Why More Health Techs Should Embrace the Product and Platform-Led Growth Model

Once a health tech product or solution has been delivered to market its fate is arguably sealed.

You may have identified the gap or the problem to solve, but did you have the right team in place to constructively challenge your proposition, to ensure that what you’re bringing to market is actually valuable?

Competitive pressure can lead to behind the scenes airbrushing or scrimping, in the rush to ‘differentiate’. Reality eventually catches up, and reveals too many products have become obsolete, considered by users to be irrelevant, cumbersome to use, or over-engineered.

One tried and tested approach to ensuring you minimise the risk in getting it wrong is the product and platform-led growth model (PLG). An increasing number of successful health techs have adapted and refined this model on their own terms, at different stages in their growth. And we see that it continues to serve them well in both their portfolio and geographic footprint expansion.

If ever there was a more compelling GTM blueprint to consider this is it, especially as enforced cost cutting measures show no signs of ending across health tech.

Taking Stock

PLG is appropriate for vendors of all size. Incumbents may have to implement widespread transformation to accomplish it, while SMEs looking to scale may already have some elements in place.  It’s arguably essential in any post M&A scenario.  

At face value PLG seems simple. But it’s not.

It forces you to dismantle your internal approach to product design, sales, marketing, and GTM strategy. Out are hierarchies, in is empowerment.

Firstly, the ‘product’ component is a misnomer. Across Healthcare we’ve endorsed the ‘product fit’ context. But PLG insists that client-side, your product must deliver tangible outcomes post-implementation. But that doesn’t mean ‘product first’ at all costs, especially to your business. Get this wrong and you have every other team running down the wrong track.

You need to consider the alignment between your intended product and your overall business and bottom line, as well as that of your partners. That means a series of ongoing checks and balances, treading fine lines on a number of fronts along the way.

Your ultimate goal is to get your product in front of real users, not buyers, who often have a different set of priorities. Their positive experiences can go viral and act as a gateway into their peer networks. Hope or assumption as a strategy won’t get you there.

Setting Up Your ‘A’ Team Through (Re) Discovery

PLG elevates the ‘Discovery’ phase to centre stage. Product teams get to act as proactive influencers in the overall company strategy and vision. They get room to breathe through this phase, alongside a range of cross-functional experts from your other teams, brought in to contribute to this early stage. This bottom-up approach authorises product leaders to overwrite or dismiss a top-down push for features or short-term thinking.

This sets a commitment to and among your teams, as well as the market: a culture of more balanced opportunity scoping generates a viable proposition that speaks to your organisation’s strengths, and makes sense for you to pursue. Discovery helps define your USP and keep it centre stage.

The best analogy is to think of the flywheel, where core strength is enhanced when more aligned force is applied to keep the wheel in motion and prevent it from derailing. Underpinned by mutual respect, accountability, all incentives are reset to new metrics.

Post-delivery, client relationship management obviously comes to the fore. And PLG also rewrites this remit.

Your Cultural and Operational ‘Shift Left’

The cross-functional culture seeded through Discovery now extends across your lines of business, further empowering all your teams to keep delivering value.

By embracing platform thinking, you form a series of small teams with the authority to work together continually to oversee these areas: core IT capabilities; business capabilities; and customer journeys. Modularity is the glue that binds.  

Together they navigate the layers of product strategy, business case analysis, demand forecasting, product-led growth tactics, your ongoing investment in technology, and end user validation. These are your under-writers, keeping you grounded.

And by keeping your fly wheel well oiled, the portfolio you offer has greater potential to serve new customers in adjacent healthcare sectors and new geographies.

Your new proposition will now embody these features:

  • The art of listening: Your sales teams will remain ‘customer obsessed’, but will no longer this pressure your product teams into a  conveyer belt of new features, or constant tweaks to customise.

Working alongside your product and engineering teams, they appreciate the power of pre-configured or modular solutions, and how this can actually help achieve superior outcomes.

  • The ‘why’ not the ‘what’: How it helps, not what it does. Storytelling can weave rich examples of inspired actions from peers achieved pragmatic, innovative outcomes. Case studies can be effective in highlighting outcomes to your technically geared audience.

Consistency in design: Helps your clients eradicate variation across their workflows. Building standardization into your processes still leaves scope to creatively address local needs.  

  • The power of data: Analytics captured contextually reduce the need for hard intrusive selling and indirect user feedback. Customer Success and Product Marketing can focus on nurturing customers with higher lifetime values. Data driven insight also supports richer storytelling.

If you’re sceptical about this, then ask yourself: Why we still have so much shadow IT, incumbent solutions dripping in bells-and-whistles add-ons, or so many point solutions across Healthcare? Something has got lost in translation.

For reference, these health techs examples are testament to the power of PLG.

BT Health | Moving Beyond Connectivity at the Speed of Trust

Telcos successfully embedded within Healthcare remain a rare breed. All the more noteworthy then is BT’s virtual ward & care launch in the UK, spanning AI and digital therapeutics, underpinned by two years’ collaborative preparatory work.

Over that period, we’ve had hints on its Healthcare go-to-market intentions, but have had to wait to see how the promised new strategic direction would scope out.

Continue reading “BT Health | Moving Beyond Connectivity at the Speed of Trust”

Converged Healthcare and Life Sciences in 2030 | Scenario Planning

With no end in sight to the tumult gripping markets, trying to ringfence global directional trends across Healthcare and Life Sciences (HLS) in 2023 is pointless. Scenario planning offers a comparatively better grounding than demand forecasts.

You may feel immune to the course corrections underway within tech innovation circles: the 5G underwhelm; wearables overload; metaverse retreats; SPAC cash crunches; Prescription digital therapeutics (PDTx ) hurdles; generative AI landing out of left field, igniting overnight euphoria.

