The Billion Dollar Opportunity: Startups in the HealthTech industry [CEO of Guardant Health AMEA]
COVID-19 pandemic crisis has redefined the way digital healthcare services are carried across to people. As we witness more startups in this emerging industry, great opportunities lie ahead for startup founders. What are the trends in the healthtech industry? And what are the challenges faced by startups entering the healthtech industry? In this blogpost, we have Simran to share with us!
Simran is an accomplished healthcare professional with over 15 years of senior management experience across diverse geographies in Asia pacific with expertise in genomics, medical devices, IVD, biopharma and healthcare services. He has demonstrated skills in business operations, strategy, mergers and acquisition, due diligence, change management, biz dev and financial management of multi-market and regional businesses.
1) Morning Simran, can you start by sharing more about yourself. What sparked your interest in this Health-Tech industry?
I have been in the industry for more than 15 years, and health tech has always been a key passion of mine. I studied Biomedical Sciences in NUS back then, and it was an area of key focus at that point of time. There was a lot of buzz around building up a biopolis and setting up of the biotech in cluster and industry in Singapore, and I got excited about that and started doing more in that field.
As I learnt about biomedical sciences in NUS, I was given the opportunity to go for NUS Overseas Colleges (NOC), where I was part of the first batch that went to Biomed, which was the first initiative by NOC to start looking at the biotech cluster and scope. As I was part of that programme, I went into the startup environment in the tri-state area, consisting of Philadephia, Delaware and New Jersey. There are a lot of biotech companies and pharmaceutical companies in that particular cluster itself, and I learnt considerably about entrepreneurship, specifically Bioentrepreneurship, where I got the chance to interact and network with many CEOs in that sector, learning about what were some of the business needs and market needs in that space.
Hence, I got really excited and went into the entrepreneurial hub as prescribed by the programme itself, starting a concept and going through various business plan competitions. Some accolades include being Semi-finalists in the Wharton competition, taking part in startup Singapore (3rd place young idea award), taking part in the Lee Kuan Yew business plan competition and winning that too. That sort of started up the process as my first foray into the scene- it was a very steep learning curve and I used a lot of my dad’s money as well - not as judiciously as I would do now, but overall that gave a good understanding of what entrepreneurship means and how youths can start up a business.
Unfortunately, that didn’t work out very well- hence I decided to wind that down and go into traditional business, but I still stuck very close to the health care industry as my passion. I went into Frost and Sullivan consulting and then IMS Health for some time, heading up their Asia pacific region for healthcare consulting devices and services. I moved on from there to Quintiles, which at that point of time was the largest contract research organisation globally, becoming the Head of strategy for the region.
How I came into the industry was that I used to provide a lot of consulting services to Quintiles. Their CEO said, you know, we’re giving you a chunk of cash, why don’t you just come in and join me to transform the business internally? 😂 I came in and was asked to grow the business from 400-500 million to a Billion dollars in 5 years within the Asia Pacific region. That was a huge challenge and I worked through to transform the business, and that got me exposure to different markets like Korea, Japan, Taiwan, China and India to transform them. Since medical devices and diagnostics was still a big passion of mine, I then created the entire div for medical diagnostics for IQVIA. Hence, although IQVIA used to focus on biopharmaceuticals, we started the entire division for devices and diagnostics- which was interesting and I ran that business for a couple of years, bringing in a few hundred million in terms of revenue, then deciding to move back to entrepreneurship.
What I did was I then moved into a company with very disruptive tech in cancer diagnostics, and I set up the entire business in Singapore for Guardant Health Asia Middle East and Africa (AMEA), and we were able to build up the entire infrastructure in Asia, Singapore and Japan; and now we are probably the leaders in liquid biopsy.
2) What exactly is Healthtech and why does it matter in this time and age?
Healthtech is a broad organisation! You have Biopharmaceuticals, Medical Devices and Diagnostics as large pillars, and now you have Digital therapeutics, Variables and Wellness modules- a whole cluster of different things. Ultimately, they use technology to alleviate diseases or uplift health and wellness across different populations.
In terms of the lure of the industry, the lure is being able to make an impact in the lives of others. What drives me in cancer diagnostics is that cancer at the core is a genomic disease, and unless you’re looking at the genomic profiling of the cancer patient, how do you give the best treatment that is the most beneficial? You need diagnostics. That is what drives me, and for those who are interested in making an impact in the lives of other people, Healthtech is probably where you need to be.
3) In the Healthcare industry, the trend is becoming more consumer-focused, consumers are becoming more tech-savvy and organisations are forced to innovate like never before. What can emerging startups do to differentiate themselves?
Typically the healthcare industry is pretty slow in tech adoption, you see the fact that u-waves of tech typically go into other industries first and stays there for a while, creating use cases before it gets applied to Healthcare. It’s an industry that’s slow to adopt new tech, as you’re dealing with people’s lives. You need to be certain the tech will impact in a meaningful way, that the cost cannot spiral out of control, and you should be able to bend cost and mortality curves.
Where there are pockets of opportunities now is that the COVID situation has helped in accelerating adoption across industries, more so in healthcare because it’s a health pandemic. The use of teleconsultations has increased tremendously, we ourselves have gone into web education, teleconsultations and even mobile phlebotomy services so that patients don’t need to go into the hospitals for a blood draw, minimising cross infections. Furthermore, there’s a lot more education on infection control, and there’s a lot more usage of data and AI in healthcare. Even in our technology, we have combined Biochemistry and Next-generation sequencing, as well as combining AI and machine learning- in the back end, the Bioinformatics engine is driving us to look at genomic sequences in DNA, to be able to make sense of what are the mutations driving a particular patient’s cancer.
