Trending in Healthcare - Johnson & Johnson Innovation

2017

Trending in Healthcare

Trending in

Healthcare

An exploration of the science, technologies and trends with potential to radically change how, when and where people receive healthcare We live in a time of extraordinary innovation and technological change. With a touch on a smart phone, we can pay bills, summon a ride, and instantly communicate with anyone in the world. Yet healthcare has been slower to take advantage of these innovations. In fact, many of the ways we think about disease and medicine are firmly rooted in the 20th century, or even back in the Industrial Age.

“The time has never been more exciting than today because of new technologies, new platforms and new insights on what is happening in biology...” Paul Stoffels, Chief Scientific Officer of Johnson & Johnson

No longer. Advances in science and technology have created new opportunities in treating and preventing disease, as well as promoting health and wellness, that once seemed possible only in science fiction. We can now envision reading everyone’s

entire genetic code—and even printing personalized DNA drugs. Our devices can measure everything from heart rhythms to blood sugar and analyze that data in real-time to spot troubling trends. We are beginning to focus on the genetic drivers of diseases instead of on where in the body those diseases originate. “The time has never been more exciting than today because of new technologies, new platforms and new insights on what is happening in biology,” says Paul Stoffels, Chief Scientific Officer of Johnson & Johnson. “Unprecedented—and yet key— discoveries pose a series of incredible opportunities to prevent and intercept diseases.” Realizing these possibilities is difficult, however. Especially when the new approaches challenge traditional business models. At an event organized by Johnson & Johnson Innovation earlier this year in San Francisco, about 50 participants from across the industry discussed the major trends that are transforming healthcare, and how to foster an environment that encourages these innovations. This report builds on those conversations, along with additional interviews and research. Some of the ideas discussed aren’t new—the goal of preventing disease instead of waiting to treat it dates back at least a century. But technological advances and scientific breakthroughs are for the first time presenting new possibilities for turning these ideas into reality.

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Trend #1

You Have the Whole (Medical) World in Your Hand

Trend #1

You Have the Whole (Medical) World in Your Hand How smartphones, big data and artificial intelligence are helping to prevent, intercept and manage disease

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The supercomputer in your pocket is already collecting an incredible amount of data about your life—and new capabilities are being added almost daily. Your smartphone can collect and analyze information from its own sensors, as well as using apps designed for specific activities, such as fitness, diet and disease management trackers. We also have a huge amount of data generated from years of interacting with the healthcare system—doctors’ records, x-rays, test results, and much more.

The problem is that these data are widely scattered among different hospitals, doctors, systems and servers. “The systems in the U.S. are so fragmented,” explains Sandi Peterson, Group Worldwide Chair for Johnson & Johnson. “We need to figure out how to actually unleash all of that data.”

“The systems in the U.S. are so fragmented. We need to figure out how to actually unleash all of that data.” Sandi Peterson, Group Worldwide Chair of Johnson & Johnson

That’s why one of the most important technology advances is taking place behind the scenes. Companies are creating software that can extract data from any electronic record system. This information can be put into a “data lake” where various parts can be combined and easily accessed. “It is a really interesting time to be able to make that breakthrough,” says Peterson. This ability to combine once-disparate medical records opens the door to seeing previously unrecognized signals in the data noise. Imagine the additional power of such analyses when they include records from scores of millions of patients’ own devices.

The new connections are also changing how ordinary people interact with their doctors. Going to the physician for a routine checkup could become a thing of the past; constant, passive mobile tracking of a person’s health factors can identify when it’s time to see a physician, instead of making appointments on an arbitrary date. When people do see a physician, it will be a much more meaningful interaction. Instead of taking basic, static measurements—weight, blood pressure, resting heart rate—your doctor will have access to a digital chart showing trends in all those numbers since the last visit. That will make it easier to highlight areas of concern or improvements to celebrate. Moreover, with artificial intelligence and machine learning, our connected devices will get better at recognizing, tracking and diagnosing symptoms. We will have the availability to replace in-person visits with at-home diagnostic self-checks using devices connected to smartphones. There may be no need for time-consuming and uncomfortable experiences such as mammograms or blood-work for diabetes. Already, it’s possible to connect a $99 credit cardsized EKG monitor from start-up AliveCor to your smartphone, collect the data with an app and immediately send the information to doctors anywhere in the world. Other lifesaving uses may include spotting irregular heart rhythms that can presage heart attacks and strokes. One company, Graphwear Technologies, is even creating a smartphone-linked wearable patch that measures glucose levels, blood electrolyte amounts, and hydration without the need for a drop of blood.

