DIGITAL 2035 A Futures Report on Healthcare and Technology “Now is the time to act and build the future we want.” The Business Innovation Garage

2 FOREWORD

What lies ahead for Novo Nordisk?

It’s impossible to predict the future—so why should you care about the future scenarios in this report?

Read further and you’ll find thoroughly explored trends and issues that will have a massive effect on the way Novo Nordisk does business fifteen years from now.

Why 2035? It’s just far enough ahead to bring a sense of curiosity and excitement for a moment that we can’t predict with full accuracy, and just close enough to develop concrete The Business Innovation Garage is a newly formed plans of action to achieve what we want. Even though the future will almost certainly look department within Global IT that identifies and different from what we’re describing, it is necessary to use fictional narratives to start a drives growth opportunities created by emerging dialogue, ask questions, and challenge assumptions on what’s next for us as a company. technology. Our strategic focus is on solutions and technologies that are new to Novo Nordisk and

Technology will play a prominent role in the future, and we have seen how the current trend new to the pharma industry. towards digital transformation is changing the way we live and work. These scenarios focus Interested in understanding how the trends and on technology as the driving force that will lead us to the futures we’ve illustrated and help scenarios in this report could impact your area? us achieve the ambitious goals we’re pushing for in this report. Do you have an idea for a game-changing approach to our business? Now is the time to act and build the future we want. We hope you’ll agree with us that the potentials are limitless. Get in touch with us by writing to: Matt Dugan (MYDU), Head of Innovation.

Thank you to the participants and stakeholders who provided important business and industry insights, which greatly contributed to the production of this report.

3 “We chose to go to the moon in this decade and do the other things—not because they are easy, but because they are hard.”

John F. Kennedy, 35th President of the United States

“I don't think the space station is innovative. Going to the moon was innovative because we had no idea how to do it.” Peter Diamandis, Founder of X Prize Foundation and Cofounder of Singularity University

4 Moonshots are ideas that strive for 10x growth while the rest of the world is aiming for 10%. It can't be achieved by working harder alone —you have to be willing to try seemingly crazy ideas.

Huge Problem Moonshot

Break- Radical through Solution Technology

Anatomy of a Moonshot

5 “Big Tech companies like HP and Amazon and Apple and Google and Microsoft all realize that [healthcare] is the largest remaining industry that has not been revolutionized by modern technologies that have transformed every other big industry in the United States.” “We didn’t set out to John Scully, Chairman of RxAdvance and Apple’s Ex-CEO disrupt healthcare.

> CNBC, Feb 2020 1 We set out to meet the needs of our customers at Walmart.”

Sean Slovenski, Walmart President of Health and Wellness

$5.4B > Forrester, July 2020 3 US digital health companies raised $5.4B in venture funding across the first six months of 2020. The sector is on track to have its largest funding year ever.

> Rock Health, 2020 2

6 Table of Contents

6 Executive Summary

8 Introduction 9 > The Terminology 1 0 > The Methodology

11 Key Trends

27 Scenarios 28 > Scenario 1 – Computer Says Go 34 > Scenario 2 – Now You See Me 4 0 > Scenario 3 – Rise of the Giants 46 > Scenario 4 – Mc Healthcare

52 Sources

5 EXECUTIVE SUMMARY

Synopsis

This report looks at current signals and trends in healthcare, empower the patient. But there’s also a re-bundling on the technology, and society to imagine possible futures of the horizon with platforms like Apple Health trying to become the healthcare industry up to 2035. Fourteen key trends and four central health data hub. scenarios have been identified and developed to provide orientation for ideation and decision making about new products, > New players are entering the healthcare market to disrupt. technologies, and business models that have the potential to Tech companies and retail giants are making their moves, shape the future of Novo Nordisk. bringing their digital technologies expertise and massive customer data and experience. Pharma, with its current focus on research and manufacturing, is in danger of being pushed to the fringes of the network as a provider of intel and a receiver Key Takeaways of fulfillment orders. > AI is one of the essential tech healthcare trends that influence most other trends and touch all aspects of healthcare—from > The COVID-19 pandemic has accelerated many trends diagnosis to drug development to preventive care. But the towards digital healthcare like telemedicine, the unbundling crux is data to train the algorithms. Collecting and controlling of services, on-demand supply chains, and more. Startup health data will be the key to shaping digital health, while investments have exploded in these areas. No matter when the regulation and concerns about privacy and discrimination will crisis ends, it has already changed the healthcare landscape. make data ownership more complex. > It can be easy to just focus on the next big thing in technology > Digital approaches allow for an unbundling of healthcare and business. Still, forces of climate change, deglobalization, that used to be pooled around providers like hospitals— populism, and polarization dramatically shift the overall technologies like telemedicine and distributed triage offer context for these trends. Technology can no longer be looked patient-centric services that can be more personalized and at in isolation.

6 EXECUTIVE SUMMARY

Overview

Key Trends

VALUE-BASED POLARIZATION AI-DRIVEN CONSUMERIZED HEALTH AS MODULAR A CRISIS OF HEALTHCARE OF DATA HEALTHCARE GENOMICS THE NEW LUXURY HEALTHCARE TRUST SHIFT OWNERSHIP

NEW PLAYERS DIGITAL BY PERVASIVE SYNTHETIC ON-DEMAND THE END OF NEW SUSTAINABLE IN HEALTHCARE DEFAULT PROFILING MEDIA SUPPLY CHAINS GLOBALIZATION INNOVATORS

Future Scenarios SCENARIO 1 – COMPUTER SAYS GO SCENARIO 2 – NOW YOU SEE ME What if tech companies like Apple, What if Augmented Reality lenses instead of using their devices simply become a consumer product, to collect health data, start using them changing how people look at their health? to sell health insurance?

SCENARIO 3 – RISE OF THE GIANTS SCENARIO 4 – McHEALTHCARE What if new players enter the healthcare What if new technologies enable a franchise industry, disrupting not innovation but model that creates access to telemedicine, distribution, with one giant company in AI diagnosis, and virtual treatment to those for particular eager and ready to make big moves? whom it wasn’t previously available or affordable?

7 INTRODUCTION

The Futures of Healthcare

The tectonic plates of the healthcare industry are shifting. The first chapter contains 14 key trends, from AI in healthcare Digital technologies are changing what healthcare looks like to on-demand supply chains, that describe various today. One example: the smartphone has become the new developments influencing the coming years in the healthcare hub for personal health, replacing the GP. The seismic waves industry. The second chapter combines these trends into four of this transformation can be felt ever closer. But what will different scenarios to imagine what a future might look like change for whom and over what period of time is incredibly when these trends continue on their trajectories. Signals— hard to predict. things that are happening right now—accompany all trends and scenarios to ground the future in the present. This report looks at current signals and trends to imagine possible and plausible futures of the healthcare industry to The trends and scenarios presented in this report are an enable a fresh conversation about new ideas and approaches. invitation to broaden the horizon and challenge common The key to being successful in a perpetually changing world is assumptions about a future that too often feels predetermined. not to predict one probable future but to prepare for multiple But until the future becomes the present, it remains open. possible futures. That is why this report presents four different scenarios highlighting several plausible developments. Identifying those early on allows investment in new products, technologies, and business models that have the potential to shape a preferable future. The key to being successful in a perpetually changing world is to prepare for multiple possible futures.

8 INTRODUCTION

The Terminology

A Signal A Pattern A Trend A Future Scenario

A signal is a piece of current informa­ A collection of signals that point in A hypothesis about where a pattern The actual change is much more complex tion that points to a possible change the same direction is called a pattern. might go by extrapolating from the than anticipated by individual trends because in the future, like a news article or a It strengthens the expectation for present into the future is called a trend. different trends all influence each other. statistic. For example, a telemedicine a possible change in the future. At this point, the analysis moves A scenario combines different trends and startup receiving funding could be If several startups with similar from observation to speculation or describes a certain point in the future where a signal for telemedicine becoming ideas for telemedicine get funded, prediction. A trend could describe the they all have become a present reality. It asks: more important in the next months for example, and a study also finds more significant role that telemedicine What would the future look like if these and years. confirming results, it is a pattern. could play in preventive care, for hypotheses are proven true? It describes, Nevertheless, signals and patterns example. It helps to anticipate a for example, the life of a patient in a future are still observations of the present. specific development in the future with telemedicine, AI-driven diagnostics, and adapt accordingly. and a value-based healthcare system.

past future past future past future past future

SIGNAL PATTERN TREND FUTURE SCENARIO

9 INTRODUCTION

The Methodology

Researching the Signals

Extensive research was conducted to find signals and patterns that could point towards possible and plausible futures of health, looking at trade news and publications, trend briefings, societal studies, scientific articles, and conference papers. The findings were then discussed with a group of senior stakeholders from inside Novo Nordisk to reflect upon and extend.

