Digital health is up there in terms of the potential to transform healthcare as we know it. As one CEO of a digital health company said “when software enters an industry, in the early days people discredit it for child’s play - a toy or a game, but one day incumbents wake up and they can’t recognize their industry anymore and won’t know where to start”. We share this belief as do many of our colleagues in this burgeoning industry.
However, while product and service innovations in digital health have been plenty, impact at scale on patient outcomes, business outcomes, and population outcomes have yet to be realized and this makes us ponder - will this ever happen and when?
Finding a way to scale digital health solutions in critical, the industry needs it badly to keep the enthusiasm (and investment flowing). As we reflect on the digital health industry’s handful of successes and many failures, a few themes have stood out.
Be forewarned that this isn’t a big reveal. From our POV scale in digital health will require 5 key elements:
- Companies that tenaciously focus on delighting the end-user (patient/provider)
- Stakeholders that ensure value is created and shared with the ecosystem (patient, provider, payer, channel)
- Creativity in constructing a business model within existing payment structures and/or with novel models native in the SaaS industry
- Integration of solutions without friction into the healthcare ops/IT workflow and
- Agility in commercialization capabilities as much in SW development.
This may sound like common sense, but for some healthcare industry veterans, these concepts are farther afield than for someone in tech. We believe success will accrue to those digital health companies who can take these imperatives that are common sense and put them into common practice within their organizations and within the healthcare industry.
In July 2019, we gathered at The Royal Children's Hospital, Melbourne with a hand-selected group of the HealthXL community to discuss why the rest of the world should be looking at Australia for digital health.
Read on for the distilled insights from the day and the thought leaders who took part in the following conversations:
- Digital health commercialisation and the Australian opportunity
- Precision health: Predicting and preventing disease — not just treating it
Digital Health Commercialisation and the Australian Opportunity
The HealthXL Community prides itself on bringing together the most relevant and diverse expertise - this conversation was no exception with representatives including Australian clinicians, governmental organisations, pharma, tech companies, payers and foundations:
- Grace Lethlean (Group Lead), VP Program Design and Delivery @ ANDHealth
- Kwang Lim, Clinical Director Medicine and Aged Care @ Royal Melbourne Hospital
- Judith Ngai, Health Content Solutions Manager @ Bupa Australia
- Belinda Keefe, Senior Manager @ Medibank
- Angela Ryan, Chief Clinical Information Officer @ Australian Digital Health Agency
- Mark Buzza, Global Director of Biomedical Research Programs @ Movember Foundation
- Justin Braver, Senior Strategy Advisor @ Medibank
- Adam Wardell, Head of Business Development at Novartis, Australia & New Zealand @ Novartis
- Peter Kambouris, Director, Health And Biosecurity, CSIRO
As the group discussed Digital Health commercialisation, 3 key takeaways emerged:
- Defining customer and revenue streams early is essential for commercialisation success to be an option. Understanding how the money flows (and achieving mutual benefit for users, customers and payers)
- Solving a real clinical or social problem as well as a real financial problem is key. Being guided by the problem and co-designing solutions with this understanding front and center in close collaboration with key stakeholders sets the stage for success
- Being absolutely clear on the value propositions for both the user or users and the customer. They are likely to be different value propositions.
Beyond the above, there is also a point to be made around the ability of companies to be agile in their go-to-market approaches. Digital Health products, being software based, inherently are meant to evolve and improve with customer use. Designing effective pilots, learning and iteratively deploying the product is critical. Companies that embrace this and don't go with a heavily fixed product may be more likely to succeed in realising commercialisation success.
Additionally there is the matter of customer success and ongoing engagement. Digital health solutions are largely intended to be less transactional than drugs or medical devices. Ensuring customers use the product and realise benefits is key to continued engagement and value. What good is a diabetes disease management program if patients don't use it or doctors don't change their interventions based on this. Companies must invest and prioritise ongoing customer success across the B2B2C touch points - patient engagement, provider workflow and payer/hospital business process.
The Australian Advantage
During the conversation in Melbourne, Australia was regarded (unsurprisingly) as being advantageous for successful digital health commercialisation on a number of levels. Some of the main reasons Australia was regarded as an attractive opportunity for DH commercialisation included:
- Australia is an emerging digital health ecosystem with early successes on which to draw. Significant health system investment and emerging buy-in from key stakeholders further adds to its appeal.
- Trust in the Australian brand in the Asia-Pacific region
- Facilitation of DH collaboration (including. test beds, engaged clinician groups, Government, and industry programs)
- Ability to provide evidence of claims through world class research
- Universal healthcare lends itself to longer term and larger scale business models
Defining Success in DH Commercialisation
So how do we measure commercialisation success? The group saw one form of commercial success iIn cases where large incumbent organisations in health care buy and develop digital health solutions to bolster their pre-existing offerings the group saw one form of commercial success. Beyond this, the development of evidence of efficacy for a product should be held in high regard alongside consensus that evidence of commercial evidence must be gathered alongside clinical patient outcome metrics.
While the above points drew consensus, there was a healthy tension in the group between the commercial companies and not-for-profit organisations. Commercial representatives focused heavily on implementation and sustainable business success, while the non-for-profit representatives veered towards defining success as grant funded short-term implementation.
As with any digital health conversation, finding a shared vocabulary and defining an understanding of certain terms and concepts was crucial. Some of those debated included:
- Variety of commercialisation (success) definitions - solves a real problem; has an exit; has secured investment and has secured sustainable uptake; has turned research into practice; ; has implementation with widespread use and uptake; has experience with diverse payers outside health (eg. Life insurance).