So what, you say, we operate in the heritage end of the clinical spectrum.  And since linear decisions about tech and digital procurement across HLS are atypical, our strategy remains sound enough overall to carry on. It may take longer, but we’ll get there.

You may end up wrong footed. Relying on a single customer base, however compelling your proposition, increasingly leaves you vulnerable to a ‘must win at all costs’ culture, blinkered to alternative routes to market.

The Need for Transformation Finally Dawns

Particularly since Q4 2022 we’ve seen a raft of strategic moves from across HLS: restructuring; C-Suite flush outs; portfolio reworks; unlikely partnerships.  

More incumbent providers and life sciences organizations are finally acting on what they’ve known for some time: they cannot singlehandedly offer the end-to-end contexts patients need; and that they must commit to full throttle transformation, or risk disintermediation. For some, there is a lot at stake over the next 5-7 years in relation to R&D, next generation intervention, and commercialization.  

In contrast, the pioneering health techs and retail pharmacy go from strength to strength. The strategic investments they committed to as far back as 10 years ago are delivering yet more new service lines, geared to precision.

We’re now seeing credible moves towards end-to-end services in multiple contexts. But this time around there is no competitive land grab. The successful disruptors are already finding ways to innovate with and from inside the HLS system, to work with incumbents to remove friction points.

Convergence Will Underpin The New World Order

And there’s more on the horizon. Convergence is the ultimate target outcome. I dedicated my 2022 predictions to the theme of convergence, underpinned by four interrelated themes:

Strategic Orchestration  : Extending the multi-disciplinary and hybrid- capability model across secondary care and its adjacent sectors. This is now also impacting primary care  

  • The Power of One : Cross-functional teams need a  common data infrastructure that aligns to their inter-operational evolution
  • The Curated Experience : The dawn of truly targeted intervention and therapeutics
  • Ecosystem 2.0 : The composable-principled ecosystem that can support Healthcare and Life Sciences to align, empower, and transform is only starting to emerge.

I believe that much of what’s currently playing out validates this new foundational model.

Scenario Planning In a Nutshell

Deciding where you (re)position gets more critical with each passing year, as buying power shifts, different services skills are sought, and managed contracts face greater scrutiny.

By considering a range of plausible (but not certain) scenarios, based on market signals of varying strength, you create space for your teams to craft future states, both positive and negative.

Interpreting The Signals

By example, the four future scenarios to 2030 outlined below are framed within two axes: appetite for convergence and  AI maturity level – which I see as wholly aligned. Underpinning these are 64 variables.

As we move towards greater convergence, no single HLS sector dominates. Here, the HLS actors evolve beyond their core position, to assume different roles within new configurations:

  • Acting as a leader in one scenario
  • Acting as a new partner in another scenario

In fact, within three of these scenarios, there are HLS companies that are outperforming the incumbents.

A growing shift in mindset is resulting in more incumbent leader viewing convergence as a way to remove the burden of innovation from their shoulders, and a strategic accelerant to Transformation.   

Here’s some further detail on each scenario.   

The Secure Landing Zone

The Membership Economy

The New World Symphony

The Real Game Changers

Scenarios will help your teams not only to assess the strength of your position within each future state, but also to validate, flag up, and steer what you do next in response.

I hope this proves useful. In future posts, I’ll highlight strong exemplars.

If you have any questions or would like to explore further, feel free to reach put to me. 


              

NHS Health Tech in 2023 | Focus on Jobs to Be Done

‘Jobs to be done’ will dominate the NHS 2023/24 radar: Clear outcomes; RoI; More of what has supported successful delivery. Tech to underpin weak foundations, boost efficiency, empower.  

A tall order, given the new regional Integrated Care Systems (ICS) cluster model is still bedding down. But post pandemic, buyers better appreciate their tech assets. They have a greater awareness of the futility of point solutions, and need for aligned tech and digital investment.  

The North Star aspirations don’t disappear, but are de-escalated in the face of more frontline mission critical needs. They’ll also face competition for available budget. The strongest demand potential will come from so-called ‘Arms Length Bodies’ (ALBs) such as the new NHS Transformation Directorate (the merger of NHS England, NHS Digital, and Health Education England), given their remit on national-level futureproofing. However, growth opportunities may be confined to vendor relationships forged through the pandemic.  

An NHS Digital Maturity Framework Remains Elusive For Now

If you’re a vendor of US origin, you will likely have been reassured by the partnership between HIMSS and NHS England to co-design a digital maturity assessment framework – recognised internationally, HIMSS provides a solid benchmark on which to pursue and measure excellence. It also helps providers (aka Trusts) to align their investments.

That partnership has been dissolved, with consultancy McKinsey recently awarded a 2-3 year contract to deliver a baseline and an enhanced assessment of maturity across NHS providers and ICSs. Seven pillars will underpin: ‘well-led; smart foundations; safe practice; support people; empower citizens; improve care; and healthy populations’.

NHS England has made several attempts at such an assessment in recent years, yet has achieved very little to-date.

Clearly no-one can wait until this latest project takes off. Common sense alone indicates that maturity levels across ICSs still vary considerably, and will do so beyond 2023. While ambitious and well-led providers have always mapped out their own trajectory, and had the funds to support this, 2023/24 is all about coming together as a local geographic ICS cluster, to audit, streamline, and map immediate priorities.

That of course doesn’t mean that these ambitious providers will stall their strategy while others play catch up. This is an ongoing tension that ICS leaders and their Boards will have to manage.

