A Call to Action for Value Management

By Nathan W. Tierney
Director of Value Management
and the Author of
Value Management in Healthcare







In healthcare, the overarching goal for providers, as well as other stakeholders, must be improving value for patients. Here, value is defined as the health outcomes achieved that matter most to patients relative to the cost of achieving those outcomes. Improving value requires either improving one or more outcomes without raising costs, or lowering costs without compromising outcomes, or both. Outcomes empower patients, clinicians, and payers and will influence the future healthcare delivery landscape in three distinct ways:

1. Patients shall choose the providers for their care based on outcome value scores
2. Providers shall be data-informed to make targeted improvements and learn
3. Payers shall measure return on investment and direct patients to high-value providers 

My upcoming, evidence-based book seeks to provide healthcare delivery organizations a Value Realization Framework and methodology for establishment of Value Management Offices in order to support quality of care and provide safe delivery of value-based outcomes that matter most to patients, clinicians, and payers. 

“The universal development and reporting of outcomes at the medical condition level is the single highest priority to improve the performance of the health care system”- from Redefining Health Care, by Michael E. Porter and Elizabeth O. Teisberg.

Problems Facing Healthcare Delivery Organizations

Globally, countries are investigating new healthcare delivery strategies to prioritize value-based outcomes over volume. National governments are introducing policies, implementing new reimbursement methods, and collaborating with health organizations to enact change. The new laser-beam focus on achieving the best health outcomes for patients at the lowest cost will transform the healthcare industry. 

Companies are also interested in value-based outcomes. These companies are paying high prices for employee health data in order to predict risks and health needs. The implications for this situation are significant for employees, employers and insurers. As an example, if a company thought you were at risk for diabetes, it might offer you an incentive to join a weight-loss program or send personalized reminders to visit a doctor for a checkup.  Employers do have a vested interest in healthy and productive employees as well as a fiduciary interest in what they pay for employee healthcare insurance, but does use of health-related data constitute improper use of employer and employee relationship?

From the Strategy that will Fix Health Care, by Michael Porter and Tom Lee:
“Provider organizations understand that, without a change in their model of doing business, they can only hope to be the last iceberg to melt. Facing lower payment rates and potential loss of market share, they have no choice but to improve value and be able to ‘prove it.’”

Recommendation for Healthcare Delivery Organizations

It is recommended that organizations create a Value Management Office to serve as a center of excellence for determining evidence-based outcome measurements. This facilitates the creation of value-based care and payment models. Value-based care and payment models support IT governance by evaluating business case investments and projected benefits to link people, processes, and technology. Patients and providers should work together to define and drive the industry towards value. 

Implementation of a collaborative Value Management Office enables organizations to evaluate projected and realized strategic, operational, and financial benefits from major business process changes, and enterprise initiatives, and establishes critical value-based care models. The shared vision is for Healthcare Delivery Organizations to apply value management as a way of doing business to ensure efficient deployment of capital, improved clinical outcomes, and achievement of strategic, operational, and financial objectives.

Healthcare organizations are examining innovative ways to deliver improved patient outcomes at lower cost. This has involved traditional process improvement methodologies, which have been effective in reducing traditional defects and efficiency improvements. However, these efforts have failed to utilize new technologies, analytics and value frameworks that provide both horizontal and vertical alignment for value-based healthcare.

The Value Realization Framework provides the methodology for aligning Mission, Vision, and Values with concrete Critical Success Factors (agency goals), measurable Key Results Indicators (outcomes), objective and measurable Key Performance Indicators (actions). The methodology seeks to ensure quality of care, patient safety, and Health Information Technology Programs, which improves service delivery, product delivery, information security, fiscal management, clinical outcomes, and operational metrics (Figure 1). 

This standards-based process also ensures present IT systems continuously perform as required, contribute to overall business goals, and delivery of expected outcome-oriented results. 

 Figure 2: Value Realization Framework

Conclusion

Primum non nocere, “First do no harm,” the Hippocratic Oath calls on the healthcare community to ethically uphold the highest standards of providing safe and quality care to those in need. This calling goes beyond minimizing mortality rates and instead requires standards with which to achieve a predictive outcome. A standard is something quantifiable and used as a measure or model in a comparative evaluation to determine the value of an outcome. Without standards, there can be no improvement, which is why establishing a center of excellence to determine outcome measurements is so critical. Only through establishment of a Value Management Office and a standards-based Value Realization Framework will Healthcare Delivery Organizations truly shift from reactive to proactive in the provision of value-based care. This shift is the catalyst for change within our healthcare system that empowers patients, clinicians, and payers by delivering desired clinical, financial, patient satisfaction, employee satisfaction, process improvement, and learning and growth outcomes from the perspective of the individual – not the institution. 

If Value = Outcomes (Benefits) / Costs (Inputs), then the value story is providing any patient regardless of sex, age, race or location, a safe and quality health outcome relative to the cost of achieving those outcomes. A Value Management Office can help be the conduit for telling your organization’s value story.

Nathan Tierney is an accomplished senior executive and leader in value management, with over 21 years experience in multibillion-dollar domestic and international operations, developing innovative and profitable methodologies, advising disparate levels of leadership, and managing in complex environments. 

He has a proven track record of performance in all fields, and a natural propensity to analyze outcomes both strategically and objectively while remaining pragmatic and focused. Information about Nathan's upcoming book, Value Management in Healthcare: How to Establish a Value Management Office to Support Value-Based Outcomes in Healthcare, can be found here.

