July / August 2019

™ JULY/AUGUST 2019

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TOP 50 MEDICAL DEVICE COMPANIES IN THIS ISSUE

MEDICAL DEVICE COMPANIES

CEO of Cancer Treatment Centers of America on Industry Challenges Roche, Cathworks, Molnlycke, Velano Execs on the Hospital System Allergan International President on Patients Evaluate Pharma World Preview 2024 Execs from UCB, Celgene and more on Why I Work in Healthcare

FINDING EMOTIONS IN EVERY MOLECULE, CELL, PATHOGEN, AND ANTIBODY At AbelsonTaylor, we get emotional about science.

For us, there’s real emotion buried in everything from molecules to K-M curves. So we get down to the cellular level to find emotion in the science that lets us tell a human story. One that HCPs will connect with. Because we’re not just inspired by science— we feel the data.

the publication for healthcare sales & marketing leaders™

TABLE OF CONTENTS Publisher’s Letter..............................................................................................................................................4 Editor’s Letter.....................................................................................................................................................5 Editorial Board....................................................................................................................................................7

ARTICLES Spotlight: Raj Garg, former CEO of Cancer Treatment Centers of America..................................9 Roundtable: Roche, Cathworks, Molnlycke and Velano Execs on Med Device and Hospitals...................................................................................................................... 13 Top 50 Medical Device Companies........................................................................................................... 23 Evaluate Pharma’s World Preview to 2024........................................................................................... 29 Industry Trends: By The Numbers............................................................................................................ 37 Great Minds: Allergan International President Marc Princen on Working With Patients........................................................................................................................... 39 Motivideos: To Use In Your Meetings......................................................................................................41 UCB, Celgene, Roche, Amgen and other Execs on Why I Work in Healthcare........................... 45 Innovation: Klick Health offers its Adaptive Brand Playbook.......................................................... 51 Agency and Provider Directory.................................................................................................................. 57

3 | HS&M JULY/AUGUST 2019

Publisher’s Letter

A New Record for Medical Device I am not surprised that the medical device sector grew exponentially last year. Medical device, medical equipment, capital equipment and medical technology companies were up to $413B from the $329B achievement of 2017. That’s 20% over the 11% growth of 2017. All but nine of our Top 50 companies experienced a revenue increase from 2017.

And this is at a time when the sector is more diverse than it has ever been. Consider the following list of medtech advances predicted for this year. There are now smart inhalers, which are anticipated to significantly increase proper usage among asthma patients. Wireless brain sensors with bioresorbable electronics will dissolve in the body after they have served their purpose. Of course, 3D printing will continue to prove its value in helping to build implants and joints, develop more patient-specific functionality in prosthetics, and “print” pills that contain multiple drugs to help release them in a timely manner.

CARI KRAFT

Further improving the usefulness of 3D printing, artificial organs are gaining a purchase in the industry.

We can now create blood vessels, ovaries and even a pancreas in the laboratory – organs that can actually grow within the body. Wearables also continue to be a major category, tracking and sending data on vital signs. As we’ve noted in these pages, precision medicine is emerging, making personalization more effective in diseases such as cancer (see our interview in this issue with Raj Garg, former CEO of Cancer Treatment Centers of America).

It’s this kind of progress that has driven the size of the medtech sector, even during a slow period for acquisition activity. It’s one more inspiration that adds to the many reasons noted in “Why I Work in Healthcare.”

And as always, please keep the feedback coming. It all goes to making the magazine better for all of us.

Cari Kraft, Publisher

CLICK HERE TO GET TOP 50 MEDICAL DEVICE COMPANIES

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HS&M JULY/AUGUST 2019 | 4

Letter from the Editor

Drug Prices and the Cost to the Industry The New York Times recently ran a comprehensive editorial on the state of the industry with respect to drug pricing. This issue, of course, is a large contributor to the poor image that healthcare companies have among the general public. And that image is driven significantly by a few bad players in the industry.

But no one can deny that prices have increased regularly in the last few years. Our featured executive, Raj Garg, discusses this topic in our Spotlight article in this issue.

