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Babylon Health is a health service provider that provides remote consultations with doctors and health care professionals via text and video messaging through its app. It is best known for its use of artificial intelligence. The subscription private healthcare service launched in the UK in 2013 and has since expanded internationally to Canada, Rwanda, Saudi Arabia and the United States. A subset of its services are also available in Cambodia, China, Hong Kong, India, Indonesia, Laos, Malaysia, the Philippines, Singapore, Taiwan, Thailand and Vietnam. Babylon Health achieved “unicorn” status in August 2019 after a funding round which raised $550 million in new investment. As of June 2020, there are approximately 1.3k employees listed on Babylon Health's LinkedIn page. It has over 4.4 million registered patients and provides 4,000 consultations per day. In its December 2019 report, The Care Quality Commission awarded Babylon Health an overall “good” rating, and an “outstanding” rating in leadership.

General
The company was founded in 2013 by Ali Parsa, who was previously the CEO of the Circle Health hospital operator and former investment banker. Babylon Health, formerly Babylon Health Services Ltd, is owned by it’s holding company Babylon Holdings Limited along with Babylon’s technology branch, Babylon Partners Limited. In 2014 Babylon Health Services Ltd. became the first service of its kind to be registered with the Care Quality Commission, the health care services regulator and inspector in England. In 2020, Babylon made its first investment in another company, leading a $30m series B round, investing in US-based health kiosk operator Higi. At the time, Babylon made clear that ‘more strategic investments and partnerships’ would follow. In 2019 Babylon was awarded the World Government Summit Award in Dubai, for Emerging Technologies. The same year the company won the RDB Innovator of The Year award in Rwanda, for being the first fully integrated mobile healthcare to operate in Rwanda.

Naming History
The company is called Babylon because of the ancient city of Babylon. 2,500 years ago in Babylon, citizens that needed medical advice would gather in the town square to share their beliefs and thoughts on ways to treat common illnesses. As explained on the company’s website, it is believed that, as a result, Babylonians enjoyed the longest life expectancy across the ancient world.

Company Growth
Babylon reported the following financial figures:

Babylon Health’s employees have grown from 300 in early 2018, to 1,500 in late 2019. As of August 2020, it’s LinkedIn page currently lists 1,322 employees. At the time of Babylon’s series A funding, in January 2016, Babylon had 150k registered users. In June 2017 Babylon Health claimed to have had 800k registrations. By May 2018, it was said to have 2 million members. As of May 2020, Babylon Health is said to have 4.4 million members.

Services
Babylon Health provides healthcare services through its website or iOS and Android mobile applications. This is funded variously through a subscription-based model, pay-as-you-go payments, centrally funded initiatives like the UK’s NHS, the Government of Rwanda, or as part of health insurance packages.

The service allows users to add family members to their account so that they can share health information and GP appointments. There is not a family package though, each subscription needs to be paid for separately.

Video Consultations
Through the Babylon app, users can receive health information, have video and audio chat appointments with a doctor, advanced nurse practitioner, prescribing pharmacist, diabetic specialist nurse, physiotherapist, travel health nurse, or dermatology GP at any time and any day of the week. If the doctor issues a prescription, Babylon sends this electronically to the users’ designated pharmacy.

Symptom checker
Users can use the app’s symptom checker service to select the symptoms they are experiencing and receive most diagnostic information, advice and information. The symptom checker chatbot feature uses artificial intelligence to suggest diagnoses based on the user’s inputted symptoms, health history, medical condition data and a knowledge graph built by the company. The Babylon Chatbot is registered as a Class 1 Medical Device, though is not suitable for all patients.

In March 2020, Babylon Health entered into a three-month trial with Sanofi to embed the symptom checker on Sanofi’s Buscopan and Dulcolax websites to enable users to diagnose digestive health issues. Free video consultations were provided to the first 400 users, however it is reported that the service was used over 100k times in its first month alone.

Babylon Monitor
The Babylon Monitor feature allows users to sync their physical health data (through wearable devices) and manually log their mental health trends in order to receive relevant advice and information.

Babylon Health-check
Babylon’s Healthcheck service, launched in October 2018, asks users to answer health questions in order to build a “digital twin” of the user and assess the user’s overall general health, in relation to lifestyle, mental health, current organ health, and future disease risk. The user receives a report with advice and health information based on national guidelines and standard medical practice.

