Healthcare and life science companies are transforming their business models from product development toward precision medicine. Vasant Narasimhan was appointed in 2018 as the new CEO of Novartis—a global pharma company. He champions a multi-faceted strategic intent: 1) transform the company from “selling pills” to investing heavily in discovering of new treatments that combine life sciences and digital technologies. In Spain, José Marcilla, the Director General of Novartis Oncology, pioneered an organizational transformation by developing (1) a cell-based innovation organization and process and (2) a new startup accelerator. This case explores both initiatives and their far-reaching consequences. The “Spanish experiment” helped to develop of digital services that reach the patient in a highly regulated environment. This duo of cases—Novartis Oncology Spain: Agile Innovation and The RWE (real wold evidence) Cell—gives students the opportunity to examine the motivations behind the transformation at Novartis, explore the implementation of its strategic intent, and ask what is the appropriate pace for such a dramatic change. The case is taught as a single class for decision-making regarding which cells and startups are suitable to be continued given the innovation horizons. By walking with students through these innovation horizons, the case enables decisions to be made about whether this pioneering Spanish program should be continued or not.