The Times editorial outlined a handful of remedies that have been proposed. We’re curiNEIL GREENBERG ous about your reaction. Read over these suggestions, and send us your own view of how we can handle the problem.

Price drugs based on the benefits they provide. The article points out that this is how it works in much of the developed world. “Britain will cover a new medication only if the benefits it provides are high relative to its price.

Germany will pay more for a new drug [if it’s] better in some way [than the old one].”

Negotiate with drug makers. Governments elsewhere have the option to negotiate directly with drug companies.

Here, private insurers and the Department of Veterans Affairs can do so, but Medicare and Medicaid cannot.

HHS can grant waivers to states that want to exclude certain drugs from their Medicaid plans. This patchwork of policies is confusing and often leads to consumers trying to end-run the system.

Consider seizing patents. This is a rather extreme measure, but there are laws that permit it to be enacted. Section 1498 “allows the government to override any patent if the patent holder is compensated fairly,” and has been used in the past. “March-in rights” lets the government take over a patent on products invented with government money. This provision has never been used, but there is increasing pressure for the government to do so.

Involve the Federal Trade Commission. Noting that the FDA “has attempted to name and shame drug makers who use dubious tactics to prevent generic medications from coming to market,” the editorial points out that approval of generics has increased recently, although many aren’t available in the U.S. These and more are gaining momentum as all parties wrestle with the overall cost of healthcare. Your thoughts?

We’ll be pleased to feature them here.

We try to keep up with all this, and bring you the people who have a grasp on change. We hope that it will be informative, and assist you in furthering the work you do every day. Let us know what topics will be most useful to you!

Neil Greenberg, Editor To become an HS&M contributing author or provide feedback, please email me at ngreenberg@hsandm.com.

5 | HS&M JULY/AUGUST 2019

THERE ARE SOME THINGS PEOPLE JUST WON’T TELL YOU BUT THEY’LL TELL US IN CONFIDENCE. AND WE’LL TELL YOU. There are a lot of opinions people never offer you about your company. What the pain is. What you could be doing better. What they think of your competition. How to talk to them effectively.

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For details on how the Private Process works, and the kinds of answers you can get, contact us now at ngreenberg@hsandm.com.

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Editorial Board

the publication for healthcare sales & marketing leaders™

Chris Bergstrom Publisher Cari Kraft Editor Neil Greenberg Contributing Editor Jill Donahue Creative Director Hedy Sirico Digital News Rick Cataldo Digital News Chris Manning Associate Publisher Natalie Newcamp EDITORIAL BOARD: Kristen Sharron-Albright Head of Marketing at Noven Pharmaceuticals Chris Bergstrom Associate Director, Digital Health Expert at Boston Consulting Group Sebastian “Sebby” Borriello Vice President, Chief Commercial Officer SK Life Science Lewis Chapman Vice President, Global Commercial Operations AllCells, LLC Maria Finlay, MBA Associate Director of Oncology Marketing, Teva Oncology Nick Gurreri Vice President New Products at Alexion Pharmaceuticals, Inc. Bob Roda VP and General Manager at BD

Associate Director, Digital Health Expert at Boston Consulting Group Chris brings almost two decades of commercial expertise as an entrepreneurial executive at large medical device and high-growth digital health companies, and he provides “on the ground” advice for implementing digital health solutions. He currently serves as the expert on digital health at The Boston Consulting Group (BCG). Before joining BCG, Chris was the chief commercial officer (CCO) at WellDoc, a pioneer in digital health. He also held progressive roles at P&G, Roche, and Becton Dickinson. Chris was a senior advisor to several digital health innovators, including MyOwnMed, LiftOff Health, HelpAround, Heart Beam, iSageRx, and Alere Home Monitoring. He also advised the Leona Helmsley Charitable Trust and the Saatchi & Saatchi Wellness Board.

Chris holds two digital health patents and has won multiple awards.

Sebastian “Sebby” Borriello Vice President, Chief Commercial Officer SK Life Science Sebby currently servies as the Vice President, Chief Commercial Officer at SK Life Science.