Ask A&E
Ask A&E is a triage tool similar to NHS 111. It allows patients to input their symptoms, and then advises a course of action – such as attending an emergency department, calling an ambulance, booking a GP appointment, visiting a pharmacy, or staying at home and monitoring their symptoms. In 2020 it began to be used at Royal Berkshire NHS Foundation Trust, Royal Wolverhampton NHS Trust and University Hospitals Birmingham NHS Foundation Trust.

Users can also order specific health tests and receive their results through the app.

COVID-19 Care Assistant
In March 2020, Babylon Health launched the COVID-19 Care Assistant feature in response to the COVID-19 pandemic. The feature combines COVID-19 information, self-isolation advice, a symptom logger, live chat, and a hospital referral feature. It is available to all UK users, with plans to release the service internationally. Of the 31,000 users who used the app in March and April, half were identified by it as having “risk of coronavirus”.

Sales of COVID-19 tests
In May 2020, Babylon Health offered finger-prick COVID-19 antibody tests for purchase at £69. During this time, Babylon controversially offered the tests for free to its employees in return for access to their results. That same month, the Medicines and Health Products Regulatory Agency (MHRA) asked all providers of COVID-19 antibody testing services using capillary blood collected by a finger-prick to temporarily stop providing this service until home collection of this sample type is properly validated for use with these laboratory tests. MHRA advises that the public should ignore any result they get from the private kits.

International
Babylon Health currently has operations in the United Kingdom, the United States, Rwanda, Canada, multiple countries across APAC and the Middle East.

UK
In the UK, Babylon Health is available as a private subscription service, a private pay-as-you-go service, as a free service through the medical insurer Bupa and through the National Health Service (NHS) as the service ‘GP at Hand’. All of its doctors are NHS-trained and GMC registered.

GP at Hand
In November 2017 Babylon launched GP at Hand, providing a free at the point of service, NHS, version of its services. Users can book appointments with GPs and other medical clinicians through the GP at Hand service. As well as being able to select the time and date of their appointment, they are given the choice of speaking to a medical practitioner over the phone or via video chat. If necessary, users can request in-person appointments at one of Babylon Health’s clinics. As a functioning clinic, GP at Hand clinicians can prescribe medication, issue sick notes, and refer users to specialists.

At launch, the service was available to those who live in zones 1, 2 and 3 of London. The free NHS GP at Hand service offered on the Babylon Health app requires users to deregister from their existing GP surgery and register with GP at Hand. The app operates through the Hammersmith & Fulham clinical commissioning group (CCG), an NHS body for the London borough with the same name. It was reported that 7,000 people joined the service in its first month of operation.

When GP At Hand first launched, the service was not available to people with: complex mental health conditions; or complex physical, psychological and social needs; or dementia; or learning difficulties; or drug dependence. It was also unavailable to pregnant women, adults with a safeguarding need, older people with conditions related to frailty, and parents of children who are on the ‘child at risk’ protection register. In November 2018, following an NHS safety review, these restrictions were lifted. By January 2019 GP at Hand had established a Care Coordination Team to support people with very high needs such as the above.

Expansion History
In January 2018 Babylon had planned to open surgeries in both Birmingham and Manchester, but these plans were scaled back following recommendations by the NHSE Regional Directorate. In September 2018, however, Health Secretary Matt Hancock, called for GP at Hand to be made available across England. In February 2019, it was announced that the service would be extended to Birmingham. This was not welcomed by Richard Vautrey, the Chair or the British Medical Association, who called to wait until the independent evaluation into Babylon GP at Hand had been published. Babylon opened registrations for patients in Birmingham and Solihull on 19 June the same year for up to 2,600 registered patients. Launch was delayed by a month due to Hammersmith & Fulham CCG missing a deadline to upgrade its referral software. The cap was then removed in December 2019.

Current
Babylon's NHS services now covers 84,000 registered user-patients, making it England’s second-largest GP practice. The GP at Hand service accepts users that live within 40 minutes’ travel of one of Babylon’s seven London clinics (two of which are in Fulham, with the rest in the Westminster, Canary Wharf and Kings Cross areas) and, for users in Birmingham, registration is open to users who live within the Birmingham City Council, or Solihull Metropolitan Borough Council boundaries.

