SHIFTING FROM VOLUME TO VALUE MAKES SENSE

[vc_row][vc_column][vc_column_text]The concept is certainly gaining increasing prominence around the world. Based on the research of Harvard’s Michael Porter, VBHC provides a framework for restructuring health care systems with the overarching goal of value for patients.

The World Economic Forum has calculated that, despite advancements in medical knowledge and innovation, society is not getting the full value of the annual AUD$8 trillion spent worldwide on healthcare.

Australia’s healthcare expenditure is $170 billion, representing 10.3% of GDP, meaning one in every $10 in the economy is being spent in the health sector.

MTAA CEO, Ian Burgess said that although Australia has a very good health system, with increasing pressure on our healthcare dollar, our current service delivery system provides fragmented care, siloed funding and differences in outcomes and clinical practices.

“If Australia seeks to become the “healthiest nation on earth” it’ll need to transform its healthcare system to be fit for the 21st century,” said Mr Burgess.

Some of the speakers noted the challenges in the current environment of elevating a value and outcomes debate when the Government has decided to remove rewarding superior clinical performance as part of the Prostheses List Agreement with the MTAA.

Healthcare should be driven by a relentless focus on delivering outcomes that truly matter to patients and to the community, in a financially sustainable manner.

The day started with Tessa Kowaliw, Women‘s Healthcare Australasia and patient advocate. It set the scene for much of the day by ensuring patients were front of mind by making sure we address outcomes that are meaningful to patients.

Mr Burgess said: “All stakeholders need to ask themselves “what will this change mean?” or “when will it happen?” but also “how do we get there?”

“The medical technology industry makes a highly significant contribution to the quality of healthcare in Australia in helping people live longer, healthier and more productive lives.

“To prepare for this changing environment, it will be important for medical technology companies to understand, demonstrate, and clearly articulate how their offerings can not only improve patient outcomes but also create value for healthcare stakeholders.”

All presenters agreed the full implementation will take time due to complexity and will require significant change and reforms.

PulseLine is pleased to say for those that missed the event in the coming weeks we will be releasing video interviews with the presenters.

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SOUTHERN HIGHLANDS HOSPITAL INVESTS IN LATEST MEDICAL EQUIPMENT TO IMPROVE ENDOSCOPY SERVICES FOR PATIENTS

[vc_row][vc_column][vc_column_text]Southern Highlands Private Hospital, located in Bowral NSW, provides an extensive range of onsite medical, surgical, rehabilitation, oncology and palliative care services for the community of the Southern Highlands, and beyond to the regional and rural areas.

Patient health, safety and comfort are the hospital’s main concerns and Southern Highlands Private Hospital continually monitors and evaluates its performance to ensure compliance with world-class hospital standards.

In keeping with the hospital’s enviable reputation for high quality care, Southern Highlands recently upgraded to the latest endoscopy platform from Olympus, ensuring that all patients requiring an endoscopy procedure such as a colonoscopy and gastroscopy, in the local community and beyond, have access to the latest technology.

“Ensuring patients health and wellbeing, safety and comfort is our top priority and we are very excited about continuing to provide endoscopy services, by investing in the latest technology from Olympus, the world leading manufacturer of this type of equipment. The Private Hospital aims to continue to provide accessible services to our local community and beyond, and to achieve this, we offer an innovative ‘Open/Rapid Access Service’ so endoscopies can be performed in a timely manner by both the Gastroenterologists and Specialist Surgeons,” said Jenny Harper, CEO, Southern Highlands Hospital.

The new fleet of endoscopes have the latest imaging technology that allow for superior magnification and accurate detection of polyps and pre-malignant lesions in the gastrointestinal tract. They are particularly useful to differentiate different polyp types and tell benign polyps apart from malignant ones. This technology results in greater confidence to provide appropriate therapy for such lesions.

According to Dr Farzan Bahin, a Gastroenterologist who provides Endoscopy Services at the Private Hospital, “The newer scopes have improved handling capabilities which allow for a smoother navigation of the instrument and thus a decreased requirement for deep sedation during the procedure. This enhances the overall experience for patients having their procedures at Southern Highlands Private Hospital. The overall outcome for patients and the community are very likely to be improved through the introduction of the latest generation of endoscopes.”

