Evolving Business Models in Medtech with Focus on Digital Health


Deepak Sahu

Deepak Sahu

Partner, Alira Health
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Andrea Varsavsky, Ph.D.

Andrea Varsavsky, Ph.D.

VP, Delivery Operations, Evidation Health
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Celeste A. James

Celeste A. James

VP, Equity and Population Health, Big Health
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Yury Rozenman

Yury Rozenman

SVP Business Development, Propeller Health (ResMed Company)
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Deepak Sahu  0:02  
Thank you, everyone. Great to be here. It's a Friday thing going on, I understand, but there are a lot of people joining us online too. So, today, what we are going to discuss is on the evolving business models in the medtech business, especially digital health. Over the past two days, we have heard about a lot of innovations in the medical devices and digital health forming solutions around it. However, the industry has always struggled to monetize the monitor is whatever the digital components are. Whoever is a stakeholder provider,payer, patients have always appreciated the digital part in the offerings, but have never been made a successful business case for those innovations to survive. And I have personally seen while advising a lot of different companies, that many digital innovations do not see the light of the day as they don't think about the business models early enough. So to discuss this today, with me, we have got an amazing panel. We have got with us Andrea Varsavsky VP of delivery operations with Evidation health. We have with me Celeste James, VP of equity and population health at BigHealth, doing amazing job in expanding health equity and mental health access. We have with us, Yury Rozenman, with SVP of business development with Propellor health which is a part of ResMed. Today, Propellor health has been a pioneer in making various payer contracts and trying ways to monetize it with different stakeholders. So we will have a great chance to listen from Yury on how they have able to turn that. And Andrea is over here with her background in product development is to tell how this business models could be best realized. So why don't we do this, we pass on to for street introduction, a sort introduction, and then we'll move on to the topic and dear to you.

Andrea Varsavsky  2:22  
Sure. So I can give a short introduction. As Deepak said, I'm here to represent the voice of product development. I've got a long history of working in medical device r&d, in epilepsy in hearing science, and then more recently in glucose sensor development, that Medtronic and so I have a lot of, I guess insight as to what it takes to build products. Now I'm quite a different role. I'm in a digital health company called Evidation Health. And what we do is we try to bring information, actionable information to patients outside of the clinic wall. And so what that means is a lot happens between physician visits a lot, a lot of information or a lot of things can occur and want to make sure that people have access to that in between in that time. And so, right now, we do that by partnering with pharma and medtech companies so that we can drive research to innovate. But we also just recently started launching some prototypes of things that we might interact with clients or customers or participants directly. As an example, we've got a flu surveillance monitoring, which people opt in, and we guide them to see, you know, hey, something's changed in your behavior, maybe something's different, you should go to a doctor and check it out. So more as an augmentation type of strategy. So with that in mind, I think when I'm thinking about digital health, we have quite a broad understanding of what that might mean. And specifically, we're very interested in how to marry consumer grade information with medical grade information, because there's a lot of data out there that is imperfect, but still valuable. So I'm happy to be here. Thank you for inviting me.

Celeste James  4:03  
Wonderful, good morning or good afternoon. My name is Celeste James and I am the Vice President of equity and population health at BigHealth. I fairly recently in the digital health world. My first foray I came for many years at Kaiser Permanente where I serve to advance health equity through with a focus on community based health. And so I'm delighted to be now with BigHealth, guiding our big vision to be a company that is, is really focused on mental health equity. Big health is a digital therapeutics company that has delivered treatments for insomnia and anxiety. Those are two current treatments. We are clinically based, evidence based company that supports mental health through digital therapeutics. Our effort is really to be a non-drug option for people who suffer from these disorders. We believe that we can be that we can operate at scale, that we can provide mental health care for those who need it most. My job is specifically to help us to evolve our business model to enable us to reach people who are who have the highest needs, and the lowest access to mental health care. Currently, our model is to provide these services through health plans and through employers, we pioneered a very innovative model of working with pharmaceutical benefit managers to be able to be reimbursed as one would be reimbursed for, for drugs through pharmacy budgets. So my job is to help us to evolve beyond that to scalable reimbursable models to reach underserved populations. So I look forward to talking more about that. And I'm delighted to be here as well.