Sebby’s career has included executive sales and marketing positions at Cempra, Mentor Worldwide LLC, Johnson & Johnson Healthcare Systems Inc., Ethicon, Inc. and OrthoMcNeil Pharmaceuticals, Inc. Sebby received his B.A. in Public Administration from St. John’s University in ‘81, and received his M.S. in Organizational Dynamics from the University of Pennsylvania in 2001.

© 2019 CL Media Inc., Philadelphia, PA

Maria Finlay, MBA

CL Media is not responsible for any unsolicited contributions of any type. Unless otherwise agreed in writing, CL Media retains all rights on material published in HS&M for a period of one year after publication and reprint rights after that period expires.

Email ckraft@hsandm.com.

Director of Channel Marketing, Incyte

To advertise in HS&M, please contact Natalie Newcamp at nnewcamp@hsandm.com

7 | HS&M JULY/AUGUST 2019

Maria has over 20 years of commercial marketing, sales leadership, women’s leadership and operations experience. She has led multiple brand marketing and cross-functional teams at Johnson & Johnson, AstraZeneca and Teva Oncology before joining Incyte; where she is in charge of access and reimbursement strategies and tactics, advancing impact with payers, PBMs, state societies, federal channel, pathways, GPOs, community oncology strategic accounts, and hospital system business stakeholders.

Bob Roda

Editorial Board

President and CEO, Menarini Silicon Biosystems Bob Roda is a senior commercial executive with extensive experience in delivering business growth and profit in the medtech and diagnostics sectors of healthcare. He currently serves as the President and CEO of Menarini Silicon Biosystems, where he is responsible for driving the commercialization of novel cancer diagnostics. Previously, Bob held a variety of roles of increasing commercial responsibility at Becton Dickinson. Most recently, he was VP and General Manager of the MPS business unit as well as leading the commercial integration of the CareFusion acquisition. Bob also had a successful career within the MD&D sector at Johnson & Johnson. His diverse background includes positions in business development and senior leadership roles in sales and marketing at Johnson & Johnson Medical, Inc., Ethicon, Inc. and Ortho-Clinical Diagnostics. While at J&J, Bob also served as the executive sponsor of the Commercial Leadership Development Program as well as the chair of the VP Marketing Council for all of MD&D. Bob is a highly respected, successful global leader with proven abilities in diverse disciplines. He holds a Bachelor of Arts degree from The College of Business Administration at the University of Rhode Island.

Lewis Chapman Vice President, Global Commercial Operations, AllCells, LLC Lewis Chapman is currently the Vice President, Global Operations at AllCells, LLC. He has spent over thirty years in health care management. He served as VP of Global Strategic Marketing at BioMarin Pharmaceutical from 2007 to 2012, where he was responsible for strategic marketing and product portfolio analyses, and implemented medical education, brand enhancement and sales support programs on a worldwide basis. He oversaw the global launch of Kuvan, which in the U.S. was 112% to budget in 2008, the first year on the market. Previously, he worked with Alpha Inntech Corporation as Vice President Global Sales and Marketing, where global sales grew 26% in 2004 and 22% in 2005 under his leadership. Lewis started his career with Eli Lilly & Company, with roles at Syntex and Genentech, where he was responsible for the global commercial launch of Activase (t-PA), the largest biopharm product launch in the history of the industry up to that time (first year sales $187 million).

Nick Gurreri Vice President New Products, Alexion Pharmaceuticals, Inc. Nick Gurreri is a business leader and General Manager with over 25 years of consistently achieving high performance and profitability through strong leadership and cohesive team building in the biopharmaceutical and medical device industries. Nick has held executive positions at Medgenics, Insmed, Pfizer, Pharmacia and Bristol-Myers Squibb. Nick received a BS in Mechanical Engineeringfrom the University of Delaware, and also acquired a Master of Science in Information Assurance at Carnegie Mellon University.