_______________________________________________

i Porter, M. E., & Lee, T. H., MD. (2013). The Strategy That Will Fix Health Care. Retrieved October 12, 2016, from https://hbr.org/2013/10/the-strategy-that-will-fix-health-care

ii Adapted from International Consortium for Health Outcomes Measurement. 2012 

iii Maslow, A.H. (1943). “Psychological Review – A Theory of Human Motivation
 

iv  Porter, M. E., and Teisberg, E. O. Redefining health care: creating value-based competition on results. Harvard Business Press. 2006 

v  Wired Magazine (2015). “Security this Week: Employers are Paying Data Firms to Predict Your Health Risks”http://www.wired.com/2016/02/security-this-week-employers-are-paying-data-firms-to-predict-your-health-risks/ Access February 20, 2016
 

vi Porter, M. E., and Thomas H. Lee. The Strategy that will Fix Health Care. Harvard Business Review. 2013 

vii Adapted from International Consortium for Health Outcomes Measurement Intro Presentation. 2015

Frost Perspectives/Healthcare Transformation of Medical Device Industry

   
By Brahadeesh Chandrasekaran
Industry Analyst, Transformational Health
Frost & Sullivan

Introduction

The pressure to reduce healthcare expenditure, intensifying competition, and consolidation of hospitals and health systems has brought unprecedented changes in the way medical device companies do business. The dynamic marketplace is transforming the traditional way of doing business and requires the medical device manufacturers to rethink their existing business models and create value proposition for customers through innovative products and solutions. This transformation of medical device industry is fueled by an ageing population, proliferation of chronic diseases, increasing emphasis on quality of care and treatment, stringent regulatory landscape focusing on patient safety and cost-containment, empowered and informed customers, and emerging technologies.

The Market – Global Medical Devices Market

While medical device manufacturers are striving hard to address the challenges, the dynamic marketplace also presents huge opportunities for the companies.

Exhibit 1: Global Medical Devices Market, 2015-2016

Source: Frost & Sullivan

Note: In-Vitro Diagnostics is not included in medical devices market

The global medical devices market is estimated to be $330 billion in 2016, an increase of 4 percent growth from 2015. Orthopedics is the largest segment in the medical devices market and it is estimated to remain so for the next 5 years, contributing approximately 14 percent of the global market. Minimally invasive devices and cardiovascular devices complete the top three segments of the medical devices market with approximately 12 percent and 10 percent respectively.

In terms of region, United States led the market with approximately 39 percent of the global market followed by Japan, Germany and China. The top 10 countries contributed to almost 80 percent of the global market.

The Big Picture – Changes in Medical Device Industry

The transformation of existing business models in the medical device industry is primarily attributed to the four factors:

1. Cost and Pricing Pressure: The declining R&D productivity coupled with increasing pricing pressure has resulted in eroding profit margins for medical device manufacturers. Hence medical device companies need to optimize their R&D investment to have right product mix and high manufacturing efficiency. One of the key strategies of medicaldevice companies is the focus on high growth markets and high growth segments to increase the profit margin and minimize the risk of pricing pressure in developed countries such as the US and countries in Europe.
2. Power Shifting to Payers and Providers: Payers and providers are gaining more importance in the selection of medical devices. The move towards value-based care is allowing payers and providers to reap benefits with improved quality, patient outcomes and better profitability. Though medical device companies are facing uphill challenges in adjusting to the new value-based payment models, it provides opportunities for the companies by working closely with payers and providers and provides a holistic approach for patient care, which is essential for long-term sustainability. The new models include risk-based revenue sharing models where companies share the risks and profitability with the providers on an individual patient basis.
3. Digital Transformation: Similar to other industries, medical device industry is undergoing digital transformation to control costs, enhance patient care and improve utilization of providers. The wearable devices are already starting to deliver their value-proposition by providing continuous monitoring of patients that has high significance in patient management. Digital technology provides opportunity not just to enhance the patient care but also provide data to make informed business decisions. For example, data from the connected devices can help manufacturers better understand the patient behavior, and performance of the devices. Such data provide valuable insights for the medical device companies to develop more effective products and solutions. For example, according to the medicaldevice recall report FY2003 to FY2012 by FDA, the number of medical device recalls increased 97 percent during this period. Digital technology such as predictive analytics or patient monitoring features in devices can help companies to proactively identify the quality issues and improve the device performance. In addition, digital technology allows companies to provide a holistic approach in care delivery and expand in to new service areas of patient management.
4. Healthcare Consumerism: Consumerism in healthcare is playing a significant role in transforming the traditional way of care delivery. The increasing awareness among patients increases their choice of choosing healthcare services and enables them to actively participate in the management of their health and wellness that led to new concept known as Do it Yourself (DIY) health concepts. The consumerism in healthcare has allowed device companies to focus on new initiatives in reaching out directly to them.

Exhibit 2: The need for Transformation in the Medical Device Industry

Source: Frost & Sullivan

These factors are leading to an integrated approach by the medical device companies in providing a holistic approach to the patient care from a pure play medical device manufacturer.