Identifying the Key Trends

Out of the immense collection of signals and patterns, 14 key trends were identified that will potentially have a substantial impact on the healthcare industry in the next 15 years. They cover a wide range of topics from technology to business to society but are by no means exhaustive. Each trend consists of the context for this trend, a collection of signals, and a hypothesis about where this trend might go in the future.

SIGNALS > KEY TREND > FUTURE SCENARIOS Developing Future Scenarios

Different key trends were combined to create the contexts for four different future scenarios to make the healthcare industry’s potential evolutions more vivid. Each future scenario includes a collection of signals, a scenario introduction, and a micro- fiction describing this future from the perspective of a news article.

10 The Key Trends Developments in technology, business, and society that will have a massive influence on the future of the healthcare industry.

11 KEY TRENDS

Overview

These trends have been selected as potent disrupters of the status quo in healthcare and pharma. We used them in this report to challenge current expectations and identify new opportunities.

Value-Based Polarization Health AI-Driven Consumerized Healthcare of Data as the Healthcare Genomics Shift Ownership New Luxury

Modular A Crisis of New Players Digital by Pervasive Healthcare Trust in Healthcare Default Profiling

Synthetic On-Demand The End of New Sustainable Media Supply Chains Globalization Innovators

12 KEY TRENDS AI-MADE DRUGS DIET MANAGEMENT BIASES IN ALGORITHMS

AI-Driven Healthcare

about five years to develop a drug for human use.) 5 Context Gut microbes, with the help of AI, can now reveal the AI in healthcare has arrived at a level that enables perfect diet. 6 Apple is not building health-related better diagnoses based on big data and allows for features into its consumer products; their ultimate new tools in predictive healthcare. It is speeding up goal is to create a HealthOS. 7 Novartis has brought drug development. Silicon Valley giants see Microsoft on board to provide AI-capabilities to every healthcare as a profitable application for their employee, which means that Novartis’ research data AI-investments. Many pharma players lean on their will be processed on Microsoft’s infrastructure. 8 expertise because they lack both the technology and the data. Additionally, the proliferation of devices that Hypothesis track every aspect of our life has created so-called digital twins. Big Tech has successfully monopolized AI will change the way practitioners work through tele-/ those data sources. remote diagnosis, partial replacement of diagnosis, and individual drug development for patients. AI is one of the essential tech healthcare trends, which influences Signals most other trends. But its success will also be based Compared with radiologists from the US, Google’s on tech companies’ ability to deal with the growing DeepMind’s AI system reduced false-positive rates evidence of biases in algorithms that may lead to false (when an image is falsely identified as abnormal) results. AI will need to lose its black-box status and by nearly 6 percent and false-negative rates (when become more transparent for patients and doctors cancer is missed) by over 9 percent. 4 An AI-created to trust its diagnoses and advice. Solving trust issues drug is about to be used on humans for the first time will make consumers more willing to share their data after just 12 months of development. (It usually takes through a variety of new health-related devices.

4 nature, 5 BBC, 6 The Spoon, 7 Divinations, 8 DailyAlts 13 KEY TRENDS CRISPR GENE EDITING NANOTECHNOLOGY SYNTHETIC BIOLOGY

Consumerized Genomics

could revolutionize many fields within medicine and Context healthcare. Just recently, scientists have used CRISPR Below the radar, there’s a groundswell of new scientific and patient-derived stem cells to reverse diabetes. 1 0 areas that are born of combing different fields to Other scientists have created Molecular Robots, little discover new routes to innovations. Synthetic biology bits of DNA, that can collect specific molecules and takes inspiration and insights from engineering, design, deliver them to specific places. 1 1 Nanotechnology has and computer sciences to create living organisms envisioned this concept for a long time. that don’t already exist in nature. This allows for new approaches to a lot of old problems. Hypothesis In nanotechnology, instead of trying to shrink technology to the molecular level, you create it directly Often overlooked in the hype around digital out of DNA. That’s just one example of the many new technologies emerging from Silicon Valley, the scientific opportunities that have opened up. advances in the field of synthetic biology might make for the most significant changes in healthcare and health in general over the next 15 years. If synthetic Signals biology delivers most of its currently anticipated The Human Genome Project was a milestone in potential, other trends like AI, unbundled healthcare, scientific discovery. Now, scientists have started a and brain-hacking will have dramatically different new one. Where the last one was focused on “reading,” trajectories. i.e., understanding the human genome, now the goal is to “writing.” 9 CRISPR-Cas9 is one of the most promising (and highly debated) gene-editing technologies that

14 9 Wired, 10 FierceBiotech, 11 Caltech KEY TRENDS PERSONALIZED HEALTHCARE POPULATION HEALTH OUTCOMES-BASED PAYMENT

Value-Based Healthcare Shift

real-world evidence for health and cost improvements. Context The Netherlands is one of a few countries already Most business models of our current healthcare investing in outcomes-based healthcare (€70 million system are based on people getting sick, not people from 2018-2022). 1 2 Outcomes-based payment is getting well. The vision of a value-based healthcare used to address the US healthcare financing crisis: system is trying to turn this around (reward health). successful implementation of outcomes-based The broad idea is to use digital technologies to track payment could lead to a trillion dollars of cumulative different patient measures in their everyday lives to savings in the United States over the next decade. 1 3 show how their quality of life has improved. This will fundamentally change how the healthcare industry Hypothesis works. A value-based system is shaping up to become the most significant paradigm shift in the healthcare Signals industry over the next ten years. Interoperability When the incentive is to have a healthier population, and data standardization will be critical drivers, but it leads to two approaches: personalized health and they might be spearheaded by the likes of Apple and population health. One will try to find the best individual their hubs for EHRs. This trend is closely connected therapy and the other will identify areas of unmet with other trends like the un-bundled healthcare need across a large group of people. A value-based infrastructure and AI-driven healthcare, making this healthcare system combines both. For pharma, this new system possible. Pharma’s challenge is to integrate shift would move them away from promoting features much more into these new data infrastructures and and benefits of individual products to partnering across provide clear evidence of how they add value. one or more disease states. The key is to provide

12 Government of the Netherlands, 13 McKinsey 15 KEY TRENDS BIG TECH SURVEILLANCE REGULATION WAR ON DATA

Polarization of Data Ownership

states like India, Indonesia, and South Africa. 1 5 China’s Context Social Scoring Systems is treated with criticism and Who can use which data, and who has a veto on that fear in Western countries but enjoys high popularity decision? This concerns everyone, from Big Tech, among the growing Chinese middle class. 1 6 Cities can pharma, citizens, the USA, Europe, China, the BRICS, become key agents in the transition from surveillance etc. Currently, the status quo balances between the capitalism, where data ownership is opaque, to a model US’s approach, which simply stores everything it where data is a common good, co-owned by all citizens. 1 7 finds and generates, China's boldness in claiming partial government ownership and lack of care for Hypothesis ethics, and the EU’s urge to regulate ownership for its citizens. Blockchain, as a technological concept, Data is an essential source for most digital services, tries to solve many of those issues, but concrete including AI, which will continue to be a hot commodity. solutions are still scarce. Whoever owns the data owns the future. With the growing demand for regulations, it will get harder for tech companies to harvest data without any Signals compensation or revenue sharing. Big Tech is trying to force its data contracts on under- The different approaches to data ownership between regulated countries. For example, Google provides the US, China, Europe, and other countries will grow its AI-based medical diagnostics to the Aravind further apart and create uncertainty in a complicated hospital in India for free in exchange for the medical global system. Interoperability, both technological and data. 1 4 Several developing countries refused to sign political, is in decline. an international declaration on data flows because it caused a war on data between Big Tech and upcoming

