"Digital is becoming a cost of entry now for pharma companies"

Paddy: Hello everyone and welcome back to the podcast – ‘The Big Unlock’ and this is Paddy and it is my great privilege in order to have as my special guest today, Greg Silvestri, Head of digital health and innovation for AbbVie. Greg welcome to the show.

Greg: Hey Paddy, thanks for having me today.

Paddy: You’re most welcome. So, Greg for those who may not know AbbVie and AbbVie’s history, of course the blockbuster drug that drives most of AbbVie. Do you want to share a little bit of background and overview of the company before we launch into our conversation today.

Greg: Yeah absolutely I would be happy to. So yeah I think most people you know AbbVie as the Humira company as its often times reference to. But, you know AbbVie is a company that’s been you know had split out from Abbott about five years ago and as a company that obviously is really founded around Humira really a big driver of where the company’s gotten to over the last five years. But you know it’s a company that’s really diversified now and so when you begin to look at our portfolio really where we’re major players across Immunology, you know Women’s Health, Oncology so it’s really an exciting company to be at because you know again while we’re known for Humira there’s a lot happening across the portfolio. Being a company that is still only five years old, being independent and then on top of that of course with what’s most exciting about it is all the innovation and the areas that we are now getting into in the digital health space as well.

Paddy: That’s awesome and we’ll talk a little bit about that I know that AbbVie has ventures, a venture capital arm, that’s been making a number of investments also in this space and will hopefully be able to talk a little bit about that and what the investment philosophy is and how it drives digital. But, to begin with what does digital really mean in the context of a company like AbbVie and in general to the pharma sector do you want to maybe share a few thoughts on that first.

Greg: Yeah it’s you know it’s an interesting question it’s one that I get asked a lot and you know it’s one of those things now having been at multiple companies and being in digital health and innovation rolls people often the first question you always get is so what is our digital health strategy, what is it going to be and the first thing I like to tell people is that digital health isn’t a strategy right it’s an enabler to an overall strategy you know. it’s just another tool that we have to really unlock value and to think about strategically every company looks at what they want to be different and depending on what you want to do at a let’s say a corporate level, at a commercial level, at a development level. You then look at your enabling technologies and what you can do from a digital standpoint and those things should help you ladder up back into what your overall strategy is. And, so really digital means different things to different companies right for some companies within pharma it’s simply about enabling the development of molecules more efficiently or effectively in a clinical trial through you know whether it’s just simply being able to measure things objectively in a better way in a setting where you know where patients actually live and work, in ways that are meaningful for them, it can be actually thinking about developing a digital therapeutic to replace a molecule or it can be some sort of combination in between right and so I think again it’s all ladders back up to what the company want to be and then building your approach to digital with those enabling technologies that way.

Paddy: Well that’s very interesting. So, from what you said the focus areas as far as digital strategies are concerned in pharma or maybe a little bit different from that of let’s say a health system or a hospital in the context of hospitals, health systems or even health insurance companies we hear a lot about patient engagement or caregiver enablement as the big focus area you know telehealth and whatnot. Now you did you just mentioned drug discovery which seems to be a big focus area for pharma so in that sense is there a fundamental difference between, lets say pharma and other sectors within healthcare as it relates to approaching digital.

Greg: Yeah I don’t necessarily know if it’s if it’s different I think they’re complementary and what I mean by that is when you think about what everybody is doing within digital right it’s all about sort of dynamic shift in terms of where the focus of power is moving towards right and we’re trying to put more of that focus back on the patients and when you think about things around engagement right what does it always come down to whatever it is we’re trying to do within digital it’s around outcomes right and we’re essentially at the end of the day trying to make people healthier trying to improve outcomes and ultimately right if we want to break it down like how do we take cost out of the system right across the board. And, so I think that’s where you get a lot of that overlap and I think what’s important about that particularly when you think about some of the strategies that come out of pharma is if you look at the changing dynamics within the payer landscape and what not a lot of these things are becoming cost of entry now so if you’re not coming with a digital product or a digital solution along with a molecule you’re actually putting yourself behind the eight-ball a little bit. And what I mean by that is if you let’s just take a look at biologics and drug delivery right now so if you think about that space right we are moving into a world where a lot of the focus is being shifted on to the patient in terms of a lot of these new biologics are you know large injections they’re viscous and a lot of them are now happening in the home and our efficacy right is based off of how well people can actually take these injections as an example which is then also tied to our reimbursement and so based off of that we need to have tools in place so we can actually understand how people are using our products and to actually enable the best experience that they can because in these areas where you’re seeing you know kind of essentially commoditization of molecules and kind of dancing on a pinhead for differentiation of new products sometimes that experience is going to be the differentiator between how effective your product is and you know tied to again if you’re looking at different risk share models or you know some of these new emerging reimbursement strategies being able to have that tie into an ecosystem with digital is going to be it’s going to be critical.

