innovation in healthcare€¦ · innovation defines healthcare dr. joseph lister conceived of...
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INNOVATION IN
HEALTHCARE
A CHECK-UP
• LIVING “UNNATURALLY” LONGER
• MAJOR DISEASES ELIMINATED
• PHYSIOLOGY EXHAUSTED
THE RELEVANCE OF INNOVATION
INNOVATION DEFINES HEALTHCARE
Dr. Joseph Lister
conceived of
antiseptic technique
100 years earlier
Dr. Charles Dotter conceived of
angioplasty in 1964
Opposed to Innovation?
• Select Events from Treatment Chronology
▪ LAD/ANTERIOR MI
▪ Transported by car to hospital
▪ Treated: Oxygen Tent, Heparin
▪ Breakfast: Bacon, sausage, hotcakes
▪ Lunch: Hamburger
▪ First work visitor: 17 days
▪ Moved to chair: 28 days
▪ Climbed stairs: 42 days
• Spent last 9 months in Walter Reed w/Ischemic Cardiomyopathy
• Died: Heart Failure
WHAT IS INNOVATION?
CAN WE “SEE IT?” IS THIS INNOVATION?
• Resolve AS
• Replace open heart surgery
• Non-surgical; 1-2 day admit
• 10+ years Quality Life
• Next: Low risk, Mitral and Tricuspid
• Resolve HF
• Replace heart transplant
• MIS cardiac surgery
• 7+ years Quality Life
• Next: Completely percutaneous
TAVR LVAD
IS THIS INNOVATION?DIGITAL PLATFORM FOR TEETH GRINDING (BRUXISM)
• Neuromodulation
• Sensors, Bluetooth, haptic feedback
• Realtime data
• Disruptive technology
• Reduction of bruxism session by 7 sec. at 6 mos.
SHOULD WE PAY FOR THIS INNOVATION?
Maybe no?
Maybe yes?
LEGITIMATE CONTROVERSIES IN INNOVATION
• Robot-assisted surgery: Twice the price
• Is robotic surgery worth the cost?• Robot-Assisted Surgery Costs More
But May Not Be Better
You tell me:
• 45-70 yo male
• Prostate Cancer diagnosis
• Nerve-sparing radical prostatectomy
• “Experienced” surgeon
• Risks:• Clean Margins• Impotence• Incontinence
“No thanks, Doc, I’ve heard it’s not cost-effective”
CASE STUDY: SURGICAL ROBOTICS
Innovative?• Haptic Feedback
• Eye tracking camera motion
• Fixed Fulcrum
• 3-D imaging for all observers
• Replicate Lap Surgery
Cost Effective?• Reusable Instruments
• New Business Model
“I’d like a competitor, I’d like to use
the robot in more procedures without
a cost penalty, and I’d like more
surgeons comfortable using it”
ENABLING MEDICAL INNOVATIONWHAT’S NECESSARY, BENEFICIAL?
MaterialsBatteries
Micro
Motors
Robotics
Telecom
Digital/AI
Sensors
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MACRO DRIVERSPopulation Aging
• 60% of population has a chronic
condition
• >75 million have 3+ chronic conditions
• Between 2000-2030, 46 million more
people with CC (Spain)
• Patients with 4+ CCs use 2x resources vs.
those with fewer
• 83% of spending is on CCs
• Avg: 15 annual office visits
• Avg: 50 annual prescriptions
MACRO DRIVERSCompounding
150 2 4 6 8 10 12 14
Japan
Germany
Canada
Australia
UK
US
Annual Doctor Visits per Person
Source: World Bank
0
2000
4000
6000
8000
10000
12000
Health Care Costs per Capita (US$)
Source: Peter G. Peterson Foundation
WELL DOCUMENTED INEFFICIENCIESPoor outcomes; Underutilized system
WITH NO RELIEF IN SIGHT
0102030405060708090
100110120
1970 1990 2010 2030 2050 2070
Beneficiaries in Millions
10,000 New Medicare Beneficiaries Daily
Medical Device Spending vs. National Health Accounts Expenditures, 1989-2011
DEVICE COSTS A DRIVER?
DEVICE COSTS STABLEUS=EU=JAPAN
GROWTH IN MEDICAL DEVICE PRICING IS LOWUS CONSUMER AND SELECT MEDICAL PRICES
WHAT DO WE KNOW SO FAR?
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• PROBLEM OR SOLUTION?
CASE STUDY: HEART FAILURE
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• REPLICATE NATURE (MS+PFO)
• DUMP PRESSURE TO VENOUS “RESERVOIR”
• REDUCE LEFT ATRIAL PRESSURE
• LIVE LONGER, LOWER COST OF CARE
CASE STUDY: HEART FAILURE
• NO GOOD DRUG OR BEHAVIOR FIXES
• COST…$200BB AND 400K DEATHS PER YEAR
• DIABETES, CANCER, HEART DISEASE
• BYPASS SURGERY WORKS: <2% GET IT
CASE STUDY: OBESITY
• RESULTS MATCH SURGERY: > 50% EWL
• IMPLANTS OUT TO 3 YEARS
• NO CHANGE TO DIET/EATING HABITS
Restrict
Insulate
Mix
CASE STUDY: BYPASS WITHOUT SURGERY?