16 14 Linkedin, 15 Livemint, 16 The Conversation KEY TRENDS ACCESS TO TECHNOLOGY HEALTH AS STATUS SYMBOL

GOFUNDME HEALTHCARE EXCLUSIVE TREATMENTS Health as the New Luxury

Developing a whole new set of multi-sensory Context experiences is transforming the hospitality industry. 2 1 The positive correlation between per capita income #GoFundMe Healthcare: People have to tell extremely and health is one of the best-known in international emotional, heartbreaking stories to collect money development. Health has become a primary way to from their friends to pay for expensive but necessary display wealth and show richness without showing treatments. 22 off. There is a growing dichotomy between hyper- individualized health solutions for a wealthy minority Hypothesis and a majority suffering because it can barely afford most health care services. Wealthy customers will continue to push for more exclusive services to live longer and healthier lives. A positive outcome would be if these developments Signals deliver better healthcare for the general population. Expansive fitness platforms are adding AI algorithms: But the danger is that it will foster a more “[offering] the only truly intelligent, custom adaptive- distinctive two-class system between those who can training solution on the market.” 1 8 afford the very best healthcare and those who cannot. Patients without access to or a lousy ranking in According to the documentary “Feel Rich”, the hip-hop public healthcare system could flock to home-brewed industry takes health and wealth seriously. Rappers synthetic drugs and CRISPR kits­—with unintended as social climbers celebrate their opportunity to live consequences. a healthy life now. 1 9 The millennial luxury traveler is more interested in wellness than ever before. 20

18 MobiHealthNews, 19 Vibe, 20 4Hoteliers, 21 Boca Terry, 22 The New Yorker 17 KEY TRENDS TELE-MEDICINE DISTRIBUTED CHATBOTS

PATIENT-CENTRIC PATIENT EMPOWERMENT Modular Healthcare

The COVID-19 pandemic has been an enormous Context accelerator for this unbundling trend. In particular, Digital approaches allow for an unbundling of the use of telemedicine to avoid in-patient care healthcare that used to be pooled around providers sky-rocketed. 24 like hospitals. Technologies like telemedicine and distributed triage offer patient-centric services that Hypothesis can be more personalized and empower the patient. Instead of channeling all patients through the same Now that far more patients are been accustomed process (of a hospital, for example), diagnoses for to telemedicine due to the COVID-19 pandemic, minor symptoms can be conducted virtually, thus this trend is expected to only accelerate further into keeping the emergency room free for the urgent cases. a widely distributed healthcare system with Instead of one provider (GP or hospital) making all the unbundled care services, especially when combined decisions, the patient can choose between different with other trends like AI. providers for different aspects of the service line. Thinking about the longer term: there’s a new development of “re-bundling,” for example in TV shows. And with central platforms like Apple Health, we also Signals are getting the first glimpse of this happening for Infermedia 23 is one of the new tech startups offering healthcare in the future, which opens up the question: healthcare providers a way to pre-diagnose, triage, What will become the new hub for healthcare? and direct patients to appropriate medical services New InsureTech startups like Elma25 position with the help of chatbots, apps, and AI., reducing the themselves more as a healthcare company, not as significance of GPs and moving the point of decision to insurance, and their focus is really on optimizing insurance companies, for example. healthcare and taking care of people.

18 23 Infermedica, 24 Fast Company, 25 elma KEY TRENDS CONSPIRACY THEORIES POLARISATION POPULISM ANTI-VACCINATION

A Crisis of Trust

another health-related conspiracy theory can directly Context influence the future of essential technology for digital

Fake news has often been blamed for the rise of healthcare. These can no longer be considered fringe populism and the spread of conspiracy theories, views whilst populist leaders continue to preach on but the root of the problem goes much deeper. these topics. Polarization has increased dramatically due to a connection with identity. People interpret the world Hypothesis according to the world-view of their “tribe,” not facts or rational thoughts. And with this behavior comes a Any new cure, vaccine, diagnosis tool, or other health- zero-sum/us-vs-them thinking in which compromise is care technology is in danger of triggering a public considered a loss. Advances in detecting and flagging backlash and polarization. Pharma companies will have fake news are being made but so far fall short of to face a public debate in which scientific facts play a making an impact. declining role, and a healthcare conversation in which fringe theories become mainstream. How do you develop and market drugs when a growing group in Signals society doesn’t trust you anymore, no matter what you

The genuine danger in conspiracy theories can be tell them? observed in the anti-vaccination movement, where a The hope that populist leaders and the proponents of long-debunked study has led to an ongoing campaign conspiracy theories will debunk themselves has not all over the world that directly impacts healthcare worked out so far. So players in the healthcare industry and the fight against disease. 26 The prevalence will have to make this trend an essential driver in all of this movement, especially within well-educated plans for the future—at least as long as no solution is groups of society, is harrowing. The current backlash feasible or the trend is not declining. against 5G (burning of cell towers, 27 etc.) shows how

26 nature, 27 CNET 19 KEY TRENDS STARTUP / RETAIL / GOVERMENT HEALTHCARE GROUP PURCHASING VENTURE CAPITAL

New Players in Healthcare

are helping increase competition, transparency, Context and even emergency preparedness; 31 they are an While obvious players like pharma, insurance companies, archetype for new partnerships. Governments are and many other providers and payers fight about moving the needle by introducing pricing controls on future shares of the healthcare market, some new pharmaceuticals and medical technology devices. 32 players are emerging. With them, they bring the potential to shake up the industry from new and Hypothesis unexpected positions. The healthcare market is becoming more fragmented and thus much harder to observe. New players from Signals unexpected fields are entering it to disrupt. Pharma, While Amazon changed consumer shopping with its current focus on research and manufacturing, habits, Walmart adopted new solutions for its is in danger of being pushed to the fringes of the customers’ needs—like integrating outpatient network as a provider of intel and a receiver of healthcare services. 28 Best Buy is focusing its future fulfillment orders. Others like insurance companies or on digital-health initiatives, moving from selling devices Big Tech are trying to become the central platforms to adding analytics and services to helping seniors that steer the integrated systems of future healthcare. grow old, for example, with the help of their trusted But there are always new possibilities in the shake-up customer-service workforce. 29 Venture capital firms of an existing landscape. Why let new players be the are cooperating to create a technology security only ones to disrupt when old players can do the same, certification for digital healthcare because this regularly reinventing their role in the changing system? makes the difference between life and death for their startups. 30 Group Purchasing Organizations (GPO)

20 28 Forbes, 29 Digital Commerce 360, 30 TechCrunch, 31 RevCycleIntelligence, 32 Deloitte KEY TRENDS BRAND AUTHENTICITY BRAND PURPOSE WHOLISTIC LIFESTYLE

Digital by Default

diversity—they expect a lot from brands that want Context to cater to them, and they can rally the troops Friction between generations has always been a source quickly if they feel burned. From AI-based astrology of innovation and change. As new generations like to biohacking—they are open to fringe (mental) millennials and Generation Z are staking their claim healthcare movements, but often their meme-based and defining their world-view, markets have to adapt. approach to new things is indistinguishable from Young people around the globe are living their lives trolling. 33-36 digitally by default. What will happen when the generation that has grown Hypothesis up with all those digital tools and services moves to the center of attention in the healthcare market? Technologies change and so does their users' behavior. The healthcare industry will need to adapt to the world-view and needs of new generations. Signale The next generations are much less willing to accept Young people in their teens and twenties are already the status quo. If push comes to shove, they’ll start used to a more holistic lifestyle with a focus on their own thing instead. But simply developing an mental health. They are familiar with meditation, app for everything won't solve the problem. intermittent fasting, and all the diets from paleo to These digital-first generations are also the most vegan. They can’t imagine dating some who hasn’t critical of the downsides of the digital world. But this been to therapy. They manage their health completely challenge also provides an opportunity for those who digitally. Every non-digital interaction with providers do it right. And that usually means building the future and insurance companies feels like an unnecessary with them instead of for them. drag. Authenticity, purpose, sustainability, and

