This is the ninth report in the Connected World Market Insights Series.
This report is also part of the Transforming Health Market Insights Series.
As our healthcare system faces ever-increasing challenges and fiscal pressure, there is a growing consensus that we need to refocus efforts on preventive health. At the forefront of this movement are Ontario entrepreneurs and innovators who are developing novel technologies and business models targeted at helping individuals live healthier lives and prevent the onset of disease. These new solutions hold great potential for empowering individuals to take control of and invest in their long-term health. In doing so, these innovations will help create a healthcare system that is effective and sustainable.
This blog complements a series of reports that investigate the transformation of healthcare that is currently underway in Canada and Ontario. In previous reports (Transforming Health: Part 1 and Part 2), the MaRS Market Intelligence team focused on the decentralization of healthcare and the use of health information technologies to connect all system players in order to enable the seamless delivery of health services. In this blog, we highlight the renewed efforts and investments in preventive health and the role Ontario health IT startups and entrepreneurs play in driving this new paradigm.
There is a common belief that the largest contributing factor to the health of a population is the quality of medical care. However, research over the last few decades has consistently shown that the quality of medical care has only a small impact on the overall health of a population.1 As Figure 1 shows, the greatest determinant of health is behavioural patterns, followed by genetic predisposition to disease and social circumstances. Despite this, the majority of healthcare expenditure has been on medical treatments, and not health promotion and other strategies that aim to prevent the need for medical care.
Figure 1: The determinants of health
Like many countries around the world, Canada has a system designed around a reactive approach to health. This is often coined as a “sick care system.” In this paradigm, the predominant focus is on diagnosing and treating disease, with less focus on its prevention. The notable exception is cancer care where prevention, screening, diagnosis, treatment and palliative care are fairly seamlessly integrated into one contiguous system with an overall macro budget aligned around outcomes.
In 2013, only 5.1% of the total healthcare expenditure in Canada was for public health,2 which encompasses activities related to health promotion and prevention. Given that health systems in Canada and globally are facing severe fiscal constraints, and an inability to meet the demand for services from an aging and growing population, there will be a greater focus on preventing illness in the coming years. For instance, a report authored by two of Canada’s leading economists projected that with the current paradigm, by 2030, healthcare spending in Ontario will account for 80% of the province’s total program spending (from its current portion of approximately 50%).3 Much of the increase would be derived from treating—instead of preventing—chronic diseases.4
Based on these projections, there has been a renewed focus in public policy to develop preventive strategies that improve the well-being of Canadians while ensuring fiscal sustainability of the healthcare system so that it will be there if and when Canadians fall ill.5,6 A 2013 study by the World Health Organization (WHO) that reviewed the clinical and academic literature found strong evidence to invest in health promotion and disease prevention.7 These findings are consistent with the local findings of the Public Health Agency of Canada (PHAC) who reported that many preventive health interventions are cost-effective relative to treatment or the next best prevention alternative.8 In many, but not all, cases, preventing disease is less expensive than treating the disease and dealing with the economic and social burden once the condition has developed.9
Recognizing the importance of investing in health promotion and prevention, the government of Ontario has recently announced that health promotion and education will be one of the four key objectives of its Action Plan for the next phase of transforming Ontario’s healthcare system.10 Table 1 details the four objectives and provides examples of health promotion initiatives aimed at informing and helping Ontarians understand how to live a healthier life.
Table 1: The Ontario Ministry of Health and Long-Term Care: 2015 Action Plan for Health Care
The four main types of chronic illnesses are cardiovascular disease, cancer, chronic respiratory disease and diabetes.11 Worldwide, approximately 36 million people die every year of (largely) “preventable” chronic illnesses.12 In addition to having a high mortality rate, chronic illnesses also cause disability, which can often last for many years of a person’s life. A common measure that quantifies the burden of disease is the Disability-Adjusted Life Year (DALY). According to the WHO, 50% of the global burden of disease (DALYs) is due to chronic illness.13 Among the four main types of chronic illness mentioned above, cardiovascular diseases are the leading contributor to the global burden of disease.14
In Canada, about 40% of the population (aged 12 years and over) are living with at least one chronic condition and at least 80% are at risk of developing a chronic illness.15 Annually, about two-thirds of deaths in Canada can be attributed to some form of chronic illness.16 What is unsettling is that many chronic illnesses are preventable as they are often caused by proximal risk factors such as lifestyle choices.