Yury Rozenman  5:54  
Things Celeste, good morning, everyone. My name is Yury Rozenman, I'm delighted to be here. It's been a fantastic couple of days, listening to pitches as well as presentations from you know, early startups, innovators that really driving significant digital transformation in this space. My background is primarily pharmaceutical started out that Pfizer doing analytical developing clinical development as well as licensing and the commercialization of novel pharmaceutical entities. Over the last five, seven years, it's been primarily a journey through digital health, initially with Qualcomm life with the focus on connectivity and really driving, remote patient monitoring and remote therapeutic monitoring use cases across multiple disease conditions. I have also done significant amount of work at Fitbit, with the focus on software as a medical device, sort of walking that narrow path for a consumer grade device, but at the same time, being able to do early disease detection and progression for a number of indications one of them been atrial fibrillation on the wrist, as well as sleep apnea. And of course, these are the the areas that not only interesting from, you know, ensuring that you do the early diagnosis but also providing treatment to patients early. Some of you may know that atrial fibrillation and you know, a lot of patients find out that they actually have afib, when they actually admitted to a hospital with a stroke. So those are the kinds of sort of early disease detection opportunities, they can certainly, you know, predict and prevent the type of conditions that could lead to very, very serious consequences.

I'm with Propeller health, which is part of ResMed. We are a digital health company focused on asthma and COPD. But as well as closely related comorbidities, especially through our relationship with ResMed which for you know, as a as a name implies, stands for respiratory medicine has been on the front end of this path to help patients dealing with sleep apnea, as well as very acute respiratory conditions. At propeller initial focus was around hardware and enabling connected drug delivery and being able to detect date and timestamp of the inhalation. And as we progressed through our commercial path, we expanded the reach to also provide patient engagement patient support patient intervention options by working directly with patients and users. And then of course, the platform for healthcare professionals, which can intervene and provide education support that, you know, coaching for patients as well as others that participate in healthcare, as well as software as a medical device and algorithms to detect and manage conditions associated with respiratory conditions. So looking forward to our discussion.

Deepak Sahu  9:33  
Thank you. Let me start this with Salus we have a lot of definition of digital health going around. So people start with digital surgery, people go to consumer health, the spectrum issues, what is digital health for you?

Celeste James  9:51  
So at BigHealth, we look at digital health and more or less three categories. One being telehealth, which is of course, driven by either a physician or therapist or other at the end at one end and the patient at the other. This is a given shortages, especially of therapists related to mental health. This is not a scalable option, but it certainly is a clinically based one and an evidence based one as well. The second is, is wellness apps, there are a number of wellness apps that have emerged. And wellness apps also have their place in the marketplace. Oftentimes they are, they are not evidence based clinical treatments, but they are scalable. And then they are then somewhere in the middle, we have digital therapeutics, which in the case of BigHealth, ditch, our digital therapeutics are clinically based clinical solutions or evidence based clinical solutions. We provide these therapeutics, as I said, to address currently to address insomnia, and anxiety, two of the most common mental health conditions. And so this, these, these treatments, do not require a coach or a therapist, they are intended to reduce some of the stigma surrounding digital surrounding mental health care. They are convenient, they are affordable, and they can be and we are definitely working to make sure that they are culturally responsive. So those are the three categories that we typically look at when we consider consider digital health and our own digital therapeutics.

Deepak Sahu  11:32  
Thats good, Andrea for you, what is digital health?

Andrea Varsavsky  11:35  
Yeah, that's a kind of terrible question to ask an engineer, naturally gravitate to everything it could be right. And it is such a broad category, because you know, as a concept is anything related to how we use digital technology to impact health. So totally agree with the classifications categories that Celeste just spoke about. So they don't just focus about what what it's like for evolution, which, as I mentioned, to us, it's really about bringing insight outside of the clinic walls. And so without necessarily, it doesn't have to be consumer, it doesn't have to be medical grades that really just outside to augment health in everyday life as opposed to just having very discrete events that in which the patient's consult with the physicians. I know that there is much more to digital health, and that this is just what Evidation does. I know in my past life in Medtronic, they were very different types of digital health, some of which overlap with us last spoke about that even just like insight based type of, I guess, applications that would say, Hey, this is how your health is going, given every ecosystem of every medical device that you're on. This is the benefits that we're seeing, these are the trends that we're seeing, and providing that so that you can augment how someone can manage their own therapy.

Deepak Sahu  12:49  
This good, Yury its your opportunity right now. So just want everyone to realize how varied the definition of digital health.