33 The Future Laboratory, 34 FierceHealthcare, 35 Time, 36 MedCityNews 21 KEY TRENDS SOCIAL CREDIT SCORE DIGITAL TWIN BLOCKCHAIN AUTOMATIC DECISION MAKING

Pervasive Profiling

company that many have been unknowingly exposed Context to is Zeta Global, 39 which scores on how much The finance industry has been using credit scoring money individuals are likely to spend. France-based for decades. With greater quantities of data collected startup Sim&Cure 40 has developed a patient-based about our lives, more and more decisions are digital twin for treating aneurysms. Finland’s Oura automated with the help of scoring. Smaller, cheaper, raised $28 million from Square, Google’s Gradient and more connected wearables allow the collection of Ventures, and others for its smart wellness ring and is tons of personal health data. This enables the creation mainly used to track more in-depth sleep data. 41 of so-called digital twins—digital health data profiles that can be used to test treatments. Hypothesis

We are already moving into the direction of behavioral Signals and biometric scoring. Healthcare insurance, combined China is establishing a society-wide social credit with social scoring is possible. This is another trend scoring. More than 33 million companies in China where regulation will have a considerable influence have been given a score, and many companies on the outcome over the next ten years. Future tech have already been blacklisted. 37 China also exports will track even more health data with, for example, this system to other countries via its Belts & Roads internal (nano) sensors and AI. But there are many initiative. Hangzhou plans to turn their COVID-19 app open questions like centralization vs. decentralization, into a permanent health tracker: The city’s health competition vs. collaboration, and data ownership. commission said the proposed system would be a This is why Blockchain technologies provide a lot of “firewall to enhance people’s health and immunity” potential in this space. after the pandemic. 38 One example of a scoring

22 37 New Horizons, 38 The Guardian, 39 The Wall Street Journal, 40 Ansys, 41 Tech.eu KEY TRENDS DEEPFAKES RENDERED HUMANS VIRTUAL DOCTORS

Synthetic Media

any give text. 43 They offer specific speech engines for Context different contexts, from call centers to audiobooks, Human to human interaction is the pinnacle of to adapt the voices. Samsung's Star Lab was the viral communication. New AI technologies allow the hit of CES 2020, with the NEON concept developing generation of media featuring artificially rendered full-person real-time avatars with which to have humans. Deepfakes have been the most prominent conversations. 44 One of the presented avatars was example in this field. We are moving into an age of a doctor. abundant possibilities, from story-telling to hyper- personalized media. This trend is already changing Hypothesis processes and business models in the media industry and will spill over into other industries soon. A lot of conversations in the context of healthcare are The question we are facing is no longer what is real, deeply personal and are based on human to human but if we will even care. interaction. But what if healthcare professionals could be available at any moment, speaking your language, appearing in a manner (calm or energizing) that’s Signals helpful for situations like instructions on how to take Synthesia creates original videos with personalized medicine, a pretest before an appointment, personal and localized messages, using human-like avatars training for post-surgery recovery, etc. How far are with correct facial expressions. 42 This allows, for people willing to let go of speaking with a human for example, to produce translated promotion or training the possibility of an instant, hyper-personalized human- videos automatically. Voicery uses its AI-driven text- like avatar? And for which context first? to-speech technology to create individual, natural- sounding voices for organizations that then can speak

42 Synthesia, 43 Voicery, 44 Good Content | Tech 23 KEY TRENDS AMAZON BLOCKCHAIN DRONES 3D PRINTING

On-Demand Supply Chains

a devilry fleet, as Ford has shown by reducing both Context the time and cost associated with the production of The rise of everything on-demand has put a lot more parts. 47 IBM, Merck, and Walmart have successfully emphasis on supply chains to deliver on this promise. finished an FDA-backed drug-tracing pilot based on Logistics are getting unbundled and disrupted by new Blockchain technologies. 48 The system could track players and technologies, from drones to 3D printing drug movements while also limiting the flow of private and, of course, AI. Everything is becoming faster and information and, most critically, work across partners better connected. Companies need to adapt rapidly that don’t otherwise interact. and continuously. In a digitized global economy, supply chains are no longer an afterthought of products and Hypothesis services but have become highly contested sources of power and influence. Idle autonomous cars could make in-city delivery even faster, and new technologies like 5G and edge computing will play a massive role in this area. But Signals with the growing importance of supply chains also No other company understands the future of logistics come more significant challenges as the chains are like Amazon. From their aircraft fleet and their easily affected by global crises like pandemics and drone program to same-day delivery—they anticipate the consequences of climate change. Supply chains the wishes of the modern consumer and the supply will have to become more resilient. Customers, on the chains needed to fulfill these. UPS and Matternet other hand, are going to request far more information have begun delivering medical supplies via drone about the products they purchase. Technologies like at UC San Diego Health. 45 Drone usage has also Blockchain promise to provide transparency (for both seen a sharp uptick during the COVID-19 pandemic. 46 B2B and B2C) while managing the growing complexity. 3D printing is becoming an essential part of maintaining

24 45 Matternet, 46 Geospatial World, 47 Truck & Fleet Middle East, 48 CoinDesk KEY TRENDS UNCERTAINTY TRADE DISAGREEMENTS NATIONALISM BORDER CONTROL

The End of Globalization

the trade in services growing much faster than the Context one in goods. Labor-cost arbitrage has become a The globalized world economy used to consist largely minor factor compared to knowledge for global value of Western countries organized around the US, but chains. 49 The COVID-19 pandemic has accelerated that order is increasingly in disarray. While the US’s a lot of the deglobalization developments. Countries role is declining, other countries like China and India raced to close borders for medical supplies and are are moving into the nascent vacuum. The organizing trying to lock in companies developing a vaccine. principle of globalization used to be close coordination There was almost no globally coordinated response and collaboration. But growing uncertainty has driven to the crisis. 50 a lot of countries to put their national interests first. They are no longer willing to have the rules dictated by Hypothesis the big ones. The global economy is becoming more fragmented and complex. Countries will try to become less dependent on other countries for economic reasons or resilience in global crises. This trend is also closely connected Signals to other developments like growing nationalism and The ongoing trade disagreements between the populism. The global economy in 15 years could US and China and their tax penalties have been a look very different from now. The world during the primary source of uncertainty. Both governments COVID-19 pandemic can be taken as a possible have also used economic pressure for their political scenario of what lies ahead. Uncertainty is the most interests. Trade agreements, in general, have faced significant factor, and governments will try to fight it backlashes around the world. But there are also more by shaping their contexts in their favor. fundamental structural changes in globalization like

49 McKinsey, 50 The New York Times 25 KEY TRENDS GROWING INDEPENDENCE DEVELOPMENT BANK LOCAL PROGRAMS

New Sustainable Innovators

a new Africa strategy aimed at partnership instead Context of tutelage. 53 Accepting Africa’s new role is crucial to First, Second and Third World countries—this counter outside influences on the continent. There’s categorization is losing its footing as countries in even substantial talk about debt cancellation. the second and third tier are no longer willing to accept the hegemony by the First World that is based Hypothesis on aid and economic development. They want to grow more independent and coordinate eye-to-eye Former Second and Third World countries are (“cooperation”—not “aid’). Instead of being customers developing a much more self-confidence. Companies for generic products, they would rather be partners for wanting to operate in these countries will need developing local sustainable solutions. to adapt to this and face more competition when these countries try to protect and foster their local companies. They will set up more local cooperations Signals with the help of accelerator programs, joint ventures, The health ministers of Brazil, Russia, India, China, and partner networks, instead of using brute force to and South Africa (BRICS) intensified the coordination insert themselves into a market as the “savior.” of their activities, and BRICS’ New Development Bank is providing funding for local health initiative in the member countries. 51 Banks like HSBC have set up regional startup accelerators with the help of local partners to cater to a community of social entrepreneurs in the Middle East. 52 The EU introduced

26 51 The Hindu, 52 Arab News, 53 European Commission The Future Scenarios Four possible futures of healthcare in the year 2035.

27 SCENARIO 1

Computer Says Go AI is the paradigm shift in technology with the biggest potential to change what healthcare will look like in DIGITAL BY DEFAULT 15 years. This scenario asks what happens if constant HEALTH AS THE NEW LUXURY health data tracking and AI-based diagnosis are linked

POLARIZATION OF DATA OWNERSHIP with a younger generation demanding new gadgets and apps for their mental and physical health while PERVASIVE PROFILING also being critical of uncontrolled data collection. AI-DRIVEN HEALTHCARE One tech company wants to be part of the answer.