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Trend #1

Some of the technology on the horizon does seem to leap from the pages of science fiction. The Qualcomm Tricorder X Prize, for instance, is awarding $10 million to a company that can make a hand-held device, similar to the tricorder in Star Trek, capable of monitoring vital signs and diagnosing 15 diseases, including chronic obstructive pulmonary disease (COPD), diabetes, strep throat, stroke, melanoma, and HIV. One of the two finalists for the prize, a system called DxtER™, incorporates years of experience in clinical emergency medicine with an artificial intelligence engine that can instantly interpret the data coming from the sensors. These advances can not only save lives, but money as well. In one 16-month pilot project, 50 people suffering from congestive heart failure—and an average of seven other chronic illnesses—in rural Arizona were outfitted with home monitors that measured weight, blood pressure, heart rate and oxygen level. The data were automatically sent to a regional health center. The results: The average number of days each patient spent in the hospital plunged to just over five days from 14, saving more than $90,000 per person. Meanwhile, pacemakers have shrunk to the size of a vitamin capsule, and routine genome sequencing is within reach. “In genomics today, we are doing things

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for a few hundred dollars that five or ten years ago would have cost $10 million,” says Othman Laraki, co-founder and CEO of Color Genomics. “That’s pretty amazing.” In January 2017, Illumina CEO Francis deSouza unveiled a new sequencing machine fast enough to read an entire genome in an hour and at an eventual target cost of $100. These innovations, and many more, have the potential to bring profound change. When the first human genome was sequenced in 2003, pioneers like J. Craig Venter predicted a new era of medicine, in which discoveries about the molecular mechanisms of Alzheimer’s, cancer, and many other diseases would usher in new and better treatments. That era has been slow in coming, but the explosion of new genetic data may now put it within reach. “We now have the opportunity to really understand disease at a molecular level,” says Rich Heyman, founder of cancer drug developers Aragon and Seragon. “In oncology, we can literally diagnose the phenotype from the genotype of the disease.” As David Ewing Duncan, CEO and Curator of Arc Fusion and a Health Strategist-in-Residence for IDEO, puts it: “I think the 21st century is about connecting up all of the things that we took apart the last 500 years.”

Trend #2

Power to the Patients

Trend #2

Power to the Patients How enabling engagement may make our interactions with the healthcare system more meaningful and productive

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Trend #2


Imagine combining all of the data about a person, from a lifetime of medical records to real-time information from wearable devices and new generations of sensors, and then using artificial intelligence and experienced doctors and nurses to create a “check engine light” for your health. People could receive that information over social media or smartphone apps with simple reminders, encouragement, or warnings.

Many studies show that when patients know more about their health and the management of their diseases and conditions, their outcomes are better and the costs of their care are lower. The phenomenon is called “empowerment” or “engagement,” and a whole set of companies are springing up to work with healthcare providers to measure and boost that engagement. Getting people to take advantage of these new systems can be a challenge, however.

“If health-related data were available to the 325 million people in this country, they will force change.” Gerald (Gary) Bisbee, Jr., co-founder, Chairman and CEO of The Health Management Academy

“I think that there’s an absence of engagement in health, broadly,” says Ciara Kennedy, president and CEO of Amplyx Pharmaceuticals. “Many people tend to think about health only when they worry they are about to lose it, or when they get a diagnosis.” So how can engagement be increased? One important part of the answer is just making it easier for people

