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The Big Tech In Healthcare Report:
How Facebook, Apple, Microsoft, Google, & Amazon Are Battling For
The $8.3T Market
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Contents
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Key Findings
8
Market Drivers
24
Facebook
41
Apple
54
Microsoft
72
Google
90
Amazon
7
Note: “Big Tech” includes Facebook, Apple, Microsoft, Google, and Amazon.
Overview of big tech companies’ activities in healthcare
Both investor and executive attention
to healthcare peaked over the last
year…
•
Earnings calls mentions of
“healthcare” peaked in 2020 as the
businesses grappled with protecting
their workforces during the pandemic.
• Venture capital funding to healthcare
companies has also surged. In fact,
healthcare funding had a record
quarter in Q1’21, where companies
raised a total of $31.6B.
•
Big tech has invested in deals worth a
cumulative $6.8B since the start of
2020.
Big tech companies took new steps to increase their market opportunity in healthcare…
•
Facebook launched a preventative health solution in the US and a provider search tool to help
users find affordable care in their communities. Meanwhile, the company’s Oculus team is
working with teaching hospitals to deploy VR-based medical education tools.
•
Apple updated Watch and iOS to capture even more health metrics, including blood oxygen
level, and created a data sharing feature so users can share medical data with providers. The
company also launched a subscription-based streaming platform with exercise classes.
• Microsoft dropped $19.7B to acquire Nuance, a leader in conversational AI for healthcare. The
company also launched Microsoft Cloud for Healthcare, a tech stack for enterprise healthcare
organizations that combines AI, automation, and low-code app development.
•
Google launched a camera-based search tool that uses AI to diagnose skin conditions. The
company also launched an EHR search solution for providers, an interoperability solution for
payers, and a return-to-work test and trace program for employers.
•
Amazon launched Amazon Care, Amazon Pharmacy, and AmazonDx in the past year, all
consumer-focused healthcare services. The company also unveiled AWS for Health, a suite built
to support data science efforts within enterprise healthcare organizations.
Key Findings
8
Market
Drivers
9
Healthcare is on executives’ minds
BIG TECH IN HEALTHCARE: WHY NOW?
Mentions of “healthcare” in earnings calls, 2008 – 2021 YTD (7/6/21)
87% of the corporate officers
surveyed in big companies
said they believed the cost of
health benefits will become
unsustainable over the next
5-10 years.
How Corporate Executives View
Rising Health Care Cost and the
Role of Government, Kaiser
Family Foundation
10
Globally, healthcare spend climbed to $8.3T
by the close of 2018.
Global health spending is expected to climb
at a 3.9% CAGR between 2020 and 2024.
This cost burden weighs on payers, risk-
bearing providers, employers, and
consumers and creates opportunity for
industry outsiders to establish healthcare
vertical offerings.
Why? Because healthcare is an $8.3T
industry...and growing
11
The US leads in excessive spending at $3.8T
The US healthcare industry, which
accounts for 45% of total global health
expenditures — or $3.8T — is
underperforming compared to other
developed nations and has become a
target for disruption.
The US spends far more on healthcare
than any other country. Employers, like
FAMGA, bear much of the cost.
Despite increases in spending, life
expectancy in the US is falling, and
remains far lower than in other developed
countries.
12
Cost reduction pressure is driving healthcare out
of the hospital
Healthcare revenue continues its decades-
long march out of the hospital and into
outpatient markets, where the barrier to entry
is far lower.
As consumers seek care in an increasingly
oversaturated ambulatory market, FAMGA
companies are positioning themselves to
own a piece of healthcare’s new digital
ecosystem.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018Distribution of Inpatient vs. Outpatient Revenues
1995 –2018
Outpatient
Inpatient
13
New entrants are meeting patients where they
are with on-demand house calls…
Founded: 2014
Stage: Series D
Total Raised: $170M
Founded: 2013
Stage: Series D
Total Raised: $407M
Founded: 2016
Stage: Series C
Total Raised: $148M
Primary care
Urgent care
Acute care
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…while virtual care vendors are scaling digital
care delivery
Founded: 2013
Stage: Convertible Note
Total Raised: $735M
Founded: 2015
Stage: Series B
Total Raised: $66M
Telehealth
Remote patient
monitoring
Digital
therapeutics
Founded: 2013
Stage: Series D
Total Raised: $285M
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Covid-19 has accelerated healthcare’s digital
transformation…
“Approximately $250B — or ~20% — of all Medicare, Medicaid, and Commercial
outpatient, office, and home health spend, could potentially be virtualized.” –
McKinsey 2020 Virtual Care Study
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…especially in driving increased adoption of
new digital health tools
Use of newer digital health
technologies is continuing to
grow.
Adoption of telehealth,
wearables, and digital health
tracking surged in 2020.
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Where Big Tech
Is Making
Moves
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Tech giants are well
capitalized to
accelerate the shift to
digital
They are some of the world’s
biggest and most profitable cash
hoarders.
To transform the healthcare market,
big tech can fund moonshots,
pursue acquisitions, introduce their
own new solutions and services,
and place strategic bets in startups.
$196B
$157B
$135B
$90B
$68B
Apple
Alphabet
Microsoft
Amazon
Facebook
FAMGA & their cash stockpiles
As of March 2021
19
$1,546
$1,595
$2,627
$2,207
$3,729
$3,139
42
36
46
42
39
26
0
10
20
30
40
50
$0
$1,000
$2,000
$3,000
2016
2017
2018
2019
2020
2021
INVESTMENT TRENDS
Funding amount ($M)
Deal count
How FAMGA’s invested across healthcare
Total disclosed healthcare funding that involved participation from big tech venture
arms, 2016 – 2021 YTD (7/6/21)
20
FAMGA can leverage scale and large active
user bases…
WHAT ADVANTAGES DO TECH GIANTS BRING?
