Consumer Digital Health

Transcription

1 Consumer Digital Health How Market Shift Is Leading to New Opportunities Written by SVB Analytics: Steve Allan CFA Head of SVB Analytics Scott Winder Director Alex Lee Manager Emily Wengel Associate

2 Table of Contents 3 Consumer Digital Health: Introduction & Financing Trends Overview 9 Healthcare Consumers: Fundamental Needs of the User 13 Financing Trends: Shift Toward Clinically Driven Consumer Health 17 Fitness/Wellness: Adapting to the Market 22 Disease Management: Growth Opportunities 28 Market Outlook: Assessing Consumer Health Opportunities 30 About the Authors 31 About Silicon Valley Bank and SVB Analytics Consumer Digital Health 2

3 Consumer Digital Health: Market Shifts to Focus on Engagement and Improved Patient Outcomes Consumer Digital Health Companies address the needs of patients and healthcare consumers Investment trends in digital health are shifting from consumer wellness applications to clinically driven solutions that drive better health outcomes at lower costs. This next wave of financing focuses on encouraging consumers and patients to change health-related behaviors, underscoring the greater opportunities for companies with solutions that create value for payers, providers, employers and consumers. This is the second in a series of reports from SVB Analytics examining Digital Health. In this report we: Analyze broad consumer health trends and business models Examine the shift in investments from consumer wellness to clinically focused solutions Describe adaptation strategies of consumer wellness and wearables companies Explore potential areas of opportunity in disease management Consumer Digital Health 3

4 Digital Health Landscape Patients / Consumers Employers / Payers Genetic Screening Social Support Professional Search Insurance Search Enterprise Wellness Enterprise Health Management Disease / Medication Management Education Fitness / Wellness / Wearables / Tracking Patient Engagement / Benefits Data Driven Payers Focus on Health Outcomes Digital Therapeutics / Pill Plus R&D Patient / Professional Interaction Patient Surveillance Remote Monitoring Clinical Telemedicine Electronic Medical Records Patient-Clinician Communication Value Based Care Population Health Management Operations Risk Adjustment / Payer Administration Practice Management & Operational Workflows Focus on Healthcare Costs Operational Image Management / Analytics Decision Support & Analytics / Predictive Medicine Marketing / Customer Experience Networking / Education Care Coordination / Communication Life Science / Other Systems / Healthcare Professionals In our first report, we provided a framework that landscaped the digital health sector. In this report, we focus on consumer digital health investment trends. Consumer Digital Health 4

5 Focus on Consumer Health: Categorizations Patients / Consumers Genetic Screening Disease / Medication Management Digital Therapeutics / Pill Plus Social Support Patient / Professional Interaction Education Remote Monitoring Professional Search Telemedicine Insurance Search Fitness / Wellness / Wearables / Tracking Patient-Clinician Communication For our analysis, we looked at three key themes: clinical enablement, consumer activation and education and transparency. We also grouped consumer digital health into seven categories, and focused on fitness/wellness and disease management. Clinical Enablement Disease Management Disease/Medication Management Digital Therapeutics Monitoring Remote Monitoring Communications Telemedicine Patient-Clinician Communication Consumer Activation Fitness / Wellness Fitness Wellness Wearables Tracking Education and Transparency Medical Education Education Social Support Genetic Screening Provider Search Professional Search Insurance Insurance Search More Clinically Focused Less Clinically Focused Consumer Digital Health 5

6 Consumer Digital Health Financing Trends Overview 70% Investments in Consumer Health Companies as a Percentage of Total Digital Health Investments (2011 to Q2 2016) $3,500 60% $3,000 Percentage of Total Funding 50% 40% 30% 20% $2,500 $2,000 $1,500 $1,000 Total Funding ($M) $ (Consumer) Consumer Funding (%) 10% $500 0% (E) $0 About 55% of all digital health investments since 2011 have been in companies whose technologies interface with the consumer in some manner. This reflects the convergence of technologies to drive and measure improved health outcomes and cost savings, and funding is following. Source: Rock Health Database; Q2 SVB Analytics Analysis 2016(E) is extrapolated based on 2016HY Consumer Digital Health 6

7 Strategic Investors Actively Investing in Consumer Digital Health Consumer Digital Health Investments (2011 to Q2 2016) Top Strategic Investors Focused on Consumer Health $3,000 60% 1 $2,500 50% 2 Total Funding ($M) $2,000 $1,500 $1,000 40% 30% 20% $500 10% 6 $ (E) 0% 7 Crossover Investments Financings without Strategic Investor Financings with Strategic Investor % of Deal Count with Strategic Investors 8 The number of deals with strategic investors participating has slowly increased over time, as tech, life science, healthcare and insurance companies seek to partner and collaborate with startups. * Crossover investments represent investment rounds greater than $100M that are led by a crossover investor Source: Rock Health Database; Q2 SVB Analytics Analysis 2016(E) is extrapolated based on 2016HY Consumer Digital Health 7