Paddy: So, you’re almost saying that you know digital enablement is almost like table stakes for entry and for remaining competitive in the marketplace in some ways, is that correct?

Greg: I would definitely say that and I think you’re already seeing that right so obviously in some chronic areas right you can you can point to diabetes and say it is essentially cost of entry at this point and you can clearly see as you’re starting to look at other chronic areas particularly where there’s a lot of costs right that’s where you’re starting to see most of the end roads with it right. So it’s all-around hypertensive, you know obesity, non-compliance diabetes, asthma those are your those are really the areas where it’s ripe and it’s becoming just simply cost of entry.

Paddy: All right that’s very interesting so that indicates a level of maturity in the marketplace as well. So you mentioned digital therapeutics. So can you talk a little bit about what kind of initiatives are the near-term focus areas for AbbVie and how are you really going about harnessing in your role the innovations that are available in the marketplace either through the startup ecosystem or through partnerships or even through internal initially. Can you talk a little bit about how AbbVie is approaching it.

Greg: Yeah we mean we’re definitely looking at things from a buy-borrow-built perspective right. We’re not locked into one particular strategy in terms of thinking about digital now the thing that we are doing right is I think if you look at the digital space it’s matured a lot in the last let’s even say three years and so I think we’re the shift has sort of happened and we’re where we’re going with things is that you know a couple years ago it was all about the sensor right and everybody was fascinated by just the data that could come off of the sensor and what we’ve seen very quickly is that there’s not value in data and so what I mean by that is there was that period where just think simply being able to capture transactional metrics off of a single sensor, everybody thought there was going to be tremendous value in that and now where we’ve gotten to and I think because of it as the commoditization of the tech is we can measure most things right so we’re not so much enamored by the technology anymore but we’re more thinking about these sensors as enablers to a broader intervention right. And, so the approach that we’re taking is actually one that is agnostic of technology. So, our whole strategy starts without talking about technology it’s again all around what are we solving and bringing a lot of elements of you know design thinking and co-creation with our patients into the process to really again understand what is meaningful to them what are the constraints for that patient population to ensure if we are going to be bringing some sort of digital technology in that it actually works right from an experience standpoint and then again if that’s laddering back up into what our overall strategy is. So, the biggest thing that we’ve been doing is trying to get people out of the mindset of being so enamored by the widget and focused on the actual technology and more around the problem in what we’re solving and then working backwards into what is that ultimate you know perfect solution going to be for that patient population or what not and that’s where we get into them at that point, thinking about buy-borrow-build right is there something that is off-the-shelf that is perfect for us to a company for us to partner on or is there you know maybe somebody that has about 50% 60% of the way there that we can partner and get them you know that extra 50% so we’re in a good place to be able to leverage that technology.

Paddy: So, that’s an interesting observation you made that the technology bite itself is not something you want to be enamored with at a point where that is the end you’re really using technology to drive new experiences new ways of doing things and you know some might argue that the whole technology first or put to put in another way you know build it and hope they will come kind of a mindset it’s not really going to work in healthcare. At the same time the technology is an important enabler using the technology to accelerate innovation or to reimagine the way you engage with patient or reimagine your different processes in your value chain also is important so it looks like you know, you’re, in your strategy of buy-borrow-build you’re definitely it seems looking into the ecosystem for interesting technologies that can help drive your digital journey or digital strategy. Can you talk a little bit about specifically what are the things you look for when you go into the market and what are the things that you feel like you’re best off doing internally?

