How Merck's innovation team seeks business models beyond the pill

By Jonah Comstock
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JONAH_COMSTOCK_HEADSHOTWhile increasing collaboration between payers and providers was a major theme at HIMSS in Orlando last week, one other major stakeholder has been quite a bit harder to find in conversations about big data, ACOs, and digital health. As Forbes columnist David Shaywitz wrote yesterday, pharma has been noticeably hesitant to jump into the fray.

At Merck however, a dedicated innovation group called Merck Medical Information and Innovation (M2i2) has been quietly working for a year and a half on building partnerships with providers, EMR vendors, and startups to explore some of the possibilities of digital health, as well as how accountable care is changing the healthcare system.

"We think that there's a transformation that's waiting to happen,"  M2i2 Director Aman Bhandari told MobiHealthNews. "Some people say 'The work that you're doing, population health, that seems like the work of delivery systems. That seems like the work of payers or plans.' Ultimately, we see a major convergence happening in terms of goals and outcomes and we see a real systemwide refocusing on values and outcomes measurement as the central theme that's driving everyone across the industry. We think there's an extraordinary opportunity for pharma to have a seat at the table that it hasn't had before and we're hoping to give it that."

M2i2 recently published a Slideshare describing some of the partnerships it has embarked on over the past year and a half. Most involve funding research projects, but some get Merck scientists involved to a varying degree. One example is the partnership with Boston Children's Hospital to study insomnia through Facebook and Twitter feeds, which we wrote about last week

"Merck is funding the research, but I think there's also a broader digital health agenda that we're really kind of pursuing and this is a big part of it, which is around this notion of defining what I call digital phenotypes," Merck Chief Medical Information and Innovation Officer Sachin Jain said. "We think many diseases will actually have a phenotype that presents through patient use of technology. ... So we're working with John Brownstein, who I think shares this interest and has deep research expertise in the use of social media data and we collaborated on the project. Ultimately he has full responsibility for the protocol as well as the analysis, and our primary function is really funding at this point, but we definitely shaped the agenda together."

M2i2's partnerships fit into three broad categories: capturing the patient voice, clinician-facing technologies, and innovative uses of data. The Boston Children's partnership fits into the first category, as do Merck collaborations with PatientsLikeMe and Roni Zeiger's Smart Patients. Merck is taking data and insights from both PatientsLikeMe and Smart Patients and applying them to larger company operations.

The second category encompasses partnerships with EMR vendors and clinical decision support tool makers including Humedica (now owned by Optum), Practice Fusion, Allscripts, CECare, and the Health Data Consortium.

"Our relationships with EMR vendors are about enhancing clinical decision support, which I think is an area that needs a lot of attention," Jain said.

The third category, innovative uses of data, is the one in which Merck is actually working with provider organizations including Northwestern, Harvard Medical School, and Huaxi Hospital in China. It also includes Maccabi in Israel and the Regenstrief Institute in Indianapolis -- institutes Jain called "two of the world's leading informatics research institutes".

"Engaging in longterm relationships with these collaborators allows us to actually create new data science capabilities that don't exist in other places," Jain said. "For example, at Regenstrief we're funding the connectivity between bone marrow density data and EMR data and are able to do research that's not readily done in other areas."

Maccabi is also located in Israel, home to a large medical startup culture, and M2i2 uses it's relationship there to tap into that scene. Bhandari stressed that M2i2 endeavors to partner with as many different kinds of stakeholders as possible, including working with large and small companies.

"We're trying hard to work with entrepreneurs and startups, one because they've got the best technology that's out there, but also to bring that Silicon Valley DNA to our thinking and to our company to help us move faster and better and get access to the best talent outside the company," he said.

Bhandari and Jain acknowledged that regulation can be a hindrance to certain kinds of partnerships. But they also hope that the research Merck is funding will help to get some innovative technologies over their regulatory hurdles.

"That's why in some of these cases we're really pushing on the scientific angle, and our view is that that's going to make a contribution to the field as a whole," he said. "When you think about data coming from a variety of digital health sources -- whether it be mobile, whether it be the web, whether it be sensors -- you know that's an area that's in tremendous need of scientific validity and rigor. So we're hoping that by demonstrating that kind of scientific rigor and sharing those learnings, it actually pushes everybody ahead, and it's actually a contribution to the field."

Jain acknowledged that a lot of the learnings from these projects don't correspond directly to helping Merck sell more pills. But like everyone in health care, he contends, pharma needs to recognize its role is changing with the times.

"The ultimate incentive is that we as a company are gradually finding our way into the outcomes improvement business, as opposed to the pill and vaccine business," he said. "And as we do that, I think we realize that data and technology and health information technology are going to be critical enablers. ... What we're doing is starting to get comfortable as an organization using some of these technologies, using some of these platforms, and we think that they're all going to guide us to a future in which we're all reimbursed differently and we're all measured on the outcomes that are achieved in real world settings. So this is all a work in progress, and we recognize we can either be a part of the change or be subject to the change. This is our opportunity to help change the future."