Yury Rozenman  12:59  
So digital health really refers to the use of information and communication technology, in medicine, and other health disciplines to manage illnesses, risks and facilitate wellness. So it's a very, very broad definition. I don't really like it, because I think the only way really, to make a difference is to get much more focused. And, and focus comes from fully understanding the needs of the patients and being able to manage the needs of patients across all of the different stakeholders, whether it's, you know, pharmaceutical company, payer or provider, and sometimes there is, of course, tension. And my focus at propeller is really twofold. One is around digital companion, and the other one is around digital therapeutic. And when it comes to a digital companion, it's more of a short game. It's some things that you can do today, easier. The validation and the regulatory path is simpler. And then when you think about a digital therapeutic is more of a long game, you know, you have to start now, in order to be able to benefit from the options and opportunities that come. Especially for a standalone, digital therapeutic. It may come sooner, but it's when you think of a digital therapeutic in the context of an add on therapy with a pharmaceutical entity, that is something that needs to happen sooner rather than later from a point of view of participating in the clinical path to get there with approval and being approved in the same context as a typical chemical and biological entity. So, you know, as we begin to think about to commercial and business models, it's very important to focus on what do we actually mean? Because if we use the very broad definition of digital health, than pretty much any company can indicate that they participate in the digital transformation, leading to digital health, whether you're providing compute and storage, to a digital digitized imaging records, you can claim that you're participating in digital digital health, but in reality, are you really moving the needle and helping patients live healthier and more productive and fulfilling lives? That is, of course, then questionable. So my preference as we begin to have this discussion is to be begin to kind of map real journeys for patients that can, you know, derive benefits through potentially digital therapeutics or digital companion approaches.

Deepak Sahu  15:58  
Thank you Yury, the focus of this panel will be and should be on the evidence and based evidence based medicine. Right. So that's where we are focusing on I'll start with sellers again, since we are discussing about business models. What have you seen? If you help people realize how do you monetize and how do you grow the access to a particular digital health? That will be really helpful. So we're all eager to see what are the different business models that have been successful in this field.

Celeste James  16:32  
Yes, yes. Well, as I stated earlier, I'm, I'm learning more and more in my three plus months with BigHealth, about the different models that are out there. But what I can say is that the business models that are most likely to succeed are the ones that that are going to provide convenience, affordability, access, and by access, I mean availability, when where and how the patient wants it needs it. And as I mentioned, cultural relevance and cultural responsiveness. So, you know, we have seen in the last couple of years, again, I'm going to focus on BigHealth that our focus on mental health, we have seen that the pandemic has, has contributed significantly to mental health to what we are seeing now as a mental health crisis. We have also observed across the globe, the effects of our reckoning with race, racism and inequality in this country and others, that has also contributed significantly to a mental health crisis. In the last, in the last couple of years, and through the pandemic 1/3 of American adults have, I have reported having some challenges with mental health, specifically, anxiety and depression. So there's a great need for mental health care. And at the same time, there is a significant shortage of therapists. 75% of therapists and another report say that they have extended wait times, sometimes months. So given the shortage of therapists, the increased demand, as well as the the ongoing stigma around getting mental health care treatment, we feel very, very certain that digital therapeutics have a place in addressing these issues. So, so, again, our current model is that we are, we are reimbursed through by through partnerships with health plans, and an employer groups, and in our partnership with CVS health through PBMs. Pharmaceutical benefit managers. Now, obviously, that has some challenges. We are also at big health dedicated to mental health equity, which means that we want to serve among our population, we want to serve people who are underserved or poorly served by the medical system, we know that there are deep health disparities out there that we must address. And so in order to reach people who are have the highest rates of mental health challenge, and the least access, we have to be able to expand those models. So we are looking at creative partnerships with community providers. Obviously, Medicaid and and Medicare, Medicaid and Medicare are also avenues to ensure reimbursement and to reach populations that most need it. But we're going to have to be extremely creative. And we're beginning to do that. And that's one of again, my job's is to intentionally create models that are going to enable us to reach populations that need it, and to be able to be reimbursed for it. So I think that, you know, we're going to see lots of different models evolving, but I believe that we're going to have to work very creatively with with community based partners, build trust and build access to those who need it.

Deepak Sahu  20:00  
Celeste, these are great points. One follow up to that is, how critical is the data in this business model?

Celeste James  20:08  
Thank you for opening that I should have said that data is absolutely critical. We have to know not only are our treatments effective, safe and effective, but we have to know if they're serving the needs, if they're creating remission rates that are comparable to to other treatments. In the case of meeting the needs of underserved populations, we want to make sure that our treatments are creating remission rates that are comparable to the general population. So that means we want to make sure people are using the products using the treatments, they're staying with them. We know that therapy, especially in populations that tend to be medically underserved, that sticking with treatments is very difficult. One because of the inconvenience, and also because of shame. And if we can reduce those barriers, which we intend to do, then we're more likely to see the readmission rates that are comparable to the general population, if not better. So data is really, really key to that we have to collect it. And we know to make to be a value to payers, patients and providers, we have to be able to create, provide data. And and big health is doing that.