One Provider’s Innovation is Another’s Foundation

To support vendors on where to direct their effort through 2023/24, Experiential HealthTech has mapped out which digital and technology areas are high priority, and therefore most likely to attract available budget.

These priorities are grouped across four categories, to reflect both the disparity in maturity levels at individual provider level, and the greater need to align capability and ambition at ICS level. The technologies listed below are not exhaustive. We are not implying that tech procurement teams will move in linear fashion from one category to another.

This selection also chimes with those frontline operational targets we believe to be of highest collective priority in 2023: earlier diagnosis, referrals, co-ordinated pathways, patient flow, remote monitoring, and workforce management.

  • Foundational: Providers at this level are largely playing catch up. Note that dozens have yet to deploy an EHR. Amongst those that do have one, order comms modules may not necessarily be in scope. A lack of modern Wi-Fi infrastructure clearly stalls new OOH models of care and inhibits patient-centric services. Cloud may or may not be deployed – the most likely exposure will be through EHR vendors. Even instances of small data may be alien to many clinical and admin teams at this level;

  • Momentum is building: Providers making investment decisions at this level have already taken successful steps towards more co-ordinated care, and are looking to replicate early wins, to perhaps address co-morbidity. In these contexts, workflow and patient flow are being prioritised. Recognised gains also include richer data collection at a clinical and operational level;

  • Evolving | Needs guidance to build business case: More mature providers are looking to align and advance their ambition through deployment of these technologies. They may either be aware of peer success in these domains, or feel these to be a next natural transformative step. Either way, they’ve reached the stage where they need support on relevant metrics to include to present their case to the C-Suite;

  • Innovational: Those individual providers or ICS clusters poised to take evolutionary steps towards more of an ecosystem model, where interoperability is understood, data maturity comparatively high, R&D relationships a part of their remit, and more widely shared governance is culturally appreciated.

The opportunity for you lies in deciding which part of the maturity spectrum you want to support. Each category above offers scope for elasticity on which tech is deployed, so ground your value proposition. Be specific. Meet their goals. Ditch generic promises. Your ability to adapt is key.

At an ICS cluster level, expectation and need converges in relation to data & literacy, cloud, cyber, automation, and integration. User and IT team experiences so far have been mixed, partly through some vendor hype, so step up support for more granular roles-based education, transparent pricing advice, modernization, and workload migration.    

Also worth bearing in mind is the growing peer-to-peer influence via the NHS Blueprints (managed by FutureNHS). Published by providers that have successfully modernised and transformed, they are granular best practice guides. Not all of these blueprints are glamorous, but they clearly illustrate the power of peer influence and gap in transformation and modernisation that’s still out there.   

More ambitious tech deployment guides are in the pipeline (see below). Aim to tie in your poster clients here, in context.      

One important point to note at this stage is that ICSs are not yet empowered to buy tech and digital as a single buying unit.

Acute care remains the most lucrative demand path, in terms of direct spend, its role as clinical lead on new service models, or partnerships with Life Sciences. Mental health and community less so. Private providers will extend their remit to reduce the NHS frontline backlog, but digital maturity varies greatly here too. GPs are in flux. Social care has yet to line up.    

Note that the time to impact buying decisions is shorter this 2023/24 Financial Year, since we have the certainty of a general election by year-end 2024 latest. This mandates a Purdah period, banning new spend from when the election date is announced, until the elected government is in place. That can eliminate six months of activity.

Vendor-Side Jobs to be Done

This ‘sleeves rolled up’ approach applies equally to you the vendor community. Competition continues to intensify, but that doesn’t necessarily reflect a sell-side completely aligned to real world demand.

Incumbents, especially within the clinical software side, continue to add more bells and whistles as a competitive response, without addressing the many enforced workarounds needed to overcome current solutions failings.

Use your current internal cost cutting measures to trigger a reset of priorities, with your partners in tow. Be realistic.

Your pre-sales teams should expect to have to graft harder to qualify leads. Account Managers will need to dig deeper on core and aligned need.

Simply Experiential | A Framework for Vendors and Their Partners

Below are the first-tier components of the Simply Experiential™ framework, which I use with my clients to review the impact of their internal operations on their market success today, as well as their robustness for future-mapping.

It’s a really useful way to bring often disparate teams together, to touch base, strategize, and plan together more effectively.

Your teams and partners explore their beliefs and assumptions about your culture, intention, and context in the market, and assess the spectrum of your capability now and in the future.  

While health tech buyers certainly value culture, their loyalty is gained more through a deep-seated commitment to understanding their need at a granular level. Bear in mind that while the vendor and SME community believe they already show this, many experiences shared from across the NHS provider community reveal disconnect, disappointment, and hollow promises.

The framework has more detailed layers, and offers the ability to either hone-in on a specific area that needs to be addressed, or use it to baseline your next steps considerations.  Think of it as an anchor to your strategic backbone.      

The Bottom Line

The NHS will remain a tough sell in 2023/24. Not all wish lists will be fulfilled. But the tide is turning. With an upcoming general election, it’s natural to anticipate yet further government-led reorganization, especially should a new party get elected into power.

Should the ICS model not survive in name post-2024, its mission will – the NHS has come too far. It’s the many iterations and redesigns over the last decade that have brought the NHS in England to this point. Shaky as it may seem, it’s the best strategic steer we’ve seen, and continues to hold promise.

Effort committed now across your teams will lay down the marker for a greater dividend in the mid-term opportunity pipeline.

Discord Within the Ohana Tribe | What’s Next for Salesforce?

When a pioneer and elusive competitor like Salesforce falls from its pedestal, it lands hard. And its leadership is judged all the more harshly.

Perhaps it was always naïve to assume that the co-CEO model, and post-acquisition mergers would be any smoother here. But Marc Benioff has built momentum around ‘Ohana’. This past month has diluted the strength of this culture when pitted against profit.

