The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates

Remaking Health Care With Wearable Technology And Digital Health A VIEW TO THE FUTURE

NOVEMBER 7TH, 2017

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 2

DISCLAIMER

The views presented here are those of the

author, and not necessarily those of his

employer or its affiliates.

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 3

Healthcare

Consumerism…

What’s driving it?

Are consumers engaged?

What is the problem?

What can be done?

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 4

Number of health and wellness apps have soared over past few years…more being developed every day

Sources: 1. Number of Health Apps Soars, but Use Does Not Always Follow, Medscape Sept 18 2015; 2. Examples of Pre-Market Submissions that Include MMAs Cleared or Approved by FDA, FDA

website

mHealth apps on Google

play and App store1>165k

~125kfocus on fitness, lifestyle,

diet and other categories

~40k focus on medical

applications

~220 FDA Cleared Mobile

Medical Applications2

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 5

Wearables industry is expected to double by 2021

Announcements over past few months

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 6

Clinical grade diagnostics are being designed to look like consumer grade products

From the Lab to Home – Increasing the Frequency of Diagnostic Data

AnalyzerCartridges

Test

results in

10 minsLink to

clinicians

Consumer Generated Analytics for the Clinicians

Smart accessories for iPhone to manage common conditions like ear infections

Self

Monitoring

Self

Analysis

Doctor

Review

Sources: Cue; AliveCor; Apple; CB Insights; Frost and Sullivan

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 7

Direct-to-consumer genetic testing is becoming a lifestyle choice

Sources: How many paying customers does 23andMe have? – Quora - Alex Khomenko, Co-founder @ Cureatr; 1st engineer @

23andMe; Helix website

125000180000

500000

650000

1000000

1200000

2000000

2011 2012 2013 2014 2015 2016 2017

Number of genotyped customers by 23andMe since 2011

Other companies

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 8

Setting of care is changing from office to retail and homes

Sources: Why We’re Picking Walmart And CVS Over Doctors’ Offices, Huffington Post 2015; Healthcare 2.0, CB Insights July

2016

Telemedicine is increasingly being offered as part of basic medical

coverage

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 9

Healthcare

Consumerism…

What’s driving it?

Are consumers engaged?

What is the problem?

What can be done?

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 10

Healthcare is at a pivotal point due to multiple converging factors

Lack of Access

to Care

Technology

Availability

Access to New

Funding

Increasing

Healthcare Costs

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 11

U.S. spends 17% of GDP on healthcare but ranks last among wealthy countries on quality

Life expectancy vs. health expenditure by countries,

1970 - 2014Overall healthcare quality ranking,

2014

Sources: "America’s inefficient health-care system: another look“, Lane Kenworthy; K. Davis, K. Stremikis, C. Schoen, and D. Squires, Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care

System Compares Internationally, The Commonwealth Fund, June 2014.

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 12

Employers carry a large share of the costs and are passing them on to employees

Sources: 2017 Milliman Medical Index, http://www.milliman.com/mmi/

43%57%

Employees Employer

Cost sharing between employers

and employees, 2017

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 13

While over 50% workers are enrolled in high deductible plans, there is a general lack of transparency in cost of care

Sources: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2006-2016; A knee replacement surgery could cost $17k or $61k. And

that’s in the same city, Washington Post January 21, 2015

10%12%

18%

22%

27%

31%34%

38%41%

46%

51%

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Percentage of Covered Workers with an Annual Deductible >

$1,000, 2006-2016

Lack of transparency in cost of care

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 14

Increasing number of consumers don’t have access to basic care

Sources: KCMU analysis based on HRSA Designated primary care health professional shortage area statistics as of Aug 12, 2014 and the March 2014 annual social and

economic (ASEC) supplement to current population survey (CPS); “Why our health matters”, Andrew Weil

It is estimated that by 2020, U.S.

will have a shortage of

• 85k – 90k primary care

physicians

• 1 Million nurses

• 36k geriatricians

• 157k pharmacists

Percent of population residing in primary care health professional shortage areas

