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[Music] hello everyone welcome to a risk conversations webinar of the geneva association titled digital health is the euphoria justified and this is the namesake of our new publication released just yesterday to coincide with universal health coverage day which is tomorrow december 12th i am pamela corn the geneva association's director of communications and i am the moderator today let me also introduce our presenters my colleague adrita bakarya craven is the lead author of the report and the geneva association's director of health and aging our future will discuss the objectives of the research and give us an overview of the digital health landscape and the market and a summary of the report's findings i'm also pleased to introduce two contributors to the report akim regenauer chief medical officer of partner re will give us his practitioner's view on stakeholder perspectives and saira daffour digital health lead at the institute of global health innovation at imperial college london will share her insights and experience on the impact of digital health so far and what is needed to drive better outcomes to set the stage just a little bit for us digital health includes a broad scope of categories telehealth telemedicine wearable devices apps healthit and and more digital health technologies have a range of purposes wellness diagnostics managing disease medical products and even tools to develop or study other devices digital health is often referred to as having the potential to improve abilities to diagnose and treat disease for example or that it offers opportunities to improve medical outcomes so the implicit message that we get is that it is not there yet and our report findings which adrita will take us through in just a moment back this up with specifics on those gaps and how insurers can add value going forward but even the director general of the world health organization stated last year in their first guidelines on digital health interventions and i will quote him harnessing the power of digital technologies is essential for achieving universal health coverage digital technologies are vital tools to promote health keep the world safe and serve the vulnerable and that's why it was important for us to convene today on the eve of universal health coverage day to contribute to the conversation on how digital health can support health for all we look forward to your participation also and the second half of the hour will be an interactive q a with the audience and our presenters here you can ask a question either verbally by clicking the raise hand button in the control panel and we will unmute you or you can write your question into the space there and you should feel free to submit written questions at any point even in the first half of the hour and then we will revisit them later on so we're ready to begin and i will first turn to adrita uh the lead author of the report given that there is already a substantial amount of work out there research already undertaken on digital health what did the geneva association set out to do with this report and the timing of the report um good afternoon everybody your good morning or good evening to some of you and thank you pamela for for that very um apt introduction to the webinar um you're absolutely right uh the world is not short of literature around digital health when it comes to products services the amount of investment going in in this space what the world is short of is understanding digital health from a from an insurance from an insurer and a payer perspective so firstly if we do a google search on digital health it wouldn't take us very long to conclude that there is just a vast amount out there and what is out there in terms of products and services are often targeting the consumers directly and often also with very little information about those products about this effectiveness so consumers are partly choosing products but knowing only partial information and not really knowing how effective they are so we wanted to look at as as the industry as the insurers are we doing enough to really narrow this information gap uh and help our consumers our policyholders choose better products for themselves uh number two we when we come it comes to digital health we hear a lot about service volume um we see this number of consultations we don't hear enough about this number of consultations and therefore the healthcare outcomes are these and therefore the impact on the insurance value chain are these uh such as underwriting or claims uh we wanted to dig a little deeper into that what is what is what happens further down the value chain if you like um once the the product is already out in the market and and finally um we already know that there is there are plenty of hurdles for digital health to jump in order for it to be scalable and in that space we often hear public bodies we see non-governmental organizations we see provider groups having a big voice and we say we are not really totally sure about how the insurers are placed when it comes to these issues so we also wanted to explore that and we've tried to really answer the the question and the next slide please um in in bite sizes so firstly we looked at the landscape of the consumer-centric digital health products and by that i really mean common consumer-centric digital health products like telemedicine like apps like wearables it does not include more specialist services like your home dna testing kits or the kind of products that target the providers like medical decision making tools uh we wanted to look at what those common digital health products impact is on health behavior and health outcomes we also wanted to see what in how it influences the insurance value chain and based on these findings we have devised some recommendations for the industry going forward and you can see the the methodology that we have back to you ah i think you're on mute thank you very much adrita for that overview and for highlighting um kind of our value added to the the landscape of research out there now perhaps you can give us an overview of the digital health landscape what is happening in the market on both the supply side and the demand side um how are customers responding and interacting with digital health products yes sure um if we can move on to the next slide perfect thank you so this is really the slide is about the supply side of the market and on the left hand side of the slide you see a graph that really represents the app market and i'm starting with that for a reason what you can see is there are two clusters one is where more around wellness and the other one is