What is SandozHACk?

As a company, we are really focused on finding novel approaches to help people access high quality medicines around the world. That is the way we that we support people around the world, particularly those in under-served communities. We absolutely understand that there are healthcare challenges around the world, but we do not always know what all of the challenges are or where they are.

Since we don’t always have all the answers, we decided that we wanted to support people in their own countries and communities – on their own streets – who could spot the healthcare challenges around them. They are really at the grassroots of knowing what the problem is and having ideas about how to solve it.

To link into that agenda we decided to run a challenge called SantozHACk to find new ideas to improve healthcare access at the grassroots level. HAC stand for “Healthcare Access Challenge”, while hack is a way of tackling a problem and finding a solution.

We launched the competition back in September 2016 via social media – mainly through Facebook. We asked people if they had spotted a healthcare access challenge in their local community and whether they had an idea or solution to solve that problem through mobile or digital health.

The essence of the hack was that the solution should be an application, or something else where mobile technology could help solve their healthcare access challenge. But in turn, their solution should then increase access to medicine for patients, improve clinical information or improve the smooth running of their country’s healthcare system.

That explains why it is part of corporate responsibility and not in the digital innovation business line.

Yes. We are not looking for ideas that Sandoz can take on. This is a about backing other people’s ideas and supporting people who can help us to reach patients who struggle to receive healthcare.

Is the competition just for ideas?

The competition was open for about eight weeks and by December we had received 150 ideas from over 30 countries. It was great – we had a lot of lovely ideas that came through. We then judged those entries against the criteria for the competition and shortlisted six finalists who we helped to take their idea and share it with a broader community of people.

We partnered with an organisation called OpenIDEO, which is an online global community of thinkers who are trying to improve the situations around the world and tackle global challenges. Then, in March, we invited the finalists to London, to an event where they had access to a network of experts, people ranging from Novartis and Sandoz to people from a broader industry who could get them help and support. Over three days in London we helped them refine their ideas and at the end of the three days we took the ideas to the Wired Health conference. The six finalists pitched their ideas to a panel of judges at Wired Health, who put them through more questioning and found out how their idea would work out in practice. The judges then selected three overall winners, who received 20,000 euros each and additional support from the company.

The three winners were from Ghana, Maldives and Philippines.

What has happened to the teams since March? Are their products on the market?

They are not on the market yet. SandozHACk is very much about helping people who have got a kernel of an idea. These are people who have a great idea, but don’t know where to go with it. When we got to them they were very much in the early stages. Our funding wouldn’t help them get things to market, but would help to get things kick-started.

I didn’t think the winning ideas looked like world-changing, out of the box startup ideas…

We were looking for relatively small, local ideas that had the ability to make impactful difference to people’s lives at the local level, so that probably framed the nature of the ideas that came through.
We were not looking for the next massive innovation. For example, the idea from the Philippines is a CPR application. Being able to deliver CPR is a mandatory requirement in the Philippines. It is very difficult for the emergency services to reach patients quickly because of the diverse nature of the geography of the country, so people need to have CPR training and know how to react. A simple phone application will help the person on the street to deliver easy, life-saving treatment at the touch of a button. While this might not be as cutting edge as some of the other ideas we are seeing on the market today, it is a very local, small idea, that could be implemented easily and really make an impact in people’s lives.

Local ideas can be kick-started with 20,000 – you cannot build a world-changing startup in London with that money.

Money was one part of it, but we were very committed to giving young people access to ongoing support, expertise and access to a community of people too, not just money. Since we met in London, we now have a Facebook community. That’s where the discussion happens, talking about how we can collectively make a contribution to increase access to medicine and give young people access to a wider network of people who can help bring their ideas to life.

How do you measure the first results from this?

We are in the process of looking at that. Obviously we needed to give the winners time to gather their thoughts, but we needed to pay them the money and get all the administration out of the way early on. Now is when we are starting to go back and check in on their progress.

This is a priority for us, because as a company this is not just about passing over money and leaving people to it. It is about ongoing support, helping them when they need it and providing access to a broader community. That is where Frontiers Health comes in. We will be speaking to a few hundred people who we would like to invite to join our Facebook community. People who will hopefully be able to help the winners advance their ideas.

