Esther Dyson: “Nine out of 10 start-ups are doing the same thing as everyone else, very few are committed to doing something new and necessary”
CEO of HICCup and The WaytoWellville
Named one of the most influential women in the United States by Forbes magazine, this entrepreneur and business angel has invested in a wide variety of health start-ups using big data and information technology. Her most recent project is The WaytoWellville, a contest to create and measure the impact of healthcare programs in five communities in the United States.
Dyson was one of the headliners of the Health 2.0 Europe Congress, held in Barcelona a few weeks ago. There are many entrepreneurs who seek advice from this business angel, who has devoted a large part of her career to fostering the healthy digitalization of health through investment and ideas. This isn’t an unnecessary redundancy: beyond 2.0, her top priority is to humanize healthcare.
Do you think entrepreneurship is becoming a more solid option for many healthcare professionals?
Entrepreneurs undoubtedly have a lot of room to grow in the sector. In any case, with the start-up boom we run the risk of turning health into a series of transactions, into temporary solutions, when what a good healthcare system needs is continuity. I believe that too many start-ups are focusing on temporary solutions to a specific problem without thinking about how to integrate it into the system as a whole. Yes, the system is very large and it is difficult to be part of it, but new initiatives must make an effort to be there.
In fact, you've often complained that there is more redundancy than innovation in the health 2.0 ecosystem.
There are dozens of companies focusing on treating the same problem. Some will merge, others will die… the market needs redundancy but acting like it isn't there is absurd. Nine out of 10 start-ups are doing the same thing as everyone else, very few are committed to doing something new and necessary.
What does a start-up in this field need to be sustainable in the long term?
It must have a very good understanding of how the system works and, above all, be properly managed. Understanding how to manage the exceptions is much more important than knowing how to react under normal conditions. We have to look at it as a process: first the patient does one thing, then the doctor does another and afterwards the hospital activates a certain response. 90% of the time this is the normal structure, but the companies that stand out will be the ones that know how to act under unforeseen circumstances. Making these exceptions into the rule, that is key: to make the problems part of the solution. Many companies cling to new things that work until the rest kill them off.
Do you think the ecosystem is prepared in this regard?
I don't know it well enough to be able to assess it in depth, but I know that Barcelona is a very powerful technology hub in southern Europe. I see a prosperous ecosystem in a special region; this is where entrepreneurs come from. They don't come from the center, but from other places with the intuition that the center is too big and doesn't favor proper management.
What would you recommend for entrepreneurs who want to internationalize?
They must understand how difficult it is to break out of their region. What is foreign to them is home turf to others. They probably went to university with the head of the hospital: they’re part of the community. The challenge facing outsiders is to find allies, and they often do so in incubators in markets looking to grow or other types of associations. The key is to find a place within these networks or to create new ones. In the healthcare arena, the structures are the foundation because each patient goes through several institutions over time. Big data plays a huge role in making these connections possible.
Could we say that data and connectivity are the main trend?
Yes, connections between people and devices: sharing medical histories with the hospital, the pharmacy and the patient. Innovation will come through big data and pay-per-use systems. In the United States, everything will change when we base payment on results and not procedures. So, healthcare will focus on health more than on care. The challenge is to encourage this vision instead of offering solutions to a specific problem. When the time comes for payment, the question is easy: does the patient feel better than when they started treatment? We mustn't be subjective or just look at the packaging; we must base it on proof.
Is this what you're looking for when you decide to invest in a start-up?
I try to be very practical, if they don't have this vision I'm not interested. I like to see that there is activity, even though many focus only on transactions, and I like to know that one in 10 will be successful. But the most important thing is for them to be connected. Individually, they are just body parts and I want the whole organism. They must be part of a company or organization that integrates them.
Isn't anyone working to connect them?
People are focused on their own ideas and take for granted that someone else will take care of bringing it all together. But no, no one is doing it. The challenge is no longer to create new initiatives. I'm not saying that everything has already been invented and we have to stop working, but this is one of the explanations for why progress is so slow in this field. Hospitals are busy caring for patients and don't have time to integrate the new apps into their infrastructure or to train their workers to include them in their daily routine. Who is going to pay for a solution they don't have time to use? We have to make it easy for them.
So, if someone focused on solving this problem, they could count you among their investors.
If I were going to invest in anything, it would be in the combination of information provided through an app and monitoring with the human infrastructure. For example, while an app tells you what you have to do to measure your blood sugar levels if you are diabetic, there is also a person reminding you what to do, supporting you and setting up meetings with other patients who have the same disease. With so much technological innovation, the human factor is key.
Do we run the risk of losing this more human side of the healthcare system?
One of the main things I've learned over my professional career is how important this side is. For example, nurses are one of the most important parts and we don't have enough of them. We have to give the healthcare system the capacity, the personnel, the money and the market to add innovation and personal contact. It will be something like a health coach, a growing market where I see a great future.