Disruptive Business Models 2020


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A proposal designed to assist Company X in (1) realizing unfilled opportunities, in order to build new types of business and ultimately reshape the pharmaceutical and healthcare industry; and (2) identifying newly emerging white space and business model opportunities.

Over the next 20 years, great strides in medicine, technology, devices and healthcare are anticipated. The following, highlights some of the leading trends and business opportunities associated with major advancements, disruptive innovations and integrations anticipated in these sectors:

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Disruptive Business Models 2020

  1. 1. Disruptive Business Models in Healthcare Delivering Profitability by 2020
  2. 2. Over the next 20 years, great strides in medicine, technology, devices and healthcare areanticipated. The following, highlights some of the leading trends and business opportunitiesassociated with major advancements, disruptive innovations and integrations anticipated in thesesectors: Personalized Medicine and Healthcare: Disruptive innovators in health care aim to shape a new system that provides a continuum of care focused on each individual patient’s needs, instead of focusing on crises Personalized medicine offers the potential for revolutionary change in the practice of medicine. It also provides a unique window into therelationship between new medical technologies, new business models for health care delivery, androle of government in this unique marketplace. Using personalized medicine as a test of disruptiveinnovation in health care, innovators are seeking a different approach to these technologies inorder for them to achieve their full potential.1 Developments in technologies, such as genomics, nutrigenomics, proteomics, bioinformatics, pharmacogenetics, pharmacogenomics, and other biological applications, are enabling the march toward the practice of personalized medicine. Rapid advancements are expected to continue in the area of personalized medicine, leading to more efficient and cost- effective products and therapies.An analysis of the future for the treatment of diseases with pharmaceuticals, focusing specifically onthe field of pharmacogenomics, which uses the human genome to develop treatments, is alsounderway. One of the major aims of pharmacogenomics is to use each individuals own genome todevelop a personalized drug treatment, thereby removing the variations and adverse reactions thatcurrently occur when drugs are prescribed. A host of non-invasive personal health technology forself care, mobile care, and home care research is currently underway.For example, an experimental product which aims to combine genetic data and mobile devices togive people just-in-time recommendations about what they should and shouldnt consume, is in theworks. Its an interesting concept--nutrigenomics meets mobile computing. In brief, this productworks as follows:The PGA [Personal Genome Assistant--marketing speak for a smart phone] uses a device’s bar codereader to capture product ingredient information and respond with personalized screens ofrecommendation advice and ratings that display on a scale of -10 to +10, corresponding to analysisof integrated data from multiple sources. The PGA user can automatically and immediately identifythe personalized prevention efficacy of any product under consideration, as long as the product hasa bar code for ingredients. Consumers are equipped to make quick, yet thorough, productcomparisons that take into consideration personal health preferences and genomic informationwith special attention to a disease, syndrome, or health condition they wish to improve.Combinatorial Innovation - New Biomedical Designs:1 “Personalized medicine and disruptive innovation: Implications for technology assessment”, Schulman, Kevin A. MD; Vidal, Ana Valverde MBA;Ackerly, D Clay MD, Genetics in Medicine, Aug. 2009 2
  3. 3. The potential to combine Internet components, along software, protocols, languages, andcapabilities in ways that create totally new innovations is also being leveraged in personalizedmedicine research and development communities. In the coming decade the reliance onexperimental methods will increasingly be as a means of validating the results obtained fromcomputational methods. This will be driven by the emerging importance of empirical andcomputational methods in the design of new products and molecular entities for biomedicalapplications, such as the development of novel sensors, optimize stem cell manufacturing systemsand other processes. There appears to be strategic opportunities to exploit the efficiencies thesetechnologies offer throughout the healthcare service settings; from theatre acute hospital toassisted living facilities to the home. These combinations, coupled with on-demandsupercomputing, could potentially enable real-time decision support tools for doctors, real-timeinformation delivery for individual patients, and a tailoring of information to meet personalizedneeds.Market Growth Indications:While the market for diagnostic tests and therapies that leverage personalized medicine andrelated technologies is growing, the biggest opportunities exist outside of the traditional healthcaresector. The U.S. personalized