Coulter Partners talked recently to Tamir Strauss, Head of Customer Solutions at Huma about digital disruption and talent in healthcare.
Coulter Partners: Given Huma is at the crossover of healthcare and technology, do you see yourself as a tech business or a healthcare business?
Tamir Strauss: We are straddling the divide between traditional healthcare and technology and on the commercial side, we’re learning and gaining experience in how to monetise these new solutions. We work together with our partners to extract the utmost value from our shared assets. Many companies focus, by contrast, on a very specific disease or condition such as diabetes and create an end-to-end vertical solution. We are more an enabler for an ecosystem of solutions, which is our main differentiator as a Digital Health provider. Biomarkers are a sweet spot where others are also involved, but our goal is to combine traditional Life Science approaches with technological methodologies and create a new category of solution suites that will accelerate progress. We want to help people from all ends of the spectrum to understand the technology better and engage with it much more easily.
We have a strong technology focus, but as we mature and grow, our strategy is also evolving and we’re now marketing a suite of services and capabilities to offer partners and customers. These have a technological basis but are not necessarily traditional technology solutions. After eight years of operating in this space, our sophisticated access to data has been built on extensive networks with key opinion leaders, enabling us to accelerate its analysis. We can also bring value and experience on regulatory issues. Unlike a traditional Life Sciences regulatory team, ours is much more focused on the world of software as a medical device and all the aspects associated with the new wave of solutions that are coming into healthcare.
Similarly, we have gained experience in clinical trials and clinical validation on the software side. This dovetails into our evolving emphasis on digital biomarkers, a combination of data points usually collected through a mobile phone, a wearable device or other sensor. Through machine learning or more traditional algorithms these can be correlated to specific health outcomes including screening, diagnosis, prognosis and what would be the holy grail, prediction.
Our modular software allows one app to cater to many health conditions, collecting data points relating to those conditions and presenting these to care teams and life science companies. In addition, we offer access to integrated medical devices – a mobile device can for instance be connected to blood pressure cuffs and so on. An area we can also bring value to customers is through our global reach across 3 continents.
CP: With all these vertical solutions, would you say digital health is a very fragmented landscape then?
Tamir: Yes, I think the size of the healthcare industry dictates that it’s highly fragmented and it’s difficult to encompass the whole end-to-end world of healthcare. Vertical solutions tend to be hard to monetise at scale, however, and one can become a small part of a very big value chain. By taking a broader approach in biomarkers and the therapeutics associated with them, we will be able to solve much bigger problems not specific to a condition but specific to use cases. We believe that we can then offer users, patients, healthcare providers, governments and Life Science companies a great deal of valuable information. Population screening for instance, would be incredibly valuable for almost any condition. Our strategy is to combine the fragmented solutions into a cohesive one.
Major Life Science companies like GSK and Roche are also putting more and more resource in this area, where they can leverage the power of massive computing capabilities that new devices are providing. The ability to analyse huge datasets through machine learning and other approaches to gain insights and ideally predictions on health conditions would help fundamentally change how healthcare operates, reducing costs, increasing efficiencies and providing a more user-friendly way of addressing many unmet needs.
CP: So what are your biggest challenges to growth right now?
Tamir: The first challenge that’s common to any start up or scale up I’ve ever been involved with, is hiring. It’s very hard to find the right people to grow rapidly, especially in the current landscape in London, where there are so many tech players and not just healthcare related. Start-up unicorns are becoming the norm! When trying to hire developers, product people or designers, we’re competing with tech giants that typically have huge resources at their disposal. The traditional laws of supply and demand mean that salaries are inevitably rising.
The other more unique challenge is that we’re operating in an industry that is very conservative and traditional. Everyone understands that the future for healthcare means deploying technology and software to increase efficiencies in ways that are scalable and cost effective. They understand this intellectually, but there’s still a good deal of resistance and inertia. Education is now key to getting everyone on board and buying into this vision for the future. We need to take them along this journey with us in a “partnership” rather than a “customer vendor” relationship. It’s a much more difficult proposition than trying to sell something to people who understand exactly what they need. Because the industry is so diverse and complex, with so many stakeholders and players involved, we have chosen to supply a suite of solutions and engage with individual needs.
CP: Are you finding geographically that there are huge differences in the challenges you face? And are we leading in the UK for AI talent?
