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Next Billion-Dollar Startups: Truepill’s Dose Of Digital Disruption To The $400 Billion Pharmacy Industry

I was barely getting any sleep,” Umar Afridi, cofounder and CEO of Truepill, says of the tech-enabled pharmacy company’s early days. From 9 a.m. to 4:30 p.m. each day, he worked at Truepill’s distribution center in Hayward, California. Then he drove to his job as a pharmacy manager at a 24-hour CVS in East San Jose. On the side, he studied for a dozen state pharmacy exams so that Truepill, which at the time had no other pharmacists on staff, could legally ship to those states. “It was a pretty crazy first year,” he says with characteristic understatement.

That craziness has paid off for Afridi, 37, and his cofounder, Sid Viswanathan, 35, who hope to upend the staid, heavily regulated pharmacy business with technology. Truepill, which is based in San Mateo, California, shipped its first prescriptions in 2016. Last year its revenue reached $48 million, helped by the fast growth of direct-to-consumer customers like Nurx, which sells birth control, and Hims, which focuses on remedies for hair loss, erectile dysfunction and acne. This year Truepill could double its revenue to $100 million, as it expands its customer base beyond direct-to-consumer medications to prescriptions that treat more serious illnesses.

Those revenue numbers gained Truepill a spot on Forbes’ Next Billion-Dollar Startups list this year, despite its having raised just $13 million in venture funding led by Initialized Capital at a valuation of $80 million in its last round. That valuation makes Truepill an outlier on the list, as does the fact that Afridi and Viswanathan own the majority of the business and plan to continue to do so after raising the next round of capital, expected before the year’s end.

Afridi and Viswanathan—and their investors—are betting that Truepill will see a big payoff as consumers move away from in-person doctor visits and to a new model of telemedicine. “This is the building block of digital health and the future of healthcare,” says Initialized managing partner Garry Tan.

Pharmacy is a roughly $400 billion business in the United States, yet only recently have entrepreneurs begun tackling the market. In 2013, two young founders launched PillPack, a retail pharmacy startup that was acquired by Amazon last year for around $750 million. Other newcomers followed, including New York City’s Capsule, which grabbed $270 million in funding to do same-day prescription delivery refilled via text.

Truepill’s difference: Its business-to-business model makes it a behind-the-scenes player, invisible to retail customers, who will never have reason to know its name. That’s by design, and it allows Truepill to sign agreements with drugmakers and pharmacy benefit managers, those industry intermediaries that sit between insurers and drugmakers, without directly competing with them. “We’re not a traditional mail-order pharmacy,” Afridi says. “We’re way more than that.”

Afridi was born in Salt Lake City and grew up in Manchester, England, where his mother’s family was from. He studied pharmacy at the University of Manchester and worked as a relief pharmacist, filling in for those who went on vacation, in England. After passing the tests to practice in the United States, he took a job at Fred Meyer near Seattle. Unlike the typical pharmacist, Afridi always had an entrepreneurial side gig. During college, he imported performance cars, like the Mazda RX-7 and the Mitsubishi Evo 5, from Japan and sold them at a profit.

                              

While working as a pharmacist, he taught himself computer programming and began playing around with the idea of an on-demand pharmacy. His goal: to ease customers’ frustrations with waiting in line to pick up medications and to cut back the phone calls and faxes required for pharmacists to do their job. “I’ve always had a passion for technology, and every time I see a problem, I think, ‘How can technology fix this?’” he says.

Viswanathan, an Indian immigrant, had worked at Johnson & Johnson, then cofounded CardMunch, a business-card scanning app. In 2011, LinkedIn bought the startup for a reported $3 million. Viswanathan stayed at the larger company after the deal, and when LinkedIn went public the stock he owned made him wealthy for the first time. “It was fairly life-changing coming from no money to having some,” he recalls. After nearly four years at LinkedIn, he was ready to leave and work on another startup. “My only criterion was what do I want to spend the next 10 years of my life on,” he says.

While he was pondering what to do next, he stumbled upon Afridi’s profile on LinkedIn—where Afridi had changed his header to “startup founder, pharmacist”—and messaged him cold to talk about healthcare. Soon the two were meeting regularly and brainstorming ideas for a business to start together.

