The survey found that healthcare companies see major market changes driving innovation, especially those resulting from healthcare reform. Retail exchanges and accountable care organizations were the top issues cited by over 40% of respondents. Regional health plans were most concerned about exchanges due to their complex requirements. Accountable care organizations also present challenges around network management and contracting. Overall the impending reform deadlines and legal uncertainties are creating a competitive environment where agile companies focused on innovation will have advantages.
HIX 2.0: New Alternatives for State Participation in Health Insurance ExchangesCognizant
By examining the pluses and minuses of emerging forms of health insurance exchanges, states can make informed decisions on cost and performance trade-offs and arrive at an optimal HIX model that suits their operational needs and those of their constituents.
For medical device (MD) comapnies, we offer a multichannel, holistic model to bolster their bottom lines when marketing to healthcare professionals (HCPs) - including Accountable Care Organizations (ACOs) - and contending with healthcare reform such PPACA, new sales channels, advanced analytics and oher factors.
The document discusses the need for active strategic planning to address changing industry trends in healthcare delivery. It outlines political, economic, and regulatory factors impacting hospitals and emphasizes the importance of monitoring performance, making tough decisions about services, physician integration, and addressing unprofitable service lines. Recommendations include understanding community needs, assessing service sustainability, and continually monitoring service line performance.
This document summarizes a case study on applying seven principles for monitoring and evaluating systemic change to the Market Assistance Program (MAP) in Kenya. MAP aims to improve incomes of poor people through market facilitation and catalytic interventions. The case study evaluates how well each of the seven principles- indirectness of impact, depth of impact, network-driven change, unpredictability, sensitivity to external signals, information deficit, and sustainability as adaptability- fit with MAP's work. It finds that MAP staff widely accept the principles and they inform strategies, but some tensions remain between measuring systemic vs. superficial impacts, and between information needs of management vs. donors. The study provides insights into each principle and suggests MAP could strengthen its ability to measure network
In recent years, medical device manufacturers have embarked on an acquisition binge. We’ve seen a series of blockbuster deals as well as numerous smaller transactions. This M&A bonanza has been sparked in part by the belief that absolute scale creates competitive advantage.
But does it? In many other industries, we find a clear correlation between overall scale and profitability. Classic strategy has long focused on building scale because larger companies tend to wield more influence with customers and have a greater ability to maintain pricing discipline. They also benefit from the most accumulated experience with driving down costs and can spread costs over the widest base of business.
Yet in medtech, the correlation between industry scale and profitability is quite weak. Instead, Bain research shows that profitability is more a function of category leadership than overall scale.
The Rise of Value-Based Contracting for Biopharmaceuticals and Medical Techno...Nathan White, CPC
ICON Access, Commercialisation & Outcomes (ACC) - November 2017 Pricing & Market Access Briefing
AUTHORS:
Michael Pace
Senior Principal, Pricing and Market Access
Guy Sherwin
Lead Consultant, EU Pricing and Market Access
The document discusses trends in the healthcare and pharmaceutical industries, including industry consolidation through large acquisitions creating mega companies, cost pressures driving increased focus on financial controls and operational efficiencies, and continued innovation in medical devices and equipment delivering improved clinical outcomes though the industry remains fragmented.
Life Science Compliance Update November 2016Clay Willis
This document discusses value-based contracts (VBCs) and their potential impact on government pricing programs. VBCs tie drug prices or reimbursement to performance criteria or outcomes. Current guidance does not provide clear direction on how to evaluate VBCs for Medicaid pricing programs. The document suggests treating some VBCs as "temporal bundles," which would require complex pricing methodologies and adjustments over time. This could impact Medicaid rebates, 340B prices, and require manufacturers to develop processes for initial pricing estimates and true-ups. Manufacturers need coordinated approaches across functions to evaluate VBCs and understand impacts on commercial and government programs.
HIX 2.0: New Alternatives for State Participation in Health Insurance ExchangesCognizant
By examining the pluses and minuses of emerging forms of health insurance exchanges, states can make informed decisions on cost and performance trade-offs and arrive at an optimal HIX model that suits their operational needs and those of their constituents.
For medical device (MD) comapnies, we offer a multichannel, holistic model to bolster their bottom lines when marketing to healthcare professionals (HCPs) - including Accountable Care Organizations (ACOs) - and contending with healthcare reform such PPACA, new sales channels, advanced analytics and oher factors.
The document discusses the need for active strategic planning to address changing industry trends in healthcare delivery. It outlines political, economic, and regulatory factors impacting hospitals and emphasizes the importance of monitoring performance, making tough decisions about services, physician integration, and addressing unprofitable service lines. Recommendations include understanding community needs, assessing service sustainability, and continually monitoring service line performance.