2020
200M+ Prime
Members
1.6B+ Facebook
DAU
1.65B Active
Devices
5.5B Searches
per Day
1.5B Windows
Users
1.85B
Daily Active Users (DAU)
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…as well as massive data and technology
capabilities
The virtuous cycle of
data network effects
Users contribute
more data
Which means…
Big tech companies can:
✔Leverage vast user bases to scale
and undercut incumbents on costs
✔Harvest their growing health data
✔Use data and innovation to offer the
latest technologies
And repeat this cycle.
Products get
smarter
More people use
the service
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FAMGA are also some of the world’s most
valuable and recognized brands
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MARKET DRIVERS
Consumerization of healthcare
Consumerization of healthcare is
creating opportunities for new
entrants to outshine industry
incumbents with low-cost, more
convenient services.
Healthcare’s cost burden
Employers and consumers are
bearing the brunt of rising
healthcare costs and are investing
in cost containment strategies.
Demand for AI and automation
Unrelenting administrative
burden has created
opportunities for big tech to
streamline processes with
AI and automation.
What’s driving big tech activity in healthcare?
Enterprise interest in smart devices
Consumer devices – like wearables and
smart speakers – are finding a home
in healthcare and are beginning to
draw subsidies from industry
incumbents.
Explosion of health data
Interoperability mandates are exposing
more health data than ever before.
Big tech is building the tools needed
to help consumers and healthcare
organizations put it to use.
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Facebook
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“We‘ve focused on trying to make sure that we understand the effects of
using our services on people’s well-being.”
EXECUTIVE’S PERSPECTIVE: FACEBOOK
Mark Zuckerberg, Facebook CEO
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BUILDING CONSUMER TRUST IN
FACEBOOK
Consumers turn to the internet for
health information, but distrust
what they see on social media.
Facebook is working to remediate
its reputation through partnerships
and fact-checking.
ESTABLISHING FACEBOOK CREDIBILITY
IN HEALTHCARE AI
Industry incumbents are partnering
with tech giants to accelerate use of
data and AI. The Facebook AI
Research lab is working on multiple
healthcare initiatives.
WHERE FACEBOOK IS FOCUSING
INCREASING OCULUS AND PORTAL
DEVICE SALES
New consumer devices are finding
a home in supporting health-
related use cases. Facebook sees
opportunities for Oculus and Portal
within the industry.
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Theme 1: Building consumer trust in
Facebook
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Blood donation
THEME 1: CONSUMER TRUST
100M people across 27 countries have
signed up to get notifications about
local blood donation drives.
Facebook’s suicide prevention algorithm
has flagged 1,000+ wellness checks to first
responders.
Suicide prevention
Opioid reduction
Facebook, Twitter, and Google have partnered
to offer resources to those struggling with
substance misuse.
Facebook’s partnerships on public health issues
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…as well as personal health issues
Preventative health
THEME 1: CONSUMER TRUST
Launched in 2020, Facebook’s preventative health tool is
designed to help its users keep up with routine health and
wellness tasks. Recommended actions are based on
guidelines from:
• The American Cancer Society,
• The American College of Cardiology,
• The American Heart Association, and
• Centers for Disease Control and Prevention.
The tool will initially focus on prompting users about
checkups related to heart disease, cancer, and flu
vaccinations.
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Tackling health-related misinformation head-on
Source: Amazon
THEME 1: CONSUMER TRUST
The World Health Organization has
partnered with WhatsApp and
Facebook to power its Health Alert
service.
The effort will disseminate COVID-
19 updates directly to citizens
across the globe in Arabic, English,
French, Hindi, Italian, Spanish and
Portuguese.
Facebook has focused its efforts on
combating misinformation during
COVID-19. The company fact checks
COVID-19 related posts, and directly
notifies users who engage with
misinformed posts.
Facebook has established a $100M
investment fund to support local
journalism during the pandemic. It has
committed another $20M to its Alliance
for Advancing Health Online.
A portion of those funds are being used
to create an international fact checking
fellowships and public health
communications strategies that will
combat health-related misinformation on
a global scale.
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Theme 2: Increasing Oculus and Portal device
sales
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Oculus in healthcare
THEME 2: FACEBOOKS HEALTHCARE DEVICE PLAYS: OCULUS
Healthcare partners are using Oculus, Facebook’s VR
platform, on a range of efforts, including pain
management, physical therapy, and senior wellness.
The Oculus team’s most widely adopted efforts have
grown from its work in VR-based medical education.
Launched in 2017 with Children’s Hospital of Los
Angeles, it has deployed VR-based medical training
programs to health systems globally.
Notable enterprise adoption of Oculus:
Cultivating demand for AR/VR in healthcare
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Portal in healthcare
THEME 2: FACEBOOKS HEALTHCARE DEVICE PLAYS: PORTAL
Facebook’s streaming video device, Portal, has seen an uptick in adoption by
enterprise healthcare organizations during the pandemic. Health systems are
deploying Portal to help combat social isolation and help patients stay
connected to their families while in the hospital.