medicine market is estimated at about $232 billion and is projected togrow 11% annually, nearly doubling in size by 2015 to over $450 billion. The core diagnostic andtherapeutic segment of the market—comprised primarily of pharmaceutical, medical device anddiagnostics companies—is estimated at $24 billion, and is expected to grow by 10% annually,reaching $42 billion by 2015. The personalized medical care portion of the market—includingtelemedicine, health information technology, and disease management services offered bytraditional health and technology companies—is estimated at $4-12 billion and could grow tenfoldto over $100 billion by 2015. And the related nutrition and wellness market—including retail,complementary and alternative medicine offered by consumer products, food and beverage, leisureand retail companies—is estimated at $196 billion and projected to grow by 7% annually to over$290 billion by 2015.2 Biomarkers: Every disease leaves a signature of molecular "biomarkers" in our body — genes that turn on and off or proteins released into the bloodstream. Biomarkers measured in blood and other samples can tell us the state of our health and how we might respond to treatment. They are powerful tools that can detect certain diseases at their earliest stages before symptoms appear, when they are most treatable. Biomarkers can alsoguide the physician to prescribe an effective drug that will be free of side effects. Biomarkersrepresent the future of medicine, in which disease diagnosis, treatment, monitoring and preventionwill be guided by a continual readout of our molecular make-up.2 “The New Science of Personalized Medicine”, PriceWaterHouseCoopers, 2009 3
  4. 4. Convergence of Medical Device, Drugs, Molecular Medicine and Bioinformatics:Convergence is expected to be one of the leading trends going forward and is being made possibleby enabling technologies, such as bioinformatics. Implications of such convergence of medicaldevices with molecular medicine include early and faster diagnosis, better prognosis, and tailoredtherapy with higher efficacy and diminished side effects. This is expected to further lead todevelopments in preventive and personalized medicine.Convergence will also be taking place across healthcare products and industry segments that areanticipated to transform the medical device industry. The convergence of devices with molecularmedicine, data processing, and communication technology is allowing significant advances in manyaspects of device technology. Convergence/Advanced Applications of Nanotechnology in Medicine, Healthcare, Devices, and Cosmeceuticals: Perhaps the boldest application of nanotechnology lays in medicine, healthcare, and cosmeceuticals. Most sickness, injury and stress can be traced to cellular malfunction. Current medicine does not allow doctors to treat selective cells. Instead, todays medical solutions focus primarily on symptoms that sometimes provide negative side effects. Surgery saves lives, but it also causes trauma. Chemotherapy destroys cancer, but healthy cellsoften die in the process; and far too often, the cancer returns.Nanomedicine:Nanomedicine, the medical application of advanced nanotechnology also promises a bold futurethat will enable people to enjoy life without sickness, disease, and aging. By as early as mid-2020s,scientists hope to construct tiny nanorobots that can manipulate atoms inside cells. Injected intothe blood, these clever ‘bots would repair tissues, clean arteries, attack cancer; even reverse theeffects of aging.3More than ten years ago, simple low-cost techniques improved the design and manufacture ofnano-microchips. That unlocked a multitude of methodologies for their manufacture in a wide-range of applications including optical, biological, and electronic devices. The joint use ofnanoelectronics, photolithography, and new biomaterials, has enabled the required manufacturingtechnology towards nanorobots for common medical applications, such as surgicalinstrumentation, diagnosis and drug delivery.Nanotechnology deals with structures smaller than one micrometer (less than 1/30th the width ofa human hair), and involves developing materials or devices within that size. To put the size of ananometer in perspective, it is 100,000 times smaller than the width of a human hair. In clinicaltrials, doctors have injected nanoparticles that seek out cancer cells and destroy them withoutharming normal cells. Although these particles cannot be programmed like nanorobots, they are amajor reason for optimism at the National Cancer Institute, whose former director stated that alldeaths from this dreaded disease will be preventable by 2015. Nanorobots work like tiny surgeonsas they flow through damaged bodies making repairs. On command, they can erase wrinkles,eliminate excess fat, strengthen muscles and bone, restore hair, replace missing teeth, erase plaque3 ‘Nanomedicine could end sickness, disease, and old age by mid-2020s, experts say” February 29 2008, Futuretalk 4