about health condition management what we see is that acts around wellness is really the domination they dominate the market we look we're looking at over 60 percent of the market share nonetheless you know disease-specific apps are on the rise the thing to point out here is what we are told that there are about 200 apps that are related to health in some way or the other are published on a daily basis and more remarkably a very few of these apps we are talking about less than 100 or even less than 50 that are actually being downloaded more than 10 million times a vast majority of the apps have been downloaded for about 5 000 times and now one could argue that you know these uh your data is about three years old this is a very very fast moving area i i buy that that's that's true but even if you notch up the figures in by by few hundred or even two thousand what you're left with is a very vast and fragmented market and it's just out there the second thing we see is telemedicine and needless to say during cobit 19 we have seen it has been a great catalyst in terms of the uptake of telemedicine and you can see it from the figures from the u.s and we have seen similar stories in the uk and many other countries across the world um what so beyond going beyond covert 19 if you want to look at it more broadly um we we look at um we looked at europe that's where we got our data from most of the time and we see certain non-communicable diseases have got a very sharp focus telemedicine has got a very sharp focus on some of the ncds and on other regions and i i must admit and this is and this is something that comes across in the report as well finding comprehensive data in the rest of the world has been really very very hard um but nonetheless what we can say with some um some confidence is that digital health is really on the rise in asia uh and uh and we have certainly seen that being even expedited during the covert times especially in markets like china around telemedicine uh but beyond that even uh in in less sort of affluent settings across the planet uh in in asia in africa in we we see a simple analog phone penetration which is very very high in some of these markets paved the way for incredible amounts of innovation so we have seen mobile health uh of mobile money that has been historically there something like impesa in in east africa that is now moving into the health domain to see how you can also tap in those consumers with that we also see uh primary health care and essential health services being uh provided in remote settings using telemedicine we see that in rwanda through babel we see that in bangladesh through telenor health and there are many others next slide please this is the demand side of the market and you can see the prominent themes here and i won't go over that what i want to mention here is that volume matters but who is generating the volume and how also matters and these are some of the things that i want to highlight in this slide so firstly if you again look at the app market uh in europe for instance the app market hugely favors the young population rather than the old on the other hand you see a great interest in accessibility of health information portals which has got a greater appeal to a wider section of the population we also see some universal themes here which is around trust i have used the u.s data here but there has been there are findings from other servers that are outlined in the report where we see a common concern about how data is being used for digital health and consumers are simply not clear about that and also in asian markets we see consumers want their insurers and their employers being more involved in the way they want to integrate digital health in their lives because it shows what a fast-moving market that is or that those are and digital health is growing so they want some help in terms of navigating that space next slide please um and then finally we come to uh what effect is it really having on health behavior and health outcome now there is a lot of detail in the report and there's a lot of detail on the slide but the big message here is that the evidence of digital health on health behavior and health outcome is inconclusive um and what is out there also does not it's not clear how high cost consumers and high-risk consumers are are represented in the study that are out there that's being conducted um and that is that is a big concern um because these are the normal pain points of society of health systems of pairs um so in order to really harness this technology for the better well-being we we need to be able to look into that of course there are domains where digital health has had some favorable effects uh certain chronic condition management etc but we have seen it being combined with other things like they've been combined with say some form of incentive or some sort of physical consultation as well so it begs the question is digital health alone is it enough um the caveat here is also some of the programs have not been running long enough so maybe we are also wanting the results too soon that may that is very possible but also if we do want to see those results in 5 10 15 years time and we do want to see the results in the right places we need to start measuring them now but we also need to start thinking about what we need to measure thank you thank you adrita and i think sire will pick up on some of those um impact or lack of impact issues later on um thank you for giving us a very full overview of the context right now not only what's going on the supply side but also customer sentiment putting it putting it in the context of covet 19 and a lot of interesting geographical information there so i think these were the results of your desk research and the literature review portion of your research effort but you also did a survey of payers and providers um and of course as the geneva association um being think tank for the global insurance industry we're really interested in in what you heard from insurers and then what you advise based on based on those findings sure if we can move on to the next slide please great um i will keep this short um again detail a lot of detail in the in the report what you see on the slide on the left hand side is a very simple insurance value chain it is effectively what happens when you in order to market and sell the policy and what happens when somebody claims for the policy so this is effective the value chain and we looked at how part of it was literature review and we looked at how it has really affected all these different functions and the big message here is again uh if we bring in the animation please uh thank you um is the