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DIGITAL HEALTHRecommendations for a sustainable
transformationApril 2019
2DIGITAL HEALTH
Recommendations for a sustainable transformation
#1Digital health promises
INTRODUCTION
Digital technologies, without a doubt, bring great value to the healthcare sector and their use is
a hot topic in the industry. “Transformation”, “revolution”, and “disruption of traditional care
pathways” are all words that come to mind.
Relying on its promised potential, investments in innovative digital health projects have exploded
in the past five years. Yet, few solutions have managed to find their market, and huge successes
are rare. France must address this challenge, from a regulatory, legislative, and economic
perspective.
In this publication, we highlight obstacles to the development of digital health in France and
propose recommendations for its sustainable development in the French territory.
Digital health is defined as "the application of
Information and Communication Technologies (ICT) to
the field of health and well-being"1. Under the guise
of a health transformation promise and more
generally of the patients’ care transformation,
digital health occupies an ever more prominent place
in today’s debates. It has gradually become an
unavoidable topic as it addresses several issues:
patient empowerment, P4 medicine* development,
homogeneization of the access to care... It impacts
the entire health ecosystem from pharmaceutical
industries to public authorities, health professionals to
patients, who are at the heart of this turmoil.
Digital health is a breeding ground for innovation.
Many development projects have been conducted
due to the significant investments. The total amount
of digital health investments has annually
increased by more than 30% since 2011, and the
number of deals has been multiplied by 3 [A].
INTERNATIONAL FUNDING DYNAMICS OF DIGITAL HEALTH2
Fundingamount (M$)
Number of deals
A
* Predictive, Preventive, Personalized, Participative
The place of France in this ecosystem remains minor.
The amount of funding in digital health reached
€395M in 20173. However, examples like Doctolib
or Alan (see following pages) are genuine successes
for new entrants in the digital health sector. They are
the main drivers of this transformation.
Giants of the tech industry have also seized
digital health. GAFAM(*) and BATX(*) have massively
invested billions of dollars to transform the way care
is provided or financed4. They have also
approached French players several times. For
example, Sanofi and Google have been working on
new solutions for diabetic patients, leading to the
creation of a dedicated joint venture: Onduo.
Perceived as a serious threat to historical healthcare
players, tech giants bring unprecedented breadth to
digital health internationally. They are also pushing
European and French players to "ramp up" on the
digital issue in the broad sense, in order to protect
their sovereignty.
As a result, market estimates for digital health are
optimistic. For example, Roland Berger recently
published a quantitative analysis of the digital
health market estimated at $79 billion in 2015 and
$206 billion in 2020, which represents an annual
growth rate of 21%5. These figures encourage both
innovators and investors to take on the challenge of
digital health.
FACTORS OF DYNAMIC IN DIGITAL HEALTH
B Technological development
(algorithms, computing power,
sensors, medical devices ...)
Increasing adoption of
digital by professionals
and patients
Unprecedented increase of
health expenditures
Need for life course and patient
experiences improvement
Willingness to develop an
egalitarian care system
Several factors explain this spectacular dynamic.
Health spending is exploding at a global scale and
is an increasingly important part of GDP, especially
in the most developed countries. Due to this
challenging financial context, many countries seek to
optimize the system of care without compromising its
quality, turning to new solutions such as digital
health.
Technological maturity (algorithms, computing
infrastructures, sensors, medical devices, etc.) is also
a strong factor. This technological expansion has
gradually democratized the use of digital health
solutions for patients and professionals, but much
remains to be done.
For example, the Villani report published in 2018
states, "AI opens up new opportunities for constant
innovation in French pharmacopeia by building
diagnosis and therapeutic strategies that are more
adapted to the patient's needs, environment and way
of life."6
* GAFAM : Google, Amazon, Facebook, Apple, Microsoft
* BATX: Baidu, Alibaba, Tencent, Xiaomi
3DIGITAL HEALTH
Recommendations for a sustainable transformation
#2Major constraints
Digital health also promises to provide equal access
to care by contributing to the creation of a
sustainable offer for all. Finally, it allows the
imagination of higher quality but less traumatic life
paths and experiences. This is true for both patients
and caregivers.
These five development factors [B] explain the
dynamics of digital health and respond to strong
public health and medico-economic challenges. The
clinical situations that can benefit from digital
contributions are abundant. All stakeholders in the
ecosystem are impacted by these benefits.
Need and demand are noticeably two different
things. Despite many relevant initiatives, the
promised digital "disruption" of healthcare struggles
to take shape. One of the best indicators of this
inertia is the small number of start-ups that have
developed an autonomous and sustainable activity
by offering digital services to the health ecosystem.
