Pharmaceutical companies are becoming more deeply involved with a side of healthcare that has traditionally been the purview of medical devices companies. With the introduction of connected devices, pharmaceutical companies are preparing to transform from solely treatment manufacturers and providers to integrated healthcare solution providers, opening up a new world revenue opportunity. For example, Boehringer Ingelheim and Propeller health are developing connected smart inhalers and provisioning digital services. Medical Design & Outsourcing spoke with Vaishali Kamat, head of digital health at Cambridge Consultants, to explore this trend.
MDO: Can you explain how pharma is breaking into the digital health market, which is traditionally a medical device vein?
VK: Most pharma companies made their initial foray into digital health by launching their own apps, primarily as marketing and education portals. Some got good reception from consumers, but the market uptake of such apps has not been comparable to other third-party apps for disease management or consumer apps accompanying wearable devices.
In the past year or so, we have seen several pharma companies get interested in connected drug delivery devices, with which they can track drug usage and monitor adherence to therapy. Most of these devices have an accompanying app that may include features to influence and improve adherence or capture other data relevant to the individual disease. More recently, these companies have become interested in the use of consumer devices like activity and sleep monitors to obtain additional information about patients from their daily lives. Such tools help the companies gather evidence of disease progression or outcome of therapy. This trend is resulting in non-traditional partnerships with consumer companies; for example, Novartis and Microsoft working together to monitor MS patients using the Kinect platform and Biogen Idec using FitBit devices for gait assessment.
When it comes to connected devices and wider data platforms, different pharma companies are taking different approaches. Some are relying on short-term, third-party partnerships as they test the waters, while others are adding significantly to their in-house resources based on the belief that they will need strength in this field over the long term. Some small companies have been successful in developing a focused solution. Propeller Health, for example, has concentrated on inhalers for respiratory diseases and partnered with several pharma companies like Boehringer Ingelheim and AstraZeneca. Other large technology players, such as Qualcomm Life, are also vying for a slice of the pie by providing a wider data-handling platform suitable for a range of applications. Given that this is not a core competence within pharma companies, it makes for a symbiotic relationship and a quicker path to conduct clinical trials.
Thinking further ahead, several companies have recently partnered with IBM Watson Health to access its analytics platform and capabilities, to start extracting insights from the data collected.
MDO: What is the drive behind these companies wanting to develop digital solutions?
VK: There are a few key drivers behind the rush for digital solutions. For one, the need to engage patients and consumers with digital technology is a priority. Consumers are rapidly developing expectations of data from the healthcare industry. Moreover, with the ever-increasing competition and the threat from generics as well as the lack of mega blockbuster drugs, engaging consumers to retain loyalty has become important in order to maintain revenues. Providing a wider healthcare solution, rather than simply a drug is seen as a potential avenue to providing greater value and improving outcomes, so as to justify desired pricing of the therapy.
In addition, the technology needed, (e.g., sensors, connectivity, wearables) is available and accessible at an affordable cost point. The penetration of smart phones across the globe means that pharma companies now have the tools required to deploy smarter digital solutions.
And of course, we are seeing a move toward outcome-based payments. The pressure of increasing healthcare costs has led to significant changes in the industry, especially in the US market. With the Affordable Care Act coming into effect and enforcing penalties on readmissions, bundled payment schemes, creation of accountable care organizations (ACOs) as well as the advent of payments based on performance of therapies, there is a pressing need to do more than just get a drug on the market. Pharma companies will need to provide solutions that can improve or influence compliance to therapy, track specific biomarkers, or provide companion diagnostics that can track effects of the therapy and provide evidence of the therapy working (or not) in the form of improved outcomes. Novartis recently signed the first-of-its-kind risk-sharing reimbursement deal with two major private insurers in the US for its new heart failure drug, Entresto. It is a sign of things to come.
MDO: Have pharma companies figured out what is really involved in deploying a successful digital health solution?
VK: The answer is unclear as of now. Several pharma companies have made public announcements about trials with connected devices or using other digital technology for tracking patient metrics, but not many have yet outlined a clear commercial strategy or roll-out plan. This is perhaps because it is still early days or perhaps because they haven’t yet figured it out. Time will tell.
We continue to emphasize the importance of thinking before doing – it is critical to formulate a longer term strategy, really figure out what value proposition can be delivered to various stakeholders, and consider the end-to-end solution, before jumping into a specific device or app development.
MDO: What skills and expertise will they need to handle connectivity, data capture and data access?
VK: To develop a digital health solution that can gather required data without being a burden and help rather than hinder, requires strong user-centered design techniques. Careful thought is required to develop elements that will make a user stick with a particular solution. Pharma companies need to consider how to simplify patient’s lives and still ensure desired behavior. Not all users and conditions are the same. Significant amount of research has been undertaken in behavioral economics – it is important to understand the key drivers that are relevant to your target user population and design the solution and user experience accordingly.
For custom development, technology expertise in both hardware and software is critical, specifically elements such as choice of chipsets, the data model, and software architecture to enable a scalable and secure solution. The regulatory bodies are paying close attention to the security measures built into solutions, thus appropriate levels of access controls for various types of users must be implemented and strong authentication methods built in without burdening users.
Pharma companies also need to recognize the change in mind set required to deal with digital health solutions. The pace of change in technology as well as user preferences is much higher than these companies have been traditionally used to. It requires a different approach to managing and handling risk, as well as a slightly different regulatory and development strategy. Mobile devices changes at a much faster pace than medical devices and thus the solutions being developed will need to be robust enough to adapt or to be modified easily in order to withstand changes, e.g. in the OS or handset. More importantly, the approach must be one of launching a minimally viable solution, learning from it and iterating rapidly. This is critical to deliver and maintain a successful digital service.
Delivering a digital health product is much more than just developing the connected device and app. It necessitates a change to the organization, and outlook, as well as additional capabilities in functions such as IT and customer service. You now have a direct connection to the end user, like never before. That is a privilege as well as a responsibility.
MDO: What are the key ideas that such companies should keep in mind as they look for contract expertise?
VK: The most important aspect to look for in a contract firm is prior experience – someone who has been there before, understands the pitfalls, and can articulate a strategy to tackle the various aspects of delivering a solution.
Pharma companies should ensure that any partners they choose understand the market just as much as they understand the technology, so that they can provide well-rounded guidance for end-to-end development.
Developing a digital health solution requires a complex balance between user requirements, performance, cost, time to market, etc. Thus, a firm that can bring various skillsets (e.g. design, engineering, software, human factors, etc.) to bear will be a better choice, rather than one that is just good at one thing like IT.
Getting an independent opinion on third party technology solutions – such as a cloud service platform or connectivity solution – prior to engaging in a deal would be prudent if in-house skills are not available to sufficiently vet potential partners.