Digital Health for Ordinary Citizens - Tobias Silberzahn, Leader of McKinsey & Company's Global Health Tech Network

DR. RISHI DESAI: Hi, I'm Dr. Rishi Desai. Over the past two years, we've been keeping close track of the evolution and adoption of healthcare technologies in the U.S., but today, we're going to explore what's happening in Europe and specifically in Germany. Our guest is Tobias Silberzahn, a partner at McKinsey & Company in Berlin and leader of the company's Global Health Tech Network. His educational background is in biochemistry, and specifically, immunology. So much to go through today with you, thanks for being with us today. 

TOBIAS SILBERZAHN: Thank you for the invitation, Rishi. It's awesome to be here and looking forward to the discussion. 

DR. DESAI: Fantastic. So I guess to dive right in, I'd like to just start with getting to know a bit more about you, what got you first interested in science and specifically biochem and immunology, which is an area that I majored in in college. So I'm excited to hear that you were interested in that as well.

SILBERZAHN: Cool. Yes, indeed, I'm originally a biochemist, immunologist, and did cancer research originally. That was inspired by my family, since we have had quite our share of cancer. Therefore, I thought that it would be good to contribute towards getting more people with cancer cured. 

DR. DESAI: Do you have a mentor in your life, like when you were growing up, that opened the door for this sort of stuff for you and made you think that this could be an area you might be interested in?

SILBERZAHN: That's a great question. Not at this stage, but when I later thought of maybe going beyond basic research, and thinking about more of how things work at the health system level or healthcare innovation level overall, I did have a mentor who opened the door for me and introduced me to pharmaceutical research and development and digital health. I'm still working with him more than 10 years later. It has been not only the person who opened the door for me, but also the person who then personally inspired me and also encouraged me to move on that path and take on responsibility myself.

DR. DESAI: That's remarkable. One of the things that I've found is a common theme is good mentorship. It kind of opens a lot of doors for people and allows people to imagine possibilities that they couldn't imagine on their own. Do you mind sharing a little bit more about exactly, maybe, how you met your mentor, and what about them got you excited about this field?

SILBERZAHN: I think it was on the one hand, sort of his just personal leadership trusting in people and trusting also that young people can make a positive difference. And so, that personal leadership dimension there, but surprisingly, he was also a biochemist. Then the thinking of how to move from basic research to life science innovation and also combining that with digital health and getting it into the health system. 

If I now take a step back, and since you mentioned Germany, we have now the question of how do we want to combine four puzzle pieces: number one, our traditional medical interventions that have been there for many decades, number two, the 25-ish digital health interventions that are now coming, from online appointment booking, to tailored consultation, to digital therapeutics, number three, the whole piece around prevention—sleep, nutrition, fitness, and stress management, and the number four, the whole piece around precision medicine, the genomic space medicine. How do we bring those four things together for improved health and well-being of citizens? I think that's a big question right now in Germany, but I would say also in most other countries. 

DR. DESAI: Do you mind walking me through what got you to be able to navigate that? A lot of folks who are doing basic science can do basic science research, but aren't sure how to navigate getting into digital technologies and things that impact people in daily life. What was your journey into that space? 

SILBERZAHN: My personal journey has been very much like that of a busy person doing lots of stuff. Then, I personally just realized that I don't feel great on a Monday. I don't feel very good on a Tuesday. I don't feel terribly well on a Wednesday. So I was like, “Why is that? I'm married to a great woman. I have a great family. I love my job. Why do I feel not very well most of the time?” 

That was almost 10 years ago. Then, I got into stress management, coaching, mindfulness, and meditation. From that, I got into sleep, and improving my sleep. After that, I got into nutrition, and finally, I also got more into fitness and then trying to wrap it all together. For me, that was now almost 10 years of a trial-and-error journey. You could also say a bit of biohacking and finding my own micro habits, which led, on the one hand, to me working with a team within our own company and thinking about what should be our health and well-being program for our few thousand employees in Germany and Austria. It has also led to me doing a lot more work in the digital health space, and thinking about digital health from a citizen perspective: how can digital health benefit an ordinary citizen or an ordinary patient? That's then often more about real engagement, convenience, and also, fun, and less about interoperability and the sort of technical topics that are often being discussed in the industry. 