SandozHACk is not an isolated programme in the company. It is part of a much bigger commitment and investment in digital, which is a big priority for Sandoz and, going forward, to Novartis. So this links into the priorities of our business and where we see things moving forward.

What is next for SandozHACk? Another round in 2018?

For sure! We are still planning how we will launch it, but I would say another SandozHACk will launch in early 2018. We are looking at new ways to evolve the programme: in the first one we learned what worked well and where we can make enhancements and improvements. We are looking to bring in more support – face-to-face opportunities that will really help our investment, the ideas and the eventual finalists. For example, we hope to integrate hosting a bootcamp, which is not something we did the first time. Right now though, we are looking at what the challenge will be that we set. It will be about Digital Health though – I know that for sure.

Why do the digital sector and a pharmaceuticals-maker meet?

Pfizer recognises the impact that digital technology is going to have on the way healthcare is provided across the world. To ensure that we can continue to deliver on our commitment to patients who rely on us, we are seeking innovations from the digital health ecosystem that complement our medicines and drive the best possible outcome for patients throughout their journey.

You cannot deliver a pill in digital format though?

Our partnerships in the digital arena are all about complementing our medicines – giving patients the best outcome from the medicines we have developed and provide to society. Think about the patient journey: you have disease awareness, when patients are trying to understand what condition they have and physicians are looking at the symptoms patients describe. Then they go through the process of measurement and detection to reach a diagnosis. Once they have a diagnosis physicians make a treatment recommendation for the patient, but the patient wants to understand enough about the medicine to take it.
There are many opportunities along the patient journey for digital technology. For example, we use social media to support patients’ learning about different diseases – if they have a symptom that correlates with one of the diseases then they go to a healthcare professional for support.
We collaborate with technology startups to improve diagnoses, such as helping to improve the speed at which patients can be diagnosed with cardiac arrhythmia using simpler mobile technology instead of things like ECG monitors to measure your cardiac rhythm. Once the patient has a diagnosis and is taking the medicine, we can work with specific healthcare providers to support a patient’s understanding about how to take their medicine and to remind them to take the medicine regularly, as prescribed by their doctor.

As head of digital in international developed markets you cover all of Europe, Russia, Israel, Turkey, Japan, Korea, Australia and New Zealand: why such a combination?

Those countries are grouped together because they have similar healthcare systems and are grappling with similar healthcare challenges. When we look for digital solutions to solve those challenges, it’s likely that we can scale those same solutions to other countries in the region more easily. North America has quite a different setup in comparison.
As head of digital, I cover everything from how Pfizer uses digital technology to communicate with healthcare professionals and patients, through to the types of digital technology that support patients in getting better outcomes, like wearables, augmented reality and artificial intelligence.

Of those tech industry buzzwords, which will be the most relevant for the medical sector in the near future?

In the near-term there is huge problem with patients remembering or feeling motivated to take medicines that have been prescribed for them. The literature suggests that adherence is a global challenge, so we are exploring how technology can improve adherence for different types of patients.
The types of technology we are exploring include basic patient education tools telling them about their condition or why they should take the medicine, such as adding video content to consumer healthcare information or downloadable documents that can be read on mobile. Increasingly, we are also exploring things like augmented and virtual reality as a way to provide a more immersive educational experience to patients.
Ultimately, the pharmaceutical industry has always suffered from this challenge of adherence. What has changed in the last 10 years is mobile technology. Now patients have a powerful computer in their hand, giving us a better opportunity to provide educational content to patients so that they get the best from their medicines.

Is there a good solution for chronic disease patients to get a reminder? Wouldn’t a calendar alert do? Do they need a fancy app for that?

All patients are different. Patients’ adherence to their treatment varies for different reasons. If they simply forget, a reminder will help them. But some patients need educating about the necessity of taking their medicine and want to address concerns they have around taking medicines, like side effects. There is no single solution that fits all patients – we look at the types of patients suffering from a particular condition, break them down into different segments to understand what the challenges are for that segment and find technology solutions to address those challenges. What mobile does is give us an opportunity to provide different interventions, ranging from a simple text message reminder to video content informing them about their condition.

