On Thursday, Geisinger Health announced its CEO Dr. David Feinberg was leaving to fill a newly created leadership role at Google, a sure sign the tech giant wants to cash in on the $3.5 trillion healthcare industry.
Google is not the only one. Five the world’s 10 largest companies have announced major health initiatives over the past year, including: Amazon, Apple, Berkshire-Hathaway, JPMorgan Chase and, now, Alphabet, Inc. (Google).
Sources close to the Google announcement said Feinberg will report to AI head Jeff Dean, who we’re told led a months-long search for the right candidate. According to CNBC’s Christina Farr, who first reported on the details of the transition, “Feinberg’s job will be figuring out how to organize Google’s fragmented health initiatives, which overlap among many different business.”
Google Isn’t New To The Healthcare Game
Google’s interest in consumer health dates back more than a decade. In 2008, it launched Google Health, an attempt to create a repository of health records, connecting vital patient information with healthcare providers such as doctors, hospitals and pharmacies. The vision was ahead of its time. The venture shut down in 2011.
More recently, the company doubled down on Artificial Intelligence (AI) through Verily, an entity focused on precision medicine and disease-research projects. And last July, Google hired former Cleveland Clinic CEO Dr. Toby Cosgrove as executive adviser to its Cloud healthcare and life sciences division, areas of the company that don’t appear to overlap with Feinberg’s role.
As details of Feinberg’s new position get sorted out, one question emerges from this high-profile hire: Where might Google go in the healthcare space?
Turning An Information Company Into A Healthcare Player
At the Stanford Graduate School of Business, I teach a healthcare strategy class along with Dr. Robert Burgelman. Part of his research centers on “cross-boundary disrupters”—companies that dominate in one arena then transfer that expertise to a new industry.
For Google, which fancies itself an “information company,” I’m intrigued by the potential to marry its information services (and other billion-dollar Google initiatives) with a healthcare agenda.
Thanks to the brilliance of its founders, Sergey Brin and Larry Page, Google’s search expertise far outpaces the rest of the industry, even two decades after the company launched. And thanks to the business acumen of former Google CEO Eric Schmidt, the company has mastered revenue generation through a combination of paid search, advertising and derived-user information.
The challenge Google now faces is monetizing its profitable search and business proficiencies within the world of healthcare—a space overflowing with complex rules, regulatory prohibitions, and serious patient trust issues.
The Future Of Healthcare: In Dr. Feinberg’s Own Words
Though he never mentioned he was applying for a new job—nor did he call out Google or any of its competitors by name—he spoke at length about technology’s role in healthcare and the need for industry-wide disruption.
Combining Dr. Feinberg’s comments and professional track record with what we know about Google’s current projects and products, here are five healthcare opportunities Google might seize upon in the near future.
1. Boosting home health
According to CNBC’s early reporting, “One particular area of interest is building out a health team within Nest to help manage users’ health at home, as well as to monitor seniors who are choosing to live independently.” The Nest family of home-automation products—everything from digital doorbells to thermostats to home security—are designed to place Google squarely in the center of the American home, powering everyday life.
Dr. Feinberg, who served as CEO of UCLA’s hospitals before joining Geisinger, has long been an advocate of bringing care out of the medical facility and into the home. In our interview, he compared hospitals to Blockbuster – that mossy old brick-and-mortal concept from a century ago. Feinberg predicts half of today’s inpatient services will soon be rendered in people’s homes, and without the many risks associated with a hospital stay (ranging from infection to delirium).
Expanding on the theme, Feinberg wondered, “Why do people have to come to a doctor now? I don’t go to the bookstore anymore. I don’t go to my travel agent anymore. I can do so much through my phone. Why can’t I tell you what my symptoms are, and have you hook me up with someone who can help? If I do need medicine, why don’t you just drone them to my house? Those types of interventions I think are coming and those disruptions are absolutely crucial.”
For any patient who has been sick enough to be in the hospital, a suite of Google healthcare products could be extremely valuable and, compared to the cost of hospital monitors, a bargain.
2. Solving healthcare issues with transportation
Under Brin’s direction, Google was an early innovator of self-driving cars. Others in the automotive and transportation industries have since taken the lead, but healthcare could be an interesting avenue for the company to reengage in this space.
Dr. Feinberg pointed out that only “20% of whether we live or die (is) based on going to good doctors and good hospitals.” He told me a far greater percentage of health is based on “your social environment, your access to clean food, your access to transportation…”
Cars, it turns out, lower barriers to better health. They take people to doctors. They bring doctors, medications, nutritious foods and devices to people’s homes. Companies like Uber and Lyft have taken steps in this direction, but Google has the potential to disrupt these disrupters. Today, the factors limiting home delivery are cost and time. Driverless cars can overcome both.
3. Using big data to battle disease
Google’s most popular applications – from Maps to Drive to Gmail to Chrome – connect people with vital sources of information. Each application is informed by algorithmic data and, increasingly, machine learning.