  5. 5. buildup; even correct failing vision.4 Nanotechnology and Cosmetic/Skin Care Products: There are growing markets in nano-cosmetics, which are estimated to gross $27 trillion (domestic) by year 2010. All of the major cosmetics companies like L’Oreal, Estee Lauder, and Shisedio have nanoparticles already in many of theirproducts, which are already generating excitement for its potential use in anti-aging products.When properly engineered, nanomaterials may be able to topically deliver retinoids, antioxidantsand drugs such as botulinum toxin or growth factors for rejuvenation of the skin in the future.Experts state that in anti-aging products, nanotechnology may allow active ingredients that wouldnot normally penetrate the skin to be delivered to it. For example, vitamin C is an antioxidant thathelps fight age-related skin damage which works best below the top layer of skin. In bulk form,vitamin C is not very stable and is difficult to penetrate the skin. However, in future formulations,nanotechnology may increase the stability of vitamin C and enhance its ability to penetrate the skin. Nanorobotics-Future Medical Treatment at the Cellular Level: In the future, nanorobots may perform all kinds of important jobs for humans, including health-related jobs such as molecular repair. For example, many bacteria come equipped with flagella propellers which are powered by nanomotors. Nanorobotics may assist in functions related to sensing and detecting, communications, disease, aging, and genetics. NanorobotsInitial uses of nanorobots to health care are likely to emerge within the next ten years withpotentially broad biomedical applications. The ongoing developments of molecular-scaleelectronics, sensors and motors are expected to enable microscopic robots with dimensionscomparable to bacteria. Recent developments on the field of biomolecular computing hasdemonstrated positively the feasibility of processing logic tasks by bio-computers, which is apromising first step to enable future nanoprocessors with increasingly complexity. Studies in thesense of building biosensors and nano-kinetic devices, which is required to enable nanorobotsoperation and locomotion, has been advanced recently too. Moreover, classical objections related tothe real feasibility of nanotechnology, such as quantum mechanics, thermal motions and friction,has been considered and resolved and discussions about the manufacturing of nanodevises isgrowing up. Developing nanoscale robots presents difficult fabrication and control challenges. Thecontrol design and the development of complex integrated nanosystems with high performance canbe well analyzed and addressed via simulation to help pave the way for future use of nanorobots inbiomedical engineering problems.54 “Nanotech promises wealth, efficient healthcare’, Dick Pelletier, Jan., 2010, Futuretalk5 Center for Automation in NanoBiotech, 2010 5
  6. 6. Nanodevices: Nanorobots are also nanodevices that will also be used for the purpose of maintaining and protecting the human body against pathogens. They will have a diameter of about 0.5 to 3 microns and will be constructed out of parts with dimensions in the range of 1 to 100 nanometers. Such devices have been designed in recent years but no working model has been built so far.NanorobotsThe powering of the nanorobots can be done by metabolizing local glucose and oxygen for energy.In a clinical environment, another option would be externally supplied acoustic energy. Othersources of energy within the body can also be used to supply the necessary energy for the devices.They will have simple onboard computers capable of performing around 1000 or fewercomputations per second. This is because their computing needs are simple. Communication withthe device can be achieved by broadcast-type acoustic signaling.A navigational network may be installed in the body, with station keeping navigational elementsproviding high positional accuracy to all passing nanorobots that interrogate them, wanting toknow their location. This will enable the physician to keep track of the various devices in the body.These nanorobots will be able to distinguish between different cell types by checking their surfaceantigens (they are different for each type of cell). This is accomplished by the use of chemotacticsensors keyed to the specific antigens on the target cells. When the task of the nanorobots iscompleted, they can be retrieved by allowing them to exfuse themselves via the usual humanexcretory channels. They can also be removed by active scavenger systems.Some possible applications using nanorobots are as follows: --To cure skin diseases, a cream containing nanorobots may be used. It could remove the right amount of dead skin, remove excess oils, add missing oils, apply the right amounts of natural moisturizing compounds, and even achieve the elusive goal of deep pore cleaning by actually reaching down into pores and cleaning them out. The cream could be a smart material with smooth-on, peel-off convenience. --A mouthwash full of smart nanomachines could identify and destroy pathogenic bacteria while allowing the harmless flora of the mouth to flourish in a healthy ecosystem. Further, the devices would identify particles of food, plaque, or tartar, and lift them from teeth to be rinsed away. Being suspended in liquid and able to swim about, devices would be able to reach surfaces beyond reach of toothbrush bristles or the fibers of floss. As short-lifetime medical nanodevices, they could be built to last only a few minutes in the body before falling apart into materials of the sort found in foods (such as fiber). --Medical nanodevices could augment the immune system by finding and disabling unwanted bacteria and viruses. When an invader is identified, it can be punctured, letting its contents spill out and ending its effectiveness. If the contents were known to be hazardous by themselves, then the immune machine could hold on to it long enough to dismantle it more completely. 6
