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“Innovation platforms are ways to bring together different stakeholders to identify solutions to common problems or to achieve common goals.” CGIAR and ILRI, in their brief on innovation platforms, provide a succinct definition of the terminology as it has come to be used today.
“An innovation platform is a space for learning and change. It is a group of individuals with different backgrounds and interests. The members come together to diagnose problems, identify opportunities and find ways to achieve their goals” (http://r4d.dfid.gov.uk/pdf/outputs/Water- foodCP/Briefl.pdf).
Innovation platforms are used in various fields from agriculture to networks to medical technology to innovate new solutions, products, and technology to address problems faced by the community at large. These innovation platforms tackle challenges and opportunities at different lev- els—from a city or across a country in a geographic setting, or through a value chain in an economic sector, and hence can be thought of as working on several levels. A platform based approach often works well in areas of high complexity—where the solutions to problems need a multidisciplinary approach, such as in medical technology innovation.
Innovation platforms are created by different types of institutions and individuals. These could be in the private sector, by the government, or even by developmental nonprofits. Typically, innovation platforms have a focus that would bring different kinds of people together. The focus could vary from a specific technology to an industry vertical. Often, an important component of a successful innovation platform is the capacity building ability and opportunities available. These could be from basic training to develop its members skills to a programs that teach more complicated processes. But the goal is to enable more of its members and stakeholders to become problem-solvers to make the platform succeed.
Innovation platforms can be thought of as dynamic agents for systematic attempts to enable change in the ecosystem. At its core, innovation platforms, facilitate dialog and understanding among stakeholders and provides space to create a common vision and mutual trust (http://r4d. dfid.gov.uk/pdf/outputs/WaterfoodCP/Brief1.pdf). Innovation platforms allow groups to come together to identify the problems faced by the community in the chosen focus area and to together develop solutions that would be beyond what an individual could themselves typically hope to accomplish. It can be argued that innovation platforms lead to better informed decisions in the innovation process as a result of more members’ contributions. These lead to opportunities to create wider impact for the benefit of the community through demand-driven approaches to innovative research and development. Innovation platforms enable collective contribution of its members to be greater than the sum of its members’ individual contributions.
Innovation platforms can’t be considered the solution to all problems, and could deter innovation in certain contexts and situations. The progress of the innovative work, through such innovative platforms, typically requires the buy-in of all the members in the group. Homann-Kee Tui et al. state that ‘members have to be willing to work together and trust each other. Social and institutional conflicts, lack of political will, and power structures can hinder the growth of the innovation platform’ (http://r4d.dfid.gov.uk/ pdf/outputs/WaterfoodCP/Briefl.pdf). Innovation platforms often require a long-term perspective in its workings to become successful in its outputs. It could be difficult to monitor and evaluate such platforms systematically.
Hence, the appropriateness of innovation platforms to foster innovation in different areas would depend on the circumstances. Sometimes “other approaches, such as more traditional research coordination meetings, stakeholder consultations, or participatory research methods, may be more appropriate... (and) these methods can be used in conjunction with innovation platforms” (http://r4d.dfid.gov.uk/pdf/outputs/WaterfoodCP/ Brief1.pdf).
One such innovation platform was created by InnAccel, a medical technology accelerator based in Bangalore, India. InnAccel is India’s first medical technology acceleration company focused on innovation for low and mid-income markets. It has built a proprietary innovation platform, and forged partnerships with national and global entities, to support startups and entrepreneurs. InnAccel is led by an experienced management team and advised by industry leading experts (http://www. innaccel.com). However, before such an innovation platform was set up, the company conducted a feasibility study to understand the demand, the market, the stakeholders and the ecosystem at large, which would enable it to provide the most value to the members of its innovation platform.
The Feasibility Study done by InnAccel was conducted by an external consultancy firm called Strategic Development Services that specializes in such infrastructural projects. It was conducted over 8-months and included extensive secondary as well as primary research. The primary market research included 35 in-depth, one-on-one interviews with a broad cross-section of stakeholders, and 15 focus group participants. Stakeholders from academia, clinics, hospitals, government agencies, investors as well as large and small MedTech CEOs were interviewed from October 2012 through April 2013.
