Digital health news update: A view from Barcelona and Austin

March 28, 2018 Matthew Arnold

Ah, springtime, when a healthcare marketer’s thoughts turn towards conferences! A few folks from DRG Digital were in Barcelona last week. Here’s some of the themes that stood out for them:

  • European pharma leaders are wrestling with recruitment of rare disease patients for clinical trials, and this need is driving a wave of tech-pharma partnerships, including Sanofi’s tie-up with digital clinical trial specialist Science 37. Finding these patients is everyone’s problem within pharma companies, and responsibility for solving it needs to be shared across silos. Addressing the trend of global pharmas hiring chief patient officers, CSL CEO Paul Perreault told EyeforPharma attendees: “I don’t need to hire a chief patient officer – I’m the chief patient officer.” At CSL, it seems, the buck stops there.
  • Another trend our team heard in Barcelona was an increasing skepticism that physicians and other customers care in the slightest about pharma brand marketing efforts. Grunenthal’s global head of commercial excellence, Florent Edouard, put it succinctly when he threw up a slide reading “KILL THE BRANDS.” Grunenthal, he said, is here for their customers, not their brands, and is shifting focus away from promotion and sale of individual molecules in favor of a more customer-centric approach.
  • Of course, getting to that consumer-centric promised land is a different matter than talking about it. IQVIA (nee IMS/Quintiles) reported that around 1 in every 3 of their clients has their sales and marketing teams working together on CRM efforts. A customer experience panel comprised of pharma execs lamented that they have plenty of customer journey maps, but most of them are poor quality – a none-too-subtle way of elbowing their agencies and consultancies to get better at understanding the CX.
  • The culture clash between a promotional legacy rooted in direct sales and the increasingly multichannel, multi-customer present continues to roil the pharma industry. Teva’s head of human channels, Davidek Herron, shared that he’s had some candid conversations with the company’s reps about getting with the digital picture. The message? If you can’t adapt to using new technologies for communicating value to your HCP customers, you might not belong here. Tough love, but Manhattan Research data on how physicians view sales reps supports this view.
  • On a more positive note, our team heard many examples of tech-pharma fusion, all centered on patient outcomes. One standout: Takeda’s president of Europe and Canada, Giles Platford, discussed a partnership with Sivan Innovation, the Israeli startup that created Moovcare, an app that can serve as an early warning system for relapses, alerting oncologists based on self-tracked patient data. In a randomized clinical trial, Moovcare increased median overall survival by 58%, and Takeda and Sivan have begun to explore applications for other cancers.

That tech-biotech convergence was, well, looking a little more awkward down in the land of brisket and Bitcoin, where the biohacking, nootropics-huffing move-fast-and-break-things crowd had little patience for the plodding regulatory tracks their biopharma fellows have to lap in order to get new therapies approved, according to a Stat report from SXSW’s health track. And in another neon-tinted color piece from SXSW, MM&M said “Speculation ran wild about how Amazon, Berkshire Hathaway, Walmart, Blackstone and the like might go about attempting to transform the health ecosystem.” Heated speculation, nothing in the way of answers, but a clear theme: Nobody’s expecting government to step in and fix the U.S.’s convoluted system of healthcare payment and provision, so hopes – and, for healthcare industry incumbents, anxieties – are high as a host of tech behemoths tinkers away at solutions.

PM360 heard a lot of buzz at SXSW around reinventing the PHR, what with Apple wading into that space in a big way and partnering with 13 health systems in a deal that the Harvard Business Review says “could herald truly disruptive change in the U.S. healthcare system” by “liberating health care data for game-changing new uses, empowering patients as never before.” Pharmas are partnering with tech giants, too. “ It seems more and more that tech giants are the partners of choice for traditionally risk-averse big pharma companies—if they are going to get their feet wet in the world of digital innovation,” reports PM360, noting J&J’s announcement of a joint venture on surgical robotics with Alphabet at SXSW, as well as Roche’s recent acquisition of Flatiron Health and Novartis’s joint venture with Qualcomm.

Beyond the cloistered confines of the health track, SXSW is all about the boffo gimmicky stunts by tech giants (oh, and also something about bands?). This year’s Google Assistant-driven house, an expansive two-story, connected-to-the-rafters Victorian in downtown Austin, did not disappoint, and though it was more about turning on the lights than staying on top of your medication regimen, it gives you a sense of just how transformative this emerging field of technologies will be for healthcare.