8 Strategic Investors Shift to More Clinically Focused Investments Clinically Focused Consumer Digital Health Investments* (2011 to Q2 2016) Other Consumer Digital Health Investments* (2011 to Q2 2016) $2,000 50% $2,000 50% $1,800 $1,800 $1,600 40% $1,600 40% Total Funding ($M) $1,400 $1,200 $1,000 $800 $600 30% 20% Total Funding ($M) $1,400 $1,200 $1,000 $800 $600 30% 20% $400 $200 $0 10% 0% Crossover Investments (E) Financings without Strategic Investors Financings with Strategic Investors % of Dollar Investments with Strategic Investors *Includes Clinical Enablement Companies $400 $200 10% $0 0% Crossover Investments (E) Financings without Strategic Investors Financings with Strategic Investors % of Dollar Investments with Strategic Investors *Includes Consumer Activation and Education and Transparency Companies Strategic investors have recently shifted their attention to clinically focused startups as they begin to see how technologies designed to affect patient behavior can generate better health outcomes and cost savings. * Crossover investments represent investment rounds greater than $100M that are led by a crossover investor Source: Rock Health Database; Q2 SVB Analytics Analysis 2016(E) is extrapolated based on 2016HY Consumer Digital Health 8

9 Healthcare Consumers: Fundamental Needs of the User Consumer Digital Health 9

10 Overview: Empowering Patients Is Key to Fixing Healthcare System Challenge Fundamental Need Solution Lack of choice and price transparency Consumer- Friendliness Improve consumers' access to healthcare and their user experience by making healthcare easier to use Poor health literacy Knowledge Create access to education and relevant and personalized health information Lack of tools to manage health and wellness Engagement Engage and affect behavioral change in healthcare consumers to better manage their own health Consumer Digital Health 10

11 Consumer Digital Health Framework Knowledge Engagement Consumer-Friendliness Genetic Screening Social Support Disease / Medication Management (incl. Fitness/Wellness) Remote Monitoring Challenge: Lack of choice and price transparency Solution: Improve consumers' access to healthcare and their user experience by making healthcare easier to use Education Professional Search Insurance Search Fitness / Wellness / Wearables/ Tracking (for leisure) Patient-Clinician Communication (incl. Telemedicine) Consumer-Friendliness Digital Therapeutics / Pill Plus Knowledge Challenge: Poor health literacy Solution: Create access to education and relevant and personalized health information Engagement Challenge: Lack of tools to manage health and wellness Solution: Engage and affect behavioral change in healthcare consumers to better manage their own health Consumer Digital Health 11

12 Consumer Digital Health Framework Knowledge Engagement Consumer-Friendliness Challenge: Lack of choice and price transparency Solution: Improve consumers' access to healthcare and their user experience by making healthcare easier to use Knowledge Challenge: Poor health literacy Solution: Create access to education and relevant and personalized health information Consumer-Friendliness Engagement Challenge: Lack of tools to manage health and wellness Solution: Engage and affect behavioral change in healthcare consumers to better manage their own health Consumer Digital Health 12

13 Financing Trends: Shift Toward Clinically Driven Consumer Health Consumer Digital Health 13

14 Financing Trends: Historic Investment Trends Weighted Toward Wellness $3,000 Total Capital Invested by Category (2011 Q2 2016) Total Capital Invested ($M) $2,500 $2,000 $1,500 $1,000 Disease Management Remote Disease Monitoring Management Remote Monitoring Communications Communications Fitness / Wellness Fitness / Wellness Medical Education Clinical Enablement Consumer Activation More Clinically Focused $500 Provider Medical Education Search Provider Search $0 Insurance Insurance Search (E) Education and Transparency Less Clinically Focused The advent of the quantified self movement in the early 2010s attracted significant capital, especially in the fitness and wellness category. Source: Rock Health Database Q2 2016, Pitchbook, Q2; SVB Analytics Analysis 2016(E) is extrapolated based on 1H 2016 Consumer Digital Health 14