28 SCENARIO 1 COMPUTER SAYS GO

Current signals pointing Health app users tend towards this future to be wealthier

People making at least $100,000 a year are 18 percentage points more likely to use health apps than those who make Apple provides hardware for less than $50,000 (45 to 27 percent). mental health research > Morning Consult, Jan 2019 55

Apple is teaming up with the University of California, Los Angeles (UCLA) to launch a three-year study to Google's DeepMind AI outperforms understand how sleep, physical activity, heart rate, and daily routine can impact anxiety and depression. doctors in identifying breast

> MacRumors, Aug 2020 54 cancer from X-ray images

> nature, Jan 2020 56

million % times +23Apple Watch shipped 7.6 million units 62So far the meditation app Headspace has been worldwide in Q1 2020, rising an above-average downloaded more than 62 million times in 190 countries. 23 percent from 6.2 million in Q1 2019. It already has over 2 million paid subscribers.

> Patently Apple, May 2020 57 > TechCrunch, Feb 2020 58

29 SCENARIO 1 COMPUTER SAYS GO

Generation Z

Personalized Nutrition

Viome examines your microbiome with the help of AI % % to create personalized dining recommendations featuring 62Gen Z members are confident that technology 58More than half of the Gen foods that are an ideal fit for your biology. will do more good than bad. Some 62 percent Z responders (58 percent) > The Spoon, Feb 2020 62 are optimistic that digital technologies will distrust tech companies and help solve the world's problems” personal use of their data. App + AI = Health Insurance

59 60 > Forbes, Jul 2020 > Forbes, Jul 2020 Zurich has started developing Azul, an AI based virtual assistant that scans your face and gives you The European Commission investigates a quote for life insurance based on how healthy you really are. the acquisition of Fitbit by Google > Community of Insurance, March 2020 63 “The use of wearable devices by European consumers is expected to grow significantly in the coming years. This will go hand in hand with an Personal Health exponential growth of data generated through these devices. This data provides key insights about the life and the health situation of Tracking & Scoring

the users of these devices. Our investigation aims to ensure that control Hangzhou, a city in China plans to turn the COVID-19 app by Google over data collected through wearable devices as a result of the into a permanent health tracker. For example, drinking a transaction does not distort competition.” glass of white wine could set your score back by 1.5 points, Margrethe Vestager, European Commissioner for Competition while sleeping for seven hours could improve it by one point.

> European Union, Aug 2020 61 > The Guardian, May 2020 64

30 SCENARIO 1 COMPUTER SAYS GO

An article from the future

“If you zoom out into the From wearables to health apps—digital future, and you look back, gadgets and tools are an increasingly and ask the question, bigger part of a healthy lifestyle. ‘What was Apple’s greatest Today they have established a preventive contribution to mankind?’ care system, independent of medical It will be about health.” providers. A fitness tracker might know Tim Cook, Apple CEO more about the health of the person > CNBC, Jan 201965 wearing it than their physician. Tech companies like Apple have introduced health data graphs that collect health % data from many connected sources. 55of adults who do not track blood pressure with What could happen in the future if those an app said they would consider it, compared to companies decided to do more than just 16 percent who currently do. The numbers are similar for medication management, mood, and collect that information? blood sugar. TAKE A GLIMPSE INTO THIS FUTURE > Morning Consult, Jan 2019 66

31 PREMIUM OFFICER 11:15 SCENARIO 1 COMPUTER SAYS GO Please note: Your last requested weekend activity will change your risk group status. Do you want to confirm the booking? SKY NEWS 365

Apple Wants to Give Everyone Their Own Personal Doctor, But at What Cost?

BY ELINA REBANE AUGUST 23, 2035, 11:00 MESZ

HEALTH AGE Apple Health’s AI-driven platform offers unprecedented personalization and 42 Your Health Age is an always-on accessibility, but a year after launch some health and privacy advocates estimate of how healthy you are, relative to your real age. are raising concerns.

Apple CEO Tim Cook took the stage at an event in Brussels last “By harnessing the power of data collection and prediction night to finally unveil the tech giant’s plans to roll out its Apple we’re moving healthcare from reaction to prevention, and Health platform in the EU. Dubbed “Siri but for healthcare” the providing our users with not just peace of mind, but also HIP & WAIST heavily AI-and-data-driven service has been a runaway success saving them potentially tens of thousands of dollars in medical Waist Circumference: 33 in in the US, where competitive pricing has allowed it to fill an expenses,” Cook said. “We believe that shift—from trying to Hip Circumference: 38 in Waist to Hipe: 0.87 in important gap in the market in a country where millions still cure medical issues to preventing them from happening in struggle to afford medical insurance. the first place—is one of the most important and exciting developments in the history of modern medicine.” Apple Health users must have a compatible Apple device and an iCloud account before signing up. There is a monthly fee, Apple Health’s prevention strategy comes in the form of with tiered pricing ranging from $99.99 to $299.99 a month. what it calls “wellness coaching”, where the app gives lifestyle The basic plan comes with a free Apple Watch, which the management advice and sets goals for everything from user must wear at all times, while higher-priced tiers include diet and exercise to sleep and social activities. It’s this part deals with Apple’s third-party partners that provide everything of Apple’s strategy that has turned the insurance premium from gym memberships and Peloton bikes to smart scales model on its head, as repeated failure to comply with advice and discounted at-home genome testing kits. Higher tiers and targets—or even just patterns of extravagant eating and also include sliding scale coverage for prescription drugs and drinking—can lead to the user’s monthly premium increasing, surgical procedures. or restricted access to certain parts of the service.

34 SCENARIO 1 COMPUTER SAYS GO

Stop searching, Cook explained the new approach to premiums in simple Research shows that people start leading, now! terms. “We are introducing a system where you'll no longer who live in poverty or have to Get our curator update for need to worry eating that one extra cupcake if you're dieting, work several jobs struggle with your AI assistant. It will find the most relevant health or spend countless hours researching the best wellness trend. the kinds of routines that Apple research papers for you and Our platform will do it for you.” A video went on to show “Mike” Health enforces, as they’re tired summarize the key points! at a bar, who had just received a notification from Siri that and short of time, which often FREE TRIAL he shouldn't order another beer—otherwise his insurance leads them to take shortcuts premium would increase by $1.35. The reach of the platform regarding things like diet or became apparent after showing how the AI made a decision exercise. The irony is that it’s

HEALTH SCORE based on viewing his recent beer purchases on his Apple card. exactly these people who are attracted to Apple because of the 4.2 advertised low premiums. Your Health Score the difference between the “It’s a carrot and stick approach to healthcare, of a kind we’ve At the other end of the scale it means that those who can Health Age you started at an your current not seen micromanaged so closely before,” explains Dr. Gillian afford it simply opt out of the nagging and restrictions by Health Age. Improve your health by lowering Collins, a healthcare expert at Stanford University, over Skype. paying higher premiums. Apple needs to get it right in terms your score! Health “It works great for many people, and less well for others. of increasing access and balancing equality if they want to truly BLOOD PRESSURE see game-changing success with this model.” Trends 117/79 mmHg Report Despite Apple Health’s high adoption rate in the US, many 120 bpm BODY MEASUREMENTS analysts are more muted about the service’s chances in 2036 Weight: 155 Ibs 115:08 min Preparing for BMI: 23 Europe, pointing to the fact that most EU citizens have access kCal 1.508 tomorrow’s 120 km to some form of low cost or socialized healthcare. As such, possibilities today 34.4 km/h Apple is focusing heavily on the UK market—where the NHS is struggling to recover from punitive austerity measures—as well as attractive partnership deals that include cheap gym memberships and spa retreats.

The data from your next ride could save you money. How about that for motivation to get a new personal record?

35 SCENARIO 2

Now You See Me This scenario combines current developments in ARTIFICIAL INTERACTIONS technology like AR glasses and synthetic avatars A CRISIS OF TRUST with scientific breakthroughs like CRISPR,

HEALTH AS THE NEW LUXURY as well as societal trends like beauty filters among influencers and protest movements, to ponder CONSUMERIZED GENOMICS the potential future impact these could have on NEW PLAYERS IN HEALTHCARE preventive healthcare.

