The Propell Group - ESSEC Business School - Digital Health Innovation

ESSEC ASIA-PACIFIC Ÿ MSc Management of Health Industries – Digital Health
16th April 2015 Ÿ Singapore Ÿ The Propell Group
INNOVATION
Digital Health
@enquirepropell
#DigitalHealth

Julien
de SALABERRY
Experienced regional head and GM. 15+
years in healthcare with leading brands
including Eli Lilly, Boston Scientific,
Baxter, GSK, Merck & Co. Significant
Asia Pacific Experience.
The Propell Group is a boutique
venture investor and adviser firm
focused on early stage companies in
healthcare technology
a.h.a.! is a dedicated health-tech
accelerator focused on Asia 4 Asia
healthcare technology innovation
Co-Author of iDisrupted
Founder & CIO Ÿ The Propell Group
M: +65 9488 7334 Ÿ julien@propellgroup.biz
@enquirepropell

©2015 by The Propell Group - All rights reserved. Proprietary and Confidential.
•  Objectives & Expectations
•  Digital Health Briefing
•  Digital Health in Asia
•  Healint: Asia DH Case Study
•  Q&A
Digital Health Innovation

INNOVATION
Digital Health
"That's the promise of precision
medicine -- delivering the right
treatment at the right time, every
time, to the right person"
— President Obama —
President of the United States of America

•  Digital Healthcare is disrupting healthcare and its established players
•  Technology is driving a new paradigm to create better health care
•  Developing markets can leapfrog their healthcare infrastructure limitations
•  New opportunities are opening to shape the new paradigm
Healthcare is changing dramatically

The convergence of digital revolution with health:
ELEMENTS
Wireless devices
Hardware sensors
Sensing tech
Microprocessors
Integrated circuits
The Internet
Social Networking
Genomics
Personal genetics
What is digital health?
LEXICON
Wireless Health / mHealth
e-Patients / eHealth
Quantified Self / Self-tracking
Wearable Computing
Telehealth & Telemedicine
Personalized Medicine / QS
Health IT
Connected Health
Big Data / Health Data

Digital health frequently features in the media
Why Digital Health
Will Have Huge
Impact
March 3, 2014
By Todd Hixon
Digital Health has big buzz this year.
For example, it was a hot topic at both
the Consumer Electronics Show
(“CES”) and the more-serious JP
Morgan Healthcare Conference.
(“Digital Health” refers to products and
businesses that apply modern digital
technologies — the web, mobile, the
cloud, miniature sensors — to
healthcare.)
J.P. Morgan health
conference points toward
a hot year in digital
health
January 15, 2015
By Mark Sullivan
The J.P. Morgan event was a very different
scene, of course, and much smaller, but the
same energy for health tech was palpable
there, too. This conference usually focuses on
biotech and medical device companies. But
this year, the number of digital health
companies was decidedly larger and more
visible

Digital health ecosystem: The new paradigm
Doctors
Efficient Healthcare
Better regulations
Insurance
Customize Packages
User specific rates
Enterprise
Faster discovery
Consumer insights
Individuals
Preventative Care
Personalized Care
Government
Efficient Infrastructure
Better Policy
Shared Information Cloud
Outbreak reports
Health tracking
Claims reporting
Insurance cover
Clinical trial data
Consumer reporting
Sensors and Trackers
Wellness reporting
Population Data
Public Awareness

Digital Health Market Landscape

1.  Big Data and Impact on Healthcare
2.  Advances in Wearable Sensors and Devices
3.  Business Models in Healthcare Companies
4.  Funding Trends
5.  Evolving Regulations in Digital Health
Focus: Digital Health Innovation

“Healthcare isn’t a science problem,
it’s an information problem”
— Thomas Goetz —
Author of The Decision Tree: Taking
Control of Your Health in the New Era of
Personalized Medicine
Big Data
& HEALTHCARE
SECT ION 1

