Implantable Medical Devices and Healthcare Affordability: Exposing the Spiderweb

Description

The United States spends more than 17% of its GDP on healthcare, while other developed countries average 8.7% of GDP on healthcare expenditures. All this spending doesn’t equate to value, quality, or performance, however. Among 11 high-income countries, the United States healthcare industry ranked last during the past seven years in four key performance categories: administrative efficiency, access to care, equity, and healthcare outcomes. This book presents the implantable medical device (IMD) supply chain ecosystem as a microcosm of how these challenges of affordability and healthcare outcomes are created and are allowed to fester. The IMD Spiderweb, as the authors call it, is exposed as an example of how a wide range of participants―including physicians, health system CEOs, group purchasing organizations, health insurance companies, and supply chain executives―become ensnared in a web designed to benefit only one player. Health systems in the United States pay as much as six times more for some IMDs than their counterparts do in Europe, and prices for the same IMD model vary even among different U.S. hospitals. While there is a fascination with the latest and greatest device, there is also a shroud around visibility into how these products have performed and are likely to perform in patients. The costs continue to rise not only in healthcare expenditures, but also in death and disability. The IMD Spiderweb is presented as a prime lesson in the challenges in healthcare affordability and outcomes that occur throughout the entire healthcare industry. It is also put forward as an opportunity. The story behind how these challenges arose and continue to be deepened by the current healthcare ecosystem also provides a foundation for solutions. Cover Half Title Title Page Copyright Page Contents Foreword Preface Acknowledgments About the Authors Introduction: Challenges in Healthcare Affordability and Outcomes Starting with Where We Are Now The Implantable Medical Device Market as a Symptom References 1. Getting Clarity on Where We Are in Healthcare Meet the Participants Medical Device Manufacturing Companies Group Purchasing Organizations (GPOs) Hospitals and Health Systems Health System Supply Chain Executives Physicians Payers Patients Speaking of Patients… Value in the Comfortable Ecosystem References 2. Removing Blind Spots: Medical Device Affordability and Transparency The Search for Clarity Paying More for Unproven Technology Creating a New Model Revealed Obstacles and Opportunities A Structure Centered Around Alignment The Pursuit of Removing Barriers to Transparency Continues Summary 3. GPOs: The Promise of Collective Buying Power Reducing Costs by Leveraging Purchasing Power—The Promise of GPOs Do GPOs Increase Competition? GPO Transparency Improving Healthcare Processes Comes with a Cost A Changing Healthcare Landscape Brings Diversification to GPOs Moving Deeper into Healthcare Organizations Raising the Specter of Unhooking from GPOs The Opportunity for GPOs in the Medical Device Value Proposition References 4. Supply Chain and Physician Considerations in Value Analysis The Value of Supply Chains in Healthcare What Is Value Analysis? Physician Preferences and the Supply Chain: The Challenge of Alignment Alignment vs. Non-Alignment: The Disadvantage for Health Systems Medical Devices and the Concept of Alignment References 5. Stepping up to Affordability Challenges The State of Healthcare Expenditures Getting to Significant Reductions—The Earned Price Model Affordability and Transparency Challenges in Medical Devices Challenges with Physician Preference The Key to Getting at Hidden Costs Is Alignment References 6. The Spiderweb and Alignment A Healthy Healthcare Supply Chain Starts with Leadership Optimal Alignment in the IMD Supply Chain Ecosystem “Comfort” in the IMD Spiderweb The Content—Physicians The Conflicted—Health Systems and Commercial Payers Health Systems Commercial Payers Lack of Data The Complicit—GPOs and Device Manufacturers Group Purchasing Organizations The GPO Role in Maintaining the Oligopoly References 7. The Spider in the Spiderweb A Spotlight on IMD Manufacturers How the Process Works (or Doesn’t) A Permissive IMD Ecosystem Pervades Around the Globe ICIJ’s Eye on Medtronic Acceleration Also Affects Affordability Taming the Spider and Deconstructing the Web References 8. Escaping the IMD Spiderweb Assessing Where We Are Estimating the Monetary Opportunity What Are We Up Against? How Does the Model Move Forward? The Big Picture A Call to Action Index