  7. 7. --Devices working in the bloodstream could nibble away at arteriosclerotic deposits, widening the affected blood vessels. Cell herding devices could restore artery walls and artery linings to health, by ensuring that the right cells and supporting structures are in the right places. This would prevent most heart attacks.6 M-Health: In the future Mobile Health (M-Health) applications will take advantage of technological advances such as nanotechnology, device miniaturizations, device convergence, high-speed mobile networks, and advanced medical sensors. This will lead to the increased diffusion of clinical M-Healthsystems and services which will have a powerful impact on the health care sector (Healthmonitoring is repeatedly mentioned as one of the main application areas for Pervasive computing.Mobile Health Care is the integration of mobile computing and health monitoring. It is theapplication of mobile computing technologies for improving communication among patients,physicians, and other health care workers. As mobile devices have become an inseparable part ofour life it can integrate health care more seamlessly to our everyday life. It enables the delivery ofaccurate medical information anytime anywhere by means of mobile devices. Recent technologicaladvances in sensors, low-power integrated circuits, and wireless communications have enabled thedesign of low-cost, miniature, lightweight and intelligent bio-sensor nodes. These nodes, capable ofsensing, processing, and communicating one or more vital signs, can be seamlessly integrated intowireless personal or body area networks for mobile health monitoring. In this paper we presentIntelligent Mobile Health Monitoring System (IMHMS), which can provide medical feedback to thepatients through mobile devices based on the biomedical and environmental data collected bydeployed sensors.7As more smart health solutions and medical devices compete for clinician and consumer adoption,questions about measurable benefits for health are coming to the fore. Widespread adoption of theiPhone and other smart phones by physicians may well lead to a new acceptance of devices andapplications that across the industry. Mobile application developers report that several mobileapplications are now used by more than 900,000 physicians globally and a recent survey of about350 clinicians found 60 percent are interested in the iPad and 20 percent intend to buy oneimmediately. Transforming the role of patients and empowering them to manage their ownconditions are being spearheaded by new products and tools to help patients prevent and controlchronic diseases. Analysts have estimated that by 2020, that one of every 5 dollars of the GDP willgo to healthcare, and 75 percent of those costs are from chronic diseases.6 NanoRobots; ShortCircuit; Newsletter of IEEE Bombay Section; 19997 Intelligent Mobile Health Monitoring System (IMHMS) - Lecture Notes of the Institute for Computer Sciences, Social Informatics andTelecommunications Engineering; Department of Computer Science and Engineering, Bangladesh University of Engineering and Technology;Rifat Shahriyar, Md. Faizul Bari, Gourab Kundu, Sheikh Iqbal Ahamed, and Md. Mostofa Akbar; 2010 7
  8. 8. The intersection of three important technologies –biosensors, data aggregation and socialnetworking—gives patients access to information and control over their healthcare. Examplesinclude a number of new products and applications that leverage the technologies and lead to the“observer effect” where merely being watched leads to behavior modification, such as:  A prototype patch that offers real time data about the wearers caloric intake--and the number of calories burned in the past 24 hours--such a potentially disruptive technology. The patch is still being developed and works as follows: It consists of a single chip surrounded by numerous sensors, electrodes, and accelerometers, embedded in a foam adhesive patch. The system, which is designed to be replaced once a week, measures a variety of things (temperature, heart rate, respiratory rate, skin conductivity, possibly even the amount of fluid in the body), then throws the data into an algorithm to calculate the number of calories consumed, the number burned, and the net yield. Caloric-intake measurements are accurate only to about 500 calories. The patch sends this data via a Bluetooth wireless connection to a dieters cell phone, where an application tracks the totals and provides support. "You missed your goal for today, but you can make it up tomorrow by taking a 15-minute walk or having a salad for dinner," it might suggest. Both the concept-- the ability to track calories consumed and burned with relative accuracy, assuming it pans out--as well as the integration with mobile technology point to how significant this sort of device could be in motivating behavior change. It has the potential to be much more accurate in determining net gain or loss and is most useful for measuring trends over the course of a week or a month. 8