The outcome of the research was that requisite services and infrastructure specific to MedTech innovation did not exist in India, and that there was a tremendous pent-up demand for such an ecosystem by MedTech startups. The respondents indicated that the ecosystem was suboptimal with key gaps that were barriers to success for MedTech startups. Some of the key gaps identified are in the Table 5.1.
Further analysis of the results revealed some of the key elements that InnAccel would need to provide in its innovation platform to be successful. These key elements from the Feasibility Study are stated in Table 5.2.
The findings from the Feasibility Study were revalidated by the respondents, and viewed as barriers to success for start-up MedTech ventures. The study indicated that InnAccel would be filling a huge gap in the market, and providing a sorely needed resource for innovators. An initial concept of the working of the innovation platform devised was tested out by different respondent groups. Further, a 100% of all respondent groups reacted positively to the concept and validated the demand for a MedTech Accelerator. Not only the concept, but also the business model along with the revenue model was tested out on the so-called ‘customers’ of the accelerator—the startups and entrepreneurs working in Medical Technology. These startups and entrepreneurs provided strong validation for InnAc- cel’s fee + equity stake model for acceleration services, with more than 90% of respondents reacting favorably to the model, when accompanied with access to capital.
TABLE 5.1 Gaps Identified in the Indian Medical Technology Ecosystem
Source: Feasibility Study for a MedTech Accelerator, Strategic Development Services. June 2013.
TABLE 5.2 Key Elements for a Successful MedTech Accelerator in India
Source: Feasibility Study for a MedTech Accelerator, Strategic Development Services. June 2013.
Strategic Development Services, based on its expertise and experience, even provided a recommendation to InnAccel based on its analysis of the data collected from the study. It said, “Based on historical success in other geographies as well as our experience and information developed during the course of this study, we believe that the for-profit, investment portfolio model is best suited to the vision and mission of InnAccel.” It even identified that the experience, reputation and domain expertise of the principals was the key success factor, which it described as the ‘most critical element of success.’
Once it was concluded that the development of a MedTech Accelerator was not only feasible, but also sorely needed, some of the other recommendations included are Table 5.3.
InnAccel then tried to understand the MedTech ecosystem in India and its extent. It found emerging MedTech clusters in several parts of India, and a growing interest in MedTech commercialization and innovation by most academic institutions. There was some evidence of nascent cluster development in all of the major population centers, but Bangalore continually emerged as the most logical choice for the initial location. Bangalore has a concentration of research institutions (both public and private), as well as the most advanced entrepreneurial culture in India, and a GDP of $83 billion. Bangalore is also recognized globally as a technology hub, and is one of the top preferred entrepreneurial locations in the world. About 70% of the top venture capital firms in India have a presence in Bangalore.
TABLE 5.3 Strategic Development Service’s Key Recommendations
Source: Feasibility Study for a MedTech Accelerator, Strategic Development Services. June 2013.
InnAccel decided that it would be highly selective regarding tenants for the Accelerator. Sources of potential tenants were to come primarily from academic and research institutions initially, and subsequently augmented by various sources such as potential investors, hospitals, corporate spin-outs, independent research institutions, community MedTech entrepreneurs and to a lesser degree, start-ups attracted from outside the Karnataka region.
InnAccel has taken a holistic approach to MedTech innovation, and provides a complete bouquet of services and infrastructure specific to the MedTech industry. The pillars of its innovation platform are in Figure 5.1:
InnAccel provides an 18-36 month acceleration program to selected entrepreneurs and teams. It helps teams convert ideas and concepts to market-ready and regulatory compliant medical products. It aims to do so while minimizing risk, cost, and time to market for the startup. InnAccel offers lab infrastructure at its Bangalore Accelerator, along with experienced management support, and access to capital to help the startups succeed. The model for this innovation platform is to partner with entrepreneurs and provide physical infrastructure, clinical, engineering, and
FIGURE 5.1 Multi-pronged acceleration model (Source: InnAccel’s Corporate Deck October 2015).
business expertise along with access to capital in exchange for an equity stake in the company.
