Oli Hudson, content director at Wilmington, explores the ongoing integration programme in the NHS and some fresh things for medtech to consider – what can it bring to the table?
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April 1, 2021 saw a landmark moment: all areas of the English NHS became integrated care systems.
Between now and April 2022, we will see the drafting of single-pot budgets, aligned incentive contracts, strategic plans, stated outcomes, and the establishment of provider collaboratives, that will certainly make integrated care seem less like a theoretical abstract and more like reality.
That said, medtech may be forgiven for thinking – what, in essence, does this change about our business model? Much has been written about the development of integrated care at a policy level, not least by this author on this platform, but changes on the ground and to sales may be difficult to identify – there are still the same patient groups, the same clinicians and surgeons, the same hospital settings, and the same challenges in bringing a product to market and seeing it achieve widespread adoption.
We at Wilmington Healthcare believe that this worldview would involve missing a big opportunity for partnership with the NHS.
What is integration trying to achieve?
At its most basic level, and drawing from global initiatives where integration has succeeded, there are three aims to integration; improving clinical outcomes; reducing cost; and improving patient experience.
In all three areas, the fundamental positive force is organisations working together. Evidence based pathways assuming the best techniques and staff are used on the right patients, with quality rather than institutional convenience at the core, improves outcomes; patient-centred financing and population health budgets allow the cost of care to be spread around a system in a rational way, improving cost; and the joining up of services into one streamlined pathway – with all clinicians involved in the episode talking to each other – improves patient experience. And all three aspects reinforce each other.
So medtech should be asking itself with each strategic round: what can we bring to the table in each of these areas?
Clinical involvement
One little-mentioned aspect of this integration is the involvement of clinicians. As laid down in the Integrated care white paper, they will have to be involved at a deep level in order to make this work, and moreover, these clinicians will increasingly understand and accept they have a role in cost management.
Industry has strong relationships with supportive clinicians and is well placed to be supportive in the process they will have to go through, of interrogating pathways of care. Fruitful conversations could be had along the lines of unmet needs, and for the possibility of care integration in mutually important therapy areas.
Medtech may well have distinctive assets and competencies to contribute and have solutions to provide in those three areas of improved outcomes, reduced costs, and improved patient experience.
For example, much work will be carried out in the upcoming months costing pathways and consolidating all the different interventions that might take place – diagnosis, referral, consultation, pre-op intervention, procedure, recovery, rehabilitation, monitoring – in an episode of care such as a joint replacement or transplant operation.
Aligned incentive contracts will accelerate the adoption of these approaches by using financial incentives to suppress the previous philosophy of revenue-by-activity, and increase the focus on outcomes, for example disincentivising revisions and complications-management work.
This kind of wider health economic thinking – that the value of an implant lies not just in its use in a single procedure, but in what it could represent to a patient in terms of overall experience, fewer interactions with fewer healthcare players, how it affects the overall health economy both in terms of best use of resources and most effective clinical outcomes – is what these clinicians will need to reshape pathways, and what medtech is very well place to provide.
Any therapy area where there are multiple points of access for a patient, managed across multiple locations, where there are significant ‘pain points’, excess costs, and missed opportunities to offer optimal care, is one where industry can get involved in partnership with the NHS to help improve in the context of integration.
From organisational sale to system sale
The classical focus on a point sale to clinicians and, latterly, procurement, will increasingly become a systems sell to clinical networks across several providers.
This is going to mean a shift from selling inputs such as clinical efficacy, safety and unit pricing to selling outputs like real-world outcomes and total care costs. While this has been a part of the commissioner conversation for market access, what is new is the need to have similar conversations with providers to drive usage.
This means medtech operatives will have to be fluent in the nature of that system, the providers within it and the clinical networks driving techniques, product use, and innovation. It may well mean enhanced capabilities in account management, health economics, product development and marketing. In order to make business cases viable across systems, customised approaches may also be needed in terms of using system data on their populations and understanding the system’s performance metrics.
What can medtech bring?
There are several things medtech could consider bringing to the integration conversation with system leads and clinical networks. Industry always has deep knowledge of specific conditions and is at the cutting edge of scientific developments to treat them. It can also bring global perspectives on best practice, possibly with concomitant economic modelling to back up a business case for change.
This could include your own rigorous understanding of the end-to-end patient, clinical and commissioner experience in your area, and understanding what could be improved, for example in patient flows and sources of waste, duplication or inefficiency. Real world data may be needed; seeking that real world data could indeed be the locus of a partnership project with the NHS. Another avenue to explore might be partnering with other companies specialising in a different aspect of patient care within the same pathway, to offer a more holistic solution.
The next steps
One of the great reckonings to come is the management of demand; we know about the backlog caused by the pandemic, but this is only part of the story. Healthcare going into the next decades will have to become much more geared towards managing demand, especially in high volume specialties.
This is going to prove an extreme test for providers. Provider networks – the burgeoning integrated care partnerships and provider collaboratives – are talking a good talk at the moment, with some producing plans with ambitious aims. But we have to acknowledge that these are organisations in their infancy and will soon become aware of their own limitations. This will be the time when medtech partnerships are likely to emerge, perhaps as manufacturers playing a role as care extenders; perhaps through the ongoing agreement of managed service contracts; perhaps as medtech becomes itself a partner in delivery, offering end-to-end solutions in key specialist therapy areas.
