Steve How, of Wilmington Healthcare, explains why medtech companies need to align their value proposition with the integrated care agenda.
The recently published NHS Long Term Plan, which provides a blueprint for the way local health systems should design and deliver services, states that all areas of England will be covered by an Integrated Care System (ICS) by April 2021.
The NHS has promised £4.5 billion of new investment to fund expanded community multi-disciplinary teams within ICSs, comprising staff such as GPs, pharmacists, district nurses, community geriatricians, dementia workers and Allied Health Professions (AHPs), social care and the voluntary sector.
These multidisciplinary teams will be aligned with Primary Care Networks (PCNs), based on neighbouring GP practices that work together, typically covering populations of between 30,000 to 50,000 people.
One of the key objectives of integrating teams is to boost out-of-hospital care and “dissolve the historic divide between primary and community health services.” In particular, the NHS wants to avoid a third of all outpatient appointments within five years.
These changes, which support the joined-up approach that we have already seen in the new NHS Supply Chain Operating Model, have profound implications for medtech companies across all product areas from high tech goods to consumables.
When creating a value proposition for the NHS, medtech companies should consider how integrated procurement teams will measure costs across the whole care pathway, including failure rates, inpatient stays and infection rates. Industry also needs to think about how procurement teams will align with key Long Term Plan aspirations, such as the need to bring care closer to home and reduce hospital bills. This situation is evolving as procurement teams need to manage their system integration.
For example, when looking at the treatment of benign prostatic hyperplasia (BPH), there are a variety of options and they have different care pathway and cost implications. Treatment that involves traditional and more invasive surgery would be carried out in a hospital under general or spinal anaesthesia and would require a hospital stay. Innovative new technology can avert the need for invasive surgery and enable procedures to be conducted under local anaesthetic; however, it may be more expensive to buy than the equipment used in traditional surgery.
Consequently, when trying to convince an ICS to invest in an innovative new technology, a company would need to consider how it could offset the cost elsewhere in the pathway. For example, the NHS might save money because patients do not need to stay in hospital and there is a lower risk of complications. As this is an evolving situation, it will be necessary to ensure all parties in the NHS are aligned e.g. procurement, ICS transformation leads and clinicians.
When trying to sell costly high-tech products to the NHS, medtech companies could consider approaching Academic Health Science Networks (AHSNs) for support. AHSNs can provide localities with financial support for the adoption of new assessed technology using the innovation fund, and they have a clear responsibility for promoting innovation. The Long Term Plan makes it clear that service improvement must be addressed in tandem with innovation; hence AHSNs are also closely aligned with NHS RightCare and Getting It Right First Time (GIRFT). In addition to ensuring that their proposition meets the NHS’s wider needs, medtech companies could also ask GIRFT and NHS RightCare to evaluate a product within the system.
When looking at medium cost equipment, such as that needed for diagnostics, point of care will be particularly important. If equipment could be sited in a community health facility rather than a hospital, for example, this could be shown to bring considerable savings to new place-based NHS care systems. This may change the end purchaser.
Medtech companies also need to define who will be doing diagnostic testing within integrated care teams. With radiologists in short supply, what other healthcare professionals may get involved in diagnostics? What teams will they sit in and who will they work for within the wider ICS?
Turning to consumables, such as sip feeds and wound dressings, integrated care poses a particular challenge for industry, since these types of goods have often been provided free or as loss leaders to hospitals, possibly along with a nurse, as part of a wider care package to support the use of a piece of technology. Once the patient has returned home, primary care has been charged for the ongoing use of the consumable goods.
When dealing with ICSs, medtech companies need to consider the whole system pathway and ensure that procurement teams understand the balance between consumables, hardware and associated services from an industry perspective. Industry needs to communicate the true value of products and services that have been provided free of charge to hospitals and justify the need to charge for certain products once the patient returns home.
In essence, the integrated care agenda is forcing medtech companies to rethink the value of all their products – from consumables through to high tech goods. To align its proposition with the NHS’s long-term vision, industry must look at costs across the whole care pathway, identify where savings can be made and show how it can help the NHS improve patient outcomes. Industry must also realise the NHS is still getting to grips with these changes and not all areas or people are on the same page.
To find out more about how the Long Term Plan will impact on the medtech industry, download the report Looking ahead 2019, here.
