An active industrial physician started a business. After a crisis of bankruptcy, it became a fast-growing startup. Mr. Youta Yamada of iCARE, tackles workers' health issues

It has been a long time since health management attracted attention. After the corona disaster, companies are becoming more aware of their employees' health. However, many companies want to implement health management initiatives but find it challenging to handle employees' health data in various formats or lack the knowledge and expertise in health and medical care.

In this interview, I spoke with iCARE Co., Ltd., a company developing and providing Carely, a health management cloud and consulting service for occupational health professionals that can solve such problems. We interviewed  Mr. Yota Yamada, the founder and CEO of iCARE, who founded the company while working as an industrial physician, to learn more about the history of iCARE, the inspiration behind the service, and episodes of fundraising.

In medical school, I learned that everything would come full circle if you did the right thing.

First, could you give us an overview of iCARE's business operations?

 We develop and provide Carely, a health management system for companies.

Until now, corporate HR personnel and labor managers in companies have been storing employee health information, such as health checkups and stress checks, in a disorganized manner and spend an enormous number of man-hours to organize the information. In addition, the inability to grasp the health status of the entire company meant that issues could not be formulated, and information could not be utilized to implement and promote health management measures.

Carely is a cloud service that can solve such problems. In addition to centrally managing employee health information online, Carely also provides health data analysis by experts and consulting services to promote health management, enabling companies to implement their health policies properly.

According to the issues of each company, it is possible to establish an online consultation service with experts that does not involve the human resources department and to follow up with employees appropriately with consideration for personal information.

I would also like to ask about the inspiration for Carely. However, I think it would be better to first ask about your career and experience as an active industrial physician.

Yes, I agree. My decision to start a company with the theme "health of working people" deeply relates to my experience after becoming a physician. Perhaps, it may be easier to convey the story of how I started my company if I start talking about my career.

Mr. Yamada, could you tell us about your medical school days? I heard that you graduated from Kanazawa University School of Medicine. What were your medical student years like?

At that time, I was in the minority among medical students,  but I was a student who always imagined that I would be a medical resident in the future. I always studied what I could do to be helpful there.

Many medical school students at the time didn't study, even though they were university students, saying, "I can only have fun now". I did not like that. After becoming a resident, there was no help from the seniors or classmates in the field. I was afraid I might cause an accident at the site if I played around during my undergraduate years.

So, while looking at the students who were having fun, I didn't want to be complacent but devoted myself to studying with an eye toward practical application in the medical field. Then, in my third year, two or three students who were the type who wanted to study like me got together and started a study group.

It's impressive that you voluntarily set up a study group.

In that group, senior students were teaching the junior students in a way that would be useful in the field. At first, people looked at us and criticized saying, "he's just studying", but as the school year progressed, the number of participants gradually increased, and before we knew it, there were nearly 200 students in the group.

​At that time, I realized that even if we were in the minority in what we thought was the right thing to do, we found friends and kept at it, and the circle would expand into something "natural". This experience may have been the original experience that led me to choose entrepreneurship.

The Importance of "Management" Seen in the Medical Field on a Remote Island

What was your career like after graduating from university and becoming a resident physician?

It was a career in which I repeatedly learned from my mistakes and found my next course.

As a resident, I was assigned to Okinawa Prefectural Chubu Hospital, one of the top-level training hospitals in Japan, where I had to be on duty once every three days. It was a harsh working environment.

On the other hand, I approached the management to improve the system of the harsh working environment, which led me to move to a hospital on a remote island.

I was young then and had no idea what the management was doing. So, in the end, the hospital's management did not listen to me. And I decided to change my training to Kumejima Public Hospital in Okinawa Prefecture, where a position was available.

Kumejima is an island away from the main island of Okinawa, correct? What kind of training period was it?

It was a period during which I was able to develop my overall skills as a physician. There are few physicians on remote islands, so I had to deal with patients as a physician regardless of the title of a resident physician.​

However, while working like that, one day, I learned that the hospital management was not doing well. I wondered why the management was not doing well despite the on-site physicians working hard. So, to improve the management of Kumejima Hospital, I took various actions, such as establishing a system to accept more terminally ill patients and trying to improve the recruitment of nurses, which was not being done.

But in the end, most of my efforts failed. I still needed to acquire solid management knowledge to think about sustainable hospital management. With that in mind, I began attending Keio University Business School to obtain an MBA.

Issues related to workers and health that I saw through my part-time job at a psychosomatic medicine clinic

Getting an MBA while working as a doctor must have been quite challenging.