Although the headlines have been slanted towards the enterprise perspective, its HLS businesses will not be immune, given the strategic direction in which they’re being pulled. Salesforce has been gearing to move deeper into the HLS stack, yet clearly views a single integrated proposition (enterprise bleeding into vertical portfolios) as logical from a cost and profits perspective.

Note that Salesforce has read the markets clearly, and in polar opposite style to the recent move from Oracle, has been delivering a mature response, recognising the buyer preference for hybrid choices to extend capability. HLS can also gain from some of the recent enterprise-side additions:

  • ‘Bring your own AI’, a combo of Amazon’s ML SageMaker and Salesforce’s AI solution Einstein
  • The ‘Amazon S3 Connector for Tableau’
  • Blended FHIR and HL7v2 protocols

Aligning Buyer-Seller Ambition

But the HLS buyer lens is narrower. Up until now, each core portfolio offer from the Salesforce stable has been clear cut in its support of meeting their key transformational milestones: Tableau (HIPPA compliant Cloud; Data Visualisation & analytics); Mulesoft (interoperability; EPR integration layers); Slack (collaboration); and Salesforce Marketing Cloud (Patient Experience & Engagement). In tandem, Salesforce has been positioning on Product-Led Growth.

The risk with this shift – which is more than cross-selling – is that HLS perceives such an integrated extensive proposition as overwhelming, or inaccessible to current need and pace.

Case Study | The NHS and Public Sector in England

Salesforce is in the midst of a second attempt to anchor itself across the NHS. Its first attempt was in 2013 in England. However, given the transformational overhaul underway at central and frontline levels back then, it proved challenging for many buyers to clarify their tech needs.

Tableau is an important part of the Salesforce portfolio mix. With data, analytics, and data literacy identified as high priorities for all clinical and non-clinical roles, Tableau is accessible, and therefore facilitates building a business case. But its Account Managers will face a hard graft.

Currently, the Tableau footprint is small at individual provider level, despite the central procurement on their behalf by NHS Digital in 2021: other legacy choices continue, while an ‘Enterprise’ deal struck with Microsoft to include free Business Intelligence instances is proving an obstacle to greater Tableau uptake. Microsoft Teams also penetrated the NHS heavily as a collaborative tool through the pandemic.

In recognition of the challenge, Salesforce is positioning with data driven use cases: workforce management, outpatient flow, screening, patient outreach, advanced therapy management, and drill-down population health.

More encouragingly, Tableau has built a solid relationship with the Open Data and Data Visualisation team within NHS Digital during the COVID-19 pandemic. Although Tableau takes most of the credit for the outcomes achieved – including the donation of the sizeable software implementation – it was once again comfortable working alongside AWS.

The reference above to drill-down population health use cases stems from this relationship. Such was the success, that at one point, 75% of Local Authorities in England were also using the Tableau dashboard on a daily basis, to co-ordinate vaccine outreach at neighbourhood level. A closer strategic partnership between Tableau and NHS Digital appears likely. Migration to the Cloud has been cited as one element on the ‘to do’ list.

In addition, its recent Memorandum of Understanding (MoU) signed with the Crown Commercial Service across the Public Sector may raise the Salesforce profile through buyers’ exploration of low-code no-code capability, alongside access to free experimental project support, and discounted training, among other benefits.

These MoUs are increasingly common across the UK Public Sector, providing one way for vendors to gain more rapid wider-scale accreditation through a commitment to favourable pricing arrangements and access to innovation. It’s not the only procurement channel open to technology buyers – in the UK they can choose from a vast array of frameworks – but it’s good for brand credentials and relationship building.

The Experience Layer Develops

Given the likelihood that Salesforce Executives knew about the planned New Year layoffs. investment in HLS has continued.

The extent of Salesforce’s HLS ambition was evidenced in November, with the range of enhancements to its ‘Patient 360’ platform, introducing support for behavioural health teams and pharmacists, a nod to the multidisciplinary service model many healthcare systems are striving to develop.

Support for crisis centres shouldn’t go unnoticed either. Although a budget may not be directly available at this level, their inclusion will likely be steered from the sizeable provider or payer installed base already supported by Salesforce.

Charting New Routes to Profit-Led Growth

What’s particularly exciting is the newly minted retail strategic announcement between Salesforce and Walmart, potentially carving a new route to exploit ahead of some of its rivals.  

Leadership at Walmart has multiple times over proved itself as visionary. The suggestions above in relation to a Healthcare setting may never materialise in this form, but given the ambition of both parties in the US, and the struggles of many of the leading ‘disruptors’ over the last year, this level headed coupling could break new ground.

Walmart’s Commercial Technology unit reflects the confidence to take its in-house developed solutions to the wider market. It’s worth noting too that it already excels at data-driven insight, honed through its loyal consumer-side installed base. With clinical trials the next frontier within retail health, Salesforce could prove a worthy ally for Walmart to accelerate effort here, given its solid footing within Life Sciences.

Salesforce’s Commitment to ‘The Experience’ Will Be Tested

FY2023/2024 is pivotal.

Given its HLS footprint, the pieces are in place to exploit a range of intersectional investment contexts, since provider, payers, medtechs, and Life Science players are each seeking models towards sustainable value based care. Each of these sectors will encounter Salesforce in different contexts.

But Salesforce has also suffered a slew of voluntary departures among key execs from across the business, which may concern prospective buyers and its installed base alike. With ‘trailblazing’ currently not a priority across HLS, neither price hikes nor reduced support will be palatable, as many vendors are already discovering.

