The Propell Group - Singapore Futurists - The Future of Health

1. SINGAPORE FUTURISTS  Future of Health 12th April 2015  Singapore  The Propell Group @enquirepropell #HealthTech FUTURE OF HEALTH

2. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. •  Digital is disrupting healthcare and its established players •  Technology is driving a new paradigm to create better health care •  Developing markets can leapfrog their healthcare infrastructure limitations •  New opportunities are opening to shape the new paradigm Healthcare is changing dramatically

3. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. The convergence of the digital revolution with health: ELEMENTS Wireless devices Hardware sensors Sensing tech Microprocessors Integrated circuits The Internet Social Networking Genomics Personal genetics What is digital health? LEXICON Wireless Health / mHealth e-Patients / eHealth Quantiﬁed Self / Self-tracking Wearable Computing Telehealth & Telemedicine Personalized Medicine / QS Health IT Connected Health Big Data / Health Data

4. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. Digital health frequently features in the media Why Digital Health Will Have Huge Impact March 3, 2014 By Todd Hixon Digital Health has big buzz this year. For example, it was a hot topic at both the Consumer Electronics Show (“CES”) and the more-serious JP Morgan Healthcare Conference. (“Digital Health” refers to products and businesses that apply modern digital technologies — the web, mobile, the cloud, miniature sensors — to healthcare.) J.P. Morgan health conference points toward a hot year in digital health January 15, 2015 By Mark Sullivan The J.P. Morgan event was a very different scene, of course, and much smaller, but the same energy for health tech was palpable there, too. This conference usually focuses on biotech and medical device companies. But this year, the number of digital health companies was decidedly larger and more visible

5. ©2015 by The Propell Group - All rights reserved. Proprietary and Confidential. Digital health ecosystem: The new paradigm Doctors Efficient Healthcare Better regulations Insurance Customize Packages User specific rates Enterprise Faster discovery Consumer insights Individuals Preventative Care Personalized Care Government Efficient Infrastructure Better Policy Shared Information Cloud Outbreak reports Health tracking Claims reporting Insurance cover Clinical trial data Consumer reporting Sensors and Trackers Wellness reporting Population Data Public Awareness

7. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. 1.  Big Data and Impact on Healthcare 2.  Advances in Wearable Sensors and Devices 3.  Impact on Business Models 4.  Funding Trends 5.  Regulations Implications Focus: Digital Health Innovation

8. “Healthcare isn’t a science problem, it’s an information problem” — Thomas Goetz — Author of The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine Big Data in HEALTHCARE SECTION 1

9. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. Big data is processing huge amounts of data to understand actionable insights. What is big data? “When we talk about areas of large and growing volume (petabytes), variety (structured vs unstructured) and high-velocity data; then those things are present in some combination, we consider that big data.” — Tom Lawry— Director, WW Marketing Microsoft Volume amount Variety type and sources Velocity speed Veracity quality & trust

10. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. 6 Ways Big Data is Changing Healthcare Genomics & Beyond Next generation sequencing, data management & analysis Data Analytics Transforming Data: working with and mixing data sets Public Awareness Planning and Preventing: Using data to reduce and prevent disease Support Providers Clinical and Non-clinical Intelligence: Combining a greater variety of data Support Self-Care Patient Focused: Increase variety and frequency of data Health Eco-system Collaboration: Pooling data from many sources for bigger & better results

11. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. Cloud-based, collaborative technology platform for next generation sequencing and analysis tools Genetic analysis applied to discover which healthcare methods work, and for whom. Cloud-based platform that can rapidly analyze and annotate personal genomes Personal DNA analysis and interpretation service for individuals Genomics & Beyond Next generation sequencing, data management & analysis

12. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. Predictive analysis to recognize health patterns and reduce re-admission Free health records platform which aggregates population health data across multiple sites •  Founded in the US – now launched in the UK Uses natural language processing to turn data into insights about compliance, revenue cycle, etc Cloud-based platform focused on standardizing health record management across providers Data Analytics Transforming Data: working with and mixing data sets

13. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. Big global data sets available to help guide policy decisions and improve population health Scans social media to forecast and track outbreaks of disease Identify counterfeit drugs and enable pharmaceutical companies to track drug distribution Real-time surveillance for emerging public health threats by scanning informal sources Public Awareness Planning and Preventing: Using data to reduce and prevent disease

14. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. Cloud-based platform to improve cancer by organizing the world's real-world oncology data Cloud-based computing platform to aggregate data from many disparate sources Deep analysis and evidence-based reasoning for more precise diagnosis and clinical decision making. Lumiata applies big data-driven medical science to patient data to optimize health care interactions Support Providers Clinical and Non-clinical Intelligence: Combining a greater variety of data

15. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. Diabetes management solution for patients, health systems, and payer groups Asia founded remote monitoring for physicians to manage chronic patients Collects data and organizes feedback to help patients better manage asthma Creates innovative and cost-eﬀective online behavior- change programs for chronic diseases CDC Recognised Support Self-Care Patient Focused: Increase variety and frequency of data

16. ©2015 by The Propell Group - All rights reserved. Proprietary and Confidential. Health Eco-system Collaboration: Pooling data from many sources for bigger & better results Global wireless health connectivity platform to bring new and old healthcare data together in new ways Consolidation and analysis of personal sleep, wellness and fitness data on one platform Allows apps that provide health and fitness services to share data with the Health app & with each other

17. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. The Value of Big Data in Digital Health $40-70 B Right Innovation $300B $450B Healthcare Savings due to Big Data Right Value Right Provider Right Care Right Living $50-100 B $50-70 B $90-110 B $70-100 B •  Targeted disease prevention •  Data-enabled adherence programs •  Alignment around proven pathways •  Coordinated care across providers •  Shifting volume to right care setting •  Reducing ER rates •  Payment innovation & alignment •  Provider-performance transparency •  Accelerating discovery in R&D •  Improving trial operations $300B to $450B in reduced healthcare spend

18. “Technology may replace up to 80% of what doctors do” — Vinod Khosla — Founder at Khosla Ventures SECTION 2 Wearable SENSORS & DEVICES

19. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. Wearable ecosystem: Biosensing Wearables Activity Trackers e.g. Fitbit, Misﬁt Smart Watches e.g. Garmin, Apple Smart Clothing e.g. Athos Patches & Tattoos e.g. Zio, MC10 Ingestibles & Smart Implants e.g. Proteus BioSensors Devices that convert a biological element into a signal output Wearables Are on- or in-body devices that enable user experience

20. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. •  Create a wealth of data in real time •  Measure physiological parameters easily •  Relate trends, behaviors and environments to health and wellness •  Analyze trends to understand the health ecosystem Why do wearable and sensors matter?

21. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. Wearable and Sensors Life Cycle & Common Uses Cloud Processing & storage Community & Comparison Feedback Personal Results Sensor(s) Records Data Weight Under 20%: Acid Reﬂux or Indigestion, Digestive Health 40% 65% Vital Signs 37% 58% Sleep Patterns 30% 54% Calories / Fat Intake 32% 37% Blood Sugar 21% 61% Exercise / Physical Activity 24% 36% Common Wearable Uses Consumers Physicians

23. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. Athos LumoGarminWatch APPLE WATCH Smart-watch with activity accelerometer and HR monitor ATHOS Clothing with integrated wearable technology capable of tracking heart rates, breathing levels, and more GARMIN 920XT Triathlon training smart-watch with GPS, HR monitor & activity accelerometer LUMOBACK Measures posture, steps, how long you sit, and how you sleep Wellness Lifestyle monitor, intended to increase wellness

24. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. Alivecor CueZioScout ALIVECOR Heart Monitor is a single-channel ECG recorder that is portable and easy to use - FDA approved! SCANADU SCOUT Sophisticated physical exam: tracks & trends body vitals ZIO by iRythm Micro sensor for long-term monitoring of cardiac rhythms CUE Personal cartridge driven saliva analysis Diagnostic, Chronic & Monitoring, Intended to aid medical systems and speed diagnosis

25. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. APPLE’S HEALTH ECOSYSTEM •  HealthKit provides a health data clearing house, collecting data from many kinds of devices from smart-watches to hospital based ECGs •  FDA-regulated medical devices are able to send information via HealthKit and accompanying apps leading to breakthroughs in continuous monitoring as well as data analysis and sharing •  ResearchKit is a platform which enables the constant monitoring of symptoms and reactions to medication from a very large clinical trial patient sample •  The current clinical trial approach is to cease the monitoring when the trial is ended to submit the data to the FDA THE CASE FOR BEST BIOSENSING WEARABLE •  We all own one •  We take it everywhere we go •  It is full of sensors which track our every move •  A simple app can turn it into a powerful healthcare and wellness tool: •  Sleep •  Activity •  Lifestyle •  Habits Mobile Phone The most powerful biosensing wearable available?

26. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. Today’s Market: Wearable devices and sensors Disease management Preventative health Remote monitoring & care Detection & screening Consumer personalized medicine Predicting and controlling outbreaks Barriers Poor Management No sustainable business model Perverse money-driven intentions Lack of awareness and initiative Making raw data valuable Regulatory hurdles Early Adopters WELLNESS Self-initiated health tracking Quantiﬁed Self MEDICAL Doctor-initiated prescribed health intervention US $3 BILLION 100 million devices 2014

27. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. Today’s Market: Wearable devices and sensors Less expensive Over-the-counter Longer Battery Life Easier to use More sensors Drivers Better compatibility with existing devices More public awareness and marketing Medical community adoption Improved manufacturing Better distribution Mass Adoption WELLNESS Self-initiated health tracking Mass Adoption of Quantiﬁed Self MEDICAL Doctor-initiated prescribed health intervention Mass Adoption within health community US $12 BILLION 400 million devices BY 2018

28. Business MODELS “Great products are becoming a commodity. It's the combination between great products and a great business model that is going to keep you ahead of the competition in the coming decade.” — Alexander Osterwalder — Business Model Generation, a global bestseller on the topic of business model innovation SECTION 3

29. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. •  Spending is ineﬃcient or non-existent •  Policies are shifting in mature & developing countries •  Increasing focus on outcomes, not volumes •  New business models are forming to address changes •  76% of Fortune 50 companies are now in healthcare The healthcare business landscape is shifting

30. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. Developing Solutions Free cloud-based health records platform which aggregates population health data across multiple sites Supported by advertising IN ASIA Using mobile phones and devices for innovative and practical solutions for cost eﬀective healthcare services Supported by Enterprise IN ASIA Employee engagement platform that drives productivity and manages cost though employee wellness Supported by Employers IN ASIA Electronic Health Records (EHR) mHealth (Mobile Health) Health Insurance / Employee Wellness

31. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. Business Models: B2B vs B2C USED BY CUSTOMERS B2B Supported by insurance/pharma Supported by advertising Supported by physicians Supported by advertising Supported by business Supported by business Supported by customers Attracts 80% of Funding é Higher willingness to pay é Greater lifetime customer value ê Longer sales cycles ê Requires gatekeeper approval or system integration B2C ê Lower willingness to pay é Quicker product iterations and user feedback é Shorter Sales Cycle ê Crowded Landscape USED BY BUSINESS PAIDBYBUSINESSPAIDBYCUSTOMER

32. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. •  Targeted research through rational design model •  Customised clinical trials through pharmaco-genomics •  Individualised medicine •  Real World Evidence research •  Digital marketing, tracking and sales Rebooting The Life Sciences Industry

33. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. Partnership with Genomics England to mine information from a government project to decode the genomes of 100,000 patients from NHS patients with cancer and rare diseases to discover personalised medicines •  Year-long trial announced March 2015Has announced 12 undisclosed partnerships with academia and corporate: •  Signed collaboration with Pﬁzer for the study of Crohn’s disease •  Signed a $60M deal with Genentech (Roche) for the study of Parkinson’s Disease Pharmaco Genomics: The future of drug design The Past: Molecular screening libraries used by most large drug companies and academic centers The Future: Identifying the root cause of, or critical aberrant protein associated with a particular disease and use this template to design the antibody or molecule to block it

34. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. Clinical Data: Next generation clinical trials and RWE Innovative tele-health solutions through interactive health technology platform that consists of medical devices, application software, mobile apps, cloud-based web applications focused on CV clinical trials Open-source platform that empowers researchers to design and administer app-based health research. Initial focus on breast cancer, diabetes, Parkinson’s disease, CV and Asthma Platform and algorithms allow to gather and show data for faster clinical trials, and to support patients and doctor in the extreme complexity of the real-world Neurology and Immunology treatments •  Post launch real-time patient data from extremely large numbers of patients •  Increasingly important data sets for market access and reimbursement §  Velcade (J&J) for the treatment of Myeloma ($35,000 p.a.) was initially rejected by NICE (UK). J&J agreed not charge any patient not deriving beneﬁt. Velcade was approved

35. “Investments in digital health are having a positive impact and the momentum is likely to continue and cause changes throughout the entire healthcare ecosystem. In particular, the pharmaceutical industry is poised to take advantage of digital and mobile innovation allowing them to “go beyond the pill” — Jack Young — Head – Qualcomm Life Fund Funding TRENDS IN DH SECTION 4

36. ©2015 by The Propell Group - All rights reserved. Proprietary and Confidential. •  Key investment themes taking shape •  Venture capital funding doubles again •  Growing number of technology and strategic investors •  M&A deal flow growing •  Strong IPO trend •  7,500+ DH startups across the globe Significant activity in Digital Health funding

37. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. Venture funding of digital health continues to outpace other sectors Health Sector Funding Changes Based on total funding from 2012 and 2013 2013 vs 2012 2014 vs 2013 All Sectors Digital Health Med DevicesBiotech 9% 61% 29% 127% 10% 29% -17% 21%

38. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. Venture funding of digital health: Key trends Top Trends of Digital Health Funding 2011 to 2014 Ranking 2011 2012 2013 2014 1 Healthcare Consumer Engagement Healthcare Consumer Engagement EHR & Clinical Workflow Analytics & Big Data Data aggregation & analysis to support a wide range of healthcare use cases 2 Analytics & Big Data EHR & Clinical Workflow Analytics & Big Data Healthcare Consumer Engagement Consumer tools for the purchasing of healthcare services or health insurance 3 Digital Dx Personal Health Tools & Tracking Digital Medical Devices Digital Medical Devices Software / hardware designed to treat a specific disease or condition 4 EHR & Clinical Workflow Care Coordination Population Health Management Telemedicine Delivery of healthcare services through virtual channels 5 Post-acute Solutions Wearables & Biosensing Wearables & Biosensing Personal Medicine Software to support the practice of medicine customised to an individual’s genetics 6 Hospital Administration Telemedicine Healthcare Consumer Engagement Population Health Management Platforms for managing population health under the shift to risk-based payment models

39. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. Acquisitions: Is this the start of Digital Health sector consolidation? 95 M&A Deals in 2014 - $20B ACQUIRER TARGET Flatiron Health Altos Solutions Teladoc AmeriDoc Evidera Archimedes Optum Audax Roche Bina Technologies MDLive Breakthrough Hearst Health CareinSync Cambia Health ClarusHealth Merck eCardio Google Lift Labs UnitedHealth Group MedSynergies WellTok MindBloom HCA PatientKeeper Facebook ProtoGeo (Moves) AirStrip Wireless Sense4Baby MyFitnessPal Sessions WebMD TheraSim Covidien Zephyr Technologies Sector # of M&A deals Health Tech Med Device Payer Biopharma Provider Other Healthcare Tech Other 47 8 6 6 4 4 7 13 ACQUIRER TARGET VALUE BD CareFusion $12.2B Cognizant TriZetto $2.7B Cerner Siemens Health $1.3B Optum Alere $600M Aetna bswift $400M Brighton Health Privia $400M GE API Healthcare $340M Emdeon Change Healthcare $185M Medtronic Corventis $150M Astra Zeneca Deﬁniens $150M Intel Basis $100M Everyday Health Medico.com $100M Millenium Labs RxAnte $70M St Jude Medical CardioMEMS $60M Care.com Citrus Lane $49M Advisory Board Co. HealthPost $25M Weight Watchers Wello $9M Premier Meddius $8M DISCLOSED UNDISCLOSED