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see their doctor. All of the Cleveland Clinic’s family health centers now provide a patient portal on their websites, for instance. Through that portal, patients can see their provider’s entire schedule and make their own appointments. Another key step is better educating patients about their conditions, so that they know exactly what’s happening with their health—and what the next steps in their care might be. That step can be made easier by the growing flood of information coming from mobile sensors and devices, more accessible medical records, and smart tools for making sense of the data. “If health-related data were available to the 325 million people in this country, they will force change,” predicts Gerald (Gary) Bisbee, Jr., co-founder, Chairman and CEO of The Health Management Academy, a group of executives from the country’s largest integrated health systems. But not just any data. The information must be “actionable,” offering people clear guides on what to do—or not to do. “I think the huge potential for technology is to be able use these large data sets to predict and understand what is it that you are likely to have and what is the best way to really manage you,” says Anne Wojcicki, CEO and co-founder of 23andMe, which markets genetic testing to consumers. Healthcare can learn from retailers like Target or Walmart, Wojcicki and others suggest. These companies collect huge amounts of data on their customers, so that “when you walk into a store, they know exactly what you are likely to buy,” says Wojcicki.

Trend #2

Retailers, hotel chains, airlines, and many other businesses also strive to build relationships with customers, using rewards and loyalty programs, and communicating on Facebook and other social media with highly targeted ads and reminders. “We are definitely seeing a trend, a new relationship between companies and their customers, such as a rise in membership models,” says Jeremiah Owyang, founder of Crowd Companies. An approach where patients are diagnosed with a condition and would receive a plan to manage their care right away would be a stark contrast to our current system, where it’s usually left to individuals to navigate fragmented health records, siloed specialists, and conflicting services. Pharmaceutical companies could also reach out to consumers with easy-to-use apps for reporting both good and bad experiences with drugs, for ensuring that people are taking the correct doses of the right medications, or even for participating in clinical trials. (See Trend #4.) “There is a real opportunity to take the genetic information and connect that into consumer populations to look for who are the right people for the right drug,” says Johnson & Johnson’s Stoffels. History shows that patients can indeed be an incredibly powerful force in driving progress towards new treatments. A prime example is HIV/AIDS. The healthcare industry, government agencies, and academic researchers worked together to develop drugs to fight HIV, “but it was the patient activation, the drive of the patient to get to the best possible therapy, and the community of patients that made it happen,” says Stoffels. Yet, even with all of today’s mobile technologies and tools, getting people to engage more in their own health will be challenging. Convincing them to actually


change behaviors will be even harder. A system of rewards and targeted messages, as used successfully by retailers, might work, experts say. So might boosting incentives for people, such as actually paying them for data, says Linda Avey, co-founder of We Are Curious (and co-founder of 23andMe). Greater consumer engagement in healthcare also brings up one more worry for the traditional healthcare industry—competition. Just as ride-sharing apps are challenging the taxi business and home rental apps are upending the hotel industry, nimble and innovative outsiders are moving in to grab shares of the $3 trillionper-year healthcare business. “Non-traditional players are rushing into the healthcare ecosystem,” says David Kirkpatrick, founder, host, and CEO of Techonomy Media. People can already drop in at CVS MinuteClinics, get their genes analyzed directly by 23andMe, and upload and track their data on We are Curious or Apple Health. Tech and telecom giants such as Google, IBM, and Samsung are investing in devices, software, and communications tools. And peer-to-peer efforts that follow the general model of, say, Airbnb, are springing up. “There’s one startup called HelpAround that enables patients to share equipment with each other, peer to peer,” says Crowd Companies’ Owyang. One of the interesting tensions now in the marketplace is whether healthcare companies or their tech competitors will have the advantage in developing new systems. Healthcare companies have far deeper knowledge of often-arcane healthcare systems—and thus, might be able to better develop and tailor new technology that meets specific needs. On the other hand, the tech industry may be able to come up with more user-friendly solutions, changing the healthcare systems themselves to take advantage of the technology’s capabilities.

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Trend #3

From Sick Care to Well Care

Trend #3

From Sick Care to Well Care How new business and reimbursement models are needed to drive change

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Trend #3


“We have been in the sick care business for 100 years,” says Johnson & Johnson’s Peterson. “But what we really want to be in is the well care business.” That goal is now within sight, thanks to the recent flowering of innovation. Spot the first signs of heart disease with smartphone EKG monitors, home blood analyzers, and other mobile diagnostic tools, and the healthcare system (either with live doctors and nurses or intelligent software) can then step in with guidance and encouragement for changes in exercise, diet, and medications. That could dramatically reduce the number of angioplasties or bypass operations. Similarly, regular remote monitoring of blood glucose, weight, and other parameters can catch the first signs of diabetes, leading to interventions that prevent the disease from progressing—thus slashing the enormous toll the disease takes in patients’ lives and healthcare

costs. And quick, inexpensive genome sequencing can identify DNA changes that lead to cancer in its early stage, when treatments are generally much less invasive and more effective.