Partners will therefore be key to translate Salesforce aspirations and uphold its commitment – but several are also riding out their own storms.

Palantir and the NHS | So Near and Yet So Far

Palantir positions itself as a data harmonizer, integrator, and analytics facilitator, yet its National Health Service (NHS) detractors label it a data thief. The current barrage of recycled criticism surrounding the company is short sighted, when really, Palantir is being scapegoated for a decade of poor NHS leadership on nurturing a data driven culture.

Now, the NHS Transformation Directorate (a merger between the former NHS Digital, NHSX, and NHS England) is spending inordinate amounts of time defending its decision to exploit the effective partnership it forged with Palantir through the pandemic.

One upcoming ‘open’ contract, yet to be run, must rank among the most controversial in the history of NHS technology procurement:

  • A five-year relationship (with an option to extend by a further 2 years) worth £360m, to co-create a national data analytics platform, aka Federated Data Platform (FDP). This will enable analysis of disparate data streams from across the 42 newly established local Integrated Care Systems (ICSs).

Three key issues underpin the hotly debated and at times mis-interpreted discourse:

  • Outward behaviour has had the rumour mill running at an all time high that Palantir and NHS leaders have already jointly decided the structure and running of the FDP, so that the open tender is no more than a rubber-stamping exercise, to camouflage the award of the biggest chunk to Palantir. This also includes the recruitment of two former NHS England executives who had been working closely with Palantir through the pandemic;

  • No NHS-wide debate has been held to champion this next chapter, or reassure frontline teams on data sharing and privacy-by-design. Contrary to general perception, we’re told that the FDP is not intended to directly support patients’ care. It will reportedly initially be used for the national management of vaccines and immunisation programmes, population health, elective waiting lists, and meds & equipment supply chains;

    • Yet, relationships are further strained when we’re to believe that shared care records, which the vast majority of ICSs now have created in some form, will feed into the FDP.  Not everything adds up, and key stakeholders rightly expect transparency;

  • The company’s heritage in classified security and military-related contracts.

So much so that the release of the tender has been delayed twice so far.

Blinkered NHS Leadership

Perhaps part of the problem here lies in the drive by NHS leaders to accelerate at scale and pace. They have a legacy of spectacular failure in public, patient-advocacy, GP, and provider engagement over data sharing, ownership, and privacy.

That US providers continue to renew Palantir contracts seems to offer no reassurance on issues such as trust and data privacy. If anything, this further stokes the debate on the higher likelihood of the English model ‘descending’ towards privatised healthcare – in a culture steeped in free at the point of care, any mention of patients paying for at least some of their healthcare sparks outright fury. And yet the reality is that the self-payment model has been gaining traction among those unwilling to sit out delays of several years before being offered intervention. 

There is a huge spectrum of digitally enabled transformation across the NHS. The successful stories emanate from strong local leadership teams. This in itself represents another oddity within NHS policy here : When it suits, frontline leaders are offered match funding for tech innovation and advised that ‘local knows best”; in other instances, such as with this FDP, a top down model is all but imposed.    

Drowning in Data Yet Low Population Health Insight

We know that the ICSs and their aligned Boards have multiple challenges ahead to ensure on par digital maturity, while still grappling with paper-based settings and EPR deficits (a mandate has recently been set to close this deficit).

The NHS needs and wants much of what Palantir has to offer: a federated setting with strong governance foundations, interoperability, model-agnostic methods, open architecture, operational & decision intelligence, AI-on-the-fly, AI for IoT and Edge, “co-create once and repurpose”, and vertical platforms.

Most recently, through The London Medical Imaging & AI Centre for Value Based Healthcare, NHS leaders had a golden opportunity to create a wider coalition of the willing among frontline teams, to embrace a federated learning model. That hasn’t happened, with the result that this apparent leapfrog into a longer term and more consequential relationship is drawing such criticism and alarm.

But there is a clear line between both these projects: in the Value Based Care initiative, although tech companies were clearly involved, NHS Digital was in the driving seat. In this FDP initiative, the feeling is that these same leaders are handing over the crown jewels of NHS rich data to Palantir.

The justification for the tender is that the skills needed to build and manage such a platform go way beyond the collective capability of the NHS frontline, at a time of its greatest operational challenge.

While there are clinical and IT leaders who support this move, the drive to embed this nationally is still facing strong resistance. Not to over-simplify the tensions here, it’s worth busting some myths over Palantir:

Palantir Takes Up Mentoring

Palantir has clearly worked its successful pandemic relationship with the NHS to good effect. That approach too has been criticised. But let’s face it, this is no different a tactic from other vendors over the years, including many of those that stood up solutions for free through COVID-19. Equally, many vendors have over the years sought my advice on which among the NHS England/NHS Digital/ NHSX leaders they should woo, to embed their respective tech philosophy.   

Palantir has also stepped in to reassure on what to expect, should it win the largest part of the FDP work. But much of the language used is elusive to many frontline teams.  

The NHS Transformation Directorate may plough on and coronate Palantir, offering the 3 other related FDP tender parts to other bidders – note that the names in the running are not mainstream to the NHS. One of these vendors has confirmed its intention to submit a bid as part of a consortium.  

This is a further irony given the range of high calibre partners signing up to work with Palantir in general, many of which independently have forged solid trusted relationships with the NHS, and which within the context of this FDP contract will have to engage with Palantir on some level.

Or, as is currently politically fashionable, we may yet see a U-turn (expensive).

There is perhaps never an optimal time to go ‘big and bold’, but this is what’s being prioritised. This is high stakes for both the NHS and Palantir.  

Expect the debate to rage on, post-contract award. This expenditure carries all round high expectation on deliverables and frontline outcomes over the timelines carved out.

