All cards on the table. In 2019 digital health did not fix healthcare. It's still clear that only a small part of the innovation healthcare needs is digital. Like any year, 2019 has had its peaks and troughs for digital health. Our take? We still have some way to go before we can claim that digital intervention has made healthcare substantially better - but we’re seeing progress. 

Looking back we saw some partnerships mature and flourish, others stumble and fall. We saw continued growth in the hive-mind understanding of digital health around some of the most promising use cases and regulators stepping up their game to facilitate change. There was also a growing presence of big tech moves (some more welcome than others) in addition to broadly increasing activity in mental health, digital therapeutics and social determinants of health. 

It’s important we pause and reflect on the 12 months of frenzied activity in order to step into 2020 well prepared - we want to hold that space for you. Here are some of our highlights from the year to set the scene before we share our perspective on the trends to come in January. 

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Digital Health Collaborations & Partnerships 2019

Health innovation doesn’t happen in a vacuum (not the first or last time we’ll say this). In the past 12 months we have seen partnerships and collaborations diversify and mature across the sector, and others come to a pointed end. 

Collaborations and Partnerships at HealthXL 

This year at HealthXL we expanded our own partnerships with other industry leaders to accelerate understanding and action. One collaboration that gained particular attention was the recent coming together of the Digital Medicine Society (DIME), the Digital Therapeutics Alliance (DTA) and NODE Health to contribute to increased understanding of the vocabulary in the health innovation environment. As an extension of this mission to foster understanding and collaboration to help industry leaders and innovators navigate towards true outcome improvements, we also brought together some of the foremost leaders across the globe to share musings, skepticism and learnings at 8 HealthXL gatherings in Shanghai, Melbourne, Dublin, New York, Tokyo and Florida. Our 4 quarterly research reports also would not have been possible without the contribution of our expert community! 

In 2019 we were also delighted to deepen our collaboration with current customers while also forging new partnerships including dermatology focused Almirall with CDO Francesca Wuttke at the helm and UCB, a bio-pharmaceutical company focused on immunology and neurology. 

HealthXL expanded our footprint geographically with the launch of partnerships with Medibank, Australia's second largest payor and Monash University’s Turner Institute for Brain and Mental Health, one of Australia’s largest Institutes for brain and mental health.

We initiated a number of strategic research projects for clients such as EIT Health, a consortium of over 140 partners from leading businesses, research institutions with a goal to contribute to increasing the competitiveness of European industry, and ConvaTec, an international medical products and technologies company offering products and services in the areas of wound and skin care, ostomy care, continence and critical care and infusion devices. 

Beyond health systems and pharma companies, we also started to work with agencies and consulting houses such as The Kinetix Group, ZS Associates and Evolution Road to support on their advising services around digital health in addition to deepening our work with startups bringing on Health Catalyst, Sleepscore Labs and Investors such as Livongo affiliates 7wire Ventures. 

Partnerships and Collaborations Further Afield

In the wider community numerous partners emerged that promised to tread new ground - some getting closer to delivering on expectations than others. 

DTX and Pharma: Sandoz and Pear Therapeutics’ relationship, which many enthusiastically lauded as a big deal for paving the way in an unprecedented space of DTx commercialization, came to a sudden halt. This U-turn of two of the first Software as a Medical Device (SaMD) approvals, reSET and reSET-O, gives us a reality check in terms of expectations and the multitude of variables at play in these previously unexplored partnership dynamics. 

In a more positive vein for DTx and Pharma, Sanofi and Happify announced their plan to submit their co-developed digital therapy to the FDA  for clearance as a medical device for MS patients. The good news is that people are taking mental and behavioural health aspects of disease more seriously and providing digital solutions that are better suited to managing the same. 

Biofourmis also recently announced that they will run trials with their pharma partner Novartis in the heart failure space. The acquisition of wearable Biovotion by Biofourmis also lends itself nicely to the testing and measurement of digital biomarkers in these trials. As an outcome, we can expect some much needed regulatory movements in the clinical trials and novel biomarkers avenue. 

The bottom line here? This is a marathon, not a sprint and while this particular partnership didn’t go to plan that’s not to say the DTx opportunity as a whole is degenerating - in fact 2019 DTx activity nods to the opposite as infrastructural partnerships develop (e.g. Express Scripts enabling clinicians to prescribe 15 vetted solutions including Propellor and Omada).

