Optimizing the Outcome-Based Model for Healthcare

Author: Pat Mallon, Vice President, Healthcare Account Management & Sales

The Affordable Care Act (ACA) is gradually shifting the focus of the healthcare industry. Changes in the reimbursement process are driving companies to use an outcome-based model instead of more traditional reactive approaches. Health and Human Services set a goal to apply half of Medicare payments to value-based alternative payment models, like accountable care organizations, by 2018. This will drive medical device companies to take a fresh look at their business models and keep up with the overwhelming industry trends.

A New Landscape for Device Providers

The Centers for Medicare & Medicaid Services (CMS) now allows more companies to provide medical device services. Any business that can meet the CMS standard set can now supply these devices to its customers. Reimbursement for the devices is changing as well, shifting toward a standardized model that may not account for the more advanced features of a product. In some cases, this pushes reimbursement down by more than 50 percent.

For medical device companies, this means the entire landscape is shifting toward a more patient-centered model. Customers won’t always have to seek out their physician for monitoring devices; therefore, they won’t need to constantly turn to their doctor to manage their care with these products.

Putting the Patient at the Center

Patients are now central to creating profitable operations for medical monitoring device companies. Companies need to focus on helping the user manage their own care. Providing a well-rounded suite of services that focuses on the patient is quickly become the go-to path for success in this industry. A major focus of medical device use today is on prevention rather than treatment. Medical services are looking to an outcome-based model which rewards companies for the end result of their services and encourages quick recoveries, lower readmission rates, and lower infection rates.

Working with the Patient

Medical device companies can move successfully toward the outcome-based model by providing more personalized patient interaction. Partnering with an experienced outsourced patient care delivery provider allows companies to provide prompt, professional responses to patient usage trends encouraging better use of their products.

For example, a patient care delivery specialist could analyze the feedback from a cardiovascular monitoring device to determine a problem with blood sugar levels and contact the patient with friendly reminders about following their heart-healthy diet plan. Outsourced patient care providers can:

  • Improve workflow using proven infrastructure organization
  • Offer support and care delivery for both at-home and on-site business models
  • Offer specialized talent that caters to patient support rather than device development, as is typically the focus in-house

For many medical device suppliers, their core competency resides in their ability to focus on disease management and product development. Effective patient care and outreach can combine in-house efforts with an experienced outsourced team that already meets FDA compliance standards. This helps improve patient engagement, promotes better adherence, and improves predictive modeling allowing companies to stay competitive in the face of a changing healthcare landscape.

pat mallonPat Mallon, Vice President, Healthcare Account Management & Sales at Sykes Enterprises, Inc. is responsible for the management of the Healthcare vertical including P&L, Program Management, sales and business development. In addition he provides direction for marketing and lead generation strategies and execution on account plans for increased penetration and margin enhancement. When he is not working, he spends his time with his wife, son, and daughter or volunteering for several charitable organizations. Pat is also a connoisseur of scotch – his favorite is 18 year Macallan.

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