    Can the Virtual Ward Model Evolve?

    Virtual wards seem a win:win. But some stakeholders are sounding a cautionary note over their sustainability, highlighting the ambiguity about what actually defines a ward. We need to unpick the fundamentals before considering what’s next.

    Hailed as a mission critical enabler through Covid, virtual wards, although not new, are being positioned as the common sense answer to many of Healthcare’s service delivery problems. Aligned to ‘RPM’, they offer a clearer context from both the patient and clinician’s perspective, and help frame the service expectation.

    But the evidence gathered in support to-date is narrowly confined, relating largely to:

    • Earlier discharge of selected patients to continue acute rehab/treatment at home – the emphasis and related costing focusses on releasing hospital beds;

    • Wards set up on the fly to deal with covid diagnosed patients – understandably perhaps, cost benefits analysis may be absent.

    While the more personalised care elements of the ward are attractive, this promise of on par hospital-grade care is interdependent on a robust back end, even before we consider technology. This is as much about patient-and work flow, and outcomes, as it is bed management. And in the overall backdrop of what most Healthcare systems are grappling with, the messaging risks appearing over-simplistic, downplaying the need to pre-plan heavily.      

    Care From Anywhere?

    Post-pandemic, there’s a clear push to anchor this model. NHS England for example wants its 42 Integrated Care Systems (ICSs) to each plan for between 40 to 50 virtual beds per 100,000 population. Indications from the frontline are that this target won’t be met.

    Nonetheless there are NHS success stories, with several providers extending pilots. In July 2022, the Leicester, Leicestershire and Rutland ICS signed Spirit Health, which over time, will implement virtual wards for 16 digital pathways, supporting over one million people.

    This is one of the few providers not to position around beds. Plus, it will advance into more complex conditions.

    And this reflects the cross roads we‘re at. Virtual wards are critical, but scale-out needs long term aligned local planning, as well as legacy resource and tech issues to be resolved. Wards can’t happen at the side-lines.

    Once embedded, they can help underpin the more complex Hospital at Home model. Ireland for example, building towards a tech-enabled reconfigured system, will pursue this route, incrementally building evidence and co-designing with patients from the outset.

    The Open Competitive Field is Intensifying

    As more providers look to work through post-pandemic backlogs, there is a golden opportunity to win their trust through lower risk pilot studies – which remain the preferred route – but the race to build share is intensifying.

    This is about change management. As the competitive field opens up, more vendors are stepping up to support the virtual ward’s evolution outside their core offer, as a way of differentiating. Support addresses governance, digital literacy, virtual ward champions, Allied Health Provider empowerment, UX, patient education, and data planning.

    Some vendors are highly credited in other contexts, and through acquisition see this as a natural portfolio extension. Others also offer at-home nursing, tele-health and prescription delivery services. Some are specialist medtechs, while others offer vital signs monitoring equipment, adaptable to a wide range of pathways.

    Some are further differentiating through proprietary technology, but operate within Cloud infrastructures. Partnerships are increasingly key, with the likes of Verizon, Atos, and Medeanalytics being signed.    

    Virtual wards are about so much more than offering a patient kit, or wearables, and vendors should expect to be tested on several fronts.

    Those vendors emerging with freshly minted contracts to either scale across a region or across multiple pathways have used co-design to evidence how a templated approach can accelerate the pace at which multiple other virtual ward pathways are implemented, once the foundations are in place. They are setting the expectation for others to match, or surpass.

    Virtual wards are exciting, but they must be handled carefully. And as they evolve, we foresee a defined role for newer players such as Pharma to add value.   

    Below are some suggestions on how vendors can position on value.

    Multimodal Learning and Composite AI | Accelerants to HLS Precision

    It may be counterintuitive to position AI as an accelerant to precision. And yet an under-exploited paradigm, Multimodal Learning combined with Composite AI, is powering discovery, resetting the benchmark for ‘real world’, and evidencing that precision medicine isn’t a pipe dream. If a broader range of stakeholders across Healthcare & Life Sciences are to benefit, our mainstream conversation needs to evolve. More SITS vendors must step up in support.

    We know that a lot of work under the ‘AI’ banner has as many moving parts and shortfalls as it has roadblocks. We also know that embedded within the volumes of good data collected across HLS are swathes of rich but untapped information.

    We have reached a tipping point: our current practice of training algorithms from a single modality (e.g. imaging, text, or stats) to validate a tightly defined query doesn’t do justice to our universal efforts to understand comorbidity, monitor disease recurrence, or advance personalised care, and drugs discovery.  

    There is an alternative aligned approach, with successful field deployment:

    • 𝐌𝐮𝐥𝐭𝐢𝐦𝐨𝐝𝐚𝐥 𝐋𝐞𝐚𝐫𝐧𝐢𝐧𝐠: Disconnected, heterogeneous (raw) data is harmonised, mined, and then unified into a single model;
    • The backbone powering this is 𝐂𝐨𝐦𝐩𝐨𝐬𝐢𝐭𝐞 𝐀𝐈, which exploits a range of ML and non-ML techniques, in the context of the specific problem to be solved. This range works together sequentially to ‘fuse’ this data, by disassembling and normalising within one specific technique, before sending it on to another technique to apply further meaning – ‘passing the baton’, in a relay race, if you like. This multi-dimensional approach to tackling real-world problems delivers more granularity and scalability, which has eluded HLS.

    Once synthesized, the insight is unified within a framework, which can be shared – several are available through open-source.

    Blending The Known Unknowns with the Unknown Unknowns

    The sheer range of data that can be exploited may seem over-whelming. However, multimodal isn’t a new approach, with pioneers across HLS already comfortably sharing their respective data with partners to advance.  

