In recent years, there has been a rise in new healthcare services that utilize the latest ICT technology, including health promotion services on smartphones, genetic analysis services for individuals, remote consultation and treatment services, AI image-based diagnosis, etc. We have approached Mr. Masanori Akita of MTI, a LINK-J supporter who has entered the healthcare industry by harnessing mobile services and who is actively developing his company's business operations, to participate in a dialogue with his long-time acquaintance Mr. Jun Oi of DeNA on the current state of these services and their future prospects.
New evidence that the Internet and digital environments can bring to healthcare
――Both of you have always envisioned a future where the health of people can be enhanced through the use of ICT. How did each of you come to be involved in digital health?
Oi In my case, I had originally worked at the Ministry of Internal Affairs and Communications where I was mainly responsible for local government finance. From that standpoint, I have always been concerned with the sustainability of social security benefits. Subsequently, when I joined DeNA in 2013 after working for a medical corporation, my feelings on that matter became even stronger and I considered if there was anything I could do as a private corporation. On the other hand, as DeNA is not a medical institution and in view of DeNA's founder Ms. Namba's philosophy of "before one falls ill," DeNA began to engage in direct-to-consumer (DTC) genetic analysis services as far as healthcare initiatives went. Indeed, DTC genetic analysis services aim to improve the quality of life before individuals fall sick by allowing them to be aware of their risks of suffering from particular lifestyle-related diseases by comparing the results of their genetic analysis with statistical trends. Although we specialize in the provision of services, we are not experts in the study of genome. Therefore, we have conducted joint research with the Institute of Medical Science at the University of Tokyo which specializes in genome research, and used the findings of this research to benefit the society at large through DeNA.
Akita For me, I left Canon to join the mobile service company MTI in 2007 because I had wanted to create services that can transform the lifestyles of people around the world, which was how I became involved in the healthcare sector. We could see that the industry was gravitating towards personalized healthcare, and so our company decided to set up DTC genetic analysis service operations at a time when it became possible to perform genetic analysis for just tens of thousands of yens. I was tasked with overseeing these operations and pursuing future opportunities on this front.
―― In other words, both of you are competitors in the DTC genetic services domain?
Oi When I first met Akita, there wasn't even a market to speak of, much less any competition. So, I think of that as a "collaborative" phase rather than a "competitive" one.
Akita Oi is a friend of mine who always had an eye on the healthy development of the industry. As the industry was in its infancy then, there were many problems such as the participation of businesses that lack scientific basis and inadequate regulations. We set up an industry association and collaborated with the Ministry of Economy, Trade and Industry to establish the industry regulations.
――In addition to genetic analysis services, a variety of other healthcare services based on the Internet and digital environments are also emerging. How would you assess the value that this digital revolution can bring to healthcare?
Akita I think the value that it can bring is unprecedented as a massive amount of data can be stored, analyzed, and used to benefit users, consumers, and the society. One good example of this is our company's service "Luna Luna" for women, a mobile service that records and automatically manages the user's menstrual cycle which has been downloaded a total of 14 million times (as of July 2019) in the 19 years since it was launched in 2000. By analyzing the collected data, we developed our unique ovulation date prediction logic that differs from the Ogino method. This has dramatically increased pregnancy rates of women, with some studies showing that one in 30％of mothers who have recently given birth use our company's service. It can even be said that digital health has contributed to relieving Japan's declining birthrate.
Oi I also feel that there is value in establishing data-based services and facilitating the emergence of new evidence. As long as something is regarded as a "healthcare" service, I believe it is necessary for the provision of that service to be based on healthcare data. Our company uses "kencom," a healthcare entertainment app that supports the promotion of individual health, to track changes in our users' lifestyle changes and medical checkup results, as well as the effects on their health status and medical expenses. Because Japan has a national health insurance scheme whose coverage extends to individual medical expenses (receipts for health insurance claims), it is also significant for us to establish evidence that can contribute to our overall health as well as positive economic effects.
Akita In the past, when infectious diseases used to be the main cause of death for people, the treatment of these diseases was the foundation of medical care. However, in the present day when 70% of deaths are caused by lifestyle-related diseases, it has become evident that it is more important for us to change our lifestyle by watching our diet and exercising. The World Health Organization has expressed tremendous optimism that a digital approach could be useful in transforming our behavior in that regard.
Mr. Masanori Akita Executive Officer and Deputy General Manager of Healthcare Operations Division at MTI Ltd./ LINK-J Supporter
The difficulty of monetization. A result of the prevailing mindset.
―― As far as digital health is concerned, it has been said that monetization is a challenge.
Akita Because of Japan's social security benefits provided under the national health insurance scheme, it is rare for people to have the mindset of "making an investment in advance to safeguard their health."
Oi That is also something we are working on. People can visit the hospital without paying much when they fall sick, and they don't get paid for staying healthy. Because the value of health is not quantified, healthcare services are hardly popular by any means. In order for these services to be used, some form of incentives need to be given.