focus on how digital health is being used by insurers it is concentrated right at the beginning of the process we are seeing vast amounts of effort being put into marketing and distribution of products we have seen innovation in other areas we have seen innovation in underwriting we are seeing innovation and customer engagement but they are relatively small and they are not widespread um they they still some some of them still remain a relatively sort of small scale um innovation uh within large companies what we did then in the survey um and in a way the survey findings are very congruent with that uh but the research with the literature review um in that we asked our insurers respondents you know what is and providers what is your strategic focus for doing digital health we again heard the same thing we heard more about marketing sales market growth those were the buzzwords that we we heard a lot more of than other things we also asked insurers where do they see the opportunities we heard a lot around oh we we really see this as an opportunity to tackle ncds but there wasn't a lot to say we want to tackle ncds to do what in the valley team which area do we want to change as a result and we also asked both insurers and providers you know in terms of its implementation so we asked insurers where they are using digital help again the focus very much was on marketing and distribution than in other areas and we ask providers indirectly if they feel that a digital health has really been optimized across the patient journey or consumer journey and the overwhelming message was no um beyond this uh so basically we're just going back we are three different questions but they all indicate a very narrow focus um uh so moving on we also see uh the target population of those that who responded to the survey they're relatively young and this again is matches the literature uh in terms of reimbursement we see a very a big polarization in terms of who pays for it a lot of people say oh the insurers reimburse me for it and the others say you know consumers reimburse us for it we see fee for service as a very dominant uh way of paying uh for these products um and then there are challenges a lot of it you know would not come to as a surprise to a lot of us uh the resource availability prioritization providers concerned about misaligned incentives and market fragmentation but also external barriers like trust comes up again and again it's very confident with the other things that's come up in the research the literature next slide and basically based on this we devised six areas where we would we want to see how the industry can take this forward to the next level one is really starting at the right right at the beginning we we want to see we but the industry really needs to figure out what is digital health going to do for them uh we need a holistic strategy is it just for marketing or is it to really address some of the deeper issues of of health and well-being for society or health systems for pairs which is prevention and management of chronic popular chronic illnesses in an aging population and we haven't really defined that strategy for us so that is like the really the place where to where to begin um then it's about evidence i think we need to invest more about in claims analysis to see where the pressure points are and then the second part of it is then then targeting you know products that are effective towards those and for that you need to really have an you know a way to to generate that evidence and have some basic evaluation standards aligning payment incentives we need to think about going beyond fee for service the fifa service is great for generating volume but it is also known to generate unnecessary volume which somebody is having to pay for it it's either the consumer or the payer uh so if we start thinking about value-based reimbursement methods to start sharing the risks that would be a wise step forward next slide please um then it comes down to the issue of trust we have heard this in many ways in the report and we tend to think that if something is regulated it's trusted well as it turns out it's not quite the case with digital health and we therefore think that it needs a much more customized and a personalized approach like a charter either at the company level or the country level or the regional level more ambitiously maybe at the global level that can spell out how you know digital health data is being used what is it being used for who is it being shared with i think consumers need to know and as a result of this they also will uh have more trust in the in the system and there is no a hard way regulatory way of doing things these are softer approaches and something that we have to get our head around and find ways of of addressing um we need to also recognize our own capacity when it comes to digital health we are very quick to say oh what is our e-governance structure what's the regulators doing what's the government doing that's important and we absolutely need to have that conversation but we also need to get our own house in order uh from insurers from speaking to colleagues we have heard again and again life insurers and health insurance solutions don't even speak to each other in terms of data what do we need to do with that we also probably need new talent in the system to really start having this joined up approach so again it's starting to think about what are those capacity needs that we have internally and and exactly and finally creating a digital market space which is really moving towards something like a a curated linkedin or an amazon of credible apps or digital health solutions out there that have followed some basic standards for evaluating their efficacy and that has created a bank of credible apps that insurance or insurers or any payers can buy from and that can happen at different levels it's an ambitious vision but given the level of fragmentation in the market that is potentially where the private sector can really come in particularly the insurance thank you thank you adrita that was um very i think full guidance um on how insurers can take this forward and i can tell you that we're already getting interest in a closer look at the survey results uh maybe even beyond what you have in the report so we can we can go back to that member of the audience for now we will move on to akim akim is a practitioner so he has a multi-pronged perspective he has a view on um healthcare systems the customer the insurer and i think a very good understanding of the status quo right now um so it'll be interesting i think for everyone to hear about how you perceive how you perceive perspectives levels of