Many stakeholders hope that we will soon stop
referring to "digital health" but simply to health, the
same way we stopped talking about "digital phone"
or "digital camera". Nevertheless, there is a long
way to go before imagining a large-scale adoption.
Five constraints limit the development of digital
health despite positive and encouraging signals.
The "gadget" effect
The first of these constraints is related to the very
nature of services delivered. Many digital solutions
have been identified (sometimes rightfully) as a
"gadget" without a real calling.
This feeling, shared by both professionals and users,
raises many doubts as to the usefulness and
establishment of an actual service provided by
digital technology. The absence of a label and less
stringent controls than for health products (medical
devices or drugs) reinforce this impression.
The proliferation of solutions contributes to this
"rough" aspect of the digital health ecosystem. For
example, of the more than 300,000 mobile health
apps available today, the vast majority are services
targeting consumers with no proven medical
benefits7. For such services, the risk of "gadget"
effect is greater.
Technological focus
The second constraint relies in solutions themselves.
The exponential development of increasingly
accurate sensors or ever more efficient algorithms
push those who innovate to develop solutions with
substantial technological components.
Doctolib is the European leader in online and mobile
booking. The company raised €61M in 2017, the
record of the year in Europe. The service brings
together 45,000 healthcare professionals, 800
partner institutions and 16 million visitors per month
in France and Germany.
In July 2018, Doctolib announced the acquisition of
the platform MonDocteur and became a pioneer of
the digital health market concentration in Europe. In
March 2019, it becomes a French unicorn, joining the
select club formed by Vente-Privée, Blablacar and
Deezer.
4DIGITAL HEALTH
Recommendations for a sustainable transformation
These developments are sometimes made at the
expense of a real understanding of future
prescribers’ or users’ needs and expectations. Such
solutions rarely meet their market and, when they do,
it is very often short-lived. While France can boast
about having developed a dense network of
technically innovative start-ups, profitability remains
a fiction for almost all of them.
The partitioning of expertise
The third constraint is related to a difference in
perception and agility between healthcare
companies and digital start-ups. These differences
can be observed at different levels, such as the
development schedule. Developing a new therapy
takes between 10 and 20 years and costs between
1 and 2 billion Euros**. This data shows a glaring
discrepancy with digital solutions, which are much
less expensive and more agile. In addition, where a
drug is developed in a linear fashion once the
candidate is identified, developing and updating a
digital solution is iterative. The regulatory
environment, as it is built today, also poses many
constraints in terms of evaluation and timing. This
calendar is often impossible to follow for a start-up
that must quickly test and prototype a solution in its
market.
The difference of perception is finally observed on
the economic level. From the laboratory’s point-of-
view, sales of digital solutions cannot be as high as
those generated by a “blockbuster” molecule.
The lack of substantial evidence
A fourth major constraint is the ability to demonstrate
the positive impact of the use of such solutions, and
this is critical. Due to remaining doubts and the slow
adoption of digital health, companies operating in
this area struggle to demonstrate through clinical
studies the benefits of their solutions.
A digital health solution will be considered as a
medical device. It is therefore imperative to
anticipate a research and development effort similar
to the standards of this industry and not to that of
mass consumption. These standards lead to long and
costly studies which require specific expertise.
The absence of payers
The fifth and final constraint to the development of
digital health solutions is the absence of clearly
identified payers. Initiatives that have successfully
taken steps to support a public health system are
rare. Those who rely on a model where the patient
pays out of pocket access to the digital service are
even more so. This is particularly true in France
where it is difficult to imagine paying for prevention-
oriented solutions. In addition, many initiatives are
offered for free and are essentially unprofitable.
The main payers who are ready today to invest in
these solutions are either private ones (insurance,
mutuals, ...) or the patient himself. Encouraging
signals showing a willingness to publicly support
digital solutions in telemedicine have, however, been
expressed. The question about who pays for these
solutions is essential and determines the definition
of a sustainable and autonomous economic model.
** Depending on the actual cost of new molecule development, the order of
magnitude of the Bn€ is globally accepted.
Alan is a digital health insurance start-up. In 2018,
the company raised € 23 million.
Alan's proposal is to significantly simplify health
insurance contracts for employers and the self-
employed. One of the major aspects of this
transformation is the 100% digitization of services
for beneficiaries.