Kristen Sharron-Albright Head of Marketing, Noven Pharmaceuticals Kristen Sharron-Albright, the current Head of Marketing at Noven Pharmaceuticals, was until recently VP Sales and Marketing, Anti-Infective Marketing and Institutional Sales Specialty Care Business Unit at Pfizer. She is an experienced business leader with 20 years of experience in the pharmaceutical and biotechnology industries. She has a strong track record of delivering results in highly competitive and complex markets. Starting her career in sales at Eli Lilly, she then held positions of increasing responsibility at Lilly, Neurogen, and Pfizer, where she was responsible for sales and marketing in a franchise business model. In her spare time she volunteers, serves on the leadership committee for her church, and enjoys hiking.

HS&M JULY/AUGUST 2019 | 8

EXECUTIVE SPOTLIGHT

Raj Garg: A Healthcare Leader Shares His Views on the Industry’s Challenges Raj Garg is a former CEO, McKinsey Senior Partner, healthcare attorney and physician. This background gives him a broad and deep perspective on nearly every corner of the health care industry.

In particular, we were impressed in our conversation with Raj at his rare ability to integrate across subsectors of health care. His talents for insight and leadership have given him a unique point of view on how to deal with some of the great challenges in healthcare.

He’s a strategic, inspirational, values-based leader with a proven P&L track record. He led the Cancer Treatment Centers of America as CEO and president. He served on its board and its executive, finance & risk, science, strategic growth, and talent committees. In a short time, he orchestrated a massive turnaround that sustained the $4.5 billion enterprise by reducing costs, attracting a strong leadership 9 | HS&M JULY/AUGUST 2019

team, creating a culture of accountability, and establishing a strategy for growth. He has a reputation for courageous and tireless leadership—often in short supply— among his peers, as well as those that worked with him at CTCA. Prior to CTCA, Raj spent 25 years as a leader in healthcare at McKinsey & Company. There he advised CEOs and C-suite executives of leading companies in the U.S., Europe and Asia. His experiences span the business value spectrum, including strategy, M&A, postmerger integration, sales and marketing, and operations. His clients included top ten companies across biopharma, medical device, ancillary service, and provider/payor subsectors.

In short, there’s hardly a corner of this industry where Raj does not have experience or where he has not applied his considerable wisdom. Given our focus on hospital

systems in this issue, we asked Raj a few questions that drew from his experience on both sides of the table.

Q: Given your recent turnaround experience with CTCA, what observations would you have for our readers on hospital providers?

Hospital systems have been and remain under significant financial pressure as health care costs remain a central policy issue. For many institutional providers, 3 percentage points is a good margin. We are seeing some bifurcation among providers—for example, the regional IDNs (Integrated Delivery Networks) seem to be gaining the upper hand on performance and growth given their greater holistic alignment of incentives and scale.

For other providers, it’s a paper thin margin. The accelerated turnaround that I orchestrated at CTCA, an

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EXECUTIVE SPOTLIGHT out-of-network provider of cancer care, is symbolic of these pressures. Managing outsized bad debt, AR and denials, ensuring a disciplined approach to procurement, aligning provider compensation in a compliant fashion, controlling IS spend, and developing a network that can channel patients to the appropriate site of care to manage costs are among the many issues that providers must manage to maintain their bare margins. This does not even start to address the growth-focused topics that they must juggle in parallel.

To work with hospital providers as customers, pharma, biotech and med device companies need to understand these and other aspects of what the provider customer is managing daily. Providers are routinely taking fresh cuts to their economics as commercial payors reduce reimbursement and promulgate new rules and policies that result in more denials, requests for documentation, and delays in payment. In parallel, government payors are also shifting reimbursement across services and specialties, and often reducing it.

One big area is clearly drug pricing. For hospital systems, drugs used to be one mechanism that helped generate some margin.

That is under severe pressure now.

The rollback in CMS reimbursement for the 340B drug program last year resulted in a 26.5-28.5% haircut (depending on whether one includes the impact of sequestration). This clearly impacts the 340B eligible entities, which does not include for-profit systems. It will be interesting to watch whether, as a result, drug utilization rises in places like cancer facilities.

11 | HS&M JULY/AUGUST 2019

A further systemic issue for all Medicare providers is the mismatch and delay in reimbursement adjustment for drugs as prices increase. The lag period means that for roughly nine months, provider reimbursement is based on an outdated cost basis. On the commercial payor side of the equation, hospital provider contracts with payors are under pressure, as commercial payors decrease their reimbursements for drugs and drug administration fees. Further, commercial payors may allow an annual increase in the drug cost but this falls far short of the total increase in drug prices that healthcare companies are pushing through each year.