Deepak Sahu  21:15  
That's that's great to understand Celeste from your perspective, and also move to Yury right now, because Yury has worked with different stakeholders on different business models. If you have to pick top two or top three business models that you have seen, has become effective in the domain, that will be helpful because I'm coming from a place where many digital therapeutics or software as a medical device to come to us and say, Hey, Deepak, I just got two pair contracts. And they go and they get listed on an IPO. And then they realize that the larger access is not there to solicit points. So they have never looked at the affordability, the access part of it. So help us understand how those business models have been successful. Which are those top two or three you have seen?

Yury Rozenman  22:14  
That's, that's a great question. I would say from a business model perspective, you do need to look at different stakeholders, and manage their needs. Sometimes, and especially not only from the point of view of pharmaceutical industry paying provider, but you also need to look at the geo context and where the companies are located and where they're serving. So the business model that seems to work when you're working with pharmaceutical industry, which gets funded easier, is the area around demand generation. So even though it may seem somewhat sinister to only think of it as the demand generation, but being able to identify patients early, whether they are the right candidates, you know, for the drug, you know, by doing early detection, whether it's around, you know, atrial fibrillation, or diagnosing patients with Alzheimer's, through the use of various tools and technologies to identify who is in that early stage, and potentially can be helped through therapy, whether it's a typical classical therapy through a drug, pharmaceutical entity, or whether it's something that combines digital, with the pharmaceutical as a result of early disease detection. So if you're working with a pharmaceutical company, trying to pitch idea around patient engagement, patient support, it is interesting, but it's difficult to get it funded right from the get go. It's much easier to focus on those areas that drive that level of demand generation, and potentially, let's say exacerbation. So to give you a real example, if you're thinking about respiratory, such as let's say asthma, starting let's say with with a drug, which is based on inhalation therapy, could be the first step. And in US typical therapy, let's say for a single or double or triple is going to be somewhere between 100 to $400 per patient per month. And as you may know, you know, over the course of four or five, six months, you see the level of adherence dropped about 50 to 60%.

So being able to support the second model, where you are driving adherence in patients in continuation to use the medication correctly is extremely important. Building on that using the data to predict where potential exacerbation may happen, so that the patient can be switched, potentially to a biologic, which is a lot more expensive of anywhere from 3000 to $4,000 per patient per month. Those are very difficult points and patient journey. And at the same time, it's difficult for payers and providers to assume that level of costs without the data and the evidence driven approach to ensure that patient is, is at that point in their disease progression. But those are the business cases that certainly gets funded because it's important to either keep the patient on therapy, conventional therapy for as long as possible by ensuring that they adhere and then complying to the treatment plan that has been prescribed. And if they're infected here and then complying and doing doing everything they can, then maybe that's the right point to step them up to a more expensive treatment. And that point is important to a payer, who is trying to provide all of the guidance and coaching and support to delay that point in time, whereas a pharmaceutical company may be interested in getting some of those patients on the therapy quicker. And that is the balance that is important. And it does drive a number of commercial and business models, certainly for us, at propeller across all of the stakeholders.

The reason, it's also important to think about GEOS, because the same business case is applicable in US may not be as applicable outside of us to give you an example, inhalation therapy, let's say in us maybe $300 to 400 dollars per patient per month, if you're operating on a bad 30% gross margin, you have about 100, maybe $130 left, meaning pharmaceutical company to do something about it to do some level of intervention and use that money. If you are operating in Europe or in UK, it may only be 50 Pound sterling. So again, operating on the same 30% gross margin, you only have 17 or $18 left, pounds left. In that particular case, the focus on pharma to drive to be the payer and to support the program may become a lot more difficult. So you may really need to work with the integrated payers such as the NHS to fund the program for the patients directly. So it's important to consider business models not only as you think about the each individual stakeholder and what's important to them, but also to think about where they're located, and how to configure those types of models. So I'll stop there

Deepak Sahu  27:34  
Thank you, I did not want to interrupt the chain of thought, because I realized from your response is, there are multiple stakeholders, and everyone has a different need to do that. And that brings me to the most important internal stakeholder in the company. You have you resellers coming to you with different product features that is being expected out of the market. And the reason why I really wanted the product development team to be here is to give those business models any light of the day, the product development team needs to be behind. So tell us from a lifecycle approach perspective. How do you deal with so much of demand? And what is the criticality for you to understand the business model?

