and slowed speech (Cummins et al., 2015). Hypothesized theories of auditory differences include: planning and speech production impairment; diminished working memory processes; and deteriorating neuromuscular coordinations (Cummins et al., 2015). Together, these findings demonstrate observable and potentially objective differences in depression phenotypes.

We aim to publish our findings in peer reviewed journals in the coming year in collaboration with HKU professors. We have two approved studies, one by HKU HREC: EA220361, and HKDU Ethics approved our DigiACT Trial: 2022/08

The team has 3 full-time staff, 2 part-time staff, and 4 clinical advisors for reviewing the clinical trial.

The whole team has been working on the solution for 3 years.

We are committed to incorporating diversity, equity and inclusion in our work. We believe this principle is essential to achieving our mission of providing accessible and innovative healthcare solutions for all. Here are some actions we do to ensure that our work is inclusive and equal: 

In our business model: 

- We are an equal employment opportunity employer, committed to ensuring a gender-neutral workplace by recruiting individuals from diverse backgrounds. We are also working to implement policies to ensure a non-discriminatory hiring process and will work with human resources consultants to further enhance our programs as we scale.

In our service model:

- We are committed to developing our solutions in different languages and cultures to ensure that our platform is accessible to all members of the community. Currently, our platform is available in English and Chinese, but we are actively working to expand our language offerings and data repositories to include different families.

- Availability and inclusion are important elements of our products. We strive to create an inclusive model that enables all users to work or contribute. For example, we are incorporating features specifically designed for disability and mobility into our infrastructure, to ensure that our platform is accessible to everyone.

In our technical model:

- We are committed to ensuring that our AI models are unbiased. To do this, we look at a variety of data sources that show the distribution of populations in the states and cities we serve. For example, in Hong Kong, we have a distribution of the Han Chinese population, but we also see a large population of people from India, Pakistan, Middle East and Africa. By including diverse datasets, we aim to eliminate biases and ensure that our technology serves all communities equitably.

It is also important to ensure that our leadership team and board reflect diversity and inclusion, and we actively seek to increase diversity, equality and inclusion among our employees and the company. We have established a committee within our company to address these important issues, ensuring that we prioritize diversity, equity and inclusion in all aspects of our organization. In addition, we are committed to working with groups such as the Hong Kong Cancer Fund to prioritize the participation of underrepresented communities in our research studies.

Revenue model:

Hollo distributes this product on a Prescription model, where payers (private or reinsurance) pay for our 22-day mental health prescription program. The estimated price of the product is US$200/year,  which is in line with current market rates. Users gain access to screening, treatment, and a dedicated psychologist potentially to monitor the data, only cases labeled as Serious will be referred to an external psychologist, within those 22 days. Patients can continue assessments and exercises throughout the year. We will look for pricing models that are flexible and appropriate for our product market segment. Although this pricing strategy is designed for Hong Kong, we are keen to explore inclusive and economically viable pricing policies for other regions.

Channels & Partnerships:

Our partnership network includes healthcare providers, supporting organizations for mental health referrals, insurance partnerships to enable financial aid for community members, pharmaceutical companies that distribute primary treatment to patients, and patient-support groups. We value a closed feedback loop with our providers and users to develop our product. We maintain a relationship with multiple regulatory bodies (ISO, FDA, HIPAA, GDPR, etc.) to audit our product on clinical, technological, and social levels.

Key Activities:

Our company focuses on research and applied research through our business model. Our key activities in research include expanding our clinical pipeline by investigating new interventions that support chronic and rare patient backgrounds in mental health. We developed our Acceptance and Commitment Therapy (ACT) program for cancer patients, and we plan to explore applying this treatment manual towards other comorbidities. Furthermore, we're exploring how our multimodal AI diagnosis model can apply itself to the HiTOP diagnosis model.

Segments:

Our key customers are payers in the healthcare system, including out-of-pocket payments and insurance coverage in private clinics and hospitals, and government-subsidized payments in public hospitals. In Hong Kong, 70% of healthcare transactions occur in the public hospital system. We're exploring potential collaborations with pharmaceutical companies as payors for delivering important healthcare data about patient populations using their drugs or vaccines. Such partnerships would be key in delivering effective models for low-income communities, especially for chronic conditions and rare diseases. Our key beneficiaries are patients experiencing mental health issues as comorbid conditions to their chronic condition. We're exploring including healthcare providers in the platform, but it requires overcoming the training required to use such platforms in their care programs.

Cost Structure:

Our multidisciplinary team is agile and functions on both operational and research bases. Our core business team comprises both software experts and sales/marketing members. Our research team focuses on Data Science, Psychology/Cognitive Sciences, and some software members focused on quick deployment and testing. Alternatively, other large costs for our development would include covering our Clinical Trials for the product per therapeutic. Currently, we've spent around 150K USD on our first pilot clinical trial (UX research, software development, team, CRO Engagement, deployment, etc.). As a model, this can be scaled for other therapeutics, as well as a higher cost range for FDA-regulated RCTs.

Currently, we have secured over 4 Million HKD (570K USD) in equity-free capital through multiple grant and incubator structures, and we will continue exploring further grants and matching funds from the Hong Kong government, accelerators, and private investment. We are currently closing a 1M USD seed round. After our first clinical trial in October 2023, we'll launch a series A round of fundraising for around 8 - 10 million USD, seeking a combination of angel investors and healthcare venture capital. To ensure long-term financial sustainability, Hollo will leverage a combination of revenue streams. 

Prescription Model: Hollo will offer a 22-day program for mental health treatment that requires a prescription from payors, including individuals or insurance companies. Our pricing model is in line with market rates at an estimated US$200/year, and we aim to explore inclusive pricing models for other communities.

Digital API Services: Hollo plans to offer digital API services for digital health platforms to generate revenue from licensing fees. This model will enable us to scale our product to reach more patients and healthcare providers.

Collaborative Grant Projects: Hollo will explore collaborative grant projects with non-profit organizations to leverage their funding and resources, thereby expanding our reach and impact.

By combining these revenue streams, we'll ensure that our expected expenses are covered. Our multidisciplinary team will focus on research and applied research to expand our clinical pipeline and ensure that our product is inclusive and effective for all communities. We'll maintain a relationship with regulatory bodies and have a closed feedback loop with our providers and users to develop our product.

Total: US$ 573,040.37

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US$ 57,559.86    (HK$ 450,000)    Microsoft Imagine Cup

US$ 12,791.08    (HK$ 100,000)    Cyberport Creative Micro Fund

US$ 25,582.16    (HK$ 200,000)    Good Seed SIE Fund

US$ 63,955.40    (HK$ 500,000)    Cyberport Incubation Programme

US$ 127,910.80  (HK$ 1,000,000) Technology Startup Support Scheme for Universities

US$ 76,746.48    (HK$ 600,000)    HK WeVenture Gear Up Programme

US$ 1,279.1       (HK$ 10,000)     HK Challenge Plus Social Innovation Champion

US$ 3,837.32       (HK$ 30,000)     City I&T Grand Challenge Innovation Award

US$ 102,328.64  (HK$ 800,000)    City I&T Co-Creation Fund

US$ 33,256.81    (HK$ 260,000)    Founder Investment

US$ 67,792.72   (HK$ 530,000)    Angel Investment