This document summarizes a case study on applying seven principles for monitoring and evaluating systemic change to the Market Assistance Program (MAP) in Kenya. MAP aims to improve incomes of poor people through market facilitation and catalytic interventions. The case study evaluates how well each of the seven principles- indirectness of impact, depth of impact, network-driven change, unpredictability, sensitivity to external signals, information deficit, and sustainability as adaptability- fit with MAP's work. It finds that MAP staff widely accept the principles and they inform strategies, but some tensions remain between measuring systemic vs. superficial impacts, and between information needs of management vs. donors. The study provides insights into each principle and suggests MAP could strengthen its ability to measure network
In recent years, medical device manufacturers have embarked on an acquisition binge. We’ve seen a series of blockbuster deals as well as numerous smaller transactions. This M&A bonanza has been sparked in part by the belief that absolute scale creates competitive advantage.
But does it? In many other industries, we find a clear correlation between overall scale and profitability. Classic strategy has long focused on building scale because larger companies tend to wield more influence with customers and have a greater ability to maintain pricing discipline. They also benefit from the most accumulated experience with driving down costs and can spread costs over the widest base of business.
Yet in medtech, the correlation between industry scale and profitability is quite weak. Instead, Bain research shows that profitability is more a function of category leadership than overall scale.
The Rise of Value-Based Contracting for Biopharmaceuticals and Medical Techno...Nathan White, CPC
ICON Access, Commercialisation & Outcomes (ACC) - November 2017 Pricing & Market Access Briefing
AUTHORS:
Michael Pace
Senior Principal, Pricing and Market Access
Guy Sherwin
Lead Consultant, EU Pricing and Market Access
The document discusses trends in the healthcare and pharmaceutical industries, including industry consolidation through large acquisitions creating mega companies, cost pressures driving increased focus on financial controls and operational efficiencies, and continued innovation in medical devices and equipment delivering improved clinical outcomes though the industry remains fragmented.
Life Science Compliance Update November 2016Clay Willis
This document discusses value-based contracts (VBCs) and their potential impact on government pricing programs. VBCs tie drug prices or reimbursement to performance criteria or outcomes. Current guidance does not provide clear direction on how to evaluate VBCs for Medicaid pricing programs. The document suggests treating some VBCs as "temporal bundles," which would require complex pricing methodologies and adjustments over time. This could impact Medicaid rebates, 340B prices, and require manufacturers to develop processes for initial pricing estimates and true-ups. Manufacturers need coordinated approaches across functions to evaluate VBCs and understand impacts on commercial and government programs.
J.p. morgan 6th annual – brazil retail & healthcare check uprimagazineluiza
Magazine Luiza reported strong financial results in the second quarter of 2012 driven by sales growth and expense reductions. Net revenues grew 22.3% compared to the previous year through a 21.6% increase in gross revenues. The retail segment saw a 19.7% revenue growth and 13% same-store sales growth. Internet sales increased 45%. Gross margins improved by 0.7 percentage points to 33.5% due to higher margins from consumer financing. Operating expenses declined as a percentage of revenues through cost savings initiatives. Magazine Luiza expects to continue growing through store expansion and maturation while maintaining financial discipline.
The article provides a simple overview of clinical informatics. It discusses the driving forces behind health informatics, including the need to provide better care to more patients with constrained resources. It explains how clinical informatics aims to achieve these goals by optimizing various stages of the patient journey through the use of technologies like electronic health records, clinical decision support, and data analytics. The focus of clinical informatics has narrowed to using IT systems to support clinicians. While the core principles remain the same, technology is now more pervasive in healthcare. Clinical informaticists play an important role in bridging clinicians and IT to effectively apply technologies for improved patient care.
The document summarizes research on women in leadership roles on corporate boards and in the C-suite. It finds that companies with more women on their boards tend to have more women in top executive positions over time. Specifically, having more women board directors correlates with higher percentages of women in line roles involving profit-and-loss responsibility, which is seen as experience needed to advance to the highest leadership levels. The document also discusses how quotas for women on boards in Nordic countries have increased the number of women in executive roles, showing that increasing women's representation at the board level can help advance more women throughout organizations.
Zero Suicide in Healthcare: International Declaration & Social Movement (The ...David Covington
Adopt the mindset. Change the world. It's the only goal we can live with.
Draft agenda and narrative executive summary in preparation for the gathering of 40 worldwide experts traveling from 15 countries to Atlanta September 21 & 22 as part of the International Initiative for Mental Health Leadership (IIMHL) 2015 Leadership Exchange and co-sponsored by the International Association for Suicide Prevention (IASP).
The Healthcare DENMARK magazine, gives you an overview of the Danish healthcare system.
If you feel inspired to visit Denmark, please feel free to contact us.