15 Financing Trends: Rise of Clinically Driven Consumer Health Percentage of Total Deal Count Over Time by Category (2011 Q2 2016) 100% 90% 80% 70% Disease Disease Management Management Remote Monitoring Remote Monitoring Communications Clinical Enablement More Clinically Focused 60% 50% Communications Fitness / Wellness 40% 30% Medical Education Fitness / Wellness Provider Search 20% 10% Insurance Medical Education Provider Search 0% Insurance Search (E) More Consumer Focused Education and Transparency Less Clinically Focused There has been a gradual shift toward increased investment activity in the more clinically focused categories of disease management, remote monitoring and communications. Source: Rock Health Database Q2 2016, Pitchbook, Q2; SVB Analytics Analysis 2016(E) is extrapolated based on 1H 2016 Consumer Digital Health 15

16 Financing Trends: More Clinically Focused Companies Receiving Early-Stage Funding Clinical Enablement Disease Management Monitoring Communications Investment Amount by Stage of Development (2011 Q2 2016) Consumer Activation Fitness/Wellness Education and Transparency Medical Education Provider Search Insurance Search $1, $1, $1, $1, $1, $1, Funding ($M) $800 $600 $ Funding ($M) $800 $600 $ Funding ($M) $800 $600 $ $ $ $ $ (E) Early Mid Late Total Deal Count $ (E) Early Mid Late Total Deal Count $ (E) Early Mid Late Total Deal Count The clinically focused areas of disease management and patient-provider communications are seeing an increase in early-stage funding, indicating new startup formation; consumer activation and education and transparency companies are maturing, with fewer early-stage rounds raised. Source: Rock Health Database Q2 2016, Pitchbook, Q2; SVB Analytics Analysis 2016(E) is extrapolated based on 1H 2016 Early Seed and Series A, Mid Series B and C, Late Series D and later Consumer Digital Health 16

17 Fitness/Wellness: Adapting To The Market Consumer Digital Health 17

18 Fitness/Wellness: Decline in Valuations and Investment Size Median Pre-Money Valuation of Fitness/Wellness Companies (2011 Q2 2016) Median Invested Capital of Fitness/Wellness Companies (2011 Q2 2016) $40 $20 Median Pre-Money Valuation ($M) $35 $30 $25 $20 $15 $10 $5 Median Invested Capital ($M) $18 $16 $14 $12 $10 $8 $6 $4 $2 $ H 2016 $ H 2016 Series Seed Series A Series B Valuations and financing round sizes have declined in 2016 due to increased competition and shifting investor interest toward clinical applications, forcing wellness companies to adapt. Source: Pitchbook, Q2; SVB Analytics Analysis Consumer Digital Health 18

19 Fitness/Wellness: Companies Adapt to Changing Marketplace Strategy Description Examples Strategic Exit Sell business to strategic partners Acquire Partner Develop Acquire companies to build clinical programs Partner with academic institutions to conduct clinical studies and provide ancillary data Develop features or pivot business model in order to collect real world data or gather clinical-grade data As investors move toward more clinically focused strategies, wearables and wellness companies are executing different strategies to adapt to this shifting landscape. Consumer Digital Health 19

20 Fitness/Wellness: Exit to Sports and Fashion Companies If you don t have a brand, it is hard to be legit in this space. Sonny Vu, Chief Executive and co-founder of Misfit Acquirer Target Date Deal Value ($M) Invested Capital (IC $M) EV / IC Multiple 2/12/2016 $85M $16M 7.4x Sports Fitness Apparel 8/5/2015 $235M NA NA 2/4/2015 $474M $18M 26.3x 2/4/2015 $85M $6M 13.7x Software 12/6/2013 $150M $24M 6.3 Fashion Tech 11/11/2015 $250M $64M 3.9x 3/25/2014 $100M $37M 2.7x Hardware Facing declining investor interest, companies that are not adopting clinical strategies are instead choosing to sell to sports and fashion retailers. Among those, software-focused firms are receiving the highest exit multiples. Source: Capital IQ SVB Analytics Analysis Wall Street Journal - Fossil Group to Buy Misfit for $260 Million Consumer Digital Health 20

21 Fitness/Wellness: Companies Partner, Acquire or Develop Clinical Technologies Consumer Clinical Acquire Acquisition Has FDA approval [and] understands how to run a clinical trial with hospitals and wellness providers. 87 patents, >500 trillion data points Partnered for diabetes prevention Acquisition + Personnel Two 510k approvals Real-time patient monitoring on physician smartphone CEO of Spectros becomes Chief Medical Officer of Jawbone Partner $6.5B IPO Partnership: Study on weightloss and breast cancer prevention Announcement: 200 clinical studies run on Fitbit / Fitabase App Hire: VP Digital Health from Walgreens Develop Kickstarter: Branded as DIY Vital Signs Device Regulatory: Announces Plans for 510K Submission $10.5M Series A Forms clinical advisory board Announces plans for clinical trials $35M Series B Used for clinical development and regulatory approval in U.S. and China Jawbone, Fitbit, and Scanadu started in consumer wellness and have made acquisitions, formed partnerships and started internal developments to adapt to the changing marketplace. Source: Company Press Releases, Mobihealthnews, FastCompany, clinicaltrials.gov, Fitbit S-1 Consumer Digital Health 21