InnAccel has formed strong partnerships and strategic relationships with a number of national and global entities including medical colleges and hospitals in various regions that enable startups to gain clinical input, conduct fieldwork, and carry out early testing of products. InnAccel’s relationships with leading academic institutes in the country provide access to students as well as strong engineering and technical expertise to our startups. In addition, the global partnerships enhance the flow of ideas, funds, and entrepreneurs to the innovation platform built in Bangalore. InnAccel’s Acceleration process is outlined in Figure 5.2.
The pathway to successful device development is cyclical and iterative as ideas are prototyped, tested, improved, retested, optimized and finalized. InnAccel has built a proprietary Product Engineering and Development Platform, which coupled with acceleration support, enables startups to undergo the product development path successfully, identifying and managing risk effectively during execution.
One of the key elements of such an innovation platform is the selection of appropriate entrepreneurs and projects. Criteria such as in Table 5.4 could be used to guide the selection process for an innovation platform.
FIGURE 5.2 InnAccel’s Acceleration process (Source: InnAccel’s Corporate Deck October 2015).
TABLE 5.4 InnAccel’s Selection Criteria For Acceleration
One of the key facets of a successful innovation platform is capacity building. InnAccel, through its Entrepreneur in Residence program aims to train passionate individuals in this regard. InnAccel looks to support entrepreneurs who have a passion to transform healthcare through MedTech innovation. Entrepreneurs could explore an innovative idea, clinical area, or preidentified clinical needs in a structured fashion. The Entrepreneur-in Residence program is custom designed for entrepreneurs—either working alone or in an existing team, and is typically completed in 4-6 months. This program helps entrepreneurs achieve a comprehensive understanding of the clinical need and environment, explore different solutions to the identified need, and develop a viable business plan to develop and commercialize their solutions. The program culminates in a presentation of the business plan to InnAccel’s management team, which evaluates the entrepreneur for acceleration. The selected entrepreneurs are accepted into InnAccel’s acceleration program and become eligible for seed funding for their venture.
Another such innovation platform is CAMTech, which is the Consortium of Affordable Medical Technologies, based out of the Massachusetts General Hospital in Boston. The CAMTech India program focuses on technologies for Reproductive, Maternal, Newborn, and Child Health (RMNCH). It follows a public-private-partnership model that is “designed to accelerate medical technology innovation in order to improve RMNCH outcomes around preventable deaths in India and other low- and midincome countries” (http://www.massgeneralcenterforglobalhealth.org/ camtech/#mission). The program is funded by USAID, Bacca Foundation, and Omidyar Network. CAMTech works with multiple stakeholders in the Indian Medical Technology ecosystem to not only develop new technologies in RMNCH but also to build local entrepreneurial capacity.
CAMTech has a similar program in Uganda, with similar goals targeting the African ecosystem (Figure 5.3).
CAMTech conducts Clinical Summits, Medical Hack-a-thons, Innovation Awards, along with setting up Co-Creation Labs. In addition, it has setup an Online Innovation Platform that aims to address a critical gap in the ‘MedTech ecosystem by providing expertise, resources and targeted support to global health innovators.’ This Online Innovation Platform would bring innovators in touch with experts, investors, clinical opportunities, other partners and resources necessary to accelerate the development of the technology (http://camtechmgh.org/about) (Table 5.5).
Other successful innovation platforms in MedTech includes the Biodesign Program, which was created in 2001 at Stanford University using an unmet clinical need approach to drive innovation. It is a medical device innovation program and process that has been taught to 141 Fellows, 900+ students, and 100 executives over the years. 38 companies have been formed by those trained in the Biodesign process, creating more than 600 jobs. These companies have raised close to $362 million in external capital (Figures 5.4 and 5.5).
An example is Kerberos Proximal Solutions, which has created a device that removes blood clot material in the treatment of coronary and peripheral artery blockages, reducing stroke complications and neurological deficits. The company was acquired by Foxhollow Technologies for around $32 million in 2006. Another is Acumen Medical, which has created a device for visualization and cannulating the coronary sinus to
FIGURE 5.3 CAMTech activities (Source: CAMTech website: http://www.massgener- alcenterforglobalhealth.org/camtech/).