Andrea Varsavsky  28:24  
Yeah, I would say that it is incredibly important for business development to be in lockstep with product development. Don't leave it to the engineers to figure out what they want to build, because they will build crazy stuff, it's literally going to happen, we have very limited, like if you're thinking about the different stages of product development, there is a very early r&d that you need to do to vet out technology. As a minimum, I'm not saying at that stage, you need to have a full fledged business model and know exactly how it's going to work. But as a minimum, you need to understand what user needs you're trying to solve. Because if you leave it to the engineer that will take it in the direction that probably no one else was just thinking about personal experience getting very excited about a filter that I was like geeking out over. Honestly, I was the only person that was interested in that that's not useful. That's not money well spent for the company. And we do have limited resources. So the earlier we can understand what the user needs are going to be, then we can start the solutioning process and start vetting out technology that will tell you what the bounds of that might be down the road. Now when you get to the product development, actual implementation or the actual product development lifecycle, I'd say that you need to be even more informed at that point. And the reason for that is that the product development lifecycle even though it's fine tuning technology has been vetted. It takes a very long time, particularly in med tech. And details matter here. If you think as an example. I don't know distribution channels is going to be direct to the consumer or over the counter. The things that you need to qualify as a product development person in those two scenarios might be completely different sterilization parameter As packaging parameters, shipment testing conditions that you need to understand how much shelf life something is going to be even qualifying shelf time itself, if it's going to be over the counter needs to be a lot longer need to build a fundamentally different product. So at that point, again, it's not about how you're going to be charging, necessarily how you're going to be making money, but at least understand how the product is going to be used to sufficient detail so that you're building the right, de risking strategy in that process. If that makes sense.

Deepak Sahu  30:26  
That makes a lot of sense and there, but help us understand also the part of the data. I have seen more than often that the business, the business side, the marketing team, the corporate strategy come to you or to the development team with a request, can I have this data point? Can I can I gather this data point can this data point could be reflected. So how often have those not being successful?

Andrea Varsavsky  30:55  
I just happened to be many times in which we're halfway through a development cycle and someone from a different function, whether it be r&d, or otherwise comes as well, but actually wanted to see this data. It's like, we haven't built that in, right. And so you really have to get creative around how to get that information. I think one thing that r&d should do, as part of the conversations with the business development, is understand the range of things that might be possible, because you can do a lot of diversity just by building infrastructure, whether it's the data structures or the collection, or the information that you're collecting, even honestly, just the interfaces between the software and the hardware, that prevent you from doing things once you've gotten too far down the road, right. And so, if we can build a system as flexible as possible, it can fit the refinement of the business model can have more flexibility in how it would be implemented. Does that makes sense?

Deepak Sahu  31:48  
That makes a lot of sense Andrea. For, for us, he one thing that I have realized in this first developing digital health space is a lot of ideas is there outside people want to do many things, people want to publicize many data people want to help each other. But when it comes down to the product development, there is feasibility aspect of it sometimes some camera is not available, sometimes the chips are not available, sometime particular signal is not coming out of the system. But you're trying too much to pressurize your product development team that leads to down the road recalls, down the road not serving the needs of the client, not needs of the stakeholders. But since we are over there, and we have discussed about what are different business models that have we have seen and worked, I'll put us in a very difficult situation to see what business models have failed. Celeste, from your experience and how many of those you have seen failing.

Celeste James  32:53  
Again, what I would like to speak about is what I know will will reduce failure rates in terms of business models and in terms of digital health. And that is again, ensuring that that that that your treatments or that your solutions are clinical in nature that they have the evidence behind them. Big health has had a 13, has done 13 randomized control trials, and has 64 publications. So we are heavily researched perhaps the most researched digital therapeutics on the market currently. And we are very much as I said before, focused on reducing bias and reducing stigma in mental health care. And so when you talk about product development, we have we've developed frameworks for cultural responsiveness in in product design, that are agnostic of the product or the treatment, but really about the process. And so to the extent that we can focus on and standardize certain processes to ensure that we're meeting the needs of our patients, the less likely we are to fail. And likewise, in our research, we have frameworks, again focused on equity, diversity and inclusion in research so that we are getting more diversity in our clinical trials. And again, meeting user needs doing lots of user research and ensuring that we're, that we won't that we won't fail for lack of meeting the needs of, of the patients who are using our treatments. So I think being able to do that create frameworks, standardization that we share with the industry will certainly help to to ensure no failure.