Integrated Approach towards Patient and Disease Management: A Holistic Approach

Historically medical devices have been narrowly focused on singular aspect of a disease or condition. As the complexity of the diseases and the financial burden increasing day by day, there is a need for a multi-level approach to disease treatment. Thus medical device manufacturers are focusing on developing new technologies and services that work with an integrated approach of care continuum, a shift from silos approach. Integrated care reduces the costs and improves the patient outcomes. The integrated approach aims to provide end-to-end solution not just for patients but also for providers in improving their efficiency, infrastructure and treatment efficacy.

Exhibit 3: Evolving Medical Device Business Model towards an Integrated Approach

Source: Frost & Sullivan

For example; in 2013, Medtronic, a leader in the medical device industry, announced the formation of Medtronic Integrated Health Solutions, a new business focused on developing novel partnerships with hospitals, physicians, payers and health systems to deliver high quality care in a cost effective way. The solutions aimed at managing, modernizing, optimizing and developing cath-lab facilities and bring sustainable efficiencies and patient recruitment programs to hospital cardiology department. Medtronic’s Integrated Health Solutions goes beyond the management of cath labs and focuses on creating efficiencies along the entire care continuum, supported by system components such as telehealth. The main goal is to deliver value, optimize outcomes and cost of care delivery, through vendor-independent solutions and long-term partnerships. Similar types of services are offered by many other companies such as Boston Scientific, Philips, St. Jude Medical, etc.

Established medical device companies are embracing this new paradigm and are finding a way to expand the traditional way of doing business and are changing their business models not just from a product perspective but also from a process, service, and relationship with stakeholders’ perspective.

Role of Connected Health Solutions

Connected health solutions enables patients, care providers and payers to access data effectively and make informed decisions on the quality and outcomes of treatment. At a time where the demand for healthcare services continues to rise because of aging population, constrained budgets for hospitals, lack of access to healthcare in many countries, and increasing costs for advanced treatment, the role of connected health is highly significant as it is capable of delivering cost-effective solutions and can significantly improve the patient outcomes. The connected health solutions have allowed medical device companies and digital technology companies to bring out solutions that provide comprehensive care.

For example; Propeller health, a digital health technology company, develops sensors and digital platforms that are used to collect patient medication data and turn it into actionable insights for patients and care providers for the treatment of COPD and Asthma. The company has already partnered with leading inhaler manufacturers such as GSK, BoehringerIngelheim, etc. to integrate their digital technology with the inhalers for improving patient outcomes. In addition, Propeller health partnered with the Institute for Healthy Air, Water, and Soil, the Louisville Metro Public Health and Wellness Department, and the Robert Wood Johnson Foundation officially launched an initiative called AIR Louisville, a first-of-its-kind collaboration using digital technology to improve asthma. The initiative aims to track the asthma patients in Louisville and leverage the data from the Propeller health’s inhaler sensors and asthma management system to make informed decisions on management of patients and environment in Louisville.

The role of connected health solutions is expected to have a huge impact in the transforming healthcare system towards personalized medicine and allow companies to develop technologies, products and solutions towards patient or consumer-centric approach.

The Future

The inevitable radical change in the medical device industry will redefine the traditional way of doing business. Medicaldevice companies that embrace and align their business strategy according to these changes will sustain and can remain profitable. Digital health solutions will play a significant role in the medical device industry and the customers will not only include physicians and GPO’s but also C-Suit, Consumers and Payers. Scalability beyond traditional product offering and competing beyond a company‘s traditional industry will be important, as more companies will begin to converge products and services. Companies like Apple, Google, and IBM will continue to compete outside their domain, pushing traditional healthcare companies to break their dominant business model. Medical device manufacturers must incorporate a socially beneficial aspect to their business models. The preference of payers and consumers will incline toward companies that help them improve their lives and treatment outcomes in a cost-effective way.

What to Watch for in 2017: More Technology,Better Access

With commentary by
Jay Rajda, M.D., M.B.A., FACP
Chief Clinical Transformation Officer
Aetna





Whether it’s smart watches, fitness trackers or artificial intelligence, technology is a part of the health care industry. At Aetna, our experts keep track of technological advances as a part of our mission to increase access to high quality, cost effective healthcare.

Technology opens doors for continuity

The opportunity to use a laptop or smartphone to remotely consult with a physician is convenient and cost effective, and so telemedicine is increasingly popular with patients, providers and insurers alike.

Jay Rajda, M.D., MBA, FACP, Aetna’s chief clinical transformation officer, said the technology and models used for telemedicine will evolve and provide an opportunity for more “continuity” of care remotely.

“Thus far, the most prevalent model one where telemedicine is used primarily for low-complexity urgent clinical issues” Rajda said. “We are excited about the prospects of the role of telemedicine in chronic condition management. As we further develop consumer-centric care models, the ability to access continuity of care by connecting with one’s own primary care physician to manage diabetes or hypertension, could be a valuable proposition for the consumer, improving patient satisfaction. At the same, it holds promise to be able to fulfill the triple aim of improved access and quality, and reduced costs.”

Find balance between wearables, apps and evidence-based medicine

The technology in today’s wearables can detect if someone is walking, running, swimming or climbing and can recognize a person’s emotions. For example, one wearable monitors a person’s breathing patterns to determine if they’re stressed. If they are, the wearable vibrates, prompting the person to take a deep breath.

As technology continues to develop, physicians have to strive to continue to create doctor-patient relationships, according to Gabriela Cora, M.D., DFAPA, a medical director for Aetna Behavioral Health.

