Public procurers in the EU are under pressure to focus on price in public tenders. However, using a value-based procurement framework that considers outcomes and quality can help capture the value of innovative products. As tenders typically have strict criteria defined in invitations, companies need to develop value-based pre-tender strategies up to 18 months in advance. These strategies should identify the key outcomes of importance to stakeholders and how the company's product or solution best meets customer needs and differentiates based on quality criteria.
The healthcare industry is far from an uncomplicated sector, next to the economical issues you can never overlook the ethical aspect. During this training pharmacutical pricing expert Raf De Wilde guides you and your pricing peers through all these obstacles.
Fundamentally, this comprehensive article examines the significant factors that should be taken into account before making industrial pricing strategies and policies, such as pricing objectives, demand analysis, cost analysis and competitive analysis in depth. As well as pricing strategies in competitive bidding, pricing strategies for new products and Pricing throughout the product life cycle are expected to be discussed. Furthermore, industrial pricing policies, such as list price, trade discounts, quantity discounts, cash discounts and geographical pricing will be elaborated under this article.
The purpose of this presentation is to introduce you to the varied issues and structures that influence the way pharmaceutical products are priced in today’s complex health care market.
Awareness of the different mechanisms behind the costs of prescription drugs and medical services will help you determine the pricing strategy of your product/services to be competitive in today’s challenging/evolving health care environment.
This is the powerpoint version of the content from my latest article posted on LinkedIn: https://www.linkedin.com/pulse/discussion-pricing-concepts-easy-recipe-healthcare-marketers-tangun
The healthcare industry is far from an uncomplicated sector, next to the economical issues you can never overlook the ethical aspect. During this training pharmacutical pricing expert Raf De Wilde guides you and your pricing peers through all these obstacles.
Fundamentally, this comprehensive article examines the significant factors that should be taken into account before making industrial pricing strategies and policies, such as pricing objectives, demand analysis, cost analysis and competitive analysis in depth. As well as pricing strategies in competitive bidding, pricing strategies for new products and Pricing throughout the product life cycle are expected to be discussed. Furthermore, industrial pricing policies, such as list price, trade discounts, quantity discounts, cash discounts and geographical pricing will be elaborated under this article.
The purpose of this presentation is to introduce you to the varied issues and structures that influence the way pharmaceutical products are priced in today’s complex health care market.
Awareness of the different mechanisms behind the costs of prescription drugs and medical services will help you determine the pricing strategy of your product/services to be competitive in today’s challenging/evolving health care environment.
This is the powerpoint version of the content from my latest article posted on LinkedIn: https://www.linkedin.com/pulse/discussion-pricing-concepts-easy-recipe-healthcare-marketers-tangun
Factors effecting selection of distribution channelsShubhanjali -
introduction to distribution
distribution channel
market intermediaries
factors affecting selection of distribution channels:-
1. Nature of product
2. Nature of market
3. Nature of middle men
4. Nature of manufacturing units
5. Competition
6. Govt. rules & policies
conclusion
references
Distribution Channels and Marketing Intermediary in E marketing Nischal16
This Presentation is about a brief introduction of Distribution Channels and Marketing Intermediary in E marketing. Also Focuses on Logistics and Supply chain management and Distribution Strategy used by Amazon India and all other valuables information. Hope you all like the content, presentation. Thank You!☺️☺️☺️
Understanding purchasing orientation is important for B2B companies and suppliers. The more complex the product/service exchange will result in higher degree of power balance and dependency in supplier relationships.
Healthcare pricing for indian market place during universal health coverageVishnu Gupta
A Suggested universal process & pricing system in Healthcare delivery in India. Concept is being suggested in context of upcoming Universal healthcare for all citizen.
Freedom of choice: How to make your product fit for a market full of choicesSKIM
In a world of proliferating choices, how do you get customers to choose your product? Providers in telecom and technology industries do not only struggle with rapidly changing markets and fierce competition, but also with increasingly demanding customers who have a multitude of options at their fingertips. Do you give your customers full freedom of choice allowing them to create their individual product or do you present them with selected predefined packages?