progress and the different challenges yeah thank you pamela perhaps we start with the first slide i do it as a practitioner of course i have some experience working for several re-insurers but i have also been coached and educated in clinical medicine so i were more than 12 years in different hospitals and i keep on following this i understand my role a little bit as playing the bad guy or coming down to earth i would like to make clear at the beginning i do not deny all this digital health i think we barely need it but we should refrain of describing a bright new world but analyzing how the world looks like right now and perhaps we take the next slide i do it with uh with three different angles but before i start with that i would like to make some opening remarks in terms that we are talking about health data and health data are not just fitness data or lifestyle data but they are each and everything what is our personal makeup in terms of their behavior and medical history very often it's dubbed all of the 21st century and that's atmosphere because it's very valuable but at the same time these data are very personal very sensitive just to give you a few examples you know genetic genetic testing very very sensitive mental do you want that your employer or your insurer knows about your anxiety and panic attacks the same applies to hiv or sexual transmitted diseases or cancer which is still a disease with which a lot of taboos then the data are very fluid just take the genomic science and our 30 thousand genes of course we know exactly how the different nucleotides look like but the genes are either on or off and in any nanosecond this changes so once we have a perfect holistic feature of one person a millisecond later it's totally different very complex interactions so very often it's mixed up with pnc data and non-health data health is much more complex and it's subject to tight regulations next very often uh we call we discuss about integrated personal health information or eco health system so by and large i understand this on the one side is organization and management of all digital health services on the other side we have to take into account the patients and the providers next and as a practitioner i always will quote and a precise uh example you see here this green face of this green icon is a diabetic patient and of course it's up to date uh the white colors in the in in the faces is wearing a mask yeah next one so we start with a healthcare system and the healthcare system is you see on the right side just a selection of dozens if not more stakeholders very important stakeholders and the healthcare system is featured by a fragmented maze with very complex interactions where one stakeholder don't want to share the health data with the other because i'll say they have power then a very low e health literacy um so we eat very often of digital health transformation programs and we shouldn't forget that this entire system rakeem i'm sorry akeem your microphone is maybe um having some friction with your um wire i'm not sure so okay it's pretty much where your microphone is yes yeah okay plus please interrupt me it should not be yeah i think it's okay i think it's okay okay yeah so um regulation just think of the regulatory approval which is very often missing in the apps or the certification consumers don't do not know which health apps are really valid and then the lack of financial motives because most of the healthcare system is state subsidized next uh the positive side the upside you may be very surprised is the pressure on health budget this is very often described but if we split it up what are the different factors which cause the restriction on health budget these are five pillars or five factors one is the advances in medicine that's we all know technological innovation we we talking about this today demographic aging the more the average age of a given population is the more more beats the more disease these people are then we have a shortage of health care system professionals and last but not least and this will expedite the entire process covered 19 costs a lot of money next so we have a slow adaption of digital tools and still a long way of transforming health care so just next to start with a precise and concrete example the diabetes person has has got an insulin pump which helps to mimic the way a healthy pancreas normally is working but there's no interaction between the daily consumption consumption of the various meals you know that people very often be diabetics or other make a photo from their daily meals and put it in the social media so where's the interaction the the technology is already there they could calculate the carbohydrates and adjust automatically the insulin dosage which is necessary for the diabetes diabetes patient is the technology there it does not work and this applies to all internet of things artificial intelligence big data blockchain wearables etc application is lagging behind next one the consumer or the insured or the patient uh we all know that there is a they should play an active part in the digital health ecosystem and we know just on a sketchy feature the consumer nowadays are always online they serve on all channels be it the smartphone computer whatsoever they are adjusted and used to convenience just the example of this notification ongoing notification once you have ordered something on amazon they are agile and they should be empowered this is what the consulting firm always tells us the consumer or the patient wants to be empowered and wants to have a participatory house as a physician i have a little bit a different view but see we can discuss this later on next personalized health service precision medicine is another key word and to tell you as a physician that's a very long way ahead of where it already starts is in cancer medicine here we have a very personalized diagnosis and treatment in the meantime but all the other diseases a long way to go next one what we see with the growing concerns because it affects our business model is the trend to over-the-counter medicine self-health care that you can test yourself against for hiv for sask of two for your uh 23 chromosomes which you take a swap and send it to california to 23andme and they analyze your entire genome and nobody none of the stakeholders of the healthcare system knows the results neither the insurers so what's about next sharing the data the health data the and that's very sketchy and simplified the physician the consumers have more trust they would be more ready to share the health data with their physicians the juror not that much very often not so again next coming down to us a practical example