Cracking the commercial code in digital health

The article notes that failure in digital health is the norm, the successes few. Innovating in this space is hard on multiple levels. Even if a solution survives internal incubation, its demise too often comes in the ‘wild’ thanks to a range of issues that might include patient apathy, health system inflexibility, payer indifference or physician overload.

Beyond general healthcare ecosystem complexity, the proximal reasons for this lack of success to date are worth exploring before we examine the way forward.

Pharma set, and in some cases retains, unrealistic expectations. Digital evangelists rushed to make promises that health technology would be revenue generating. While few now expect that digital health solutions will now be significant stand-alone revenue generators, the belief that they might serve to shore up mature or declining franchises dies hard.

Digital hires didn’t fit culturally

Elizabeth said that developing successful digital health solutions typically requires colleagues with very different cultures and mindsets to collaborate effectively and share a common approach but this often didn’t happen.

Pharma executives or regulatory colleagues used to developing a strategy for molecules typically have had very different world views to those tasked with developing medical devices or digital colleagues developing app interfaces.

If this all sounds overly negative towards the industry, it is not meant to be. Pharma shares the scars of battle with dozens of failed digital health startups. Large-scale independent successes have also been few to date, despite significant venture backing in the sector. Digital health solutions often require deep changes in the way care is delivered, with benefits that take time, often years, to demonstrate.

Even apparently successful pioneers have foundered for want of a sustainable business model. Just look at Pear Therapeutics, which filed for bankruptcy earlier this year despite having three FDA-cleared prescription digital therapeutics (DTx) apps.

Despite the failures, opportunity abounds

Pharma is emerging from a period of reflection and disillusionment about its effort/reward ratio in digital health. Despite the scarcity of solutions that have achieved large-scale commercial impact so far, digital solutions are in use to great effect across a range of therapy areas and there is much useful experience to be learned from here. Examples include digital/drug combinations such as Propeller Health’s asthma inhaler companion or connected pill bottles.

In order to build on these opportunities, however, pharma will need to ingest and apply the lessons learned so far from attempts to develop and deploy digital health solutions. The industry is closer to mastering data gathering skills and defining how to choose appropriate biomarkers and endpoints. It has learned much about gathering data from wearables, working with patients, using AI and harnessing real-world data but there is more to do.

Elizabeth said that it's essential to foster close cross-functional team development. Building teams that cross functional silos and who clearly communicate what they each need for a solution to work is key. 

A range of measures might include: adherence improvements; real-world data (RWD) enabling better pricing and reimbursement; quality of life improvements; other care cost savings made; reduction in hospitalisations or the number of follow-up visits or both.

From patient centred to ecosystem focused

Pharma’s evolution towards putting the patient at the centre of its mission, as important as that is for future success, is necessary but not sufficient when it comes to digital health.

In digital health it’s not just about the patient. The complexity of the healthcare ecosystem and the need to gain buy in from multiple stakeholders with varying and even clashing incentives is perhaps the chief barrier to pharma’s attempts to achieve commercial impact.

Elizabeth said that this demands that new development programmes are now built with the entire healthcare system in mind. Incentivising patients to engage over time must also be matched with incentives for physicians and payers.

She adds: What reward do they get in return for the time taken in engaging and for providing the data required of them? Are they being asked to download yet another app or login to a new portal? “No physician wants a new workflow or a higher workload. Payers are looking for ways to lower costs but this has to be integrated into healthcare workflows. If a solution is not integrated in this way, it will have adoption issues. “As well as being efficacious, a digital health solution has to lower the total cost of care and it will be necessary to quantify the value of delivery very closely - now as well as down the road. Payers will be looking for an immediate ROI.”

One template for how to develop such an ecosystem-first approach is the DTA’s DTx Value Assessment & Integration Guide. Elizabeth notes that although this is specific to digital therapeutics, it may serve as a useful template for a wider array of digital health solutions. “It has a useful checklist of evaluation considerations, such as clinical impact, usability, economic assessments and so on that you can use to help cover off on blind spots. Few companies can hit all those marks first off, and this offers a way to be more rigorous.”