6 Ways Big Data is Changing Healthcare
Genomics & Beyond
Next generation sequencing, data
management & analysis
Data Analytics
Transforming Data: working with
and mixing data sets
Public Awareness
Planning and Preventing: Using data
to reduce and prevent disease
Support Providers
Clinical and Non-clinical Intelligence:
Combining a greater variety of data
Support Self-Care
Patient Focused: Increase variety
and frequency of data
Health Eco-system
Collaboration: Pooling data from many
sources for bigger & better results

Cloud-based, collaborative technology platform for
next generation sequencing and analysis tools
Genetic analysis applied to discover which
healthcare methods work, and for whom.
Tute Genomics is a cloud-based platform that can
rapidly analyze and annotate personal genomes
Personal DNA analysis and interpretation
service for individuals
Genomics & Beyond Next generation sequencing, data management & analysis

Predictive analysis to recognize health patterns and
reduce re-admission
Free health records platform which aggregates
population health data across multiple sites
Founded in the US – now launched in the UK
Uses natural language processing to turn data into
insights about compliance, revenue cycle, etc
Cloud-based platform focused on standardizing
health record management across providers
Data Analytics Transforming Data: working with and mixing data sets

Big global data sets available to help guide policy
decisions and improve population health
Scans social media to forecast and track
outbreaks of disease
Identify counterfeit drugs and enable pharmaceutical
companies to track drug distribution
Real-time surveillance for emerging public health
threats by scanning informal sources
Public Awareness Planning and Preventing: Using data to reduce and prevent disease

Cloud-based platform to improve cancer cancer by
organizing the world's real-world oncology data
Cloud-based computing platform to aggregate data
from many disparate sources
Deep analysis and evidence-based reasoning for
more precise diagnosis and clinical decision making.
Lumiata applies big data-driven medical science to
patient data to optimize health care interactions
Support Providers Clinical and Non-clinical Intelligence: Combining a greater variety of data

Diabetes management solution for patients, health
systems, and payer groups
Asia founded remote monitoring for physicians
to manage chronic patients
Collects data and organizes feedback to help
patients better manage asthma
Creates innovative and cost-effective online behavior-
change programs for chronic diseases
CDC Recognised
Support Self-Care Patient Focused: Increase variety and frequency of data

Health Eco-system Collaboration: Pooling data from many sources for bigger & better results
Global wireless health connectivity platform to bring
new and old healthcare data together in new ways
Consolidation and analysis of personal sleep,
wellness and fitness data on one platform
Allows apps that provide health and fitness services
to share data with the Health app & with each other

The Value of Big Data in Digital Health
$40-70 B
Right
Innovation
$300B
$450B
Healthcare Savings in the US
due to Big Data
Right Value Right
Provider
Right Care Right Living
$50-100 B
$50-70 B
$90-110 B
$70-100 B •  Targeted disease
prevention
•  Data-enabled
adherence programs
•  Alignment around proven pathways
•  Coordinated care across providers
•  Shifting volume to right care setting
•  Reducing ER rates
•  Payment innovation & alignment
•  Provider-performance transparency
•  Accelerating discovery in R&D
•  Improving trial operations
$300B to
$450B in
reduced
healthcare
spend

“Technology may replace up to
80% of what doctors do”
— Vinod Khosla —
Founder at Khosla Ventures
SECT ION 2
Wearable
SENSORS & DEVICES

Wearable ecosystem: Biosensing Wearables
Activity
Trackers
e.g. Fitbit, Misfit
Smart
Watches
e.g. Garmin, Apple
Smart
Clothing
e.g. Athos
Patches &
Tattoos
e.g. Zio, MC10
Ingestibles &
Smart Implants
e.g. Proteus
BioSensors
Devices that convert a
biological element into a
signal output
Wearables
Are on- or in-body devices
that enable user
experience

•  Create a wealth of data in real time
•  Measure physiological parameters easily
•  Relate trends, behaviors and environments to health and wellness
•  Analyze trends to understand the health ecosystem
Why do wearable and sensors matter?