TABLE 5.5 Description of CAMTech’s Activities
Source: Recreated based on inputs from CAMTech’s website http://www.massgeneralcen- terforglobalhealth.org/camtech/ facilitate LV Lead delivery. Medtronic acquired the company in 2009 for about $370 million. Oculeve, another Stanford Biodesign startup with a device to treat moderate to severe dry eye, was acquired by Allergen in 2015 for $125 million.
The products developed by the Stanford Biodesign companies have together treated over 500,000 patients. The Stanford Biodesign program has sprung out 5 Global Programs, with 39 global fellows and 6 global faculty conducting these programs across the world in countries like Japan,
FIGURE 5.4 Source: http://www.massgeneralcenterforglobalhealth.org/ camtech/
figure 5.5 Source: http://www.massgeneralcenterforglobalhealth.org/ camtech/
Ireland and Singapore. One such program is in India—the Stanford India Biodesign Program.
The Stanford Biodesign, in its global avatar, launched the Stanford India Biodesign Program (SIB) in 2007 in New Delhi. SIB is jointly run by AIIMS, IIT-Delhi, the Dept. of Biotechnolgy, and Stanford University and has trained 32 fellows since inception. Till date, it has led to the formation of 6 companies working on India-specific unmet clinical needs. An example is Consure, which has developed a device to manage fecal incontinence in bedridden patients. It recently raised Series A funding of $4.5 million at a valuation around $15-20 million. The program has also led to the development of 7 other technology solutions that have been licensed out to industry players. Thorashield, a novel device for safer pleural tapping was licensed to MecMaan Healthcare in December 2013 for development, and is currently making initial limited sales to hospitals in North India. Another innovative technology, Bioscoop—for liver biopsies, was licensed to IndioLabs in 2013 for further development, and is currently undergoing safety testing at the beta-prototype stage.
The outputs of some of the successful medical technology incubators is captured in Table 5.6. Among 53 companies incubated by these incubators, a little more than half, went on to get acquired by others and nearly 10% went public. The combined capital raised by these companies is a staggering $1.6 billion, and the impact created by the medical device solutions on the healthcare systems around the world is significant.
ExploraMed in mountain view, California, is a private medical device incubator set up in 1995, largely to develop Dr. Josh Makower’s ideas into commercial entities. ExploraMed has led to the creation of 6 companies that have collectively raised close to $700 million in venture funding. Three of these companies have been acquired by other medical device companies, including Acclarent in the ENT space—that was sold to Johnson & Johnson in 2010 for around $785 million. Another ExploraMed company—transvascular, which developed several revascularization technologies, was bought by Medtronic in 2003 in a stock swap deal valued at around $59 million at that time. ExploraMed’s venture partner for all its companies is new enterprise associates.
Incube Labs was set up in 1995 in San Jose, California, by Mir Imran, one of the most prolific medical device innovators who holds over 250
TABLE 5.6 Successful medical technology incubators outputs
Source: Table recreated based on information from individual incubator websites.
patents. It has sprung out 22 companies over the years, with 11 companies acquired and 4 companies that went public. An example is Percu- Surge, which allows cardiologists and interventional specialists to capture embolic debris during interventional procedures to prevent vessel blockage and damage to the heart, was acquired by Medtronic for $225 million in 2000. Another company, Physiometrix, which made noninvasive devices such as EEGs, raised around $20 million in an IPO in 1996 and was subsequently acquired by Hospira in 2005 for about $23 million. Medtronic also acquired another Incube Lab company—Vidamed, for around $326 million in 2001, when it was already public (IPO in 1995). Incube Labs is backed by Incube Ventures and VentureHealth and currently has three companies in its portfolio that are in the market, and five that are in the premarket stage.
