Louis Derick Payet’s Post

'Resourced-constrained settings' to a large degree describes the healthcare sector in southeast Asia (ex-Singapore of course!). There are 700 million people in the region and simply not enough doctors, nurses, hospitals and pretty much anything healthcare related available to meet the existing healthcare need. The big opportunity for digital health in the region is the ability to unlock improved healthcare access for broad segments of the population and allow existing healthcare resources to be amplified and treat more people. The other big opportunity is to deliver preventative care models to reduce the burden on the existing healthcare system. The alternative solution is to build more hospitals, train more healthcare professionals and build more infrastructure to meet the regions growing healthcare needs. No surprises that this won't work here, and it isn't a viable solution in any country outside of Asia either. The article gives a nice snapshot of exactly how a digital health product can improve healthcare accessibility by making better use of existing healthcare resources. Diabetes and anything related to it like diabetic retinopathy is poorly diagnosed in southeast Asia. Detecting diabetic retinopathy late and treating people when they start showing symptoms (going blind) places an un-necessary burden on an already strained healthcare system. To help with the problem health tech mixed with a bit of AI magic can be used to mass screen people in a cost-effective manner and support the early detection and treatment of suffers when the cost of treatment is low. All of this works with the existing healthcare system but helps to optimise the use of these resources. The opportunity for digital health to improve health equity is something governments in SE Asia clearly believe in. It's why so many of them are aggressively supporting the local use of digital health solutions and I'd expect to hear more stories like the one below popping up in the future.

When it comes to innovation in the digital health space in Asia I'm quick to nod my head to Korea and now India when it comes to developing and commercialising digital health products. Japan, while it took an early lead in the region with partnership like the Shionogi & Akili Interactive deal, quickly in my opinion fell behind other countries in the region. One company that is pushing the boundary on innovative commercial models using digital health products is Japanese Pharma giant Otsuka. In April the company launched the digital therapeutic product Rejoyn as a supportive treatment of depression. The second digital health product they have just launched is a support app to help Alzheimer caregivers called 'Elevmi'. The products still plays in the mental health space but is quite different to Rejoyn as it targets caregivers rather than the patients. I guessed they missed the memo about Japanese companies being slow to try innovative new ideas in the digital health space!! This is a really interesting strategic play by Otsuka as it looks like the company is putting in multiple digital health services that can support users of its drugs. It makes a lot of sense, selling drugs and not digital health products remains the primary focus of pharma companies and investing in digital health products to support this goal makes sense. The revenue model for Elevmi isn't discussed but I would be surprised if the company didn't bundle it with its Alzheimer drugs and offer it as an added benefit to patients and their families. Could this model help pharma companies stave off to a degree generic competition? Brand drugs vs generics is a very different competitive offering to brand drugs + digital health product combo vs generic drug alone. The open question is how much will payors and patients value the combo and what value will they ascribe it vs a generic alone. Also is Otuska an outliner in the pharma sector or is this signaling a new approach to how pharma companies adjust their business models and look to more directly engage patients? Regardless of how this works out, a big positive from this approach is the benefit that patients and families could receive from using products like Elevmi.

The Peterson Health Technology Institute report on the 2024 State of Digital Health Purchasing offers some interesting insights into the purchasing and evaluation decision made by key digital health buyers in the US. It is the first time the group has published this report. So the data is taken at a static time point and it will be nice to see in the future how a time comparison of the data would look like. Looking at how parameters like motivations for spending on digital health shift over time should give an interesting read on shifting sentiments in the space. Personally I was surprised to see cost of the solution being the primary motivator to consider switching a digital health product, followed second by user satisfaction. Perhaps I shouldn't be surprised since digital health companies don't do head to head studies on competitors so changing a product due to perceived comparative benefits can be difficult to judge. One of the things I am vocal about in the digital health space is a majority of the value of a digital health product is not in the tech itself but is captured in the ability to execute a commercial plan and deliver a digital enabled service. Building a great digital health product is part of the battle and many companies have done this, but building a scalable profitable business out of this product is something very few companies have managed to do. This report captures some interesting metrics from B2B buyers that emphasis the importance of commercial execution, to pick a few: i) A majority of vendor contracts are short-term (1-2 years, 59% of contracts) highlighting substitution risk is very high if the delivery of the commercial partnership is poor ii) Top reasons for being willing to terminate are price (79%) and then user satisfaction (59%), again highlighting the importance of service delivery to kept users happy iii) 79% of agreements include a outcomes based payment highlight poor service delivery will have an adverse impact on the vendor financials I do assume many of the digital health products covered in slide 8 are patient facing and include some element of direct patient engagement by the vendor (i.e: Noom, Hinge, Hims & Hers, Maven etc). This would not apply to any patient facing digital health products that are used without any human support, then again I can't think of any that have managed to scale their revenues just by selling the product alone!