Studying at business school alone was so demanding that I had to cut back on sleep, so I quit being a doctor for the first year and focused on my studies. From my second year onwards, I had more time, so I started working part-time at a clinic with internal medicine, my specialty, and psychosomatic medicine, which I was interested in.

How did you become interested in psychosomatic medicine?

As an internist, I had the experience of examining many patients with mental disorders. Mental disorders cause physical symptoms such as headaches, dizziness, and heart palpitations, and many people initially visit an internal medicine physician because they are concerned about such symptoms.

However, since there is no problem regarding internal medicine, we would have them go to psychiatry or psychosomatic medicine; for some reason, many of them suffered from symptoms that did not improve. I wanted to know how such a situation could arise, so I began to look into psychosomatic medicine.

When I worked at a psychosomatic medicine clinic, I noticed the large number of working adults who came to the clinic with depression and insomnia. As I tried to understand why working people are prone to mental illness, the existence of industrial physicians came to the forefront. The question arose once again as to why the health of the people working at companies was not maintained despite the presence of an industrial physician.

​When I became an occupational physician, I could see the situation surrounding workers' health from a completely different perspective than when I had worked in a psychosomatic medicine clinic.​

So, what was the situation like?

There was a situation where individual values and organizational theory did not mesh, and the employees were working in a situation where they had to put up with a lot of things.

A company needs rules and restrictions to run organizations well. Even with these restrictions, I felt that it was necessary to think about how each individual could work in their way and still be enthusiastic about it. To create a world where working people can work happily and in good health, creating a system as a group is essential. This realization led to the founding of iCARE and our current business.

I see. So, your experience in a psychosomatic medicine clinic led to the founding of iCARE?

That's right. The work that we spend most of our lives doing is not being made meaningful due to our environment, and it can make people unhappy. These challenges are occurring not only in Japan but also globally. I started iCARE because I felt it was my life's mission to tackle this significant challenge.

The first service did not sell and was on the verge of bankruptcy. A pivot and a return to the basics led to the birth of Carely.

Did you have the idea for Carely from the beginning?

We had arrived at almost the same idea. Despite many twists and turns, in the third year since our founding, we released a service called Catchball, which allows for the collective management of employee health information in a form similar to an electronic medical record. However, Catchball did not resonate with HR personnel and management, and only one company purchased the service in six months. We were even on the verge of bankruptcy.

Looking back at Catchball's failure, I believe that one of the reasons was that we were too early to launch the service in the current trend. At that time, "health management" was barely recognized, stress checks were not mandatory, and work style reforms had not yet begun.

When the situation continued to be unsustainable, and we lost sight of what we were developing the service for, we pivoted our business.

What kind of project did you establish next?

It was a health consultation service using chat. At the time, chat-based services were popular among B-to-B businesses, so I thought that by applying this system, we could create a health consultation service that could be easily used by people working at small and medium-sized companies.

We successfully raised funds based on this service, and for a while, I was working on a chat health consultation service.

Could you tell us how you arrived at Carely from there?

The health consultation business was targeted at small and medium-sized enterprises. However, after two to three years of operation, I began to feel that there were limits to the expansion of the business. Then I looked around at the global market and realized the times were changing. I decided to go back to the basics, thinking that now that the companies were becoming more conscious of health, the Catchball system might be a service that could be adapted to their needs. The result was Carely, an enterprise health management cloud service released in March 2016.

What do you think was crucial in getting Carely off the ground?

I think there were two points. First, unlike Catchball, Carely was designed to meet the needs of large enterprises. The second is that we simplified our business model. In particular, chat health consultation was a B-2-B-2-E model, so while employees may have appreciated the service, it was difficult for the company's management to perceive the service's merits. However, Carely is a B-to-B service, and it went out to solve the "difficult employee health management" pain point on the company side. As a result, the business began to grow rapidly.

First fundraising, meeting a reassuring and earnest partner

iCARE is currently in Series E; isn't that correct? How has your fundraising been so far?

We welcomed Mr. Keisuke Wada of Incubate Fund as our first investor in 2015, and I feel that it was an excellent opportunity to meet Mr. Wada, with whom we share the joy of iCARE's success.

Why did you choose Mr. Wada as your first investor?

It was because I realized that he genuinely wanted to support us, which may have been influenced by his personal experience with the crisis awareness of workers' health. We met with about 20 to 30 investors when we started raising funds. All of them were interested in iCARE's business and listened intently, but Mr. Wada's interest and enthusiasm for iCARE were outstanding among them.

Mr. Wada conveyed his seriousness about investing in us in various ways, such as allowing us to meet the managers of the companies he had invested in and learning about us and our industry. Seeing that, I decided to ask him to invest in us.

