Big Tech companies dominate much of our news and affect nearly all levels of the ecosystems in Silicon Valley. Ever since Hewlett and Packard started tinkering in their garage in Palo Alto back in 1938, birthing what later became Silicon Valley, this region has set the agenda on tech and startups in general. To this day, The US maintains its status as the highest-ranked country for startup activity in both innovations and funding. The US ranked almost four times that of the second highest-ranked country in the world, the UK. And Silicon Valley remains the most prominent global startup ecosystem by a massive margin. However, Big Tech is no longer just tech. It includes and bleeds into nearly every other industry and facets of life. The health space is no exception, and the mere magnitude of these captains of industries sets and, to some extent, redefines the path that the health space is on.

The health space is Denmark's largest export sector, climbing to nearly 20 percent in 2022. In the US, it is not only one of its strongest exports, but it is also the highest revenue-generating industry by far. This matters when tech giants chase opportunities, and it shows.

The traditional healthcare business model is typically defined by the so-called 5 P's. Each P represents a link in the value chain, and all of them constitute the health space. The question is, will Big Tech break this chain, add links or turn everything upside down?

The above investment map tells us that Amazon is massively moving in on all the 5 Ps of the health space. The company now provides patients with care plans and prescriptions through its AmazonPharmacy. It is also capturing the provider and supply chain market in medicine by moving towards a hybrid primary-care option with its AmazonClinic - further incubating its broad portfolio of other health-oriented investments. Moreover, through deployments of several integral tech solutions, Amazon is actively creating and applying for precision medical tech and medicine, thus jumping on to pharma. It explains why we are beginning to see headlines such as: “Amazon launches cancer vaccine clinical trial in partnership with Fred Hutchinson” (Business Insider, July 2022). 

Underlying all of the above, patients, or more accurately; customers, remain to be influenced and monitored through the ever-improving wearables (Halo) and home ecosystems (Echo, Alexa). Amazon is becoming a significant and very serious player across the entirety of the health space value chain, and they are rethinking “business as usual”.

Google aims to be a full on life sciences brand; it is doing so by providing a leading cloud platform for life science, pharma discovery, and precision medicine. It is moving its search engine capabilities into the provider healthcare by integrating patient tools directly into its search engine results – while also embedding patient solutions like cost estimates and scheduling. For example, CareStudio allows providers to search for health data records directly. They are exploring how AI can diagnose cancer, prevent blindness and more. In the near future, Google is expected to deploy and integrate its own de-identifying datasets, thus aiming to resolve the privacy issues we often see with sensitive patient information. In their own words; “Google Health is committed to helping everyone, everywhere be healthier.”

Almost surprisingly, though, Google does not lead in consumer variables, yet Google’s Android is the leader in the smartphone OS space, and it is looking to grow its share of the monitoring market this way, which includes the clinical monitoring space. We can mention HealthConnect, which provides a common set of fitness and health data APIs. GoogleHealthStudies allows self-enrollment and participation in medical research. DermAssist identifies and answers questions about skin conditions through AI analysis of related photos.

It is the official statement of Microsoft that they want to transform the healthcare journey. The company sees its greatest opportunity in owning, collecting, and selling healthcare data. With innovative enterprise tools pre-built for healthcare, HIPAA-compliant features, and healthcare data connectors, Microsoft offers a comprehensive software platform and cloud solution for the health industry. With Azure’s data and AI, it enters the provider market, as well, by delivering real-time data analysis and emergent reporting. Pharma too is on the agenda.Through partnerships with Novartis, Veradigm, and Novo Nordisk, for example, they are developing products and solutions to accelerate drug discovery and development, streamlining clinical trials, and enhancing patient engagement. 

Microsoft continues to increase its efforts on security and privacy – the ever concern in healthcare communications – including a provider-led data platform for de-identifying patient records. Also, though still hyped, Microsoft is experimenting with AR/VR to solve surgical training challenges.