    Equally, composite AI may seem daunting, but that need not be the case. The beauty of composite is its elasticity, in that only a few techniques need be applied for greater effect, in alignment to the range of data held, knowledge gaps that need to be filled, and respective skills base.

    Acknowledged gains of Composite AI include:

    • More granular information than RWE
    • Deeper understanding at a molecular level
    • Outperforms single modal AI
    • Embeds Federal Learning and privacy-by-design
    • Preservation of human knowledge within the loop ‘rounds out’ the data interpretation more deeply, thereby strengthening the analytical process
    • Users/collaborations add ML/AI techniques at their own pace and capability

    Explainability Versus Interpretability

    We may all be familiar with the concept of Explainable AI (XAI), but it’s a generic reference that a whole range of stakeholders, each with differing priorities, are supposed to get their heads around.

    This is where the notion of a trade-off in a pragmatic sense needs to be introduced to the mainstream conversation. As we apply some non-ML approaches techniques, which make up the other part of the Composite AI toolkit, in our quest for better detail, the black box comes fully into our front mirror. And we know the level of discomfort this provokes within the HLS community.

    While some stakeholders may be comfortable with ML and automation, since these have been widely debated and evidenced, most will not be familiar of the inner workings of a composite model. While these HLS roles don’t need to be experts, there is a strong argument now for at least familiarising them with the basic principles, in relation to those techniques which lend themselves to high explainability, versus those that don’t.

    For example, decision trees, which embed graphical representation, can convert data into a narrative of what’s going on. In contrast, Deep Learning, where the model trains itself to process and learn from data, yields low explainability, since the neural networks within are very difficult to interpret.

    The trade-off here is whether to accept higher accuracy over single modal AI models, in exchange for less transparency behind the findings in complex data scenarios. We are after all still struggling to strike a balance between the flow of innovation, data fatigue, and actionable insights. This debate will continue for the foreseeable future.

    With Multimodal Learning, No-One Acts Alone | Biotech Orchestrates; Pharma & Providers Collaborate

    To relieve the burden of ML/AI maturity, this approach validates the need for Orchestrators from across HLS. The growing momentum behind Trusted Research Environments (TREs), systems thinking, and openEHR, across organisations and between research partners, is testament to this. These practices also help to position both Multimodal Learning and Composite AI in a constructive pragmatic light, as multi-disciplinary practices that advance great work among mutually respected peers.

    SITS vendors have a role to play here too, alongside HLS teams, to champion the collection of good data, while working to ethics, non-bias, and responsibility. These are challenging but necessary codes of data management conduct that we must instil.

    Current composite capability across HLS is already generating richer insight to supply novel intervention. Above are some of the key areas which stand to gain a lot, from healthcare systems such as the HSE in Ireland and NHS in Scotland currently rolling out Living Labs, through to the ongoing collaborative work across clinical trials and drugs discovery. With regulation in more European countries starting to acknowledge and reimburse digital therapeutics, this will, over time, pave the way to capture even more real world data at the edge.

    One example is oncology, where multiple projects are exploiting multimodal data in one clinical area, and applying it to another, to better understand the correlation between some comorbidities – powerful stuff. Among these are the many Pharmaceutical leaders shifting their teams’ focus to targeted therapeutics designed for smaller patient cohorts.

    Although in many, but not all instances, AI-first biotechs are the Orchestrators, they’re financially supported by a growing number of Pharma partners, via outcomes-based collaborations.

    I’ve highlighted the biotech community in other posts as a cultural breath of fresh air. Yes, some parts of the sector are having a rough time at the minute, but there is some brilliant work coming through from pioneers, some of which feature above. The fact that they refuse to form exclusive relationships, yet are highly sensitive to IP preservation has been encouraging more from within the Pharma community to strike partnerships underpinned by Multimodal Learning and Composite AI.

    From big tech, SaaS and vertical cloud players have been among the more recent additions to the Composite AI field, and all the signs, including investment, indicate they’re taking this seriously. More providers are joining. And this can only be good.

    Composite AI isn’t a silver bullet. More SITS vendors can help to curate, steer, and widen their services offer. Skills support is also a solid way to build customer loyalty.

    The Bottom line

    We need a move away from the lean diet of ‘ML is doable in single mode; AI is elusive’.

    We also need to put our burgeoning information pipelines to much netter use. Composite AI offers an effective path through which to advance at a pace and scale superior to most effort under way today. And while Composite AI isn’t for everyone, it can support multiple current and emerging use cases.

    Further, as the concept of Ecosystem 2.0 evolves, Multimodal Learning and Composite AI will attract high calibre members, excited by the potential of what can be achieved together, with confidence.

    Retail Pharmacy’s Transformation and the Foothills of AI

    Once outliers, incumbent US retail pharmacy chains have spent the last 6 years manoeuvring into position as the lynchpin for the Quadruple Aim.

    Given the complex make-up of the US Healthcare system, this has been no mean achievement, and should be applauded. Yes, the market is large enough to keep attracting new players looking to disrupt primary care, such as Babylon Health. But Retail Pharmacy already enjoys a solid footprint across all US States, with a rich heritage of customer loyalty.

    Its leaders have evolved to the point where advancing deeper into the Healthcare stack with a well-rounded primary care offer makes so much sense.

    Transformation and the Order of Competitive Play

    We talk about Transformation, Digital Transformation, and Disruption as if organizations are hard wired to know when and how to ‘do’ this.