Wearable and Sensors Life Cycle & Common Uses
Cloud Processing & storage
Community & Comparison
Feedback
Personal Results
Sensor(s)
Records Data
Weight
Under 20%: Acid Reflux or Indigestion, Digestive Health
40% 65%
Vital Signs
37% 58%
Sleep Patterns
30% 54%
Calories / Fat Intake
32% 37%
Blood Sugar
21% 61%
Exercise / Physical Activity
24% 36%
Common Wearable Uses
Consumers Physicians

Wearable and Sensors Market Landscape
WELLNESS DIAGNOSTIC CHRONIC MONITORING

Garmin LumoFitbitWatch
APPLE WATCH
Smart-watch with activity
accelerometer and HR monitor
FITBIT SURGE
Smart-watch with activity
accelerometer and HR monitor
GARMIN 920XT
Triathlon training smart-watch with
GPS, HR monitor & activity
accelerometer
LUMOBACK
Posture monitor
Wellness Lifestyle monitor, intended to increase wellness

Alivecor CueZioScout
ALIVECOR
Heart Monitor is a single-channel ECG
recorder that is portable and easy to use
- FDA approved!
SCANADU SCOUT
Sophisticated physical exam:
tracks & trends body vitals
ZIO by iRythm
Micro sensor for long-term monitoring of
cardiac rhythms
CUE
Personal cartridge driven saliva analysis
for wellness management
Diagnostic, Chronic & Monitoring, Intended to aid medical systems and speed diagnosis

APPLE’S HEALTH ECOSYSTEM
•  HealthKit provides a health data clearing house, collecting data from many kinds of devices from smart-watches to
hospital based ECGs
•  FDA-regulated medical devices are able to send information via HealthKit and accompanying apps leading to
breakthroughs in continuous monitoring as well as data analysis and sharing
•  ResearchKit is a platform which enables the constant monitoring of symptoms and reactions to medication from a very
large clinical trial patient sample
•  The current clinical trial approach is to cease the monitoring when the trial is ended to submit the data to the FDA
THE CASE FOR BEST BIOSENSING WEARABLE
•  We all own one
•  We take it everywhere we go
•  It is full of sensors which track our every move
•  A simple app can turn it into a powerful healthcare and wellness tool:
•  Sleep
•  Activity
•  Lifestyle
•  Habits
Mobile Phone The most powerful biosensing wearable available?

Today’s Market: Wearable devices and sensors
Disease management
Preventative health
Remote monitoring & care
Detection & screening
Consumer personalized medicine
Predicting and controlling outbreaks
Barriers
Poor Management
No sustainable business model
Perverse money-driven intentions
Lack of awareness and initiative
Making raw data valuable
Regulatory hurdles
Early Adopters
WELLNESS
Self-initiated health tracking
Quantified Self
MEDICAL
Doctor-initiated prescribed
health intervention
US $3 BILLION
100 million devices
2014

Today’s Market: Wearable devices and sensors
Less expensive
Over-the-counter
Longer Battery Life
Easier to use
More sensors
Drivers
Better compatibility with existing devices
More public awareness and marketing
Medical community adoption
Improved manufacturing
Better distribution
Mass Adoption
WELLNESS
Self-initiated health tracking
Mass Adoption of
Quantified Self
MEDICAL
Doctor-initiated prescribed
health intervention
Mass Adoption within
health community
US $12 BILLION
400 million devices
BY 2018

Business
MODELS
“Great products are becoming a
commodity. It's the combination between
great products and a great business model
that is going to keep you ahead of the
competition in the coming decade.”
— Alexander Osterwalder —
Business Model Generation, a global
bestseller on the topic of business model
innovation
SECT ION 3

•  Spending is inefficient or non-existent
•  Policies are shifting in mature & developing countries
•  Increasing focus on outcomes, not volumes
•  New business models are forming to address changes
•  76% of Fortune 50 companies are now in healthcare
The healthcare business landscape is shifting