(HPSAs), 2014

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 15

Technology is disrupting every industry

2006 2011 2016

Tech Company

$612Bn

$535Bn

$448Bn

$401Bn

$368Bn

$406Bn

$376Bn

$276Bn

$236Bn

$228Bn

$447Bn

$383Bn

$271Bn

$293Bn

$273Bn

Sources: Wikipedia: https://en.wikipedia.org/wiki/List_of_public_corporations_by_market_capitalization#2016

Top 5 publicly traded companies (by market cap)

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 16

The pace of technology adoption is quicker than ever

Percent of U.S. Households

Source: Nicholas Felton, The New York Times: http://www.nytimes.com/imagepages/2008/02/10/opinion/10op.graphic.ready.html

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 17

Cost of technology infrastructure is rapidly declining

Average cost of a sensor today

is ~$0.5

Amazon Web Services

costs ~ $0.023/GB/Month

Cost of decoding a human

genome estimated to

reduce from $1,000 to $100

Source: Decreasing Cost Of IoT Sensors: Will It Accelerate The IoT Adoption? Tin Phan, IOT One 2016; AWS website;

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 18

Since 2014, over $14bn have been invested in digital health by venture capital firms

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 19

“Tourist” investors led over 60% of the deals adding liquidity in the market

• “Tourist” investors

defined as any VCs with <

3 deals since 2014

• Over 110 global VCs have

invested in U.S. based

digital health companies

• 84 funds have only closed

1 deal

• 387 funds with < 3 deals

since 2014 were U.S.

based

Source: CB Insights database

Note: Colors represent

countries from which funding

has been flowing into the U.S.

based digital health companies

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 20

Healthcare

Consumerism…

What’s driving it?

Are consumers engaged?

What is the problem?

What can be done?

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 21

Consumers want engagement in their healthcare decisions

Sources: Frost and Sullivan; * American Well-sponsored survey of 2,019 Americans (2015)

** Cisco-sponsored survey of 6,000 people in 10 countries (2013)

64%

70%

of consumers would see a doctor via video*

of consumers would rather have an online video visit than

an in-office visit to obtain common primary care

prescriptions*

Physicians Patients

2016 Global Survey:

Can patients manage their own health?

40% gap

41%

81%

76%of patients say access to care is more important than

physical human contact with their care provider**

70%of patients would trust an automated device to provide a

diagnosis and determine whether or not they needed to

see a doctor**

74%of patients are comfortable having their health records

available in the cloud, assuming adequate security

(excluding Germany and Japan)**

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 22

But existing tools have demonstrated limited success

Sources: Deloitte Center for Health Solutions Survey of US Health Care Consumers, 2015

Interest in using pricing tools Interest in using technology to monitor a

health issue

Interest in using technology to

support adherence

Very Interested Somewhat Interested Not Interested

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 23

Adoption has not translated to engagement

Sources: eMarketer, Oct 2015; mHealth Engagement Issues Still Stand Between Wearables and Healthcare, Eric Wicklund - May

2016; mHealth and Wearables, Elena Izmailova, Takeda – Feb 2017

U.S. wearable adult users, % of population

10%16%

25%

2014 2015 2016

30%

2017

Drop-off Rates

18% Fitness

bands 22% Smart

watches

Challenges

Unfulfilled

Expectations

Lack of

Meaningful

Insights

Data

Volume

Wearables

Overload

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 24

Enterprise systems have not benefited end consumers

Sources: EHR adoption rates, Practice Fusion; How data is changing healthcare, CB Insights

Electronic Health Records (EHR) adoption rate in the US

40%

48% 50%

63%66% 67%

2012 2013 2014 2015 2016 2017

• Current EMR systems have limited

interoperability

• Most patients don’t know/ can’t

access data that’s relevant for them

• Out of hospital data not well

integrated into current EMRs

• Patients are now generating much

more of their own data which is

seldom used for clinical decisions

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 25

“Evolving” regulations have left consumers vulnerable to false claims

Sources: Mobihealthnews, March 23 2017

• Three mobile health apps, Runtastic, Cardiio, and Matis penalized

by New York Attorney General's office for alleged misleading

claims and irresponsible privacy practices

• The developers agreed to change their labeling and privacy policy

implementation and paid a combined $30,000 in penalties

• First time when state AG office weighed in on potential misleading

advertisement in addition to FDA and FTC

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 26

Healthcare

Consumerism…

What’s driving it?