DR. DESAI: Do you feel like that kind of biohacking that you did for yourself where you  did an exploration of sleep, and meditation, nutrition, and exercise—is that culturally becoming more normalized in Germany? Do you notice a lot of people thinking along those lines? If so, when did that begin in Germany, or Europe, more broadly?

SILBERZAHN: Yes, great question. Thinking about it, I feel that a lot of that started with the wearables. Well, people sort of started becoming more aware of tracking some parameters. It's also, now, a bit of a sort of additional push of caused by the whole tragedy of COVID, where people, especially on the mental health side, feel that they need to pay closer attention to staying in a positive mind frame, and getting to what we in our health and well-being program describe as micro habits that help you be happy and healthy during your week, or during your life. 

DR. DESAI: Do you think that these micro habits are things that are gaining more and more traction in Europe, or do you feel like you're seeing this, from your perspective, around the world? Is Europe ahead of the curve, behind the curve, or kind of at par? What is your sense of where Europe fits with this, relative to the rest of the world? 

SILBERZAHN: If I look at broader health and well-being offerings, I feel that currently in Europe there is quite a bit of interest to tackle those topics on the employer level, bringing health and well-being more as almost like a skill in some places, where then people are equipped to be happier and healthier and more balanced than they used to be. There is quite a bit going on on the employment level. 

I feel that if I look more towards the digital health world and digital health of multi-service offerings -- like tying together online appointments, booking tailored consultations, digital therapeutics, chronic disease management remote monitoring, electronic patient records, and so on -- there I feel that Asia is moving quite quickly in that space because they have several digital health ecosystems, where there are already, I would say, 300-plus million people as part of a broader ecosystem, and then digital health is part of such multi-service offerings, part of such an ecosystem. There, I would say Europe is further behind, because the health infrastructure, the built infrastructure like hospitals, etcetera, are much more dense and much more available than in many parts of Asia. Therefore, there is less pressure to create those digital healthy ecosystems. 

DR. DESAI: That's interesting. Do you mind just citing, are there specific examples in Asia that you've noticed as being in the lead because of maybe the infrastructure issues that you just mentioned putting so much pressure on them to do so?

SILBERZAHN: There are a few examples I would mention in China, where there are several hundred million in those digital healthy ecosystems. What I find interesting, from a European perspective, is that they combine things that might be coming from different silos in Europe. They often include the provision of care as well as health insurance offerings, which are two different silos, you could say, in European healthcare. But then I think, similarly, we see some of those digital health ecosystems emerging in India, where it's also a virtualization approach. Some of the health-related institutions in India feel that today, they are serving a certain amount of people that are in driving distance of the institution. For them, now, such a digital health ecosystem that brings together different things, from tailored consultation, to online pharmacy, to diagnostics at home, actually helps to expand access also into areas where they, or where people generally, have less access to high-quality health services. 

DR. DESAI: There's a phrase that I think is important for me to fully understand, and for our listeners, too, which is the “digital health ecosystem.” You've used it a number of times and I want to make sure I'm hearing your explanation of it. So the classic model, let's call it is, let's say I have diabetes. It's very poorly managed. I see my doctor. I drive to my doctor's appointment, I go there maybe every three months, they check my hemoglobin A1C, and maybe it keeps climbing upwards and they tell me, "You know, Rishi, you should eat better. You should exercise." I go home, I don't eat better. I don't exercise, and of course, my A1C gets worse and worse. That's one model.

What does the digital health ecosystem model look like for that kind of patient? What would they be wearing? How often would they check in? What would be different? Do you mind just walking through that with me?