The November 2011 issue of Medical Solutions magazine from Siemens focuses on innovations in healthcare technology and delivery. It describes how partnering with Siemens to build and maintain hospitals can improve performance by combining the latest technology with ongoing support. The issue also explores advances in imaging for breast cancer detection, diagnosing alcohol abuse, upgrading urology systems, and using integrated healthcare IT solutions. Additionally, it examines medical tourism and competitiveness in magnetic resonance imaging.
2016 Patient Safety & Quality Healthcare MagazineRyan Vincent
This document summarizes advertising opportunities for Patient Safety & Quality Healthcare, a publication focused on patient safety and quality improvement. It provides information on display advertising sizes and rates, as well as opportunities for online, email, and sponsored content advertising. The target readership includes healthcare executives, clinicians, and those involved in patient safety, quality improvement, and risk management.
Mission health Magazine, Health Magazine, Magazine Design, Magazine Layout De...KS Designers
This document provides information about a health magazine called Mission Health. It includes details about the editorial board, contents of the current issue, and contact information. The magazine aims to raise health awareness and provide a complete healthcare guide covering topics like heart attacks, cancer, stress management, and lifestyle issues. It also contains medical directory listings and expert advice from doctors. The publication serves as a one-stop resource for readers on various health topics and connects them to healthcare professionals.
Medical devices equipped for the futureBrand Acumen
The document discusses disruptive changes underway in the medical devices industry that will transform it over the next 5 years. It identifies 5 major disruptors: 1) a power shift to payers and providers who are focusing more on cost and value-based evidence, 2) heightened regulatory scrutiny that is increasing compliance costs, 3) unclear sources of innovation as R&D spending yields diminishing returns, 4) new healthcare delivery models that are shifting care settings out of hospitals, and 5) a need to serve lower socioeconomic classes in developing markets. The disruptors threaten $34 billion in industry profits by 2020 but taking appropriate measures could help maintain revenue growth and offset margin declines, preserving significant value for medical device companies.
Historically, the medical device industry has been highly attractive and relatively stable. As a consequence, established players have been able to compete successfully across the device spectrum, applying common business models and processes without much need for differentiation.
The future, however, is very different as disruptive change is underway. Companies will need to look at new segments and offer end-to-end solutions to secure additional revenue and maintain their profit margins.
The document summarizes a report from the Deloitte Center for the Edge about long-term trends fundamentally reshaping business landscapes called "The Big Shift". It finds that return on assets for U.S. public companies has declined 75% since 1965, suggesting the current way of doing business is broken. The report provides industry-level analysis of these trends for nine major U.S. industries. It finds few safe harbors from increasing performance pressures and that industries are experiencing these pressures earlier and more severely depending on their involvement with digital technologies. The report also discusses how customers and creative talent are benefiting from these trends more than companies are.
The document analyzes the healthcare industry in the U.S. and how IT can help small and medium enterprises provide insurance to employees. It identifies four key factors impacting the industry: the Affordable Care Act, digital/IT infrastructure, advances in omics sciences, and the rising global middle class. Recommendations include using IT to customize insurance solutions for SMEs to help them comply with the Affordable Care Act's mandate of providing insurance to employees.
The document analyzes the healthcare industry in the U.S. and ways IT can help small businesses insure employees. It discusses four key factors impacting the industry: the Affordable Care Act, digital/IT infrastructure, advances in omics sciences, and the rising global middle class. The recommendations suggest that IT companies can create customized solutions to help small businesses comply with the ACA's insurance mandate for employees.
This document discusses privacy and security concerns regarding mobile health (mHealth) systems. It notes that as mHealth applications collect more personal health and location data from devices like smartphones and sensors, questions arise around patient privacy, data sharing, security, and how to properly obtain user consent. The document examines these issues and their implications for the relationships between patients, healthcare providers, and other stakeholders in mHealth. It argues that addressing privacy, security, and regulatory challenges will be important to enable the continued growth of mHealth.
White Paper - Internet Marketing Strategies For The Medical Device Industryjerryme5
This is a White Paper that I wrote, while employed at Exemplum, that talks about various marketing strategies that medical device companies can use to leverage the Internet to market their products more effectivelty.
Unique Device Identification and GS1: Defining Elements in the Future of Glob...Loftware
This white paper, as the title suggests, is about new national and international mandates for a global standard to be used
in the Unique Device Identification (UDI) of medical devices and other healthcare products. It examines the global trading
opportunities, on an enormous scale, that can be captured by early adopters or forfeited by default by those who wait,
dismiss the idea, or discount the powerful market and competitive forces that UDI developments are driving. Also offered
is a starting blueprint for regulatory compliance professionals, packaging engineers, C-suite executives and manufacturing experts who agree the time to start meeting the UDI opportunity has clearly arrived.
