Healthcare has never been short of ambition.
We continue to develop remarkable technologies. Precision medicine. Personalised therapies. Digital solutions. Connected care.
The list keeps growing and that is the good news.
The difficult news is that many healthcare systems are struggling to absorb all this innovation.
Between 2005 and 2025, per capita healthcare spending across OECD countries grew at a CAGR of 2.6% per year, amounting to an increase in spending of almost 30% over this period. GDP per capita over the same period was 1.45% per year, accumulating a total increase of 15.5%. Add to that that not every growth euro in GDP finds its way into healthcare funding, certainly not in the insurance based systems, where those contributing through their payroll are increasingly outweighed by those receiving and not contributing any longer.
Meanwhile, reports by the European Parliament or the WHO point to the increasing shortage of healthcare professionals in Europe.
This creates a double squeeze: More patients. More treatment options. Likely higher costs. But not necessarily more money, more staff or more capacity.
Healthcare is being asked to do more, for more people, with resources that are becoming increasingly constrained.
Why Market Access Keeps Looking Up
Traditionally, med tech market access has focused on the “top line”, on optimising “reimbursement” levels for their technologies directly or indirectly by helping to improve their customers’ income. But this top-line has never been harder to influence than now. France is de-reimbursing technologies from its LPPR list and integrating them half-heartedly into the DRGs, leaving speciality centres that provide this care more than others with watered-down and insufficient funding for innovation.
Germany has only recently implemented the AOP reform; introduced hybrid DRGs, soon to be replaced by ambulatory flat rates again; is still rolling out major hospital reform, only to be topped by the incoming “GKV-Beitragssatzstabilisierungsgesetz” (yes, seriously, this is a word), which will put a cap on hospital budget growth and which will make the use of the often-quoted NUB mechanism as a way to finance innovation an even more daunting challenge than it already was.
And England? The NHS has been on a constant road to reform probably since its inception and whilst the new NICE HealthTech Access Programme makes perfect sense on paper when it comes to supporting innovation in med tech, there seems to be a widening gap between these good intentions by one arm’s-length institution and national commissioning and procurement (we are yet to see how the cardiology super-tender will play out and how much room there will be for innovative solutions entering the space before the tender re-opens).
The list is longer, but you see my point: shaping traditional “reimbursement”, the top line of a customer’s P&L gets harder and will for sure require more focus, more resources, more compelling value propositions and more convincing evidence than ever before. So the question arises: will the top line be worth our while and should it be our only focus?
The answer is “yes, but” and “no”. Letting go of the top-line is not an option. If med tech manufacturers are not ringing that bell and continue to remind payers and policy makers of the value that innovation in medical technology has brought to patients and society and will continue to do so, then nobody will.
So yes, industry needs to continue to focus on the top-line and here comes the “but”: only if it makes sense. In dire funding times like the ones we live in, we need to ask ourselves, more critically than even before, whether our innovation really addresses that unmet clinical need; whether it has a value proposition that is strong enough to be prioritised and whether we have the evidence that it takes to prove it. And whether payers will see this as a funding priority, even when healthcare budget reforms are tabled every year.
But here is an additional perspective: In times of diminishing returns of our top line endeavours, there is still a lot to gain by looking at the bottom line of our customers. Alongside reimbursement models, we need to understand hospital economics, operational models, patient flows and staffing requirements. Alongside payer economics, we need to focus on provider economics. Alongside the top line, we need to explore the bottom line.How does a technology affect the resources required to deliver care? What bottlenecks can it remove? What extra capacity could it create? What operational problems does it hemp to solve? What about total cost of ownership for the customer, beyond the initial investment in each technology?
Answering these and other related questions offers a new perspective to HE&R work and has an additional benefit: it will be of immediate interest to our hospital customers today. It affects their profitability and is much more of a buying decision than a promise to fix reimbursement, which will require more faith and more patience.
From Efficiency Potential to Real Change
I see you nodding. So far, so good. But here is the catch: Healthcare is full of “theoretical” savings. One hour less nursing time. Thirty minutes less procedure time. One day shorter length of stay. Once we identify them, we dutifully convert these into euros. And off we send the sales team, equipped with impressive customisable spreadsheets, they usually do not feel fully comfortable with in the first place. But the real challenge goes beyond their discomfort.
Saving one nursing hour is not automatically valuable, neither is the 30 min less procedure time and not even the day less of in-hospital recovery.
That value becomes real only when customers can act on the efficiency gains. Will additional patients be treated? Can surgical throughput, i.e. cases, increase? Couldd staff shortages be mitigated so that overtime can be reduced and attrition be managed effectively? Will procedures that were previously impossible now become feasible?
In other words: How do we really get to the bottom line? How do we turn a savings potential into reality?
We need to make the efficiency gains tangible. We start with a clinical study that delivers the underlying evidence of what we are promising. But beyond that, moving from theory to practice, we need a credible model that can be customised, replicated, scaled and published. And from there, we will need to go the final implementation step: Getting from theory to practise can be as simple as replacing some beds with reclining chairs in the wake-up room. But someone needs to identify these bottlenecks first. Changing processes does not come easy and it needs to be worth it. It can only be done in close collaboration with the customer and goodwill and trust are needed. It will not work with every customer and it requires a pioneering mindset on both sides.
And finally, monetisation: Efforts like these are difficult to bill, but can be considered an investment into a lasting supplier-buyer relationship. They can also be integrated into a solution-selling approach that goes beyond product transactions.
For years, market access has been looking up, towards payers, policy makers and reimbursement systems. It is time to look down as well. Down to the hospital floor. To patient pathways. To staffing constraints. To operational bottlenecks. To the everyday realities of delivering care.
The future of market access is at least dual: continue improving the top line while exploring how medtech innovation can improve the bottom line.
After all, adequate reimbursement is a necessary condition to innovation, but implementation is what makes innovation matter.
Tell me what you think. Do you agree with my analysis of the top-line challenges? What is your experience with the bottom line? Does it play an increasing role in your Market Access approach? What would you need to be successful?
Let’s talk: Markus@metismarketaccess.be