Healthier Tech for Healthier Humans
We design human-centered digital products by bringing our strategic, creative, and technical expertise to every stage of the development cycle. With decades of experience across health technologies, we combine elegant patient experiences (PX) with the requirements of HIPAA compliance and secure architectures and integrations.

headquarters
other locations
Focus
Portfolio
XPRIZE Foundation, Blue Note Therapeutics, University of Oregon, Avant Assessment, Nulia, Ksana Health
Reviews
the project
Mobile App & Web App Dev for Mental Health Technology Firm
"They were collaborative, and their design work was outstanding."
the reviewer
the review
A Clutch analyst personally interviewed this client over the phone. Below is an edited transcript.
Introduce your business and what you do there?
I’m the CEO of Ksana Health, a mental health technology startup. We build software for both mental health research and mental health services.
What challenge were you trying to address with Twenty Ideas?
We needed help building the MVP of our web and mobile apps.
What was the scope of their involvement?
They did a thorough R&D process to extract our ideas and desires for the product. They then recommended specific programming languages and technologies for the problems we presented to them. After that, the team designed and developed our mobile and web apps and did backend engineering for data service.
The web and mobile apps were linked to our system. The mobile app enabled users, typically a patient, to share data with their practitioner. It also allowed practitioners to communicate with a patient between appointments. On the other hand, the web platform summarized data and activity occurring between practitioners and patients, which would be used for administrative purposes. The mobile app was available on iOS and Android.
What is the team composition?
We worked with the CEO and a team of web and mobile developers and UI/UX designers.
How did you come to work with Twenty Ideas?
We were located in the same area, and they had a positive reputation for providing high-quality services and a high level of technical expertise.
How much have you invested with them?
We spent $200,000.
What is the status of this engagement?
We worked together from September 2020–November 2021.
What evidence can you share that demonstrates the impact of the engagement?
We were quite satisfied with the overall engagement because Twenty Ideas helped us achieve two critical milestones, including helping us reach our fundraising goals and having an MVP that we’re now piloting with several clinical partners.
How did Twenty Ideas perform from a project management perspective?
Their project management was excellent. They communicated well through Slack, and they were very organized and transparent. We used Jira for tracking and other tasks, and we also had weekly meetings.
What did you find most impressive about them?
They were collaborative, and their design work was outstanding.
Are there any areas they could improve?
Their communication was not strong initially, but it improved over the course of the engagement.
Do you have any advice for potential customers?
Set up good communication protocols early on, especially ones that increase transparency.
the project
Mobile App Dev for Therapeutic Development Startup
“They’ve demonstrated their awareness of not only trends but also user preferences — they know what works.”
the reviewer
the review
A Clutch analyst personally interviewed this client over the phone. Below is an edited transcript.
Introduce your business and what you do there.
I’m the head of product of Blue Note Therapeutics, a startup focused on prescription digital therapeutic development for oncology patients. We specifically deal with the mental health and emotional challenges related to cancer, such as depression, anxiety, and distress.
What challenge were you trying to address with Twenty Ideas?
We needed help with design and development to add features to our MVP.
What was the scope of their involvement?
Twenty Ideas has helped us design a major product feature for our mobile app. Their service included UI/UX design and product analytics.
First, they mapped our business objectives and the product metrics to help us track if those objectives were being met. Then, they built the feature and connected the pieces in a product dashboard. They also redesigned the backend of the product with a new architectural design and implemented it.
What is the team composition?
We work with a project manager, 3–4 designers, and 2–3 developers.
How did you come to work with Twenty Ideas?
We connected to Twenty Ideas through a mutual partner. They had previous experience with healthcare and wellness mobile products, and we liked their design team’s creativity.
How much have you invested with them?
We’ve spent around $500,000.
What is the status of this engagement?
We started working together in June 2020, and the engagement is ongoing.
What evidence can you share that demonstrates the impact of the engagement?
Twenty Ideas’ designers have worked quickly to improve our existing app, and they’ve had good ideas. The design for the major feature was thoughtful, and they’ve demonstrated their awareness of not only trends but also user preferences — they know what works.
The technical team has been a good strategic partner, looking far beyond the scope of the project to our long-term needs and helping us make good choices.
How did Twenty Ideas perform from a project management standpoint?
Overall, Twenty Ideas’ team is solid regarding deliveries and timelines. They cover key topics and address any issues in our weekly meetings, and we have ad hoc meetings to solve additional problems as needed. We also have access to their Jira account.
What did you find most impressive about them?
A key differentiator of Twenty Ideas is that they’re more a strategic partner than just a development agency. They have strong design and development teams.