The document summarizes the results of a 2012 survey of the pharmaceutical industry. It finds that three-quarters of respondents ranked changing the commercial business model as a top priority. Companies are increasingly focusing on market access strategies, realigning sales forces, and managed markets. Respondents also reported widespread adoption of tablets and increased use of social media like LinkedIn and Facebook.
The survey summarizes the findings of a survey of US and European healthcare buyers regarding trends in medical device purchasing decisions. It finds that over the next three years, purchasing decisions will be less influenced by physicians and more influenced by hospital administrators focused on value and outcomes. Customers now prioritize reducing total healthcare costs over other outcomes when differentiating new products. As a result, medical device companies will need to demonstrate the value of their products in improving outcomes and lowering costs if they want to succeed amid increasing commoditization pressures in many product segments.
This document discusses three main challenges facing the medical technology industry: 1) sustaining innovation given strains on the industry's traditional innovation model, 2) delivering value and health outcomes as payment models shift focus from volume to quality, and 3) fueling growth opportunities in the emerging "health outcomes ecosystem." The medical technology industry faces unprecedented challenges from trends in capital markets, deals, and regulation that threaten key aspects of its business model. Companies will need to adapt their approaches to innovation, value demonstration, and growth strategies.
The document discusses recent healthcare reforms in the United States and their potential impacts. It notes that the Patient Protection and Affordable Care Act aims to increase insurance coverage while lowering costs. Additionally, the HITECH Act promotes the meaningful use of IT in healthcare to improve quality and reduce spending. Major effects may include 45-55 million Americans gaining insurance, increased use of electronic health records and pay-for-performance programs between providers and payers. Overall the reforms seek to align financial incentives around improved patient outcomes and care coordination.
This paper briefly describes what competitive intelligence is, then proposes a competitive intelligence initiative along with suggestions for a structural framework, scope, and individual skills and tools necessary to be successful.
J.p. morgan 6th annual – brazil retail & healthcare check uprimagazineluiza
Magazine Luiza reported strong financial results in the second quarter of 2012 driven by sales growth and expense reductions. Net revenues grew 22.3% compared to the previous year through a 21.6% increase in gross revenues. The retail segment saw a 19.7% revenue growth and 13% same-store sales growth. Internet sales increased 45%. Gross margins improved by 0.7 percentage points to 33.5% due to higher margins from consumer financing. Operating expenses declined as a percentage of revenues through cost savings initiatives. Magazine Luiza expects to continue growing through store expansion and maturation while maintaining financial discipline.
The article provides a simple overview of clinical informatics. It discusses the driving forces behind health informatics, including the need to provide better care to more patients with constrained resources. It explains how clinical informatics aims to achieve these goals by optimizing various stages of the patient journey through the use of technologies like electronic health records, clinical decision support, and data analytics. The focus of clinical informatics has narrowed to using IT systems to support clinicians. While the core principles remain the same, technology is now more pervasive in healthcare. Clinical informaticists play an important role in bridging clinicians and IT to effectively apply technologies for improved patient care.
The document summarizes research on women in leadership roles on corporate boards and in the C-suite. It finds that companies with more women on their boards tend to have more women in top executive positions over time. Specifically, having more women board directors correlates with higher percentages of women in line roles involving profit-and-loss responsibility, which is seen as experience needed to advance to the highest leadership levels. The document also discusses how quotas for women on boards in Nordic countries have increased the number of women in executive roles, showing that increasing women's representation at the board level can help advance more women throughout organizations.
Zero Suicide in Healthcare: International Declaration & Social Movement (The ...David Covington
Adopt the mindset. Change the world. It's the only goal we can live with.
Draft agenda and narrative executive summary in preparation for the gathering of 40 worldwide experts traveling from 15 countries to Atlanta September 21 & 22 as part of the International Initiative for Mental Health Leadership (IIMHL) 2015 Leadership Exchange and co-sponsored by the International Association for Suicide Prevention (IASP).
The Healthcare DENMARK magazine, gives you an overview of the Danish healthcare system.
If you feel inspired to visit Denmark, please feel free to contact us.
The November 2011 issue of Medical Solutions magazine from Siemens focuses on innovations in healthcare technology and delivery. It describes how partnering with Siemens to build and maintain hospitals can improve performance by combining the latest technology with ongoing support. The issue also explores advances in imaging for breast cancer detection, diagnosing alcohol abuse, upgrading urology systems, and using integrated healthcare IT solutions. Additionally, it examines medical tourism and competitiveness in magnetic resonance imaging.