GP At Hand surgeries score broadly in-line with national averages in the GP Patient Survey :

An Ipsos Mori poll found that GP At Hand’s patients are generally younger (94% of patients are under 45 years old), live in more affluent areas (two-thirds), speak to their doctor more often, and are healthier than national averages. Whilst the NHS pays “six times more for treating an elderly female than a younger male”, the service has been criticised for ‘cherry picking’ users due to its user demographics.

Future Expansion
It has been reported that Babylon is currently in talks with a ‘significant number’ of hospital trusts in England regarding expansion plans.

Bupa
In June 2018, Babylon partnered with Bupa to provide unlimited access to its services to its corporate customers.

Wolverhampton NHS Trust Partnership
On 23 January 2020, Wolverhampton NHS Trust and Babylon announced a 10-year partnership to develop ‘digital-first integrated care’. The 300,000 patients in the NHS Trusts’ catchment area will access an app that combines their primary, secondary, and community care services in addition to Babylon’s standard app features. The service is due to be available by the end of 2020.

Rwanda
In September 2016, Babylon Health launched in Rwanda as ‘Babyl’ in partnership with the Bill and Melinda Gates Foundation. Rwanda was the first country outside of the UK to acquire Babylon Health’s services. Partnering with the government, they now serve over 30% of the adult population.

By May 2018, Babyl was reported to have 2 million members, covering roughly 30% of Rwanda’s adult population.

In January 2020, Babylon Health reported 1 million completed consultations in Rwanda. In March 2020, the company signed a 10-year partnership with the Rwandan government, agreeing to roll out Babyl to all Rwandans over the age of 12 through the government’s community-based health insurance scheme, Mutuelle_de_Sant%C3%A9. The new agreement also embeds Babylon’s AI technology within Rwanda’s healthcare system, as medical staff will be aided by Babylon’s AI-powered triage and symptom checker platform.

The Minister of Health in Rwanda, Dr. Daniel Ngamije, stated that the aim of the scheme was to “help stop self-diagnosis and self-medication which leads to longer-term complications... our medical professionals will be able to spend more time and resources on the most serious medical cases”.

USA
Babylon began building a team in North America in 2018, growing to 30 staff members by the end of that year. The size of this team more than doubled to 75 by the middle of 2019.

In August 2019, at the time of Babylon’s series C funding announcement, Babylon stated that the new investment would, amongst other uses, allow for international expansion into the U.S.

In January 2020, Babylon launched their service in the U.S. in partnership with Centene, one of the largest US Medicare insurance companies, through its brands Fidelis Care and Home State Health. Babylon also collaborated with Ascension, one of the largest private healthcare systems in the United States, on SymplCheck. Babylon’s partnerships in the US include organisations such as Bloomberg, BNP Paribas, HSBC, Shell, Buzzfeed, AON, Bill & Melinda Gates, and Prudential.

All of Babylon’s services in the USA are compliant with the Health Insurance Portability and Accountability Act.

In May 2020, Babylon Health announced a new partnership with Mount Sinai Health Partners, which would make the app and its healthcare services available to New Yorkers during the COVID-19 pandemic. New Yorkers are able to consult doctors from the New York Telemedicine Association. During the same period of time, Babylon became available in California, by partnering with Health Net of California Inc. and Health Net Life Insurance, who offer the Babylon services at no cost to their Health Net members.

Southeast Asia
In 2018, Babylon Health launched services in Singapore and Hong Kong, after signing an agreement with Prudential to release AI-powered digital health services in Asia estimated to be worth $100 million. According to the Business Times and Prudential, Babylon Health is the first AI-enabled health service offered by an insurer across Asia that enables users to assess their current and future health needs.

Healthcare services are available in the following countries following Babylon Health’s partnership with Prudential and the Pulse app: Vietnam, Thailand, Malaysia, Indonesia, the Philippines.

In April 2018 Babylon agreed to provide its artificial intelligence technology to Tencent’s WeChat in mainland China. However, in February 2020, Tencent announced that it is collaborating with Zhong Nanshan to set up a Big Data and AI Joint Lab. Tencent also self-developed its own AI Triage Assistant and open sourced the code to help fight COVID-19.

Saudi Arabia
In February 2018, after partnering with THIQAH, Babylon began providing services to the citizens of Saudi Arabia. Services are limited to its symptom checker and AI chatbot. This partnership marks the launch of AI health services in the country.