Approximately 80% of cases of heart disease, diabetes and respiratory diseases, and 40% of cancers can be prevented by:
Despite these facts, the trend continues:
In addition to carrying a tremendous social burden, chronic illnesses have a significant impact on the Canadian economy. Annually, chronic illnesses cost Canadians $68 billion in direct healthcare costs and $122 billion in productivity losses.19 The need to reduce the incidence of chronic illnesses in Canada is therefore closely tied to the economic prosperity of the country.
Pairing preventive care programs with drug adherence programs
Preventive health programs can take on many different forms, and can be primary, secondary or tertiary. One type of secondary prevention program is a suite of interventions to prevent the deterioration of a disease condition and/or its relapse. Asthma control is a good example of how the use of preventive drug therapy can help to limit the exacerbation of a disease.20 However, evidence shows that the regular use of preventive therapies for asthma is as low as 28% in developed countries.21 Similar results are seen in other disease areas. For example, there is poor adherence to drugs (e.g., acetylsalicylic acid [ASA], and drugs to lower cholesterol and blood pressure) that prevent cardiovascular diseases.22
The results of poor adherence to secondary prevention therapies are poor health outcomes and increased healthcare costs.23 It is therefore very important to pair preventive drug therapies with adherence programs. Many studies have shown that investing in adherence programs results in cost savings due to the prevention of disease relapses and/or complications.24
In Canada, 50% of Canadians do not take their medication as prescribed.25 Startups as well as other health innovators are at the forefront of developing solutions to address this pressing issue. For instance, the Ontario-based startup, JAeMarketing Management (JAeMM), has developed an enterprise software platform called Pharma Velocity™ (PV) for healthcare and retail pharmacies. It is currently supporting several hundred retail pharmacies in Canada and enables the broad delivery of personalized treatment and adherence programs, as well as other patient services, through a patient’s choice of channel. These channels include web, mobile, text, email, voice or call centre contact. PV is centrally managed by each retail chain or institution. PV can cost-effectively and securely deliver programs for thousands of treatments, and support many thousands of healthcare professionals and millions of patients. PV also offers programs to support adherence to other healthcare processes, such as patient pre-op and post-op care and symptom tracking. This helps create a better hand-off between institutional and community-based services. With increased use of platforms such as PV, patients can become more engaged in their long-term preventive healthcare and improve adherence, leading to better health outcomes.
With rising healthcare costs, there is a resurgence of interest in preventive care. Many startups and entrepreneurs are developing new technologies that will help individuals live healthier lives and prevent the onset of chronic disease. By investing in these technologies, more costly downstream interventions to manage and treat illnesses can be avoided.
Over the last few years, there has been a proliferation of wearable devices, lifestyle and fitness apps, and other health and wellness tools. With the growth of this sector, individuals now have more knowledge about their health than ever before. These new technologies are enabling consumers to gain a better understanding of their body and make the appropriate adjustments to live a healthier life. In our previous report, Wearable Tech: Leveraging Canadian Innovation to Improve Health, we discussed some of the Canadian startups in the wearable health market and their impact on improving health and fitness. As the adoption of these devices grows, consumers are starting to realize the real benefits of these new technologies. A recent survey by PwC found that 56% of American consumers believe that the average life expectancy will grow by 10 years because of wearable health devices.26
In the following section we take a look at three young Ontario healthcare companies that have embedded the core concepts of preventive health into their business model. Each of these startups is working toward empowering customers to live healthier lives.
Founder: Jeff Ruby
Headquarters: Toronto, Ontario
Newtopia specializes in inspiring individuals at risk for developing chronic disease to make the right lifestyle choices so they can live a healthier life. Newtopia was the winner of HealthKick 2014; an annual conference organized by MaRS Discovery District that features Canadian high-impact, investment-ready healthcare startups. The company recently attracted high-profile investors such as Bloom Burton & Co., a leading investment banking firm based in Toronto.