Big Tech Partnering for Data Access: There was recent uproar associated with Google’s partnership with US hospital network Ascension which provided the tech giant with access to millions of medical records unawares to patients and clinicians. This is a stark reminder of the gaping blind-spots still at play in digital health when it comes to privacy and regulation, the power and data hunger of big tech to get ahead of the curve, but also the growing focus that big tech is attributing to their place in healthcare e.g. Google’s acquisition of FitBit. After the activity this year from Big Tech, something tells us it’s just the beginning of the big tech foray into healthcare.  

A Maturing Market? End of the IPO Drought, Investments & Acquisitions

This year saw the so called ‘Digital Health IPO Drought’ come to an end with some big ticket public offerings including Livongo, Health Catalyst and Phreesia in addition to some pretty sizable acquisitions such as Google/FitBit, Biofourmis/Biovotion, American Well/Aligned Telehealth (again another move for mental health) and Amazon’s second digital health acquisition of Health Navigator.

Investments and acquisitions were also put into question in 2019: 

• Patients Like Me’s acquisition and incorporation into UnitedHealth Group's research arm, which is focused on health innovation and improvement, raising questions around data ownership and privacy 
• Proteus scaled back after their anticipated $100 million funding round fell through
• Sanofi’s step back from Onduo, its joint venture with Verily with hints of retrospective overinvestment

While investments, acquisitions and IPOSs are important we acknowledge the need for data insights beyond this. n 2019, we enabled our customers to stay abreast of these changes with a collation of added data points for true context to guide their strategic navigation. 

Some quick stats on how we approached this below: 

• 85,818 healthcare companies tracked on the HealthXL platform 
• We saw 9,396 partnership announcements between digital health companies and other players
• We tracked 8,316 product launches 
• Identified 204,123 digital health and health tech related research publications 

With these data points centralised we want to help the community develop a more nuanced view of what success actually looks like for a digital health company.  

Growing Evidence and Regulatory Moves 

The call for evidence in digital health is growing louder. As a sector we are starting to get to grips with the types of evidence (both clinical and economic) that we should expect based on different therapeutic areas, risk levels and presence of unmet need. 

When we evaluated the past 5 years of digital health related publications (RCTs, feasibility studies and beyond), we noticed a considerable rise in those focused on cardiometabolic disorders, musculoskeletal disorders and neurology. There appears to be a clear alignment with these conditions and the opportunity for technology to address rare conditions with few pharmacological treatment options, conditions with low understanding of patient symptoms and QoL at home. 

One of the most recent and most exciting additions to HealthXL aims to address the ever expanding place of research and evidence. To kick off this unique research feature, we have added validated company research to 1000 company profiles within each of the 23 hand-selected HealthXL Segments with our sights firmly set on mapping the digital health universe in 2020. From opportunities in Pharma R&D to disease management, we have enriched hand selected solution profiles with investment information, partnership insights and now evidence to help our customers understand what companies have the most validation (clinical, economic, or other). 

Within this data we noticed there was a doubling down on Digital Therapeutic related publications from solutions looking to excel in the market and firmly align themselves with the agreed definition of DTx including the following: 

• Akili -  A Videogame-Based Digital Therapeutic to Improve Processing Speed in People with Multiple Sclerosis: A Feasibility Study.
• Better Therapeutics - Estimating the Impact of Novel Digital Therapeutics in Type 2 Diabetes and Hypertension: Health Economic Analysis.

Working alongside the 2019 focus on evidence, global regulators and policy makers worked hard to reform systems and facilitate change:

• January 2019 kicked off with another Big Tech move with the FDA approval of Google’s Verily Study Watch to to monitor ECG
• Just this October Germany launched a regulatory overhaul aiming to be a European leader for digital health, encouraging payers and providers to leverage and recommend validated solutions with their Digital Health Act
• We also saw progress of the FDA pre-cert program with Pear’s digital insomnia therapeutic Somryst entering the process as the first software as a medical device product to be submitted through the regulator's pilot pathway.

So, what will the next decade of digital health hold? Proceed with Caution and Hope 

There are some interesting wheels in motion and great learning from both successes and failures that we have gained in the past 12-months. Watch this space for our January predictions of what this may mean for the key areas of activity in 2020. 

Thank you to all our members and subscribers worldwide - looking forward to working with you next year! We’ll continue to have our finger on the pulse of digital health going into the new decade and continue to respond with distilled insights via our data platform, events, blogs, podcast and research reports. Looking forward to seeing what 2020 has in store!