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D6   disruptive technology th - salon b

D6 disruptive technology th - salon b






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    D6   disruptive technology th - salon b D6 disruptive technology th - salon b Presentation Transcript

    • Disruptive Health Technologies:Implications for HTATrisha Hutzul – Global Surgery Group (J&J)May 7, 2013
    • Technology Disruption“You want to look at which ones have a chance of having avolume impact on many, many people, or large segmentsof society.”Eric Schmidt, Executive Chairman Google
    • Big “D” or Little “d”How disruptive a technology is depends on breadth andscope of impact.A truly disruptive technology impacts:• Healthcare delivery system• Payment mechanisms• Care pathway• Patient outcomes
    • BIG “D” or Little “d”DeliveryVehiclePaymentSchemeSite oftechnologydeliveryPatientOutcomesTECHNOLOGYIMPACTWhoHowInsuranceORHCPOfficeBillingCodes(DRG/FFS)ProcurementRecurrenceQOL-ADLHomeHCPDeviceDrug NurseMachine
    • Canada and InnovationCanada was ranked 13 out of 17 in innovation by McKinseyand Co in 2008Conference Board of Canada placed us at 14 of 17thWHY?
    • Surgery performed through small incisions or a naturalorifice using video cameras and specialized instrumentation.This approach is often referred to as laparoscopic.Minimally Invasive Procedures: Defined
    • Little “d” - MIPDeliveryVehiclePaymentSchemePatientOutcomesTECHNOLOGYIMPACTHowBillingCodes(DRG/FFS)ProcurementRecurrenceSSIQOL-ADLOpenMIP
    • Internal data on file: Thomson-Reuters. Estimated Procedure Volumes — 2010Scope of ProceduresRepresenting 4.4 Million PatientsGENERAL SURGERYAppendectomy — 474,032Cholecystectomy — 1,017,342Reflux Surgery — 60,515Ventral Hernia Surgery — 384,669Inguinal Hernia Surgery — 564,160WOMEN’S HEALTHHysterectomy — 555,574UROLOGYProstatectomy — 109,040THORACIC SURGERYWedge Resection — 37,676Lobectomy — 56,766BARIATRIC SURGERYGastric Bypass — 167,166Gastric Banding — 82,105Sleeve Gastrectomy — 17,718COLORECTAL SURGERYColectomy — 296,949Hemorrhoid Surgery — 585,671
    • Benefits to MIP AdoptionHospital Length of Stay (LOS)1Payment SystemQOL: Pain, ScarringRecovery TimeIn certain procedures: Nosocomial Infection Rates2Readmission RatesPatient Outcomespage 91. Gunnarsson C et al. The effects of laparoscopic surgery and nosocomial infections on the cost of care. Value in Health. 2008 July; Vol 12, Issue 1.2. Brill A, Ghosh K, Gunnarsson C, Rizzo J, Fullum T, Maxey C, Brossette S. The effects of laparoscopic cholecystectomy, hysterectomy, and appendectomyon nosocomial infection risks. Surg Endosc. 2008 Apr; 22(4):1112-8.Hospital Length of Stay (LOS)1Delivery Vehicle
    • Barriers to MIP AdoptionCodingOffset of instrument cost to LOS – silo budgetsPayment SystemHealthcare cost analysis concerned with cost management verses measuring healthimpact on economic growth (indirect cost drivers)Patient OutcomesDelivery VehicleMIS Trainingpage 9
    • Procedure Rate of MIPHemorrhoidectomy – Removal of Hemorrhoids 9%Colectomy – Partial or Complete Removal of Colon 28%Hysterectomy – Removal of Uterus 44%Appendectomy – Removal of Appendix 82%Reflux Surgery – Surgery of Gastroesophageal Reflex Disease(GERD)90%Bariatric Surgery – Weight Loss Surgery 90%Cholecystectomy – Removal of the Gallblader 95%VATS – Pulmonary Wedge Resection 35%VATS – Lobectomy 27%Inguinal Hernia Surgery – Groin Repair 19%Ventral Hernia Surgery – Abdominal Repair 35%MIPAdoption RatesInternal Data on File: Thomson-Reuters 2010
    • The BIG “D” - VERV™ Patient ManagedNeuromodulation SystemDelivers a pulse envelope(high + low pulse signals)to calm nerves - ‘need’verses ‘urge’
    • BIG “D” - OABDeliveryVehiclePaymentSchemeSite oftechnologydeliveryPatientOutcomesTECHNOLOGYIMPACTWhoHowInsuranceORHCPOfficeBillingCodes(DRG/FFS)ProcurementRecurrenceQOL-ADLHomeHCPDeviceDrug NurseMachine
    • Benefits of Non Surgical OABNo DIN – cannot be paid through existing Pharma modelNot surgery – cannot be paid via existing OR budgetsPatient pay?Patient OutcomesPayment SystemDelivery Vehiclepage 9Non surgical ,non drug TxNon invasive, not implantableKeeps patients mobile, out of LTCMove from surgeon to specialistCan be patient delivered
    • Barriers to OAB Market EntryWhere does innovation ‘fit’ (not drug or surgery)?Lack of procedural coding and payment schemePatient OutcomesImportance of chronic verses acute illnessOAB non priority illnessDelivery VehicleMove from OR to HCP office to homepage 9Payment Scheme
    • Disruptive Technology BarriersShort lifecycle of medical technologiesLength of time to commercialize disruptive technologiesverses short to medium term ROIMarkets with high evidence requirements and market entrybarriers also with smaller commercial opportunityBarrier: Innovation Uptake
    • Disruptive Technology SolutionsIndustry• Develop strategies to minimize market entry barriersearly in product lifecycle• Allow companies to make „go no go‟ decisions earlier ininnovation cycle by ensuring HTA is part of planningprocessHTA• HTA moves from policy analysis → advisement →implementation (Brazil ANS)• Innovation fund (UK)
    • Disruptive Technology SolutionsBoth• Health authorities in addition to clinicians need to beinvolved earlier in proof of testing• Idea generation• Product development phase• Demonstrate value to the RHA, procurement:• Better patient outcomes• Reduction in costs• Efficiency