José Marcilal

Photo: The Managing Director for Novartis Oncology Spain, José Marcilla. Credit: Courtesy of the interviewee

By Alba Casilda

There are two major revolutions impacting the healthcare sector at the same time. So explains Novartis Oncology Spain. On the one hand, digitalization is changing every company's internal processes. Its CEO, José Marcilla, says: “We want to take advantage of innovations such as artificial intelligence, machine learning and blockchain to drive prevention, diagnosis and treatment of diseases and research into new molecules.” But, at the same time, healthcare is also being disrupted by the biomedical revolution, “which arose as a result of discovering the human genome and is leading us towards more personalized medicine,” he adds.

The company, aware of this context, began a transformation process in 2019. Under the corporate mission “Reimagining Medicine,” it initiated a period of change to “succeed in a competitive and constantly evolving environment, while always maintaining the objective of providing patients with a greater benefit”, Marcilla notes.

What was Novartis Oncology España's motivation to begin this transformation?

We started by defining an unboss culture, where leaders must provide clarity on the company's purpose, objectives, strategies and priorities, and to do so, we worked with the extended leadership team. We also shared a dream: to cure cancer someday. I am certain that cancer will be cured someday. In at least 10 to 15 years, we will succeed in the chronification of this disease.

We then conducted an exercise with these leaders to analyze what the healthcare sector would be like in ten years' time. We studied trends, new players, customer and patient needs and the organizational structures and capabilities required for this new context.

You discuss the importance of personalization in achieving your goal, but which innovations would you consider to be contributing to new advances in precision medicine?

In addition to an understanding of the human genome, immunotherapy is proving crucial. Through it, we are learning how we can activate our own immune system to identify cancer cells. The combination of mutation-targeted therapies and immunotherapy is changing the face of medicine. For example, we have drugs that specifically treat melanoma in people with a particular gene mutation. This also requires a general biomarker analysis and the study of the patients' genetic profile.

You have created an external innovation program. How does an industry as regulated and a priori rigid as the pharmaceutical industry manage to implement innovation in day-to-day healthcare?

One of the lessons we have learned is that healthcare professionals need to be educated in new technologies. To do so, we launched The Innovation Wave program last year, which aims to help them become the driving forces behind the healthcare system's digital transformation. In healthcare, machines will never be able to replace healthcare professionals, but professionals who do not use technology could be replaced by those who do.

We also wanted to capture disruptive innovation from beyond our own corporate world through the StartUp Acceleration Program. In order to solve the challenge of improving patient diagnosis and treatment, we established an alliance with Conector. Fifty start-ups applied and two won. We are currently piloting a start-up's MVP [minimum viable product] in a leading Madrid hospital.

Finally, the third element of our model is related to establishing partnerships. Before, we created egosystems where the corporate was at the center and everything else revolved around it. Now we want to create ecosystems. For example, we are collaborating with Disney to improve the stay of children hospitalized with cancer, and with the Ricky Rubio Foundation to promote lung cancer prevention campaigns and to humanize hospital spaces, among others. 

“Before, we created egosystems in which the 'corporate' was at the center and everything else revolved around it. Now we want to create ecosystems.”

In the healthcare sector, innovations such as digital therapies are emerging, what is Novartis' opinion on this trend?

Several of these therapies have already been approved by the Food and Drug Administration (FDA) in the ophthalmology field. At Novartis, we are also committed to digital therapies: using data and digital tools to rethink current treatments and explore cutting-edge fields that provide better patient experiences and outcomes. One example is Amblyotech, a software start-up that has developed a digital treatment for amblyopia.

Internally, you have opted for agile methodologies and the creation of cells as working groups, how do they work and what results are you obtaining? 

  We have designed a model based on the concept of ambidextrous organization. On the one hand, we maintain the hierarchical structure that all corporations have, but we also have teams that work on disruptive innovation. These teams or cells are made up of professionals from different profiles and departments. It is also very important that field delegates participate in these cells, as they are closer to the customer and we rely on them for first-hand insights.

This has made it possible to strike a balance between exploiting and exploring new solutions across departments. It has also helped us develop horizontal talent and enable leadership members to engage with people they do not directly work with. In general, we have been achieving better results, pivoting with clients and detecting ideas or projects that didn't work more quickly.

As part of this business model transformation, you have commented that the pharmaceutical sector must be more service-oriented. What is Pharma as a Service (PaaS)?

Many industries are already implementing the service concept, and I always wonder how it has not yet taken hold in the pharmaceutical sector. Beyond a drug, we must provide value to people and the healthcare system. I believe that more service models will appear with which pharmaceutical companies will also provide this added value.

You might produce a drug for breast cancer and also offer an application for women to monitor the side effects they suffer. It's about adding value beyond the drug.

 “Beyond a drug, we must provide value to people and the healthcare system.”

Artificial intelligence is one of the technologies present in several of the company's ideas arising from these cells, how is this technology benefiting you?

We are using artificial intelligence in the development of a platform called Sens to avoid delays in clinical trials. At times, some centers were late in including patients in these trials and we were unaware of what was happening. Through artificial intelligence, we can anticipate this so that clinical trials run as quickly as possible, while respecting legal and regulatory processes.

Furthermore, at Novartis, we currently have more than a million molecules stored in a library and we don't know what they can be used for. We have signed an agreement with Microsoft to take advantage of its artificial intelligence functionalities, speed up research times and predict  what potential clinical benefits these molecules could have.

In addition to Microsoft, there are other technology companies that are capable of entering sectors such as healthcare. How do you respond to giants such as Amazon, Google or Apple entering the market?

We have signed another agreement with Amazon to improve the logistics and supply of medicines. I think the most important thing is collaborating and taking advantage of all the companies' strengths to achieve better patient care. When you see these companies' forecasts, it becomes clear to you that they are moving into the healthcare sector. For example, Amazon has opened an online pharmacy in the United States.

These are companies that are very good at managing the customer and user experience. Who knows if at some point they will start looking into it. One thing we have in common is that any of us is or will be a patient, so the healthcare sector is something that affects us all. This is where the concept of coopetition comes in. We will be in competition for some things and in others we will collaborate.

In your opinion, what do you think the future of the pharmaceutical industry will be like and what challenges lie ahead?

I foresee three main challenges. One is reputation. I feel that pharmaceutical companies must do better at explaining why we do things and what we do them for. We won't be a successful industry if society has no confidence in us. We have to meet the highest standards of quality and ethics over and above the requirements of regulation and society itself.

“The pharma sector will not succeed if society has no confidence in us”

On the other hand, we must analyze how we advance with precision medicine which is changing the paradigm of chronifying and curing, and we must consider how to become a sector in which the value of a drug is measured as opposed to its price.

The final challenge is that of technology, i.e., we must be able to use new technologies to improve patient care and help many more people.

Published by OPINNO © 2022 MIT TECHNOLOGY REVIEW spanish edition