Pulse:Perspective – Clive Pinder, NED & Global Corporate Development In Digital Healthcare
Clive Pinder: Insights on Digital Health – A US Perspective
Clive sits on the Commercial Advisory Board of Ieso Digital Health and is a passionate advocate for the competitive advantage that can be realised by using digital technology to transform the delivery of healthcare. Over recent years he has both advised and invested in a number of businesses, including Imperative Health (sold to AXA), NW London NHS Trust, College of Contemporary Health, Bupa, AmericanWell, Healthwise and Healthbox. He is also involved in social enterprise projects in East Africa, which gives him a unique perspective on private and public healthcare eco-systems around the world. Clive was previously Managing Director of vielife, which he developed and sold to Cigna, Managing Partner at KPMG’s ‘Digital Business’ practice and Client Partner at Viant, which was recognized by Fortune Magazine as one of the ‘Best Managed Hi-Tech Companies’ in 1999. His work has also been recognised internationally by Time Magazine and the American Broadcasting Company and he has contributed to two best-selling books on the digital economy.
This month Clive gave Coulter:Pulse his analysis of the Digital Health market in the USA:
The key differences in healthcare in the USA are both the huge scale and complexity of the system and its nature typically as a free market. Significant opportunities and significant barriers present themselves as a consequence. By contrast in the UK socialised medicine represents the biggest buyer of healthcare and it is to a large degree a managed market. Nevertheless it is wrong to assume this means there is only one buyer. With the NHS divided into hundreds of CCGs and hospitals that buy individually, it’s not simply a case of selling a solution just once to one customer. Ultimately the end user is a living breathing human, whose physiology is the same whether American or English, and solutions should effectively be the same to this customer. But the way in which we reach that patient, the way healthcare is monetized and the business model that is adopted is what makes the difference. Key to any service is who is going to pay for it.
Another obvious difference that contributes to the complexity is legislation. Clinical compliance in the US is controlled by federal agencies in much the same way as in the UK we have NICE, but in the US medical boards vary state by state and the US is not a single market for the delivery of healthcare. A digital health platform like Ieso’s for instance, can be used by a clinician in a US state, but not in another state unless licenced there by that state’s medical board. Medical devices need to have FDA approval and HIPAA compliance sets the standard for protecting sensitive patient data. Regulatory bodies are aggressive in penalizing companies who do not comply.
Digital Health Innovation and Investment
The open nature of the US market drives more innovation than would be found in a system like the NHS which is not competing for customers. For payers or providers in the US competition for customers is typically fierce. And scale is an additional factor, with some 18% of GDP spent on healthcare in the US in contrast to 9% in the UK. Funding is much more sophisticated and readily available and the inherent advantage of market size attracts investors. The US is an excellent proof-of-concept or pressure test market. If you can make it in America you should be able to make it anywhere and bigger risks are taken for bigger rewards.
Investors in the US understand risk and are often seen as more entrepreneurial than counterparts in the UK who have built success traditionally in industry or manufacturing. A great deal of new money has been made in high risk new technology environments. The biggest funds these days are mainly found in the northeast corridor between New York and Boston, in the Silicon Valley and in big centres like Chicago, Atlanta, Nashville and Tennessee. More mature than the Life Science clusters that are growing in the UK, US regions have developed centres of medical excellence and healthcare ecosystems that have grown up around them. An example is around Minnesota, where the Mayo Clinic is based. My sense is that on the west coast VCs are more interested in massive consumer driven solutions and are more B2C oriented, whereas on the east coast investors are predominantly interested in clinical B2B (and then C) style businesses and the whole healthcare ecosystem.
Drivers in Digital Health
Digital technology allows us to tailor messaging and treatment to individuals rather than mass populations. Now that we can analyse DNA for instance, we know that people’s responses to drugs can vary depending on their DNA. There is evidence for example that statins don’t work for people with certain DNA structures . Within 20 years doctors will be able to check before prescribing any medication to patients and optimise it for their DNA.
While medicine is generally applied to cohorts and uses randomised control studies, the idea of tailoring care to an individual rather than to a cohort requires a fundamental shift in approach, both in how we treat and how we communicate with patients.