5DIGITAL HEALTH
Recommendations for a sustainable transformation
Digital health is a great driver of innovation and
improvement in the supply of care. The full
development of this transformation can only be
achieved on the ground by allowing players from this
ecosystem (from start-ups to large groups) to better
integrate, accelerate their development and
imagine innovative business models. 3 key pillars
of particular interest can be imagined. [C]
#3At the dawn of a new era for healthcare
PILLAR 1: Digital awareness forhealth purposes
The use of digital health represents an excessively
wide range of solutions that may have very different
goals. The "gadget" effect that is often pointed out
undermines the credibility of health solutions in the
strict sense. It is imperative to consider digital as a
vector of genuine health benefits and not as an
accessory. Such benefits will be more easily
demonstrated in medical contexts rather than in
mainstream prevention. Once digital health is proven
to be useful and effective in such environments, it will
be easier to generalize it for everyone. Beginning
by demonstrating the impact of digital health on
patients and in a clinical context is key for its
gradual adoption.
Professionals (doctors, pharmacists, nurses, ...) have a
key role in the credibility of digital technologies in
the hospital but also in community medicine. Their
involvement is a key success factor to the
development of digital health. Healthcare
professionals must be enlisted at two levels:
– The first level is contribution (alongside
patients) to the development or validation
of the solution.
– The second is involvement in the business
model to facilitate market buy-in.
Getting the support of physicians and taking the
input of pharmacists into account are key levers for
legitimizing digital health. It is a way of
demonstrating its greater potential and a way of
obtaining the acceptance of all relevant
stakeholders. The development of specific labels to
build legitimacy is another key lever.
WeHealth by Servier is the digital health entity of
the pharmaceutical company Servier.
This agile structure aims to develop operational
partnerships with start-ups to bring products and
services to the patient. Examples of WeHealth by
Servier’s partners include Bioserenity, Deeplink
Medical and Cardiorenal.
6DIGITAL HEALTH
Recommendations for a sustainable transformation
PILLAR 2: Valuing data in businessmodels
A connected medical device or a mobile application
would not create, on their own, the full value of
digital health. The value lies also in the analysis of
aggregated data that allows to draw conclusions.
Although today this value is poorly captured, it will
play a vital role in future business models. What will
this role be? And who will be leading this revolution?
A first lever deals with the education of
stakeholders on the value of data. For many of
them, data is difficult to value as an intangible asset.
However, this data makes it possible to optimize the
management of patients and the healthcare system
overall. It makes it possible to identify the warning
signs of a biological or physiological drift and to
better anticipate its consequences. It is also the data
which, in large quantities, makes it possible to
improve the predictive power of the solutions as a
whole.
Even if "prevention is better than treatment", it is
difficult to demonstrate the medical and economic
potential of a preventive approach based on a
digital technology. This is even more relevant in a
country like France, where treatment is covered by
the national healthcare system, while preventive care
may be paid out-of-pocket by patients & consumers.
The payer is an essential stakeholder in
demonstrating the value of digital health. His
absence can be fatal. Without this demonstration, it
is unlikely that the proposed solutions will fit into a
care pathway. It is even less likely that they will get
supported by public payers in the same way a drug,
a pacemaker or a laboratory assay are.
Therefore, it is imperative to use the data not as a
means of monetizing information, but as a tool to
demonstrate the interest of the solution from
clinical and health economics standpoints.
The second lever is to engage a payer by using the
intrinsic value of the data as an incentivize. In 2018,
the main players who are approached to take
charge of digital health solutions are those from
insurance and mutualist companies. These
organizations will be able (and willing) to support all
digital health solutions only if they have a sufficient
level of evidence. These first steps are important.
They must be able to generate irrefutable evidence
of the viability of digital health from all
perspectives: patients, professionals and payers. In
the long term, we can imagine care pathways where
digital technology has its role to play, with public
financial support for all or part of this unique
medicine called P4.
The value of digital health lies in the savings
generated from better patients’ care. This value is
difficult to assess today. Nevertheless, it is based on
this economy that all stakeholders (start-ups,
pharmaceutical companies, payers, healthcare
professionals and patients) can ultimately be paid.
The case of Withings / Nokia Health is emblematic
of the unstable situation of digital consumer health.
Withings was bought by Nokia in 2016. In March
2018, the digital health industry is looking for a
new buyer as it has not kept its promises in terms of
sales. Nokia is not a start-up but expresses through
this brief experience the lack of maturity of a
business model based on the consumer.
Today, Withings came back to its French founder,
Eric Careel, and is strongly refocusing its strategy on
healthcare, with appropriate features.
7DIGITAL HEALTH
Recommendations for a sustainable transformation
PILLAR 3: Facilitate the development and implementation of solutions
Rapid implementation of field solutions among users
is fundamental to demonstrate the value of a digital
health offer.
A first lever is to break silos of expertise. A start-up
or a digital group needs skills of a pharmaceutical
or medical device company. These skills help identify
clinical, regulatory and R&D issues specific to the
health sector. It is also an opportunity to unlock ways
to support development. Conversely, this laboratory
needs the ideas, the agility, the objectivity of the
digital players. In addition, digital technology skills
are rarely held internally. Building a virtuous and
open ecosystem is key. In France, the WeHealth by
Servier initiative illustrates the virtue of bringing
major groups and players together in order to boost
the digital health sector. The 39BIS laboratory of
Sanofi illustrates another model of integration.