Developing Solutions
Free cloud-based health
records platform which
aggregates population health
data across multiple sites
Supported by advertising
IN ASIA
Using mobile phones and
devices for innovative and
practical solutions for cost
effective healthcare services
Supported by Enterprise
IN ASIA
Employee engagement
platform that drives
productivity and manages cost
though employee wellness
Supported by Employers
IN ASIA
Electronic Health
Records (EHR)
mHealth
(Mobile Health)
Health Insurance /
Employee Wellness

Business Models: B2B vs B2C
USED BY
CUSTOMERS
B2B Supported by insurance/pharma
Supported by advertising
Supported by physicians Supported by advertising
Supported by business
Supported by business
Supported by customers
Attracts 80% of Funding
é Higher willingness to pay
é Greater lifetime customer value
ê Longer sales cycles
ê Requires gatekeeper
approval or system integration
B2C
ê Lower willingness to pay
é Quicker product iterations
and user feedback
é Shorter Sales Cycle
ê Crowded Landscape
USED BY
BUSINESS
PAIDBYBUSINESSPAIDBYCUSTOMER

•  Targeted research through rational design model
•  Customised clinical trials through pharmaco-genomics
•  Individualised medicine
•  Real World Evidence research
•  Digital marketing, tracking and sales
Rebooting The Life Sciences Industry

Partnership with Genomics England to mine information
from a government project to decode the genomes of
100,000 patients from NHS patients with cancer and
rare diseases to discover personalised medicines
•  Year-long trial announced March 2015
Has announced 12 undisclosed partnerships with
academia and corporate:
•  Signed collaboration with Pfizer for the study of Crohn’s
disease
•  Signed a $60M deal with Genentech (Roche) for the
study of Parkinson’s Disease
Pharmaco Genomics: The future of drug design
The Past: Molecular screening libraries used by most large drug companies and academic centers
The Future: Identifying the root cause of, or critical aberrant protein associated with a particular disease
and use this template to design the antibody or molecule to block it

Clinical Data: Next generation clinical trials and RWE
Innovative tele-health solutions through interactive health technology
platform that consists of medical devices, application software, mobile
apps, cloud-based web applications focused on CV clinical trials
Open-source platform that empowers researchers to design and
administer app-based health research. Initial focus on breast cancer,
diabetes, Parkinson’s disease, CV and Asthma
Platform and algorithms allow to gather and show data for faster
clinical trials, and to support patients and doctor in the extreme
complexity of the real-world Neurology and Immunology treatments
•  Post launch real-time patient data from extremely large numbers of patients
•  Increasingly important data sets for market access and reimbursement
§  Velcade (J&J) for the treatment of Myeloma ($35,000 p.a.) was initially rejected by NICE
(UK). J&J agreed not charge any patient not deriving benefit. Velcade was approved

•  Creative disruption / destruction from technological advances
•  M&A activity
•  New entrants
Life Sciences Disappearing Act

Francois
CADIOU
Francois has 13+ years of extensive
experience in the pharmaceutical and
medtech industries, ranging from clinical
development, finance, IT, operations, to
market access.
Healint is a healthcare analytics
company based in Singapore. Our
mission is to leverage data science to
improve patient’s lives.
Founder & CEO Ÿ Healint
M: +65 8615 4482 Ÿ francois@healint.com
@Healint

“Investments in digital health are having a
positive impact and the momentum is likely
to continue and cause changes throughout
the entire healthcare ecosystem. In
particular, the pharmaceutical industry is
poised to take advantage of digital and
mobile innovation allowing them to “go
beyond the pill”
— Jack Young —
Head – Qualcomm Life Fund
Funding
TRENDS IN DH
SECT ION 4

•  Key investment themes taking shape
•  Venture capital funding doubles again
•  Growing number of technology and strategic investors
•  M&A deal flow growing
•  Strong IPO trend
•  7,500+ DH startups across the globe
Significant activity in Digital Health funding