2016 Patient Safety & Quality Healthcare MagazineRyan Vincent
This document summarizes advertising opportunities for Patient Safety & Quality Healthcare, a publication focused on patient safety and quality improvement. It provides information on display advertising sizes and rates, as well as opportunities for online, email, and sponsored content advertising. The target readership includes healthcare executives, clinicians, and those involved in patient safety, quality improvement, and risk management.
Mission health Magazine, Health Magazine, Magazine Design, Magazine Layout De...KS Designers
This document provides information about a health magazine called Mission Health. It includes details about the editorial board, contents of the current issue, and contact information. The magazine aims to raise health awareness and provide a complete healthcare guide covering topics like heart attacks, cancer, stress management, and lifestyle issues. It also contains medical directory listings and expert advice from doctors. The publication serves as a one-stop resource for readers on various health topics and connects them to healthcare professionals.
Medical devices equipped for the futureBrand Acumen
The document discusses disruptive changes underway in the medical devices industry that will transform it over the next 5 years. It identifies 5 major disruptors: 1) a power shift to payers and providers who are focusing more on cost and value-based evidence, 2) heightened regulatory scrutiny that is increasing compliance costs, 3) unclear sources of innovation as R&D spending yields diminishing returns, 4) new healthcare delivery models that are shifting care settings out of hospitals, and 5) a need to serve lower socioeconomic classes in developing markets. The disruptors threaten $34 billion in industry profits by 2020 but taking appropriate measures could help maintain revenue growth and offset margin declines, preserving significant value for medical device companies.
Historically, the medical device industry has been highly attractive and relatively stable. As a consequence, established players have been able to compete successfully across the device spectrum, applying common business models and processes without much need for differentiation.
The future, however, is very different as disruptive change is underway. Companies will need to look at new segments and offer end-to-end solutions to secure additional revenue and maintain their profit margins.
The document summarizes a report from the Deloitte Center for the Edge about long-term trends fundamentally reshaping business landscapes called "The Big Shift". It finds that return on assets for U.S. public companies has declined 75% since 1965, suggesting the current way of doing business is broken. The report provides industry-level analysis of these trends for nine major U.S. industries. It finds few safe harbors from increasing performance pressures and that industries are experiencing these pressures earlier and more severely depending on their involvement with digital technologies. The report also discusses how customers and creative talent are benefiting from these trends more than companies are.
The document analyzes the healthcare industry in the U.S. and how IT can help small and medium enterprises provide insurance to employees. It identifies four key factors impacting the industry: the Affordable Care Act, digital/IT infrastructure, advances in omics sciences, and the rising global middle class. Recommendations include using IT to customize insurance solutions for SMEs to help them comply with the Affordable Care Act's mandate of providing insurance to employees.
The document analyzes the healthcare industry in the U.S. and ways IT can help small businesses insure employees. It discusses four key factors impacting the industry: the Affordable Care Act, digital/IT infrastructure, advances in omics sciences, and the rising global middle class. The recommendations suggest that IT companies can create customized solutions to help small businesses comply with the ACA's insurance mandate for employees.
This document discusses privacy and security concerns regarding mobile health (mHealth) systems. It notes that as mHealth applications collect more personal health and location data from devices like smartphones and sensors, questions arise around patient privacy, data sharing, security, and how to properly obtain user consent. The document examines these issues and their implications for the relationships between patients, healthcare providers, and other stakeholders in mHealth. It argues that addressing privacy, security, and regulatory challenges will be important to enable the continued growth of mHealth.
White Paper - Internet Marketing Strategies For The Medical Device Industryjerryme5
This is a White Paper that I wrote, while employed at Exemplum, that talks about various marketing strategies that medical device companies can use to leverage the Internet to market their products more effectivelty.
Unique Device Identification and GS1: Defining Elements in the Future of Glob...Loftware
This white paper, as the title suggests, is about new national and international mandates for a global standard to be used
in the Unique Device Identification (UDI) of medical devices and other healthcare products. It examines the global trading
opportunities, on an enormous scale, that can be captured by early adopters or forfeited by default by those who wait,
dismiss the idea, or discount the powerful market and competitive forces that UDI developments are driving. Also offered
is a starting blueprint for regulatory compliance professionals, packaging engineers, C-suite executives and manufacturing experts who agree the time to start meeting the UDI opportunity has clearly arrived.
The document summarizes the results of a 2012 survey of the pharmaceutical industry. It finds that three-quarters of respondents ranked changing the commercial business model as a top priority. Companies are increasingly focusing on market access strategies, realigning sales forces, and managed markets. Respondents also reported widespread adoption of tablets and increased use of social media like LinkedIn and Facebook.