It is essential to develop these de-
compartmentalization efforts in France in order to
accelerate the digital transition.
Leveraging regulation is also key. This is essential for
digital health. It ensures the security of the data and
the integrity of the stakeholder (patient or
professional). In Europe and France, particular
attention is paid to the protection of citizens and
their medical data. This is a major issue. Digital
health, however, requires more flexibility and
confidence in our ability to innovate ethically and
with respect for the individual. Since data is the
driving force behind digital innovation, facilitating
access to data is mandatory in this context. The
example of the FDA Pre-Certification Pilot Program
is an encouraging signal in line with registration
procedures’ simplification for such digital devices. It
allows notably a kind of supplier’s approval rather
than an evaluation of each version or evolution of
the solution subject to approval.
3 AREAS OF WORK AND 6 LEVERS TO BUILD A MODEL OF SUSTAINABLE ACTIVITY IN DIGITAL HEALTH
C
3
Educate patients, professionals and institutions about the role of data
Anchor data in business models
VALUE CREATION AROUND THE DATA
2
Break silos between digital and healthexpertise
Streamline the regulation procedures of digital solutions
ACCELERATION OF PROOF-OF-CONCEPT STUDIES AND DEMONSTRATIONS OF VALUE
1
Mobilize health professionals in development and dissemination
INTEGRATION OF DIGITAL HEALTH IN A CARE JOURNEY
Start by demonstrating a benefit in a medical context
AREAS OF WORK LEVERS OF DEVELOPMENT
8DIGITAL HEALTH
Recommendations for a sustainable transformation
D DIGITAL HEALTH IS EVERYONE’S CONCERN
Start-up Bring digital skills, flexibility and agility are mandatory
Laboratories Bring clinical and regulatory skills and help funding innovation
Private payers Trigger tangible demonstration of digital health solutions’ value
Public payersIntegrate proven digital health solutions into care pathways andsupport them financially
Regulatory
authorities
Provide a flexible legal and ethical framework for quick proofs ofconcept
Care giversApprove and/or recommend digital health solutions by participatingin their development and democratization
PharmacistsAct as the patient's main point of contact for digital health and themain channel for solutions’ deployment
CONCLUSIONSDigital health is an essential part of the 21st century’s public health and its promises have not yet
been fulfilled. Despite significant efforts, France has not made great strides in this field. To do so,
incremental projects that concretely and sustainably improve the quality and effectiveness of the
health system need to be conducted.
To make promises of digital health meet reality, 3 areas of work must be reinforced: raise
awareness among healthcare professionals, allow rapid implementation of solutions, and push
data as the key component of business models.
Sustainable digital transformation of health is everyone's concern: pooling skills, financial
participation, and regulatory simplification are as crucial as digital innovation. [D]
Patients Seize digital health to take on new responsibilities for care
9DIGITAL HEALTH
Recommendations for a sustainable transformation
ALCIMED (www.alcimed.com) is a consulting company specialized ininnovation and new business development. ALCIMED worksextensively for the life sciences industry (healthcare, food/feed),chemistry, energy, aerospace, defense, and public policies.
Within ALCIMED, Highway to Health (H2H) is an initiative which hasthe ambition to understand and analyze the challenges of the healthdigital transformation in terms of technology and market.
PLEASE FEEL FREE TO GET IN TOUCH WITH US FOR
ANY QUESTION OR COMMENT
Jérôme SEON
Director ALCIMED Lyon
+33 (0)4 37 48 22 09
Jerome.seon@alcimed.com
Benjamin D’HONT
Great explorer in digital health
+33 (0)6 83 68 06 46
Benjamin.dhont@alcimed.com
This publication has been written with the purpose of sharing general orientations. We invite the reader to rely onspecific support before making strategic decisions. ALCIMED can not be held responsible for the consequencesrelated to the use of the information contained in this publication.
SOURCES
[1] La e-santé, bibliographie thématique, IRDES, March 2018 (source OMS), (link)
[2] Rapport, StartUp Health, 2018 (link)
[3] Baromètre EY du capital-risque en France, 2017 (link)
[4] Google, Amazon, Facebook, Apple : quels sont leurs projets dans la santé ? , Usine Digitale, Février 2018
[5] Roland Berger, Digital and disrupted: all change for healthcare, Sept 2016
[6] Rapport Villani, Focus 2 - La santé à l’heure de l’IA, 2018 (link)
[7] Prescribable mHealth apps identified from an overview of systematic reviews, npj Digital Medecine, May 2018
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