In a world where people have vast amounts of information at their fingertips, and where apps and wearable devices give people access to a variety of metrics, Cora emphasized the importance of not overwhelming people with data. She said she finds the blurring line between technology and health care interesting, but reiterated that diagnoses and treatment will be supported by “evidence-based medicine.”

“The integration of technology in health apps and wearables will make a difference as long as it relies on healthy standards,” Cora said. “This is going to be the greatest opportunity – and challenge – in the years to come.”

New payment models may also impact access

Physicians will also be paying attention to large-scale changes that can affect patients, according to John Moore, D.O., FAAFP, Aetna’s medical director for the United States’ Northeast Region. This includes the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), which went into effect on Jan. 1, 2017, and changes the way Medicare physicians are paid.

Moore explained he’s interested to see how changes from the federal level can impact an individual patient’s opportunity to access affordable health care.

“It’s really critical for health care patients to have coverage to the best of their ability,” Moore said. Noting that the future of the Affordable Care Act is uncertain, Moore continued, “Generally, physicians would like to see patients have access to affordable health care.”

To learn more about timely medical news and analysis, please visit: 
https://news.aetna.com/2017/02/2017-more-technology-better-access/

New Developments in Robotics Rehabilitation

 

By Alind Sahay
Vice President
Noxilizer, Incorporated







Today, robots are present in a variety of application areas in the healthcare space – in surgery, pharmacy, rehabilitation, hospital services and many other areas.  This trend is more recent in the area of rehabilitation robotics but is accelerating and some market research reports are predicting over 20% year-over-year growth.

Rehabilitation robotic systems are used in order to restore function or to provide assistive motor and motion functions.  These robots are generally segmented into assistive robots, prosthetics, orthotics, therapeutic robots and exoskeleton robots.  Intuitively, it makes sense to use robots for rehabilitation therapy as there is need for repetitive motion which needs to be in a specified and controlled range to stimulate recovery and not cause damage.  Additionally, robots generally have feedback devices and can measure progress of recovery and can therefore be used by therapists to optimize settings for patient recovery.

Though the current market for rehabilitation robots is relatively small (a few hundred million) when compared to surgical robots (a few billion), this market is expected to grow rapidly with advances in sensor technology, processing power, robotic technology and the potential for use of Artificial Intelligence.  Therapeutic areas for rehab robots include a) acute and chronic neurological disorders arising from stroke, traumatic brain injury, spinal cord injury, cerebral palsy, multiple sclerosis etc. b) orthopedic rehabilitation and c) other non-neurological and non-orthopedic  areas.  A quick review of the incidence and prevalence of stroke on a worldwide basis indicates a potential for a significant multi-billion dollar market.  At this time, although there are some leading players in this space, there is no dominant player.

For stroke therapy, there is general clinical agreement that, at a minimum, the introduction of robotic systems into clinical practice is useful in promoting the standardization of treatment and cost-effective use of human resources.  There is sufficient clinical data that shows that early treatment and intense treatment is better for recovery from stroke – and deployment of robots has the potential to ensure proper early and intense treatment.  However, the current robotic devices are heavily task oriented and provide simple repetitive movement patterns.  There is significant research in the use of engaging games coupled with automation that has shown the possibility of further improving outcomes.  These games, by engaging the patient, provide the possibility of improved therapy compliance and also, by their very nature stimulate neurological recovery in ways that a repetitive movement pattern cannot.  Games, though need to be well designed for this purpose.  There are a number of research institutions that have designed such games and some well-funded spin-off companies based on this research.

As we look at the future, one key factor that is a barrier to adoption is the cost of these devices.  The more complex high-end robots in the neuro-rehab space may cost around $100,000 and some of the more sophisticated exoskeleton assisting devices may cost around $200,000.  To improve adoption these prices need to come down and/or more innovative business models need to be developed that reduce the cost of use to customers.  Within the U.S., re-imbursement models for rehabilitation treatment do not allow for direct payment of costly robotic systems, rather treatment costs have to be fitted within the Medicare re-imbursement models. A 1990 study estimates the total direct cost of stroke to be $40.6 B, split into 45% short-term care costs, 35% long-term ambulatory costs and 17.5% nursing home costs. With well-thought studies, it should be possible to generate evidence that long-term care costs will come down with improved recovery and capture part of the savings from cost-reduction to either insurance or to patients/family.

In addition, there appears to be significant opportunity for companies to launch products using strategies similar to gym equipment.  For clubs, equipment is generally higher end and economic models are based on membership dues.  Some more well-to-do customer buy equipment for home use.  Companies should explore this model (and some are beginning to do so) as the opportunity is large due to high numbers of chronic patients and the willingness to pay for lower ‘club’ dues rather than high therapist fees in a hospital setting.

Clinical data for the use of robotic systems for therapeutic and functional rehabilitation is promising.  Robotics intuitively makesense for systematic rehabilitation.Coupled with gaming, connectivity and artificial intelligence, robotic systems have the potential to make significant positive impact on the lives of patients and reduce the economic and social impact, specially, of neurological related issues.  In the long-term, costs will come down and businesses will come up with innovative economic models based to significantly drive adoption.

Alind Sahay is a research and development business leader and innovator with over 20 years experience developing and launching innovative medical devices for global markets, which includes over 12 years leading product development for image based robotics at Integrated Surgical Systems and navigation systems at GE Healthcare. His business development experience encompasses defining and executing on technology-based opportunities, including licensing and collaborations.