By then, other startup pharmacies, like PillPack, were making inroads with retail customers. Rather than compete in what had become a crowded space vying for retail customers, Afridi and Viswanathan figured they could operate in the background, using technology to build an extremely efficient pharmacy distribution center. “Truepill is what you get when you put together a pharmacist and a software engineer,” Viswanathan says.

“This is the building block of digital health and the future of healthcare,” says Initialized Capital’s Garry Tan.

Their idea coincided with the rise of new direct-to-consumer health brands that needed a distributor that could follow all the pharmacy regulations. To consumers, these Instagrammable health products don’t look like drugs, and often their subscription boxes contain a mix of both prescription and over-the-counter products. But if there’s even one vial of prescription pills going out in the mail, the startup sending it needs a pharmacy to fulfill the order. In talking with Nurx, Viswanathan says, “we came to find out they were literally picking up the phone to mom-and-pop pharmacies in different states.” They gained a customer by offering a better way.

In 2017, Andrew Dudum cofounded Hims, the fast-growing direct-to-consumer therapeutics startup for men, and he, too, signed up with Truepill. “We knew from the beginning we were going to grow very fast,” Dudum says. “We expected 30 to 50 orders per day, and that was the scale we communicated to Umar and Sid that we needed to be prepared for. In the first week, we were getting 500 orders per day.” Today, Hims, which is valued at $1.1 billion, does thousands of orders per day and is one of Truepill’s largest customers. “They figured out a way to scale with us,” Dudum says.

At Truepill’s Hayward distribution center, all orders come in electronically. When Hims sends a prescription for finasteride, the male hair-loss treatment, for example, it goes through electronic vetting and then a robotic machine pulls the 1-milligram tablets from custom-made 1,000-count bottles into a small pill vial that gets labeled with Hims branding. That automation allows Truepill to work more efficiently than a traditional retail pharmacy. So, too, does its focus on a small number of medications: Ten medications, including finasteride and the erectile-dysfunction drug sildenafil, represent 80% of its volume. Its scale in those allows Truepill to turn over its inventory every few days and gives it the power to negotiate prices with drug manufacturers and pharmacy benefit managers on those products.

“Truepill is what you get when you put together a pharmacist and a software engineer,” says cofounder Sid Viswanathan.

For Afridi and Viswanathan, direct-to-consumer medications are just the beginning. They are starting to sign agreements with drugmakers and pharmacy benefit managers, though they won’t name those larger partners yet. This shift comes none too soon, as Hims has announced that it would open its own pharmacy in Ohio to shift a portion of its distribution in-house—a move that Viswanathan says will begin to impact Truepill in 2021. “Hims is a large part of the business in quantity, but not in revenue,” he says, noting that medications reimbursed by insurance are higher cost than lifestyle meds that consumers pay for out of pocket. Truepill currently has two distribution centers and is adding another five.

Afridi and Viswanathan’s next step: building a nationwide network of doctors in every state that will enable their pharmacy startup to play a bigger role in the shift to telemedicine. Those doctors will allow it to work directly with makers of specialty medications, say, so that they can distribute their medications to consumers more easily. Over time, Truepill figures its orders could rise from 5,000 to 10,000 per day to 100,000.

“Lifestyle and ED [erectile dysfunction] medications have allowed us to build the infrastructure to all these other areas,” Afridi says. “There is a lot of innovation that needs to happen in the space.”

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I’m a senior editor at Forbes, where I cover manufacturing, industrial innovation and consumer products. I previously spent two years on the Forbes’ Entrepreneurs team. It’s my second stint here: I learned the ropes of business journalism under Forbes legendary editor Jim Michaels in the 1990s. Before rejoining, I was a senior writer or staff writer at BusinessWeek, Money and the New York Daily News. My work has also appeared in Barron’s, Inc., the New York Times and numerous other publications. I’m based in New York, but my family is from Pittsburgh—and I love stories that get me out into the industrial heartland. Ping me with ideas, or follow me on Twitter @amyfeldman.