Are there any areas they could improve?
They’re more expensive compared to other options. However, those options might not deliver the same level of quality or strategic partnership.
Do you have any advice for potential customers?
The better you can articulate and define your company and product objectives, the more you’ll get out of the engagement.
the project
Custom Application Dev for Education Nonprofit
"It's rare to find development vendors with the ability to think strategically and critically."
the reviewer
the review
A Clutch analyst personally interviewed this client over the phone. Below is an edited transcript.
Introduce your business and what you do there.
At the time of working with Twenty Ideas, I was an executive director for education and equity work at the XPRIZE Foundation.
We were running a large-scale field trial that ended up being the largest adult education program for basic-level-and-below adults in the US, with 12,000 participants in three cities.
What challenge were you trying to address with Twenty Ideas?
The main problem we were trying to solve was around the trial we were running. We were trying to integrate eight different applications from other developers and build a platform for a difficult-to-reach population without a lot of experience with tech. We had to collect data, onboard people, and randomly assign the eight different interventions we were using in order to test which one worked best.
What was the scope of their involvement?
Twenty Ideas worked with us from the ideation of the problem and its solution to building out the platform and database. There were a lot of technical challenges around data collection and making sure that all the different apps were integrated into the same platform. We could figure out how to do it with paper and pencil, but we had to translate all of that into engineering problems and product development. Therefore, we submitted multiple technical challenges to them.
They used a number of technologies to develop a backend, an Android app, and a web interface. They also did the UI research and design. Essentially, they acted as an outside CTO and ended up becoming our tech partners for Adult Literacy XPRIZE. We used the SQL database they generated with the judges of the competition.
In the end, the consumer-facing product was an Android app, which acted as the front door for participants in the field trial to be onboarded. They would take a quiz for determining their level and whether or not they should be participants in the trial.
What is the team composition?
I worked closely with Mike (Founder & CEO), and we had other team members working with Twenty Ideas. There were 4–5 people from each side working on this project regularly, and it was pretty integrated.
How did you come to work with Twenty Ideas?
I met Mike at a conference. We had a panel on what we were doing, and he came up to ask what kind of help we needed. We had different organizations submit proposals, but Twenty Ideas got the best by far. They understood what we needed, and we felt the most comfortable working with them.
How much have you invested with them?
The total cost was over $300,000.
What is the status of this engagement?
We started talking about the project in July 2016, and Twenty Ideas started the work in October of that year. We worked with them for two years or more on that project.
The final deliverable for the field test portion was done in December 2018. The second phase overlapped a bit with the first, and it continued until October 2019 but it was a smaller amount of work.
What evidence can you share that demonstrates the impact of the engagement?
Without Twenty Ideas, it would’ve been impossible for us to pull off this $16 million project. They were a relatively small part in terms of total spend, but a massive part in our ability to execute.
With a lot of tech vendors, we could tell them what we needed and they’d build it, but they wouldn’t have been true partners. They would’ve built features without thinking through them, so there would’ve been a lack of integration and cohesion to the different parts. We needed partners who understood what we were trying to do and cared about it getting done.
We were able to depend on Twenty Ideas to think through those issues. They worked hard, bought into this, and solved our problems.
Furthermore, they did follow-on work on another part of the project and caught that one of our other vendors wasn’t doing something right. They were constantly scanning the data to see any inconsistencies in it. That’s the level of attention to detail and care that Twenty Ideas put into the work.
How did Twenty Ideas perform from a project management standpoint?
They were guests in our Slack, and we had a dedicated channel with them. My team used Asana or another project management software.
What did you find most impressive about them?
Their most impressive thing was how much they cared. Twenty Ideas literally felt like members of our team, and I think that’s a rare thing to find with a vendor. They put in extra hours even though we were paying them a monthly retainer, not an hourly rate. We had a certain number of allocated hours, but the team went over them.
Also, it’s rare to find development vendors with the ability to think strategically and critically. There are vendors that can take care of the strategy part, but they won’t do the implementation, or vice versa. Twenty Ideas understood the problem, thought strategically, came up with solutions that made sense, and involved us in that process. Even though that’s a standard best practice, it’s rare, and Twenty Ideas did it incredibly well.
Their third differentiator was that they could solve really difficult problems — the types that usually require an internal team.
Are there any areas they could improve?
There were times when we gave them a task like running a query on the data, and they jumped on it without asking enough questions about why. Those were things that weren’t part of their core competency, so both sides ran into frustrations.
Do you have any advice for future clients of theirs?