Are consumers engaged?

What is the problem?

What can be done?

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 27

Successful solutions necessitate convergence of various factors

SYSTEMS INTER-

OPERABILITY

USER CENTRIC

DESIGN

CONTEXTUAL

INFORMATION

CARE

COORDINATION

OUTCOMES

DEMONSTRATION

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 28

Organizations are designed around their core strengths –difficult for one company to deliver everything

USER CENTRIC DESIGN

OUTCOMES DEMONSTRATION

CONTEXTUAL INFORMATION

SYSTEMS INTEROPERABILITY

CARE COORDINATION

Winner of multiple user experience

awards

Compiles temperature, air quality and

humidity data; sends to patients

Enables seamless communication

between PCP and mental health providers

Collects, integrates, standardizes and delivers

data from over 400 digital technologiesTracks consumer biometrics, provides

coaching and help form healthy habits

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 29

Even innovation pioneers learned it a hard way…

Example – 23andMe

Sources: Genomics: the next phase of personalized medicine, CB Insights

• 23andMe was one of the first

companies offering consumer

focused genetic tests to

determine predisposition for

certain diseases

• Fell behind on communications

with FDA, resulting in temporary

ban

• Took more than 2 years to secure

a green light from FDA to screen

for 10 diseases

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 30

Healthcare

Consumerism…

What’s driving it?

Are consumers engaged?

What is the problem?

What can be done?

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 31

Start with a user-centric product design that is built for your specific consumer need

• Leverage user-centered design best practices but

also adapt those to your patient population…one

size does not fit all

• Resist feature creep

• Provide control to patients for sharing their

information with other stakeholders

• Conduct iterative testing for a number of use cases

• Be ruthless and strip out any unnecessary

functionalities

• Show vs. tell

Example – Hatch Baby Products (Winner of multiple

user experience awards)

Sources: http://app.hatchbaby.com/#sixthPage

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 32

Add context to the information for meaningful insights

Sources: https://breathe.propellerhealth.com/

Example – Propeller Health for COPD

• Adding context to the available

data points unlocks rich insights

• Makes patient – provider

conversations meaningful

• Allows for customization of plan

and impacts outcomes

• Enhances engagement

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 33

Allow interactions…it takes a village!

Sources: Quartet Health (https://www.quartethealth.com/patients)

Example – QUARTET HEALTH

Connect patients to a goal-driven

therapy program

Pair primary care providers with

the best mental health providers

Enables seamless communication

between PCP and mental health providers

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 34

Demonstrate value and results to the consumers

Sources: Woebot - https://woebot.io/

Example – Woebot

• Consumers want insights and

actionable plan, not a

dashboard

• Connect the dots for them and

their providers

• Not interested in underlying

technology but how it improves

their lives

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 35

Recognize the implications of digital innovation in context of ethics and privacy laws

Example – Otsuka

Craig Klugman, PhD

Public Health Ethics, Ethics Education and End of Life Issues

University of Texas, Stanford University

Glen Cohen, JDHealth Information Technologies, Mobile Health, Health Policy

Harvard Law School, University of Toronto

Jack Schwartz, JD

Laura Dunn, MD

Informed Consent, Decision Making Capacity

University of California, Harvard University

Bioethics and Health Law

Yale Law School, University of Maryland

• Prepare on privacy and

bioethical issues

• Act as a resource for customer

questions and concerns

regarding privacy of solution

and terms of use

• Media messaging as it relates to

emerging bioethics and privacy

questions

• Informed consents and ethical

data usage

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 36

Develop robust partnerships

Sources: Validic website - https://validic.com/ecosystem/

Example – Validic

• Develop an ecosystem

• Seamless integration of

various sources of

information

• Value for all stakeholders

• Rich insights for consumers

leading to engagement

• Remove friction - siloes

The opinions expressed are those of the speaker, and not necessarily representative of the views of the speaker’s employer or its affiliates 37

And finally…

Understand that customer expectations change; be ready to listen and adapt!