Source: Next Billion-Dollar Startups: Truepill’s Dose Of Digital Disruption To The $400 Billion Pharmacy Industry

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Hi, I’m Garry Tan, venture capitalist and cofounder at Initialized Capital. We were earliest investors in billion dollar startups like Coinbase and Instacart, and we’re spending time with some of our best founders to learn the secrets of their success and see the future they’re building. Today I sat down with Sid Viswanathan, cofounder of Truepill, an API for all needs for telemedicine. Telemedicine has the potential to bring down costs and make high quality care more accessible for every person on the planet. We’re headed to Hayward, California, their west coast HQ and fulfillment center out of which they provide pharmacy services for dozens of telemedicine startups and practices large and small, shipping to all 50 states. Come learn about how as a founder, you need to choose a problem space that you could want to work on for 10 years or more. Please like this video and subscribe to my channel if you want to see more videos like this with top founders. Find Sid on Twitter at https://twitter.com/sidviswanathan Find Garry on Twitter at https://twitter.com/garrytan Learn more about Truepill at https://truepill.com Learn more about the companies we fund, and how we work with them at https://initialized.com

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Babylon Health Gets $2 Billion Valuation With New Funding That Will Help It Expand In U.S.

Babylon Health, a U.K.-based startup whose fast growth has been shadowed by concerns about the efficacy of its telemedicine apps, has raised $550 million in Series C funding, elevating the company to unicorn status. Saudi Arabia’s Public Investment Fund (PIF), which invest on behalf of the Saudi Arabian government, led the round that valued the company at $2 billion with a total of $635 million raised.

The new capital will enable the company to expand into more markets including the U.S. and Asia, Babylon said, and it will also bolster its artificial intelligence capabilities on the platform, which serves 4.3 million users worldwide. An unnamed U.S health insurer and a fund of global reinsurer Munich Re also invested. Vostok New Ventures, which already holds a 10% stake in Babylon, previously said it would participate in the new round, as did Sweden’s Kinnevik.

With an aim of cutting healthcare costs and broadening access, Babylon secured deals with Britain’s National Health Service with its apps to replace local doctor visits with video consultations and a chatbot that doled out advice on whether to see a doctor. It released a new artificially intelligent chatbot that promised to give diagnostic advice on common ailments, without human interaction. Its progress, however, was stuttered by doubts about the services’ abilities. Interviews with current and former Babylon staff and outside doctors revealed broad concerns that the company has rushed to deploy software that had not been carefully vetted, then exaggerated its effectiveness, Forbes revealed in December. The company disputed those claims, saying its software goes through many clinical tests.  The company also came under fire for failure to follow up with patients receiving mental health treatment. At the time, Babylon blamed problems with the NHS referral system.

Any blunders don’t seem to have slowed the company’s momentum.

Led by CEO and Founder Ali Parsa, an Iranian-born former banker, Babylon has also secured contracts with Prudential and Samsung. It says it now delivers 4,000 clinical consultation a day, and one patient interaction every 10 seconds.

“We have a long way to go and a lot still to deliver,” Parsa said in a statement. “While the burden of healthcare is global, the solutions have to be localized to meet the specific needs and culture of each country.”

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I serve as assistant editor for Forbes Innovation, covering cybersecurity and venture capital. I have covered politics at POLITICO, entertainment for Time Out New York, but my most fascinating beat has been covering the intersection of technology, finance, and entrepreneurship. I’m also an alumna of CUNY Graduate School of Journalism, and the University of Washington. Email tips to mmelton@forbes.com

Source: Babylon Health Gets $2 Billion Valuation With New Funding That Will Help It Expand In U.S.

Groupon Made Eric Lefkofsky A Billionaire—His Cancer-Fighting Startup Is Worth Far More

Eric Lefkofsky hasn’t taken a science class since college. But as he meanders through the Chicago lab of Tempus, his medical startup, he presents an air of expertise. “One thing you can see right off the bat is the purple staining of this cell,” he says, pointing to the pathology slide of a patient with breast cancer. He walks past vials of lysis buffer and a $1 million genomic sequencer. “Tempus is attempting to bring the power of artificial intelligence to healthcare,” he says. “The first step in all that is data.”

Assembling data was the first step in Lefkofsky’s other ventures. The 49-year-old has launched five companies worth at least $250 million apiece, each promising to transform an industry by using big data. His best-known venture is Groupon; despite the deals site’s disappointing share price, Lefkofsky is worth an estimated $2.7 billion.