Because of social media and because we understand so much about an individual’s behaviour we can now reach people with a particular medical condition much more easily than we could 15 years ago. Even for obscure diseases there are likely to be user groups and the more data we can collect, the more we know about these communities and the more easily we can leverage what is sometimes termed “the long tail” to start segmenting people into communities and target them more easily . People may then also seek support from communities or individuals facing the same conditions in order to “self-care”.
Diagnosis is based on pattern learning and recognition, an area where machines excel. Machine learning and artificial intelligence provide the way forward to improve productivity and outcomes, but educating medical professionals on the benefits is a major challenge and a significant barrier to innovation. While technology is developing in quantum leaps, doctors’ education is going through slow cycles of innovation. Of course there will be cases where the old “poke and prescribe” model is still required, where a doctor can’t diagnose without seeing the patient. But in many geographies with booming populations poorly served by low numbers of healthcare professionals such a model is just not practical in this day and age. Digital health solutions like Ieso’s are paving the way for significant advances in treatment – people with mild to moderate anxiety or depression may be treated by therabots , overseen by real-time clinical supervision, within the next five years.
Progressive GPs do not see such developments as a threat. Many recognise that 60% of those who come into their surgery don’t need to be seen by them. They could either self-diagnose, be seen by a practice nurse or indeed by a pharmacist. The concept of allowing technology to triage people to increase productivity is now gradually finding favour.
Technology can enable system integration too and avoid the duplicated form filling that has traditionally prevailed at every point of care. American Well, a large US telehealth provider now connects people instantly with doctors over secure video and provides immediate urgent care web visits for patients in 46 states. Integrated systems enable patients to be swiftly referred to a relevant specialist on the spot by the primary care physician . Allowing ‘on demand’ collaborative care and bringing specialists together in real time obviates the need for patients to schedule a follow-on visit or travel to another health centre and would deliver significant potential improvements in productivity and customer satisfaction.
We are now moving towards remote care and “on demand” care, all enabling patient empowerment. Patients live in an on-demand world and expect to access healthcare in the middle of the night just as they can book a holiday or transfer funds in the middle of the night. Diabetics these days are able to self-manage and self-medicate, supported by real-time monitoring. I can see a time when everyone will be self-monitoring via a subcutaneous device or taking a daily pill that helps them closely monitor their own health.
Talent and Digital Health skills
In the US doctors have always also been business people and it’s the norm to find clinicians who are commercially more competent than in the UK. The new CEO of Ieso, Dan Clark, is a clinician by background but also a businessman. Ultimately if you’re in the healthcare business clinical quality is everything and it is critical to be able to tick the box of clinical efficacy. Clinicians with business skills are therefore in great demand. Healthcare is perhaps one of the biggest challenges facing humanity today and while we’ve used technology to dramatically improve every other major aspect of our lives (transport, banking, shopping) there is still a sometimes Luddite approach in healthcare. The best way to drive economic efficiencies and improve clinical outcomes is to optimise demand and control supply, and technology is a proven means to this end.
My advice to IESO has been that to scale and grow rapidly they need to be in the US market. And with globalisation, technology is now revolutionising healthcare in many of the developing areas of the world, in India, Africa and China. Just as banking in East Africa has been transformed by mobile fund transfer applications such as M-PESA, healthcare too is seeing significant advances. Primary healthcare providers are looking to technology in these parts of the world; Babylon Health’s project in Rwanda for instance enables users to have virtual consultations with doctors and health care professionals via text and video messaging through its mobile application. The service will ultimately allow users to receive drug prescriptions, referrals to health specialists, and book health exams with nearby facilities. We are seeing technology slowly taking over much of the mundane work that doctors used to do, despite resistance from some who see it as a threat and a disruptor of their traditional modus operandi. In the US they refer to this as ‘enabling clinicians to manage to the top of their licence’. Finally I believe that Consumer empowerment will be key for the future of healthcare worldwide. Technology can enable consumers to take greater control of their own healthcare in a safe and more economically efficient model, and clinicians to provide more personalized and automated care.