22 Disease Management: Growth Opportunities Consumer Digital Health 22

23 Disease Management: Approaches to Engaging Patients Percentage of Total Capital Invested by Category* (2011 Q2 2016) General Disease Management and Vitals Monitoring Solutions that help patients manage any type of disease 62% 30% 8% Medication Management Disease Specific Solutions that help patients adhere to and manage their medications Solutions that help patients manage one specific type of disease or disorder Disease management and remote monitoring companies are shifting to focus on a specific disease to help patients and providers better manage the condition as opposed to providing general solutions aimed at patients facing different diseases. *Includes both Disease Management and Remote Monitoring companies and deals Source: Rock Health Database Q2 2016, Pitchbook, Q2; SVB Analytics Analysis Consumer Digital Health 23

24 I don t think you can scale a business in healthcare without working directly with the clinical entities like payers and providers. TJ Parker, CEO Source: Interview with TJ Parker, August 19, 2016 Consumer Digital Health 23

25 How PillPack Is Taking on Medication Management: An Interview with TJ Parker, CEO, PillPack Online pharmacy that uses technology to help people take medication in a timely manner Operating in the Clinical Space Consumer health companies need to develop sound business models because the patient is not the only customer the payer is also the customer. Problem Solution Most EXPENSIVE patients take 5+ prescriptions / day and have trouble coordinating their medication. Poor Adherence Manage complexity for patients Automated sign up and refills Coordination with payers Staff available 24/7 Advice to Entrepreneurs Spend time with your consumers: figure out their pain points and understand their core problems. And whether you can solve their problems with technology alone or if you need to become a provider. Know who your customers are and what they are willing to pay for. Key Success Factors for Consumer-Centric Disease Management: Expertise in Both Healthcare and Technology Patient-Centric Design The healthcare system is moving towards a pay for performance model. Pharmacy should do the same and no one is truly doing that today. Source: Interview with TJ Parker, August 19, 2016 Consumer Digital Health 25

26 Disease Management: Increasing Focus on Behavioral Change and Complex Disease Management 25 Number of Investments in Disease Management and Remote Monitoring Sectors (2011 Q2 2016) 20 Behavioral Change Psychiatry Metabolic 15 Remote Monitoring 1.0 Cardiovascular Respiratory (E) Degenerative and Complex Diseases Orthopedic Oncology Neurology There has been a steady rise in investments in companies aimed at behavioral change, while the niche targeting complex diseases is more nascent. Source: Rock Health Database Q2 2016, Pitchbook, Q2; SVB Analytics Analysis 2016(E) is extrapolated based on 1H 2016 Consumer Digital Health 26

27 Disease Management: Opportunities in Complex and Degenerative Diseases Total Medical Expenditure, by Chronic Conditions in U.S ($B) Total Investments in Disease Management and Remote Monitoring Sectors by Chronic Conditions in U.S Q ($M) $- $50 $100 $150 $200 $250 Difference $500 $400 $300 $200 $100 $- Metabolic Psychiatric 9% 24% 10% 6% 34% 15% Metabolic Psychiatric Behavioral Change Psychiatry Metabolic Cardiovascular Respiratory 11% 22% -3% 1% 19% 12% Cardiovascular Respiratory Remote Monitoring 1.0 Cardiovascular Respiratory Orthopedic* Oncology Neurology 10% 9% 14% -8% -8% -5% 6% 4% 2% Orthopedic * Oncology Neurology Degenerative and Complex Diseases Orthopedic Oncology Neurology *Excludes trauma or injury-related conditions Degenerative and complex diseases, which are difficult to manage and account for a significant portion of U.S. medical expenditures, have received comparatively lower digital health investments, signaling the space is ripe for disruption. Source: Rock Health Database Q2 2016, Pitchbook, Q2; SVB Analytics Analysis AHRQ - Total Medical Expenditure by Conditions in US, 2013 Consumer Digital Health 27