This document reviews best practice in pricing processes to provide a reference against which current practices and proposals can be tested. Our objectives have been: to research the attributes of world-class pricing through publications and academic sources; to investigate how these attributes are applied in practice to products and services; to assess pricing processes in successful businesses.
In recent years a new attitude toward pricing has emerged. Deregulation and international free trade agreements have increased competition. Price promotion has eroded the power of brand loyalty. Pricing has assumed greater importance to most businesses.
As markets increasingly assume a global dimension, customers can more easily compare prices between one region or country and another, using the internet or a fax machine. They can often locate the same product, or an
acceptable substitute, from another source. Customers are more demanding and fickle, and their expectations increasingly difficult to fulfil.
Price inflation in western economies is now at its lowest for decades. Price increases are no longer accepted without protest from customers, if at all.
The Chairman of General Electric has predicted the onset of the ‘Value Decade’. Global price competition will strengthen because of: reduced product differentiation; global over-capacity for production; significantly diminished trade barriers; efficient information and distribution systems; providing customers with easy access to the prices of suppliers; a growing lack of customers’ loyalty to individual suppliers. Choice will be increasingly driven by price.
This is a challenging scenario that reinforces the need for an integrated strategy and concerted managerial action on pricing.
Pricing processes have lagged behind developments in the market place. They are often characterised by internal conflict between accountants wishing to maximise profit per unit and marketing specialists who seek to maximise
throughput. They are also affected by the potential for strained relations with good customers.
Some companies have downsized their operations to a level where diminishing returns cause them to question the benefits of continuing to focus upon reducing costs. As they switch their attention from cost cutting to adding
value, pricing naturally assumes increased weight in the marketing mix.
We have found many companies reluctant to discuss their own processes.
Some may wish to avoid betraying a lack of sophistication.
Factors effecting selection of distribution channelsShubhanjali -
introduction to distribution
distribution channel
market intermediaries
factors affecting selection of distribution channels:-
1. Nature of product
2. Nature of market
3. Nature of middle men
4. Nature of manufacturing units
5. Competition
6. Govt. rules & policies
conclusion
references
Distribution Channels and Marketing Intermediary in E marketing Nischal16
This Presentation is about a brief introduction of Distribution Channels and Marketing Intermediary in E marketing. Also Focuses on Logistics and Supply chain management and Distribution Strategy used by Amazon India and all other valuables information. Hope you all like the content, presentation. Thank You!☺️☺️☺️
Understanding purchasing orientation is important for B2B companies and suppliers. The more complex the product/service exchange will result in higher degree of power balance and dependency in supplier relationships.
Healthcare pricing for indian market place during universal health coverageVishnu Gupta
A Suggested universal process & pricing system in Healthcare delivery in India. Concept is being suggested in context of upcoming Universal healthcare for all citizen.
Freedom of choice: How to make your product fit for a market full of choicesSKIM
In a world of proliferating choices, how do you get customers to choose your product? Providers in telecom and technology industries do not only struggle with rapidly changing markets and fierce competition, but also with increasingly demanding customers who have a multitude of options at their fingertips. Do you give your customers full freedom of choice allowing them to create their individual product or do you present them with selected predefined packages?
This document reviews best practice in pricing processes to provide a reference against which current practices and proposals can be tested. Our objectives have been: to research the attributes of world-class pricing through publications and academic sources; to investigate how these attributes are applied in practice to products and services; to assess pricing processes in successful businesses.
In recent years a new attitude toward pricing has emerged. Deregulation and international free trade agreements have increased competition. Price promotion has eroded the power of brand loyalty. Pricing has assumed greater importance to most businesses.
As markets increasingly assume a global dimension, customers can more easily compare prices between one region or country and another, using the internet or a fax machine. They can often locate the same product, or an
acceptable substitute, from another source. Customers are more demanding and fickle, and their expectations increasingly difficult to fulfil.
Price inflation in western economies is now at its lowest for decades. Price increases are no longer accepted without protest from customers, if at all.
