My name is John Hammit. I’m the executive director and co-leader of HITLAB. Our job is to continue to foster the pursuit of and the successful execution of all things digital health. So I thought it would be worthwhile to talk a little bit about digital health, about some of the mysteries, measures, and indicators. I’m going to use these as little thought bubbles, the idea being to put something in your head to use as a lens through which you hear some of the discussions and points of views being shared. So first off, I’ll admit, I’m a geek. I love technology. I have a Oura ring that measures my cardiovascular condition and tells me how badly I’ve slept. I have an Apple watch with a dozen apps that tell me all things that I probably don’t need to know that I start to worry about. I have an Apollo Neuro vibration device over here that almost looks like a police location device, and what it does is gives me a therapeutic touch. Don’t think what you just did, shame on you. It actually has programmed vibrations that are supposed to be therapeutic, provide energy, relax, et cetera. I also wear a Muse headset, Muse, M-U-S-E. It’s a device that measures your brainwaves, and I have two, one for the day, one for the night. And it tells me how I’m thinking, what my energy level is, what my stress level is. So I am a well-measured, not well-managed, but well- measured digital subject. I’ve learned some things from all that measurement. I want to share that. Number one, three martinis after nine o’clock gives you a terrible night’s sleep and a hangover. So I think I knew that a long time ago, but being measured just simply gives me confirming data. Secondly, when I get stressed and I put on the Muse headset that is supposed to give me a sense of my well-being and my mental strength and my anxiety levels, it’s supposed to give me the capability to settle myself down. Damn thing doesn’t work. It doesn’t work when you’re stressed. What I have found, however, and where are my two best friends, Gabriela and DeWinnie. There you are. I’ve used their device, a simple little silicon egg, and I’ve had it since you guys launched it in 2019, I guess. And it’s a stress measurement device. When you squeeze it, it measures the strength of your grip, records it on your phone, you can play games. It’s good for, in my case, helping to moderate my blood pressure because there’s some evidence that a sustained grip over a period of time causes your cardiovascular system to relax. But I want to tell you, when I’m stressed, my grip strength goes up 100%. So the key point is that we are surrounded with toys, some which are fun, some which are useful, but we live in a world in which there’s a lot of digital energy and digital invention and digital innovation going on. And so in preparation for these few opening remarks, I thought I would gen up my newest toy, which is Johnny Mike. Johnny Mike is a AI app and I ask Johnny Mike questions and Johnny Mike gives me answers. So pretty cool. First question I asked, what has been the best digital health success in the last 12 months? And since we’re in Columbia, think of this as an essay question. You all think of the answers in your head and I’ll tell you the answers that Johnny Mike found. Telemedicine and remote consultations. Interesting. Nice category. Digital mental health platforms. Yep, we’re seeing a lot of that. Wearable devices and health tracking. I’m the guy. AI-assisted diagnostics and remote patient monitoring. Now those are some nice categories and we’ve seen a lot of innovation, a lot of invention in those categories, so makes some sense. So I said, hmm, what about the last 10 years? Is there any difference in the last 10 years versus the last year? Last 10 years. Telemedicine. Mobile health. Wearable devices, again. Remote patient managing. AI. Electronic health records. Now there may have been a lot of energy in electronic health records, but for those of us who occasionally get healthcare, they still aren’t cool and they still don’t work well. Digital therapeutics. Now that’s a favorite of mine because it’s essentially creating a therapeutic result from a digital intervention and we’re seeing an increased evidence of that, especially in the areas of mental and behavioral health. And finally, health informatics and data analytics. And so you see that there’s a little bit of overlap, 10 years versus 1 year. So, then curiosity got the best of me, and I said, hmm, what population health measures have improved in the last 20 years? A lot of money has gone into digital health. A lot of money has gone into health science. So are there some indicators and evidence that that money has provided a significant benefit? So the answers were, life expectancy has increased. I think COVID knocked that on its butt, but that’s coming back. Interestingly, reduction in infant mortality. Decline in communicable diseases. Decrease in maternal mortality. Better control of non- communicable diseases, cancer, et cetera. Smoking cessation, access to clean water and sanitation. Mental health