what does our diabetes patient do when he goes to his general physician and he has thousands of different blood sugar readings which he can measure by a swap by his smartphone and then the app uh totally bloodless and he goes to his general physician and wants to give him all his wealth health data that's to say blood sugar readings and the general physician will say oh no another diabetes with another app this is today the 11th different app and i have no i have only a single platform how should this work next one the third and last stakeholder that's insurance and i do not distinguish here necessarily between health insurance and life insurance because i think it is in growing overlap and i play here perhaps a little bit of provocative maverick our insurance business model today is characterized by wealth of risk of no risk know-how and we have a wealth of data health data of course also but we have still very static information architectures we think very tariff oriented in the different product lines we have few touch points with our insured so the customer journey i love the keyword very often particularly in life insurance has only two touch points at the beginning and at the end and insurance policies are never very tangible yeah so insurance has a is always associated with negative thoughts thinking about probabilities that's not good for the insured huh next one if we look about other areas or perhaps the left arrow shows us insurance where's the digitalization has already has some success stories it's about marketing it's about distribution and it's about this administration again very simplified and maybe also a little provocative and if we look to the banking branch or the automobile industry that's totally different who went to a bank office or bank shop during the last 12 months almost nobody unless you need a mortgage and in terms of automobile you think the automobile industry are selling cars no way they don't sell cars anymore they sell mobility concepts mobility services which means they sell the car they sell maintenance service they sell financing they fill assistance services and to larger smaller part also insurance so where is our active role next one i think we have two challenges in the insurance industry one is by the means of digitalize we could shift from repair medicine that's to the traditional if you have got a heart attack you get a bypass etc to a more preventative medicine and we could save a lot of money the second solution and here i think of the automobile industry we should shift from a reactive payer to a proactive player which takes really care for his patience or for his con insured and just next one and that's the last coming back to our diabetes patient he has not yet a bi diabetes he's a obese couch potato and by the means of his lifestyle behaviors we could support this couch potato to prevent from developing diabetes via a targeted training by monitoring of all these biometric vitals like body mass index blood pressure etc etc and we could educate this couch potato to become a more active proactive insured in order to prevent to do from developing complications like diabetes heart attack etc thank you very much thank you so much jackie and we're so fortunate to have you bring all of those different views together for us and i especially i think benefited from these kind of um concrete connections between digital health tools and specific diseases and being able to really conceptualize how they work how digital health can work um toward those um we also saw i think a great compliment to the the recommendations adrita put forward in her report and in her presentation um about there being a more proactive role for insurers right now and to take a more holistic approach to health um so in moving on to cyra we will come back to the theme of um impact and being able to prove the benefits of digital health so adrita had given us a um an overview of of the digital health landscape and so we we know that the the supply is there the the demand is there um there is appetite on both sides but the report concludes that we are still lacking conclusions um so we turn to you saira for for more information on the challenges to generating evidence right now what's being done on the academic and research side um to kind of make up for this this shortfall sure and thanks so much and thank you again for inviting me to a contribute to the report and also to speak um today so as background i'm dr thyrogfur i'm the lead for digital health at the industry of global health innovation at imperial college i'm also a respiratory physician and the co-founder of two healthcare startups as well um so this um in evidence generation is a combination of my experiences from all the different sides from academia clinical practice and also running a startup as well and so we just jump to the next slide please so one of the big things that we always talk about is evidence um base for anything in health care and we know that we have had a significant amount of digital health input across all countries and globally but actually the evidence is really lacking behind innovation at times um and what our vision really is to do is to support the identification development of um how you can generate this evidence and in doing so how you can sustainably reduce inequalities in global health for many years to come next slide please so one of the things i mean the the obvious title of the report is the height justified so back to the fact that actually digital health has really been quite slow to deliver on its promise and going back to rita's point and right at the beginning was actually we currently um in terms of health behaviors and the health outcomes and there isn't enough um evidence to essentially say um that it's conclusive to say that it has completely improved either outcomes or behaviors and this slide here kind of takes you through some of the reasons as to why this has not happened so in terms of patients um we've not often seen meaningful improvements to patients lives and sometimes we think digital health the promises there in terms of you know a new app a new solution something technologically driven however does it solve a pain point for that patient does it help to actually improve their life in any way or is it actually creating more burden um in their life than anything else and you know after one or two times of using any given solution does there have is there any longevity in the usage of it and in terms of health systems and providers um it's very difficult to know which solutions will actually deliver good icons without having that evidence and this is one of the huge things is that there's a lack of