Venture funding of digital health continues to outpace other sectors
Health Sector Funding Changes
Based on total funding from 2012 and 2013
2013 vs 2012 2014 vs 2013
All Sectors Digital Health Med DevicesBiotech
9%
61%
29%
127%
10%
29%
-17%
21%

Venture funding of digital health: Key trends
Top Trends of Digital Health Funding
2011 to 2014
Ranking 2011 2012 2013 2014
1
Healthcare Consumer
Engagement
Healthcare Consumer
Engagement
EHR & Clinical Workflow
Analytics & Big Data
Data aggregation & analysis to support a wide range of healthcare use
cases
2 Analytics & Big Data EHR & Clinical Workflow Analytics & Big Data
Healthcare Consumer Engagement
Consumer tools for the purchasing of healthcare services or health
insurance
3 Digital Dx
Personal Health Tools &
Tracking
Digital Medical Devices Digital Medical Devices
Software / hardware designed to treat a specific disease or condition
4 EHR & Clinical Workflow Care Coordination
Population Health
Management
Telemedicine
Delivery of healthcare services through virtual channels
5 Post-acute Solutions Wearables & Biosensing Wearables & Biosensing
Personal Medicine
Software to support the practice of medicine customised to an individual’s
genetics
6 Hospital Administration Telemedicine
Healthcare Consumer
Engagement
Population Health Management
Platforms for managing population health under the shift to risk-based
payment models

Acquisitions: Is this the start of Digital Health sector consolidation?
95 M&A Deals in 2014 - $20B
ACQUIRER TARGET
Flatiron Health Altos Solutions
Teladoc AmeriDoc
Evidera Archimedes
Optum Audax
Roche Bina Technologies
MDLive Breakthrough
Hearst Health CareinSync
Cambia Health ClarusHealth
Merck eCardio
Google Lift Labs
UnitedHealth Group MedSynergies
WellTok MindBloom
HCA PatientKeeper
Facebook ProtoGeo (Moves)
AirStrip Wireless Sense4Baby
MyFitnessPal Sessions
WebMD TheraSim
Covidien Zephyr Technologies
Sector # of M&A deals
Health Tech
Med Device
Payer
Biopharma
Provider
Other
Healthcare
Tech
Other
47
8
6
6
4
4
7
13
ACQUIRER TARGET VALUE
BD CareFusion $12.2B
Cognizant TriZetto $2.7B
Cerner Siemens Health $1.3B
Optum Alere $600M
Aetna bswift $400M
Brighton Health Privia $400M
GE API Healthcare $340M
Emdeon Change Healthcare $185M
Medtronic Corventis $150M
Astra Zeneca Definiens $150M
Intel Basis $100M
Everyday Health Medico.com $100M
Millenium Labs RxAnte $70M
St Jude Medical CardioMEMS $60M
Care.com Citrus Lane $49M
Advisory Board Co. HealthPost $25M
Weight Watchers Wello $9M
Premier Meddius $8M
DISCLOSED UNDISCLOSED

Legal
IMPLICATIONS
“For a huge percentage of digital health
companies, following FDA regulations will
actually make them a better company”
— Geoff Clapp —
Mentor, Rock Health
SECT ION 5

•  FDA focus will likely be precedent for ROW
•  New DH regulations are in force
•  Not all DH will be regulated
•  Data privacy and security are growing debates
•  Growing deal flow driving momentum
Digital Health regulations are shaping up

FDA regulations: Impact on digital health
Recent FDA regulations apply to mobile apps that are
medical devices, under current definition:
“An instrument, apparatus, implement, machine, contrivance, implant, or in vitro
reagent that is intended for use in the diagnosis of disease or
other conditions, or in the cure, mitigation, treatment, or prevention of disease
of man, or intended to affect the structure or any function of the body.”
Health Insurance Portability & Accountability Act
(HIPAA)
Doesn’t regulate all medical data – regulates that data when it is in the hands
of, within control of, or within purview of a medical provider, a health plan or
other covered entity under the law – it is not a data-protection law
Increasing health data integration will mean aligning more health apps with
HIPAA
Transforms a
mobile device into
a medical device
Used as an
accessory to a
medical device
OR
AND EITHER