    The Retail Pharma sector is transforming and disrupting, with success stories to share. Its leaders have always understood that:

    • They as incumbents must disrupt beyond their installed base of customers. They haven’t deviated from their core mission – to support under-served communities – yet their strategic announcements through 2022 align to the fact that so many more US citizens fall into this category of ‘unsupported at different stages of their wellness and health;
    • Disruption generates growth – ‘going digital’ doesn’t;
    • To disrupt, you first have to define your future today, despite market uncertainties and flux, and prepare every area of your business to pursue this. This may seem counter-intuitive, but by using insight to keep track of headwinds and tailwinds, vision and strategy are better informed, and take out guess work or reliance on intuition.

    Culture| Clarity of Vision | Insight| Commitment

    There are very clear characteristics that set successful companies apart, in any sector. Above all else, the old adage about culture still rings true. Culture is their compass, barometer, and altimeter all in one. Once an organisation agrees its vision and the scale of transformation needed to deliver, culture keeps leaders and the workforce aligned.

    Successive Retail Pharmacy leaders within each of the leading 3 US players – CVS, Walgreens, and Walmart – honour these principles.

    They are champions of end-to-end thinking: Setting a vision that extends beyond 10 years; being comfortable with not having all the answers up front, yet identifying the customer of the future they want to support, through new service models. Ironically, this mindset is interdependent on openness and evolution, where collaborative solution-building becomes the norm.

    Transformation is by nature complex and can never be considered complete. Organisations need a balance of yin and yang to ensure structure and pace. That translates as driving through an internal operational overhaul, to ensure watertight efficiency. This in turn facilitates a meaningful value proposition for the market. In the case of Retail Pharmacy, all roads need to lead to value based care, underpinned by outcomes.

    But there are cautionary notes:

    • Given the installed bases at stake, at-pace scaling mustn’t compromise patient safety. Some investigative reports in the US (outside my remit) claim intense KPI metrics have led to multiple cases of prescribing admin errors. As Europe (currently a digital laggard) gears up for ePrescribing, this aspect will be scrutinised. Trust  is precious;
    • Both Walgreens and Optum Group (now a partner of Walmart) claim to be payor agnostic and champion equity, but have yet to truly reset the status quo on transparency and out-of-pocket expenses. Meanwhile, note the growing momentum behind the much smaller @RosettaHealth and its evidenced framework, delivering eye-watering savings for members.

    Insight is Our Oxygen Through Transformation

    Insight, based on good data, validates effort when we see small and ongoing positive outcomes. It keeps an organisation’s workforce and partners close to its mission. Analytics and AI-driven insight is intertwined with Transformation.

    Experiential HealthTech defines AI in today’s market context as Augmented Intelligence. This not only reflects the capability maturity across Healthcare – embryonic – but also re-enforces that AI will remain a blend of machine and human interaction. This is vital across Healthcare, which needs to keep high touch contexts- as far as resourcing permits.

    The analytics and AI maturity cycles at operational and market-facing levels are broad, and the pace and scale at which Retail Pharmacy organisations are working through these are dictated by their internal reconfigurations and partnerships.

    Throughout the COVID pandemic, one thing became clear: there were petabytes of untapped rich data across Retail Pharmacy. And like other organisations already on a transformation path, radical effective responses could be accelerated, with confidence.       

    This success will likely have altered Retail Pharmacy incumbents’ next phase priorities: while a degree of competitive overlap remains across their roadmaps, there are also liberal doses of ‘dare to imagine’, with ambition flagged against decentralised clinical trials and pharmacogenomics.    

    Technology and Digital Blend

    Tech partnerships have proved and remain invaluable to Retail Pharmacy. The collaborations being signed, to ensure ongoing enterprise and analytics/AI maturity, showcase how some ‘big’ players are comfortable carving a future-state based on value-driven partnerships and knowledge sharing, rather than ‘fixing’ Healthcare with a land grab. Nor are these retailers insisting on exclusivity – Microsoft, for example is supporting more than one with their ongoing transformation.

    These are just some of the few currently supporting the sector.

    Healthtech SMEs and AI

    SMEs in the form of biotechs, virtual care , and digital therapeutics specialists are contributing significantly across Healthcare. Some embed analytics and other AI modes as a competitive differentiator from Day 1. Many haven’t even started along this road. And yet they must, because we need to end up with SMEs that are part of a wider contribution to society, supporting real world need, workflow and other processes. Point solutions help no-one.

    For that reason, the interlinking internal and market facing transformation phases outlined above are just as relevant for them.

    Retail Pharmacy leaders’ vision does include greater collaborative SME ventures, but for the moment risk is largely managed and weighted within VC funding, or support to modernise the SME operation as a future-proof.

    As their market facing services portfolio continues to evolve and augment the Healthcare-at-Home vision, I expect to see a wide range of SME-related announcements:

    • CVS, for example, continues to back analytics and virtual care specialist Biofourmis (Series D) – and so a multimodal AI focus may yet emerge to align with CVS’ direction.  
    • In India, Walmart is training 5,000 micro and SMEs (micro enterprises are the backbone of the Indian economy) over a 5-year period. Participants will have access to advanced business tools and advisory support to grow their offline and online businesses. There is an additional potential to advance and gain accreditation through the Walmart marketplace.

    This isn’t about conquering: it is about broadening the spectrum of affordable choice, equity, and bridging more of the chasms across the Healthcare system, to enhance local population health. Good data and the power of outreach will remain critical levers. (smaller) Peers elsewhere can copy aspects of this model to start out on their own Transformation.

    The Ecosystem 2.0 Economy Beckons

    I believe the greatest breakthrough in the US initially will come from a willingness to forge a new model – based on Ecosystem 2.0 – which as composite organisations these 3 US players could orchestrate or contribute to, when the time is right.

    In the meantime, the new relationships being forged with payors and their provider networks, Pharma, and SMEs bode well.  

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