"Veterans, families and caregivers will benefit through an
increased support system. Our goal is for Veterans to feel less
isolated through more communication. We believe this
technology will help Veterans who might otherwise be
unreachable." — VA Secretary Robert Wilkie
Notable enterprise adoption of Portal:
Building on existing smart device demand
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Next up: a Facebook wearable?
THEME 2: FACEBOOKS HEALTHCARE DEVICE PLAYS: SMARTWATCH
Following in the footsteps of Apple, Google,
and Amazon, Facebook is rumored to be
developing a smartwatch of its own.
Like others, Facebook’s initial smartwatch
is expected to include sensors aimed at
capturing health-related data points. Initial
designs are focused on heart rate
monitoring.
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Theme 3: Establishing Facebook’s credibility
in healthcare AI
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THEME 3: HEALTHCARE AI
The Facebook Data for Good team has
partnered with public health agencies globally
to help them monitor and forecast the spread of
the Covid-19.
In 2018, Facebook’s skunkworks lab – known as Building
8 — was actively soliciting healthcare partners willing to
share EHR data to support SDOH research.
The team was interested in combining Facebook’s
datasets with clinical data from EHRs to explore how
social engagement data could be used to benefit SDOH
and population health initiatives.
The project was disbanded due to patient data privacy
concerns.
Facebook’s data science teams are seeking
healthcare partnerships
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…as its AI team researches medical imaging
THEME 3: HEALTHCARE AI
With partners at NYU Langone, the lauded Facebook AI
Research (FAIR) lab developed machine learning models
that could interpret x-rays to help doctors predict how a
patient’s Covid-19 condition may progress. One aimed to
predict patient deterioration, while the other predicted
how much supplemental oxygen patient might need.
FAIR also developed models that can generate equally accurate
and detailed MRIs using about a quarter of the raw data
traditionally required for a full MRI. Since less data is required,
MRI scans can run nearly 4x faster. A team of independent
radiologists compared the AI-generated images with
traditionally captured images and could not tell which were
created using the new method.
38
Its Reality Lab is advancing brain-computer
interface research
THEME 3: HEALTHCARE AI
Facebook has partnered with a team of researchers at University of
California, San Francisco (UCSF) to support research working to help
patients with neurological damage speak again by detecting intended
speech from brain activity in real-time.
The team is reporting promising results. While prior studies have shown
that spoken words can be decoded from signals recorded from the surface
of the brain, decoding quality has been limited, with error rates north of 60%
for 100-word vocabularies. UCSF’s results demonstrated an average error
rate as low as 3% when tested with vocabularies of up to 300 words.
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Key takeaways & implications
40
This year, Facebook will focus on…
KEY TAKEAWAYS & IMPLICATIONS
Theme
Building consumer trust in Facebook
Increasing Oculus and Portal device sales
Establishing Facebook’s credibility in
healthcare AI
Takeaways
Consumers are wary of sharing health data with
Facebook or trusting health information on the
social media giant’s platform — a problem that
will limit its ability to pursue a meaningful
healthcare strategy. The company is working to
repair that reputation through customer-facing
industry partnerships.
There is established demand for smart
devices in healthcare — with incumbents
showing a willingness to subsidize the cost
on behalf of patients in some cases.
Facebook is actively cultivating AR/VR, smart
speakers, and potentially wearable devices to
compete in this market.
Facebook’s research teams are actively
pursuing healthcare partnerships — though
the tech giant lacks a broader strategy that
might lead to a commercial application of its
efforts. It also lacks the data privacy
safeguards needed to pursue SDOH
research.
Implications
Expect Facebook to ramp up efforts at combating
health-related misinformation by creating
dedicated communications channels for trusted
partners. For those interested, Facebook could
become a valuable patient engagement partner.
Expect Facebook to pursue its own device
subsidy partnerships within the industry.
Facebook will continue investing in AR/VR-
based digital therapeutics and publishing
research derived from its existing Portal
partnerships.
Facebook needs to earn the trust of
enterprise healthcare organizations.
Facebook’s biggest opportunity to make an
impact is in SDOH research, but that work
cannot scale until it proves to be a valuable,
and trustworthy, partner in other areas.
41
Apple
42
ORCHESTRATING HEALTH DATA SHARING
FOR APPLE CUSTOMERS
Apple is going far beyond connecting
consumers to their medical records. The
company wants to aggregate data, secure
it, create novel data points of its own, and
then orchestrate consumer-direct data
sharing with clinicians and researchers.
EXPANDING APPLE WATCH SALES WITH
SUBSIDY PARNTERSHIPS
With iPhone, Apple invented and scaled
subsidized device sales as a business
model. Today, the company is pursuing
the same strategy for Watch, working
with payers to blunt the sticker shock of
Watch for members.
WHERE APPLE IS FOCUSING
ESTABLISHING APPLE’S HEALTH AND
WELLNESS SERVICES
Apple is actively exploring how it
might bring its own health and
wellness services directly to
consumers.
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“If you zoom out into the future, and you look back, and you ask the
question: ‘What was Apple’s greatest contribution to mankind?’ it will be
about health. We're democratizing it. We're taking what has been with the
institutions and empowering the individual to manage their health.
Tim Cook, Apple CEO
EXECUTIVE’S PERSPECTIVE: APPLE
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Theme 1: Orchestrating health data sharing
for Apple customers
45
THEME 1: APPLE HEALTH DATA ORCHESTRATION
Apple Health Records is aggregating
EHR medical data from hundreds of
hospitals across the US, Canada, and
UK.