The Chairman of General Electric has predicted the onset of the ‘Value Decade’. Global price competition will strengthen because of: reduced product differentiation; global over-capacity for production; significantly diminished trade barriers; efficient information and distribution systems; providing customers with easy access to the prices of suppliers; a growing lack of customers’ loyalty to individual suppliers. Choice will be increasingly driven by price.
This is a challenging scenario that reinforces the need for an integrated strategy and concerted managerial action on pricing.
Pricing processes have lagged behind developments in the market place. They are often characterised by internal conflict between accountants wishing to maximise profit per unit and marketing specialists who seek to maximise
throughput. They are also affected by the potential for strained relations with good customers.
Some companies have downsized their operations to a level where diminishing returns cause them to question the benefits of continuing to focus upon reducing costs. As they switch their attention from cost cutting to adding
value, pricing naturally assumes increased weight in the marketing mix.
We have found many companies reluctant to discuss their own processes.
Some may wish to avoid betraying a lack of sophistication.
This presentation by Helen JENKINS, Managing Partner of OXERA was made during the discussion on “Market study methodologies for competition authorities” held at the 125th meeting of the OECD Working Party No. 3 on Co-operation and Enforcement on 20 June 2017. More papers and presentations on the topic can be found out at oe.cd/1ZX.
Students will get the knowledge of the following-
meaning of the pricing, its importance, objectives, methods of pricing, factors affecting the price of products, An overview of DPCO (Drug Price Control Order) and NPPA (National Pharmaceutical Pricing Authority)
Seventh seminar for my Managing Marketing Processes course in the MGM program at the Stockholm School of Economics, http://www.hhs.se/EDUCATION/MSC/MSCGM/Pages/default.aspx
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
1. Using the Value Based Procurement Framework to
capture the value of our products in Tenders
A Value Based Strategic Tender Approach
Filippo Gabbia
EMEA Strategic Tender Former Johnson & Johnson
EPP Life Sciences Pricing Forum® 2019
1EPP B2Me Pricing Forum - Monetized 2019
2. 2
Public Procurers work under pressure!
The key question is why we need a tender strategy. According public procurement
laws. Public Procures should give to any interest bidder parity of opportunities, they
should not make any kind of favoritism therefore they are cautious talking to us. In
several EU countries is even difficult to talk to them. To approach tenders effectively
we need to learn to reach/talk to them using effectively the market consultation
process.
2
3. 3
Innovations are hard to sell with public tenders….
Driving innovation is in general a challenge. Hospitals have shrinking budgets and
rising costs. Innovation is perceived also as a threat to their equilibrium. They
tenders as usual and this does not leave space to innovation.
Open tenders require to define clearly the product’s specification in the invitation to
tender. If we wait when tender documents are published it will be to late to drive
innovation. Open tenders are 98% of the total tenders published on TEDs.
3
4. 4
There is a clear focus on price….
We are all here for this reason! Maybe the Price only tenders are decreasing or used
only for commodities. The biggest challenge I think today are tenders that are not
capable to differentiate.
In Most EU countries we moved fast from Hospital Based Procurement to centralized
procurement. The assessment commission are today formed by a multiplicity of
stake holders often detached from products utilization.
There is an increasing utilization of highly structured and objective tender criteria.
The Result is that those criteria often are not able to give a premium price to the
quality. For example often Drug’s tenders are based on the Active Pharmaceutical
Principle and the only quality award criteria is the delivery time/service.
4
5. 5
But how do we ensure that the quality is there?
Quality is a key element in the EU Single Public Procurement Strategy. There is a
clear policy drive to foster the use of MEAT (Most Economically Advantageous)
tenders. But the definition of quality within the rigidity of the public procurement
system is not easy.
It is not easy for us when we want to procure something. Just an example: how do
you define the quality of a bottle of wine?
5
6. We need Value Based Pre-Tender Strategies in order to
approach the Complex Public Procurement Ecosystem!
Procurers
Users
Political
Patients
Are we sure that the procurers will make the decision?
Are we sure that our Marketing Messages are consistent with a pre tender strategy?