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Trend #3

Much of the required technology already exists. And the evidence from a number of programs shows that people will change their behavior with the right information delivered in the right way. Even something as simple as text messages with tips and encouragement has been effective in helping people quit smoking. But such a shift to prevention over treatment presents a huge barrier: how will companies make money? Already, there are challenges in getting reimbursement for the costs of the technology and network of doctors needed for remote monitoring and telemedicine. More important, saving thousands of dollars per person in avoided emergency room visits means thousands of dollars less in revenue for the hospitals. Similarly, preventing even a fraction of major surgeries like bypass operations would cut payments to hospitals and doctors by hundreds of millions of dollars. “The challenge is that a lot of the payment mechanisms don’t value cost reduction,” says Rebecca Cofinas, founder and CEO of AristaMD, a digital health company working to improve specialty referrals. In theory, insurers could make money by investing in prevention. Small amounts of money spent now would save far more money later because of fewer expensive surgeries or other care in future decades. In practice, however, people switch insurance companies so often that it’s likely another company—not the original insurer that made the prevention investments—would reap the savings. One example: child obesity. Intervening early can indeed prevent later healthcare problems, bringing major cost savings. But while trying to explain the benefits of helping kids lead healthier lives and lose weight to a large insurance company recently, “I got one of the most upsetting responses,” recalls Joanna Strober, co-founder and CEO of Kurbo Health. “They said: ‘but these kids don’t play sports, so actually they cost us less because they get fewer injuries.’ They are concerned about immediate cost savings rather than the longer term savings of keeping

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a child healthy. The assumption is that someone else will pay the costs of treating diabetes or other diseases associated with being overweight in the future.” Solving this incentive problem requires a step that the Centers for Medicare and Medicaid Services (CMS) has already begun to take: changing the reimbursement model from fee-for-service to paying for value. Or more generally, selling healthcare as a service, rather than as a series of separate products.

“They are concerned about immediate cost savings rather than the longer term savings of keeping a child healthy.” Joanna Strober, Co-Founder and Chief Executive Officer of Kurbo Health

What if healthcare were more like a music subscription, for instance? People could pay a flat monthly fee that included unlimited access to most routine services, much like an Apple Music subscription allows unlimited listening. That may offer an incentive to go in for regular preventive care, reducing the chances of serious illnesses later. These are all exciting ideas, says Johnson & Johnson’s Stoffels: “We have such an opportunity to change the world from the healthcare perspective, but also such a challenge to make it all happen—bringing all of these worlds together and creating impact for the patient.”

Trend #4

Personalized Medicine for the Masses

Trend #4

Personalized Medicine for the Masses How new ways of creating, developing, and funding drugs can speed the age of individualized medicines

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Trend #4


Imagine being pregnant, awaiting the results of a genetic test to determine if your baby is healthy. The test comes back and it indicates cancer cells are circulating in your blood. The cancer

is not in your baby’s cells, it’s in yours.

That situation has occurred to a number of women during the past few years as prenatal DNA tests rise in popularity and decrease in price. While frightening, it has demonstrated that detecting cancer before signs of malignancy become apparent is possible—and it has set off a race by companies to create an early detection cancer blood test, or liquid biopsy. Advances in gene therapy have also brought incredible results. For the first time, a child with sickle cell disease was cured by the technique, for instance, offering hope in a disease that affects millions globally. “We envision a world without disease,” said Dr. William N. Hait, Global Head of Research & Development of the Janssen Pharmaceutical Companies of Johnson & Johnson. “To realize this, we have developed a compelling vision for changing the trajectory of health care based on approaches designed to eliminate disease through prevention, interception and cures.” Progress towards that aspirational goal can seem slow, however. In virtually every industry, from banking to manufacturing, new technologies have boosted productivity and cut costs. But there’s one glaring exception: healthcare. Pharmaceutical and biotech companies have experienced almost a reverse Moore’s Law, with the cost of developing new therapies more than doubling in the past 10 years to $2.6 billion, according to PhRMA. These challenges, however, are being met with innovative solutions. One trend is the increasing involvement of individuals and patient groups in research and drug development. Billionaires and family foundations are funding medical research and even clinical trials in areas ranging from psychiatric disorders and Parkinson’s disease to prostate cancer and spinal cord injury. Meanwhile, the Cystic Fibrosis Foundation has pioneered a new model for patient groups, working with companies to successfully