More and more, American healthcare providers are relying on big data to improve patient health. Patients, meanwhile, rely on the internet. Today, 43% of consumers report that the internet is their go-to resource for health-related information (only 14% say doctors). If Google already knows so much about each of us based on the websites we browse and the products we buy, why couldn’t it use that same technology to improve care delivery?
Precision medicine and predictive analytics are two of the most touted opportunities in healthcare today because they take individual health factors into account. Dr. Feinberg gave an excellent example. He said that technology enabled Geisinger to keep tabs on every single patient within a 3-million-person catchment area.
“And we know, based on how close they live to the forest, the odds of them getting Lyme disease,” he said. “We can start thinking in advance what’s wrong with people, or what could become wrong with them, and prevent it.”
The same approaches could apply to asthma, depression, cancer and heart disease. Google’s data and information services could lead the way.
4. Inventing the next generation of wearables and trackers.
With Google Fit, the company is trying to expand its market share in the very profitable fitness and health-wearable market. To date, the company trails competitors like FitBit, popular for people focused on exercise, and Apple, which is breaking into the wearable medical-device market. But Google could leapfrog both peers if it were willing to make devices designed for care provision, not just monitoring.
Most of today’s at-home wearables generate reams of data (heart rhythms and blood sugar readings). Doctors don’t want all that data clogging up their electronic health record systems nor do they want patients rushing into the office every time a single number seems out of line. What doctors want is smarter technology.
Think of it this way. A car’s sensors produce hundreds of gigabytes of data each day. But manufacturers don’t send all those data points to auto mechanics on a continual basis. Instead, manufacturers embed automobiles with algorithms that evaluate the car’s status and tell drivers (a) when everything is fine and (b) when it’s time to head to the shop.
If patients had sophisticated tools that did the same (telling them when they’re OK and when they’re not), it could transform medical care. It could advance chronic disease management from its current episodic approach to a more effective and continuous one.
Doctors would need to see patients less often, knowing their problems were under control. And when something did go wrong, patients would be notified and know to call their doctor. In healthcare, companies have shied away from embedding such algorithms and warnings into their wearable devices for fear of a legal suit should the product malfunction. But the potential here is massive.
As a former health system CEO, Dr. Feinberg has connections with medical experts across the country who could generate these algorithms, help untangle the regulatory issues and create such a product. And if these devices helped patients obtain timelier treatment with fewer visits, insurance companies might be willing to pay for the technology, something they rarely do now with the wearables currently in the market.
5. Becoming a world leader in AI
Google has made no secret of its desire to be a world leader in artificial intelligence (AI). Within the healthcare arena, the company has already made significant strides toward creating software that can diagnose radiological images and skin lesions, often with much more accuracy than humans.
Google has dozens of partnerships in the works to expand the use of AI in hospitals and diagnostic facilities. As a company that already knows more about us than any other, Google in the perfect position to know more about our medical care and information than any other organization out there. Artificial intelligence and machine learning will disrupt healthcare as we know it, eliminating an estimated 30% of care delivery that, today, has been proven to add no value.
The challenge in bringing AI to healthcare is threefold. First, relatively few patients have all their medical information stored in a single, comprehensive EHR system. Second, most EHRs are structured for billing and administration, not for healthcare delivery, which is why EHR data is rarely useful in correlating clinical outcomes. Third, even organizations that keep this type of data are reluctant to share it with a company like Google. But once again, Dr. Feinberg could facilitate the process.
Google Faces Strategic Challenges
The words “Google” and “struggle” hardly go together in the same sentence. But outside of the company’s incredible success in search, and a handful of profitable acquisitions, Google has struggled to monetize some of its projects and products.
Google’s competitors, meanwhile, have found a direct link between cross-boundary disruption and healthcare success. Take Amazon, whose core competency is retail and sales. Having recently acquired PillPack (and its 50 state licenses), Amazon may soon deliver medications to people’s home, thus making it a major player in the pharmaceutical space. Or look at Berkshire-Hathaway, which already owns Geico and could add a complementary health insurance product to its portfolio in the future.
But Google faces obstacles its competitors don’t, especially when it comes to monetizing its competitive advantage: information.
Medical information is ambiguous and difficult to navigate. Mining it for answers proves more elusive than in other industries. If you have any doubts, just ask the Watson Health division at IBM, which had to lay off workers this summer and has struggled to bring a “killer app” to market. Having powerful technology is one thing. Translating it into operational success is another entirely.
But Google has an even bigger problem than IBM. That is, consumers view their medical information quite differently than their browsing or shopping history. Most people don’t mind seeing an ad for armchairs in the margins of a webpage after Googling “armchairs.” They see it as a reasonable trade off for an excellent search experience.
But patients wouldn’t take as kindly to having their medical information sold in the same manner. Already too many companies prey on the fears, failing health or medical ignorance of everyday patients. Advertising and targeted-marketing approaches just feel different in medicine than in retail.
In the past, Google’s motto was “don’t be evil.” Convincing patients they have nothing to fear by handing over their health information online, or allowing Google to obtain it from their home, will be a major hurdle. In the end, this may be the biggest responsibility Dr. Feinberg, a trusted and respected leader, will be asked to assume.