Tempus is predicated on the theory that information, lots of it, will enable doctors to personalize cancer treatments and make them more effective. A doctor treating a patient with lung cancer might send a tumor sample to Tempus for genomic sequencing. Tempus identifies a mutation in the gene for epidermal growth factor receptor, which causes cells to grow and divide too much. With that, the doctor prescribes a targeted therapy that can have better results than chemotherapy.

So far the 700-employee company has raised $520 million (Lefkofsky put in $100 million). The lavish $3.1 billion valuation suggests investors expect his approach to make a big score, starting with cancer, then against chronic conditions like depression and diabetes. But precision medicine is a nascent field. Tempus, on its own or with a research partner, has published fewer than 20 peer-reviewed manuscripts since its founding four years ago. A competitor, sequencing firm Foundation Medicine, has published over 400 in 9 years.

While the cost of sequencing has dropped, it still runs $1,000 to $5,000 per analysis, and Tempus loses money doing it. Tempus also licenses its library of anonymized data to drug companies, insurers and researchers. Lefkofsky won’t reveal revenues, but says it gets seven-figure fees from seven of the ten largest cancer drug companies.

Lefkofsky got the entrepreneurial bug at the University of Michigan, where he studied history and made money selling carpets. In 2001, he cofounded InnerWorkings (marketing), then Echo Global Logistics (transportation) and Mediaocean (advertising software). One of Lefkofsky’s hires, Andrew Mason, pitched an idea for a business focused on “collective action.” Lefkofsky invested $1 million in what became Groupon. A year after its 2008 founding, it booked $14.5 million in revenue; in 2011, it generated $1.6 billion.

“It certainly feels like my entire career has led to this point,” Lefkofsky says. “I hope this will be my legacy project.”

Lefkofsky spent a few years dabbling on other projects, including Uptake (predictive analytics for heavy industry). “I always knew back then, [with] those businesses, that I would be in and out,” he says.

In 2014, Lefkofsky’s wife, Liz, was diagnosed with breast cancer. “I was just perplexed at how little data had permeated her care,” he says. That experience ultimately launched Tempus. (Liz has “been taking it one day at a time,” Lefkofsky says.)

Yet again, Lefkofsky needed data. But some researchers were initially hesitant to share. “They wanted us to basically send all our samples there for all our patients” in the future, says John McPherson, deputy director of the UC Davis Comprehensive Cancer Center. “But we took a more cautious approach.” They ran a head-to-head comparison involving gastrointestinal cancer between Tempus and Foundation Medicine; Tempus fared well.

                       

In 2017 Tempus reached a licensing agreement with the American Society of Clinical Oncology to extract and organize data from 1 million patient records. Today the company says it already works with 30% of U.S. oncologists; many send patient records and biopsies to Tempus for analysis. Tempus hopes to sequence 120,000 genomic samples for doctors this year.

Even with that data, Tempus faces stiff competition. Last year Swiss drug giant Roche spent $4.3 billion acquiring Foundation Medicine and big data firm Flatiron Health. Another startup, Concerto HealthAI, backed by billionaire Romesh Wadhwani, has access to many of the same records as Tempus.

                           

Doctors at UC Davis, McPherson says, have only sent about 100 samples to Tempus, considerably fewer than they’ve sent to Foundation. “I think they were a little baffled by the amount of data that came back [from Tempus],” McPherson says. Clinicians “tend to take the easier route just to save time. But there are several clinicians that are now working fairly closely on the research side with them.”

Lefkofsky remains supremely optimistic. “It certainly feels like my entire career has led to this point,” he says. “I hope this will be my legacy project.”

I’ve been a reporter at Forbes since 2016. Before that, I spent a year on the road—driving for Uber in Cleveland, volcano climbing in Guatemala, cattle farming in Urugua…

Staff writer at Forbes. Email me at mtindera@forbes.com and follow me on twitter @mtindera07.

Source: Groupon Made Eric Lefkofsky A Billionaire—His Cancer-Fighting Startup Is Worth Far More

It’s Alive! Facebook’s Surprising Video Standout Is A Horror Movie Startup

Like a proud parent, Jack Davis has covered the refrigerator in his Wilshire Boulevard office with artwork. But these aren’t crayon-drawn stick figures of Mom and Dad. They’re the stuff of nightmares—a demonic entity with shark teeth, a cannibal with thorns sprouting from his head, a tree that likes to disembowel its victims.