Tamir: When it comes to AI in healthcare there is strong leadership in the UK and in London, but also in the US, while in China we are not seeing as much. And geographic differences are fundamental, because the healthcare systems are so diverse across continents. If you are trying to build a sustainable business and monetise what you are doing, in the US some aspects are easier, for example. CPT (Current Procedural Terminology) codes exist, not specifically for Biomarkers but for remote patient monitoring, which is where we at Huma started our journey.
Monetisation is challenging, but by being present in all these regions we’re learning a great deal and can adapt our suite of solutions and services to cater to different needs, whilst also understanding the many commonalities. All healthcare systems are fundamentally trying to improve people’s health. Even in America where the healthcare system has a greater monetary focus, there is a shift towards more results-based versus activity-based payment as a result of pressure from governments and industry to deliver outcomes.
CP: What do you think would be the one change that could have the most significant impact on healthcare globally?
Tamir: The one area where you could make the most impact almost overnight is by addressing the current regulatory gap. The regulations that have evolved around traditional solutions in healthcare are now very good and fit for purpose. However, when you introduce the new world of modern software development practices, where fast iterations mean not knowing exactly what you’re going to do before you start, the regulation holds you back significantly. In Europe regulation is moving in the wrong direction, in my humble opinion. The EU’s MDR (Medical Device Regulation), when it eventually comes into force, is going to make it much harder to deploy software-based solutions in this industry versus the current MDD landscape. By contrast the US is moving more towards enabling software solutions and reducing the barriers to entry.
I think if regulators were able to combine the fundamental need to keep patients safe with the understanding that the world of software development is evolving rapidly, then innovation would explode across all areas of this industry. It would then be much easier for smaller companies to get their products into the market, start testing them and achieve outcomes relatively quickly. They could then obtain more funding to generate revenues and survive. Currently many companies fail because of massive barriers to entry and difficulties associated with deploying products in the wild.
When it comes to AI, regulators are really struggling. Traditionally, medical devices comprise a set of hardware components – usually with some software nowadays – but in a fixed design that is easily understood. For an agile device operation, turn-around times in development are measured typically in years, sometimes months. In the machine learning world that is exploding around us, however, our understanding of the inner workings is limited. Regulators seem to take issue with a statistical solution that is not deterministic, even though it may yield excellent results, in some cases significantly better than humans can achieve.
CP: Why is this? Are regulators just risk averse?
Tamir: Part of the problem is that many regulators have been operating in the space for decades and are reluctant to throw away the practices and beliefs they’ve held for a very long time. Regulators tend to be very conservative by default. Many don’t understand the intricacies of the technology, so it’s a combination of these factors and a tendency to be risk averse – after all, the role of a regulatory team in Life Sciences is to be extra cautious. An element of market forces will at some point help drive change, because healthcare systems will not survive with a growing and aging population by operating in the traditional, conservative way that they have for the last 30 to 50 years.
CP: What role do you think Big Tech companies will play in the next 5 years?
Tamir: The big names – Google, Amazon, Apple and Microsoft are all eying the space and some are actively participating. While Apple is maintaining a consumer focus, other players are happy to facilitate. Amazon Web Services are, for instance, releasing more and more services to help smaller organisations get to market sooner. I think the tech giants will carve themselves out swathes of the market where it will be very difficult to compete. They do not always have the agility, however, to adapt their business models quickly enough to completely overwhelm the industry. How much of the market they will control and how quickly they will get there is not yet clear. It’s not trivial for the tech giants to disrupt this space and some smaller companies are finding greater success. But it would be dangerous to underestimate them. With almost infinite resources at their disposal, the Amazons of this world present the biggest risk to smaller players.
CP: Where are the biggest talent gaps in your world?
Tamir: Because tech skills are highly transferable there is of course a huge shortage of tech talent and we face competition from every software organisation for this. On the healthcare side, I think there are two main talent gaps. One is in commercial skills because what we’re trying to sell hasn’t existed for the last two decades and it’s a challenge to find senior people who have experience marketing these solutions into healthcare and life sciences. The other aspect we mentioned is regulation. We’re building capabilities there but because the regulatory world is such a new world, there aren’t many people who have the vast experience of software as a medical device to navigate this tricky landscape and understand how to innovate and iterate at a fast pace while staying compliant to the regulations. There’s no magic bullet for this. We’ve done a combination of hiring more junior people who are growing into their roles, while finding the very rare, more experienced people who can mentor them and push them in the right direction.
For more information, please visit www.huma.com
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