Success with biotech or medical devices can often be found through teams of functional experts following established development, clinical, regulatory, reimbursement, and commercialization pathways to market. If every stage of that pipeline or funnel is well executed, there’s a good chance something positive will come out the other end. Not so with digital health, and as such it requires a different approach.
The value propositions in digital health are not as universally understood by customers; the clinical, reimbursement, & sales pathways not as well established; and the specialists developing them often not as aware of how interdependent each part is to the whole. This means it’s all the more probable — and riskier — that something that should have been conceived at the beginning will adversely limit commercialization at the end; or that a commercialization constraint at the end will undermine a brilliant vision conceived at the beginning. What is needed instead is a holistic vision, from beginning to end.
If traditional healthcare commercialization is akin to a pipeline, whereby each stage leads to another toward commercial success, digital health is more akin to putting on a symphony. One has to orchestrate the right balance of strings, woodwinds, brass, and percussion for the desired outcome. Failure to develop or adapt any one section from start to finish will result in poor sheet music that may not find a resonant sound or an audience. Strong multidisciplinary vision and leadership becomes all the more critical.
There are five parallel processes — or sections to the orchestra, if you will — that I’ve used in my framework for digital health planning and commercialization. The key to success lies in addressing all five, consistently and reiteratively through all stages of development from concept to scale.
1. Follow the evidence
Clinical evidence has been growing and compelling across several disease states that digital health can lead to better outcomes, especially when paired with a therapeutic solution. While HCPs might well care about improved outcomes, that alone often does not translate into a commercially viable proposition.
What is often missed with digital health is there are distinct and diverse stakeholders within a healthcare system beyond traditional partners like HCPs and Pharmacy that also need to be brought on board — Quality Improvement, Informatics, Telehealth, and Customer Experience, to name a few. The evidence must speak to them as well. This means looking outside traditional clinical endpoints of efficacy and safety and towards those that include efficiency improvements, patient retention, readmission rates, and IT requirements. White papers and case studies can be particularly effective with such audiences, and should not be overlooked.
With healthcare costs approaching 20% of US GDP, new products that don’t demonstrate value or a reduction in costs face especially steep hurdles to adoption when working across such a diverse set of stakeholders. The smart money is in its potential to reduce costs — catching symptoms early to reduce readmissions, personalizing care to minimize unproductive courses of treatment, and saving staffing time and overhead.
A digital health product’s value proposition should align to the available evidence and its stakeholder’s interests; or better yet, should be designed with multiple endpoints in mind to support a diverse and viable value proposition. If the evidence is not fully available or supportive of a particular stakeholder’s interests, alternative strategies may be needed to facilitate adoption.
2. Follow the clinical workflow
During a 4-day hospital stay, a patient may interact with 50 different employees, including physicians, nurses, technicians, and others. Given the complexity of clinical workflows and handoffs, it only takes one — a short-staffed nursing coordinator, for example — to derail an otherwise elegant and useful digital health solution.
Too often, digital health products are designed and validated with KOL input in a clinical trial setting but are expected to succeed in community settings where decision-making authority and support systems are not the same. A digital health solution should be developed for the latter as much as the former, especially for scale.
It will also anticipate the needs and workflows not only of the therapeutic specialist– but also all other adjunctive departments that may be expected to touch it. For example, I experienced firsthand the difficulties of commercializing an AI diagnostic for pulmonologists where radiology proved to be a key gatekeeper. Although the pulmonologist was deemed the primary user and customer, it needed to be optimized to radiology workflows, PACS systems, and expectations. In another case, the implementation of a promising remote monitoring device that had the physician’s enthusiastic support was derailed by office managers who reported to a different group and were not equally incentivized to staff and monitor it.
No matter how compelling the science, if the digital health product you’re selling is a square peg to a round hole in the clinical workflow, it stands a poor chance of adoption. Some of these issues can be addressed through design changes; others through sales and support processes. The key is to attune to them early and often by staying close to our customers’ clinical workflow.