Are we sure that we can win tenders increasing our intimacy with the Hospital’s C-
Suites?
We need to have a clear strategy to approach all stake holders involved in the
process with consistent, congruent messages that are fair, non discriminatory and
can support the institutions to reach their Health policy political goals.
EPP B2Me Pricing Forum - Monetized 2019 6
7. Value Based Procurement is an Industry Driven Model to
support Public Procures to approach MedTech tenders
Outcomes
Costs
incl. care delivery
Patient
HCP
Health
system
Socio-economic
impact
Provider
Other benefits for key
stakeholders
Core value: outcomes
vs costs
Broader impact on society
Importance
Source:
Value Based Procurement is an Industry suggestion to public procurers. Basically, as
Industry, we suggest how health care procurement should be done.
The Theory has been built by a working group (the community of practice) that
engaged Industry representative and public buyers coming from different countries
with the support of BCG.
The MedTech Value based Strategy is grounded into the Value Based Health Care
Principles. The core of the Model is Porter’s Value equation Core value in terms of
outcomes, that matter for patients vs. the related product and provider costs
You have a second layers that includes the benefits for all the stake holders involved
in the process.
The third layer includes the policy objectives and guideline.
EPP B2Me Pricing Forum - Monetized 2019 7
8. The MedTech Value Based Procurement Model is an
Extensive list of relevant awarding criteria
Broader impact
on society
Outcomes
Costs
Product
Care
delivery
Other benefits for
key stakeholders
Sustainability
Innovation
Socio-economic
impact
Outcomes & evidence
Outcomes focus
Disposal
Operating / healthcare
delivery
Purchasing
Maintenance
Provider
benefits
Secondary
patient benefits
Health system
benefits
HCP
benefits
Environmental impact
Socially responsible product value chain
Development of new and improved technologies
Contribution to development of health care
Impact of people not in the workforce
Burden carried by non professional carers
Impact on competition in MedTech sector
Evidence of relevant outcomes improvement
Existence of high quality outcomes data
Support in measuring and reporting on outcomes
Willingness to offer outcomes-dep. risk-sharing
Disposal / decommissioning
Cost of consumables
Price of purchasing / renting product
Conversion: staff training for new product ...
Spare parts
Patient and/or relative comfort and convenience
Patient flexibility & mobility
Impact on treatment adherence
Reduced long term costs of treatment
Reduction of rehospitaliz. / number of treatments
Ease-of-use / handling & functionality
Service contract
Infrastructure usage ...
Maintainability & technical service support
Support improving efficiency along patient pathw.
Alignment and support with reimburse. structure
Support on admin., storage and logistics
Strategic fit for provider and support of strategy
Compatibility: required upgrades to infrastructure
Technical staff time
Medical staff time using device
Secure usage for care providers
Ease-of-use / handling & functionality
Training and access to education
Layer Category Criteria
Source:
Value Equation. VBHC
implementation
Public Tenders ARE
multicriteria. Different stake
holders should be considered
Public Policy Goals
You have to remember that public tenders are by definition multicriteria (with the
exception of price only tenders). Tenders are multi criteria because a key goal of
Public Procurement is to make sure there is competition in the market. Example: if
you have all tenders based on a single criteria that only one company can meet the
tender results are predictable. It will discriminate bidders and those will be likely not
even motivated to bid.
The VBP model is an extensive list of criteria. In my experience I think that the
criteria should be tailored on the specific contracting authority need in relation to
the technology they want to procure.
Basically the Contracting/ Purchasing authority should identify a list of relevant
criteria on which they can objectively compare all bidders in order to identify the
one that best meet their needs.
Value Based Procurement is a Procurement Side approach.
EPP B2Me Pricing Forum - Monetized 2019 8
9. 9
Value Based Procurement from a Supplier Perspective
Value Based Strategic Tendering
Approach
• What are our customer’s needs in
relation to our specific offer?
• How our offer best meet those needs?
• Tender Oriented Messages
• Stake Holders Strategy (Internal /external)
• Market Consultation input
Tender Submission
• Readiness
• Effectiveness
Pre Tender Phase: 12-18 Months In-Tender Phase 20 days
The key question is what we should do as supplier to implement Value Based
Procurement?