Southern Highlands Hospital strives to improve patient outcomes and volume capability for the residents of Bowral and neighbouring communities – delivering high quality care close to home.[/vc_column_text][/vc_column][/vc_row]

PELVIC MESH SENATE INQUIRY REPORT RELEASED

[vc_row][vc_column][vc_column_text]Since February 2017, the Senate Community Affairs References Committee has considered more than 550 submissions from patients, surgeons, medical device companies, regulators and other stakeholders. The Committee also held five public hearings across Australia, hearing testimony from a number of stakeholders, including from women who bravely shared their stories of experiencing complications from their treatments.

The Committee recognised both the complexity of the conditions – stress urinary incontinence and pelvic organ prolapse – and treatment options available to clinicians and acknowledging the many Australian women whom have benefited from procedures involving transvaginal mesh products.

The Medical Technology Association of Australia (MTAA) and some of its member companies also testified before the committee, acknowledging the pain and suffering experienced by the women who had testified before the Committee, but also reiterated its agreement with groups representing medical professionals, that the products remain important treatment options.

Urogynaecological Society of Australasia (UGSA) Chair, Dr Jenny King, said the Committee’s recommendation that all mesh devices should be used as a last resort would affects women’s options for care by limiting access to the safest and most effective surgical treatment for urinary incontinence, the mid-urethral slings.

“This decision is one of the most retrograde steps in the history of modern surgery. It simply disregards sound scientific data,” Dr King said.

Australian Medical Association President, Dr Michael Gannon, added that not all women had problems with the devices.

“It [the report] fails to recognise the massive number of women who have benefited from mid-urethral sling operations,” he said.

The MTAA’s CEO, Ian Burgess, said the industry body is committed to working with the Government as it considers its response to the Committee’s report.

“Registries can be invaluable but they are complex and expensive. We need to ensure that when we set up a registry we’re very clear around what data is being collected and the extent of that data,” Mr Burgess said.

“Further, in terms of the cost of registries, we need to ensure all those that benefit pay for it – including regulators, healthcare professionals, insurers, hospitals and policy makers.

“The Committee also recommends the Department of Health work with MTAA and the Medical Board to review systems in place to support consistent, high ethical standards. The report notes the evidence of MTAA and member companies that no financial or other incentives have been provided to medical practitioners to use or promote transvaginal mesh implants, and that members of MTAA are bound by a Code of Practice that sets high standards for ethical interactions with healthcare providers.

“Should the Government accept this recommendation, we look forward to working with the Department. A key reform would be the implementation of a harmonised industry code of practice which all device manufacturers and suppliers are required to adhere to by law or regulation. The MTAA Code of Practice would be an appropriate basis for such a harmonised code.”

PulseLine understands the Government will be looking to complete its response by the end of November.[/vc_column_text][/vc_column][/vc_row]

The Patient Will See You Now

[vc_row][vc_column][vc_column_text]The details are contained in two recent publications on clinical trials activity. The June 2017 MTPConnect report titled ‘The Economic Profile and Competitive Advantage of the Sector’ is data rich and was developed with extensive input from the industry and Government. The document provides a status update and suggestions on how to further stimulate the sector. In January, Austrade issued a Clinical Trials Capability Report ‘A Dynamic Environment for Clinical Trials’, essentially a pitch to clients requiring clinical research of therapeutic products and medical devices. It highlights the range of expertise available in Australia, from cell culture and engineering to Independent Ethics Committees, by showcasing local companies and providing a directory of suppliers.

This becomes important when put in the context that approximately 75% of the direct expenditure on clinical trials in 2015 in Australia came from international inbound investment by commercial entities (pharmaceutical, biotechnology and medical device companies). Another statistic included in the Austrade report that requires consideration is that ‘medicines and vaccines are Australia’s largest manufactured export. China and the United States are the biggest markets, followed by New Zealand, South Korea and the United Kingdom.’