evidence and behind clinical outcomes whether it's value for money whether it's going to bring return on investment and for any given patient problem and there's also the lack of skills and expertise to deliver large transformation programs in terms of digital you know bringing in an electronic health record system to a hospital you know takes years of planning of implementation and then coaching of all staff as well so if you can imagine doing that with you know lots of different solutions across every single disease category it is huge and it's a huge burden as well we don't have the trained people to support any of these implementation programs um in terms of regulators and people are having to catch up very quickly in terms of creating new rules and regulations and so certainly we've seen big um steps forward from the fda and from nice in the uk and also bee farm in germany as well there's been huge strides that have been made to see and how we can implement um digital technologies into any given system but again we've not fully cracked these challenges it's very difficult and it's very difficult for the providers of for the creators of any of these technologies to follow a rapidly changing landscape as well and without very little support in terms of digital health innovators it's very difficult to actually capture the market and this is you know as experience of running a startup myself despite having you know a clinical background a policy background an academic background and knowing how to generate all these different things it is very difficult to actually enter into any given healthcare market and part of that reason is how do you generate evidence and so it's that chicken and egg situation the pear says can you tell us you know how well this will improve somebody's health outcomes or will i need patients in which to test it on but you can't test on patients until you've got outcomes on safety efficacy etc so it's new ways of finding how you can actually generate that evidence without going straight into a clinical trial and then in terms of investors as well it's very difficult to understand what is good what's bad you know if you are literally if you've not got a background in healthcare you don't know how to um you know uh how to look at the any evidence that is generated and interrogate it you see big disasters there's lots of failure rates and you know one of the the big kind of catastrophic ones has been the um you know we've all heard the theranus um story and that's people have been investing in a company where there was very little evidence in terms of showing the efficacy of a product so across the board um digital health has been slow to deliver on his promise there's lots of appetite for it there's lots of new ways of working however we need to have an evidence base to show that this works next slide please so giving um you know this is an experience um from imperial itself so i can talk you through you know what the the challenges have been in terms of developing a digital solution and taking it through from the creation of it right to through to uptake and diffusion and so one um app that has been used it was called heart when it was first started but the clinical gap that it was used to help and fight it was created to fill a clinical gap in which um we were failing to detect deterioration in very sick patients in the hospital and so this led to increased morbidity and mortality this was a recognized clinical gap and the solution which is in the form of an app was created to help recognize this deterioration and this solution was developed and iterated and tested multiple times it was called heart start with it was acquired by deepmind and now it's been run by and google health we tested the solution at um imperial college healthcare trust which is our affiliated hospital um and this took at least four years to actually organize the trial the trial itself and which has happened has taken over 23 months and it's been um trialled on a couple of different wards within the hospital not even across the whole hospital and so if you can imagine from that period of creation to testing and trialing it has been almost seven years and this is not feasible it's not acceptable um for any given digital technology because by the time you kind of get it through that seven-year period of filing and testing it you know it will essentially it'll be defunct and it won't be useful anymore so we need to find it new um and better ways of being able to test digital technologies next slide please and so we've identified common needs across digital health innovators we need to find fit for purpose and evidence generation and it's got to be pragmatic as well and we cannot rely on randomized controlled trials we need to have um more um you know we need to have um evidence generation strategies that are pragmatic that are easily and more routinely routinely being able to done to do them need access to clinicians and experts and whether this is a kind of um user experience trial or whether it's feedback or whether it's kind of running simulated trials um that's key to being able to test these there's the key issue of not being able to navigate and regulation this is becoming more and more stringent and rightly so because we need better regulation but at the same time there needs to be guidance on how to actually navigate the changing landscape and we need digital health training as well so some companies have found that they don't necessarily have the capabilities to succeed in a digital health market because you know for some reason they have not actually been healthcare providers to start with they've not been healthcare innovators and then to come into this market is very difficult without having that background and so lots of training and education there as well um and then in terms of being applicable in different um countries and in terms of being globally applicable you need to make sure that healthcare companies understand um the kind of policy practice around the globe and this is where something like the geneva association can really help with is being able to understand the context of different markets as well next slide please and again just back to the fact that evidence generation is one of the the most common issues of why um solutions do not succeed so one of the kind of big studies has shown that only 12 percent um of top-funded us-based digital health companies were able to demonstrate evidence on their digital health products and next slide please then going back to the regulatory environment so there are you know there's fda there's nice there's bee farm now and the new regulations for germany um the regulated