Currently, he is Vice President, Research and Development at Noxilizer. Previous positions include Program Director, Endo Health Solutions, where he was responsible for the complete research and development portfolio for the Healthronics product line and Director, Product Development at Terumo Cardiovascular Systems, where he managed new product development and line-extensions for cardiac pumping systems and associated disposables.

Transformational Shift: New Business Models in Healthcare

 

    PRESENTER
    Greg Caressi
    Senior Vice President,
    Transformational Health
    Frost & Sullivan

 

SESSION ABSTRACT
This discussion helped participants gain valuable insight into new marketplaces and implications across value chains. Examples of how transformation in healthcare can be leveraged to develop new business models were also presented. Participants examined top global case studies and utilized them to identify new channel partners, new customers, new convergence ideas and revenue streams across the entire ecosystem.

KEY TAKE-AWAYS:

• An assessment of the future success potential of current and emerging business models in the B2B and B2C segments across industries
• Identification of new partner networks, future customer segments and valuable revenue streams for your company
• Analysis of new product positioning, new value proposition through creation of a business model canvas

OVERVIEW

Healthcare is being transformed and new business models are evolving around six overall themes:

1. Building an Ecosystem
2. Moving from Product to Service
3. Decision Support
4. Integration Is King
5. Process Change
6. Mass Customization

Some key developments in new healthcare business models include:

• Artificial Intelligence solutions being used for workflow optimization (e.g., triage) purposes
• The use of social media, more on the consumer side than the institutional side, for purposes such as activity coaching
• The tendency to view market segmentation and/or fragmentation as an opportunity where one solution can be adapted across various stakeholders
• Enhanced patient comfort level with having their information reside in the cloud
• Consumer willingness to co-pay seems set at around $30-$50
• Genomics is one new area of innovation in business models; within 5 years it willbe considered ―malpractice not to use some genomics technologies, particularlyin oncology
• Intermountain Healthcare is one of the leaders in offering healthcare providers genomics testing
• IBM Watson is partnering with Memorial Sloan Kettering to leverage genomics and analytics
• The American Society of Clinical Oncology (ASCO) is partnering with Systems, Applications and Processes in Data Processing (SAP) to develop big data solution for oncologists nationwide
• Shared infrastructure platforms are being shared across practice groups

TAKE-AWAY

• 64% of patients would see a doctor via video
• Access and convenience is more important to patients than physical contact, many are also very unconcerned with having their information in the cloud
• Price points are similar for most available options (makes things easier)
• You can adapt one technology and one solution to many different stakeholders

ACTION ITEM

• Strive to change consumer attitudes towards healthcare delivery

BEST PRACTICE

• Reimburse only for the best pathway of healthcare delivery
• Artificial Intelligence (AI) is used for determining models and learning from them
• Find an enterprise based analytics solution located within a clinical setting
• Speed up ingestion and analytics of data
• Find the balance between one on one and subscription based model
• Retail clinics have an opportunity to provide a positive impact for minor issues
• A lot of different parts when it comes to chronic care leads to new models,
• While many in the field are reducing interaction with it, the FDA is still a central player; you need to worry about the FDA
• The first conflict point will probably be provider-payer not consumer-payer
• Cloud is the new change that has to happen, there is just too much data to house physically

FINAL THOUGHT

With the coming influx of technology and the growing consumer adoption rate, you need to really position yourself within the field and make use of the tools and analytics that are becoming increasingly more available. Cloud storage and the upcoming use of AI to help interpret all of this data in a meaningful way will be the key to success.

Q and A with
Sam Van Alstyne
Global Marketing Manager
New Products
3M Drug Delivery Systems

By Patricia Jacoby

Publications Editor 
Frost & Sullivan 

As new options in connected healthcare continue to emerge, new and sometimes unlikely entrants are also contributing to the transformation of the medical business landscape. To address this trend, Frost & Sullivan recently posed a few questions to Sam Van Alstyne, Global Marketing Manager, New Products, 3M Drug Delivery Systems. We discussed 3M’s entry into digital healthcare, their recent innovation in drug delivery and the need for effective business models to address all the changes in healthcare.

1. Can you describe your current role at 3M?

I am the Front End Innovation and New Products Marketing Manager for 3M Drug Delivery Systems Division.  My job is to work with our laboratory scientists, insights specialists and designers to develop new product concepts and take them through the commercialization process. I’m currently working on three projects – one, the 3M™ Intelligent Control Inhaler has been publicly announced.

2. Can you share any examples of new Drug Delivery Systems you are particularly excited about? 
  
The entry of 3M into digital healthcare – particularly as it applies to inhalation drug delivery.  3M is known globally as an innovative company and developed the first metered dose inhaler 60 years ago – it is exciting to see these come together. 

3. Can you discuss how 3M Science is being applied to Digital Heath Care?

It’s the theme of uncommon connections – the ability to bring resources from across the company to bear in solving a particularly tough problem. With our inhaler project, we can leverage formulation and delivery expertise from our own division, data management and analytics knowledge from 3M Oral Care and Health Information Systems Divisions to create a product that may help solve the persistent problems of medication adherence and what we call device competence – the ability of a patient to use an inhaler correctly.