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develop new treatments in addition to providing help for those with the disease. Other patients and advocates are using social media campaigns to compel pharmaceutical companies to allow compassionate use for experimental medicines or push for approval when regulators are skeptical.

“If you can start thinking about customized printing of medicines based on patient’s information, all of a sudden the traditional estimates of cost go out the window.” Oliver Fetzer, CEO of Synthetic Genomics

For instance, people living with diabetes formed a “Do It Yourself Pancreas System,” modifying an FDA-approved medical device to improve the alerts from glucose monitors. The group’s work has led to new innovations, such as real-time processing of blood glucose and predictive alerts for future high- or low-blood glucose states, hours in advance. The group was ultimately able to devise a closed-loop artificial pancreas.

Trend #4

The power of the crowd also can be seen in sites such as PatientsLikeMe.com. These sites connect people with similar conditions, collect their stories, and work with academic institutions and medical companies to use the information to improve research efforts. Meanwhile, pharmaceutical companies are trying to utilize new technologies, creating apps to connect with customers and potential clinical trial volunteers. According to a survey by Tufts Center for the Study of Drug Development, drugmakers used social media to recruit patients in 11 percent of clinical trials, with most of the companies surveyed predicting that percentage to increase. The rapidly declining costs of gene sequencing may also bring a long-expected payoff: smarter drug prescribing and better clinical trials. Testing for the variants of some genes, for example, reveals who will experience strong or weak effects from specific medicines. That enables doses to be tailored to each individual for maximum effectiveness. Inexpensive whole-genome sequencing would allow this pharmacogenetics approach to be used for virtually any drug, reducing the tremendous current toll from side effects and drug-drug interactions. In addition, gene sequencing makes it possible to spot those most likely to respond—or not to respond—to experimental drugs. Select only the good responders for clinical trials, and trials should be shorter, cheaper, and more conclusive.


The rapid increases in the understanding of the underlying mechanisms of disease are also stepping up the pace of drug discovery. New drugs that inhibit the programmed T-cell death protein (PD-1) have proven to be remarkably effective in treating melanoma, and are now being tested against a range of other malignancies, including ovarian and lung cancer. Companies are also exploring other new targets, such as the RAS signaling pathway, and developing new approaches. Examples include linking cancer-killing drugs to tumor-targeting peptides to create what is being called Pentarins™, or creating large numbers of live T cells engineered to become ferocious cancer killers. In the clinic now are new classes of drugs to fight migraines, multiple sclerosis, and Parkinson’s, along with vaccines against the Zika and Ebola viruses, among many others. In fact, the number of clinical trials registered on ClinicalTrials.gov is now three times higher than in 2010 —and nearly 60 times higher than in 2000. Finally, advances in technology are bringing us closer to truly personalized medicine. Currently, engineering patients’ own cells to fight their unique cancer, or creating other individualized treatments, is prohibitively expensive. But what if we can “write” DNA at a low cost? In fact, we can, says Oliver Fetzer, CEO of Synthetic Genomics: “If you can start thinking about customized printing of medicines based on patients’ information, all of a sudden the traditional estimates of cost go out the window.”

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Where Do We Go From Here? These ideas and examples just scratch the surface of the ongoing transformation of the healthcare landscape. In addition to welcoming feedback on this report, Johnson & Johnson Innovation is planning a continuing dialogue on these topics throughout the year to better understand how these trends are playing out in the real world. We hope to start and continue a lively conversation on the innovations, trends, and technologies that are changing the way we all experience healthcare.

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