Apple Health and HealthKit work
together to maintain a central repository
of health and wellness data generated
from iPhone and Apple Watch sensors
as well as third-party apps.
Apple CareKit engages users around
daily symptoms and treatment plan
adherence.
Apple is aggregating health data for patients…
In its most recent update, Apple
unveiled a new health trends feature
that is designed to help consumers
track health metrics over time.
46
THEME 1: APPLE HEALTH DATA ORCHESTRATION
Apple’s iOS and Watch teams continue to
advance health and wellness measurement
capabilities with its own sensors and
algorithms. To date, Apple is tracking:
…and adding novel health metrics of its own
Activity
•
Cardio Fitness (V02 max)
•
6-minute walk distance
• Walking speed
•
Step length
•
Double support time
• Walking asymmetry
•
Elliptical
• Dance
• Hiking
•
Strength Training
• Core Training
•
Swimming
• Wheelchair
Clinical
•
Oxygen saturation
•
Resting heart rate
•
Heart rate variability
•
ECG waveform
•
Atrial fibrillation
Exercise Tracking
• Walk
•
Run
• Cycle
•
Row
•
Stair Step
•
Yoga
Apple’s research teams are actively
exploring new potential health indicators
Watch might be able to help monitor.
Current research partnerships include:
Apple Heart and Movement Study
A collaboration with the American Heart Association and Brigham
and Women’s Hospital this study will explore the links between
physical activity and heart health to gain a better understanding of
potential early warning signs.
Apple Women’s Health Study
Apple has teamed up with the Harvard T.H. Chan School of Public
Health and the National Institute of Environmental Health Sciences to
gain a deeper understanding of how certain demographic and lifestyle
factors could have an impact on menstrual cycles and gynecologic
conditions including infertility, menopause, and PCOS.
Apple Hearing Study
Conducted in conjunction with the University of Michigan, this
groundbreaking study will advance the understanding of how hearing
could be impacted over time by exposure to sound at certain levels.
47
THEME 1: APPLE HEALTH DATA ORCHESTRATION
Apple recently announced that consumers using its Health app will be able to securely share
their health information with their doctors or family members. Meanwhile, researchers continue
to leverage ResearchKit to engage with participants.
Facilitating consumer-directed data sharing
Providers
Researchers
Caregivers
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Theme 2: Expanding Apple Watch sales with
subsidy partnerships
49
THEME 2: SUBSIDY DEALS FOR WATCH
Apple is pursuing subsidy models for the Watch
In tandem with the launch of iPhone, Apple worked with cellular carriers to blunt the sticker shock of the
iPhone’s price. The strategy worked, and the iPhone continues to be Apple’s best-selling device. Today, the
company is pursuing the same strategy for Watch and is looking to partner with enterprise healthcare
organizations.
UnitedHealthcare is offering Motion
enrollees a six-month Apple Fitness+
subscription and a free Apple Watch
December 19, 2020
Medicare Advantage insurer
startup Devoted Health first to
subsidize Apple Watch
October 7, 2019
Aetna insurance customers can
now earn a free Apple Watch with
new Attain wellness program
May 2, 2019
50
Theme 3: Establishing Apple’s health and
wellness services
51
THEME 3: APPLE HEALTH AND WELLNESS SERVICES
Health services is a new line of business
In December 2020, Apple
launched a streaming exercise
service called Fitness+.
The service offers a wide
variety of guided exercise
routines with regularly updated
content.
Apple Piloted Running Its Own
Subscription Based Primary Healthcare
Service With 'Apple Doctors’
June 16, 2021
The company also reportedly explored
launching, or acquiring, its own direct
primary care company, similar to the path
Amazon is taking with Amazon Care.
Apple’s effort here has reportedly stalled.
52
Key takeaways & implications
53
This year, Apple will focus on…
KEY TAKEAWAYS & IMPLICATIONS
Theme
Orchestrating health data sharing for Apple customers
Expanding Watch sales with subsidy partnerships
Establishing Apple’s health and wellness services
Takeaways
Apple has been a leader in its effort to make health
data easier for consumers to access. It launched
Health Record in 2018 so consumers can store their
medical records in iOS. Apple recently announced that
customers will be able to share those records with
caregivers and other healthcare providers. Apple is
generating its own health data through iOS and Watch
sensors and algorithms.
Apple is negotiating with health plans to offer
subsidized Apple Watches to members. The
company has established an active subsidy
arrangement for iPhone and is working to
replicate that for Watch. The company has seen
moderate interest, landing agreements with 2 of
the largest payers in the nation, Aetna and
UnitedHealthcare.
Apple launched Fitness+ to bring workout content
to users for a monthly subscription fee. Like Watch,
the company is accelerating sales through subsidy
partnerships with payers. More recently, Apple
experimented with building its own virtual care
services.
Implications
Apple will engineer an increasingly comprehensive
picture of consumer health. With medical record data
on hand, consumers can seek care from new locations,
locally or virtually. Apple will continue to lead in this
space, building sensors, algorithms, and apps to
engage consumers on health and wellness.
Expect Apple and Google to make smartwatches
a standard member benefit. Subsidized
smartwatches are going mainstream. Beyond
Apple, Google has also inked deals with Anthem
and BCBSA to bring free or heavily discounted
smartwatches to members.
Apple could be the next big tech vendor directly
competing with care providers. Today, Amazon is
the only big tech vendor offering health services to
consumers. That could quickly change as Apple
ramps up its subscription business, if it can mature
its virtual care strategy.