Examples of FDA Regulation Categories
UNREGULATED
Mobile Medical AppsSELECTIVE ENFORCEMENT
Equivalence vs.
Predicate Device
Too Innovative to
Predicate
Outside
Definition
FDA Class II Clearance
(July 2012), found to be
substantially equivalent to
the SmartTrack system.
Proteus Personal Monitor
including ingestion Event
Marker FDA Class II de
novo (July 2012)
MOBILE MEDICAL APPS
1) Transform a
mobile device into
a medical device
2) Used as an
accessory to a
regulated device
3) Patient specific analysis
and diagnosis or treatment
recommendations

Asia
DIGITAL HEALTH
“We have to link to what the global trends are.
This means looking at the emerging sectors,
verticals like technology, healthcare, and
biotech”
— Teo Ser Luck —
Minister for Trade & Industry, Singapore
SECT ION 5

•  Create greater awareness & patient empowerment
•  Facilitate better provision through private sector
•  Provide healthcare services in underserved urban and rural regions
•  Analyze trends to better allocate limited resources
Asia: Leapfrogging its immature infrastructure

•  Lifestyle and wellness apps driven by growing middle class affluence
•  Infrastructure management and modernisation
•  Chronic disease management driven by growing health awareness
•  Frugal innovation to deliver better care at a reduce price point
•  Rapid growth in telehealth to enable healthcare delivery in remote areas
Asia DH Key Trends

Digital Health: Asia key trends
200+ HealthTech Startups in Asia*
Category Total Examples
Big Data & Analytics 9
•  Genequest (JP)
•  Lean Care Solutions (SG)
Consumer Health & Wellness 44
•  BabyMe (VT)
•  Haamor (TH)
Genomics & Precision Medicine 5
•  MyCode (JP)
•  Prenetics (HK)
Healthcare Incubators & Accelerators 3
•  Clearbridge Accelerator (SG)
•  AIA Accelerator (HK)
Navigating The Healthcare System 33
•  Practo (IN)
•  Our Health Mate (SG)
Patient Engagement 46
•  Tanyadok (INDO)
•  HelpingDoc (IN)
Practice Management 29
•  Klinify (SG)
•  Medix (PH)
Sensors & Diagnostics 28
•  Reka Health (SG)
•  Healint (SG)
Telehealth & Remote Monitoring 9
•  MyDoc (SG)
•  Doktor Gratis (INDO)
Note: Not an exhaustive list!
Source: Health Startups Asia!

Venture funding of digital health: Asia key trends
Noteworthy Asia HealthTech Startups
Startup Funding ($M) Stage Principal Investors
Our Health Mate (SG) 1 •  Seed & Pre A •  LeoTech
HealthKart (INDIA) 20 •  Series B
•  Sequoia Capital
•  Intel Capital
DXY (CH) 2 •  Seed & Pre A •  DCM
PICOOC (CH) 25 •  Series B
•  Tencent
•  Gobi Partners
Reka Health (SG) 4 •  Series A •  Tembusu Partners
Practo (INDIA) 24 •  Series B •  Sequoia Capital
Meet You (CH) 50 •  Series C
•  Matrix Partners
•  K2 Ventures
Klinify (SG) 1 •  Seed & Pre A •  Jungle Ventures
Healint (SG) 1 •  Seed & Pre A •  Wavemaker
mClinica (SG) 1 •  Seed & Pre A
•  500StartUps
•  Kickstart Ventures

•  Digital Healthcare is disrupting healthcare and its stakeholders
•  Technology is driving a new paradigm to create better healthcare
•  EM healthcare will be able to leapfrog its infrastructure limitations
•  New opportunities are opening to shape the new paradigm
•  Is your organisation positioning itself to be a player?
Healthcare is changing dramatically

The Propell Group - ESSEC Business School - Digital Health Innovation

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