Newtopia takes a multifaceted approach to engage their clientele. It uses a genetic test to identify variations related to weight and lifestyle management, along with in-depth personality, motivation and readiness-to-change assessment tools. Using the information gained, the company provides clients with personalized recommendations combining nutrition, exercise and behaviour management. Customers are paired with a personality-matched care team, which includes a care manager and a certified health coach, who are responsible for motivating and encouraging clients to reach their lifestyle goals. Clients can access their lifestyle plan and track their progress through Newtopia’s online and mobile enterprise platform. This platform also integrates with various wearable devices so that clients can keep track of their daily activities in one central hub. Newtopia’s platform includes personalized gamification and a curated social health community. This community aspect is a key component of Newtopia’s strategy to help clients stay engaged and on track to meet their lifestyle goals.
Q&A with Newtopia’s founder, Jeff Ruby
Some of your clients are corporations and employers. Are corporations and employers becoming more focused on preventive care programs for their employees?
Jeff Ruby: In North America, there is definitely a role for employers to play in and around health prevention for employees. Certainly there’s an incentive for corporations to have healthier employees. Oftentimes, this will result in employees that are more productive, and happier. There also will generally be less absenteeism, and a drive for greater results in their job, which ultimately helps each corporation.
There are some big differences between Canada and the US. We’ve actually spent most of our time focused on the US market because there the healthcare dynamics are such that the corporation bears the full brunt and responsibility for both paid medical and paid pharmacy. Whereas in Canada, because of Medicare, and I’m not saying this as a negative thing, Canadian companies aren’t responsible for the paid medical side. They really just see the paid pharmacy and then the disability side.
The costs and the pain points for Canadian companies are far lower than in the US. There is a greater incentive for US companies to identify solutions that drive better outcomes, mainly because there’s just bigger economic consequence if they don’t. Canadian companies are shielded by Medicare and in some ways don’t feel the pain the same way. Therefore, they don’t have the same level of motivation and aren’t investing as much.
Your company uses genetics to help clients with weight and lifestyle management. Why is a genetic approach necessary?
Jeff Ruby: Newtopia’s belief is that in understanding people we are able to inspire them to make the right lifestyle decisions. One of the key points, or areas of understanding people, is the genetic side of things. There’s an equation: your overall health is impacted by both genetics and lifestyle decisions. By understanding both sides of the equation and leveraging some understanding about genetics, we feel that we can help to engage and motivate people to make the right lifestyle decisions. The equation is roughly about 25% genetics and 75% lifestyle.
Would a greater focus and investment in preventive care lead to a more sustainable healthcare system?
Jeff Ruby: Absolutely! Newtopia is a made-in-Canada approach. It’s not necessarily built for Canada. It was designed by a group of Canadians who are witnessing and feeling the challenges of a purely reactive healthcare system at play. It’s our sincere belief that by focusing on prevention and by identifying and inspiring individuals who are at risk, at least as a starting point, this will lead to a more sustainable system
It’s very challenging to implement prevention as a broad stroke. Implementing prevention with healthy individuals becomes a challenge around motivation and how to get people to buy in. What we’ve found in targeting the at-risk population (i.e., those individuals who have identified issues about their health that they’re not so happy with) is that we tend to see that they generally have a higher level of motivation. It’s at a perfect time, because they’ve yet to reach a point of chronic disease or something medically necessary. By focusing on that group of individuals, we believe we could save the healthcare system a tremendous amount of money. We also believe that by inspiring healthier individuals, healthier communities and healthier workforces; we will see a big impact on the overall productivity and the rate of competitiveness in Canada as well.
Founder: Dr. Jess Goodman
Headquarters: Mississauga, Ontario
Vitalsines is an Ontario-based startup and a client of MaRS Discovery District. Vitalsines has developed the iHeart Lifespan System, a Bluetooth fingertip optical sensor and iOS app that examine the shape of an individual’s arterial pulse wave. The shape of the arterial pulse wave is determined by stiffness of the aorta. Many scientific articles have shown a strong relationship between aortic stiffness and the overall health of a person. Through understanding this relationship, aortic stiffness can provide an estimate of a person’s physiological age. Depending on lifestyle choices, a person’s physiological age might be quite different from their chronological age. Using the iHeart iOS mobile app, users can track their physiological age over time and make adjustments to their lifestyle in order to decrease their physiological age and improve their health. For instance, increased daily activity, less stress and a healthy diet will all lead to a lower physiological age.
