Thriva CTO: Tom Livesey

Take us back for a bit. How did you get into health in the first place?

Let me paint the picture. It was 2015. Elizabeth Holmes was everywhere. Blood testing was all the rage. But we actually started just a bit before that blew up. My background isn't clinical. I was personally super interested in health. Back then, quantified health was the term everyone used. If you were tracking all this stuff and measuring ketones, it was a bit weird. The origin of why we started Thriva was one of my co-founders had a condition where he was testing every three months to monitor it, and the experience was really poor.

He had to take half a day off work, sit in a waiting room, and get a big needle in his arm. None of that is pleasant or fun, but you get on with it. The worst part was he didn't get his data. He'd hear, "No news is good news," but that's disempowering. No one cares more about your health than you. We wanted to change that. Remote diagnostics and blood testing were a thing, but blood testing is a blunt tool.

We wanted to prove we weren't crazy. No labs were doing this at the time. We worked with a well-known lab in London. We weren't trying to be a lab or develop testing hardware. We wanted to build a digital layer and user experience on top of accredited, tried, and true stuff. That's how we started proving we weren't crazy and that people would bleed into a tube at home, send it through the post, and get results to take action on.

Today, we focus on improving the amount of time people spend in good health, focusing on health span, not lifespan. We do this in three ways: data, insights, and support. You can't improve what you don't measure. We allow people to get the most accurate, reliable clinical-grade data about themselves regularly. We bring in other data sources, like wearable data, working with Terra API recently. Data is just data; you have to understand it and make it useful.

We provide personalized GP reports and use data tooling to help benchmark against people like you. Lastly, we support people in making changes that positively impact their health over time. We focus on feedback loops: get data, understand it, know what to do, take action, and see what happens. It's crazy how we know more about our cars than our bodies. We want to help people get data more regularly, understand it, and do something about it.

How did you create these first products? What did it look like?

We started by working with a lab and convinced them to handle the volume. It was quite scrappy. We rented a shed behind a huckle tree and packed the kits ourselves. We were in a coworking space, and everyone knew how well we were doing based on the sack we carried to the post office. Step one was proving we weren't crazy. Would people actually do this? Now, post-COVID, people are willing to do tests at home. It was scrappy and experimental, but great fun.

How did the product change over time?

We expanded the range of biomarkers available. Offering tests on Capillary samples required validation processes. We worked with labs to ensure accuracy and validity. Once we had too many tests to do in one go, we built recommendation engines to help people identify the most relevant tests. We realized this needed to be a subscription product. The value is in doing this over time. Blood testing is a blunt tool.

Historically, it confirmed hypotheses for clinicians. It wasn't built for understanding longitudinal changes. Reference ranges were based on outdated data. We worked with our clinical team to build proprietary optimal ranges based on evidence for all-cause mortality. Helping people understand where they should sit and what's optimal for them was important.

On the subscription bit, what's the optimal rate for subscriptions?

Personally, I'd do it every day if I wouldn't end up as a pin cushion, but we recommend every three months. Our customers test between three and six months, averaging every four months. Cost and operational factors drive this, but daily data would be useful. Sampling frequency is crucial. People think this stuff doesn't change often, but it does. You can influence these things, which is empowering. All the stuff we test can have a positive impact in a short time.

On the health insights bit, what have you found to be useful for people?

We test a lot of things. People often think about risk factors like diabetes and cardiovascular disease. People come to us at specific life stages, like turning 40 or after a parent's health scare. Understanding risk factors is important. Beyond that, insights that help you feel better today are valuable. It's not just about avoiding death in 40 years; it's about feeling better tomorrow. Vitamins and minerals, like vitamin D, are simple fixes.

Many of us are deficient, especially in winter. Improving supplement regimes and understanding exercise impacts are key. Risk factors are crucial for many people.

On the fundraising side, at what point did you fundraise? Was it difficult?

Fundraising was challenging. We started in 2015 and raised a pre-seed round before launching, which helped us get off the ground. Raising the next round and our series A was harder. Investors saw health as a big market but thought consumer was tough. There were barriers to entry, and the product wasn't cheap. We had to paint a picture of the future. We met a lot of people, got a lot of no's, but enough yeses to raise and be here today.

What's your piece of advice there?

It's contextual. If you have the luxury, choose someone you vibe with who aligns with your thesis. For many, it's a numbers game. Don't make trade-offs on who you work with. There are many investors. We learned to focus on the future, not today. Paint the big picture, especially when the market is nascent. Help investors understand the potential.

What's the situation of the company once COVID hit?

COVID was the fastest I have ever learned in my life. It was a terrible time for many, but amazing for what we were doing. We felt we could help with remote diagnostics. Through connections, we ended up in a Cobra meeting at Number 10. No one knew what to do, but testing was crucial. We were up against massive players for a nationwide testing program. We thought we wouldn't win, but we believed we could do it best.

We won the contract, and it took the business in a crazy direction. We went from a growing startup to doing 10,000 tests a day for COVID antibody testing. We built hardware and went through assurance quickly. We already had relationships and supply chains, so we weren't starting from zero. We ramped up quickly and had preferential distribution rights through the government.

At what timeframe is the B2B product coming into play?

We looked back at our first pitch deck and had a clear strategy: start with B2C to prove the concept, focus on UX, and then leverage a platform approach for partners. After COVID, we realized we solved problems others couldn't with end-to-end testing. We launched our B2B efforts, working with the NHS and Department of Health, as well as clinical research and trials.

Can you go into specifics on how you work with the NHS?

We integrate with their API and handle end-to-end diagnostics. One project is the health check for over-40s, which had poor uptake. Moving it remote is something we're powering. It's just launched as a pilot and will roll out soon. We work with the Department of Health on various research bodies, like VirusWatch with the ONS, monitoring post-COVID viruses. It's about seamless, easy, reliable diagnostics.