environment and for digital health is clarified but we need more evidence um and it's likely that they will require more evidence as well to make sure that um we have this space for any given digital health solution to make sure that the efficacy the effectiveness is there that it does improve patient outcomes and it does change health behaviors as well unless we have that it's very difficult to demonstrate and that any giving solution will have longevity on a given market and as i said there's lots of challenges to doing this because it's a bit of a chicken and eggs situation we cannot rely on big randomized controlled trials and big studies we need to think of more pragmatic ways for example imperial we've been using um simulation based technology as a workaround to this and seeing if that helps in a more pragmatic way we've had great results from that other things to look at are things like ar and vr scene they can be brought in to do um pragmatic testing as well so this is a changing landscape it's very exciting to see what other ways that we can do um clinical studies in terms of being able to generate evidence and we look forward to sharing more results with you in coming months and years thank you thank you so much sarah for that really deep look into what's going on on the research side um what you know what is missing and what your challenges are and what we need to do to improve patient outcomes we thank you for that we do have a few questions i think we have a little over 10 minutes so hopefully we can fit in um three questions at least um so i'll start with one that is quite uh provocative actually um one of our audience members vineet has uh has has put forward this may be for rakim but anyone um of course is free to answer digital health seems more a myth than anything close to a solution for the key challenges of public health please give us a fundamental list of principles that gives a sound evolution of this newer field of medicine i don't know if this is something for akim or if um adrito or saira if you have a response in addition i would let akim go because and then and perhaps i can bring in a policy and goal and i'm sure my tax on development just unmute yourself aki i'm sorry sorry and then i was in i was muted uh i should with me now hello yeah uh i think it's a very difficult and challenging question because i think many generations already uh fight it very hard to find a solution i told you already that health is not a mechanistic model but it's very very complex so this needs what would be i think a precondition is that you can really compile several stakeholders from the healthcare system using the same platform and developing a holistic digital solution for the patient so to do it a little bit again by the means of a concrete example if you have got a diabetes patient if let's say the most popular health app vendors could agree on a common platform so that the general physician at least in a given country but even better in in the european market would use the same platform so that the the the exchange of of um diabetes data could be facilitated it was a huge um gap forward and um just to give you another concrete example it is not utopic we have had a very challenging title in our geneva report with is digital euphoria justified if you look at the small state former soviet state of estonia which has really totally transformed their administration and also their health care system into a digital one i think this state has really proven that this is possible and feasible of course it's a state of only two million inhabitants and if i may very quickly come in i think i think uh knowing the evidence and knowing the fragmentation in the market it's it's not surprising that some people are frustrated uh and and it is looking like a myth um but i think uh we we need to start looking at what is working as well i think you you will definitely see digital health has done a great amount of work in terms of expanding access to care um it is doing a great amount of work in terms of training rural health workers and i'm not even talking about systems that are very affluent uh systems that are very mature i'm talking about systems that are very very fragmented about the kind of work that goes on in the development space certainly in sub-saharan africa and in asia the other thing is also what is our expectation from digital health i think there is data in the report to show that maybe digital health is has got a position in a mix of other services and it's that where that flare of efficiency comes in and how rather than considering it in isolation from all the other things that happen in the health system it's that definition of where this digital health and all the technology really fits in and that constellation is something that we really need to work out so i would not go as far as to saying it's a myth i think but we need to also try to dispel the myth in a much more concrete way thank you venet has expressed appreciation for your good answers um and adrita um i didn't i had no idea about the estonia example so this was um particularly interesting i think um we don't have too many other questions but there is one that is is rather general but i think it speaks to the issue that's highlighted in the report which is that digital health is seen um as a way to increase accessibility and affordability um of healthcare and and we have um an audience member based in in nigeria who is asking we have such a long way to go in africa how can we accelerate digital health in developing countries um so maybe one or more of you can dig in deeper there um i think the first thing we need to think about um is digital healthcare to achieve what i think that is that is a very key message that um that has come out of the report and we all talk about accessibility and affordability and we see to an extent accessibility has been addressed we have not really cracked the question if it really tackles affordability um so to achieve what is it is it just accessibility or is it good health outcomes is it financing and financial protection i think we need to be very clear careful about what we want from digital health and then start you know using digital health with the needed infrastructure to achieve it um again it goes back to my point to not look at digital health in a vacuum it is there to to uh in the context of universal health coverage you know for to to achieve help for all and i think what kind of health we need and how we want to achieve that help with what kind of money will define that for us as to how then it needs to happen in developing country or developed countries but there would also be a very simple example of