This combined technology can go through over 3.2 billion base pairs of DNA sequences, and can come up with the alteration driving that particular cancer. Furthermore, the sensitivity and specificity of the test is improved each time the AI programme is run. Those are the opportunities I see in healthcare, and I see a lot more applications for AI and precision medicine as a whole which will be required as a backbone to be more impactful for the patients. We also see robotics, for that there’s a lot of focus in looking at minimally invasive procedures so that there are better recovery times and better outcomes for the patients as well. There’s also a lot of focus on digital therapeutics, how are you combining a specific application- now you can use an app or sensor or algorithm that combined with a drug administered. Thereafter, you’ll have immediate feedback on whether the drug is impacting the patient positively, whether the drug has the right advocacy, or whether the dosage is right and appropriate for the patient. You have a feedback loop that comes immediately. Now you can also monitor the impact of the drug longitudinally for the patient as well- is this drug having a positive impact on the patient’s quality of life?
These are the key trends I see in AI and machine learning, robotics and digital therapeutics. Those trends are what people interested in Healthtech from other industries or are creating new startups generally go into, and those are the areas with a lot of room for growth.
4) In this industry, there are strict rules and regulations and policy changes, and new research papers are produced every single day. How do startups stay in the loop and stay actively aware of what’s happening in the industry?
This depends on the critical point, ultimately, who are your stakeholders? The center is the patient, and the physicians attending to the patient. Then comes other ancillary service providers, drugs, devices, and other therapies and diagnostics that come together to bring care for the patient. To stay abreast, you need to be plugged into the ecosystem.
Engineers always come to me and say “I have designed this device that can be advantageous in this procedure.” I will say “Have you spoken to the doctor that actually does the procedure?”
There’s no point in doing something without understanding the workflow. If that tool/device doesn’t go within the workflow, then it is meaningless: you might not be solving a problem but might be creating others. So the first step for anyone to understand the market need is to embed yourself in the ecosystem, make sure you are testing the market out, and having conversations with the various stakeholders. Make sure the solution you’re intending to do has a market need and there’s an understanding that it will not disrupt the workflow.
Hence you’re saying it’s not just about your service and product- it’s back to the fundamentals: What is the need of patients, and how are the users going to use it (physicians and doctors)
Indeed, fundamentals don’t change- just that in the Healthcare industry the nuances are much greater, you can’t say that this workflow is terrible and I’m going to change it over time. The problem is that the workflow already has multiple guidelines there- for you to be disruptive will take a much longer time. Think about how your product and execution solution works within the current workflow- and then slowly and gradually work towards creating guidelines that will change them. For you to get into the market and have adoption- you need to be addressing the market.
5) Generally, one common thing startups hear is ‘strike fast’- ie. have an idea, and strike fast. But in Healthtech, no matter how much founders understand the problem, given that trials and research have to be done, the market will change by the time the startup gets there and the time to market is relatively long. What are your thoughts on this?
I think that’s a common misconception- other industries may be different (product cycle and product life cycle), but in Healthcare you don’t have massive changes occurring very quickly- it takes time for new products to come into the market, it takes time for adoption, and it takes time for changing of guidelines for there to be mass commercialisation and penetration of the market. That misconception occurs because people think it’ll take 3-5 years to do a concept, conduct clinical trials, and get the data ready to get the product into the market with all the necessary regulatory approvals. But they don’t realise doing that itself is an opportunity to engage early adopters, KOLs, and you’re seeking the market at that point of time and gearing up the market for your product. In fact, it’s actually a huge opportunity- you’re already creating market demand before the product comes into the market, and that’s what people need to start thinking about: the work for commercialisation occurs simultaneously with R&D. That’s the part the health industry can provide for you.
Comparatively to other industries like IT, fintech, social media, digital media, you’re not going to have that short product cycle and if that is what you’re looking at, to get a product quickly into the market and see whether it works or not, then that’s probably not possible in the health industry. The long gestation time is actually for everyone, hence it levels the playing field. If you have a good idea, doing the right thing- generating right clinical evidence for market adoption, providing the right stakeholders, embedding yourself into the ecosystem- I think any new disruptive tech you bring in will hence have a relative impact. But you need to be there for the long haul.
6) What did you see in NAV that interests you to be an investor and mentor of NAV?
I’ve already done loads of angel investing, we had a group in IQVIA (the 6 of us in management) and we had our own angel funding- we’ve invested in digital therapeutics companies, EMR companies, and we are in other areas as well- when I heard about this opportunity in NAV, it caught my interest because I was already doing angel investing, something I already knew a little bit about, and had already started mentoring a lot of companies.
As an NUS alumnus, I wanted to give back to NUS. It is an interesting exercise in itself, to be part of the entrepreneurial drive in NUS and NOC- as many good ideas come out of it, and being able to provide guidance and mentorship to new startups is always exciting. And lastly how the programme has been structured- you and the rest have done a good job of creating a structure, I see more and more mentors coming into the programme, which means people are buying into the programme. As more people come in there are more opportunities for matches, and hopefully, we can make this a very vibrant community.
Thank you Simran for taking time off to have this interview with us!
We are grateful to have you as an advisor of NUS Angel Ventures.
If you have any other follow up questions, do email your questions to email@example.com
Watch the full video interview here!
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