That was kind of the gist of a HIMSS keynote by former Google/Alphabet boss Eric Schmidt, who envisioned how virtual assistants would change the consult by automating the task of transcribing patient-physician dialogue and pouring the resulting structured data into EHRs borne on HIPAA-compliant clouds. Schmidt envisioned “Dr. Liz (imagine if Siri or Alexa had gone to medical school)” extrapolating clinical insights from the resulting data to support the physician’s practice, thereby wrenching a healthcare system still wedded to faxes and pagers “out of the Stone Age.”

And in non-conference-related healthcare news:

  • Google/Verily was able to discern hypertension and risk of cardiovascular events algorithmically, based on retina scans fed into neural networks, the company announced. Though the algorithm could not quite match conventional methods for accuracy, you can imagine how this technology could come in handy in a few years when we’re all wearing smart glasses or using our camera phones as retina-scanning keycards.   
     
  • Health insurance giant Cigna announced plans to buy PBM kingpin Express Scripts for $52 million. It’s the latest shoe to drop in an Imelda Marcos’ closet of consolidation, as everybody in the drug distribution and payments game gets ready to go up against the likes of Amazon. What does it all mean? Per Forbes’ Matthew Herper: “A year ago, two of the three largest PBMs were not part of a health insurance company. Now, they all will be.”
     
  • Cigna, incidentally, has launched an Alexa Skill, Answers by Cigna. It’s basically a natural language FAQ that can answer 150 common queries -- -- for example, about what a premium is, or how a formulary works.
     
  • MM&M has a look at how video game design and augmented reality are revolutionizing medical training and education.
     
  • UnitedHealth and Walgreens are collaborating on a string of urgent care centers to be collocated with Walgreens stores. They’re starting small, with a 15-location pilot, but it fits with UNC’s Optum unit’s retail approach, says Forbes, which “also includes urgent care facilities, ambulatory surgery centers, doctor practices and related locally-based community health clinics.”
     
  • Blue Cross Blue Shield’s umbrella group is partnering with Lyft, CVS and Walgreens on a population health initiative aimed at addressing “transportation and pharmacy deserts,” recognizing that 60% of health outcomes “are driven by social determinants of health” like lifestyle and environmental factors, according to the BCBS Institute.
     
  • The bottom line behind the ride hail/retail pharmacy mash-up is that in the U.S., zip codes are a pretty good proxy for health outcomes. That’s the logic behind Aetna’s bid to make CVS the new front door to America’s healthcare system.
     
  • Akili cofounder Adam Gazzaley says the developer’s soon-to-be-filed-with-FDA game to treat ADHD works less like a behavior change program than a drug, “in that it works on the network level to change how the brain processes information.”
     
  • FDA is talking tough on PBMs, blaming “a rigged payment scheme” between them, insurers and pharmas for keeping biosimilars off the market. Meanwhile, UnitedHealthcare said it will share more of the rebates it gets from pharmas with consumers. The argument here is essentially that pharmas give rebates to PBMs – “Since you’re such a big customer, I’ll give you 7% off list price if you give our drug a better formulary status” – and the PBMs or their employer clients fail to pass the savings on to the consumer. Companies considering developing biosimilars shy away, seeing little opportunity against competitors that have essentially bribed the distributors and payers into granting them unassailable incumbency.
     
  • Here come the “copay accumulators,” programs in which insurers place a ceiling on patients’ use of copay cards and coupons, and patients are getting caught in the crossfire and socked with medical debt as a result. As MarketWatch notes, “at least four pharmaceutical companies, including Pfizer, Amgen and Sanofi, have brought up these new initiatives …. In financial filings made in the last month, with most naming them as risks.” And speaking of patients as “collateral damage” in the pricing wars, read the estimable must-follow Matt Herper’s great, sobering read on PCSK9 inhibitors.
     
  • And our friend Rich Meyer has some thoughts on the structural and cultural reasons that sales is in the driver’s seat within pharma. A sample: “Let’s be honest: pharma can say they are patient centered all they want, but the truth is they have been and will be sales driven.”

 

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