My answer is to develop Product/solution specific Value Based Pre-Tender
Strategies. Public Procurement purchase products or solutions to meet their needs
they do not purchase Companies or brands.
Public Servant must base their choices on the capacity of those to meet specific
needs. Those needs must be transparently defined in the call for tender.
Our Product Specific strategic tender approach aims to support the procurement
team to develop transparent, fair, non discriminatory tender requests that will focus
on quality.
The competition among companies will focus on the adoption of specific quality
criteria and then on the capacity to prove that its product best meet those criteria.
Pharma Public Tenders in EU can be clustered into two different tender approaches.
ONE based on the Active Principle, the competition is therefore within drugs with
the same active principle (from which the characteristic therapeutic action of the
substance largely depends). The Second Approach is on the Therapy and Indications
similarly for reimbursement.
Option One allow potentially the competition on additional outcome that may be
proved by specific drugs, the posology, all the value added services that help with
EPP B2Me Pricing Forum - Monetized 2019 9
10. the drug management, appropriateness and therapy adherence. The second could
also address the breath of indication or specific outcome on segment of population
etc… My overall impression is that the VBP approach can be applied also in the
Pharma business.
EPP B2Me Pricing Forum - Monetized 2019 9
11. 1. What are the key outcomes that matter to patient’s physicians and hospitals while
using this product or drug?
2. Can those outcome differentiate bidders?
3. Are there Specific indication/counter indication Warning and precautions Vs subject
matter competitors?
4. Are there product class related complications? How do we score on those
complication, what is the evidence?
5. What is the most important application (procedure/patients category?)
• What is the evidence on this application
• Are there particularly delicate application where this product could make the
difference?
How do we score against the subject matter competitors on the above questions?
Big Qs
Outcomes
Outcomes & evidence
Outcomes focus
Evidence of relevant outcomes improvement
Existence of high quality outcomes data
We need to work product by product to anticipate tender requests. I developed with
a cross cultural team of people with various background and tender experience
representing all EU countries a set of questions for each criteria in order to assess if
the criteria is relevant for the users and the patient in relation to the specific
product.
Outcome are key to define the value of a product/solution. First key question is:
What are the key outcomes from a customer perspective? How does the product
could impact the care process? Are there specific complications related to the
product’s utilization. It may be that the specific product does not have a direct
relation with the procedure/patient outcome. For example: cancer patients' key
outcome will be the disease removal and increase life expectancy. For example it is
difficult to link those key outcome to the utilization of different brands of sutures in
surgery or to different Drugs with the same active pharmaceutical principle. If
adverse events have been reported it may be that those led to specific warning or
precautions or even counterindication those could be a great source of
differentiation.
If a relevant outcome is not differentiating brands this could be used as a minimal
entry criteria and any proved improvement from that baseline could lead to
incremental scoring.
10
12. Example:
Outcomes & evidence
Survivorship (Subject Matter: Orthopedic Prosthesis)
What:
• Provide the evidence of product survivorship from multiple National Registers.
Why: Value to the Patient and the HC System:
• Survivorship is defined as the average time before a revision is required for any cause. Long term
survivorship is a direct measure of implant performance and is monitored rigorously in many
health care systems (the higher the number of registers the more the results are reproduced in
different HC environments, the higher the number of patients the more robust the observed
survivorship findings as the confidence interval will be narrower).
How can it be assessed:
• Survivorship can be assessed as an absolute value assessing the average probability of first
revision within the proposed registers.
• The value could be weighed on the number of registers proposed giving the highest score to the
highest number of registers and/or cumulative number of patients
11
Example how we have developed a product specific tender awarding criteria to
suggest during market consultations. Note Awarding criteria must be fair, non
discriminatory, specific and linked to the subject matter.
The What represents on of the potential awarding criteria we have envisioned
defining our product specific tender strategy. You notice that the criteria is product
agnostic.
The Why is the Value that this criteria could bring to the system. If you have HTA
models your value proposition will be stronger.