How does Pfizer co-operate with startups?

We have been experimenting with our relationship with startups for several years. In the last 12 months, we have launched a more formal programme, called the Healthcare Hub programme, which looks at the startup community in different cities around the world and enables a network of digital innovation hubs; identifying, interacting with and supporting startups who have solutions for our patients’ most challenging problems.
We started the hub programme in Berlin some time ago, because there was a huge amount of startup activity in Berlin. The German team began by running some networking evenings with startup companies, giving the startups an opportunity to talk to a big corporate and offering us the opportunity to talk to entrepreneurs about the changing world of healthcare.
That kicked off other activities, like mentoring startups in subject areas such as clinical trial design, market access, marketing and communications. There seemed to be an opportunity to roll out this collaboration to other countries in the region, where there was enough startup activity.
We do not call ourselves an accelerator. It is about looking for startups with solutions that help our most challenging patient problems, then looking for what each startup needs to develop as a company and whether Pfizer could support them with that, through things like mentoring, pitch practice to senior execs, or a more formalised collaboration agreement.
The premise is that big corporates are excellent at execution and scaling solutions – we can really help startups with that – but we could improve on our ability to ideate around a challenge and rapidly work out and prototype innovative ideas in an agile way: we call it “fast fail or fast scale”. That’s where we learn from startups, so there is something in this for both sides.
We work with entrepreneurs and involve our colleagues internally to drive a stronger culture of innovation within our organisation, which is important if we are going to be successful in this rapidly-changing world.

It seems that many large companies get excited about the startup world these days.

We have been careful to ensure we find the right partners in the startup community. We look at where our strengths are and where we can help them with innovation. We have strong local and international networks of key opinion leaders and we look for startups with more developed solutions that we can experiment with rapidly. If something is successful we can help that startup scale to other countries quickly through our international network.

It’s always interesting when large companies try to work with small companies. How do massive companies balance it?

It’s definitely a challenge, but both the startup and the big corporate are usually eager to solve it together.
We just announced a partnership with a Danish company called Cortrium – they build mobile ECG monitors, which can help detect arrhythmia. A small part of our sales team will drive awareness of the Cortrium device among the stakeholders that are important to Cortrium, because we have aligned objectives – our joint stakeholders are cardiologists. We want cardiologists to identify patients suffering from arrhythmia faster and more efficiently; Cortrium has the solution. We have worked through some of the challenges that any big corporate has when working with a small startup, but we have ended up with a solution that is a really exciting partnership, where the small company sees a true benefit coming from a large company.

Have you tried something like this before?

Cortrium is the best example. It is a true partnership that does not include any equity in the company. It brings benefits to both sides in the collaboration and the patient wins eventually.
It is the first of several collaborations we have ongoing in Healthcare Hubs across the world.

How do the Healthcare Hubs work?

They have organised events, such as networking evenings on specific subject areas where startups can come and listen to speakers talk about the subject of interest to them and brainstorm ideas with our internal colleagues afterwards – informal networking.
We have more formal partnership approaches too. In Germany and London, we have run Pfizer healthcare challenges. We formalise our outreach to startups, seeking submissions to solve key challenges that we face right now.
We put out requests to startups that have solutions to particular problems, assess the applications and offer the best ones a working relationship with Pfizer, providing mentoring by various colleagues in the business who can help them overcome specific challenges they might have. Later, we will promote them to the various stakeholders we know, giving access to our network. In four cases we have offered a small financial reward, but startups tell us that money is very low down their list of priorities when looking at programmes like this – it is more about the ability to network with a big corporate and gain experience.

I’m sure startups are interested in the potential reach you provide to the whole health care system.

Some of our challenges have attracted startups from the whole international community. Our first collaboration in Germany is with a Danish company that wanted to break into the German market with their business.

Offering part of the solution for any of these would be a massive breakthrough for any startup, but StartUp Health is aiming to solve all of them.