The gruesome creatures crawled out of the imagination of Davis’ Crypt TV, a digital studio that aspires to become the Marvel of monsters for mobile. Davis, 27, has raised $11 million from investors including Hollywood producer Jason Blum (Us, Ma), media mogul Shari Redstone’s Advancit Capital, Huffington Post cofounder Kenneth Lerer and NBCUniversal. The four-year-old Los Angeles studio, which creates horror videos for social networks, is on track to bring in about $20 million in revenue this year through production deals, running ads for films like Crawl and selling merchandise.

When he started, “no one was doing scary for mobile,” Davis says. That signaled a missed opportunity. “This is a huge genre. It has a solid fan base, and scary movies are very, very big.”

The Golden Age of streaming has birthed Netflix competitors that cater to nearly every genre, from U.K. shows on Britbox to anime on Crunchyroll and, yes, horror on Shudder and Screambox. At the same time, studios like Elisabeth Murdoch’s Vertical Networks have built audiences that are reached primarily through mobile-first social networks such as Snapchat and Instagram, which more than a billion people visit each month.

Davis and Crypt TV cofounder Eli Roth, the film director and producer who developed Netflix’s first horror series, Hemlock Grove, bet that an audience who loved films like Jordan Peele’s Oscar-nominated Get Out would snap up suspense and horror on the small screen, too.

It’s an intuition that’s paying off. Crypt TV said on Friday that it had reached a deal with Facebook to develop five series exclusively for Facebook Watch, its on-demand video service. The deal extends a partnership started in 2018, when Facebook green-lighted a 15-episode series based on Crypt’s short film The Birch.

Facebook has been paying as much as $25 million for these original shows, though the bulk of them cost $3 to $5 million, according to a person familiar with the matter. Forbes estimates the new Crypt TV deal is valued at less than $20 million. Neither party would disclose the terms of the partnership.

Facebook might seem an unlikely place to screen monster movies for Generation Z and younger Millennials, who make up nearly half of Crypt TV’s audience. One Pew Research Center survey last year found that the world’s largest social network is no longer the most popular hangout for teens, a big drop from earlier in the decade. Plus, Facebook Watch has struggled to gain traction. A year after Facebook CEO Mark Zuckerberg launched Watch to better compete with Google’s YouTube and Snapchat’s Discover, only half of Facebook users had ever heard of it, says The Diffusion Group, a media research consultancy.

Still, momentum is gathering for shows that capitalize on the network’s power to amass communities to talk about shared interests—say, Jada Pinkett Smith’s talk show, Red Table Talk, or Sorry for Your Loss, a drama on grief starring Elizabeth Olsen. Facebook says more than 140 million people each day spend at least a minute viewing Watch videos.

“It’s very hard to say that a platform … (of) two-plus billion people on it doesn’t have young people on it,” says Matthew Henick, Facebook’s head of content planning and strategy. “What Crypt does incredibly well is—because they’re able to tell their stories through many different modes or, in this case, products—they’re able to find those audiences and pull them in.”

Crypt TV taps into a community that likes to be scared. Horror has been reeling in fans on the big screen: The genre brought in a record $1 billion in box office sales in 2017, according to Comscore.

Some fans want to get their goose bumps for free. Thanks to The Birch, which was viewed 26 million times on Facebook, the studio now has 9.75 million followers, or more than triple its YouTube audience. On Davis’ fridge hang mementos from fans. One shared a photo of her tattoo—it’s of the Look-see, a creature with no eyes and flesh that’s been stitched together.

“Young people have so much emotion,” Davis says. A scary story “provides an amazing, permissive structure to take on deep emotional issues.”

A fortuitous encounter at a dinner party hosted by his parents in West Los Angeles led to the creation of Crypt TV. Then a student at Duke University, Davis found himself sitting next to Roth and began reciting dialogue from Roth’s portrayal of the bat-wielding Nazi killer Donny Donowitz in Inglourious Basterds.