34 SCENARIO 2 NOW YOU SEE ME

Current signals pointing towards this future

“What if you could interact with a simulated person to learn from them? Would you invite a synth to a dinner party?” Samsung’s Technology and Advanced Research Labs (STAR Labs) $10.82 thinks the answer is yes. billion by 2025 > Future Today Institute 67 The global augmented reality and virtual reality market in the healthcare industry is expected to reach $10.82 billion by 2025, representing a remarkable 2019-2026 CAGR (Compound Annual Post-genomic era Growth Rate) of 36.1percent. North America will dominate the global market during the projected period. Founded by genomicist Jun Wang and based in China, > Business Wire, Dec 2019 69 iCarbonX combines genomics with other health factors such as metabolites, bacteria and lifestyle choices to create a digitalized form of life.

> Top 10 of Asia, Oct 2019 68

35 SCENARIO 2 NOW YOU SEE ME

over Covid-19 Deniers Protest engineers at1000 Apple working on two AR / VR devices that are Officials say about 20,000 people attended the Berlin scheduled to be released in 2022 and 2023. The proposed protest on August 1, 2020. Organizers had declared it a goal of the team is to create something that would rival the “day of freedom” from months of COVID-19 restrictions. success of the iPhone. Demonstrators held up banners featuring such lines as > Bloomberg, June 2020 70 “Corona, false alarm” and “We are being forced to wear a muzzle”.

> BBC, Aug 2020 73

igorsaringer Smart Mirror “Many of my followers ask me for the color of my eyeshadows Apparel Company Lululemon Buys Fitness-Hardware Startup or eyeliner, unaware that Mirror for $500 Million. Mirror is I’m using my Augmented Reality what happens when your (virtual) filters.” fitness coach moves in to your tiny apartment. > Yahoo, April 2020 71 Review from Mirror Customer:

“Mirror has made my fitness © mirror.co Billion journey consistently convenient, Valuation of all AR/VR safe, affordable, flexible, and fun. […] I am doing good things for startups globally. my heart and circulation. It is beautiful and functional.” $45> TechCrunch, Oct 2019 72 > lululemon athletica, July 2020 74 36 SCENARIO 2 NOW YOU SEE ME

A snapshot from the future Body Ownership Illusion Augmented Reality (AR), the overlay of with Virtual Reality a person’s field of vision with digital Recent research has shown that people with obesity can information, may have had its origin in experience the feeling of a skinny body with the help of science fiction, but it's been inching virtual reality (VR). This can support therapy settings by enhancing positive rehabilitative outcomes. towards reality for decades now.

> MDPI, Aug 2019 75 From Google Glass to Instagram filters to Pokémon Go, progress has been slow but steady. These early examples have already hinted at the impact full AR could have on society. What if in >500 15 years’ time,AR lenses become a Google is turning its focus and investments to the digital health sector. More than 500 people consumer product, changing—among other now work at Google Health as its parent things—how people see their health? company Alphabet tries to improve the search results that consumers see when they consult TAKE A GLANCE AT THIS FUTURE “Dr. Google.”

> Forbes, Feb 2020 76

37 SCENARIO 2 NOW YOU SEE ME

Your top face filters THE GUIDE

Pixiegy Beautyline NY Augmented Reality Made You Better-Looking, 459654 but Can It Make You Healthier? Chic Rick Ramani Milano BY MARIONA PORRAS, JUNE 3, 2035, 10:05 MESZ

95924 As Bausch Health and Google Verily announce their new AR contact lens collaboration and as the popularity of cosmetic filters continues to soar, another Gordonistic Panando player enters the market: the healthcare industry.

359654 The already burgeoning augmented reality market is set to products to augmented and

Smoothy explode over the next two years following Bausch Health and virtual ones, via a mixture of Bausch and Google MOSS Google’s announcement this week that their long-awaited subscription models and Announce Lens augmented reality contact lenses will finally be available to in-app purchases. AR without the Glasses 489654 consumers this coming October, say tech industry analysts. As the popularity of these apps Antoinette Read more en Vogue London AR has enjoyed a huge boom over the last few years, driven increases, some experts are largely by the popularity of cosmetic apps and filters (most of raising concerns. “It’s relatively

75924 the top ten AR apps are from recognizable beauty and fashion early days, but we’re already seeing how these beauty apps brands such as Sephora, Maybelline, L’Oréal, Fenty, Gucci, negatively impact people’s health, both mentally and physically,” Queensie and Armani). Each one allows users to alter certain aspects of says Kara Peterson, a body image and digital cultures Pucci their appearance, from applying virtual make-up to radically researcher at Aarhus University. “People are so taken with altering the shape and of their face or body, while some give making sure their AR avatar looks just right that they’re starting 559654 instant access to the latest fashions in the form of augmented to neglect their actual health. Why worry about losing weight clothing and hair styles. It’s a highly lucrative industry for these or eating properly if these apps mean you can always look slim brands as their businesses shift away from traditional physical and healthy without any effort?”

40 SCENARIO 2 NOW YOU SEE ME

Akti Fikru Kifle Which is why one aspect of the Lens launch stood out: in one with their health, and to understand how their bodies work, Hey, did you see that three-minute video segment of the presentation, Google gave and then make better choices.” article on the AR lens a whirlwind tour of how it plans to use augmented reality apps thing? to help users manage and improve their health. While much of this looked similar to other standard health tracking apps, Broccoli (250 g) Yes, pretty excited about there was also footage of a man looking at himself in a mirror 85 calories this one! The glasses were and seeing a manifestation of his target weight looking back 8% fat never my style and I always at him, providing motivation to continue his diet through this 65% carbohydrates had to hold up the phone 27% protein to see my “hot” self and my visualization of how he might eventually look if he stuck with it. health data. Even more interesting was an app that virtually transformed Is that really working what food looked like—a clip showed a diabetic woman eating for you, this kind of a plate of broccoli that appeared—to her, through Lens—as a Free from gluten, dairy, and sugar motivation to “shed the bowl of ice cream. Although this seemed like a gimmick at first, muffin top”? Verily claimed it was part of an in-house trial that was providing No question, the traditional use of AR in nutrition is informative and encouraging results, and the woman spoke briefly about how helpfull. But does it motivate people to eat healthier? For sure. And now that it’s it was helping her overcome issues she had around food and much easier with the lens? nutrition. As exciting as this all sounds, for Kara Peterson there are still I’m so preordering it. reasons to be cautious. “It’s important to remember that this “Some of these technologies look fantastical, but we’re really is still a very new technology, it’s barely 30 years old,” she told excited about their real world results” says one head of digital Business Insider over Zoom. “We still don’t really know what research at a Danish pharmaceutical company. “We’ve seen the long-term implications could be. It’s very exciting to look over the last few decades how interactions in the digital world at these new tools, and how they can help people manage can affect people’s real-world relationship to their health and their lives or visualize improving them, but we are only just bodies, and AR really brings those two areas much closer beginning to understand how AR effects people’s self-image, together. Instead of using AR as a way of hiding ourselves, or both physically and mentally. It’ll undoubtedly have an even pretending that our health issues don’t exist, we’re looking bigger impact than TV and fashion magazines did in the last at ways in which our customers and patients can use these century, and as we know that wasn’t always in positive ways. technologies to look inward, and to get more in touch and sync It’s important to bear this in mind and proceed with caution.”

41 SCENARIO 3

Rise of the Giants Healthtech helps to transform the vision of a value-based healthcare system into reality. But it has also opened the door for new players like tech companies and supermarket chains to enter the field and leverage their expertise VALUE-BASED HEALTHCARE SHIFT in technology and distribution to gain an advantage. NEW PLAYERS IN HEALTHCARE This scenario looks at a healthcare ecosystem market that

ON-DEMAND SUPPLY CHAINS grows ever more crowded and competitive. In 15 years, the market might look very different from now.