All of the above are a wake-up call for healthcare companies to think hard about their approach to drug pricing and consider ways that make sense for their provider customers. Can pharma companies moderate drug price increases to match what providers expect to gain in reimbursement? Would companies be willing to do away with the artificial class of trade distinction that renders pricing to hospitals higher than outpatient providers? Can they be more discriminating in pricing their products based on real differentiation and value-add versus “book end” pricing? And how can healthcare companies work with providers to evolve value-based pricing, where providers are credited for drugs (especially the newer and more expensive ones) that fail to produce results in patients? Clearly, with the emergence of gene therapy, this latter mechanism will have to be considered, given the outsized cost of these new therapies.

Q: We are hearing a lot about personalized medicine these days—especially in cancer.

What’s your view on how well that is working from a hospital provider perspective?

The value of precision medicine—therapies based on a genetic understanding of the patient—especially in cancer, is clear, and hospital systems should be embracing it. New therapies like Keytruda and Opdivo have made a significant impact on cancers that were previously difficult to treat. It’s really quite amazing that these two drugs alone have multiple years of clinical trials (alone and in combination with other drugs) lined up that will continue to yield new patient benefits. These products are certainly not free of side effects but, given the alternative, they hold great value for patients. We are seeing an on-going increase in the discovery of disease-associated genes, suggesting that we will see a further proliferation of targeted therapies. Recent analyses suggest that drugs that are targeted at specific population subsets based on biomarkers have a greater likelihood of approval by the FDA. And now, with the first gene therapy coming to market, we are seeing the beginning of the move to permanent cures.

However, despite the virtues of precision medicine, provider systems face real challenges in getting their physicians to adopt precision medicine approaches. The median age of medical oncologists in the US is 54. Their formal medical training pre-dates the age of genomics. To come up to speed on genetic/genomic diagnostics and therapeutic innovations, they have to absorb an enormous amount of

information. Which genetic or genomic test to use and why? Which immuno-oncology drugs are best suited for the variants found?

What combination of drugs might have the most therapeutic effect?

What side effects to look for and how to prevent or manage them?

In cases where a clear therapy is not established, what potential therapies are worthy of trial based on the known data? And physicians need to do all of this while they are providing care to their patients—not an easy thing to accomplish.

Healthcare companies have an important role to play. First, they must give serious consideration to why they are not segmenting populations for new drugs based on genomic variants—to the extent that they continue to position a pipeline drug as suited for “all comers.” If companies want to help providers, they should start by providing drugs that are targeted, where possible, to specific patient populations. And, healthcare manufacturers must provide significant assistance in helping HCPs determine how to do that, a need that is not being fully met today. Healthcare companies can play a critical role in helping support objective physician education on the state and evolution of precision medicine. When patients have a genetic variant with no definitive existing therapy, but where the scientific literature suggests a strong signal for potential efficacy of another drug, companies could supply that drug under a patient assistance program. This would be greatly beneficial to a small cohort of patients. Given that payors uniformly refuse to reimburse for such drug uses, such programs have material

impact on patients, offset unreimbursed costs to providers, and may even provide directional evidence for potential new indications.

Q: Health tech is growing rapidly. What area of health tech is of interest to you?

Health tech feels like it is starting to come of age. And the valuations of health tech companies are soaring, but whether they will deliver on their promise is yet to be seen.

One area that I believe holds great opportunity and should be of interest to providers, payors, employers and manufacturers is virtual care. I see virtual care as being the “last mile” of health care.

It fills the gap between the patientat-home and the multiple formal care settings. Its benefits include chronic disease management, wellness enhancement, avoidance of emergency department visits and re-hospitalizations, assurance of compliance, remote monitoring, proactive self-reporting of symptoms, extension of the reach of care providers to remote areas, and more. As such, it holds promise for filling the gap that exists in health care today, and for reducing the overall cost pressure on the system.