54
Microsoft
55
“Artificial intelligence represents one of technology’s most important
priorities, and healthcare is perhaps AI’s most urgent application.”
Satya Nadella, Microsoft CEO
EXECUTIVE’S PERSPECTIVE: MICROSOFT
56
BUILDING CREDIBILITY WITH HEALTHCARE
AI RESEARCH
AI has the potential to automate
administrative tasks and close critical
insight gaps across the healthcare
value chain. Microsoft is building a
data processing pipeline purpose built
to support this transformation.
GROWING ENTERPRISE SALES WITH
MICROSOFT CLOUD FOR HEALTHCARE
Healthcare organizations were late to
cloud migration, but demand has
ramped up with the proliferation of
industry cloud offerings. Microsoft is
investing heavily to ensure its well-
positioned in the emerging market.
CULTIVATING DEMAND FOR MAGIC
LEAP AND KINECT IN HEALTHCARE
Innovation in consumer
electronics is supporting a wide
range of use cases in digital
health. Microsoft’s Xbox Kinect
and HoloLens are both finding
applications in healthcare.
WHERE MICROSOFT IS FOCUSING
57
Theme 1: Growing enterprise sales with
Microsoft Cloud for healthcare
58
Starting with an EHR-integrated patient
communication platform
THEME 1: MICROSOFT’S HEALTH CLOUD PLAYS
After the onset of Covid-19, health system leaders reported
that integrating telehealth solutions into existing clinical
workflows was the single leading technology problem they
were facing.
Microsoft was quick to respond. It has since secured
HITRUST certification for its Teams platforms and has
partnered with Epic Systems to integrate a Teams-based
telehealth solution directly within existing clinical workflows.
59
Adding enterprise innovation tools with prebuilt
healthcare connectors
THEME 1: MICROSOFT’S HEALTH CLOUD PLAYS
Microsoft’s entire Power Platform has
been optimized for enterprise
healthcare clients. The Power Platform
is HIPAA-compliant and has the
following features:
• Power BI: data analytics and
dashboarding
• Power Automate: RPA-based
workflow automation solutions
• Power Apps: Low-code application
development environment
Microsoft’s Hospital Emergency Response Power BI Template
60
Combining Apps and Azure services to drive
healthcare innovation forward
THEME 1: MICROSOFT’S HEALTH CLOUD PLAYS
Notable Clients
179 services are available within Azure’s HIPAA-compliant, HITRUST-
certified platform. These include several purposes built for healthcare
organizations:
• Azure API for FHIR: a FHIR-native data ingestion and preparation service designed to help
health systems prepare and normalize clinical data for data science projects
• Azure IoT Connector for FHIR: a service that leverages ML to assign FHIR resources to
clinical facts extracted from streaming IoT data
• Azure Health Bot: a chatbot service trained to support healthcare consumer engagement
61
THEME 1: MICROSOFT’S HEALTH CLOUD PLAYS
With its acquisition of Nuance
Communications, Microsoft absorbs an
advanced suite of solutions designed to
automate chart review and clinical
documentation tasks for doctors.
Nuance solutions are currently used by
more than 55% of physicians and 75%
of radiologists in the US and are used in
77% of U.S. hospitals.
While acquiring new tools to support clinicians
62
Theme 2: Building credibility with healthcare
AI research
63
Healthcare clients are partnering with Microsoft
for AI support…
THEME 2: MICROSOFT’S AI IN HEALTHCARE EFFORTS
Humana will partner with Microsoft to
build predictive health care solutions
using Azure cloud, Azure artificial
intelligence, and voice technologies.
October 21, 2019 |
Providence St. Joseph Health will develop
new technologies that will harness the
power of Microsoft Azure and AI to
transform the care experience.
July 8, 2019 |
John’s Hopkins Medicine partners with
Microsoft to accelerate precision
medicine with the power of Microsoft
Azure, and its AI capabilities.
June 18, 2020 |
Novartis and Microsoft announce
collaboration to transform medicine with
artificial intelligence.
October 7, 2019 |
64
THEME 2: MICROSOFT’S AI IN HEALTHCARE EFFORTS
EHR vendor Epic released an AI tool that predicts the likelihood
of no-shows to assist practices making targeted overbooking
decisions. Potential for explicit discrimination was obvious
because the predictive model included personal characteristics
that could result in healthcare resources being systematically
diverted from individuals who are already marginalized.
Researchers identified racial bias in a widely used
algorithm published by Optum. The authors estimated
that the racial bias discovered reduces the number of
Black patients identified for extra care by more than
half.
…because industry incumbents are not
inspiring confidence
65
Microsoft is working to differentiate its
technology with ‘Responsible AI’ research
THEME 2: MICROSOFT’S AI IN HEALTHCARE EFFORTS
Microsoft has secured more patents related
to medical technology than any other big tech
vendor, followed by Google and then Apple.
Today, that research is heavily focused on
bringing governance and technology to the
challenge of building ethical AI.
In addition to conducting its own research, it
funds outside research efforts focused on
building new tools and governance strategies
to improve AI fairness, data privacy, reliability,
and safety.
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…and an ‘Explainable AI’ output
THEME 2: MICROSOFT’S AI IN HEALTHCARE EFFORTS
As the healthcare industry continues to move forward
with AI implementations, the call for Explainable AI has
grown.
Doctors need more than a risk score; they need to
consider the underlying factors that contributed to a
model’s prediction for their patient. Model outputs
produced by “black box” algorithms are notoriously
difficult to explain.