40 SCENARIO 3 RISE OF THE GIANTS

Current signals pointing towards this future “You're going to see a health system that's focused on human longevity Healthcare AI Standard and aspirational living versus [being] focused on the reduction of Big names in technology, including Amazon, Microsoft, and IBM, worked with healthcare misery and suffering.” industry groups to develop a standard for the Roger Jansen, Chief Strategy Officer, Spectrum Health

use of artificial intelligence in order to be > Society for Health Care Strategy & Market Development (SHSMD) 78 able to offer value-based healthcare.

> Fierce Healthcare, Feb 2020 77

Walmart Health Center

The Walmart Health Center puts key health services under one roof, offering primary % care, dental, optometry, counseling, laboratory 75of healthcare professionals surveyed tests, X-rays, hearing, wellness education, and say tech will enable shift to value-based behavioral health. © walmart.com

healthcare model. > Forbes, Sep 2019 80

> Consumer Technology Association, June 2020 79

41 SCENARIO 3 RISE OF THE GIANTS

“We're going to have a consumer revolution in retail Blockchain for Healthcare for point of care.“ Infrastructure

“Why? Because if the Walmart [Health Centers] are successful, South Korea is developing a proof-of-concept for a and I suspect they will be, people will be able to go in and get blockchain-based data registry platform that has been these kinds of health services at a lower cost than if they had set up to help more than 11 million South Koreans health insurance.” who suffer from chronic conditions such as diabetes and John Scully, Chairman of RxAdvance and Apple’s Ex-CEO cardiovascular disease.

82 > CNBC, Feb 2020 81 > Cointelegraph, July 2020

Digital Pharmacy

Alto Pharmacy provides a full-service digital pharmacy and prescription delivery service , supported by a pharmacy management software 1CVS HealthHub500 stores will open nationally and a provider platform that facilitates prior by the end of 2021. The drugstore chain authorizations, insurance coordination, and CVS Health will provide dietitians, improved patient monitoring. They received help people monitor chronic diseases, $250M in another round of funding. and add community rooms that can > MobiHealthNews, Jan 2020 84 be used for yoga classes. © alto.com > Stat, June 2019 83

42 SCENARIO 3 practitioner through livechatorvideo,withoptionsfor and theirfamilymembers toaphysicianornurse to eliminatetravel andwaittime,connectingemployees Seattle area—partnered withOasisMedical Amazon Care—a virtualhealthclinicinthe Care Amazon > CBInsights,2020 pharmacy supply, andpharmacylicensesinall50states. gained a$100Mrevenue runrate business,anestablished mail-order pharmacyPillPack.Withthispurchase, Amazon ceutical distributionspacewithits~$1Bacquisitionof Amazon hasmadesignificantheadwayintothepharma­ Pharmacy Amazon by PillPack > Forbes,June2020 in-person follow-up servicesfrom aregistered nurse. RISE OFTHEGIANTS 85 86

© pillpack.com A story from the future the from story A CHECK ITOUT moves. big make to eager and ready seems particular in giant tech one in which future, this from a story Here’s tion? distribu­ the but innovation the not disrupting in, come players new if What change. to it slow made have decades many over established dependencies Path interests. their negotiating all patients, and providers, medical institutions, government players, of industry network acomplex is Healthcare 43 SCENARIO 3 RISE OF THE GIANTS

Search Healthcare Business Daily July 15, 2035, 10:15 AM

Jason Clark 15 min Company Q&A “Total Domination” - Email Leak Reveals Please submit your questions beforehand Amazon’s Plans for Healthcare Industry

Leticia Fernández 30 min As journalists continue to dig through the terabyte of emails dumped Whitepaper Edits by hackers on the internet last month, healthcare experts are alarmed at the Just a few this time tech giant’s aggressive plans for further domination of the sector.

Business Bully Daily 1 hr The recent huge dump of private emails between The company should follow a “strategy that is bold Newsletter Amazon executives is slowly revealing the tech and ambitious”, according to a leaked memo, that Email Leak Reveals Amazon’s and retail giant’s plans for everything from heavily will “disrupt and reshape the entire sector to do what Plans for Healthcare Industry expanding its self-driving delivery van fleet, to a Amazon has already done best—handing choice and possible low-cost airline. But one thread of emails control back to customers while also providing a

Dr Dmitry Zubaedah 9:23 between the head of the company’s healthcare division one-stop, total solution to their needs.” At a time when New AI Standards and other board members has raised eyebrows in the millions of American citizens still lack health insurance, We need to talk to the tech medical community, as it describes the sector as “ripe the plan outlines an extremely ambitious push to department for disruption.” “make insurance itself obsolete.”

Amazon is no stranger to healthcare, having pursued The memo goes on to explain that this would be Yu Haryanto 9:00 a considerably aggressive acquisition strategy over possible due to Amazon’s “comprehensive solution” Lunch Date Are we still on for today? the last decade, including gobbling up everything approach, where instead of just being an insurance from the online pharmacy PillPack to the US WalkIn company that relies on third-party services, Amazon clinic chain. Apart from some light rebranding and Health could be a complete healthcare provider, SOUL Medical Corporation 8:10 overhauling of their employees' healthcare benefits, covering everything from doctor visits to prescription Sales training however, the company has made surprisingly little drugs. “We must leverage our control over logistics The surgical sales representative innovation around its acquired assets. According and supply chains, as well as our unparalleled buying position is an OR based sales role… to the leaked emails, this may be about to radically power and market control, to raise choice while driving change. down costs for our customers—in exactly the same

46 SCENARIO 3 RISE OF THE GIANTS

Search ways we have done for everything from book retail Analysts foresee the to web hosting,” the memo explains. Marta Fiala 1 min closure of Todays Meeting This would start with driving down costs for drugs about 70% of existing Can you send me the login data and medications by becoming a leading manufacturer. for the AI again? physical locations. While Amazon has already acquired a number of pharmaceutical companies and distributors, the One page in the memo even shows a doctor on the Jason Clark 15 min memo urges the company to pursue this more beach, doing consultations on an Amazon branded Company Q&A aggressively, so that it would “no longer have to rely tablet—which some social media critics have pointed Please submit your questions on non-Amazon owned or aligned manufacturers to out is a stark contrast to current typical telehealth beforehand cater to our customer’s needs.” models, where the quest to provide rock-bottom prices to consumers has resulted in doctors working

Leticia Fernández 30 min The aim is to drive down costs so that “customers long hours in call centres around the world. Analysts Whitepaper Edits automatically turn to Amazon as their first choice that have seen the memo foresee the “possible Just a few this time for pharmaceutical needs, just as they already closure of about 70% of existing physical locations do for books, electronics, and household goods.” under this model, with the remaining sites most It suggests creating an AmazonBasics branded likely being repurposed as micro-hospitals to provide Business Bully Daily 1 hr line of cheap generic drugs, as well as cheap auto- surgical procedures and in person therapeutics only Newsletter renewing subscriptions for repeat use products such when needed,” leaving a number of unanswered Email Leak Reveals Amazon’s Plans for Healthcare Industry as insulin or antidepressants. Looking further into questions around what will likely result in a massive the future, it even outlines a few more science fiction change to the healthcare services landscape. proposals, citing plans for emergency drone deliveries Dr Dmitry Zubaedah 9:23 and a patent for a “3D pharma printer” that would New AI Standards synthesize certain medications at home. We need to talk to the tech department In a more surprising “future strategy,” the memo stated that the company is confident that it could

Yu Haryanto 9:00 be a replacement to the healthcare systems of Lunch Date countries struggling with war and economic disasters. Are we still on for today? “Amazon is well-poised to become a state provider of healthcare in Libya or Venezuela,” read a heading entitled “National Expansions?” SOUL Medical Corporation 8:10 47 Sales training The surgical sales representative position is an OR based sales role… SCENARIO 4

Mc Healthcare Decentralization is the focal point of this scenario. Imagine a less globalized world with new opportunities for regional players and localized supply chains in an THE END OF GLOBALIZATION unbundled healthcare system. From telemedicine, chatbots, NEW SUSTAINABLE INNOVATORS and the deployment of drones to economic pressure on MODULAR HEALTHCARE global corporations and new demands for domestic health ON-DEMAND SUPPLY CHAINS solutions—this is a future that is being accelerated by the COVID-19 pandemic.