The survey summarizes the findings of a survey of US and European healthcare buyers regarding trends in medical device purchasing decisions. It finds that over the next three years, purchasing decisions will be less influenced by physicians and more influenced by hospital administrators focused on value and outcomes. Customers now prioritize reducing total healthcare costs over other outcomes when differentiating new products. As a result, medical device companies will need to demonstrate the value of their products in improving outcomes and lowering costs if they want to succeed amid increasing commoditization pressures in many product segments.
This document discusses three main challenges facing the medical technology industry: 1) sustaining innovation given strains on the industry's traditional innovation model, 2) delivering value and health outcomes as payment models shift focus from volume to quality, and 3) fueling growth opportunities in the emerging "health outcomes ecosystem." The medical technology industry faces unprecedented challenges from trends in capital markets, deals, and regulation that threaten key aspects of its business model. Companies will need to adapt their approaches to innovation, value demonstration, and growth strategies.
The document discusses recent healthcare reforms in the United States and their potential impacts. It notes that the Patient Protection and Affordable Care Act aims to increase insurance coverage while lowering costs. Additionally, the HITECH Act promotes the meaningful use of IT in healthcare to improve quality and reduce spending. Major effects may include 45-55 million Americans gaining insurance, increased use of electronic health records and pay-for-performance programs between providers and payers. Overall the reforms seek to align financial incentives around improved patient outcomes and care coordination.
This paper briefly describes what competitive intelligence is, then proposes a competitive intelligence initiative along with suggestions for a structural framework, scope, and individual skills and tools necessary to be successful.
United States life sciences companies face numerous challenges in 2015 related to market changes, consolidation, pricing pressures, and health reform. Six key issues are highlighted: 1) Market reconfiguration and consolidation due to factors like expiring patents are driving the need for companies to reassess strategies and explore M&A opportunities. 2) Pricing pressures exist from government efforts to control costs and from health plans increasing efforts to reduce pharmaceutical costs. 3) Health reform is shifting the market to value-based care, requiring companies to demonstrate drugs' and devices' true value and economic impact compared to alternatives.
Life Sciences Implications of the U.S. Affordable Care ActCognizant
Life sciences companies will see substantial changes due to the upholding of the U.S. Affordable Care Act (ACA), and we offer a map of some of the forseeable developments for drug and device manufacturers, biotechnology innovators, and others. A primer on ACA impact on revenue opportunities, earnings pressures, pricing effectiveness, compliance and business models.
The document discusses four key concepts for medical device executives to understand in order to succeed in China's rapidly growing medical devices market. First, executives must seize China's market opportunities as the market is expected to reach $50 billion by 2017. Second, they must understand the Chinese government's important role in regulating the industry and procurement processes. Third, executives should monitor healthcare reforms that could impact market access. Fourth, local competition is growing, so companies must balance global and local strategies to stay competitive. The medical devices market in China offers great potential for growth but also complexity that executives must navigate carefully.
Global healthcare investment rose for the seventh consecutive quarter to surpass $34.7 billion across nearly 1,600 deals. Digital health startups accounted for 40% of deals and funding. European investment nearly doubled quarter-over-quarter while Asian investment fell for the second quarter. A flood of new entrants pushed early-stage deal share above 50% for the first time since 2019, as over half of global healthcare deals were early-stage.
2. Summary
Healthcare Reform is underway in the United States. Tier three – (shown in red below) less than 30 percent
The rapid pace of this overhaul, compounded by of respondents cited the market issue as a key driver
complex and unpredictable economic and societal of the need to innovate
trends, creates inevitable changes to how healthcare
insurance products are designed, marketed and sold Survey Findings
in the U.S., not to mention how healthcare providers Chart one below summarizes the top issues,
deliver services to the public. organized in priority order, facing healthcare providers
participating in the Kalypso survey. Further discussion
To better understand the potential impact of market of the tier one and tier two issues follows.
Written By change on the industry, Kalypso conducted a survey
Andrew Nygard of healthcare companies to identify the major drivers Chart One – Market Issues Driving
Senior Manager at Kalypso
of the need to innovate. The survey found that the Healthcare Innovation
Andrew Nygard has over
30 years of experience
large number of market issues impacting innovation,
working with services-based coupled with the impending deadlines imposed
businesses to drive change at by the Healthcare Reform Act and uncertainties
the executive and operational driven by legal contestation of the Act, is creating a
levels, instituting program
and portfolio management competitive environment in which healthcare payors
systems, and re-architecting that focus on and invest in agility, innovation and
organizational decision product development competencies will emerge with a
making systems. With the
healthcare services industry
significant advantages.
as a major focus, Andrew
works with organizations
on innovation, portfolio and The Survey
process management, and Working with product professionals in four organizations
the application of technology (a national integrated care management company, a
to meet the developing
competitive rigors of this regional health plan, a regional hospital management
market sector. company and a regional industry consortium), 16
major trends / issues were identified for consideration.