Microsoft is working to fix this with InterpretML, an
open-source toolkit designed to bring clarity to model
outputs.
Why?
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Theme 3: Cultivating demand for Magic Leap
and Kinect in healthcare
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Capitalizing on enterprise demand for Kinect
THEME 3: EXTENDING HEALTH INNOVATION WITH SMART DEVICES
Kinect, Microsoft’s motion-sensing smart
camera solution, has a long history in healthcare,
supporting early remote physical therapy efforts,
as well as several gamification solutions.
More recently, the platform has found a home in
hospitals, monitoring for falls and evaluating
newborns for possible movement disorders.
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Cultivating AR/VR use cases in healthcare
THEME 3: EXTENDING HEALTH INNOVATION WITH SMART DEVICES
HoloLens, Microsoft’s AR/VR platform, is also finding a
home in healthcare. The company directly markets the
device to the healthcare industry, with a partner
ecosystem in place to address
• Medical Training
• Surgical Planning and Intraoperative Guidance
• Acute Telehealth and Care Collaboration
At $3,500 USD each, HoloLens is an expensive piece of
hardware with a limited number of solutions ready for
use. Microsoft is overcoming this by providing clients a
way of building custom solutions on Azure.
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Key takeaways & implications
71
This year, Microsoft will focus on…
KEY TAKEAWAYS & IMPLICATIONS
Theme
Growing enterprise sales with Microsoft Cloud for
healthcare
Building credibility with healthcare AI research
Cultivating demand for Magic Leap and
Kinect in healthcare
Takeaways
Microsoft is building an innovation platform for
enterprise by combining Power Platform, Azure, and
Teams to support AI, automation, and low-code app
development efforts. This tech stack is HITRUST-
certified and FHIR-enabled and comes with
architecture plans to address common innovation
use cases in healthcare.
Traditional health IT vendors and enterprise
incumbents are fielding models that perform poorly in
the wild, lack clinical explainability, and in many cases
are biased toward already disadvantaged members of
society. Microsoft is investing and partnering to
position itself as a leader in how to implement AI
safely and fairly in healthcare.
Microsoft lacks a wearable, though it is
rumored to be exploring its options in that
space. Instead, Microsoft is focused on
growing its Azure Kinect and HoloLens
device sales. Healthcare vendors have the
potential to be an active buyer if the ROI
can be proven.
Implications
Expect Microsoft to rapidly expand its market
position supporting enterprise health innovation.
Microsoft is the best-positioned big tech vendor to
support digital transformation efforts among
enterprise healthcare organizations. Its acquisition
of Nuance will further accelerate its already strong
momentum.
Microsoft will differentiate on AI strategy and
governance, rather than just building more tools. For
several years, cloud providers have been competing
for enterprise healthcare market share by lowering the
technical barriers to adopt AI and automation. Expect
the next generation of tools to focus on responsible AI,
model monitoring, and data governance needs.
Microsoft will work to prove the ROI in
AR/VR and IoT smart cameras. To build
enterprise demand for its devices, it will
cultivate a marketplace of purpose-built
apps and mature its development
environment to cater to build or buy
strategies in AR/VR and smart cameras.
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Google
73
“Healthcare offers the biggest potential over the next 5 to 10 years for
using artificial intelligence to improve outcome.”
Sundar Pichai, Google CEO
EXECUTIVE’S PERSPECTIVE: GOOGLE
74
GROWING ENTERPRISE SALES WITH GOOGLE
CLOUD FOR HEALTHCARE
Google’s industry cloud for healthcare
combines its Google Workspace
productivity suite with Google Cloud
Platform data storage and innovation tools.
The company is aggressively pursuing the
“industry cloud” market by contributing its
own healthcare solutions.
CREATING CONSUMER DEMAND FOR GOOGLE
PRODUCTS WITH HEALTH FEATURES
BUILDING BRAND DIFFERENTIATION WITH
HEALTHCARE INNOVATION
From its earliest days, Google’s
research teams have been bullish on
healthcare applications. Not all efforts
have paid off, as is par for the course
with moonshot labs, but Google
persists and its reputation as an
innovator within the industry benefits.
WHERE GOOGLE IS FOCUSING
Google is building healthcare-specific
tech into a wide range of its existing
consumer products, including search,
Android OS, Fitbit, and Nest, to improve
clinical outcomes for users.
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Theme 1: Creating consumer demand for
Google products with health features
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Mental health
THEME 1: CONSUMER HEALTH TECH
Google Search presents 4 clinically-
validated mental health assessments
when users search for related terms.
Google has partnered with local health
agencies to ensure reputable, local
information is being displayed when users
search about Covid-19.
Covid-19
Google is baking its health solutions into search
Google fields 70,000 health-related searches per minute
"People are asking us about conditions, medication, symptoms, and insurance questions. In this case we are organizing the
world's health information and making it accessible to everyone.” — David Feinberg, MD and VP Google Health
Dermatology
Google Search allows users to take a
picture of their skin condition and uses
AI to identify possible causes (limited to
Europe at this time).
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THEME 1: CONSUMER HEALTH TECH
…as well as the Android OS
Google’s Android OS and
Wear OS have been maturing
their health and wellness
capabilities for years.
Google works with several
notable industry partners on
these efforts, including:
In more recent weeks, it has
been reported that the
Google Health team is
building an Apple Health
Records-like app that will
allow users to download and
store their medical records
data on their personal
devices.
In June 2021, it was revealed
that the team responsible for
this work was transferred to
the Fitbit organization.