The number one thing is to treat Twenty Ideas as a thought partner. This isn’t often the case because a lot of vendors can’t do it and a lot of clients don’t want that. However, treating them as a thought partner will add value to both sides.
What we ended up building was definitely not what we had in mind in the beginning, and we wouldn’t have gotten there if we’d build it with any other vendor. We got that result because we came in with questions and were trying to do something that hadn’t been done before, so we needed someone to be a partner in the process.
the project
Custom Software Development for SaaS Company
"What sets them apart was the overall consultative and partnership approach."
the reviewer
the review
The client submitted this review online.
Please describe your company and your position there.
I am the founder and CEO of a SaaS-based company, collaborative project management software for the Event/Conference vertical.
For what projects/services did your company hire Twenty Ideas, and what were your goals?
I hired Twenty Ideas to help me think through the functionality of, provide the design for, and build the company's initial release, or it's MVP (Minimum Viable Product).
How did you select this vendor and what were the deciding factors?
I interviewed several development companies. Twenty Ideas was the clear winner for a number of reasons:
- Comfort with the management and team who would be on the project;
- comfort with their process and collaborative approach;
- appreciation of the intellectual rigor they brought to the project (they didn't just "paint by the numbers", they probed the uniqueness of this project); and
- appropriateness of price.
Describe the scope of work in detail, including the project steps, key deliverables, and technologies used.
After several discussions and interviews, we finalized a "scope of work" that included:
- development on an agreed upon tech stack;
- key design elements;
- key UI/UX requirements;
- etc. Twenty Ideas then built the platform to the specs of the scope and provided QA services to ensure product quality.
How many people from the vendor's team worked with you, and what were their positions?
There were several people on the core team. These included:
- Lead developer;
- more junior developer;
- UI/UX designer;
- QA lead;
- and Mike Biglan (CEO of Twenty Ideas) for high level strategy and problem solving.
Can you share any measurable outcomes of the project or general feedback about the deliverables?
The project was delivered largely on time and on budget. The quality of the code was excellent and has provided a very strong foundation for future growth.
Describe their project management style, including communication tools and timeliness.
GREAT project management style. They are consultative, knowledgeable, questioning, encouraging, probing, etc. They are intellectually curious. They LOVE to problem solve. Communication was easy and it occurred regularly.
They "owned up" to things they could do better and immediately moved to improve them. I would put them in the over-communicate camp. I never felt we didn't know what they were working on, when the deliverables would be handed over, etc. We had regularly scheduled sessions, but any additional communications needs were always quickly scheduled. Excellent job on deliverable timeliness.
What did you find most impressive or unique about this company?
What sets them apart is the overall consultative and partnership approach. "Partnership" was not just a phrase, it was the business approach. I felt like we were "in this together" (vs they were simply a vendor for a project). They listened well, responded, stood by their work, challenged me to guide them well, etc.
Are there any areas for improvement or something they could have done differently?
Overall I have very few criticisms. If I had to nitpick for the purpose of answering this question, I would look to improve communication/expectations as the company hit "peak capacity" periods. Like many development shops, they experienced periods that challenged their capacity. Making sure existing clients are aware of these windows and managing deliverable expectations during these peak periods is something the Twenty Ideas can continue to improve.
the project
UI/UX & Software Dev for Digital Productivity Platform
“Every member of their team is knowledgeable and personable.”
the reviewer
the review
A Clutch analyst personally interviewed this client over the phone. Below is an edited transcript.
Introduce your business and what you do there.
I am the CTO of a digital productivity platform. We provide a software solution to help organizations better utilize their Microsoft 365 subscription. Our solution tells them which programs they are using, which they should be using, and helps them develop digital skills using the Microsoft 365 technology.
What challenge were you trying to address with Twenty Ideas?
We faced challenges finding enough developers in our local region and were looking for outside help. Additionally, we didn’t have anyone in-house with UI/UX expertise.
What was the scope of their involvement?
Twenty Ideas provided development and UI/UX design services for a couple of projects. When we initially started development on our project, they place a long-term front-end developer on our staff. They served as a consultant for a little over a year. All of our front-end work is done in React, with a JavaScript and HTML back-end.
During that time, they also designed the UI/Ux of our application Their team was responsible for the look and feel of our solution. After our product was completed and launched, we worked with Twenty Ideas to make the application more accessible.
What is the team composition?
We worked with one front-end developer, three UI/UX designers, and a project manager. When we worked on the accessibility, we worked with two developers, a QA engineer, and a project manager.
How did you come to work with Twenty Ideas?
They are a local company, so we were familiar with them before working together. We like to use local resources when it’s appropriate, so they were a natural fit.
How much have you invested with them?