About eight years later, Mr. Wada still supports us as a team member. We never miss our weekly one-hour meetings. When we are lazy, he scolds us, and when we are depressed, he cheers us up, saying, "It's okay". He is genuinely a reassuring business partner.

"Group mentality" is not a good idea. What are the values that are important to you to realize your mission?

Could you tell us about iCARE's company culture?

iCARE's corporate culture is described as Purpose, Credo, and Value.

We have members who share our purpose of "creating health for working people all over the world", and we also value our Credo, "You are not a professional if you do not enjoy it", and our Value, "You are not a professional if you are satisfied!". Of course, it's work, so there will be times that aren't fun. But I think it depends on how you perceive it. We want to work with people who can enjoy themselves by making everything their own.

What kind of people are active at iCARE?

Our members are all incredibly kind, but I think the most active  among them are those who can extend a helping hand when someone is in trouble.​

I also get the impression that people who are overwhelmingly opinionated and have input daily are active. To put it a little more bluntly, they input information not because it's necessary for work but because they enjoy doing so. Even if most knowledge is useless at work, they can use it to help their colleagues or in other situations. In the end, I think that people who match our Credo are the ones who are active.

On the other hand, those who prefer "clique" behavior may not be suitable for our company. I believe that creating cliques is the worst thing you can do from an organizational standpoint.

Why is that?

This is because startups like ours have to produce results as a whole team, but we start doing partial optimization. As a result of cliques, it is easy to think that we are the only ones who should be achieving results. I don't think this will help the business or the company grow.

I think this way of thinking was greatly influenced by my childhood when I lived in different places due to my father's work and also because I lived in the U.S. for a time. I could never get used to Japan's exclusive group theory.   I believe that the ideal is for individuals to be independent and team up with respect for each other.​

Could you tell us about iCARE's future goals and prospects?

There are two main goals for the future.  The first is to realize our purpose of "creating health for working people worldwide". Workers' health problems are occurring globally, so I want to contribute in some way to address them.

​The second is to "create social health".  In addition to physical and mental health, social health includes a sense of fulfillment and purpose in life. We hope to support companies in spreading such social health throughout the world. I want to increase the number of places where people can work enthusiastically and where individuals can work in a way that can be recognized and respected.

It's tough, but I think I would start a company even if I had to start my life over.

Could you give us a message of support to startups in the pre-seed stage to the seed stage?

I would like you to believe in what you are working on with your hypothesis and push through it.

As with me, the pre-seed/seed period is inevitably accompanied by anxiety. However, if you give in to that anxiety and give up on the business halfway through, I'm sure you'll regret it. It's a strange thing about people; they have no regrets when they are truly committed to something. In such a case, they will be satisfied and move forward even if they fail.

I think most startup managers start their businesses because they want to solve some social problem. If things don't go well now, it may be that, like us, the services we developed were ahead of their time. I urge you to believe in what you aim for and face the challenges ahead.

Nonetheless, even though I say this, there are many situations where I, too, find it challenging. I often feel as if I want to declare loudly, "If I were to start my life over again, I certainly wouldn't choose to start a business!" (laugh)

But, maybe, even if I redo my life, I will probably find some challenges and start a business again. If I find a challenge I can make into something so personal that I can't stay put, I will spend my life trying to solve it. I don't think that's a bad way to live.

After listening to the story, I felt that the axis of Mr. Yamada's life is "doing the right thing". However, it is challenging to do the right thing as a business.

As you say, doing the right thing as a business is challenging. Especially in the health field, the importance of health is unshakable, so everyone is 100% in favor of doing it. But whether they pay for it is another matter. A successful business requires a different perspective.

What I value in this business is how we can integrate professional and future-oriented correctness without imposing our values on the world. Often, specialists like doctors are driven by the need for correctness, but human beings are not that simple.

For example, if you, the reader, had diabetes, how would you feel if your physician monitored your blood sugar level 24 hours a day, restricted your eating, and forced you to exercise to improve your condition? I would hate it, and taking such thorough action is impossible.

It's human nature to prioritize feelings of wanting to be lazy and annoyed over what is right. That's why people won't use our services unless it's a service created after acknowledging that.
The same goes for our business. Health is important, but we will not impose it on the world. Correctness does not come first.

Finally, please give a few words to our readers.

When changing jobs to a startup, I think joining the company out of mutual love is important rather than "just shoot and hit". Do you strongly support the business and vision? And whether you want to take on the challenge of major social issues with that company. Startups are never stable, so you must identify this.

If you enjoy taking on new challenges in a life-or-death environment, I want you to try knocking on the door of a startup that you feel is the right company for you.