4. How do you see 3M’s products and services evolving to meet the current shift to value-based healthcare?

Data plays a critical role in value-based care.  You must prove outcomes – not just clinically but in the real world and data helps to do that.  One of the benefits of connected devices is that you generate longitudinal data from a large and diverse population. Instead of days or weeks of data, you can get months and years – something that would be prohibitively expensive to do in a clinical setting. That data can be examined for trends and connections providing insights not only to healthcare providers but back to the patient themselves. Empowering patients is key to reducing healthcare costs in the long term.

5. Many new opportunities exist for companies (like 3M) focused on technology and process innovation. What opportunities for technological innovation do you see in the marketplace?

Globally there is intense pressure to reduce the cost of healthcare. Sometimes this seems at odds with the desire for new, innovative products – but it’s exactly from these sorts of tensions that true creativity flows. We have a challenging situation with drug delivery since most (if not all) of the payer-quantified value comes from the molecule delivered rather than the technology which delivers it.
Yet across the industry, there are patients who do not get the full benefit of their therapy because they forget to take their medication or they take it incorrectly. In these cases, the delivery systems can help. They can remind or remove obstacles by simplifying the administration process. These devices can provide real, demonstrable value to the patient and to the payer but it’s difficult to get additional reimbursement.

6. How about improvements that can be made to the drug delivery process?

It’s not just a problem in drug delivery, I attend several digital healthcare conferences each year and I’m always amazed by the incredibly creative solutions on display and most are struggling to survive.The desire, drive and technology are there, what’s missing are the innovative business models that help turn these inventions into sustainable businesses.

7. The theme of this eBulletin is Capitalizing On New Business Models in Healthcare for Breakthrough Results. Do you think that is possible?

Who will pay for the innovation seems to be the question on everyone’s mind.  Instinctively, we turn to the payers as that is their traditional role but ways to deliver care are evolving faster than the industry can adapt. Models based on share-of-savings are popular but defining and proving what the savings are remains challenging. Looking beyond the payer and understanding who benefits, how they benefit and finding ways to partner is the way forward in my mind.
 
Excited by the ways technology can improve healthcare outcomes, Sam Van Alstyne is a software engineer who ventured into marketing and has since become passionate about digital health.  As new products marketing manager in 3M’s Drug Delivery Systems Division, Sam has responsibility for the 3M Intelligent Control Inhaler program.

Medtronic: From Medical Devices to the Transformation of Healthcare

By Hugo F. Villegas
President
Medtronic, Latin America







Medtronic is evolving by innovating in new ways and collaborating with new partners around the globe to bring meaningful innovations to market, finding ways to align value among the system’s stakeholders, and increasing access to care around the world.

Medtronic has the point of view that healthcare systems globally are not sustainable as is. New approaches and new forms of innovation are required to face the current challenges and assure that millions of people around the world are not left untreated.

Hugo F. Villegas, president of Medtronic in Latin America shares his views and the Latin American perspective, “We know that universal health should be a must, and Latin America has made huge progress in that realm as more and more countries in our region have implemented health reforms and policies aiming to achieve access to health for their entire populations; countries have even made universal access to healthcare a constitutional right. However, an aging population, the increasing prevalence of chronic diseases, fee-per-procedure payment approaches and delivery systems with misaligned incentives all contribute to the challenges in meeting the universal healthcare needs.”

In Latin America, Medtronic has taken important steps to start the conversation on an approach, known as value-based healthcare that could address these issues. Simply put, value is the idea of delivering better outcomes at a lower cost. We’reactively engaged with hospitals, payers, healthcare authorities and governments, associations, think tanks and the academia in order toexplore how the data and insights that Medtronic’s technologies create can be combined in partnership to help establish aligned value-based healthcare models.

“We currently entered into agreements to implement value-based healthcare projects in Colombia, Chile, Puerto Rico and Brazil. We believe these projects will deliver high quality care for diabetes and cardiac patients,” commented Mr. Hugo Villegas. He added, “Through these agreements, we hope to learn more about what works and share those results as a means of encouraging more private and public actors within the healthcare ecosystem in our region to implement thesenew kinds of models.”

Medtronic technologies and services, combined in partnership with healthcare system stakeholders, can create improvement in models of care and care delivery for specific populations of patients.  When incentives are aligned and payment is linked to outcomes, value creation can be measured and value-based healthcare models are possible.   “We’re exploring alternative payment models that reward value over volume” emphasizes Mr. Villegas. 

Medtronic is known for delivering high clinical value with the company’s innovative technology portfolio. We are now more and more focused on providing economic value throughour services and solutions offerings.  The proposed re-architecture of the healthcare payment and delivery systems seeks to reward patient outcomes by re-shifting the current fee-per-procedure approach to one that puts the patient at the center of care and rewards patient outcomes over volume of procedures.

As the world’s largest medical technology provider, Medtronic has a unique role to play in the move toward aligned, value-based healthcare.We also recognize that no single entity can do this alone. Only through collaboration and partnership can we transform healthcare. “We call this approach Further, Together. ‘Further’ because we will continue to drive progress in innovation and formulate powerful solutions with proven clinical and economic value as the basis of our offerings and ‘Together’ because we will forge new and stronger partnerships to help our customers to achieve their goals, deliver clinical outcomes to the patients and reduce costs” finalized Mr. Villegas.

HUGO F. VILLEGAS has been President of Latin America for Medtronic since January 2015. Hugo is responsible for the operations and business performance of the region with commercial operations in more than 35 countries. From 2013 through 2015, he was President of Latin America for Covidien, which became part of Medtronic in 2015.