awareness. So those are the improvements in health as seen by Johnny Mike on the data in the internet. So the important question. What health measures have improved as a result of the use of digital health? Is there a link between digital health invention, digital health launch, digital health solutions and outcomes? And the answers were a little more ambiguous. Access to health care. That’s healthy. Chronic disease management. Medication management. Health behavior tracking. Now, that’s a good one. And patient engagement. So in the world of internet data and the search through a semi— Johnny Mike’s not all that smart yet, but getting smarter— they’re seeing what I’d call very tenuous links between health outcomes and digital health. I’m going to go off on a segue. When I joined Johnson & Johnson as a senior executive in the 1990s, my boss was the executive responsible for the pharmaceuticals and diagnostics business at Johnson & Johnson. Joe, you were there. And the standard line on J&J at that time was— I’ll make up the numbers, but a $40 billion company with 70% of the profit coming from pharma. So I was in the right place, right? My boss says to me, first day, we are in deep poop. It takes us 10 years to develop a drug, and it takes $1 billion to develop a drug. Fix it. Because I was the guy who was supposed to figure out how technology could improve the business operation. So 1990s, $1 billion, 10 years. I asked Johnny Mike, how long and expensive is it to produce a drug today? Discovery and preclinical research, 2 to 5 years. Clinical trials, 5 to 7 years. Regulatory approval, 2 to 3 years, for a total of 9 to 15 years. So we have not collapsed the time frame with all of the investment in technology. And according to the Tufts Center for Study of Drug Development, it currently costs, on average, $2.6 billion to produce a drug and commercialize it. So for all of the effort in digitizing internal activity within pharmaceutical companies, it hasn’t improved very much. And so I’m beginning to scratch my head and saying isn’t there some evidence of success in the area of digital health? And I thought, aha, Livongo, Teladoc, they made a lot of money and they made a big splash. So I asked the question, did Livongo improve diabetes treatment outcomes? Simple question. And the answer was encouraging. There’s clinical evidence of improved glycemic control of people who are using the Livongo platform. Increased user engagement. Enhanced medication adherence are all good things in the world of diabetes treatment. And importantly, in a large population of employer-provided coverage that allowed Livongo products to be used, they saw a 22% decrease in the cost of care for people who were struggling with diabetes. And so that’s very good evidence of digital health making a difference in that population. So I think in spite of my humorous insights about the lack of evidence, I think that we have seen a number of examples and Livongo is certainly a stellar one. And again, my friends at Merck have capitalized on that and they helped make that successful. So I finally said, let’s look at the big picture. Let’s zoom out. And so I went to the authority CMS in the United States. And I found a report that was published in April of 2023. I’m going to quote from it. The United States spends twice the average of all of other OECD, Organization for Economic Cooperation and Development, companies – countries on health. Twice as much as the average of all the other countries. But, big but, has the lowest average life expectancy of that group of countries. Twice as much money, lowest life expectancy. And performs worst than the average on most population health outcomes and has more outcome-related disparities compared to other OECD countries. So that raises a very powerful question for us, and I’m going to suggest that you keep that in mind for the next three days. Are we getting our money’s worth as a population of people in need of better health care and better life and improved outcomes? Is digital health really producing a significant movement at large? That doesn’t mean it doesn’t have point solutions, but are we really making a difference for the 7 or 8 billion people who live on the planet today? CMS went on to say, according to the Commonwealth Fund International Study, found that the lower income adults in the US fare relatively worse on affordability and access to care. We heard that. They again studied it in 2021. They note that the US has the largest disparities between income groups except for preventative services and safety of care. So the charge I’m going to leave you all with this morning is you listen to the people who are sharing their point of view, sharing their experience, sharing their opinions, sharing their perspectives, and listen to it with an ear that says, can we make a difference? And what do we need to do differently to make that difference? Because if we’re going to, and I’m going to steal FFF’s phrase, if we’re going to make healthcare care, how do we do that with digital health?