46 SCENARIO 4 McHEALTHCARE

Current signals pointing Trade as a share of global towards this future G.D.P. peaked in 2008 and has trended lower ever since.

> The World Bank, 2019 87 Trade War 4.0

The EU is entering uncharted territory in trade The Splinternet is getting closer conflicts by considering retaliation against the In August 2020, the Trump administration announced a broad plan US on services and IP, including new charges to block Chinese software from being used on US devices and on carbon emissions and a tax on digital giants keep US data off Chinese cloud services. The plan mirrors China's like Google and Facebook. "great firewall" that prevents people in China from accessing most > Politico, July 2020 88 US websites and apps.

> Business Insider, Aug 2020 89

The Digital Economy Initiative % for Africa (DE4A) 58A recent study found that participants using The DE4A aims to ensure that every individual, business, and government Hinge Health’s digital exercise-therapy program in Africa will be digitally enabled by 2030 in support of the African Union's decreased their pain by more than two-thirds “Digital Transformation Strategy for Africa.” To support this objective, and anxiety and depression by 58 percent. the World Bank intends to invest $25 billion between now and 2030.”

> MobiHealthNews, May 2020 90 > The World Bank 91

47 48 $18.5 SCENARIO 4 a digital-firstfuture ofhealthcare . care withtheproactive patientengagementofLivongotoproclaim Livongo for$18.5billionbringstogetherTeladoc’s expertise in virtual Hailed asthebiggestdigitalhealthdealofalltime,Teladoc buying > Forrester, Aug2020 M c HEALTHCARE 92 > Forbes,July2020 at 3DSystems Ferdie Bruijnen,VP, Supply ChainOperations highlighted thevalueofthat.” was abigplusduringthecrisis—Covid really The distributednature ofitsmanufacturing base, andthatlowers thebarriertoentry. “Additive manufacturinghasanon-demand again hot is Printing 3D 94 billion > Arab News, Oct 2019 opportunities forstartups makingapositivesocial impact. flagship accelerator program offeringtraining andinvestment toSaudistartups.TheprogramAccelerator” istheregion’s SABB andHSBChaveopenedtheregional “C3SocialImpact Arabia Saudi for Accelerator Impact Social > VentureBeat, April2020 without leavingtheirhome. a diagnosis,treatment plan,andaprescription—all patient withhealthcare professionals toreceive mobile appandcliniciandashboard connectthe exam kitthatanyonecanbuy. Theaccompanying Tyto Care hasdeveloped ahandheld Kit Exam Home 95 93

© tytocare.com SCENARIO 4 McHEALTHCARE

A feed from the future Tanzania’s New In parts of the world where 5G Digital Health Strategy technology leapfrogs the creation It enables a health system that is patient-centric, data of digital infrastructure, the driven, and guides the next five years of digital innovation in the country. It ranges from strengthening unbundling of healthcare makes it disease surveillance, reporting, and response, to the use possible to offer remote medical of telehealth to build health worker capacity in a changing services locally. The following digital landscape, while providing specialized care to the country’s most remote corners. presentation of this future goes

> Path, Feb 2020 96 beyond the typical Western frame of patient care and imagines “5G will enable the industries' a model that provides access to digital transformation clinical aid with telemedicine, in the future, such as smart AI diagnosis, and virtual treatment health­care, smart ports, smart mining, and smart manu­ to those for whom it wasn’t facturing in South Africa.” available or affordable before. Khaya Dlanga, CMO of South African REVIEW THIS FEED ITEM mobile operator Rain

> RCR Wireless News, July 2020 97

49 SCENARIO 4 MC HEALTHCARE

2 HOME SEARCH

TRENDING Healthcare CEO Heralds FEEDS “Post Borders” Future READ LATER HEALTH IT INSIGHTS / JANUARY 12, 2035 / 3:00 PM / KEEP UNREAD / HIDE RECENTLY READ Blue Ant CEO uses TED talk to outline vision in which clinic franchises “break down barriers of

+ ADD FEED access and affordability”, but critics warn of inconsistent regulations and standards.

Helle Bigend, CEO of Belgian Healthcare giant Blue Ant, used Blue Ant’s “new approach” is one that’s actually very familiar her talk at TEDxCopenhagen this week to announce the from other sectors: franchising. For a flat (and at this point, company’s plans to launch its chain of Your HealthChoice undisclosed) setup fee anyone can buy what Blue Ant clinics across Asia, Europe, and the US by the end of next year. is calling a “healthcare launch pad” allowing them to set up a digital clinic. Bigend points out that the majority of The Your HealthChoice model, which the company has been the services the clinic provides are telehealth-based with trialing in a selection of African and South Asian countries for patients getting advice and diagnosis via a mixture of remote the last two years, has proved popular in developing markets healthcare professionals and AI-powered apps—but many due to its use of virtual and telehealth products to provide also choose to launch in mobile spaces, such as a converted what Bigend calls “a world leading package” of services. truck or bus. It’s this aspect that Blue Ant is pushing as the Get early access service’s main selling point to patients in the Global South— Submit your data now to get access to the beta version “For too long, families in the Global South have had to look access to knowledge and expertise that has previously been of our AI Advisor. on enviously as the so-called developed world has enjoyed unavailable outside developed nations.

APPLY NOW the best healthcare modern science has to offer, whilst patiently waiting to see what drugs and services Western Diagnoses with Blue markets allow to trickle down to them,” Bigend said. Ant's algorithm are “Not any more. With Your Healthchoice we’ve blown open expected to reach a those barriers, with a new approach and philosophy that means that we can provide the newest innovations and life- staggering 1 million per saving products directly to whoever needs them, regardless day. of borders.”

52 PRIVACY STATEMENT SCENARIO 4 MC HEALTHCARE Dr Saadaq Daleel Incoming Holo Call Accept Decline

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TRENDING “Your Healthchoice franchise owners will still need to contract opening of new call centers in Chennai and Tunis.

FEEDS local healthcare professionals for when physical treatments are required—a process we are making increasingly easy API READ LATER for them as we expand our global database of Blue Ant Telemedicine Virtual Clinic verified HCPs,” Bigend outlined. “But for the majority RECENTLY READ of patient interactions we are offering something unique: Virtual Clinic the ability to talk directly to one of the best doctors in the Blue Ant + ADD FEED Diagnosis world, instantly and conveniently, and at a price everyone e-Pharmacies Algorithm Virtual Clinic can afford.” Bigend also presented footage of one mobile Your Healthchoice clinic, located on the outskirts of Mogadishu in Somalia, and run by Saadaq Daleel. The blueprint for Blue Ant's operating model relies on an interconnected network of telemedicine services, online The footage showed a handful of patients sitting in a clean, pharmacies, and virtual clinics—all going through the company's well-lit space, talking to clinic staff or having video calls with patented AI diagnosis alogirthm. remote doctors in private booths while their children played soccer in the yard. “Two years ago these patients would have Other critics cite the lack of a requirement for prospective had to queue for four hours to see the one doctor that was franchise holders to have any medical qualifications or operating in this neighborhood,” claimed Bigend. “But now background as a cause for concern. For example, Sadeeq the clinic is nearly empty, even though it’s serving upwards Daleel had previously managed two fast food restaurants in of 750 patients a week, with many choosing online services. Mogadishu—in fact, his Your Healthchoice clinic is based in Most of them need never come into the clinic unless to pick the converted KFC outlet that he used to run before it went up prescribed medications, as they’re being connected to out of business. world-class practitioners from their homes.” Bigend concluded her talk with a comparison to the success The scheme hasn’t been without its critics, however. A recent of Airbnb as a disruptor of the hotel industry over thirty years news report about clinics in the Nigerian city of Lagos claimed ago. “[Airbnb], the biggest hotel chain in the world, does not that many patients never actually got to talk to a doctor, and own any physical hotels or rental properties. Blue Ant will be instead were left to decode the often confusing diagnosis given the biggest healthcare company in the world that will have no by Blue Ant’s still-in-beta AI agents. “These are nothing physical clinics or treatment centres.” but teething problems,” a Blue Ant spokesman said at the time, citing a delay in recruiting telehealth doctors, but promising that the situation would be soon resolved with the PRIVACY STATEMENT 53 Sources

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