Villegas began his 28 year career in sales for Johnson & Johnson, after which he held positions of increasing responsibility, from marketing to general management. He was Country Manager for J&J Peru and J&J Venezuela and subsequently led regional marketing for the company’s Cordis division. Villegas then became Regional Vice President of Johnson & Johnson Latin America and from 2006 until 2013 Villegas was transferred to Madrid, Spain as Regional Vice President of Johnson & Johnson Europe’s Medical Technology.

In 2013 Villegas brought a strong strategic vision and passion for growth and became President of Covidien Latin America. Under his leadership, Covidien’s regional business accomplished double digit growth. After Medtronic’s acquisition of Covidien in early 2015, he became President for the new, expanded operations of both companies across the continent.

Why the Connected Patient is the Killer App in the Digital Age of Medicine

If you search on the phrase “killer app”, you will find a definition along the lines of a feature, function, or application of a new technology or product that is presented as virtually indispensable. The two essential components of the killer app being:

1. Competitive features and function
2. Indispensability

Before diving into the healthcare part of this, it is worth mentioning one of the all-time great killer apps in consumer technology: The Sony Walkman.

Unlike the stereo system in your bedroom, it fit into a backpack, and you could take it with you. Additionally, you could listen to music of your own choosing whenever you wanted, as opposed to whatever the radio played. And by 1983, cassette tapes had outsold vinyl—so you could get virtually any album to play on it, which made it even more indispensable in the market.

Competitive Features and Functions in Medical Technology

Considering some of medtech’s great killer apps over the last 15 years—from remote monitoring systems for cardiac pacing to molecular diagnostics using the human genome—there is a common denominator that threads across the features and functions of these products. Simply put, they have slowly but surely become more centered around individual patients and their lives.

Whether it was the Bluetooth-enabled data uploads that were patient-triggered (from the nightstand!) in early remote monitoring or the patient’s own biology that led to improved diagnosis, it’s easy to identify “patient-centric” features and functions. But historically, a practical challenge to even the most novel diagnostics and therapies becoming indispensable in the market was that patients had minimal role in determining product value.

This is rapidly changing in the digital era.

How the Connected Patient Will Define Value in our Future
 
Alec Ross, the author of NYT bestseller Industries of the Future, has an intriguing way of looking at our eras of progress and the markets that revolved around them—basically, it comes down to raw materials and who has owned them. In the agricultural age, landowners owned the farmland; in the industrial age, corporations owned the iron.

Today, in the digital age, individuals own data. And in the digital era of medicine, patients and their data underlie the volume-to-value transformation…starting right now.

Why now? Because every single connected consumer in the US is a patient at some point. But as importantly, patient-consumers have integrated healthcare into their daily lives and are exhibiting new behaviors because of it. For example, Google has reported that “healthcare where and when I want it”-type searches have surged since 2013, and in 2016 the majority of health-related searches shifted from web to mobile for the first time in history.

If healthcare technology is becoming integrated into the real life of patients, the way we measure health outcomes should reflect this shift.

This takes us full-circle, back to patients and their digital data and why they are key to our value-based future—with their help, their data can be used to quantify and enhance health outcomes outside of clinic walls, so we can finally see what’s working, or not, in the real life of patients. And if real life patient data is redefining health outcomes, and outcomes are the basis of value-based care, then connected patients are the virtually indispensable component of healthcare in the 21st century. I.e., the connected patient is the killer app in the digital age of medicine….as the famous Sony Walkman ad said, “There’s a revolution in the streets.”

Deborah Kilpatrick, Ph.D., is an executive with broad experience in development and commercialization of new medical technologies and products for primary care and specialty channels. Her operational roles have spanned domestic and global leadership in R&D, corporate strategic planning and new technology incubation, as well as marketing, sales, and reimbursement in Fortune 500 and Silicon Valley start-up healthcare companies. 

Richard Milani, Chief Clinical Transformation Officer at Ochsner Health System, is also Vice-Chairman, Cardiovascular Diseases at Ochsner Health System. He has helped to shape and lead the Ochsner organization for almost eighteen years.

Ochsner Health System is an Evidation Health partner and Louisiana’s largest non-profit, academic healthcare system. To learn more about their medical expertise and innovationOchsner’s digital health capabilities, visit ochsner.org and https://www.ochsner.org/io

To learn more about how healthcare companies are using Evidation Health’s Real Life Study Solution to quantify health outcomes in the digital era of medicine, follow @evidation.

Navigating Through a Landscape of Change at the 22nd Annual Medical Technologies: A Frost & Sullivan Executive MindXchange

                       

 

Amid an eclectic, global crowd of key healthcare industry leaders, medical technology experts, and seasoned business entrepreneurs, two constant event themes emerged early on: uncertainty and adding value to the healthcare continuum.  Moreover, keynote speaker address titles included long tail key phrases like, Adopt or Die, and Changing Channels, or Adoption of New Technology. Each keynote address introduced well-documented evidence pointing to an emerging era of unprecedented change in healthcare and the struggle to find business strategies that adds value for advanced medical technology in a value-based healthcare ecosystem.

This survival of the fittest mentality combined with the movement to value-based care dominated not only the main sessions of the 22nd Annual Medical Technologies: A Frost & Sullivan Executive MindXchange, but also subsequent follow up conversations at lunch, dinner and into the night as colleagues and new friends gathered in small groups to debate the way forward. This heightened level of dialogue and sense of urgency continued for over three full days of interactive sessions and team-building exercises orchestrated by the Frost & Sullivan Events Division.