Canada
In September 2018, Babylon announced its partnership with the Canadian digital solutions company Telus Health. The app was released on 5th March 2019 and features the same services as the UK app including the symptom checker chatbot. Initially, only British Columbia users had the option of booking video appointments with a doctor.

In March 2020, concern was raised in regards to fair funding as family doctors were, during COVID-19, being paid $20 per call, whilst Babylon doctors received $38 per call under an Alternative Relationship Plan. This led, later that month, to Alberta Health issuing temporary billing codes, increasing family doctors pay to $38 per online consultation.

As of 30 July, 2020, video and audio doctor consultations are also available to users in Alberta, Ontario, and Saskatchewan.

AI research
Babylon Health has been active within the AI research community, with a concentration on natural language processing and knowledge graphs. Its research has been published in several peer-reviewed journals including:

1. In 2017, working with David Turban of Cambridge University, at the International Conference on Learning Representations introducing an ‘inverted softmax’ for identifying translation pairs when training bilingual word vectors and, in doing so, showing that the corresponding linear transformation between two spaces should be orthogonal.

2. In 2018:

a. at Ontology Matching 2018 (part of the International Semantic Web Conference) on building large medical knowledge graphs.

b. working with Dr. Renate Schmidt of the University of Manchester, at the 9th Workshop on Ontology Design and Patterns, on methods and metrics for knowledge base engineering and integration.

c. at the International Semantic Web Conference on (1) reasoning with textual queries, (2) utilising semantic web technologies to create linked data graphs for healthcare services , and (3) a novel approach and practical algorithm for ontology integration.

d. at the International Conference on Learning Representations on finding optimal representation spaces for unsupervised similarity tasks.

3. In 2019:

a. At the conference of the North American Chapter of the Association for Computational Linguistics: Human Language Technologies, on correlation coefficients and semantic textual similarity.

b. At the 36th International Conference on Machine Learning on the subject of model comparison for semantic grouping.

c. At the 7th International Conference on Learning Representations, proposing a novel fuzzy bag-of-words representation for text, DynaMax (an unsupervised and non-parametric similarity measure) and proposing that max-pooled word vectors should be computed via fuzzy Jaccard indexes.

d. At the European Semantic Web Conference on ontology-based interactive systems for understanding user queries. In particular, this covered ‘a framework for automatically building a small dialogue for the purpose of bridging the gap between user queries and a set of pre-defined (target) ontology concepts’.

4. In 2020:

a. At the thirty-fourth Association for the Advancement of Artificial Intelligence conference on artificial intelligence on the ability for embeddings to correctly encoder the similarity between medical terms.

b. At the European Semantic Web Conference, on on-the-fly knowledge extraction from large knowledge bases using hybrid reasoning.

c. In the Association for Computational Linguistics journal on estimating mutual information between dense word embeddings.

In June 2018, the company stated that its AI had the ability to diagnose health issues as well as a human doctor. This statement proved controversial, with the Royal College of Physicians making a formal statement that further trials were needed. In partnership with the Royal College of Physicians in the UK and Stanford Primary Care and Yale New Haven in the US, Babylon’s AI was tested on the publicly available questions in the MRCGP (Member of the Royal College of General Practitioners) exam. The AI achieved 81 percent; 9 points higher than the average passing score for UK medical students. Additional tests were run against seven primary care physicians and found that Babylon’s AI gave a safe triage answer 97 percent of the time. These results, again, proved controversial, with one paper in The Lancet questioning the methodology used, stating that it was not as rigorous as the real test. In early 2020, Dr David Watkins, a UK clinician unconnected to Babylon, manually ran 2,400 tests of the AI finding ‘fewer than 100 results which he considered concerning’. After investigation, Babylon upheld 20 of the concerns raised as errors, though noted that the 0.8% error rate was significantly lower than the average clinician error rate of 1-2%.

In September 2019, the algorithm led to a widespread discussion on the different ways that patients report symptoms after suggesting different diagnoses for the same symptoms depending on the gender of the user. The same symptoms were inputted under the guise of a female and male user. The symptom checker chatbot suggested that the female user’s symptoms were possibly caused by depression or a panic attack. The male user’s symptoms were also attributed to a potential panic attack, but gastritis and emergency heart problems were also given as a cause. Babylon Health’s AI and innovation director stated that the chatbot AI operates a “probabilistic model” that had found that “when people report symptoms or report information about their previous history... there are going to be differences in cases and in symptoms between men and women”.

