While there are many barriers to bariatric surgery, one of the lesser-known barriers has historically been the complexity of the patient care pathway – a problem that the COVID-19 pandemic has only intensified.
Medtronic has been quietly working in the background to put technology to work to breakdown this barrier, and to help bariatric surgeons build a more patient-centric practice.
“The pandemic certainly put additional pressure on the ability to treat bariatric patients,” Matt Anderson, senior vice president and general manager of Medtronic’s advanced surgical instruments business, told MD+DI in an exclusive interview this week. “It certainly added another dynamic in being able to reach patients, attract them into the treatment funnel, keep them in the care pathway until they have surgery, and then ensure that they get the right result moving forward.”
This is why the $5 billion business unit is taking a broader approach beyond just offering surgical tools and technologies designed for the operating room.
Compared to pharmaceutical therapies and lifestyle changes alone, Anderson said bariatric surgery has been proven to play a big part in helping patients achieve meaningful weight loss.
“And despite perceptions that are out there to the contrary, it's pretty darn safe, due to advancements in both technology and also techniques over the past couple of decades,” Anderson said. “Nearly all procedures today are performed in a minimally invasive fashion … and complication rates have really been driven down, below 2%, which is pretty much in line with other common procedures, such as having your knee replaced or your gallbladder removed.”
Yet, at the end of the day, Anderson says only about 1% patients suffering from severe obesity who are eligible for bariatric surgery actually go through with it.
“There are significant barriers that still remain outside of the operating room that are keeping a lot of people from pursuing the treatment,” Anderson said. “… There are awareness challenges, fear, stigma, historical bias both on the part of a prospective patient but also referring physicians.”
But even more notably, he added, is the complexity of the treatment pathway a patient has to go through before they even enter the operating room.
While that patient care pathway varies a lot from one geography to the next – even within the United States – there are three general buckets involved with preparing both physically and psychologically for bariatric surgery, Anderson said. That’s not to mention the hoops insurance providers make patients jump through to qualify for bariatric surgery.
“Until recently, a lot of payers have even required patients to fail a medical treatment before they are eligible for surgery,” Anderson said, although he said that is changing somewhat depending on the payer.
He said that somewhere north of 50% of patients who have a bariatric surgery consult end up dropping out before the procedure because the process tends to be so onerous and not very patient-friendly.
Then, for those patients who do go through with the procedure, there are lifestyle adjustments they must make afterward in order to achieve the desired weight loss results and healthcare benefits.
“Our core has always been tools and technologies in the operating room, but also the training that goes hand in hand with that, that's what we have been known for historically, and that's helped surgeons take complication rates down,” Anderson said. “… But if we're going to be the trusted partner to surgeons that we need to be – and that's a big focus for us – we wouldn't be doing our jobs if we didn't look for ways to help surgeons beyond those tools and technologies in the operating room.”
He said Medtronic has created a service around its bariatric surgery offerings designed to understand what barriers each customer is struggling with the most and then offering solutions to help them get more eligible patients into the bariatric surgery funnel.
“We've done some direct-to-patient awareness campaigns that can help generate leads and ultimately attract more patients into the treatment funnel, educational events to help assist the surgeon in reaching out to primary care providers and other referring physicians to educate them and to overcome some of the historical bias associated with surgery,” Anderson said.
At the height of the pandemic, one of the major challenges for bariatric surgeons was reaching patients remotely. So, Medtronic also worked with surgeons to make sure they knew how to navigate telehealth options.
“There were a number of things that we developed over time, and the one that excites me probably the most is some of the technologies that we've started developing that can help surgeons stay better connected with patients before and after the procedure.
Specifically, Medtronic has developed the GoFurther patient engagement app. Anderson describes it as a software-enabled virtual service designed to support the care pathway with features like progress tracking through the pre-op qualification steps, as well as follow-up steps to help patients maximize the results that they achieve after the procedure through lifestyle adjustments.
"That connectivity pre- and post-procedure is just so important," Anderson said.
So far, feedback regarding the GoFurther app has been quite positive, he told MD+DI.
"Surgeons, I think, are really excited about what potential there is there as they look at building out their bariatric practices," he said. "Some of the feedback we've gotten really affirms the level of partnership that they're feeling from us. It's really affirming that helping them solve these problems is meaningful and is different from what they're seeing from anybody else in the space."