Neil Fraser
President, Medtronic Canada
With the COVID-19 pandemic impacting the lives of millions, the race to find a solution to this healthcare crisis is on. Medical technology can have an extremely positive impact on health care although in some cases it is limited because access to that technology is restricted. For example, a transcatheter aortic valve implantation — a minimally-invasive aortic valve replacement procedure that replaces open heart surgery — can be a lifesaver for someone getting a heart valve replaced in the middle of a pandemic, as it gets patients out of the hospital faster and with a lower risk of infection than open heart surgery.
Canadian healthcare policy has traditionally stood in the way of patient access when it comes to new health innovations, but the COVID-19 pandemic is shifting things rapidly.
Earlier this year, the Government of Canada launched a competition to fund rapid research on the COVID-19 virus, partnering with leading Canadian research groups as well as the World Health Organization and the Global Research Collaboration for Infectious Disease Preparedness for a total investment of $6.75 million.
In an effort to limit the spread of the COVID-19 virus in Ontario, the Minister of Health has also taken action to temporarily ensure improved access to telemedicine and remote monitoring support. These strides are helpful in the short term, and a learning for us moving forward. Imagine if the new measures also prioritized minimally-invasive surgery like aortic valve replacement and other proven innovations that reduce the length of hospital stays, or the likelihood of infection. The impact could be huge.
Reinvigorating Canada’s ailing health care system
Canada’s health care system desperately needs improvement to meet our evolving needs. We must re-examine how we approach health care innovations. We simply haven’t effectively evolved our system and policies to leverage the technology, talent, processes, and treatments that could improve clinical outcomes — for example, reducing readmission to hospital rates — and reduce the overall cost of care, all while boosting our economy.
We need to focus on demand-side innovative policies that make it easier for the public sector to ask for innovative solutions to help solve some key societal healthcare issues — like we’re doing right now with COVID-19, to encourage them to adopt these solutions, and to make the process of innovation procurement and adoption much easier.
Demand-side innovation policies are public measures that encourage innovation by increasing the demand for them. From a health care perspective, demand-side innovation would equate to the health care system (the government) proactively seeking out innovative solutions to respond to a health care challenge, rather than the current system in which companies with innovative technologies try to sell them to the government as the solutions they need.
The way to activate demand-side innovation policies is to remove the barriers to adopting innovation
Improving innovation adoption nation-wide
To accelerate innovation adoption, we need to employ value-based procurement (VBP) principles, which focus on providing health products and services of the greatest value — that is to say, the best outcomes at the lowest costs, not just the lowest cost. Think of a patient getting open heart surgery because it might be less expensive in the short term, instead of a minimally invasive procedure.
We must develop or adapt a current federal agency to have a joint health and economic development mandate, similar to the UK’s NHS Innovation Accelerator.
“The way to activate demand-side innovation policies is to remove the barriers to adopting innovation,” says Neil Fraser, President of Medtronic Canada, a leading medtech company. “First, we need direct procurement to acquire innovative solutions that provide superior value to the health care system. Second, we must adjust physician fees and training to incorporate newer, more valuable products and approaches into workstreams. And third, we have to adjust hospital and health care budgets and behaviours to reimburse these innovations.”
Learning from pandemic response
The current system — in which doctors are incentivized for tasks instead of outcomes, they usually have to see a patient in person to get paid, and department budgets are allocated in silos — needs to change. Under this model, there’s no incentive to have less expensive health care providers, to use virtual visit options, or to adopt innovations that might cost more in one department but result in overall savings for the hospital or health care system.
Demand-side innovation policies will help to spur demand for innovative solutions to some of our biggest health challenges, including COVID-19. Some of these policies have already been implemented, at least temporarily.
With effective leadership, collaboration, and a commitment to a new way of looking at innovation, Canada can reshape its health care system and effectively meet the health challenges of our times, today and in the future.
Current Challenges
There are three key issues with current policies that impede health care innovation in Canada:
Funding mechanisms
Canadian physicians continue to be remunerated predominantly by fee-for-service (FFS) payment models. Rewarding the volume of services — rather than their value — discourages the adoption of innovative technologies or new ways of working.
Procurement policies
Hospital procurement policies were developed with good intentions — standardization and cost savings — but can be counterproductive to acquiring the short- and long-term clinical and economic benefits of new treatments, services, and technologies. In picking the lowest sticker price, we don’t always end up with greater long-term savings and outcomes.
Reimbursement Policies
The long and complicated process for obtaining reimbursement for new technologies — which can take years — provides no incentive for innovative companies to introduce new technologies to the Canadian market and limits patient access to care that could improve outcomes.