By using the iHeart Lifespan System, individuals can have better insights about their body and can work toward becoming healthier.
Q&A with Vitalsines founder, Dr. Jess Goodman
What was your primary motivation for starting your company?
Dr. Goodman: About 15 years ago, my Tai Chi teacher, a Taoist monk, asked me to show people why they should stretch between the heart and the kidneys. That was it. From there, everything sort of evolved and I was just so surprised that there was a scientific body of knowledge about aortic stiffness relating to health that hadn’t been applied to wider consumer needs.
How would you rate our healthcare system in terms of having a preventive system in place for individuals?
Dr. Goodman: I’m a doctor serving a general practice. Every day when I get people coming in to see me, I say to myself again and again, “There’s so little I can do for this person compared to what they could do for themselves.” I do not have the resources or time to help people get to the point where they have the ability to optimally monitor and manage health. As a society, more and more people want to take responsibility for their health. Our society at present does not devote adequate money or training towards empowering consumers with an ability to understand how to stay healthy.
As a physician, I’m encouraged to monitor chronic illness (diabetes, hypertension, obesity and so forth). However, I am not incentivized to sit down with people and take the necessary time to do a 360° life assessment and say, “Here’s your life, here are your habits, let’s work together to change them.” I spend significant amounts of time with people helping them change psychologically in order to have healthier relationships and feel better about themselves. I get paid for that, but I don’t have the ability to spend a lot of time with people and say, “Let’s take your life apart and see where you, through your daily habits, can improve your health, maintain your health and prevent illness.”
I think our healthcare system should support the creation of a new kind of healthcare provider role for lifestyle modification that is funded by government and integrated into healthcare teams. This role would require a combination of skills possessed by psychologists, fitness trainers, kinesiologists and dietitians—all rolled into a paraprofessional life coach role. I work in a family health team. We have social workers, dietitians, psychologists, clinical pharmacologists, nurses and so forth. It’s a very role-oriented process. You have a mental health issue? You’re going to see the social worker. You have a dietary issue? You’re going to see the dietitian. We need somebody that can act as life coach with wide-ranging and integrative skills and knowledge. It’s not a role that exists today but it is desperately needed.
Over the next ten to twenty years, how will our current healthcare system be transformed?
Dr. Goodman: There are three trends emerging in the next ten to twenty years that are going to change healthcare and the way people monitor and manage their health and their lives.
The first is the emergence of 24/7 wearable monitoring solutions that will change the way people understand what it means to be human and will forever change the concept of “health.” We will generate a view of human life that has never been seen before when people are able to:
When we reach this point, biodata will be flowing from individuals, recording life in a multi-dimensional way. Apps based on this data will create views of life that are impossible to imagine today.
The second emerging trend is the use of physiological parameters by consumers that are not recognized by healthcare providers today as having value. One of these parameters, aortic stiffness, is well accepted in the scientific literature as a powerful indicator of heath, but is not being utilized clinically or by consumers today. My company has developed iHeart to give consumers an ability to cost-effectively use this novel but valuable parameter.
There are many other underutilized parameters. For instance, the amount of impact force your feet are exposed to with each step is an important factor in the development of knee, hip and lower back arthritis. It is also valuable to know how much lateral movement and rotation your body experiences as you move. There are questions about the movement of the body as a whole that can provide insight into health. How well does your spine move? How mobile are the great cavities enclosing your chest and abdominal spaces, where all of your internal organs are located and depend on motion to enhance their internal circulation? What do the sounds generated in your abdomen mean in relation to a gastrointestinal function? These are parameters which are little used, but can give individuals an understanding of health now, as well as coming health changes in the near future and years down the road. Continuously worn sensors will open up our eyes to the human condition in a brand new way, reminiscent of Galileo looking through the first telescope and seeing the moons of Jupiter.
A third trend is that there will be a move away from Western medicine’s discriminative approach to diagnosis and treatment. This approach has a goal of finding a very specific cause for illness leading to very specific treatment. We’re going to be moving away from a predominantly discriminative approach to an approach that respects and considers the Eastern medical integrative approach. This integrative approach asks the question, how does everything work together? How do my lifestyle choices improve overall health and how does everything fit into that equation? Nothing can be left out. Everything works together. We are very symbiotic organisms with all of our organs, vessels and tissues working co-operatively. Each part is essential and plays a critical role in maintaining health.