Apple wants to change the way we see and define health. Their strategy is to be the main line of clinical tools for patients, providers, and pharma. The Health app, feeding its iPhone and wearables, aims to retain and build users by catering to their health and wellness needs. With new features like fall detection, heart rate monitoring, ECG sensing, skin temperature sensors, crash detection, …51 features, and counting…, the Apple Watch functions as a monitoring device of immense potential and real-world impact. For example, FDA recently enabled OTC hearing devices, inviting the Apple AirPods to enter the space of hearing aids. Further, The Apple Research app enables self-enrollment in clinical and academic studies, opening a path into pharma.

It is evident that Apple is attempting to cross the gap between consumer demand and clinical needs. Combining patient data and provider solutions will drive institutions and their members to purchase their devices. We already see how healthcare organizations, fitness companies, and health insurers use Apple Watches as incentives to foster healthier behavior: Insurers like Aetna, UnitedHealthcare, and John Hancock understand Apple tools as a vehicle to increase profits by encouraging healthier behavior and earlier (less costly) detections.

Meta stands out, but is it a Ninja approach or a sleeping giant? The company entered the health space well before COVID-19 with preventive health tools connecting people to resources and checkup reminders through their Facebook-platform. The company launched healthcare solutions with a focus on alleviating and providing information about diseases. They did so in collaboration with major healthcare providers in the US (American Cancer Society, the American College of Cardiology, the American Heart Association, and the Centers for Disease Control and Prevention). However, due to the criticism Meta encountered when its Facebook-platform was used to disseminate misinformation, health related activities seem less active than the other tech giants. Is this a symptom of market resistance or a tactical choice? Time will tell, but in the meantime, their focus on AR/VR draws prominent traces into the health space - for example, through their collaboration with universities in using VR with surgical training.

Oracle has seen the future. The company focuses on becoming a major healthcare cloud player, moving from a modular platform to an all-in-one health cloud with AI/ML functionality. They are going for providers, payers and public decease preventions.  Further cemented by their exclusive contract with the Department of Defense and the acquisition of the Cerner health-tech giant. In their own words, Oracle is massively advancing health with “Intuitive, secure, and intelligent tools that improve care access, drive informed decisions, lower costs, and save lives.” Their portfolio of solutions includes integrated telemedicine, provider voice interface, disease-specific AI/ML modules, big data of 92m patient records, robust business in clinical trials, drug discovery, and even pharmacovigilance.

It is evident that these tech giants, these captains of Silicon Valley, are evolving beyond being providers of tools. And it is not only the giants. Albertson's (a grocery chain) launched Sincerely Health in February this year. Best Buy (an electronic retailer) has ventured into health devices, telehealth and patient engagement. Dollar General (a chain of variety stores) plans to become a "healthcare destination". Walgreens (a pharmacy) aim to open more than a hundred full-service doctors' offices. Costco Wholesale (a member based grocery store) offer flat-fee healthcare to its members. The founders of Instacart (a grocery delivery company), Spotify (a music streaming service), and Coinbase (a cryptocurrency exchange) have all started new healthcare companies. And the list goes on.

Are they disruptors, or are they lifting the industry into the future? Do we need to add more P's, or do we need to understand how "patient" is a dying term? Is it C for customer? C for consumer? Or is it H for human? Hard to say, except we are standing at unprecedented times, where data and access to big-data have never been more impactful and quick to market; feeding new solutions and innovative approaches faster than ever before.

It is beyond doubt that Silicon Valley is doing its best to uncover areas that are complementary to pharma, the development of medicines, and tools for efficiency and health-optimization. But it is important to accept that we are no longer at the beginning of a transitioning phase; we are in the middle, where one must trail these new technologies and understand how the industry is under assault. The 5 P's are being remodeled.

Silicon Valley is progressive and proactive when it invests and helps nurture moonshots, innovative solutions, M&As, and startups. What happens in Silicon Valley is a step stone to what will happen globally. Danish companies, Danish solutions, and Danish startups can play a significant role here and help shape where the health space is going. In addition to Denmark having a terrific ecosystem for digitizing healthcare services, it has one of the most vital entrepreneurial cultures in Europe. With the right solutions, fresh ideas, and a critical and thoughtful approach to Big Tech, there is a standing opportunity for Denmark to lead and take an active part in shaping what is coming.