Greg: Yeah so we again we take an approach of thinking about desert from the standpoint is that there are short-term needs and then there’s going to be long-term right. And, so our approach again is grounded in what we’re solving and the reason we do that is because if you don’t take that approach and you get more enamored on the technology what you end up happening is getting stuck in a world where everything is an app and what I would challenge people is to think about right now everything is we’re very much tied to screens right and so inherently when we think about solutions we say well we you know people don’t people sort of use saying I need an app as a way for talking about a digital strategy right much like we call a Kleenex or you know Xerox things like that right we get focused in on a particular thing that means something actually much bigger and so what we try to do is again getting people out of thinking about apps and thinking about the problem because you know I really think screens are going to be going away in the next couple of years when you start to look at the trends of zero UI and what you know a lot of companies are doing in terms of you know Apple and Google and Amazon and talking about trying to get your phone essentially into your ear right they’re calling them hero bowls but then also looking at how we’re all guinea pigs every time we put our air pods in or we’re talking to an echo right we’re all sort of moving towards this reality of not actually using screens and so you know what our approach has been is understanding for our let’s just take an example for someone let’s say with Parkinson understanding in the short-term what does good look like for them and what sort of you know technologies can we bring in to let’s say either better assess disease progression or look at things in terms of you know clinical tests that happen actually outside of the clinic in the short-term but then also thinking about again the constraints of that patient population and things that they may have from some physical limitations and whatnot, dexterity and whatnot, and think about ways that we can totally change that engagement. And, so a lot of that involves thinking about what are your patient reported outcomes and things and then trying to identify emerging technologies that we can partner with and say are there ways that we can actually you know validate these PROs and you know get in that sort of futuristic world that we like to be in you know. The other challenge I would I would say and something we talk about often as beyond screens going away as you know is PROs and in clinical trials going away and can we get to a world where everything is truly passively collected and so that when you kind of think about those two worlds it’ll help you develop a roadmap that gives you short-term within the next two to three years what you do but then also your longer-term vision in terms of you know partnerships and some of these you know emerging zero UI technologies and whatnot.

Paddy: That’s it that’s again another interesting observation and so there’s obviously implications for you know for both the consumer of these technologies and also for those who are developing these technologies. So, you know as we as we all know there’s billions and billions going into funding innovative startups and you know and many of them don’t make it right and I’ve read stats from <15:52>IQ VIA and others that say that it’s you know more than 150,000 mobile apps out there in the Apple and the Android stores but a very small number are actually being used meaningfully if you go by you know if you go by the number of downloads and so on. So, if we are moving towards an environment where it is let’s say screen less and it’s a zero UI environment. How do these innovative startups find a place in the world? Are they all going to have to eventually converge on a handful of devices that become the gateway now to managing the patient experience take an iPhone for instance or in you know or an echo, Amazon echo. What do you think you’re better with this?

Greg: Yeah, I don’t think it’s particularly zeroing in on a particular technology or a few technologies. I think the challenge with a lot of these startups has been they’ve taken almost a consumer approach to the technology and what I mean by that is when you look at a lot of companies from my perspective that have failed or struggling, they have some interesting technology that they’re then trying to essentially figure out a healthcare problem for right. So they’re actually attacking the issue backwards which is more of that sort of you know commercial Silicon Valley sort of approach right where we have something interesting and let’s see if we can actually figure out a way to implement it in a way that’s meaningful for folks right. And, so in healthcare I think that it doesn’t work right, and I think that’s where you’re seeing the challenges and we’ve always seen the challenges is that a lot of these startups don’t have a good understanding of healthcare and healthcare systems and just workflows and actually how healthcare gets delivered. On the other side of the world which is only the challenges a lot of people within Pharma can’t speak the same language as a lot of these startups and so because of that I think you’ve seen a lot of these companies that are failing and so do I think we’re going to get stuck into you know to your to your question a world of just simply an echo or an iPhone like no because again in a world of let’s keep moving down so right now it’s an app and then it’s going to go towards some sort of zero UI but probably after that it’s going to move towards an implantable right or something like that. And so again in that sort of scenario it’s not about the technologies, it’s about how we solving the right problem and then the solution that we’re adopting is going to evolve and you know an example of that I always like to give is if you’re starting a new job right same sort of thing when it comes to technology development and your first day let’s say you don’t know the area where your office is, which obviously you would have you already interviewed there but let’s just hypothetically say you don’t know where you’re going right. If you start your new job in 1985, the solution and the product you’re going to adopt is going to be a map right but as you move on if you start your job and let’s say 1995 right just it’s probably going to be you know or later on than that it’s going to be you’re not going to flip the map anymore you’re going to select MapQuest or and print out your directions and then it’s going to be a GPS that’s on your dashboard then it’s going to be you know ways and then it’s going to be a self-driving car and it’s all these sorts of things right. So yeah you can see fundamentally we can’t articulate what the technology is going to be, but it’s the same problem exists and so we just need to stay grounded in that problem and let the technology evolved.