As Figure 1 demonstrates, multiple factors contribute to clinical trial placement. When considering the shift over time in the type of clinical trials being conducted in Australia, the influence of a number of these factors is obvious. Previously, Phase III studies were the largest component of activity, however Phase I trials numbers have increased steadily, growing 17.2 % from 2012–2015, compared with 1.8 % globally over the same period. This is a reflection of the strong competitive position of Australia in conducting complex studies as a result of our world-class healthcare system, high quality medical research infrastructure, skilled workforce of scientists and healthcare professionals, including internationally regarded clinicians.

At the same time, the later phase, higher patient number studies have been increasingly placed in more populous locations in the Asia Pacific, Eastern Europe or Latin America, as the larger patient pools shorten recruitment times, and ultimately, the time to market of new products. Additionally, Australia’s population size and distribution mean that more investigational sites must be established to reach target recruitments when studies are placed in Australia, resulting in a higher per patient cost than other countries. Significant efforts have been undertaken on a number of fronts over the past decade to increase recruitment efficiencies. These include the streamlining of ethic approval processes via mutual recognition and increased public awareness. In 2015, of the 1,305 industry-sponsored studies in Australia, Phase III accounted for 40%; Phase II, 22%; Phase I, 18%; Phase IV, 4% and Other, the remaining 16%.[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_single_image image=”1759″ img_size=”full” add_caption=”yes” title=”Figure 1 Factors considered when selecting countries in which to conduct a clinical study”][vc_separator][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]Investigational site governance continues to be an issue that negatively impacts Australian’s overall competitiveness. At present, sponsors must negotiate indemnity contracts individually with each study site, adding to the administrative burden and time required to initiate the study.

In terms of strengths, Australia’s stable business operating environment is currently ranked 14th out of 190 countries by the World Bank in terms of ease of doing business. The fast, streamlined regulatory pathway to conduct clinical trials via the TGA Clinical Trial Notification (CTN) system continues to be the envy of many countries. Harmonised ethics review processes and availability of Ethics Committees in both the private and public sectors, provide opportunities to speed up approvals. Australia’s strong intellectual property system which, in 2017 was ranked 10th globally, in terms of security (out of 127). Finally, research & development tax incentives for clinical trials mean that for the same early phase study, Australia is up to 28 % cheaper than the US before-tax incentives, and 60% after-tax.

The 2014-15 Federal Budget established a Medical Research Future Fund (MRFF) to be an ongoing source of funding to support medical research projects and infrastructure in Australia (the Government currently spends around AU$3 billion annually). By 2020-21, the MRFF is expected to have a balance of AU$20 billion, the net earnings from which will produce a permanent source of revenue. In 2016, a Biomedical Translation Fund (BTF) was created to complement the MRFF via commercialisation of health research.

Clearly, the strength of the sector today is in no small way due to the ongoing commitment and support of successive Australian Governments.  As Figure 2 illustrates this has, and will continue to, deliver enormous value to our nation and should be acknowledged.[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_single_image image=”1760″ img_size=”full” add_caption=”yes” title=”Figure 2 The value of clinical trials in Australia”][/vc_column][/vc_row][vc_row][vc_column][vc_zigzag][/vc_column][/vc_row][vc_row][vc_column width=”1/4″][vc_single_image image=”1750″ img_size=”large”][/vc_column][vc_column width=”3/4″][vc_column_text]

ABOUT THE AUTHOR

Nick Campbell is the Chairman of Nexus Asia Pacific and has previously worked in the MedTech and pharmaceutical industries.[/vc_column_text][/vc_column][/vc_row]

World Glaucoma Week

[vc_row][vc_column][vc_column_text]Lois Barry is a 74-year-old Victorian who has suffered from glaucoma for many years. But thanks to a new minimally invasive surgery Lois is the recipient of micro-stent device to treat her glaucoma, potentially saving her eye sight.

Although there is no cure for glaucoma, with treatment, in most cases glaucoma can be controlled and further loss of sight prevented or delayed. Generally, there are no symptoms or warning signs in the early stages. The loss of sight is usually gradual, starting with side vision being lost before the patient becomes aware of any problems.