SILBERZAHN: Sure. I'm happy too. Thank you for bringing that up. I feel the terms platforms and ecosystems are widely used, and a lot of people understand very different things. When I now use the word ecosystem, I think of it as an interconnected set of services, through which then citizens or users can fulfill their needs in one integrated experience. 

If I would sort of just use an example three or four years ago, we would have point solutions for digital health. I would have one app for online appointment booking. I would have another app for medication management. I would have a third app for the tailored consultation. I would have a fourth app for the online pharmacy, and I would have a fifth app, which would be my electronic patient record. When I talk about these digital health ecosystems in India, then, it is an interconnected set of services. A lot of what leads to their adoption, and in the research that also we've done on these ecosystems, is that they are built around citizen convenience. 

So if I walk that through, it could mean that I'm—if we take the diabetes example, if we think that I'm a diabetes patient, then I usually would have some sort of wearable, and I could be part of a patient remote monitoring program. But then, I would submit my blood glucose level or HbA1C levels regularly. I would also submit my weight regularly, and maybe even my steps and my sleep. Now, I'll quickly turn futuristic. But today, that allows the doctor to look at that and give me coaching advice, saying, “To be on a better track, why don't you try X or Y? “

But what I'm also quite excited about is that you then can link digital therapeutics or chronic disease management programs into this. Then, maybe it's not the doctor coming up with the tips based on the data that they see, but it's also a program built on cognitive behavioral therapy, matching and gamification that keep me on track in a fun way, not in that way that a very serious doctor intervenes and says you need to do X and Y. I think that is what we see today. 

In the future, of course, the more futuristic stuff is that we then can also go towards disease prediction and interception. That, of course, would work in a way that if I use certain wearables that then would track my sleep, heart rate, maybe soon a continuous blood pressure monitoring which is on the horizon, and other things, then, Rishi, if you would run that program, you would be able to say, “Well, based on Tobias's sleep pattern, fitness pattern, heart rate pattern, blood pressure pattern...” You can build a relatively simple algorithm already today, where you say, “Well if he continues on that track, there is a high chance that he will have diabetes in five years,” or a certain chance that he will have heart failure in five years. Then, the beautiful thing is that you can intervene, and say, “Look, Tobias, you are on the track, but let us try XYZ to intercept here,” and don't get down that path. I think that is one of the cooler things on the horizon. 

DR. DESAI: This is very, very interesting and I love the example that you're offering, because I'm imagining a scenario where let's say, I'm your doctor and I see your heart rate went up, blood pressure went up, you woke up out of your sleep. I would know that you had a nightmare. I would know that based on the data. A lot of people I would imagine would say, “Well, that's the kind of information I don't want my doctor to just know,” or “I don't want out there in the data. I don't want my data on and things that are that private to be out there.” I'm curious, in Germany, specifically, what is your sense of people's attitudes towards their personal data being used? 

What you're describing makes perfect sense. Better diabetes management, very few people would argue against that. But I can also imagine a lot of people being concerned about this and the ramifications of it. We always hear about data breaches and things like that. So, what is your sense of the general populace's willingness to be part of this new way of taking care of themselves?

SILBERZAHN: Yes, that's a great question. From my perspective, and also from a person that runs a health and well-being program for a few thousand people, I guess it's a customer segmentation question. Some people are extremely interested in that, and are grateful in looking forward that they finally found something that helps them feel better or be better. But then there are people when it comes to health and well-being who might say, "Oh I've tried this and I've tried that, and it didn't work, and I'm frustrated. Leave me alone." There are other people where it depends on the situation. They want, of course, to be in the driver's seat. 

I think there are two pieces of things I want to share from a German perspective right now. On the one hand, there have been surveys of the population, another one just going to be read out, a large one in May, asking people, “How are you feeling about your health data, tracking your health data and sharing your health data?” Actually a very large percentage even said—and I think that was more than 50% in our survey last year—“I would donate my health data if it is for a good cause like helping with healthcare innovation or finding cures to diseases.” Even if it doesn't benefit themselves in a data donation kind of mindset. That was surprising to many. 