Paddy: Interesting, so I want to talk a little bit about your investment portfolio right I mean at AbbVie ventures, you know you made a bunch of investments, you made some strategic partnerships to it, so what’s been the philosophy behind these investments what are you looking for from these entities?

Greg: Yeah so you know it’s I think its evolving as well right so I think the area that it’s evolving more and more is around the digital space and so you know we’ve got some well-known partnerships out there particularly with Calico and things that we’re working on there which has been really successful and I think you know where we’re at is where we have a pretty clearly defined approach to digital in terms of some of our emerging course therapeutic areas that we want to be in and so now what our approach has been is actually again thinking about both short term and long term and so what I would say around our approach is we’re thinking about the next three to five years in terms of what we need to deliver but then also hopefully going to be placing some bets on what that more future vision for digital and what AbbVie is going to look like in terms of partnerships from you know small start-up companies, Academia, Consortiums and then you know some other let’s say potentially bigger technology investments as well so we’re sort of again all over the map in a way but it’s sort of focused in a manner if that makes sense meaning short-term to long-term priorities.

Paddy: Yeah so one of the things that I want to go back to your earlier comment about zero UI technologies and I think the example of the self-driving car and going from a map to a self-driving car that knows where it needs to go and all you do is provide an address for instance that’s all powered by a lot of AI technologies right it’s looking at a lot of data is learning on its go and making sure that it’s not making any mistakes optimizing for the roads etc, etc. So where does now AI is a much hype term but there is also some reality to it where do you feel that fits in your overall strategy do you look at the look at AI as something that you know you want to invest in as an entity or are you looking at your partners to it you know sort of infuse the technologies and the products and platforms with inbuilt AI functionality so it’s like to your earlier term it’s kind of like table stakes the cost of entry where do you see where do you see that in the overall spectrum of expectations?

Greg: Yeah so you know for us it’s hand in hand right when we think about a digital strategy that’s certainly a component of it right, so we can call it you know, we can call it AI, we can call whatever we want to call it but at the end of the day again if you’re thinking about as we talked about earlier that evolution right from 2015 being about data and 2018 and 2019 being about actionable information. The only way you get there is through analysis right and so let’s call it AI but we have now these disparate data streams that are coming off of these sensors right so these are the enablers that in isolation don’t provide any value when you’re able to look at those things in combination and actually make sense of it right that’s when you are able to get to actionable information and that is ultimately where the value within digital is right and then I think we’re seeing that evolution and what that does when you’re able to do that analysis and make meaningful get meaningful information out of these sensors then it opens up everything for you right it opens up that ecosystem it opens up all those areas of intervention that you can make and it goes from a reality that takes you from passively tracking to then actually being proactive in terms of interventions and actually you know engagement right and that’s ultimately where we want to get to so I think it I think whatever we want to call it it’s actually what’s what is really the anchor to what’s going to be the future of digital and if digital is really going to work.

Paddy: Yeah it’s very interesting so now what are the you know what are the top two or three challenges in making all this come together with data of course we know that in healthcare there’s a problem with interoperability there are no defined standards especially in the context of exchanging electronic health record information as an example but what do you think are going to be the biggest challenges to making this vision a reality or getting to where you think you need to be for AbbVie.

