Key Takeaway: The world’s biggest tech firms, including Alphabet, Amazon and Apple, are using cutting edge digital technologies to build the future of healthcare, a more than $7 trillion opportunity.
For Kate Rosenbluth, then a neuroscientist at Stanford Neurosurgery Center, watching a man sob as he was told he couldn’t get surgery to control his shaking hand was pivotal.
“He was inconsolable,” she wrote in a blog post. “How could it be that no one could help Jim?”
Rosenbluth started Cala Health in 2014, spending five years developing a watch-like wearable that stimulates nerves at the wrist to treat essential tremors. Her vision drew in Google-parent Alphabet, one of several large tech companies expanding rapidly into healthcare.
For patients suffering from the disorder, the device may allow them to return to daily activities. For Alphabet, which has twice invested in Cala Health, it is one small part of a grand vision: to remake the healthcare industry by funding scores of startups in artificial intelligence, cancer detection, drug development and more.
Alphabet is one of several of the world’s biggest technology companies spending billions of dollars chasing the $7-plus trillion healthcare market.
Alphabet has thrown scores of ideas at the wall in early-stage investments, betting that some of them will stick. Apple, with its omnipresent devices and large user base, has focused on collecting and protecting health data. Amazon has drawn on core businesses in logistics and retail to make care more accessible. Other tech companies, like Microsoft and Uber, are also investing in the space.
Healthcare is not a side project for these companies, but an increasingly larger part of their mission. In a CNBC interview in January, Apple CEO Tim Cook said that people will one day say that “Apple’s most-important contribution to mankind has been in health.”
What Apple, Amazon and Alphabet have in common is money and ambition—enough to transform the healthcare industry for patients, providers, and everyone in between.
Moonshots
Alphabet has always prided itself on a culture of experimentation, from spinning out prototypes through Google Labs to letting employees spend time on independent projects. The company is taking the same approach—along with mountains of cash—to the healthcare sector.
Since 2007, Alphabet and associated funds have incubated or invested in 152 healthcare startups, according to a Karma analysis of data from Pitchbook. These investments were made through an array of different entities, including a research arm, a venture capital fund, a private equity firm, and an accelerator.
The company has more cash on hand than any other, recently overtaking Apple, and makes the most venture investments of any corporation. By spreading the wealth, Alphabet has placed bets on everything from cancer detection and medical imaging to flu vaccines and health insurance. The most active bettor: GV, formerly Google Ventures, has invested in at least 101 healthcare companies, including Cala Health.
GV first invested in the California-based company in 2016 and then again last May, as part of a $51 million Series C round with Novartis, Johnson & Johnson, and others. The diverse mix of strategic investors has been a boon to the company, said Ryan, the CEO, which combines work in neuroscience, data science, and wearable tech. “GV has been very helpful to us, especially from the recruiting perspective and for some of the work we’re doing to build out our cloud infrastructure,” she said.
Alphabet’s investments include large companies flirting with an IPO, like the genetic testing company 23andMe, as well as small, stealthy ones, like the gene-editing startup Trucode. It also has a particular focus on machine learning. Almost a fifth of Alphabet’s healthcare investments are in the artificial intelligence space according to Pitchbook data, and the company recently absorbed the healthcare unit from DeepMind, its standalone AI research firm.
The Everything Clinic
In contrast to Alphabet, Amazon has made a handful of large, public healthcare plays to expand access to care.
Several have drawn on the company’s existing strengths in logistics and retail. Last year, Amazon bought PillPack, a prescription drug delivery service, for $753 million. The idea is to do to CVS and Walgreens what the company did to large brick-and-mortar booksellers, and persuade the almost one in two Americans who take prescription drugs to buy more of them online.
“GV has been very helpful to us, especially from the recruiting perspective and for some of the work we’re doing to build out our cloud infrastructure.”