3. Follow the patient
Digital health patient journeys must consider not only their disease state but also their journey in relation to the technology. Design and processes need to be addressed early in development so that the solution matches the patient journey, not the other way around.
This includes asking questions such as: At what point exactly will the patient get engaged with the digital health solution — at the start of the appointment or near the end? Will they be expected to download or fill something out themselves, or will someone help them do it? How will they remain engaged, from the first point of contact through the second, third, and beyond? How will a product that works for technologically savvy patients — but not others — be received by the healthcare providers responsible for administering it?
Solutions that integrate well with the patient’s journey and enjoy strong patient pull-through can go a long way to ensuring its success, particularly if there is a lift required on the clinical side as well. But it is not sufficient to assume that a patient will choose to adopt or remain engaged with digital health just because it is in their interests or their doctor has ordered it. Some of the most effective practices on digital engagement from consumer products like social media have not yet been fully embraced by digital health, and are worth a closer look.
Data privacy and the role of data processors (in the case of the GDPR) have to be maintained while being relatively painless for patients and clinical staff alike. A large number of patients do not respond positively to their health data being tracked, even with privacy safeguards, and may need to be engaged in more creative, less threatening ways.
Finally, digital health solutions should be designed to be painless for patients to adopt, available when they need it, and in a manner they’ll use. QRC codes are one example of a solution that integrates smoothly with a patient’s journey, provided they are presented at the point of care. Expecting patients to take steps before or afterward significantly decreases its adoption, and may frustrate the providers as well.
4. Follow the money
There has been much said about reimbursement schemes such as CPT codes for RMD/RTM in the USA and DiGA in Germany. While these have a place, I do not believe many of the most promising opportunities lie solely with stand-alone reimbursement. The rates are too low, and the requirements too cumbersome to make for a viable, long-term business model.
Rather, the business model for digital health lies in its value as part of an integrated solution — for example, an AI diagnostic that predicts response rates to a particular medical device or a remote monitoring app that improves outcomes for a paired biologic. In such cases, the value of digital health can be ascribed to savings to a health system, more personalized and effective use of a therapy, and reduced waste. The value creation and propositions from such integrated solutions are in the billions, as opposed to in the millions for stand-alone digital health reimbursement.
This will require following the money in new and creative ways. For example, towards capitated models where the cost of digital health and associated therapeutics are brought under one umbrella. Or risk-sharing arrangements and rebates between industry and providers, where the promise of digital health can be uncovered by how much they complement a given therapeutic to yield desired savings or outcomes.
5. Follow the sales channel
Finally — and this I believe is often missed by the brilliant academic minds working on digital health today — someone is going to have to work with providers, patients, and healthcare systems on the ground to make the product work. Even if the product is designed to integrate seamlessly with clinical workflows and patient journeys, there’s an old adage that “when you’ve seen one healthcare system, you’ve seen one healthcare system”. To be successful, digital health solutions need to be integrated at the local level, often with an individualized understanding of that particular customer’s workflows and systems.
This requires a sales channel that can execute digital health effectively and consistently. In some cases, having strong Subject Matter Experts (SMEs) working closely in tandem with an established sales force can work, but that requires seamless collaboration that doesn’t place an undue burden on the customer. Generally, the fewer cooks in the kitchen, the better. In other cases, the solution may lie in having the digital health solution so closely integrated with therapy that support and implementation naturally follows existing processes. Alternatively, the product could be designed with special attention towards deployment, such that it stands a better chance of working within existing sales channels.
Most startups don’t have large enough or multidisciplinary teams to effectively market and sell digital health on their own. And many larger industry players have entrenched sales channels that don’t pivot or adapt easily to the unique requirements of digital health. Those companies that manage to partner or adapt to successfully complete the final mile in healthcare delivery will be the most likely to succeed.
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Alex Alviar introduced one of the first integrated solutions in digital health, comprising an AI diagnostic paired with a therapeutic solution. He has also consulted to several startups in digital health, and experienced the successes — and failures — of launching digital health in a variety of global markets.
Tesseract Ventures 