The How is the process the Contracting authority could follow to objectively
compare bidders. In this case we have also identified a potential exclusion criteria
that is supported by a relevant authority.
This is an Ideal formulation of the criteria and the assessment methodology. The
contracting authority will go through internal and external consultation (which for us
are a kind of black box) and will phrase the criteria in its own way. My assumption is
that the better structured our proposal is the higher is the probability that they take
it as it is.
Note the criteria is able to differentiate different knee implants, it does not
differentiate hips implants therefore a different strategy could be used such as:
10/17/2019
05_ASM09_ColleenGoggins_v32.ppt 11
13. Minimum entry criteria: rates of revision of 5% or less at 10 years in at least one
national register. E.g NICE recommendation (In-Out or No Score if not reached)
EPP B2Me Pricing Forum - Monetized 2019 11
14. RW Example: Outcome Based Criteria in Tender
Croatia National Tender Orthopedic Implants
Open Procedure. MEAT with 3 criteria:
Relative Clinical Efficacy and Safety 35 points out of 60
The PA required Suppliers to provide survivorship evidence from at least 3 National
Registers and provided a detailed scoring system for each product category.
Following the example for Knee and our internal score assessment
Implant Level Points
Comp. 1 Highest level 31
Comp. 2 Highest level 31
Comp. 3 Intermediate level 20
Comp. 4 Intermediate level 22
Comp. 5 Intermediate level 16
Criteria based on Survivorship has been used in several EU tenders, I’m aware of
examples from Spain, Sweden, UK and Croatia.
This example is in my opinion the best. The table represent our analysis of the score
according the given criteria. This criteria is relevant for the product category.
If you are competitor 1 or 2 probably it is a good idea to define a key stake holder
advocacy strategy involving users maybe also patient’s associations and politicians in
order to maximize the use of the criteria and its weight. This will maximize your
pricing strategy.
Note if you are competitor 1 you should also put in place a key Criteria strategy to
make sure you will get an advantage over competitor 2.
If you are competitor 3, 4, 5 you should assess the risk that this criteria is used and
monitor its potential application for example during the market consultation. If the
contracting authority decides to use it you should put in place an advocacy strategy
to minimize its weighting otherwise the effect on price will be detrimental.
12
15. Price or Costs?
• The most economically advantageous tender can be identified on
the basis of the price or cost, using a cost-effectiveness
approach.
• Contracting authorities are required to provide in the
procurement documents the method they will use to determine
the costs….
• The cost effectiveness method should be based on objectively
verifiable and non-discriminatory data….
Ref. Art. 67 and 67 EU 24/2014 (enacted in all EU countries)
The ne EU public Procurement directive opens clearly the opportunityto assess
products on costs vs price. This potentially allow to consider the full cost of care.
It is important for you to understand the legal requirement in relation to the cost
effectiveness approach. Value Based Procurement is often confused or mixed with
Health Economics. There has been tentative to use HTA methodologies into
procurement process od medical devices.
My view is that Health Economics focus on the Payer’s and Provider relation and it is
the base of the decision to reimburse a Technology or a Therapy. Health Economics
can also impact the decision to allocate specific Budget at Hospital level. Most of the
time the studies requires specific hypothesis or are applied to limited settings.
VBP Procurement defines the relation between Provider and Supplier. The Provider
through VBP must choose the Product (within the chosen technology or Therapy)
that best meet its needs. First of all the competition in Open Tenders (98% of
tenders) is within the same technology. PPI could be used also to compare different
technologies but this still embryonal.
The public provider must choose the product treating fairly all bidders and avoiding
any risk or discrimination or favouritism.