Similarly, Amazon is trying to become a major distributor of hospital supplies, and recently unveiled an app for some Amazon employees that provides health services by video and chat. It has also partnered with JPMorgan Chase and Berkshire Hathaway for a joint healthcare venture to lower costs and improve health insurance for the companies’ combined 1.2 million employees.
“It’s exciting to think about the possibility of primary care generally being more accessible, and what that could do to change the disease trajectory,” said Vanessa Mason, a research director at the Institute for the Future, a non-profit research organization that covers the healthcare space, to Karma.
To be sure, Amazon is investing in promising, early-stage technologies also favored by Alphabet. In 2017, Jeff Bezos joined GV and Bill Gates in a $1.2 billion funding round for Grail, a biotech company developing blood tests to detect cancer early. AWS, Amazon’s cloud computing platform, also provides various technologies to drug developers and hospitals.
But the overarching project is to make healthcare available to more patients, more cheaply, by combining virtual and in-person care. “You haven’t really had an integrated approach to having both of those things together, certainly not at scale,” said Mason. “With Amazon doing it, there’s the possibility of that actually occurring and becoming more normal.”
Data-driven
In the most tightly focused strategy of the three companies, Apple has prioritized drawing health data from its devices. Users have long been tracking weight and step counts through the iPhone, and the latest Apple Watch can perform an ECG to detect irregular heart activity.
Apple is seeking new ways to help patients analyze and secure their health information. “Tim Cook has made it almost the company’s mission to be a steward of consumer’s data,” said Katy Huberty, a researcher at Morgan Stanley, to CNBC. “So if there’s any technology company today that’s well-positioned to build the trust of health care institutions and consumers, it is Apple.”
An April research note from Morgan Stanley pegged Apple’s opportunity in the space at up to $313 billion. Huberty said that the company already has almost 60% of the revenue share in wearables today, and might apply its use of health sensors to other products, like AirPod earbuds.
Healthcare organizations can also register with Apple’s Health Records directory, which enables patients to download their own electronic health records. An early study from the UC San Diego Health system, one of the first participating organizations, found that the service helped patients better understand their health and communicate with providers. And later this year, the new Research app will let patients participate in large medical studies from their phones, in areas like women’s and cardiovascular health and hearing loss.
“It’s exciting to think about the possibility of primary care generally being more accessible, and what that could do to change the disease trajectory.”
Ana Gupte, a long-time healthcare analyst formerly at SVB Leerink, told Karma that she expects Apple, Amazon and Alphabet to partner with traditional healthcare actors, not replace them.
“They can spawn new ideas, they can come in with internal capabilities and offerings that might have value to both the payers and providers, and through them, to the patient,” said Gupte. “I don’t see them, at this point, broadly disrupting the incumbents in the healthcare system.”
Like the big tech companies, those incumbents are also spending heavily on new technologies, both internally and externally, she said. The healthcare sector poses relatively high barriers to entry, including government regulation, compared to the conventional tech sector. The Apple, Amazon and Alphabet initiatives have also raised concerns about patient privacy, data security, and the affordability of services.
Mason, the IFTF researcher, told Karma that there are still a lot of unanswered questions about patient data: “What are you entitled to know, to understand, to be able to protect? What are you able to use? What are you able to leverage, whether for your actual health benefit or potentially for revenue generation?”
Mason also said that these companies are entering the space without the same regulations or ethical standards as traditional healthcare organizations. They will have to balance the gains from advancements in healthcare technology and delivery with the risks of collecting, analyzing, and profiting from huge volumes of patient information.
“I don’t think there’s any single entity that has a good answer to that,” she said. “My concern is that it’s a back-burner concern, secondary to their gaining market entry and adoption at levels that they’re used to seeing from their franchise products.”
Rosenbluth’s device has been a life-changer for Cala patients, Renee Ryan, CEO of Cala Health, told Karma. Some are able to drive again and one patient, a painter, was able to pick up his passion again, she said.
“People are able to return to those activities that they love. That’s what’s really impactful for us,” she said. “People can actually get back to doing what they did before.”