Health and wellness support
Health record data
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It’s betting big on its own wearable strategy
THEME 1: CONSUMER HEALTH TECH
• Activity
• Sleep patterns
• Sp02
• Respiration rate
• Skin temperature
• Resting heart rate
• Heart rate variability
•
ECG waveform (includes AI to
spot atrial fibrillation)
•
Electrodermal activity (used to
monitor stress levels)
In 2019, Google acquired Fitbit for $2.1B to compete
with Apple and Samsung in the wearables market.
Since then, Google has shifted much of its Google
Health team to Fitbit and has announced intentions
of migrating Fitbit to its Wear OS operating system.
Commercially, Fitbit has found success pursuing
subsidy partnerships with insurers to drive sales.
Notable partners:
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Google Nest now also tackles consumer health
THEME 1: CONSUMER HEALTH TECH
The team at Nest has updated its Nest Hub to
passively track sleep patterns without requiring a
wearable.
Nest’s new sleep tracking feature is built with Soli,
a miniature radar designed to support gesture
control and motion sensing. It provides detailed
movement data to track sleep without a wearable
or a camera.
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Theme 2: Growing enterprise sales with
Google Cloud for healthcare
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Google’s industry cloud strategy starts with a
HITRUST certified Google Workspace
THEME 2: GOOGLE’S HEALTH CLOUD PLAYS
Google has secured HITRUST certification for its entire Workspace product suite, giving enterprise
healthcare organizations a SaaS-based productivity suite capable of supporting patient
communications, scheduling, messaging and collaboration, and even telehealth visits.
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Adding interoperability tools to streamline
health data research
Source: Amazon
THEME 2: GOOGLE’S HEALTH CLOUD PLAYS
Notable
Clients
Cloud Healthcare API allows
healthcare organizations to integrate
on premise enterprise systems with
Google Cloud through HL7v2
messages, FHIR v4 APIs, or DICOM.
Consent Management allows healthcare
organizations to comply with interoperability
laws by offering consumers control of sharing
their data.
De-identification models scrub clinical
data of PHI prior to data analysis or
external sharing
HITRUST certified data cloud services
support data preparation, training, and
visualization.
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Source: Amazon
THEME 2: GOOGLE’S HEALTH CLOUD PLAYS
In February, Google Health launched Care Studio, an
AI-powered EHR search tool designed to aggregate
clinical information from many sources and present it
based on its relative importance.
Google rounds out its industry cloud strategy
with SaaS solutions for enterprise healthcare
Care Studio
Streams
Google Health absorbed Streams from DeepMind in
November 2018. The app acts as a virtual assistant
for clinicians, monitoring patient condition with
predictive analytics and pushing alerts to the care
team. Today, the app is used by the NHS to forecast
kidney injury in hospitalized patients.
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Theme 3: Building brand differentiation with
healthcare innovation
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THEME 3: HEALTHCARE INNOVATION
Google has developed models that
analyze retinal images and identify
more than 50 eye diseases,
including diabetic retinopathy and
macular degeneration.
Google is building models to detect a wide range
of conditions…
Ophthalmology
Cardiovascular
disease
Anemia
Retinal scans have also proven to
be valuable in assessing
cardiovascular risk. Google is
working on models that predict
heart attack and stroke.
Retinal images are also
supporting work to quantify
hemoglobin levels and identify
anemia.
Multiple “explanation” techniques suggest that
the optic disc is important for detecting anemia
from images of the back of the eye.
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THEME 3: HEALTHCARE INNOVATION
Google’s research on mammography interpretation
found that its model spotted breast cancer with
greater accuracy, fewer false positives, and fewer
false negatives than experts. A follow-on study is
evaluating how this model performs in the wild.
…such as models tackling cancer screening…
Breast cancer
Google’s research on lung image
analysis improved lung cancer detection
uncovered 5% more cancer cases while
reducing false-positive exams by more
than 11%.
Lung cancer
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THEME 3: HEALTHCARE INNOVATION
Google is working on models that can help
pathologists score tumor aggressiveness in
prostate cancer faster and more accurately.
…and cancer treatment
Assessing cancer
aggression
In ongoing work with Mayo Clinic, Google hopes
to speed up radiotherapy treatment planning for
head and neck cancers by automating manual
image annotation work that can take several
hours per patient.
Accelerating
radiotherapy planning
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Key takeaways & implications
89
This year, Google will focus on…
KEY TAKEAWAYS & IMPLICATIONS
Theme
Creating consumer demand for Google products with
health features
Growing enterprise sales with Google Cloud for
healthcare
Building brand differentiation with healthcare
innovation
Takeaways
Google’s consumer health efforts span the breadth of
its organizational chart, with Search, Fitbit, Android,
and Nest. The company has been much slower to
market in some areas – such as medical record data
aggregation services or atrial fibrillation alerts – but
first to market with others, like DermAI.
Behind Microsoft, Google has the most publicly
disclosed healthcare clients leveraging its industry
cloud solutions. The company was also just behind
Microsoft on securing HITRUST certification for its
public cloud infrastructure and introducing native
support for FHIR data ingestion.
Google’s healthcare research is heavily focused
on building AI to support diagnostics, clinical
surveillance, and treatment optimization. Its
labs have pursued healthcare initiatives since
their earliest days, and some models are
already reaching commercial availability.
Implications
Google’s consumer health strategy and pace of
innovation will remain fractured. Google’s consumer
health strategy is poised to remain siloed. Its core
healthcare strategy team, Google Health recently
dissolved its consumer health teams, moving them to
other parts of the business. Do not expect a well-
orchestrated consumer health strategy.