While respondents were also given the opportunity to
enter additional trends or issues, no additional issues
were highlighted.
Survey participants were presented with a list of Tier One Market Issues
market issues that drive healthcare innovation and More than 40 percent of respondents identified the
asked to identify their top three concerns for product following two challenges as among the top market
development. The responses can be categorized into issues they anticipate driving innovation and product
three tiers: development in the immediate future.
Tier one – (shown in yellow below) greater than 40
percent cited as a major concern. Retail Exchanges
This was the number one market issue identified with
Tier two – (shown in green below) between 30 and 40 58 percent of respondents citing this as a top three
percent of respondents identified these as a concern. market issue. Mandated by healthcare reform, retail
96 Benefits Live Magazine | January | 2012
3. exchanges will define base product designs for participating To alleviate retail exchange concerns, regional and single-
plans. This means more complexity for healthcare payors as state plans can position themselves to compete in this
they rush to meet mandated plan requirements from design, emerging marketplace by setting a development strategy
network and administrative standpoints. based on:
Regional plans appear to be the most concerned about this 1. Aligning their decision makers on the changing
market issue (83 percent) as opposed to single-state plans demographics and channel implications for products offered
(50 percent). National plans rated this as a lesser concern through these exchanges
with 20 percent of responses. These responses seem to
indicate that: 2. Working with developing state or regional exchanges in
the definition of based and premium product offerings
1. Regional plans anticipate facing a significantly more 3. Designing product platforms to simplify administrative
complex environment and lack the scale of operations to execution across multiple states / regions
address these new requirements. At 83 percent this was
the highest impact issue identified by any group. 4. Pursuing a structured development of plan offerings
targeted at achieving certification by the mandated October
2. While single-state plans rated this high it was ranked 2012 date
second behind Accountable Care Organizations and on par
with three other market issues. Single-state plans anticipate
struggling to meet emergent exchange requirements but are
Accountable Care Organizations
Accountable Care Organizations (ACOs) have the potential
not as concerned as regional plans.
to radically alter the service delivery model for healthcare.
By integrating all parties’ (Independent Physician
3. National plans indicate they believe they have the
Associations (IPAs), facilities, labs etc.) activities and
scale of operations and have made sufficient investments
financial compensation around a patient’s outcomes, they
in upgrading administrative systems (e.g. member
have a tremendous potential to improve patient care as well
management, claims and network management) to handle
as reduce costs.
the demands of retail exchanges.
retail Exchanges However as NPR noted earlier this year “ACOs have
been compared to the elusive unicorn: everyone seems to
know what it looks like, but no one has actually seen one.”
This uncertainty, coupled with the enormous implications
ACOs hold for network management, billing systems and
contracting, makes this the number two issue product
development professionals are tracking with 45 percent of
all respondents listing it as one of their top three issues.
This is likely due to corporate product development
1. http://www.npr.org/2011/04/01/132937232/accountable-care-organizations-explained
Benefits Live Magazine | January | 2012 97
4. aCCOUNTABLE CARE ORGANIZATIONS As High Deductible Health Plans (HDHPs) have
increased in popularity, rising from 17.5 percent in 2007
to 24.9 percent in 2010 of all insured lives , the need to
provide consumers access to cost and quality of care to
aide decision making has increased dramatically.
hdhp pERCENT OF iNURED
Organizations with centralized corporate product
development organizations (as opposed to federated
development models aligned directly with geography or
market segment) were much less likely to cite ACOs as a
top 3 issue (29 percent vs. 45 percent.)
A major assumption in the design of these products is that
organizations enjoying access to scale economies in consumers incentivized to minimize costs and information
addressing system and contracting issues rather than about the costs and quality of the services they purchase
being limited by the fragmented abilities of federated will make better decisions and lower overall healthcare
organizations. costs as a result. However, to date consumers have
experienced a shortage of information upon which to
Harnessing the potential for coordinated care delivery make these decisions.
across the major parties will be a major task requiring the
focus and collaboration of parts of payor organizations Developing and presenting cost and quality information
that traditionally have been managed in silos including to consumers is a daunting task in terms of its underlying
medical management, product development, network complexity (e.g. how to easily portray the inherent trade-
management and claims and billing. offs between price and nebulous and often contentious
quality indicators) and technical difficulty (e.g. database
To be successful in addressing the potential and and website design). This practice also challenges
challenges of ACOs, payors will need to focus on: entrenched industry norms around pricing secrecy -
viewed as “trade secrets”-and physician quality.