I know many who say selling to the NHS is impossible. What's your advice?

Don't do it. We got fortunate. We had forays into working with the NHS that we gave up on. Funding was a challenge, and the landscape is difficult. Navigating a big corporate is hard, but this is another level. Find key people and get a pilot live. Proof points and momentum are essential.

I remember seeing Thriva everywhere. What can we learn about customer acquisition from the B2C side?

Our growth and marketing team is incredible. Constant iteration is key. What works today might not work in a month. Early growth came from Facebook ads, but it's expensive. Building other channels, especially organic ones, is crucial. Focus on brand. It's a long-term investment. Brand is what people say about you in the pub. We did stunts, which were fun but not effective. We had a billboard with the smallest penis in the UK, saying there's nothing wrong with a small prick.

It didn't work for us but did for the agency. Don't put all your effort into one thing. Build systems and iterate quickly. Think about the message and who your best customers are. Don't just focus on acquisition; focus on long-term customers.

I've seen LabCorp or Quest launch their own API and consumer product. In five to 10 years, will labs go direct to consumers, or will companies like Thriva go full stack?

I think it will be the former. Labs see the consumer wave and want a piece of the pie. Running a lab is different from building a preventative digital healthcare product. Labs will try, but success remains to be seen. Strong partnerships or acquisitions are more likely. We've considered building or buying a lab, but it's a different focus. You need serious scale for it to make sense.

When I went from Finger Prick to Tasso, it was mind-blowing. I don't feel anything. Was there a meaningful change when you introduced this?

Yes. Originally, testing companies used a lancet for finger pricks. It wasn't super painful, but it put people off. Tasso is a mechanical leech that draws blood painlessly. We've worked with them since 2017, and the product just came to market. It's a big change. Our acquisition grew, and failure rates improved. People get a better experience with Tasso. It's easier for the customer. There's still room for improvement, and we work closely with Tasso to enhance the product.

How do you deal with logistical problems like temperature changes or postal delays?

It's a challenge. In tech, things are more controlled. In the physical world, anything can go wrong. We've experienced crazy issues. We build systems to control as much as possible and provide a great experience. We work on reducing issues, like using Tasso. We integrate with suppliers and build redundancy into the supply chain. Great customer support is crucial. We advise customers on when not to send samples. We consider the entire service design to ensure a smooth experience.

Since 2015, what changes have you seen in the industry? What do you see happening in the next 10 years?

A huge amount has changed, especially since COVID. There's more awareness and desire for understanding ourselves. Health products have improved, similar to FinTech. People engage with health proactively. Wearables and companies like Zoe show this hunger for understanding. In the next 10 years, I hope data will be taken to the next level. There's a lack of health data, especially longitudinal data. Thriver's data set is unique. The industry will do powerful things with data, leading to more personalization. Everything from prescriptions to health management will be tailored to individuals.

Medicine today is very generic. We're getting some level of personalization, but it's still largely based on biased data and studies. It ranges from what we should do daily to improve our health, like diet and exercise, to understanding how sleep impacts us. I hope in 10 years, we'll have a completely different landscape where everyone has a functional health coach in their pocket.

As a technologist, I can't avoid asking about AI. I spend a lot of time ingesting information from all grades of science. The real answer is no one knows what's going to happen. Experts have different opinions. Personally, my model of what I think will happen changes monthly. We've reached a stage where foundational models, especially large language models, are incredible. However, utility and products need to catch up, which will take time.

Many apps have just added a thin layer on top of a foundational model, but I haven't seen much that's truly valuable yet. We need products to catch up with the technology.

We haven't focused on genomic data because one of Thriva's core principles is that you can make a change. Your genes are your genes, and while some information is useful, much of it isn't actionable. We're focusing on things you can impact and change. However, there is value in combining data in interesting ways, but it's not our core focus.

Have you noticed a change in health consciousness? 

Yes, and it's been positive. Awareness is rising, and more people are getting involved. We don't want to be a luxury product; we want to help as many people as possible. Working with the NHS is exciting because it can save money for healthcare systems by preventing costly treatments down the line.

Home testing is challenging. Cartridge-based products are expensive and can't offer the breadth of tests needed. Our analyzers are state-of-the-art, and recreating that accuracy in a home device is a long way off. It's not a reality unless you're Elizabeth Holmes.

How do you make a product empowering rather than anxiety-inducing? We don't sugarcoat results. If something's bad, we'll tell you, but we emphasize prevention. It's important to engage early and not let anxiety deter you. We provide good advice and support, from automated advice to consultations with our clinical team. It's better to know and act than to find out too late.

We power Superdrug with end-to-end white label testing. We have an API for partners to request tests, manage the process, and provide white label kits and results interfaces. We work with pharmacies to accelerate testing solutions. Working with the NHS is complicated. Finding forward-thinking individuals willing to innovate is crucial. The NHS's 10-year plan emphasizes innovation and working with the private sector.

It's essential to get a pilot live, even if it's small, to make progress. We work with labs to ensure data consistency. We take raw data, structure it, and store it correctly. This ensures reliability and consistency, which is crucial for accurate results.

End-to-end means managing everything from ordering a test to delivering results. We handle logistics, from sending the right kits to scheduling nurse visits. Our logistics software ensures kits are linked to users, reducing errors and improving efficiency.

We provide a mix of lifestyle and medical advice. We recommend seeing a GP for urgent issues but offer lifestyle advice for everything else. Our advice ranges from general diet changes to specific recommendations based on data. We have health plans where users can track what they're doing and see how it affects their results. We want to make it easy for users to check in weekly without tracking every detail. This feedback helps us improve recommendations for others.

Thank you so much for having me. It's been a pleasure to share our journey and insights.