Funding rounds
Babylon has raised a total of $635.3 million in funding over 3 rounds.

In January 2016, Babylon raised $25M in funding from its series A round led by Kinnevik AB at a valuation ‘in excess’ of $100M. Other investors included Hoxton Ventures, the founders of BXR Group, Richard Reed, Adam Balon, Jon Wright, Demis Hassabis, and Mustafa Suleyman. At the time, this was considered the highest raised funding for a digital health venture in Europe.

The series B funding round was led by Kinnevik AB and raised $60M in April 2017 at a valuation of around $200M. Vostok New Ventures, was said to have invested $22.2M in this round. Other notable investors included NNS holdings, existing backers Kinnevik and the Sawiris family.

Babylon’s latest, series C funding round occurred in August 2019 and was led by Saudi Arabia’s Public Investment Fund. It raised $550M. At the time it was rumored that the round was due to have a cap of $400M, making it oversubscribed. Notable investors include the ERGO Fund, Kinnevik, and Vostok New Ventures. The Series C funding round was said to be the largest ever fundraiser in the European or US digital health sector. It valued the company at $2 billion, making it one of less than 20 “unicorn” companies headquartered in the UK.

GP At Hand / NHS funding
The NHS funds Babylon’s GP At Hand service by an average of £96.68 per patient per year, totaling, in the last financial year, £3,087,816 minus deductions. This compares to a national average of £154.81 per GP patient per year. Babylon stated that this disparity is due to funding being based on the Carr-Hill formula, which takes into account age and gender of patients.

Due to its primary surgery’s location in Fulham, payments were originally made through Hammersmith and Fulham CCG, which has proved controversial due to the strain it places on the CCG’s finances. In 2019, funding rules were changed to allow neighbouring CCG’s to support the financial cost of this. A report by Ipsos MORI published in May 2019 concluded that the Global Sum Allocation Formula was not an appropriate way of funding the service because it “doesn’t take into account demand for services”, the higher rates of turnover, and the financial impact on the wider health system. In a further NHS policy change specifically aimed at digital-first primary care, announced in September 2019, large contracts are now due to be disaggregated in the financial year 2020/2021. This will lead to the cost being spread across 17 CCGs.

Current Inspection
The most recent Care Quality Commission inspection of Babylon Health took place in September 2019 and the subsequent report was published in December of that year. CQC found Babylon Health’s service to be “good” overall. All categories of the report were marked as “good”, except for the leadership category, which was awarded an “outstanding” rating. 5% of GP practices achieved this rating for the “well-led” category in 2019. CQC stated in their full report: “The leadership, governance, and culture [of Babylon Health] were used to drive and improve the delivery of high-quality person-centered care and treatment.”

Prior inspections
The CQC published the results of its July 2017 inspection in December 2017. They reported that Babylon Health was not providing safe and effective care because some GPs did not follow the company’s own policy around checking a patient’s identity and prescribed medication outside “of their licensed indications”. Babylon initially sought to block the publication of such results, stating that they ‘demonstrated a failure to understand what Babylon does’, though they were eventually published on 8th December 2017 after Babylon withdrew the legal complaint. In the CQC’s February 2019 inspection, the Commission found that Babylon "had addressed the issues identified at the last inspection".

Matthew Hancock
The UK Secretary of State for Health and Social Care, Matt Hancock has been criticized for appearing to specifically endorse Babylon Health & GP at Hand on a number of occasions. In November 2018, Hancock was featured in a promotional article sponsored by Babylon Health that appeared in the Evening Standard newspaper. The then Shadow Health Minister, Justin Madders, said that this was a breach of the ministerial code and called for an “urgent investigation” into his conduct.

Data breach in GP app
On the 9th of June 2020, a data breach occurred in which three UK patients were provided with access to recordings of other patients’ video consultations. Babylon Health stated the breach was live for 2 hours and was due to a software error. Prominent cyber-security professionals have commented positively on the speed and effectiveness with which Babylon dealt with the incident, branding it ‘the right way to handle a data breach’. Following the breach, however, a Digital Health New investigation found that a series of app testing logs were accessible through an unprotected Firebase database. Babylon Health’s Android app security score was 10/100, putting it in the ‘Critical’ category, according to the CVSS scoring.