As we enter 2020, we take a look back at some notable digital health developments from 2019 and give our take on what we think you should be keeping an eye on this year.
Despite setbacks during the year, we predict that digital therapeutics will continue to be a central talking point within digital health, and that partnerships in this space will be on the rise.
The HealthXL market intelligence platform has identified over 130 partnerships within the digital therapeutics space. As we predicted last year, 2019 saw the formation of some significant partnerships including:
- Pear split from Sandoz and subsequent partnership with Ironwood Pharmaceuticals
- CVS, the PBM and retail giant in the USA, partnership with CBT digital therapeutic for insomnia, Sleepio (Big Health)
- Bioforumis acquisition of Biovotion and partnership with Novartis for heart failure
- Welldoc and Astellas partnership to commercialise BlueStar in East Asia
- Akili partnership with Shionogi for commercialisation, marketing, clinical development and regulatory filings in Japan and Taiwan
- Otsuka and Click Therapeutics partnership to develop a new digital therapeutic for depression
As one of the earliest, and most publicised partnerships, the industry was almost reliant on the Novartis/ Sandoz - Pear Therapeutics partnerships to pave the way for others, and publish the 'how to' guide on product development, establishing partnerships, commercializing their products. When it was announced in October of this year that Sandoz would no longer be continuing a commercial partnership with Pear, the industry was awash with uncertainty as to what this may mean for the digital therapeutics space. We were curious about how this may impact digital therapeutics companies’ attitudes to partnering with large pharma, and were happy to see that Pear continue to forge steps to commercialisation with the announcement of a partnership with Ironwood Pharmaceuticals to bring to market prescription digital therapeutics for gastrointestinal indications.
We predict that we will also continue to see money flowing into promising digital therapeutics companies, particularly in light of some notable FDA activity this year (Somryst and ReSET by Pear Therapeutics, Oleena by Voluntis etc). We are also excited to see the applications for digital therapeutics continue to expand across therapeutic areas, and see this being a driving factor for more investments in this space. For example, the announcement in August 2020 that AmblyoPlay is launching a new digital therapeutic for people with 'lazy eye'.
Beyond China - we predict increased investment in digital healthcare in Asia.
Last year we predicted a heightened focus on China as the next big digital health market. We hit the nail on the head on this one! Shortly after raising a $10 M Series A investment in August, the Carevoice launched the CarevoiceOS platform to allow its insurance client to optimise and further personalise their offerings. Last month, Tencent and Elsevier announced a strategic partnership to help share medical information with Chinese doctors. This year alone, the pharmaceutical giant Merck entered into partnerships with both Ping An, to develop an integrated care solution, and with Tencent to leverage digital platforms to promote health disease awareness as well as access to healthcare services amongst the Chinese population. Meanwhile, Huimei Health raised $30M Series C funding for the development of its new AI based clinical decision support (CDS), while the Ping An subsidiary Ping An Smart Healthcare trialed its CDSS AskBob in Singapore in a collaboration with SingHealth and the National University Health System (NUHS).
These developments signify the rapid democratisation of healthcare, which we believe will continue to spread far beyond China and impact North and Southeast Asia. The emergence of ‘healthcare at your fingertips’ model has spread across the region, evidenced in the large investments and commercial deals providers there have been closing. In Indonesia Alodokter recently raised $33M in a Series C round and HaloDoc landed the largest digital health investment of the year worth $100M. Singapore-based telehealth provider MyDoc recently partnered with Prudential, a large life insurance company in Hong-Kong, as well as with BoaViet Group Insurance, one of Vietnam’s largest insurers. WellDoc and Astellas announced a partnership to commercialise the the BlueStar Digital Therapeutic in Japan and further afield.
We predict that in 2020, we will see more digitally enabled clinical trials for cardiometabolic conditions.
Last year, we suggested that clinical trials would go virtual and that digital biomarkers would become the norm. However, as 2019 drew to a close, we saw that this was not yet a reality. In September 2019, we discussed the state of the nation for digitally enabled clinical trials at our Global Gathering in Dublin. From these discussions, we were inspired to create our next HealthXL report, which will explore the hype, the reality, and the next steps for Digitally Enabled Clinical Trial Optimization.