We have a 25-year plan to reach these 10 health Moonshots, Unity Stoakes, co-founder and president of company, told CoFounder Magazine. StartUp Health calls itself a movement, but it is functioning more like an investment firm offering much more than cash injections.

The 2011-founded StartUp Health has the world’s largest portfolio of digital health companies, with some 200 companies from 18 countries.

We think this army of entrepreneurs can help the wellbeing of everyone on the planet, Stoakes said, adding that the key to success lies in acting as the founders’ networking platform.
We consider our team members to be co-founders. We have 450 team members – a co-founder club supporting each other, he said.

“It’s a lonely journey to build a startup. There is nothing better than to have other co-founders there to talk to,” Stoakes described in the interview. “We have all these passionate entrepreneurs who are reimaging the future of healthcare.”

When growing the portfolio, StartUp Health is focusing on “batteries-included” entrepreneurs, who build companies with a long timeframe in their mind, like StartUp Health has itself. “We think in terms of years and decades,” Stoakes said.

Just like many other early-stage investors, Startup Health is helping the founders to raise money, gain customers and increase traction. Despite the decades-long perspective, 12 of its companies have already been acquired by firms including Intel, WebMD, Under Armour and Zimmer Biomet, and its companies have raised over 640 million dollars of funding since 2012.

The company – co-founded by Stoakes and Steven Krein – is chaired by former Time Warner CEO, Jerry Levin. Notable strategic partners and investors include AARP, Aurora Health Care, California Health Care Foundation, Children’s Hospital Colorado, University of Colorado, UCHealth, Steve Case, Mark Cuban, Esther Dyson, Brad Feld, Genentech, GE Venture, Janssen Research & Development, Kaiser Permanente Ventures, Robert Wood Johnson Foundation, SAP and SeventySix Capital.

With a team like this and a 450-strong founders’ network, they can do nothing but shoot for the moon.

I started losing a lot of weight, became sluggish, I was thirsty all of the time. So I went to the doctor over the summer and, in September 2013, I was diagnosed with Type 1 diabetes, Dachis told CoFounder in an interview.

The experience was quite a shock for a young and healthy man.

I went to the doctor, they gave me the diagnosis, an insulin pen, a prescription, a pat on the back and I was out the door in six minutes. I was terrified and felt very much alone with this new condition. There was nobody to talk to, no one to turn to, nobody who really understood in the immediate term what I was going through. I didn’t understand the condition at all. I didn’t know why I had got it. I didn’t know what was going to happen to my family or my kids. What would they do if something happened to me? All of these terrifying thoughts started going through my head, he said, recalling his thoughts after the 6-minute visit to the doctor’s office. My experience was so cold and disconnected. It felt so unlike healthcare.

Then he put his situation into perspective with the massive diabetes epidemic we are seeing. There are now some 500 million people worldwide with diabetes and another 500 million people worldwide with pre-diabetes or undiagnosed diabetes.
Being a tech entrepreneur, he looked to his smartphone to download an app for diabetics to track their health.

It turned out that there wasn’t anything on the market that brought together food, medication, glucose and physical fitness activity information. There weren’t any cool devices that allowed you to extract the data from your glucose meter and put it into a programme where you could run data analytics.

The idea was simple – to bring food, medication, glucose and fitness information together in one place, allowing people to feel empowered.

Because the person who is empowered with data and information can make choices. If you can make choices then you can manage this data-driven condition.

That was the genesis of One Drop.

I asked my wife if she would support me if we started another company. She thought I was crazy at first and said to me: if you can help one person with diabetes lead a better life, you should do it. So we set off to create One Drop: to transform the lives of everybody on the planet who has diabetes and a smartphone.

In the internet age the scale is massive if you hit the right chord – Dachis’ One Drop has half a million users worldwide today.

In a very short period of time we have seen a lot of people take a lot of interest in the product. That means there is a demand for tools and technology to help people manage their diabetes, Dachis said.

What makes the One Drop community unique is that members share all their data – you can see everybody’s data: how they live their lives, what medications they take. All data is anonymous, but it builds a global community of people dealing with similar challenges.