application in nigeria i assume and i'm i'm convinced that i'm not mistaken that most of the nigerians if you take a country in in the developing world own smartphones but they have perhaps not such a good infrastructure in terms of public transportation as we have it in europe so to in order to reach out to all the potential patient a simple telemedicine application platform would be would already facilitate the individual's life in terms of looking for a consultation for a doctor and he wants to to look at the skin or the tongue so he takes the camera of his smartphone and shows it to the doctor of course it's not a one-to-one um replacement by a physical contact but it certainly will improve quality of life and i i think you can even go further back than that so i think one of the big things i need to do is to ensure that any digital health solution does not widen inequalities in healthcare um and that's a huge thing that we need to consider both in high income countries but also low in middle income countries so it's that whole question about digital inclusion but actually when you look at the penetration of mobile phones and smartphones globally it's a huge number so actually even if you use the basic construct of sms messaging or you know using um some people can't read so you can't use sms you need to leave a voicemail and so using basic technologies like that to really improve accessibility of healthcare where there is nothing other than you know remote technologies such as that and so i think it's kind of using the full spectrum of it yes we have these amazing flashy digital tools on one end of the spectrum but actually we can go right back to basics and actually those solutions and interventions show much better evidence sometimes than you know this new app that can you know promises to deliver x y and zed so i think it's kind of making sure that we use the full spectrum of technologies that are available to us thanks to all of you that was an even more kind of promising outlook than um maybe some of us some of us expected so we actually had today no one raised their hand to speak um and i think as a matter of wrapping up uh on time but also not neglecting to touch on what i think a lot of us want to to hear about maybe we can combine one answer from each of you to a question i will ask with your final remarks um so that we kind of uh we create an efficient approach here so i i think we highlight we have highlighted today that um certain digital health tools have accelerated during covid um telemedicine telehealth um there was a an article in the economist just uh this week that said well actually um uh you know healthcare was one of the last industries to to undergo this digital transformation it was it was long overdue um there are also um there's also data that actually was accelerating even before covid so we see both the trend was going on before covet and it and covet helped um kind of expedite so what do we take away um from covet in terms of the the outlook for for digital health and and digital health and insurers so um are there lessons learned um uh you know what do we what should we expect i guess is the question and maybe you can um answer it from your own position and and wrap up at the same time georgia if you would like to begin perhaps i think the biggest lesson is from covert is that digital health has a role to play in our lives um but we need to define it better um both uh you know and as public sector but also insurers as pairs in the private sector um we need to understand where digital health fits in in the mix of all the things that we do for our policyholders in health and life and i i go back to this i think everything else to an extent will fall into place if we get that strategy right at the moment it feels very marketing focused it's getting the app making a policy attractive it's but it's not about okay how then we use that data to bring real value to customers life to either lower their premium or they lower their co-pays or to reduce our claims and that's got a wider effect on on the pair as well as the health system and the society overall so i would finish in that let's get our strategy right on digital health wonderful thank you adrita um akim if you would like to comment as well i see two aspects uh one mainly in the insurance industry the other mainly in medicine in clinical medicine the insurance industry i think we made a leapfrog forward in terms of distribution um interacting ourselves within our company working all from at home and by digital means but also selling our products to the clients why a digital platform in terms of medicine i think it's even bigger leapfrog ahead if you just look for covet and the development of vaccines this was really a price taking speed and this was also due to an excellent collaboration in a world where almost everybody was in lockdown but we moved ahead and in a to a considerable amount thank you akim and sarah if you'd like to finish for us sure um i think personally as my experience as a clinician over the past couple of months um digital technologies have been invaluable to make sure that we're still able to deliver care for patients i think the um the ratio is completely flipped over the past year so before we would do 10 of our consultations remotely using digital technologies now you know today i was doing a clinic 90 of all consultations are done remotely for this period in time um it's here to stay and i think what we need to do over the coming months and years is to improve the quality of evidence that we have at the end of the day someone's got to pay for this whether it's the patient is the provider or whether it's insurer um and across the board we need to make sure it's value for the patient at the end of the day and it improves their life their outcomes their behaviors but also that there is return on investment and for any given monies that are spent on it so we need to make sure that there is good evidence coming out for this we need to create ways of delivering pragmatic evidence and i think this is going to be the next step forward well thanks a whole lot to all of you for contributing your different perspectives we heard the insurance the insurer perspective we heard the practitioner perspective research and academic and clinician perspective um and so i now encourage everyone to have a look at um our new report digital health is the euphoria justified authored by adrita in collaboration with akim and sarah thank you all so much for joining us today on the eve of universal health coverage day and we hope we have um given you um a good view on how digital health plays a role so thank you very much thank you goodbye [Music]