Maria Shepherd

The medtech industry is struggling to reinvent itself. Increased pressure on medical device and diagnostics product pricing is a common strategic issue, and a primary cause is the combined forces of hospital consolidation and the strategic imperative to reduce the number of vendors supplying their systems. According to a recent American Hospital Association study, approximately 53% of hospitals are part of a health system, and approximately 20% of all U.S. hospitals are for-profit.^1,2 Both segments are growing. Adding to the compression of medtech prices is the involvement of the c-suite and hospital administrators in decisions about which medical devices will be selected for routine use. To add more imbalance to this trend, the integration of insurers and accountable care organizations (ACOs) with healthcare organizations will further increase the power of hospital administration in purchasing decisions. And finally, incentives for clinicians are changing. The percentage of physicians working in practices owned by a hospital or integrated delivery system increased from 24% in 2004 to 49% in 2013.³ Combine all of these factors and it is no surprise that medical device managers are feeling overwhelmed.

As every medical device manufacturer knows, this price pressure is real and painful. It is also proven in an index that tracks the sales of the top 10 medical devices based on total amount spent on those items annually by U.S. hospitals. The change over 12 months for the top 10 was mixed. Six devices had average selling price (ASP) declines (range -0.4% to -1.12%) and four had positive ASP increases (0.45% to 7.89%).

As these trends dominate the U.S. healthcare system, some medical device companies are rethinking a "product-only" strategy. In response to the growing power of hospital and insurer systems, many medical device companies are evaluating the addition of services or a segmentation strategy for value -based products to broaden their value proposition to clinicians, hospital executives, and administrators.

Service Strategies: Are They Working?

While many medical device companies yearn to increase their value by providing services for providers, hospitals, patients, and ultimately payers, the information required to accomplish this goal is difficult to gather. This is because the U.S. healthcare system is experiencing great volatility and most members of the healthcare workforce are fighting to keep their heads above water. When change is a constant, it is difficult to articulate the insights that the medtech community could use to build new service strategies. This is the conundrum for medtech companies that seek to provide services in addition to products. How do we dig out our hospital customers' unmet needs?

Some medtech companies are seeing success in the services sector. For example, Philips and Medtronic, two of the largest medical device companies in the world, have made notable investments in the development of service strategies. For these companies, services have become a strategic lever. Medtronic and Philips are successfully differentiating themselves in their highly competitive domains. For example, Omar Ishrak has championed a service strategy since he joined Medtronic as CEO in 2011. Even when Medtronic acquired Covidien, largely a products-only medtech organization, he stated, "...our products and portfolio of services will allow us to serve our customers more efficiently and better address the demands of the current healthcare marketplace."

Not every medtech company is performing as well in the services space as Philips and Medtronic. At an expert's panel at the October 2014 Cooley Medtech Meeting in Boston, an argument broke out between an imaging company CFO in the audience and a large Pennsylvania hospital system supply chain executive on the panel. The hospital executive challenged the medtech executive audience. "In the next three years, I have to replace $145 million in capital equipment," he stated. "My margin is 1.7% out of $2 billion, and I have to cut back by $100 million. I challenge the representatives of GE and Toshiba in the audience. Come to us with a risk-sharing plan, and show us how to improve our margins. We are willing to split the difference with you."

Words were exchanged. "Look at what Philips is doing over at Georgia Regents Medical Center (GRMC)," the Pennsylvania hospital executive continued. "They've also partnered with Duke to prove reduced length of stay."⁴  In 2013, Philips and GRMC signed a 15-year, $300 million first-ever contract to build a relationship with the goals of improving outcomes and delivering more effective and cost-efficient care to the four million to six million people served by GRMC. It sounds like a win-win. In a presentation, Philips identified the benefits for customers and patients:

The benefits for Philips? The ability to provide incremental value through a combination of equipment, solutions, and services. These contracts net Philips a predictable revenue stream and a stronger negotiating position through a long-term relationship with the hospital.

Core competency is the key to service strategy success. In Medtronic's Q4 2015 earnings call, Omar Ishrak said, "We continue to add additional services and solutions offerings. In addition to our existing Cardiocom and Cath Lab Managed Services platforms, we were excited to add Diabeter in Q4, a unique diabetes integrated care solution. We also initiated our first pilot of our Operating Room Managed Services, which combines the capabilities we have developed in the Cath Lab together with Covidien's breadth of operating room technology and expertise to provide a full service or our offering to hospitals."

Value-Based Strategies

In a recent article, Capturing the New 'Value' Segment in Medical Devices, a detailed but unsophisticated argument is made to segment products by their value to the customer and to align the level of support and services that should be provided to the segment. In the article, four segments are proposed:

While the premium differentiated and premium undifferentiated segment models are familiar and based on traditional medtech sales competencies, the value segment will require development of new methods (and competencies) to manage quality, training, and other deliverables that are required for health-delivery products. Excluding commodity-based products such as 4x4 gauze pads and other non-differentiated products, our industry may not ever be able to support a sales model that provides online support or light-touch representatives who cannot provide the clinical support required for a life-saving medical device.

Some value-based strategies may work, but low-touch models such as online support may not be realistic. Think of the bare metal stent, a product that falls easily into the value segment. An intraprocedural stent thrombosis complication (the development of occlusive or non-occlusive new thrombus with a recently implanted stent before a PCI procedure is finished) is a rare complication of PCI. However, it has been determined to occur in 0.7% of patients.⁵  At 454,000 estimated stent procedures per year, greater than 3000 patients are at risk for this complication. Online support for this type of product, as commoditized as bare metal stents have become, is not an adequate form of clinical support.

Innovation Still Prevails

In the brave new world of evolving payment models and rapidly changing reimbursement values, demonstrating economic and clinical value has become paramount. New, non-product services are a great idea and will work for companies like Medtronic and Philips that have integrated a services model into their strategies. Once the strategy is adopted and the investment in building core competencies has begun, then the process of prying unmet needs from the rapidly changing worlds of hospital and clinician customers can begin.

If your company has not yet started developing a service strategy, it may be tough to catch up with acknowledged leaders in this space. However, the service strategy is a sound one, and there is still plenty of room for innovation in the medtech services space. Finding the unmet needs in this turbulent period for our healthcare customers is more challenging, but it can be done. Build your strategy and then find the unique services that will suit your medical specialty. Be sure to prove its cost-benefit using concrete metrics such as reduction in the utilization of the healthcare system (tests, surgery, ER visits, complications, contraindications, etc.) and test the concept to assess its value and ensure the math works.

References

1. American Hospital Association. "AHA Hospital Statistics, 2013 Edition.

2. Ibid.

3. MedAxiom 2013 Annual Hospital Integration Report.

4. Carter, B, Duke University School of Nursing, Durham, N.C. Intra-abdominal Pressure Monitoring of Extremely and Very Low Birth Weight Preterm Infants (< 1500 Grams) During Enteral Gastric Tube Feedings, Study ongoing. Accessed July 5, 2015.

5. Brener et al. JACC: Cardiovascular Interventions, Vol. 6, No. 1, 2013:36 - 43.

Maria Shepherd, MBA, is the founder of Data Decision Group, which provides business and marketing strategy and product design and development consulting for medical devices, diagnostics, and other life sciences companies. She previously served as vice president of marketing for Oridion Medical (acquired by Covidien), Philips Medical, and Boston Scientific. 

[image courtesy of STUART MILES/FREEDIGITALPHOTOS.NET]