- What is ‘good’ digital health? - good outcomes for patients; evidence to reduce investment risk and/or customer risk and/or implementation risk; delivering actionable insights; striking a balance between long and short term impact.
- Validation - business case evidence; clear end points; fit into clinical workflows; measure outcomes; solve a real problem and understand the real financial burden and who is bearing it (direct costs).
The group was in consensus that securing early seed funding could be a false marker of success and that implementation/uptake at scale was key. The group also agreed that this ideally was to be dependent on an evidence-based cost benefit assessment, and funding was also required to adequately address clinical evidence needs. After all, tools that improve patient outcomes are really the ultimate goal of digital health interventions.
Early Digital HealthSuccess Stories
The group had very different definitions of ‘success’ depending on their own organisations business models. The more commercial sector participants cited business success as well as patient impact as key criteria, while the Charities and other institutions expressed a strong interest in impact measures with followed by business sustainability and to a lesser extent profit. Two main examples of varied successes were discussed:
- Seer Medical – This was initially developed by a small group of clinicians at St Vincent's Hospital Melbourne who wanted to monitor epilepsy in the home. A real need was identified for home monitoring, and from there, the initiative successfully tapped into existing medicare reimbursement codes. As a result of this effort being rolled out it, there was a reported reduction in unnecessary use of in-hospital resources. The Seer epilepsy diagnostic service is Medicare bulk-billed meaning patients do not have any out-of-pocket expenses. In 18 months, the company has grown to 60+ employees.
- Movember Patient Support: Through interviews with newly diagnosed cancer patients the Movember Foundation team found that a major pain-point for patients was the quick transition from consulting with a neuro-oncologist, to transitioning into self-management and ambulatory environments. Based on this, Movember developed an app that provides support for these patients with a peer-to-peer model. While starting with patient need, evidence is obviously key, so this intervention is currently undergoing RCT.
To maintain trust in the digital health industry, regardless of your definition of success, it is important to have clear measurable end points and claims stated up front and then satisfy them. If we can be consistent in this, we will have a stronger industry.
Australia has a great ecosystem to navigate complex value chains. Money flow is key (understanding where and how the money flows in the healthcare system in order to build a sustainable solution) and ultimately we're aiming for a triple win - improve access to outcomes, users love using it, customers are happy to pay for it. This conversation brought up some great insights, however also raised outstanding questions including the question of where does solution trust sit in the measurement of success.
Precision health: Predicting and preventing disease — not just treating it
Through initiatives in precision health, it is hoped that we will be able to harness the availability of very large data sets and our ability to interpret and analysze that data to gain a more sophisticated understanding of the determinants of health and well-being, as well as specific risk factors and approaches for individual patients.
- Nathan O'Callaghan (Group lead), Precision Health Future Science Platform @ CSIRO
- James Dromey, COO @ MCRI
- Nirasha Parsotam, Head of Health Systems Strategy @ Bupa Australia
- Sanji Kanagalingam, Executive Director @ Curve Tomorrow
- Brandon Carp, Founder @ UHG
- Jackie McLeod, Executive Director EMR Project @ Parkville Hospitals
- Melissa Wake, Scientific Director, GenV @ MCRI
- Maureen Turner, CEO @ BioGrid
In Australia, it is acknowledged broadly that there is an ability to do high quality trials rapidly. The Australian health system is high performing and researchers are embedded within the means to prototype develop and test digital technology in a timely fashion and an ability for setting up the technology for scaling and contractual studies in global markets.
Given this context, CSIRO has invested in the Precision Health Future Science Platform. However, the organisations representations recognise the need to engage with partners and collaborators and in particular actively seek input across the Health Ecosystem with some challenge points:
- Can Digital Health deliver on the promise and premise of Preventative Health?
- Can we truly achieve Personalised Digital Health?
The Precision Health group at the Melbourne gathering took the approach of splitting the group into a debate style conversation with the affirmative highlighting the positive of how digital health can deliver truly personalised, preventive health and others highlighting why it may not deliver and why it hasn’t happened already. And while all participants appeared to be pragmatic optimists, there was a relatively long list ofn these goals that would be challenginga challenge to achieve.
For the discussion on the against the overarching message was “digital is tool and enabler for health, it will not solve all; and we can’t yet do the simple stuff, what makes us think we can do this!”
Further details from the against side of the group that came through in the discussion were:
- prevention is not a priority for most consumers and there are a dearth of incentives for consumers, clinicians and the health system
- how can we scale from personal to population level
- successful will likely only come when changes are legislative
- there is an accessibility challenge with equity already a challenge and digital intervention runs the risk of exacerbating the situation,
- there are many competing products adding to confusion and adding complexity to an already stretched system
- how do we assess quality, safety, efficacy in a crowded competitive area
On the positive side the group discussed again how digital is not the entire solution and highlighted the strong requirement of human touch and interaction. In Australia, there have been distributed care models that demand in place care and support, through data integration healthcare stakeholders such as CSIRO now have access to data they never had previously. CSIRO are using Big Data to reduce variation in care, reduce unnecessary costs, distance is no longer the barrier it has been, and are getting better at good ROI.
There are active discussions on how regulation, privacy and ethics will enable the move towards Digital Preventive Health solutions as digital natives start to engage with the Health system, expecting digital solutions. Finally, the group agreed to continue this discussion about what is required to enable this in Australia, and how healthcare in Australia can come together to ensure precision health reaches everybody.
Grace Lethlean @ AND Health
Nathan O'Callaghan @ CSIRO
Vijesh Unnikrishnan @ ZS associates