28 Market Outlook: Assessing Consumer Health Opportunities Consumer Digital Health 28

29 Progression to Clinically Driven Consumer Health Solutions High-Flyers Exits Remote Monitoring 1.0 Led by the medtech sector Point solutions Rely on traditional reimbursement Fitness/ Wellness Rise of quantified self movement Tech investors galvanize market with investments into consumer hardware and software Focused on fitness and wellness Disease Management User-friendly cloud/mobile solutions, clinical-grade devices and data analytics Engage patients to actively manage their health Target financiers focused on controlling health benefit cost and improving outcomes Digital Therapeutics Predictive and personalized clinical intervention FDA-regulated, providerprescribed, combination solutions Demonstrate clinically proven efficacy and cost savings We have seen the sector's focus move from traditional devices aimed at a specific solution to consumer devices. Now, the focus is on digital solutions for disease management. Going forward, clinically proven software and hardware will be integrated to drive better health outcomes and cost savings. Source: Pitchbook, Company websites SVB Analytics analysis Consumer Digital Health 29

30 About the Authors Steve Allan, CFA Scott Winder Head of Analytics Steve Allan is the Head of SVB Analytics, responsible for the three areas of information services provided to the innovation economy: Strategic Advisory Services, Compliance Valuations, and Insights. Strategic Advisory Services provides consultative guidance around valuations, benchmarking and inorganic growth strategies. Compliance Valuations issues valuation opinions for private companies. Insight focuses on studying trends and opportunities in the private venture-backed innovation ecosystem. Steve brings a strong financial background and passion for entrepreneurship to his role at SVB Analytics. Steve earned a master s in business administration from Duke University's Fuqua School of Business and a bachelor's degree in finance from the University of Notre Dame. Director swinder@svb.com Scott Winder is a Director at SVB Analytics, responsible for managing client valuation assignments and issuing valuation opinions. Prior to joining SVB Analytics, Scott was a manager in the Business Valuation practice of Deloitte Financial Advisory Services LLP based in San Francisco. While at Deloitte, Scott provided financial advisory services related to mergers and acquisitions, accounting compliance, tax reporting and strategic planning for clients in the technology and life sciences industries, with particular experience in the biotechnology and biopharmaceutical industry segments. Scott holds a master's degree in business administration from the Haas School of Business (University of California at Berkeley), and a bachelor s degree in human biology from Occidental College. Alex Lee Emily Wengel Alex Lee is a Valuation Manager at SVB Analytics, responsible for conducting due diligence and financial analysis on valuation engagements for venture-backed companies in the Life Science sectors. Emily Wengel is a Valuation Associate with SVB Analytics, responsible for conducting due diligence and financial analysis on valuation engagements for early-stage, venture-backed life sciences companies. Manager klee@svb.com Prior to joining SVB Analytics, Alex worked as a consultant for biopharmaceutical companies, diagnostic companies and medical research institutions, assisting in corporate development, product commercialization and strategic advisory activities. Alex holds a master s of bioscience degree from Keck Graduate Institute and a bachelor s of science degree in biochemistry from the University of Nebraska-Lincoln. Associate ewengel@svb.com Prior to joining SVB Analytics, Emily worked as a business analyst at BioMotiv, an early stage biotech accelerator. Emily graduated cum laude from University of Pennsylvania, where she earned a bachelor of science in economics and a bachelor of arts in biology. Consumer Digital Health 30

31 About Silicon Valley Bank For more than 30 years, Silicon Valley Bank has helped innovative companies and their investors move bold ideas forward, fast. SVB provides targeted financial services and expertise through its offices in innovation centers around the world. With commercial, international and private banking services, SVB helps address the unique needs of innovators. About SVB Analytics SVB Analytics, a non-bank affiliate of Silicon Valley Bank, serves the strategic business needs of entrepreneurs, corporates and investors in the global innovation economy. For more than a decade, SVB Analytics has helped global business leaders make informed decisions by providing market intelligence, research, and consulting services. Powered by proprietary data, SVB Analytics has a unique view into the technology and life science sectors. This material, including without limitation to the statistical information herein, is provided for informational purposes only. The material is based in part on information from third-party sources that we believe to be reliable, but which have not been independently verified by us and for this reason we do not represent that the information is accurate or complete. The information should not be viewed as tax, investment, legal or other advice nor is it to be relied on in making an investment or other decision. You should obtain relevant and specific professional advice before making any investment decision. Nothing relating to the material should be construed as a solicitation, offer or recommendation to acquire or dispose of any investment or to engage in any other transaction. SVB Analytics is a member of SVB Financial Group and a non-bank affiliate of Silicon Valley Bank. Products and services offered by SVB Analytics are not FDIC insured and are not deposits or other obligations of Silicon Valley Bank. SVB Analytics does not provide investment, tax, or legal advice. Please consult your investment, tax, or legal advisors for such guidance SVB Financial Group. All rights reserved. SVB>, SVB Financial Group, and Silicon Valley Bank are registered trademarks Consumer Digital Health 31