• SPINAL CORD STIMULATION
• INTERRUPT SIGNAL TRANSMISSION
• PAIN RELIEF; OPIOID AVOIDANCE
• < ½ ELIGIBLE PATIENTS OPT IN
• SURGERY, BATTERY
CASE STUDY: PAIN MANAGEMENT?
• NO BATTERY; WIRELESS ENERGY
• PLACE ANYWHERE
• MIGRAINE, NEUROPATHY,
EXTREMITIES
CASE STUDY: PAIN MANAGEMENT
BARRIERS TO INNOVATIONACHIEVING VALUE-BASED HEALTHCARE?
Cost Effectivenessduration, definitions, evidence, judgment
Payment Systemspublic/private
Fee-For-Service structureInsurance cycles and motivation
Fog of innovation
Disease prevalence
System Inertia (e.g., AMA)
PRACTICAL LIMITATIONS OF PAYMENTINNOVATION FITTING CONVENTION?
• MAC’s deliver 3,000,000 claims reviews daily
• yes or no?
• “Maze of regulations”, set into law
• Congressional approval to change
• Every new technology payment process differs
• Home health: DME
• LCDs existing structures
• New Tech add-ons
• “substantial clinical improvement”
• Public and Private systems
• Up to 10 year lag
Good Luck!
INNOVATION INNOCENT VICTIMS
• 10-year Battery Life Pacemaker
• Fewer Replacements
• Who wouldn’t prefer that?
• Balloon Sinuplasty
• Avoid FESS surgery
• Shift to office procedure
• Who wouldn’t prefer that?
Reduced Volume Changed Site
INNOVATION INNOCENT VICTIMMISALIGNED INTERESTS
LAA Closure
1/6 of all strokes linked to AFIB
$40bb conservative annual
cost
LAA implant reduces stroke
Cost Effective
Cardiology Implant “cost”
Neurology Avoidance “saving”
WHAT IF WE DELIVER
PATIENTS CHEMO-THERAPY
WITHOUT HAIR LOSS?
IS INNOVATION ALIVE?
IS INNOVATION ALIVE?
GLAUCOMA
• #1 CAUSE OF BLINDNESS
• SURGERY TO PLACE DRAINS
• WHAT IF…MAKE DRAINS WITHOUT
TOUCHING THE EYE?
IS INNOVATION ALIVE?
GLIOBLASTOMA
• USE LOW FREQUENCY ELECTROMAGNETIC
FIELD TO ALTER CELL FUNCTION AND
MIMIC DRUG AFFECT
• CELLS “SEE” THE SAME EM MESSAGE
AND MAY RESPOND THE SAME WAY
IS INNOVATION ENDANGERED? FEWER START-UPS & LOWER R&D
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Medtech R&D growth pre and post 2007
Will innovation barriers make breakthrough technologies scarce?
THIS REALLY MATTERS!
WHERE DOES THIS LEAVE US?
• INNOVATIONS ADVANCE PATIENT CARE
• DEMAND IS INCREASING RAPIDLY, BEYOND AFFORDABILITY
• DISRUPTIVE SOLUTIONS ARE NEEDED; WITH HIGH HURDLE
• DISRUPTIVE SOLUTIONS MAY NOT FIT NEATLY
• INNOVATORS AND PROVIDERS SHOULD ALIGN:
• MUTUAL UNDERSTANDING OF GOALS AND BARRIERS
• HIGHER PURPOSE AND COORDINATED EXECUTION
• SPEED THINGS ALONG, PLEASE…I’M GETTING OLDER!
EMBRACE THE IDEAL OF INNOVATION!
WHAT’S HAPPENING SYSTEMICALLY?DIGITAL INVESTMENTS ACCELERATING
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• Rise of consumerism
• Increased digitization
• Data and algorithms are
products
“In this environment, the value is in the
clinical insights and trend analysis
that devices spit out, rather than in the
med device itself.”
Donald Jones, Chief Digital Officer
Scripps Translational Science Institute
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The new face of healthcare?
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• $10B market growing
at >16% CAGR
• 85% of sales for chronic
disease monitoring
Connected devices
• Focus: Professional care, Insured
applications
• Chronic Disease Mgt
• Dx creates Tx
• Cost Effectiveness
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EVIDENCE?TO USE? TO FUND?
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Medtech Industry UpdateDisease density driving industry growth
• In medtech we focus on chronic disease
categories with the highest physical and financial
costs (CVD, COPD / Asthma)
• In these very large segments, digital
technologies which capture clinically relevant
data that can standardize treatment protocols
will have enormous cost saving benefits
Source: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group, Dec. 2014 at http://www.cms.hhs.gov/NationalHealthExpendData/
$2,895B$3,057B
$3,207B$3,386B
$3,579B$3,797B
$4,042B$4,307B
$4,578B
$4,862B $5,159B
$0B
$1,000B
$2,000B
$3,000B
$4,000B
$5,000B
2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023
Health spending is projected to be nearly
20% of GDP by 2023
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Industry driversAging + Prevalence = Demand
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OECD Data. https://www.oecd.org/unitedstates/Health-at-a-Glance-2017-Key-Findings-UNITED-STATES.pdf