The Foundry was set up in Menlo Park, California in 1998. Since then, it has incubated 15 MedTech companies, 9 of which have been acquired by larger medical device companies, and 1 has gone public. Collectively, these companies are valued at over $2 billion in the market. One of its incubate companies, Concentric Medical, which made products to treat acute ischemic strokes, was acquired by Stryker Medical for $135 million in 2011. Another company, Xtent, which made drug-eluting stent systems, went public in 2007, raising $75.2 million. It later sold its technology to JW Medical in 2009 that continued development. The Foundry, through its companies, has created employment for over 500 people since inception. It is backed by Venture Capital Funds such as Domain Associates, Mor- genthaler Ventures, and Versant Ventures.
The Innovation Factory is a MedTech focused incubator in Duluth, Georgia. It was established in 1999 and has incubated 10 MedTech companies since. Its companies have collectively raised around $460 million in external funding till date. Four of these companies have been acquired by other medical device companies. LipoSonix, which uses ultrasound technology to noninvasively bust up fat in the body, was sold to Medicis Pharmaceutical in 2008 for $150 million. As recently as September 2015, another of its companies, Aquesys, which makes surgical devices for the treatment of glaucoma, was acquired by Allergan for close to $300 million. TIF’s venture partners include Accuitive Medical Ventures, Versant Ventures, and SV Life Sciences.
India, and most other developing nations today, face a key constraint in delivering affordable, quality healthcare to its citizens. This constraint is medical technology—or the devices, diagnostics, and equipment used to deliver healthcare. In India, like elsewhere, Western imports make up over 65% of the medical technology market- and serve only the high-income, Tier 1, “global Indian” consumers. These technologies are not only unaffordable by most Indians, but are also misaligned with the healthcare ecosystem (infrastructure, skill levels, etc.) prevailing outside of our Tier 1 cities. What can the government do to support such innovation platforms in MedTech in India?
The government can enable the creation of this ecosystem, and catalyze a whole wave of innovation, entrepreneurship and manufacturing in medical technology, in partnership with industry and academia. This process can be initiated by the creation of a task force to assess the potential of this sector, and examine global best practices, to create an Assessment and Policy Support Report. This Report can be prepared by engaging an external agency with experience in this sector. The Report should provide concrete policy recommendations, backed by extensive analysis, to create an innovation-led, medical technology industry in India. The Report should also provide a road-map to make India the R&D and manufacturing hub of affordable medical technology, preferably under a Public- Private-Partnership model.
A preliminary analysis of policy initiatives in Israel and Singapore, backed by learning’s from other healthcare systems, suggest 6 near-term initiatives. These initiatives should ideally be managed by a dedicated entity (like the Office of Chief Scientist in Israel) to make quick decisions for investing, facilitating, and coordinating the recommended activities and programs. This autonomous entity would work in tandem with the Ministry of Health, the Department of Science and Technology, and the Ministry of Commerce and Trade, and be the nodal agency tasked with creating a thriving MedTech industry in India. These initiatives, described below, would require a total public investment of INR 1,200 crores (~USD 200 Million) over 7 years. Most of this investment would generate attractive returns (@10-12% per annum) if the initiatives are successful. Much more importantly, this investment will catalyze the emergence of a thriving indigenous MedTech sector, which will transform healthcare for millions of Indians, reduce the import intensity (and the resultant foreign exchange burden) of our MedTech market, contribute to the nation’s Make in India thrust, and become an export powerhouse to rival the IT and pharma sectors over the coming years. 
2. Set up a grant funding mechanism for early stage MedTech research:
Create a dedicated mechanism to fund idea-stage research (preproof of concept) in priority areas of medical technology. This fund should be for individuals, research teams, and small companies, and should be adequate to support 6-8 months of early stage research.
Target: 200 grants awarded for research in high-priority medical areas.
3. Provide seed-stage capital to incubated Startups:
Besides research infrastructure, and strong incubation support, MedTech startups also need seed funding (typically INR 2-3 crores or USD 300,000-500,000) to develop well-engineered products for Indian needs, and raise venture capital for product launch and commercialization after incubation. The government should provide this funding, in partnership with private investors.
Target: Significant seed-funding with private investors in 100 Incubated startups.
4. Support the creation of dedicated MedTech VC funds:
Dedicated MedTech venture capital funds, with the requisite investment expertise and the right timeframe, are missing in the investment ecosystem in India today. The government can enable creation of such funds by acting as an anchor investor, and partnering with private fund managers to set up dedicated MedTech funds.