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16. Cost Effectiveness Approaches in tenders
Ref.
https://ec.europa.eu/health/expert_panel/sites/expertpanel/files/docsdir/opinion_innovative_medicines_en.pdf
• Price-Risk Share
• Product performance
• Specific clinical, operational of
financial outcomes
• Outcome based
Managed Entry
Agreements
• No multifactorial and easy to
measure in the short term
indicators
• Real World Evidence
• Pay for Performance/ Result
• Outcome grantee schemes
• Success fee (Risk Sharing)
• Registers
• Combination of treatments
• Digital/ patient’s compliance
What: How: Key elements:
Frankly I saw only one tender where a cost effectiveness approach was used in
Denmark for Orthopeadic prosthesis. The methodology was based on a risk/benefit
sharing approach. I’m aware also of a case in the Cardiovascular field Sau Pau
Barcelona where there was a benefit sharing.
I know also that there are pretty a lot of companies that have put in place Risk
sharing schemes, but I did not see those schemes applied through tenders.
One way to apply cost effectiveness methods in tenders is through risk sharing.
Basically the cost = Price – Risk Share.
A tangible example could come from Pharma with the Managed Entry Agreement. It
is not strictly public procurement, it is more in relation to reimbursement but those
programmes meet the public procurement requirements of Transparency,
verifiability and objectivity.
Market entry agreements can be the first step towards more elaborated strategies.
New payment models based on outcomes (value-based health care), with bundled
payments that may include bonus and penalties related to positive and negative
outcomes defined in a contract, mark a change to simply paying for a product. This
makes acquisition of medicines to treat patients closer to the commissioning of
health care services, particularly if pharmaceutical products are used in combination
with diagnostics or/and treatment involves combining several pharmaceutical
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18. How Value Added Services and new digital options
could be valued in tenders?
→ Subject Matter: Solution Vs Product
(eg 36,5° temperature Stable along the pathway to procure thermal blanket)
→ Awarding Criteria that assess the specific service
We are all developing and offering services in conjunction with our products. For
Stock Management programs, Digital solutions to improve patient’s engagement and
cure adherence. Are we able to monetize those services?
The example is self explanatory in this tender issued by UnHa In France they
procured the solution to the problem: stable temperature vs a thermal blanket.
Awarding criteria could be a mean to introduce those services. The weights of the
awarding criteria is the value that the contracting authority perceives for the service
in relation to the overall tender economy.
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19. What:
• Enhanced patient pathway program with supporting reductions in length of stay whilst
ensuring no impact on linked parameters such as adverse events, re-operation rate
and readmission rates
How can it be assessed:
• Program description with hospital examples, benchmarks and level of evidence to
prove impact on length of stay and linked parameters (adverse events, re-operation
rate and readmission rates). Alignment with international recognized protocols such as
ERAS.
Provider
benefits
Support improving efficiency along patient
pathway
Other benefits for
key stakeholders
The outer circle of Value Based Procurement focus on different stakeholders. Here
we can position criteria that could help us to drive value added services. This criteria
has been developed from a tender in Wales UK.
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20. What:
• User’s (patient’s, GP…) instruction, training tools to facilitate patient’s utilization, adherence,
engagement and to prevent user’s errors
How it can be assessed:
• User’ instruction clarity and completeness (could be also a selection criteria) .
• Build in guides
• Specific training tools/programs for optimal solution utilization.
• On line training availability and tools.
• User’s instruction embedded within App.
Patient’s/HCP…
benefits
Impact on Patient’s adherence, engagement
Digital app.
Other benefits for
key stakeholders
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21. Key
Learnings
• EU is moving toward a Single Public
Procurement Market. Similarities are more
than the differences
• Strategic Tendering is not a short term
strategy (you need top management
commitment)
• You need to move from Theory to Practice.
Examples are key
• Tenders are based on details and
commitment. Approximation and assumption
don’t work
It is a key goal of the EU commission to build a single Public Procurement Market.
This does not mean that we will see European wide tenders covering all EU markets.
This means that the obstacles that bidders have to tender in different market should
be removed. A key way to remove this obstacle is to make sure that the process to
bid is the same in all markets. The definition of Subject Matter and awarding criteria
is already the same. We can therefore build a EU strategy at least on the What they
want to procure and the How they are going to assess different bids.
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23. 20
The tender process seems like a black box….
