Insights from our Expert Roundtable Series on Oncology
Insights on digital health’s role in Oncology ft. Pfizer, Advocate Health, Verily, OncoHealth, and more.
Every Quarter we host an Expert Roundtable Series. In Q4 2023, we hosted eight executives across some of the largest players in Oncology. Companies included Pfizer, Advocate Health, RA Capital, Verily, OncoHealth, American Cancer Society — BrightEdge, Jasper Health, and VivorCare [Link to full video here].
So what did we learn from the discussion?
Let’s recap…
We hosted a fireside chat with the Global President of Oncology at Pfizer, Suneet Varma, as well as a discussion with current and former Chief Innovation Officer and Chief Medical Officers of Advocate Health and Point32Health, Rasu Shrestha MD MBA and Michael Sherman MD.
CEOs and executives with deep domain experience sat down with us to discuss how they are thinking about innovation, and how each of these stakeholders are partnering with large payer/provider/pharma organizations to deliver innovative oncology solutions. Other panelists included Rick Dean (OncoHealth), Adam Pellegrini (Jasper), Hil Moss (VivorCare), Melisa Tucker (Verily, Flatiron Health), and Alice Pomponio (ACS — BrightEdge). Below are some of the key highlights from our discussion:
Biopharma / Life Sciences
- 50%-60% of all FDA approvals have come in the Oncology space over the last decade — oncology is truly pioneering medical breakthroughs
- Large Pharma companies are increasingly looking to outsource and partner with external vendors for innovation, versus build/buy alternatives
- Upwards of 50% of all clinical trial sites are becoming remotely accessible
- Payers are more interested in value-based payment models for drugs than ever before; examples include warranties for cancer drugs, and micro-financing strategies to amortize payments over time
- Much more direct patient-facing relationships are being formed between pharma companies and patients
- There is a higher bar than 10 years ago when selling into large Pharma companies, with less focus on investing in longer-term strategic bets. (On the plus side, this can create faster/shorter feedback loops for companies to iterate, but this also means faster ROI requirements and less time to wrestle a complex pain-point)
Plans / Providers
- ROI is top of mind for all payer solutions, and Disease Management and Utilization Management are the critical payer functions in oncology
- Downside-risk arrangements in oncology are few and far between, largely driven by the scarcity of oncology practices to fill out a payer’s network, resulting in providers largely ‘not needing to enter into downside risk’ (the vast majority of them haven’t yet, and aren’t likely to)
- Moreover, established provider systems are focusing intently on clinical preeminence and safety, improving access and coordination of treatment, adopting next-gen workforce solutions (via AI) for education, and accelerating learning and discovery
- End-to-end solutions for oncology that drive value for Providers must include: Clinical Enablement tools, Cost Containment tools, aspects of Care Delivery Transformation, and Technology and Data Analytics support
- We are still in the “early innings” of defining and measuring value in cancer; the historical focus on progression-free survival or disease-free survival is strictly not enough in a VBC arrangement
- Fragmentation of payers and providers in value-based arrangements is halting progress
Startups
- Employers need to see controlled cost in Y1 and clear ED deflection (Bonus if you can address aspects of Psychosocial needs, patient copay assistance, and engagement)
- Clinics and Providers are looking for startups to address unmet needs of the populations they serve, optimize their existing workforce, and execute on psychosocial / social determinants of health
- Payers used to look primarily at “spend and trend” to inform decision making, but they are increasingly looking to bring ancillary solutions directly to the employers they serve (I’ll call it B2B2E) for MA and Commercial lives.
Technology, AI, and Other Insights
- Digital health has a unique opportunity to bridge the divide between initial design phase, and patient point-of-contact for clinical trials. (Alice described this as “bringing the outside in” to identify risks and opportunities)
- Clear opportunities exist for technology to access data silos, where data otherwise wouldn’t have been accessible
- For Generative AI, the earliest adoption is likely to be seen in coding/revenue cycle, multi-modal data curation, patient engagement, and timely population of data and insights into existing workflows
- American Cancer Society is actively providing grant funding for AI solutions in the market
So what does this mean for innovation?
It’s evident that Oncology is experiencing a transformative phase that is focused on rapid speed-to-market for new therapeutics, and an emphasis on the shift towards value-based care. This has significant implications for pharmaceutical companies. That said, health plans, providers, and entrepreneurs have a vital role to play in the distribution of services.
For large pharmaceutical companies like Pfizer, there’s a clear shift towards embracing more external innovation and partnerships. This is not limited to novel drug development, like complex biologics and CAR-T therapies, but extends to how clinical trials are conducted and even how patient care is delivered. The trend towards remote accessibility in clinical trials and the FDA’s favorability towards oncology treatments indicates a more agile and patient-centric approach in drug development and approval processes. As evidenced in Suneet’s breaking announcement of the approval to acquire Seagen that very morning, we also expect to see more reports that highlight partnership and external innovation happening in pharma, particularly oncology. Other large players that have publicly announced large digital health strategies include AstraZeneca’s Evinova platform, a unit that will operate as a separate business within AstraZeneca to oversee digital health solutions as a market primed for growth.
