Overcoming Healthcare’s Last Mile Through mHealth Solutions mHealth Summit November 2015 Anne Katharine Wales

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3 1/3 of all health expenditures will occur in emerging economies by 2022 Over the next two decades, the middle class is expected to expand by another three Billion, coming almost exclusively from the emerging world 84% cell phone ownership in emerging and developing nations

Innovations in Healthcare is focused on identifying, scaling, and learning from innovative healthcare delivery solutions around the world  Nonprofit organization founded by Duke Medicine, McKinsey & Company, and the World Economic Forum and hosted at Duke.  Aims to improve health worldwide by supporting the scale and impact of promising innovations.  Supported by and collaborates with a global and diverse group of organizations that are committed to strengthening and increasing the scale of health innovations.

To date we support 55 healthcare innovators, with an average of $2M in annual revenue and 9 years in operations 5 We have curated a network of 55 organizations that:  Provide significant improvements in cost, quality, and/or access, as measured against comparable solutions  Address critical health needs  Can be implemented via a sustainable business model

6 BrazilIndiaKenyaMexicoUnited States Population202 million1.2 billion45 million123 million318 million GNI (per capita, PPP)$15,900$5,760$2,890$16,160$55,860 Nurses (per 1K people) Internet users (per 100 people) 57.6%18 %43.3 %44.4 %87.4 % Rural Population15 %68 %75 %21 %19 % Health expenditure, total (% of GDP) Three main causes of death 1.Heart disease 2.Stroke 3.Diabetes 1.Heart disease 2.Diarrheal diseases 3.Lung diseases 1.HIV 2.Influenza 3.Diarrheal diseases 1.Heart disease 2.Diabetes 3.Kidney disease 1.Heart disease 2.Cancer 3.Respiratory disease Out-of-pocket health expenditure (% of total expenditure on health) 29.9%58.2%44.6%44.1%11.8% Radical healthcare innovation is cropping up differently in key markets, with important economic factors driving entrepreneurial opportunity

7 Get close to the patient (consumer) and follow their established behaviour patterns Borrow someone else’s assets Confront professional assumptions and ‘right-skill’ the workforce Standardize operating procedures wherever possible Reinvent the delivery model by using proven technologies disruptively Across our network, we’re seeing innovators that focus on these opportunities utilizing key principles

Technology plays an incredible driving force in this innovation

Strategic Planning Performance Management Should I franchise to maximize my impact? Is acquisition the right path? How can I collect data in a cost effective way to prove my impact? What about measuring clinical quality? Product/ Service Innovation Development What product changes should I make to best serve my customers? Organizational Leadership & Talent How do I hire, train and retain talented clinical staff? Leveraging the Ecosystem What’s the best way for me to partner with a pharma company? Funding & Investment How can I best position my organization for a series A round? Are grants ever seen negatively by investors? If healthcare innovators already exist in a proven way, why aren’t they scaling faster? What areas of support do they need to increase their impact?

1 There is a need for more coordination between active parties across the system 2 There is currently a mismatch between available capital and needs on the ground Silos of investors Hard for investors to work with Foundations and Donors Investment timeframes are too short Debt is unavailable or available at crazy rates The market is flooded with early stage free money Banks don't understand the business models Healthcare is too political Difficult to manage regulatory environments What’s stopping more investing in this space? Need for more coordination and availability of the right types of capital at the right time.

11 Rural BoP Urban/peri-urban middle-income Urban/peri-urban high-income Urban/ peri-urban BoP Delivery system Medical Device & Supplies Payment Systems Mobile & Tech Pharma Inadequate volume Infrastructure Price sensitivity Last mile distribution Inadequate volume Price sensitivity Last mile distribution Information asymmetry Price sensitivity Information asymmetry Price sensitivity Infrastructure Access Price sensitivity Quality for cost Infrastructure Price sensitivity Information asymmetry Price sensitivity Information asymmetry Price sensitivity Access Price sensitivity Quality for cost Infrastructure Price sensitivity Information asymmetry Price sensitivity Information asymmetry Infrastructure Sub-sectors Populations Logistics & Distribution Last mile distribution Inadequate volume Infrastructure Price sensitivity Infrastructure Grant Impact capital Traditional capital Healthcare ventures respond to different market challenges- each requires a unique type of capital depending on population served

Implications for Innovators Seeking Customer Revenue Seeking Grant FundingSeeking Equity Demonstrate ease of use for all users (CEO, clinician, etc) with current workflow Low-up front cost Understand all unintended consequences Illustrate increased revenue Demonstrate increased ability to reach more patients with higher quality care or at lower costs Demonstrate ability to increase care for specific population segments Show clear customer growth Set and reach revenue milestones from a diversified set of payers

Spotlight on Relief Watch

Discussion: For Innovators:  What has been your biggest challenge on your path to growth?  What types of resources or partners do you need (other than funding?) For Corporates:  How are you engaging with emerging markets and does technology play a role? For Funders:  Are you currently funding mHealth solutions? Grants? Equity?  Given the many solutions currently in the market, what makes them stand out to you?