Deepak Sahu  34:39  
So let's hear the word patient centricity in your response. The patient centricity, absolute, so help explain how patient centricity can be monetized, let's say, how does it resonate with different stakeholders in your experience as BigHealth? You talked about data? You talked about collecting data? So how that patient Centricity helps?

Celeste James  35:05  
Again, I think that it's really about showing value showing value for patient provider and, and, and the payer, right, we all have to be able to see that there is value that outcomes are improving that remission remission rates in the case of mental health, or whatever is the health challenge are evident. And and we have to be able to show that we are reducing healthcare costs, especially among those who have the highest cost of providing health care to them, who who require the highest amounts in in supporting their health care, I should say. And so if we are creating products that are centered around the patient's needs, that are convenient to the patient where and when they need their care, and then we can reduce the costs of their care and, and have a win win for all parties involved. And so if that's, if that's the question that you're asking, I think we can certainly create patient centric solutions in digital health in the same way that we've seen in in person help healthcare.

Deepak Sahu  36:17  
There's, there's where I was going, because we learned a lot about patient centricity. But even people are trying to develop an application that is patient centric, have difficulty in translating to business models. Yury, we'll end this with some of the final thoughts. The major thought of all this, all the innovations out here, were either in series B Series C, round of the funding, is when they start thinking about business models.

Yury Rozenman  36:49  
I think thinking about a business and commercial model should start pretty much from day one. Because defining who will be your target audience for your product, or your innovation should happen, not in isolation from product development, or marketing, or from the investment because, quite frankly, detachment from a business and commercial model leads you to potentially really interesting, innovative solutions that are not yet maybe ready for the market, or potentially do not really address patient needs. I think the discussion around patient centricity is extremely important. But what you will notice that in many cases, the patient is not a direct payer for the services, it is someone else who pays for it, and making sure that you establish the right balance between the patient needs, who is and who may not be the payer, and ensuring that that business model that you're addressing the patient needs, by balancing the commercial and business needs as you're developing your product really should happen on day one. If you lose that, you know that that connection, what you're very likely to see is development of something where it's a solution, looking for a problem, versus identifying a real compelling value proposition, right from the get go, then all of the pilots and proof of concepts that you're running early, they focus on that business and commercial model that you're trying to address, versus sort of trying to find yourself in constantly building that airplane as you are trying to take off. I think the more you can do upfront in defining that business and commercial model across all of the different stakeholders across various geos where you want to play. And at the same time, keeping the patient centricity element there, even though the patient may not be always at the point of that business and commercial connection. So I do think it's quite important to get that going quite early.

Deepak Sahu  39:14  
Andrea, how many times have you seen that you have started thinking about business model from the day one or the product development team is aware of the business model from day one?

Andrea Varsavsky  39:24  
I think it's getting more standard as then thinking about my early days in my career, it was a complete disconnect, at least in my experience, obviously, different companies operate very differently. But it is becoming more standard to start those conversations much earlier and engaged with across all the teams that will be involved in the development cycle much, much earlier. And so there's a lot of DRM design for reliability and manufacturing going on that really embeds that into the process. A lot of acknowledgment that technology and business models need to actually work together. So I'm hopeful that these best practices are being translated to the real world to companies and that everyone's operating much closer to that than it used to be true in the past. Of course, there's still going to be some hit or misses. So

Deepak Sahu  40:10  
no, thank you. Andrea, I will conclude this with Celeste point earlier, what will make the business plan successful? So if you can tell us, what do you think in digital health, the business which business plan will be successful?

Celeste James  40:24  
Well, we expect that in the next three to five years that digital therapeutics will be as scalable and as, as as practical as as drugs. And certainly we expect that will continue to be a non drug option, given the long term risks of taking drugs. And so we expect that we'll be able to see many business models and digital therapeutics and digital health continue to succeed, especially with the growth in technology, and a focus on patients and patient centricity. As you said,

Deepak Sahu  41:01  
Thank you so much. Thank you Yury. Thank you, Andrea. Thank you Celeste. I hope we all have had some amount of thought process over here is obviously 40 minutes and we cannot cover all the business model. The goal was to see how credit development business models work together. If you want to join and connect with any of our panelists, feel free and I will conclude this by giving a huge round of applause to the panel and also to Scott and his team who has put this together. So kudos to you guys. Thank you so much.

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