The primary problem in glaucoma is damage to the optic nerve, the part of the eye that transmits images we send to the brain. Although the exact cause of glaucoma is still unclear, it may occur when fluid cannot drain out of the eye, causing a build up of pressure inside the eye. The new minimally invasive glaucoma devices allow the fluid to drain out of the eye, relieving high pressure.

Glaucoma is the leading cause of irreversible blindness in Australia, affecting over 300,000 Australians, but it can be diagnosed with a simple eye test by an optometrist or ophthalmologist. During this week as part of World Glaucoma Week the Medical Technology Association of Australia, along with our ophthalmic members, will do our part in helping raise awareness.

According to a 2010 Access Economics report 75% of vision loss is preventable or treatable, but incredibly the economic cost to the Australian community was a calculated to be $16.6 billion in 2009.

Global advances in medical technology over the past 20 years have resulted in a 56% reduction in hospital stays, 25% decline in disability rates and increased life expectancy of approximately 3.2 years.

Technology allows patients to hear, to walk, to see, to live or to have a quality of life that they otherwise would not have. Innovation over the years has seen some critical devices develop from technologies that were lifesaving but their design and functional restrictions limited patients’ quality of life to technologies that now save lives and provide a high quality of life for patients.

Vision impairment can significantly impact the daily lives of patients in many ways such as reading and driving.

This week (12-16 March) marked World Glaucoma Week. PulseLine is supporting Vision 2020 Australia’s call to encourage all Australians to have regular eye tests, especially those with a direct family link to glaucoma, to help prevent and treat conditions like glaucoma.

Last year Lois along with her surgeon Dr Nathan Kerr spoke at an event in Parliament House to raise awareness of the life changing and lifesaving impact of medical technology.  The power and authenticity of her story left everyone, particularly our federal parliamentarians with no doubt, medical technology can change lives for the better.[/vc_column_text][/vc_column][/vc_row]

Getting the Best Value for your Buck

[vc_row][vc_column][vc_column_text]Oxford-based, Professor Muir Gray of the Nuffield Department of Primary Care Health Services, describes the genesis of this movement in the United Kingdom as occurring in the aftermath of the 2008 Global Financial Crisis. The fiscal constraints on healthcare spending over previous decades that had spawned evidence-based decision making, such as the Cochrane collaboration, health technology assessment and quality improvement, were no longer adequate. The pressure on the system forced a new approach to maximising the value generated from the available, and often diminishing, resources.

An example of this approach in action is the recent National Institute for Health and Care Excellence (NICE) Guidance that recommends stopping the annual cystoscopy used to monitor bladder cancer patients for disease recurrence. The rationale being that patients will return if/when they experience symptoms, and there is no evidence on a population level that annual monitoring saves lives. Many other interventions that could be reduced without adversely impacting population health have been identified as part of a Choosing Wisely campaign. This same initiative was launched locally in 2016 as Choosing Wisely Australia and is being led by Australia’s medical colleges, societies and associations.  [/vc_column_text][vc_single_image image=”1653″ img_size=”full” alignment=”center”][vc_separator][vc_column_text]Value-based healthcare can be formally defined as a healthcare delivery model in which providers, including hospitals and physicians, are paid based on patient health outcomes. Less formally, the intent is to ‘achieve the best outcomes, do it with minimal cost and do not sacrifice quality’. The policy has now reached our national agenda with the recently published Australian Healthcare and Hospitals Association Blueprint for a post-2020 National Health Agreement titled ‘Strategies for outcomes-focused and value-based healthcare’. They advocate a whole of Government approach to primary prevention; the availability and utilisation of real-time, linked data; and most contentiously, the establishment of an independent national health authority distinct from the Commonwealth, and state and territory health departments, reporting directly to COAG, to support integration of health services at a regional level, and all within a 2-year time-frame!