Greg: Yeah, I think it’s always it’s always interesting having you know now been at a handful of large pharma and med-device companies. The challenges are always the same but a little bit different right and I think one of the biggest ones particularly within pharma is you know pharma moves at a certain pace and technology moves at a certain pace right we know that those are not similar right so Pharma is much more plotting and straightforward right. We’re trying to marry up timelines between what you’re doing within pharma and the tech is always going to be a challenge. Now I think with some of the stuff that the FDA is doing it’s starting to or attempting to bridge that and I’m hopeful that those sorts of interventions are going to help us be more nimble moving forward in terms of digital combination products and whatnot so I think there are some potential solutions there but to me the biggest challenge is inherently pharma needs to change what it thinks it does and so for a lot of pharma companies they are a drug company or they think of themselves as a drug company and the challenge I would say across the board is that when you take a look outside of the four walls of your company you’re really an outcomes company and when you begin to think of yourselves as an outcomes company your competitive set opens up and what you’re trying to accomplish opens up as well. And so trying to make that shift in mindset from an industry like Pharma is a challenge and you know what comes along with that as we talked about before right different skill sets and ways of thinking and experiences and so those are all just I think things that are right now a lot of companies are trying to evolve into but I think it’s that shifting mindset into solutions and outcomes versus product and molecule.

Paddy: Interesting so what’s the definition of success then in your own?

Greg: Yeah so I think for us it’s around it’s really two things right so I think it’s we want to look at like most companies digital that can enable the drug development process right so how can we take friction out of the system when you think about clinical trials there’s so much so many areas that are ripe for just improvement right so that’s one is ways that we can tangibly look at the ways we’re doing trials and are we doing them better right are we able to capture measures objectively are we able to take some of the PROs out, are we able to reduce costs increase probability for success of our trials those sorts of things right. At the second time it’s about enabling commercial strategies right so things we talked about earlier around molecule plus some sort of digital solution to enable new partnerships with payer organizations or just open up some of these commercial opportunities that may not exist by simply having you know a fantastic drug that works in isolation.

Paddy: Right so some of it is also driven by the expectations around demonstrating outcomes and demonstrating the value with all the scrutiny around the cost of drugs and so on so forth is that is that what is also driving some of the digital strategy?

Greg: Absolutely, yeah absolutely right, that’s part of it too is when you have a fantastic product you want to ensure that you can actually show in a real world that people are using it properly and you know the efficacy is there so yeah absolutely that is part of it and as we talked about right moving more and more towards table stakes and a lot of these chronic areas.

Paddy: Yeah so we’re coming up to our time here so my final question for you Greg is what’s your advice to your peers in the industry namely other digital, Chief Digital Officers in either pharma or you know other sectors of healthcare and also to the solution provider let’s you know let’s recognize that there is a huge ecosystem that sees a huge opportunity for digital in healthcare and they just you know there seems to be some amount of struggle in try to make you know the correct connects and finding the right fit and ensuring that everybody is successful so what’s your advice to solution providers as well as to your peers?

Greg: Yeah I think it’s again it’s taking a step back right from the sexiness of the technology which is where we all love to talk about but taking that step back and saying is everything truly grounded in an overall strategy right and thinking about digital is not a standalone component but as we talked about an enabler to that bigger strategy right in and of itself it is not a strategy it should enable whatever your company wants to be whether it’s an outcomes company whether it’s you know whatever you want to call it so that’s number one is don’t think about it as this the siloed you know thing by itself but thinking about it as it integrates with the bigger company and I think the other part is again is it about outcomes and how it fits into the workflow right if you’re not optimizing the process if you’re actually creating complexity which a lot of these solutions currently are with when you think about dashboards and everything else that we’re asking physicians to log into right and all these other things yeah if you’re not optimizing the process then you need to take a step back and think and think about how you can actually do that so that that is the biggest thing for me is like it’s about optimization it’s taking friction out of the system and if you can look at what you’re doing and we’re not doing that then we need to take a step back and think about how to do that.

Paddy: Fantastic Greg it’s been a real pleasure speaking with you and thank you so much for sharing your insights on digital and what you’re doing at AbbVie. Sounds like you’ve got a lot of exciting things going on and I wish you the very best with all of these initiatives thank you again for being in the show.

Greg: Absolutely Paddy appreciate it and hope to catch up soon.

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