40. Asia DIGITAL HEALTH “We have to link to what the global trends are. This means looking at the emerging sectors, verticals like technology, healthcare, and biotech” — Teo Ser Luck — Minister for Trade & Industry, Singapore SECTION 5

41. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. •  Create greater awareness & patient empowerment •  Facilitate better provision through private sector •  Provide healthcare services in underserved urban and rural regions •  Analyze trends to better allocate limited resources Asia: Leapfrogging its immature infrastructure

42. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. Venture funding of digital health: Asia key trends 199 HealthTech Startups in Asia* Category Total Examples Big Data & Analytics 8 •  Genequest (JP) •  Lean Care Solutions (SG) Consumer Health & Wellness 43 •  BabyMe (VT) •  Haamor (TH) Genomics & Precision Medicine 5 •  MyCode (JP) •  Prenetics (HK) Healthcare Incubators & Accelerators 3 •  Clearbridge Accelerator (SG) •  AIA Accelerator (HK) Navigating The Healthcare System 32 •  Practo (IN) •  Our Health Mate (SG) Patient Engagement 45 •  Tanyadok (INDO) •  HelpingDoc (IN) Practice Management 29 •  Klinify (SG) •  Medix (PH) Sensors & Diagnostics 26 •  Reka Health (SG) •  Healint (SG) Telehealth & Remote Monitoring 8 •  MyDoc (SG) •  Doktor Gratis (INDO) Note: Not an exhaustive list! Source: Health Startups Asia!

43. ©2015 by The Propell Group - All rights reserved. Proprietary and Conﬁdential. Venture funding of digital health: Asia key trends Noteworthy Asia HealthTech Startups Startup Funding ($M) Stage Principal Investors Our Health Mate (SG) 1 •  Seed & Pre A •  LeoTech HealthKart (INDIA) 20 •  Series B •  Sequoia Capital •  Intel Capital DXY (CH) 2 •  Seed & Pre A •  DCM PICOOC (CH) 25 •  Series B •  Tencent •  Gobi Partners Reka Health (SG) 4 •  Series A •  Tembusu Partners Practo (INDIA) 24 •  Series B •  Sequoia Capital Meet You (CH) 50 •  Series C •  Matrix Partners •  K2 Ventures Klinify (SG) 1 •  Seed & Pre A •  Jungle Ventures Healint (SG) 1 •  Seed & Pre A •  Wavemaker mClinica (SG) 1 •  Seed & Pre A •  500StartUps •  Kickstart Ventures

44. •  Digital Healthcare is disrupting healthcare and its stakeholders •  Technology is driving a new paradigm to create better healthcare •  EM healthcare will be able to leapfrog its infrastructure limitations •  New opportunities are opening to shape the new paradigm Healthcare is changing dramatically

45. Julien de SALABERRY Experienced regional head and GM. 15+ years in healthcare with leading brands including Eli Lilly, Boston Scientific, Baxter, GSK, Merck & Co. Significant Asia Pacific Experience. The Propell Group is a boutique venture investor and adviser firm focused on early stage companies in healthcare technology aha! is a dedicated health-tech accelerator focused on Asia 4 Asia healthcare technology innovation Co-Author of iDisrupted Founder & CIO  The Propell Group M: +65 9488 7334  julien@propellgroup.biz @enquirepropell

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