Google and Microsoft’s cloud offerings will become
cornerstones of the enterprise tech stack. Expect
cloud services to be as critical to healthcare
operations as the EHR, with market share
disproportionately landing with Google and
Microsoft. These new enterprise revenue streams
will accelerate GCP’s healthcare innovations.
As Google’s healthcare AI evolves, a more
expansive clinical UX will follow. Today, Care
Studio and Streams deliver Google AI to
clinicians. As more models reach commercial
readiness, expect these to evolve into more
robust insight delivery solutions. Also expect
enhancements for radiology and pathology.
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Amazon
91
“What we don't want to see is a handful of big entities, big companies, big
healthcare systems dominating a sector."
Babak Parviz, VP at Amazon Grand Challenge
EXECUTIVE’S PERSPECTIVE: AMAZON
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BUILDING A HEALTH SERVICES BUSINESS
FOR CONSUMERS AND EMPLOYERS
Consumerization of healthcare is
creating opportunities for new entrants
to outshine industry incumbents with
more convenient services. Amazon is
all in, with telehealth, pharmacy, and
diagnostics offerings for consumers
and employers.
GROWING ENTERPRISE SALES WITH
AWS FOR HEALTH
Industry incumbents are partnering
with public cloud leaders to
transform medical care. Amazon is
working hard to make AWS a top-
tier contender in the industry cloud
market.
WHERE AMAZON IS FOCUSING
BUILDING CONSUMER DEMAND FOR
AMAZON DEVICES
Consumer devices, like wearables
and smart speakers, are finding a
home supporting many health-
focused use cases. Amazon sees
opportunities for its and smart
speakers. wearables
93
Theme 1: Building a health services business
for consumers and employers
94
Amazon Care
THEME 1: CONSUMERIZATION OF HEALTHCARE
Following the lead of a growing litany of unicorn startups, Amazon
is now competing in the telehealth market.
Launched to address rising employee medical costs, Amazon Care
brings text, video, and in-person care to members. The platform
delivers primary, urgent, and preventative services both digitally
and in-person. It also offers services addressing sleep issues and
joint pain.
The company piloted the program with its own employees and is
now selling the service to other self-funded employers nationally.
Amazon builds a better employee health
experience…
95
Amazon Dx
THEME 1: CONSUMERIZATION OF HEALTHCARE
Initially launched as a service for its own employees,
Amazon has opened its Amazon Dx service to the general
public.
The on-demand diagnostic lab is offering an FDA
emergency use authorized Covid-19 diagnostic tests for in-
home use by consumers. Its processing lab has achieved
CLIA and CAP certification — gold standards in laboratory
and pathology credentialing.
Amazon Pharmacy, built on its PillPack acquisition,
brings price transparency, home medication delivery,
and on-demand pharmacist consultations to the mail
order pharmacy market.
Amazon Pharmacy
…alongside a portfolio of ancillary services
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Amazon’s consumer health strategy takes
shape
THEME 1: CONSUMERIZATION OF HEALTHCARE
Pharmacy
services
Diagnostic
testing
Direct
patient
care
In less than a year, Amazon has launched services providing direct
patient care, pharmacy services, and diagnostic lab testing – a
blistering pace of product launches. Amazon aims to differentiate
with a more convenient patient experience and reduced overall
costs for employers, payers, and consumers themselves.
There’s room to grow. Currently, Amazon Dx only offers Covid-19
testing but there is sustained demand for expanded at home
testing services, particularly for STIs, fertility, hormone levels, and
screenings for common conditions such as Celiac and Lyme.
There is also untapped opportunity for Amazon in diagnostic
imaging services. A key cost driver in the US, diagnostic imaging
services account for $100B in largely unnecessary annual spend –
and a growing number of images can now be acquired by in-home
technicians.
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Theme 2: Growing enterprise sales with AWS
for health
98
AWS is building a FHIR data processing pipeline
THEME 2: AMAZON’S HEALTH CLOUD PLAYS
Notable Clients
120 services are available within AWS’s HIPAA-compliant, HITRUST-certified
platform, including:
• HealthLake: a FHIR native data ingestion and preparation service designed to help health systems
connect EHR data with AWS AI (SageMaker) and Analytics (QuickSight) tools
• Transcribe Medical: a speech-to-text service built with a clinical vocabulary trained to support
medical transcription use cases
• Comprehend Medical: a service that leverages ML to extract and code key clinical facts from
unstructured text
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A marketplace of pre-
trained models for
healthcare
THEME 2: AMAZON’S HEALTH CLOUD PLAYS
Amazon has cultivated a marketplace of pre-trained
models specifically designed with enterprise
healthcare in mind.
While Comprehend Medical and HealthLake are
designed to transform healthcare data into a
standardized FHIR data lake, the SageMaker model
market brings plug-and-play predictive algorithms to
help organizations generate immediate value from
that data.
100
Alexa brings voice AI to healthcare
Alexa, Amazon’s HIPAA-compliant virtual
assistant, brings conversational AI to consumers
and healthcare organizations through a variety of
smart devices.
Notable enterprise adoption of Alexa:
In 2020, Amazon launched Alexa Care Hub, a free
virtual assistant designed specifically to support
independent seniors and their family caregivers.
THEME 2: AMAZON’S HEALTH CLOUD PLAYS
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Theme 3: Building consumer demand for
Amazon devices