• Developing shared market targets, product concepts
and supporting development roadmaps across internal Given these issues payors may struggle with creating
constituents and publishing meaningful and actionable information
for HDHP consumers. One strategy that appears to be
• Integrating the emerging potential of electronic health getting traction is to work with large self-insured groups,
records or groups of groups, directly in developing and publishing
costs and employee satisfaction indices based on their
• Remaining agile enough to adapt to new business own data, rather than exposing contractual information
models as they emerge from the provider community or developing independent and challengeable quality
indices.
Tier Two Market Issues Alternative Care Delivery Models
Tier two market issues ranged from 30 percent to 40
Alternative care delivery models represent potential
percent of respondents identifying them as one of their
game changers in terms of access, cost and quality of
top three market issues they anticipate driving innovation
care. As Clayton Christenson details in The Innovators
product development in the immediate future. The top
Prescription, emergent business models such as retail
three of these issues are:
clinics or specialized practices (also known as Centers
of Excellence) are increasingly disrupting traditional care
Transparency to Cost and Quality
delivery models such as IPAs or “large box” facilities. By
Thirty-five percent of respondents were concerned with
providing lower cost, often 24/7 delivery for simple acute
improving transparency to cost and quality in order to drive
care (i.e. retail clinics), or by carving out a specialized
better decision making and enable greater accountability
practice (e.g. angioplasty), these emerging delivery
for personal care.
98 Benefits Live Magazine | January | 2012
5. models are delivering care in a more accessible, higher ASO/ASC
quality and lower cost way.
aLTERNATIVE CARE DELIVERY MODELS
Not surprisingly , single state and regional organizations
more frequently cited ASO / ASC as top three concern,
likely due in part to:
Thirty-five percent of all respondents cited alternative
care delivery models as a top three concern. Expectedly, 1. National players already having dealt with this issue with
significantly more providers (60 percent) listed this as a the larger, national accounts and having scale economies in
primary concern, as compared to 19 percent of payors. back office operations often not available to smaller players
Alternative care delivery models represent a clear threat 2. Increasing book of business turning to self-insured risk
to traditional providers, who will need to innovate to adapt pools as ever smaller organizations adopt the practice
or compete. Payors will need to incorporate access and
incentives to use these new care delivery providers into One set of successful strategies in addressing these
product designs. increasing demands for cost containment, especially for
smaller plans lacking the scale economies of national
ASO / ASC – Increased demand for and / or player, is to couple traditional agreements for administrative
complexity of relationships services with targeted medical management, health and
Thirty-two percent of respondents cited increasing demand wellness, and price / quality transparency of products.
for Administrative Services Organizations / Administrative By increasing the perceived value received by group
Services Contracts (ASO/ASC) and/or complexity of administrators by addressing core medical cost trend
relationships as one of their top three issues. Health and employee presenteeism issues, price relief on core
plans effectively lease out their proprietary networks and administrative cost structures can be achieved. A key
provide billing and/or customer support services through success factor in delivering these options will be designing
contracts with large, self-insured employers through these scalable and templated options that can be used by group
relationships, and underlying market trends make this an sales management on a repeatable basis.
increasingly important issue.
As our study showed, a large number of market issues
In 2008, 55 percent of workers with health insurance were impacting innovation are driving an increased need to
covered by a self-insured plan offered by their employer and innovate in the healthcare marketplace. This, coupled with
the percentage continues to grow as employers increasingly market uncertainty of the scope and timing of Healthcare
seek to manage their own healthcare risks to reduce cost. Reform Act mandated changes, is driving the need for payor
The impacts of healthcare costs are becoming more evident organizations to become simultaneously more agile as
to self-insured employers, and therefore are tracked more well as better structured in harnessing their organizational
closely. As a result, self-insured employers are asking health potential for innovation. Organizations will be well positioned
plans to share the risk and create more innovative service for success by:
designs. They are also demanding healthcare cost reduction
and quality improvements from payors as conditions to • Managing organizational innovation across market and
engage their services. business model changes
Because of this, an additional major driver of competitiveness • Aligning product innovation and development to corporate
and/or profitability of self-insured business for payors is back strategy
office delivery efficiency (e.g. claims processing, customer
support, etc.), rather than the traditional sources of profitability • Improving the ability to adjust course as corporate outlook
of fully under-written relationships such as Medical Loss and strategy change
Ratio management. To compete in this market, payors must
focus on operational efficiency to drive cost structures down • Developing strong internal competencies, processes and
and build or maintain competitive position in the marketplace. supporting infrastructure for product development
1. http://www.npr.org/2011/04/01/132937232/accountable-care-organizations-explained
2. Martinez ME, Cohen RA. Health insurance coverage: Early release of estimates from the National Health Interview Survey, January–September 2010. National Center for Health
Statistics. March 2011. Available from: http://www.cdc.gov/nchs/nhis.htm.
3. http://www.ebri.org/pdf/FFE114.11Feb09.Final.pdf
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