In 2015, Anthony Scott, a NHMRC Principal Research Fellow based at the University of Melbourne, considered options for introducing value-based healthcare concepts into Medicare. Achieving value for money is difficult as the market for healthcare is unique: patients do not know the value of the care they receive; Governments become involved to address market failures and ensure equity of access; and resources are frequently misallocated. Scott considers best practice Medicare rebates for specialists; pay-for-performance for GPs and hospitals; re-assessing which items are included in the Medicare Benefits Scheme (MBS) and value-based payments for public and private hospitals. He concludes that re-aligning financial incentives targeted at health care providers is likely to be more effective than adjusting patient co-payments (perhaps a nod to the $7 debacle), and although changes to improve quality are possible, they will have little impact on slowing overall expenditure growth.

One primary care initiative currently being rolled out around Australia are Health Care Homes. These provide co-ordinated care for people with chronic conditions with the value-based payments different from a fee-for-service or capitated approach in which providers are paid based on the amount of healthcare services they deliver. Bundled payments are provided monthly depending upon the level of complexity of each patient’s condition (categorised by tiers).[/vc_column_text][vc_single_image image=”1657″ img_size=”full”][vc_separator][vc_column_text]The Medical Technology Association of Australia (MTAA) have organised a full-day Value-based Healthcare Summit to be held in Sydney on April 24. Value-based healthcare will be discussed in the Australian context from a variety of perspectives including the capture of real-world data to assess value; measuring Patient-Reported Outcome Measures (PROMs); the International Consortium for Health Outcomes Measurement (ICHOM) standards; and value-based healthcare in the public & private sector.[/vc_column_text][/vc_column][/vc_row]

GO Purple for Epilepsy Awareness

[vc_row][vc_column][vc_column_text]In Australia alone approximately 250,000 people live with epilepsy and one in 25 people will have epilepsy at some point in their life.

Ask Leah Bohm what it’s like to have a family member with epilepsy but luckily for her medical technology has provided a life changing opportunity. Last year Leah spoke to a room full of politicians to tell her story. The power and authenticity of her story left everyone with no doubt, medical technology can change lives for the better.

Global advances in medical technology over the past 20 years have resulted in a 56% reduction in hospital stays, 25% decline in disability rates and increased life expectancy of approximately 3.2 years.

Technology allows patients to hear, to walk, to see, to live or to have a quality of life that they otherwise would not have. The gradual innovation over the years has seen some critical devices develop from technologies that were lifesaving but their design and functional restrictions limited patients’ quality of life to technologies that now save lives and provide a high quality of life for patients.

For Leah, her eight year old son has been living with an aggressive form of epilepsy since just before his 1st birthday. Over the years, his neurologist prescribed him drug after drug after drug, full of side effects, desperately trying to offer some relief. His condition was so bad, that Leah felt she barely knew her son. When he wasn’t seizing throughout the day, sometimes over 300 seizures in a day, he was recovering from the aftereffects.  Her son has spent at least two Christmases, an Easter and a Mother’s Day, plus a myriad of other days in hospital from the effects of his epilepsy. Most often injuries sustained from atonic episodes, where the patient suddenly loses consciousness and can fall to the ground if standing.

Eventually the neurologist suggested he be provided with a vagus nerve stimulation (VNS) therapy.

For Leah, a miracle occurred on April 24th, 2014, six months after her son’s implant was activated, he had his first seizure free day. Since then he’s been seizure fee, this has allowed her to finally meet her son, hidden for so many years by his condition. But more importantly it has given her son a future, one she never thought he would have.

Each story I hear is so uniquely powerful, and serves as a reminder of the importance of continued innovation to society and patients everywhere.

Australia has an excellent health system that makes possible some of the most up-to-date medical procedures for people like Leah’s son. We are a fortunate country that provides universal health care to all that enables wonderful patient outcomes.

I look forward during March on behalf of the medical technology industry to help raise awareness of epilepsy and Go Purple. At the end of the day everything the medical device industry does and seeks to do has patients as the core focus.[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_zigzag][/vc_column][/vc_row][vc_row][vc_column width=”1/4″][vc_single_image image=”1585″][/vc_column][vc_column width=”3/4″][vc_column_text]

ABOUT THE AUTHOR

Ian Burgess is the CEO of the Medical Technology Association of Australia (MTAA).[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_empty_space height=”10px”][/vc_column][/vc_row]