Market Access in an Era of Accountability: How Medical Device Companies Can Prove Efficacy

Medical device companies that devote resources to every phase of the patient relationship will have the biggest opportunity to secure market dominance.

Chase Hensel

Chronic disease in the United States is widespread, costing the country $2.5 trillion in healthcare spending. Approximately half of adults have one or more chronic health conditions, with heart disease, stroke, diabetes, and obesity among them. Certain health and lifestyle choices, as well as limited access to quality healthcare and disease education, all play a role in a growing number of Americans requiring lifelong medication due to chronic illness and experiencing poorer quality of life.

Medical device companies have traditionally played a role in chronic disease management but that role is both growing and changing. With policies and market forces moving towards a more connected health ecosystem, these companies are increasingly being made accountable for the efficacy of their products. They now have a bigger role to play in achieving Triple Aim goals--a framework developed to better the U.S. healthcare system by improving the patient experience of care, the health of populations, and reducing per capita costs of health care. This challenge compels medical device companies to prove their devices will improve patient health outcomes or risk losing contracts, and market share, to those who do.

What's at Stake

Competition for formulary placement is fierce--and the consequences echo beyond economic repercussions. Just last year, Medtronic successfully convinced United Healthcare (UHC) that their members needed only one insulin pump--MiniMed--firmly establishing Medtronic as UHC's preferred, in-network provider of pumps. This bold move by UHC eliminated the option for members to choose the well-regarded t-slim® pump and raised questions among the diabetes community as to the fairness of taking away product choice and eliminating competition. It also meant a loss of millions of dollars, or about 8% of annual sales, for the pump's manufacturer, Tandem Diabetes Care. At the end of the day, payers are making formulary decisions based on what will benefit their bottom line. In this case, Medtronic convinced UHC that MiniMed was better for UHC than Tandem's t-slim®. The question is, how?

The high demand for medical devices to address the growing prevalence of chronic disease and the high price tag associated with bringing them to market make it imperative that medical device companies position themselves with an advantage in formulary discussions. One way is to demonstrate to payers that they will help them save money, one of the three tenets of the Triple Aim. Healthier members cost less to insure. If medical device companies use patient data to show that their product improves health outcomes, they can claim that their product saves money--strengthening their brand with the patient community and, as a result, their own bottom line.

The Proof Is in the Data

In today's saturated market, medical device manufacturers need to prove themselves in more ways than one. To better position themselves for formulary negotiations with payers, medical device companies must be prepared to have data showing improved health outcomes.

Tracking patient interactions tells a comprehensive story, not to mention captures data that leads to deeper insight into patient lifestyles and behaviors. This data allows care teams to personalize a health coaching program that will better engage and meet the needs of each individual. A lot can happen in the months between clinic visits that can significantly impact the health of a person living with chronic disease. Health coaching equips individuals with the knowledge, tools, and support necessary to dramatically change behaviors and achieve their health goals. Personalized support offers hope to patients as they learn how to navigate their way to better health after a chronic disease diagnosis, which otherwise can be an intimidating process. The ability to collect and then analyze data will arm medical device companies with the evidence needed to show payers that their device does in fact make people healthier.

Outcomes-based medicine is driving device reimbursement. Medical device companies are more likely to be reimbursed if they select an experienced partner with a software platform that will allow them to configure a longitudinal care program specific to their products. Platform configurability is not a luxury but a necessity to deliver personalized care. Chronic disease affects each person uniquely, so a flexible platform is necessary to drive the best possible outcomes for each patient.

Putting Patients at the Center

With insurers driven by profits and device companies pressured to secure formulary contracts, patient needs often get lost in the fray, when, in fact, they should be front and center. After all, it's the overall improvement of patient health that will convince payers that a product is worth the investment. With any regimen that includes new medical devices, patient support and disease education are the most impactful ways to drive positive health outcomes for individuals living with chronic disease. And health coaching is proving to be one of the most effective ways to achieve transformative results.

Familiarizing new patients with their medical device, recording valuable patient data, and providing effective health coaching don't have to be on separate platforms. In fact, they ought not to be. Integrating all of these activities with a single goal in mind--establish and maintain strong patient relationships--is key to achieving long-term engagement and realizing the financial benefits of doing so. Simply put, rethinking the product onboarding experience transforms a cost center into a profit center.

For medical devices that require direct patient interaction, patients must be guided through habit formation and get educated about their health condition in order to improve it. With minimal effort, medical device companies can offer the resources necessary to foster greater adherence to the prescribed medical device usage. By incorporating health coaching into onboarding programs, medical device companies build early rapport with users and ultimately develop relationships which yield improved adherence and more data. The technology to get patients started in a connected health ecosystem already exists, with or without Bluetooth technology, especially given the prevalence of smartphone owners.

Completing the Virtuous Loop

Patient-centered data collection, education, and support for medical devices improves not only formulary discussions and reimbursement but also creates valuable product feedback. In turn, this improves health outcomes, reduces costs, and engages patients, fulfilling the Triple Aim. Comprehensive data collection on medical device usage provides manufacturers insights into device features, new services, or future products, further reducing operational expenses and increasing brand loyalty.

In an increasingly outcomes-based healthcare landscape, accountability for improving patient health is everything. Medical device companies that devote resources to every phase of the patient relationship--onboarding, prevention, education, maintenance--will have the biggest opportunity to secure market dominance. Do that, and reap the benefits of lower costs and greater revenue.

Chase Hensel, CEO and co-founder of Welkin Health, a digital therapeutics platform helping medical device companies improve health outcomes by strengthening regimen adherence for people living with chronic disease.

[Image courtesy of STEVEPB/PIXABAY]