Target: INR 2000 crores (~USD 300 million) of venture capital raised to fund MedTech innovation.
5. Kickstart MedTech manufacturing in India by setting up manufacturing for 10-20 high-impact products in PPP mode:
The government can, in mission mode, identify several high-value and high-impact products that are primarily imported today, and are unaffordable for 90%+ of potential consumers. These could include high-tech medical imaging equipment (fMRIs), electromechanical implants (cochlear implants, LVADs, deep brain stimulators), or surgical systems (robotic surgery platforms). Identify global MedTech leaders to partner with the government, and develop and manufacture these products for emerging markets from India, in a PPP mode.
Target: Indigenous manufacturing of 20 high-impact products for Indian and other emerging markets globally by 2020.
6. Support industry through tax breaks and preference in public procurement:
The indigenous MedTech industry can be supported through a favorable tax regime, much like the software sector was supported through STPI. Domestic manufacturing of products should be supported through subsidies, and through rationalization of duty structures. Finally, preference in public procurement can be considered for indigenous MedTech compa- nies—with some budgetary allocation for novel, IP-protected, products developed by Indian companies.
Target: Provide procurement support to 50 innovative, indigenous, products through public health procurement by 2022.
The government should target exiting the programs in 7 years, having created an ecosystem that can be completely driven by private investment. Aligning with the government’s focus on outcomes vs. outlay, the above-mentioned initiatives should be evaluated on the basis of outcomes achieved.
Table 5.7 shows the tangible outcomes that the preliminary list of proposed outcomes that the government can use to measure the success of the initiatives.
This nascent industry can be supported through tax incentives, preferential procurement in the public healthcare system, and manufacturing subsidies. Additionally, the government can Kickstart high-tech MedTech manufacturing by selecting 20 high-technology, high-impact products for domestic development and manufacturing, in partnership with global MedTech leaders. This would build domestic manufacturing expertise in the high-tech area of medical products, and support the Government’s Make in India initiative.
Globally, small private companies that have been funded through venture capital and research grants have led medical technology innovation. It is estimated that of the 10,000 unique product categories in MedTech, small private companies have developed two- thirds. Larger public companies have a very active licensing and company acquisition strategies
TABLE 5.7 Proposed Outcomes To Measure Success
to get access to these innovations and leverage their sales and marketing expertise to bring them to market.
This trend is particularly evident in the United States. The five years from 2007-2012 saw over 1,000 acquisitions of small private companies
by global MedTech players. The industry is supported by a vibrant venture
capital industry, which invests billions of dollars in startups that have identified an unmet need and are developing innovative products to meet the identified need. Technology incubators at universities, or private medical technology accelerators support many such startups. It is estimated that over a 1,000 such medical technology incubators and accelerators support companies each year.
Israel has also developed a thriving medical technology industry over the last 20 years. This was achieved by a comprehensive government program to drive innovation and research by setting up 24 technology incubators to support startups in this space. These incubators were placed under private management and substantial early stage funding was made available for startups at these incubators through liberal grant funding, and technology venture capital funds. Today, Israel has a thriving MedTech sector, with over a 1,000 companies developing innovative products for the US and Western markets. Now, Singapore is replicating the Israeli model through it’s A*STAR program to create a research-led MedTech industry.
Technology incubation, supported by research grants, and ample high- risk venture capital for early stage, research-led companies, has been the model that has successfully created these global hubs of MedTech innovation. This model can be effectively deployed in India to create the world’s first ecosystem for affordable MedTech innovation in 5-7 years, and tap the emerging global opportunity in affordable medical technology.
“CamTech: Consortium For Affordable Medical Technologies.” www.Massgeneralcenter- forglobalhealth.org. N.p., 2016. Web. 12 Mar. 2016.
“CamTech Innovation Platform: Platform To Accelerate Disruptive Healthcare Innovations.” www.Camtechmgh.org. N.p., 2016. Web. 12 Mar. 2016.
“InnAccel.” www.Innaccel.com. N.p., 2016. Web. 12 Mar. 2016.
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