A recent discussion with a potential B2B partner highlighted to me a different viewpoint when looking at the problem digital health product interoperability. Specifically how to make digital health products 'functionally' interoperable across different countries and local B2B partners. Lots of attention is going into data interoperability to figure out how different data streams can be combined in an efficient manner. Its no surprise why, the push to personalise patient treatments (including the use of AI / ML supported tools) relies on the ability to cross analyse discrete patient data sets from different sources. Peach Health Asia's role in commercialising partner digital health products across different channels gives us a unique opportunity to explore setting up commercial partnerships with varied B2B partners with different needs, systems and capabilities. Rather than look at this as a 'customisation' exercise doing this cost-efficiently is more an interoperability question tied to how versatile a product is in being deployed under different scenarios. One of the key parameters to address this challenge is the modularity of the product and whether its features be turned off and on without disrupting the product functionality. It isn't something that is top of mind for digital health developers when creating their products, products are usually designed for a single product-market fit. However in the international market no countries market and 'market opportunities' are exactly the same. The article below covers some of the solutions needed to deal with this challenge, such as setting up functions in microservices to enable modulatory and using more widely used API's. It is incredibly difficult and costly to customise a digital health product for every new market or opportunity, especially when dealing with products where a class I or II SaMD registration limits the ability to modify a product once it is approved. Don't forget going international also comes served with the whole data interoperability challenge, which represents another issue that needs to be sorted out when exploring bringing a digital health product into SE Asia.

It's an awesome feeling ✊✊ being able to support new innovative technology reaching patients in Asia. Congratulations CAPTUREPROOF team!

The role of a digital health 'aggregator' is a concept that several companies are running with in different markets. Huma is an active player in this space. The Company doesn't really use the 'aggregator' title since it operates in a different way to many of its US peers by providing a range of 'value-added' functions for its B2B customers in addition to offering a portfolio of digital health products. Aggregators work by offering portfolios of digital health solutions to B2B customers. So instead of dealing with many digital health companies, customers can access multiple digital health products from one aggregator, saving themselves time and complexity caused by dealing with many digital health product owners. At least that's the theory! A number of aggregators have popped in the US in response to end-users B2B customers becoming less willing to deal with an over-whelming number of individual digital health companies pursuing them for business (the 'point solution fatigue' problem). On the flip side many of the aggregators also control unique paths to market for their stable of digital health products, adding additional value. The aggregator model varies considerably depending on the degree of integration digital health products have with the aggregator platform. At the lean end of the equation the aggregator will simple streamline the BD process of getting a deal done with a B2B partner and leave the integration of the digital health product with the buyer to other parties. Huma sits on the opposite spectrum where it provides an extensive level of integration and other support for both digital health products on its platform and its B2B customers. This goes much farther in solving the interoperability challenge that hobbles scaling a digital health product in a clinical setting. The need in Asia for similar 'aggregator' type businesses in the digital health space is there but for a mix of reasons. Streamlining the entry of digital health solutions into the healthcare sector is one of these needs. The other need comes from dealing with the regions complexity. Asia and digital health = lots of languages, lots of different paths-to-market, lots of different payment models, lots of different interoperability issues, lots of different clinical pathways etc etc. It all adds ups to a whole lot of complexity in a set of markets that are sizeable in aggregate but, outside the big countries (China & Japan), are not so individually. This is the barrier limiting international digital health companies looking at entering the region. The dual barrier of dealing with market entry and operationalising a digital health products is a challenge Peach Health Asia can help companies overcome.