The conversation turned to Davis’ career plans. The sociology and political science major said he hoped to launch his own company, capitalizing on the dramatic shift in media viewing habits he’d observed during his four years in college. Roth had a suggestion.

“I said, ‘You know that audience that’s going to see horror movies now’—because obviously now horror has exploded—‘They’re all on their phones,’” Roth recalls. “What is the next generation of characters? Who is creating the new Freddy Krueger? Is there a way to launch a Freddy? A Jason? A Michael Myers? A Chucky? Just on your phone?”

Roth introduced him to Blum, who became Crypt TV’s earliest investor and served as a mentor to the company’s 23-year-old founder.

An early success was #6SecondScare, an October 2014 online competition that encouraged users of Vine, Twitter’s six-second video service, to upload their scariest videos.

Roth lent his name to the contest and coaxed Hollywood celebrities including Quentin Tarantino and High School Musical’s Vanessa Hudgens to promote it and serve as judges. #6SecondScare attracted 20,000 submissions and ended up featured on ABC’s Good Morning America.

In the summer of 2015, Davis’ team launched Snapchat Murder Mystery, a show that gathered ten social media influencers to a mansion party, then killed off their characters in an Agatha Christie-styled whodunit. A year later came Crypt TV’s breakthrough moment with The Birch. The four-minute video follows a terrified schoolboy who summons an ancient being in the woods to dispense a particularly bloody form of retribution on the boy’s tormentor.

Davis faces his own monster lurking in the dark: Quibi. The mobile video subscription service comes with a Hollywood pedigree, a $1 billion cash horde and some of the best-known filmmakers in horror, Guillermo del Toro (The Shape of Water, Pan’s Labyrinth) and Sam Raimi (Evil Dead), as well as Blum, producing original content.

Quibi launches in April—though Crypt TV, in classic horror film fashion, has gotten a running start.

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I’m a Los Angeles-based senior editor for Forbes, writing about the companies and people behind the biggest disruption in entertainment since cable TV: streaming video

Source: It’s Alive! Facebook’s Surprising Video Standout Is A Horror Movie Startup

Zuckerberg’s Big Hopes, a new Huawei sting, VPN truths, a five-year bet on Bitcoin, the Captcha puzzle, and more — The Overspill: when there’s more that I want to say

Afraid so: the machines are now able to beat us at this game too. CC-licensed photo by Chris on Flickr. Ahead of No. 1,000, send in your three favourite links – leave a comment, email or DM me. Popular so far: Why drowning doesn’t look like drowning (May 2018); why I hope we don’t find […]

via Start Up No.996: Zuckerberg’s big hopes, a new Huawei sting, VPN truths, a five-year bet on Bitcoin, the Captcha puzzle, and more — The Overspill: when there’s more that I want to say

Healthcare Startups Have Raised More This Year Than in 2012 And 2013 Combined – Michela Tindera

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With two months left in 2018, healthcare startups have already raised more in VC funding this year than they did in all of 2012 and 2013 combined, according to an analysis conducted for Forbes by Pitchbook. Venture capitalists have poured more than $26 billion into health startups this year. In 2012 and 2013 combined, the sector raised $22.3 billion in 12 months. So far this year that $26.3 billion has been spread among 1,540 deals, which is slightly less than half the 3,103 deals that took place in 2012 and 2013………

Read more: https://www.forbes.com/sites/michelatindera/2018/11/02/healthcare-startups-have-raised-more-this-year-than-in-2012-and-2013-combined/#521a6b867ac7

 

 

 

 

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The Startup Postmates and Visa Use To Watch Their Language Just Raised $11.5 Million To Expand – Alex Konrad

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When the startup Qordoba first met with California venture capitalists to share its software idea, its founders faced an uphill battle for attention. Its chief executive was a female ex-banker. Its chief technology officer was Syrian and had taught himself English. And their business was based in Dubai. But Qordoba was operating in a market that resonated across geographies: translation. Initially focused on helping businesses manage local teams to translate their projects and copywriting to different languages…….

Read more : https://www.forbes.com/sites/alexkonrad/2018/10/11/the-startup-postmates-and-visa-use-to-keep-their-language-consistent-just-raised-115-million-to-expand/#3d45b10a768c

 

 

 

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