We have invested about $275,000 total.
What is the status of this engagement?
Our ongoing engagement with Twenty Ideas began in September 2018.
What evidence can you share that demonstrates the impact of the engagement?
The product makes both the owners of the company and our users happy, which I consider a success. We certainly reached our goals.
How did Twenty Ideas perform from a project management standpoint?
They’re pretty well organized in terms of project management. They have a dedicated project manager who coordinates with their team and schedules periodic check-ins with us. We provide them with regular feedback.
What did you find most impressive about them?
We really appreciated being able to see them in person, since we’re local. I was never dissatisfied with the team from Twenty Ideas. Every member of their team is knowledgeable and personable. They would ask questions, provide feedback, and make sure they understood what the requirements were.
Are there any areas they could improve?
I don’t have any real criticism. If they wanted to improve, they could grow their team to be able to support more projects. I would sometimes have to wait to meet with them because they have so many clients, which is a good problem for them to have.
Do you have any advice for potential customers?
The key is communication. Make sure to make your needs well known and to get feedback from whoever you work with. Twenty Ideas was very good at asking for more detail when it was necessary.
the project
Software Development & Support for Language Assessment Co
“They don’t just code away, they have an incredible vision and ability to connect with the client.”
the reviewer
the review
A Clutch analyst personally interviewed this client over the phone. Below is an edited transcript.
Introduce your business and what you do there.
I’m the VP of products and technology at Avant Assessment. We’re a language assessment company that delivers online language assessments to measure the proficiency of test-takers. In my role, I work closely with our engineering team on the technology stacks and products we deliver.
What challenge were you trying to address with Twenty Ideas?
We brought on Twenty Ideas to serve as our engineering team.
What was the scope of their involvement?
Our company’s software is all web-based custom delivery software. When Twenty Ideas came on, they took about 14 years' worth of different developers and different approaches and unified all of them into a single code base. That was a very big task. That project took about a year.
They supported our current testing as well as simultaneously worked on unifying the code base, while we were continuing to deliver our tests and business. Twenty Ideas set up our AWS server and now manages it. They also manage the day-to-day operation of the software, including all the bugs and support issues.
Their team supports our users in the field; Most of our users are K–16 institutions. When it came to networking issues that were blocking parts of our tests, Twenty Ideas stepped in as a network specialist that helped the schools and institutions troubleshoot their network and get things working.
Mike (CEO) took on the role of being our CTO for a number of years. He sat in on our management meetings and helped guide the direction of our future growth as it relates to our tech stacks and everything connected to it. In the last year and a half, we brought our engineering efforts in-house.
What is the team composition?
We started with Mike and Trevor (Director of Engineering) and it grew from there. At one point, we had 4–5 developers as well as a network and IT support specialist.
How did you come to work with Twenty Ideas?
Mike is very active in the IT networking groups in our local area, as is our CEO. They met on a number of occasions at these tech meetings and started talking. Our companies made a connection through those associations.
How much have you invested with them?
We’ve invested a couple of millions to date.
What is the status of this engagement?
Our ongoing engagement started in January 2016. We do contract work with them now.
What evidence can you share that demonstrates the impact of the engagement?
Having our systems with a 99% uptime says something about Twenty Ideas’ ability to manage all of the servers to ensure they’re successfully running. Our uptime statistics were incredible. We can give them direction then they work on it and produce an accepted product on a tight timeline. They’re very skilled and committed.
How did Twenty Ideas perform from a project management standpoint?
That was the one area we initially had to work on. Initially, Mike and Trevor served as project managers and that approach worked when it was just 2–3 team members. As soon as the engagement got larger, they brought in a project manager. That helped to communicate timelines and communicate flow.
What did you find most impressive about them?
Twenty Ideas has a good balance of approaches to technology that are very important today. They don’t just code away, they have an incredible vision and ability to connect with the client. They pull out the real vision, take it, and communicate it to the coders so it helps them develop the right thing. That’s the magic of Twenty Ideas — their ability to hear and respond to clients in a way that’s unique and powerful.
Are there any areas they could improve?
No, nothing comes to mind.
Do you have any advice for potential customers?
Bring Mike and his team into the early discussions of the vision, ideas, and concepts you have. Trust them with that vision and understanding so they pay attention to it in each of the steps they go through. Don’t just send them a list of specifications and screenshots, that won’t allow you to receive the greatest benefit of what they can bring.
Twenty Ideas successfully finished the client's project and allowed them to secure funding. In addition, the apps they developed were used for the company's pilot phase with various clinical partners. They were organized, transparent, and responsive, allowing them to establish a strong partnership.