Digital health technologies may help contribute to multiple areas in pharma research, such as patient enrollment, data collection, novel digital endpoints, and more. However, when it comes to specific therapy areas that may be ripe for digital disruption, we believe that cardiometabolic conditions are the low hanging fruit for pharma at the moment. Firstly, there are already huge volumes of medical and consumer grade devices available within this space, as well as behavioural interventions, coaching apps, etc. Cardiometabolic conditions will likely see the quickest utilization of apps and wearables due to the presence of sensors and related technology which are well placed to evaluate those conditions. Secondly, the rise of cardiometabolic conditions is a growing concern in the US at this time, catalysing the exploration of different treatment and prevention options. We are already beginning to see pharma play in this space, with Novartis utilizing wearable sensors to track physical activity during waking and sleeping hours to determine the impact of Entresto vs Enalapril on disease treatment in the AWAKE-HF Study. We predict that in 2020 we will see increasing numbers of digitally enabled (use of wearables and sensors to collect patient data remotely, use of social media and other tools to recruit patients) clinical trials for cardiometabolic conditions.
We predict that non-traditional players will tackle the issue of SDoH in 2020.
No longer a healthcare fad, social determinants of health (SDoH) are here to stay, not least because they are the business of value-based care. While value-based purchasing models aren’t new either, we are only beginning to see ‘fee for performance’ being switched for more accountable care. With social determinants and environmental factors contributing to as much as 60% of variations in health status, more and more health systems and large health care organisations are beginning to invest in SDoH – 2019 had some real traction in this regard.
We have seen a number of different players across the entire healthcare ecosystem begin to tackle a variety of SDoH, and predict that this is just the beginning of this activity for non-traditional players in this space. For instance:
- The American Medical Association (AMA) and United Healthcare proposed a new set of 23 ICD-10 codes to standardise the collection of SDOH data in a clinically meaningful way.
- Earlier this year CVS Health and Aetna partnered to develop the technology platform Unite Us, which connects members to local care providers, as well as transportation and housing services within their community.
- On demand transport giant Lyft recently entered the healthcare space, providing patients with free or affordable transportation to non-emergency medical appointments to counteract the leading reason for no-shows at medical appointments – lack of access to transportation. In the summer of 2019, Lyft was approved as a non-emergency medical transportation service for Medicaid patients in Arizona.
Because at HealthXL we like to understand trends in depth, we dedicated our most recent Global Gathering (which took place in November in Lake Nona, Florida and which we organised in partnership with Guidewell) to the topics of next gen payers and value based care as well as social innovation for health – for a recap of the event check out our report.
We predict that in 2020, Germany and the UK will become go to models for real world applications of digital health.
Last year, we predicted that we would move beyond speculation over business models and reimbursement into actual application and generation of real world evidence for digital therapeutics - putting the tech into the hands of patients and physicians. I think it’s safe to say we got this one pretty spot on.
In June 2019, EMIS, a Leeds-based primary care software provider, announced a partnership with IQVIAs Appscript in which they will help EMIS populate their app library with the most validated and relevant digital tools to prescribe to patients. EMIS is the default EMR/ software provider for a majority of the GP practices in the NHS, and therefore, this substantially increases the number of doctors and ultimately patients who can access these apps.
We believe that the UK may soon become the go-to model for digital health companies to learn from, by first going through the NICE guidelines for validation and evidence generation, partnering with EMIS via Appscript, and generating real world data collection as an outcome. Another example is Discover-NOW by ICHP, one of the UKs seven national health data research hubs. A health data research hub for real world evidence, it brings together a collaboration of NHS organisations, industry, charities and academia, as well as patients, to help them make robust evidence-based decisions about healthcare and evaluate their interventions
Earlier this year, we also saw Germany introduce a new law which will facilitate the prescription of digital health apps by primary care physicians to their patients. After an app has proven that it meets the specified criteria, it will be provisionally reimbursed for one year by the statutory health insurance. During this time, the digital health company has to prove that the app improves patient care. If successful, the company will then negotiate a price going forward.
We suspect that other European countries will follow suit to make digital health solutions easier for doctors to prescribe, insurers to reimburse, and patients to access.
What do you think will be the talking points of digital health in 2020? We’d love to hear from you!