Garbage in garbage out. Often procurers combine previous tender documents with
feedback from Internal consultation. Today the EU commission is “politically”
pushing to use Public Procurement, the public purse, as a strategic mean to drive
innovation. They ask to engage more with internal stake holders to make open
Market Consultations
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24. Tender Procedure Subject Matter Awarding Criteria
A new solution
A solution
How do
they want
to
procure?
Just a product
What do
they want
to
procure?
Risk/Benefit sharing opportunities as performance clause within the contract
To acquire value
From Price to Value through tenders
To acquire services
How do they assess
different bids?
HOW in Practice:Strategically approach the Pre-Tender Phase
focusing on the opportunity to procure Value
PCP
PPI
Open Tender
The choice of the tender Procedure will define the level of interaction between
authority and potential suppliers. It will define the scope on which they are willing to
innovate introducing new services, or value.
The majority of Tenders (98%) are Open Tender. There is a clear EU drive to use PPI
and PCP to drive innovation in the system (which are specific negotiated procedures
to drive innovation in the system). If we want to hit our sales target we must win
open tenders.
All current Notices CPV 33000000 (all med and pharma) on 18.09.19 (11028 Open,
141 Negotiated with Competition; 7 Competitive dialogue; 3 Innovation parthnersip)
Choice of subject-matter is particularly important because it determines the
permissible scope of specifications and other criteria Prcurers may apply. This is due
to the ‘link to the subject-matter’ requirement. Public procurers cannot buy a car
assessing for example the Car’s Navigation system customer support. But if they buy
a transportation mean, or a solution to mobilize a specific category of patients they
could use solution specific criteria.
The Tender Criteria are of paramount importance since they must be able to
differentiate among different bids. If the awarding criteria are not able to
differentiate the quality the tender will be won on price.
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25. Solution Tender
Example UniHA Thermal Blanket Case (Comp. Dialogue)
• https://www.medtecheurope.org/access-to-medical-technology/value-based-procurement/
• https://ec.europa.eu/environment/gpp/pdf/news_alert/Issue11_Case_Study27_Consip_Energy.pdf
What:
• Global solution for patient’s warming
Value:
• 60% of patients are hypodermic
• Monitoring along the pathway is
imprecise
How:
• Whole patient’s pathway
• Clear outcome 36.5°
• Cooperative dialogue and discussion
with potential bidders
• Contract performance clauses
Further Proof:
• Consip Italy Integrated Energy
Service framework agreement (open
tender for energy provision and
renovation works)
Implications:
• Outcome Based Tenders are possible
• Risk sharing Agreement can be
implemented also in open tenders
• Measurability and timing of KPI is
key
Can Public Procurers buy solutions instead of products? The answer is yes as it is
proved the VBP Pilots Thermal Blanket procured by UniHa. This tender was a
competitive dialogue awarded to 3M.
There is also a great example of an open Tender in the Energy Business in a
challenging procurement environment
Both cases have a communality: the temperature is an objective outcome that can
be measured easily and directly. This opens up a key element, if Real World Evidence
is used to define outcome or even performance clause, it should be verifiable in the
short term. Verifiability is a key element in public procurement.
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26. Example: Welsh Betsi Cadwaladr 2019
• Below threshold: 100K Lst
• Subject Matter: Development of a Formal Hip Fracture ‘Enhanced Recovery Programme.
• Design and implement a formal Betsi Cadwaladr Hip Fracture Programme, which delivers a new care pathway based
on the Welsh National Hip Fracture Pathway (as a minimum), but with additional best practice interventions
recommended by NICE guidance and English Best Practice Tariff. This will deliver a consistent, standardised and high
quality patient pathway, with minimal variation in delivery across North Wales.
• Performance Based Specification with length of stay reduction goal.
• CPV codes: 72221000 Business analysis consultancy services
• 72224000 Project management consultancy services
• 79410000 Business and management consultancy services
• 79411100 Business development consultancy services
• 79421000 Project-management services other than for construction work
• Open Tender: MEAT 60% Quality 40% Price.
• Quality Criteria:
• Project Plan & Timelines; Method Statement; Evidence of Pathway Redesign; Key Personal
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