I think the other part is, and that is now a discussion that is currently being held in Germany about the public electronic patient record. In Germany, there is a law that every public health insurance needs to provide an electronic patient record to every insured citizen. Now, there is currently a discussion, on the one hand, of what are the use cases? How does this electronic patient record benefit the citizens and patients in real life? Then, there is a second discussion around data management and also the granularity of data management. 

I feel that the public debate is going in the direction of saying that citizens having granular data management rights, and also granular data access rights towards certain other stakeholders. So it could be that, because I like Dr. Rishi very much, I give him full access to all my health data. But there might be another person that I don't like as much as I like Rishi. Then, I only partially share my data, but I'm in the driver's seat. So that's a bit of the discussion that I see in Germany but also in Europe, more broadly, when it comes to health data management and also health data sharing. 

DR. DESAI: That makes a lot of sense. Obviously, this is a very moving target right now as people are I think for the first time, really thinking hard about what their data even means, and who owns it, things like that. So I think that's very logical. 

I'm curious, we are a teaching company and so we're always looking for angles to teach people. You have a lot of experience here. What is something that you think is a myth or a misunderstanding that you'd like to clear up for me or for our audience, about what you do and what you've seen, especially in the German context?

SILBERZAHN: Well, I would say in the German context, there's been a lot of discussion in the last two years about the digital therapeutics regulation and reimbursement in Germany. A lot of people have been talking about this integrated regulatory reimbursement process, and of course, for a digital therapeutics category, having software with a medical effect. In the US, one often talks about software as a medical device. But I think that is promising, because at the end of the day—you as a doctor know much better than me—at the end of the day, a lot related to health and well-being is about sustainable behavior change in terms of sleep, in terms of nutrition, fitness, and stress management. 

I feel there's been a lot of focus on one category of digital health. But overall, there are 25 plus categories of digital health. It goes from digital therapeutics to patient remote monitoring, to disease management. In that sense, I feel that there has been a bit of a misunderstanding that people were zoning in very much on digital therapeutics last year and tailored consultation the year before. But I think the real thing will come with health literacy improvement. I'm very excited about that topic. Then, also about more integrated health management or integrated disease management.

DR. DESAI: I guess on that note then, do you have any parting advice to offer the folks in our audience that are going to be clinicians down the road in terms of how to navigate this new way of delivering care. What should they be aware of as they start their careers? 

SILBERZAHN: I would say some of the interesting things that I've seen in the past years were the health and well-being promoted on the city level. Often people seem to think about the national level and the legislation. Some of the most interesting things I've seen in recent years have actually happened on the city level. For example, the city of Amsterdam in the Netherlands has done, in my point of view, a great job, where people in the city said, “How do we want to promote health and well-being for the inhabitants of our city?” Then, they set themselves crazy goals that they are not even sure whether they can be reached—a very un-German thing, by the way. They then think about, what is the strategy that we can pull off? What are the five things, six things, seven things that we reach this crazy goal in terms of the health and well-being of our population? Then, they create a multi-stakeholder alliance, you could say. There are people from the public service, there are industry NGOs, social workers, etcetera, to actually move towards that. They then go into schools. They go into sports clubs and they get to the people where they are.

I love to think about getting into the more unusual settings. How can we promote health and well-being on the city level? How can we promote health and well-being in schools, for example? So that we move in the right direction very early, instead of waiting until we all have massive problems at 50 or 60 years old, and then we try to cure things. 

DR. DESAI: Yes, that makes perfect sense and certainly offers a sort of systems approach that in so many ways, feels very European in the sense of thinking about prevention much more than thinking about treatment down the road. I appreciate that. Speaking to you has been wonderful. I enjoyed it and learned a lot. Thank you for joining us today. 

SILBERZAHN: Thank you, Rishi. It's been a pleasure and thanks for having me. 

DR. DESAI: Well, listen, I'm Rishi Desai. Thanks for checking out today's show. Remember to do your part to flatten the curve and raise the line; we're all in this together.