The last week has provided me with some interesting food for thought on the whole globalisation of digital health products concept. Naturally this would be something on the top of my mind since Peach Health Asia focuses on licensing, marketing and selling digital health products instead of building 'another' digital health product when we spot an un-met need in the regional markets. One related topic that popped up with several potential partner companies is how costly it will be to host their digital health product on local servers in Asia, as will be required in many markets where patient data must stay in the country. The monthly hosting costs, created by using essential cloud services, is huge and needs to be paid in every country the product is hosted. This essentially creates a major barrier to entering the local markets in the region. Its not something digital health companies may think about when deploying in a single country but is when going global. Another interesting idea that came up in a recent discussion, and it is something I have posted about before, is are Indian digital health products better suited to SE Asia than US and European products. Products developed in Indian need to take into account the local healthcare system limitations and lower local pricing points. These conditions are mirrored in many parts of Asia and may make products from India better suited to the less affluent but big population ASEAN local markets than their US or European competitors. Lastly the article below showcases that many (most!) of the better local digital health solutions in Asia are not necessarily better than competitors in other markets. In many cases they are not, for example most would lack the clinical validation and QMS required by say the FDA or EMEA for approval. However the simple fact is international competitors are simply not present in markets like India or other parts of Asia, which allows local competitors with decent products to flourish. This represents quite a divergence from how the pharma or medtech market operates, where international products from the big MNCs sit at the top of the food chain.

Holy grail or Achilles heel? This sums up the view in the report below on the increased use of AI in the digital health space. Will the increased use of AI in digital health create a gold mine of opportunities for these companies and the healthcare sector or will it lead to the creation of even more problems and vulnerabilities? There are no shortage of reports talking about AI and healthcare, I found this report interesting since it focuses on an insurers perspective and explores the risks created by the use of AI that need to be addressed (not surprisingly with insurance!!). The report does include an Asia perspective, but only Hong Kong and Singapore are included. Its not surprising to see the hallucination risk associated with the use of AI in patient treatment is a major concern raised by the executives interviewed. This still represents an unknown risk in the industry, with neither product developers or providers being willing to shoulder this risk. This might explain why less than 40% of digital health companies have associated liability insurance in place! Liability issues, where coming from AI taking an Alice in Wonderland trip or something more 'mundane' like patient data leaks, still represents major a barrier to the wider use of AI in the digital health space. Link to full report: https://lnkd.in/gcSE3Gb4

How can Peach Health Asia help digital health companies create commercial opportunities in the Asia region? One of these is we can support international companies looking for grant funding opportunities in the region. It was a pleasure supporting CAPTUREPROOF to win one the the prestigious InnoMatch 2024 grants, worth SGD 500,000. Full credit for the achievement goes to Meghan Conroy, the CEO of CaptureProof, who put in all the hard work and showed up in person in Singapore to help win over the judging panel on the final day. We're looking forward to see more first class international digital health products coming to the region to give consumers and patient access to more healthcare options.

Working in the healthtech space in Asia offers many personal opportunities to understand the need for what we do at Peach Health Asia. I've worked in pharma and medtech across the region for around 15 years, but rarely got the opportunity to directly engage with patients to the degree that happens in the digital health space. A more recent example of this was when we spoke to women in SE Asia about their journey going into and through menopause to understand if there was an un-met need in this space. It was eye opening to hear their challenges in understanding and finding support to deal with the changes they experience entering this stage of their life. Even more eye opening was I expected this in markets where the healthcare system is less developed, but I fell off my chair hearing similar issues in countries where the healthcare sector is well developed. The article below is a reminder of these challenges, a greater risk of cardiovascular disease is just one of the health concerns women face as they enter menopause. Digital health solutions that are a fit to the market need and address this un-met need can go part of the way to address some of the challenges facing women as they age. One of the challenges these products face is how to localise the solution to different market need. There can be big difference in how women in each country deal with healthy aging; access to information, cultural issues etc impact how to best 'fit' a a digital health product that meets the local needs. Access to healthcare in the local market also varies across the each country in the region. The issue above reflects a microcosm of a challenge facing digital health companies regardless of clinical focus; how can you adapt a digital health product and make it flexible enough that it can meet the need of disparate populations and markets across different countries.