Akita On the question of why "Luna Luna" had been commercially successful, I believe it is because "Luna Luna" has evolved to meet the needs of our female end-users as they progress through different stages in life, including needs pertaining to health management and pregnancy. In the case of pregnancy, "Luna Luna" won the support of many users as it offers each user the ability to predict her ovulation date in a way that is uniquely tailored to the individual. This in turn supports the home pregnancy needs of those who wish to take charge of their own pregnancy. It can be said that there was already a market for this prior to the availability of infertility treatment.
――In that case, how are services other than "Luna Luna" monetized?
Oi Because of the attributes of the healthcare market we have mentioned earlier, our company has decided to create a market where people can quantify the value of their health instead of directly charging users of our services usage fees. Specifically, we conceive of private life insurance and public insurance such as the national health insurance scheme as part of the same market, and we are working on initiatives to transform this market from a reactive system to a proactive one. In other words, while almost all of the 40-trillion-yen life insurance market is reactive in nature where payouts are made after the insured individual has been diagnosed with an illness or passed away, we are attempting to transform it into a proactive system where insurance is offered in conjunction with healthcare services. For this reason, we have collaborated with insurance companies to develop group insurance for companies that are promoting health management. Our company offers a scheme that provides services to support the health management of individual employees. In addition, we have plans to participate in a joint project with Yamanashi prefecture as an initiative to encourage the health promotion of those who are insured under the national health insurance scheme. This is a performance-based initiative where our company receives a portion of the savings made from the reduction in the prefectural government's financial outlay through the optimization of medical expenses as a result of utilizing this service.
Akita Our company is also trying to monetize services by targeting parties who are not end-users of the services in question, such as collaborating with life insurance companies, offering health management support for companies, and developing electronic maternal health notebooks in collaboration with local governments. At the same time, we are also developing digital services for medical institutions including electronic medical records, remote consultation and treatment services, and offering pharmacy operational support. The demand for such services is growing because of the clear improvement they bring to the efficiency of these operations.
―― In view of the lack of health-consciousness among consumers, what steps have you taken to ensure that end users continue to use the services?
Oi DeNA is a company that is adept at engaging people to use a particular service, such as our management of mobile games in the virtual world and Yokohama DeNA BayStars in the real world. In particular, we excel at going through the PDCA cycle efficiently and optimizing our services based on past logs. We apply these skills to healthcare to develop digital services that allow users to improve their health while having fun.
Akita As a company that started out in the business of music distribution, MTI also possesses strategic advantages in the entertainment sector. Even for our healthcare services, we are constantly conscious of fostering perspectives such as "living a longer, healthier life would give me more time to have fun" and "being health-conscious is cool" among our users.
Mr. Jun Oi Executive Officer and General Manager of Corporate Planning Division at DeNA Co., Ltd. / Representative Director of DeNA Life Science Co., Ltd.
Technological evolution and the sustainability of the healthcare system will be turning points in the future
――If there are turning points for digital health in the future, what do you expect them to be and how do you think digital health would change?
Akita The fifth-generation mobile communication system (5G) will be launched next year (2020), and along with it, the government's vision of Society 5.0 will gradually become reality. Society 5.0 differs from the information society of Society 4.0 in that its central feature is the cloud as well as its integration with AI. Innovation is possible when the information owned by consumers, medical institutions, and local governments that used to exist separately is connected through the power of IoT and AI. For instance, while the remote nutrition assessment that we carry out is effective, the need for human involvement makes it relatively expensive. However, if the cost of providing this service can be made more reasonable by utilizing the new technology, we expect the service to enter a phase of explosive growth.
Oi I believe that social security and the sustainability of the healthcare system will be the triggers. When the system is finally impossible to maintain and the public realizes that the burden on them will increase if they fall sick, people will naturally become more conscious of preventing illnesses. At the moment when technological evolution intersects with the limits of the healthcare system, I believe that a major transformation will take place. Having said that, we are continuing to do our best as companies to make sure that the healthcare system does not collapse.
――As medical diagnoses increasingly utilize the power of AI, the business domain of digital health is creeping ever closer to medical care. Would you eventually venture into the provision of medical care services covered under insurance?
Oi We have not made any decisions in that regard as a company, but it is true that we are approaching the domain of medical care and it has become difficult to differentiate medical care from healthcare in the digital sphere. Because of this, we have appointed a Chief Medical Officer (CMO) with a medical license and the relevant knowledge on healthcare administration in April to reinforce our company's internal structure.
Akita In the case of our company, we have already ventured into medical care through the domain of remote diagnosis, for instance. However, in the case of lifestyle-related diseases as mentioned previously, there will be a blurring of the boundaries between medical care and preventive care. Regardless if it is medical care or preventive care, the keyword here is "personalization." We would like to approach this with the stance of assisting each and every individual by taking into consideration the individual's genes, constitution, lifestyle, working style, values, etc.
――Finally, if you have any future expectations for LINK-J, please share them with us.
Akita While the healthcare and IT industries have been operating separately hitherto, it is important to integrate them and create a wide range of personalized values in an unprecedented manner. I hope that we are able to break down these industry-based boundaries and create a new era through the network of LINK-J.
Oi I agree. Instead of being held back by these boundaries, we must go beyond them and find ways to share our expertise and complement one another. Perhaps this might feel strange at first due to the different business protocols, but I would like LINK-J to perform the role of a catalyst in bridging this culture gap.