In addition to the ever present “winds of change” presentations, there were also brief presentations about seismic shifts in advanced medical technology. These discussions involved early detection and prevention of chronic and degenerative disease and the endless opportunities medical devices bring. But, break-out session facilitators went on to explain this anticipated scientific and financial bliss from advanced medical technology requires unique applications where providers can successfully detect, intervene and prevent debilitating diseases. In essence, the ability to create a blue ocean strategy for the planned data output of a new medical device. However, capitalization for mimic medical devices is challenging as is raising money for medical devices whose product produces scientific data that has little or no clinical relevance. A reported missed step when beginning a first round of capitalization is not having a planned and granular business strategy with enough follow- through to generate a return an investment for investors.

How Technology Becomes Business and Business Becomes Technology

Al Naqvi of The American Institute of Artificial Intelligence gave an in-depth presentation on the advancement of artificial intelligence and its many applications in medicine. He simultaneously encapsulated the necessity for finding a business strategy for technology and showcased how artificial intelligence is transforming the healthcare value chain.

Since the first industrial revolution in the 1750s, technology and business have been viewed as separate entities. This is referred to as strategic dualism where technology enables business. In the latter 1800s, electricity created a division of labor and mass production that enabled mass distribution. This dominated an acceptable parity between technology and business until late in to the 20th century. Then, with the dawning of information age technology, the introduction of the Internet generated a cognitive and consciousness revolution that established a reality that technology is now both the core business and strategy and that the two are indistinguishable (Cognitive singularity).

In short, machines are no longer viewed as detached inanimate objects designed solely for mass production. And with this admission we usher in the artificial intelligence (AI) revolution where we have:

 

Artificial Intelligence
 
For applications of AI along the healthcare continuum, Mr. Naqvi suggested ways AI can shape this opportunity. As Naqvi stated "You need to ask yourself these questions. What text or data can be extracted? What machine learning can be deployed to learn processes such as caring, diagnosing, and providing therapy? And lastly, how much learning can be integrated with workflows?" Naqvi then stressed the imperative for AI to contribute to healthcare by adding value. Without transforming the value chain and a sound business strategy, even IBM’s Watson is viewed as nothing more than a computer.

A Call for Ethics in Technology – Adopt or Die

Michelle Mosolgo, Chief Technology Officer, Healthcare Solutions and Services, Merck & Company, presented an emerging ecosystem for new technology adoption and outlined four linear and concurrent parameters required for cultural and industry acceptance. What was the impossible is now the expected:

1. Channels: moving away from existing and traditional channels of mobile access, websites, and social media to real-time social platforms including Facebook Live, Google Allo and voice-driven SEO and new media such as Netflix and Apple Music along with location technology innovations like Waze

• Distancing themselves from type-and-read contextual searches of the past 20 years, new connected home devices including Amazon Echo & Google Home introduce an audio component in to search queries. As a direct result, voice-driven search results provide a more sophisticated level of analytics that can provide businesses targeted solutions.

2. Product: the industrial revolution brought with it mechanical designs created by engineers. Today’s products call for Human Centered Design (HCD) which is a process on to itself which involves customers throughout the product and service design exercise. Customers can now celebrate with products that meet their lifestyle needs resulting in true perceived value that brings a much quicker and sustainable return-on-investment algorithm. With many lessons learned, adoption of technology is now more prevalent and more user friendly dictating the need for principles moving forward.

• Product Principles

• Price Point
• UX/Design
• Clarity of Purpose
• Privacy

3. People: integrated experiences must come first  and place the human in the center. Amazon is experimenting on a number of frontiers in this regard including the application of mini-drones to deliver goods and grocery shopping without challenging and annoying check-out lines.

4. New Business Models: this new and exciting frontier will blend educators with businesses who face the daunting task of simultaneously educating students and teaching employee skills to solve problems industries have not yet encountered.

TAKE-AWAY

• 64% of patients would see a doctor via video
• Access and convenience is more important to patients than physical contact, many are also very unconcerned with having their information in the cloud
• Price points are similar for most available options (makes things easier)
• You can adapt one technology and one solution to many different stakeholders

What remains is the defining of the delicate balance of technology and ethics required to oversee myriad applications for faster, smarter, and better products and services. Who decides if it is ethical for a sensor in modern vehicles to decide which of 4 passengers will survive when it deploys air bags? These are ethical questions which industry leaders and consumers must debate and solve.
 

Venkat Rajan, Global Research Director-Visionary Healthcare, Frost & Sullivan,
leads the global program focused on disruptions and transformations occurring within the healthcare sector. He directs content delivered through the interactive analysis of ecosystem maps, diagrams, scenario planning, best practice case studies, market monetization modelsand provides commentary on other topics related to a converging marketplace.
 

Patrick Riley, Senior Healthcare Analyst Frost & Sullivan, investigates and writes in the Advanced Medical Technology healthcare industry vertical globally. Currently, he is authoring a study on the Future of Robotic Assisted Surgical Devices. He is also working globally on studies evaluating the utilization and application of permanent synthetic mesh used in laparoscopic surgeries.

Patrick is also involved in Frost & Sullivan's Transformational Health effort, writing and conducting research on healthcare reform and the impact of the Patient Protection Affordable Care Act.