business case for a new technology: checklist to secure reimbursement

<Title>

Things to think about when considering how your technology might secure reimbursement

What follows is a checklist based on our 16 years of experience completing around 700 projects. Not every item is relevant to every product but we hope you find it

helpful in thinking through your positioning, capitalising on what you do know, and working out how best to bridge any gaps in the evidence supporting the case you

want to make.

Business case for a new technology: Mind Map

© Translucency Limited, 2015

To whom does it apply?

Disease/condition

Age

Sex

Geography/location

Numbers

Co-morbidities/past history

Ethnicity


What happens now?

What Tx options are there?

Where is Tx given?

What are the outcomes? Survival

Quality of life

Activities of daily living

Other

What are the problems?

1


What happens now?

What is the economic cost? Patients

• Travel

• Time off work

Healthcare system

• Provider

• Payer

Welfare

Employer

• Financial cost

• Loss of productivity

Carers/families

2


What happens now?

What is the non-economic cost Patient

• Travel time

• Time in hospital

• Unpleasantness of treatment

• Aesthetic considerations

Healthcare system

• Provider(s)

• Payer

Carers/families

What are the upsides?

3


Description of technology

Medical device

Pharmaceutical

Biotech product

Mixed/combination product

Process

Diagnostic test

Software

Monitoring

Surgical procedure


What Tx options are there?

Where is Tx given?

What are the outcomes? Survival

Quality of life

Activities of daily living

Other

What are the problems?

1 What will happen if the case is accepted?


What is the economic cost? Patients

• Travel

• Time off work

Healthcare system

• Provider

• Payer

Welfare

Employer

• Financial cost

• Loss of productivity

Carers/families



What is the non-economic cost Patient

• Travel time

• Time in hospital

• Unpleasantness of treatment

• Aesthetic considerations

Healthcare system

• Provider(s)

• Payer

Carers/families

What are the upsides?



Costs (including timing) Patients

Healthcare system

• Provider(s)

• Payer(s)

Other (welfare, employer etc)

1 Incremental cost-effectiveness of pathway


Benefits (including timing) Clinical outcomes

Savings

• Patients

• Healthcare system

– Provider(s)

– Payer(s)

• Welfare

• Employer

– Financial cost

– Loss of productivity



Externalities Effects on other parties

• Healthcare providers

– Same (other departments)

– Others

• Social services

• Other parties

ROI

Step (marginal) effects



Financial Artificial (reimbursement architecture)

Poor cost-effectiveness

Insufficient ROI

Cannot be adopted within current budget constraints

Non-financial Shortage of skilled staff

Absence/insufficiency of equipment

Absence/insufficiency of infrastructure

1 Barriers to adoption


Requires extensive implementation effort New buildings

New staff

New processes

Not perceived as a priority Not part of performance management

Not included in policies/guideline

2 Barriers to adoption


Speed of adoption

Price-demand relationship

Target market size

Financial consequences

Outcomes

Step (marginal) effects

Likely adoption curve


Health sector Past

Present

Future/ongoing

Other sectors (eg innovation, trade, research) Past

Present

Future/ongoing

Effect on variation/equality

Relevant policies and guidelines


Clinical

Managerial

Financial Are savings real?

• Cash-releasing

• Non-cash-releasing

– Consequences of redeployment

Perspectives of relevant parties

• On whom do the costs fall?

• To whom do the benefits accrue?

Summary case for adoption


Quality of studies

Applicability/generalizability of studies Patients

Current local practice

• Staff

• Buildings

• Tests

• Treatment options

Unit costs

Patterns of disease

Quantity of evidence The degree to which the evidence speaks with a 'clear voice’

Evidence gaps

Evidence


Provider(s) Who in the organisation?

• Budget-holder

• Clinician

• Manager

Which bit of the organisation?

• Whole provider organisation

• Department

Payers • Which organisation(s)?

• Who in the organisation?

1 Target audience for business case


Other parties

HTA agencies

Other health service funders e.g. Innovation bodies

Private healthcare providers private medical insurers

self-pay

2 Target audience for business case


Staff benefits Academic/career

Working conditions

Satisfaction

Organisation benefits Business continuity

Ease of supply/storage

Overcoming skill shortages

Overcoming capacity constraints

Adoption opportunities


Cost-based

Tariff-based

Nature of story


Qualitative

Quantitative

What does it mean locally?


What assumptions have been made?

How sensitive is the case to the assumptions?

Assumptions


Prepared by Translucency

www.translucency.co.uk