An interesting report from Allis highlights over 300+ partnerships have been formed in the market for digital oncology solutions since 2014, emphasizing Artificial Intelligence (60%) and Real-world data/Real-world evidence (20%) as the two largest areas of investment. Remote patient monitoring (10%), and Digital therapeutics (10%) were also included, albeit less overall investment.
For healthcare providers and plans, the focus is intensifying on not just the clinical efficacy of treatments, but also on their economic viability and impact on patient quality of life. This requires a multi-faceted approach that includes disease management, utilization management, and a more robust integration of AI and digital health tools into workflows. The challenges of measuring value in oncology care go beyond traditional metrics, calling for a more nuanced understanding of patient outcomes and experiences.
Our fragmented healthcare system and the reality that each player is seeking to maximize its share has led to value-based care lagging behind many other areas, both with respect to services and innovative pharmaceutical arrangements. Consequently, an opportunity exists for new entrants that might engage all stakeholders in a manner that allows them to optimize care by better managing the range of tools, services and therapeutics available; such an entity would also be well positioned to offer a better, more individualized patient experience, and sell solutions to the payor community.
– Dr. Michael Sherman, Venture Partner, RA Capital and former Chief Medical Officer at Point32Health
For entrepreneurs, the opportunity lies in developing solutions that address the immediate and long-term needs of both providers and payers. Solutions that offer cost containment, clinical enablement, and improved patient engagement, especially in the first year, are particularly valuable as payers continue to focus intently on ROI. Additionally, there’s a growing need for technologies that can bridge the gap between payers and employers, offering direct benefits to patient care while addressing the financial concerns of both parties.
Two years ago, you didn’t hear a lot about ancillary oncology solutions in the marketplace. Now you’re seeing RFPs that are being issued by payers left and right for these solutions, and that’s a trend I anticipate will probably continue.
– Rick Dean, CEO of OncoHealth
As part of a follow-up from our discussion, Jasper’s CEO, Adam Pellegrini, shared insights from the company’s thesis, which builds upon a study published by the Harvard Business Review from the Memorial Sloan Kettering (MSK) Cancer Center. Jasper is now actively partnering with MSK to develop this next-generation concept, aiming to deploy it more broadly across employers and healthcare systems (learn more about employer trends here and download their patient savings report here).
For biopharma, the opportunity to enhance patient access to care and leverage data more effectively remains a priority. Digital health companies are uniquely positioned to address unmet needs in oncology by tapping into real-world patient data. This data has been untapped due to its existence in fragmented and siloed systems such as EHRs. Alice and Melisa both placed emphasis on accessing and utilizing data from routine care settings, where the majority of patients are treated, which can open up new avenues for understanding and treating cancer more effectively.
We need to be focused on outcomes, not just outputs, and we need to be thinking about where along the value chain we can actually deliver more rational and ethical product design and decision making.
– Alice Pomponio, Managing Director ACS BrightEdge
Furthermore, the discussion also touched on the potential of Generative AI in transforming oncology, with applications ranging from automating back-end processes like medical coding to enhancing patient engagement. The key lies in identifying the use cases where AI can deliver substantial ROI, but it must be able to demonstrate minimal risk of patient harm. The American Cancer Society’s involvement in grant funding for AI projects, especially in survivorship and precision oncology, underscores a growing interest for AI’s role in improving cancer care and helping oncologists practice at the top of their license. Additionally, BrightEdge recently launched their BrightEdge Entrepreneurs (BEE) program, which supports the translation of therapeutic, diagnostic, medical device, and digital health innovations from research institutions into the market (read more about BrightEdge and their annual report here).
In selling to the pharmaceutical industry, folks have seen a noticeable shift towards pharma demanding quicker ROI and a focus on resolving immediate challenges, rather than making long-term strategic bets. This environment will require startups to demonstrate clear, immediate value in their solutions, emphasizing outcomes over outputs.
In essence, the integration of digital health and AI in oncology is not just about technological advancement, it’s about reshaping the landscape of cancer care to include siloed data, drive efficiency, and create a more patient-centric environment.
Opportunities
The oncology landscape is becoming increasingly collaborative, with a greater emphasis on integrating innovative treatments, digital health solutions, and value-based care models. There is a clear opportunity for new companies that can navigate the complex interplays of clinical efficacy, cost-effectiveness, and patient-centered care. From the perspective of AI integrating into workflows, the readiness for the ‘holy grail’ of clinical decision support and treatment decision-making through AI remains uncertain. However, there are a few areas that AI could begin to disrupt these existing processes. Specifically, coding and back-end automation, patient engagement and navigation, rationalizing design in clinical trials, drug development and product develop workflows, and the inclusion/introduction of siloed data and analytics into processes.
Building in the Oncology space / Interested in learning more?
Please reach out to Jon@flarecapital.com