Founder: Michael Serbinis
Headquarters: Toronto, Ontario
LEAGUE is a digital health company founded by Michael Serbinis, the founder and former CEO of Kobo. Michael is a firm believer that the future of health is preventative and made the case for it at the sold-out inaugural MaRS Morning event. His company focuses on preventative health and empowers individuals to live a healthier life. LEAGUE is currently building a mobile platform that will allow individuals to discover, schedule and pay for health services, and receive insights and personalized recommendations from their team of health professionals. The mobile platform, currently in beta, will also allow members to store their health data from a wide variety of wearable devices and health/lifestyle apps and share this information securely with their health team.
Q&A with LEAGUE founder, Michael Serbinis
What was your motivation for founding LEAGUE?
Michael Serbinis: I want to have an impact—not only at home, or in my city or country. I want to invent and build technologies that impact millions of people around the planet. When it comes to health, I believe we have a big problem on our hands and I know I can help. I know that there’s an opportunity to disrupt, or turn the model on its head, and empower the consumer. They say life imitates art, so you can draw your Star Trek references about the possibilities and the future of healthcare. I love this quote, “There are some people who live in a dream world, and there are some who face reality; and then there are those who turn one into the other.”
As a consumer, I envision a future where I am empowered to stay healthy every day, with a service that I can access anywhere anytime on my mobile device.
Will the emergence of new technologies like wearables and wellness apps result in consumers living a healthier life?
Michael Serbinis: Today, our digital footprint is massive compared to even five years ago, thanks to emails, texts, Facebook, Twitter, music, photos, etc. With the advent of the quantified self, tomorrow’s digital footprint will dwarf today’s. There will be terabytes of data created annually, and eventually monthly, about every breath we take and every heartbeat.
That data can be leveraged in so many ways by professionals, and, to a degree, by consumers. But we need technology to drive that leverage, through applications. Today, it’s no surprise that after six to 12 months, many people stop using wearables because a) the data is just not that interesting, and b) there is not much you can do with it. This will change as wearables deliver real biosignals and services. LEAGUE will make that data useful to you and your “LEAGUE” of health professionals.
How will LEAGUE help individuals live a healthier life?
Michael Serbinis: 50% of diseases are behaviour-related and largely preventable, from obesity to diabetes to heart disease. We also know that for every dollar invested in preventive programs, we can see a return on investment of $4 to $7. Investing in prevention seems to be fiscally responsible, but also one of the most impactful things we can do for our health. So where do we start?
If there’s anything I’ve learned, it’s that innovation and disruption rarely come from within an industry. It comes from people with different experiences looking at a problem in a new way. We’re excited that LEAGUE will put consumers in the driver’s seat of their health. It will span capturing, storing and sharing information; getting that information to the right health professionals; and taking action based on custom recommendations and insights. If you could take just a few minutes each day to make a healthy decision based on information that is relevant to you, you’d feel empowered to lead a healthier and happier life.
Preventive care is all about life-long engagement. How do you maintain high levels of customer engagement over an extended period of time?
Michael Serbinis: When we first thought of LEAGUE, we wanted to start with a service that was engaging every day, not just when you needed to see a health professional. The idea was to build a “LinkedIn for health,” where you were connected to your healthcare professionals, the gurus you were interested in following, and the friends and family with whom you share your health. Relevance and personalization will be key to delivering an engaging experience. Information and insights will not be enough. A list of services will not be enough. Making it relevant and useful will be critical. We are starting by connecting local health professionals with health-focused members. Then we will integrate wearables and fitness apps, and from there we will create a marketplace of content, services and insights that are designed for the individual. We aim to give individuals the ability to manage and improve their health each and every day.
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The Connected World Market Insights Series will cover such topics as:
Accessing data is key, but we think that being able to format and analyze that data is where the real value can be found. During this series, MI will delve into the market opportunity now becoming available due to progress in opening up datasets, and the development of infrastructure and analytics that are creating new services and products and bringing them to market.