From just an app, One Drop has expanded its offering, bringing to the market its own wireless glucose monitor and building a diabetes educator programme into the app.

That system has now been proven through clinical studies to be more effective than any other diabetes solution currently on the market. You have digital healthcare beyond just an app, beyond lots of users that really enjoy the product. You have a system delivering health outcomes that are abnormally better than anything else on the market.

Changing healthcare

Dachis said that healthcare services delivered via mobile phone have started to change the doctor- and hospital-centric view of the universe.

For seven out of 10 healthcare dollars spent worldwide, you’re looking at a chronic condition that a doctor can’t really make a difference to. It is up to the users, the patients, to make this change. If users can get access to the data, information, tools and technologies they need to make their choices, and they do access those, the outcome can be dramatic,” he said. “For some acute conditions, you need a doctor or healthcare system to do what it does well – deliver expensive, sophisticated, advanced treatments to deal with that acute condition. But in the world of chronic conditions like asthma, I’m certain that the doctor extracts as much value as they add, Dachis explained.

With the role of self-care increasing for chronic conditions, doctors and nurses are more important than ever in acute care.

Generally, the system isn’t very good at caring for the day in, day out chronic conditions. Individuals need to do that for themselves. When you can empower them to practise self-care, I think people will choose to do that. It’s giving them the data from the team, the tools and technologies, making it easy for people to make the right choice. I think digitisation is going to power the empowerment of individuals.

Empowerment is in full swing already – if a tech savvy entrepreneur gets a diabetes diagnosis today and grabs a smartphone, there is a One Drop community of half a million people there for them to learn from.

A combination of new underlying data technologies

The two big data standards here are FHIR and blockchain. It is not clear exactly what blockchain is, or will be, doing, but FHIR is already allowing third party applications to build on top of major enterprise medical records. Both standards are potentially breaking into who controls the data and who controls the user interface into that data.
There are a lot of questions about how fast it is changing. Some people in the electronic medical records business believe it could really transform their business within three to five years.

Movement towards new data analytics – modalities

This includes all the buzz words you hear about artificial intelligence (AI), machine learning and the internet of things, but there are couple of interesting changes going on here.
One of the new modalities is voice, voice recognition and tools like Amazon Echo and Apple’s Siri, which are starting to come to healthcare. We have a demonstration at Health 2.0 of Google Home, showing an automated connection directly into the person’s electronic medical record. Also, there’s an automated booking system just using voice – that’s an interesting new modality that might change things. You can imagine doctors in the future using voice recognition to do their own records, rather than typing.
We have lots of other modalities too, including physical manifestations. The most obvious physical manifestation is robots – we have self-driving cars on the roads and we are going to have intelligent robots working in industry and the military soon. We will have them working in healthcare quite soon too.

Organisational business models of the future

Because of the changes in technology, we are also seeing people starting to break up the segmentation of how they deal with patients, so they can quickly do different types of things with different types of patients.
There are several different players pitching to enter that market through the different types of business models: there are the old, typical hospital systems, church, companies and governments, who feel they own the market; and newer players, like retail pharmacy chains and chemists, who are now entering this space.
But there are also people coming in from completely the outside the market. People are starting up and building new provider organisations and insurance companies that do care provision directly. What we are finding in the US is that there is a lot of venture capital investment into buildings and greenfield sites, especially in healthcare. A lot of big consumer companies have all the newer technologies, such as AI and cloud-based tools, already sorted out too.

Activating Google or Amazon

These businesses are starting to be active participants in healthcare delivery in some ways.
Interestingly, 2 days after Matthew first said this, Google, or its small spinoff Cityblock, started a care delivery system with their own hospitals, called Cityblock.

General awareness

Health is not solely dependent on medical care being delivered in hospitals by doctors, but instead comes from the community. It is determined by several factors that are embedded much more deeply, such as access to food, access to parks and access to education. People have started to think globally about the impact of cities and city design on health – what is the impact of transportation or education on health? How do we change those things and start thinking about different ways of delivering healthcare?