Healthcare companies historically have been challenged on several fronts where virtual care can be a powerful tool. For example, lots of companies talk about understanding the patient journey. With virtual care, much greater realtime data would be available to help complete the patient journey picture. Nearly every biopharma company that I have worked with has struggled to craft an effective digital strategy. A single-enterprise virtual care platform can provide

the opportunity to offer customized programs across products and functions. Thus, drug-specific patient support programs can be delivered via virtual care applications. These same applications can be used to collect de-identified data, including data generated by wearable devices, from patients in a disease category. This would provide significant insight into patient/prescriber behavior as well as disease and drug-related issues. With patients in clinical trials, R&D can benefit by directly collecting patient-reported data, thereby improving data quality, reducing trial costs and saving time associated with monitoring visits. The same platform can be a powerful tool for Phase IV/ post-marketing surveillance. I also believe that there may well be FDA drug approvals that are facilitated because the “product” is both a drug and patient support program delivered via a bundled virtual care tool. These are just some of the benefits.

LOOKING FORWARD I am a staunch optimist with respect to the future of healthcare.

Just as we are living in the digital age, I am a strong believer that the next half century or more will be the age of genomics and biology.

Inherently healthcare will play a material role in shaping that era. I would urge that healthcare companies broaden their perspective and interests to proactively shape our health ecosystem. That means understanding and partnering to address the needs of the other sub-sectors of health care. Broadening our horizons and fostering collaboration will benefit everyone involved. • HS&M JULY/AUGUST 2019 | 12

ROUNDTABLE

Medical Device and Hospitals: Execs from Roche, Abbott, Cathworks, Molnlycke and Velano Offer their Insights SCOTT NELSON

Our Moderator:

Co-Founder Joovv Founder Medsider

Our panel of experts: RAMIN MOUSAVI AL CONCEMI Former VP, Surgical Marketing Mölnlycke Health Care

JAY GRAVES Founder and CEO Pathfinder Business Consultants Former VP Sales Roche Diabetes

BRETT JOHNSTON Regional Sales Manager Abbott Neuromodulation

13 | HS&M JULY/AUGUST 2019

Vice President – Global Marketing & Strategy (Chief Marketing Officer) CathWorks

ERIC STONE Chief Executive Officer & Cofounder Velano Vascular, Inc.

Opinions expressed are those of the participants and not necessarily those of the companies they work for.

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ROUNDTABLE Like everyone else in business, the medical device industry is leveling up its game in light of significant changes across several key areas: technology, patient focus, remote medicine. Of key importance, successful players will need to maintain solid relationships with hospitals, which are consolidating and dealing with their own economic, regulatory, and quality challenges. How are leading-edge medical device companies dealing with the emergence of greater demands from Value Assessment Committees?

What are the smaller and emerging companies doing to promote their innovations and stay competitive in the face of industry giants? We presented these questions and others to our panel of experts, and we think you’ll find a substantial amount of wisdom in their answers. Read on to learn from the best!

What are the main challenges today in working with hospitals and hospital systems?

AL CONCEMI: The complexity in decision making in hospitals continues to rise despite the ability to share information. Hospitals are under significant pressure to reduce costs, and one way to do that is by reducing spending on products, supplies, and purchased services. There is a strong push for “clinically acceptable” products, however the definition of this term varies widely. Medtech companies are trying to get their evidence, facts, and messages through to the decision makers, yet the ability to get time continues to get harder.

JAY GRAVES: There are so many stakeholders in the decision-making process; it takes a long time to get a consensus. In the past, you could find a coach who could point to the one or two people who would make a decision, but today it seems consensus decisions are the norm which can be complicated and time intensive.

BRETT JOHNSTON: I’ve been in the business for over 25 years and have seen business evolve from companies working directly with the end user 90% of the time to 15 | HS&M JULY/AUGUST 2019

today where you see the majority of decisions being made on a group level. Some systems operate where the end user has virtually no input on a product or service they can access. The problems associated with the centralization of decision making are not always overtly evident either. For example, if you have a good or service that improves patient care with an increase in treatment cost, but a decrease in long term patient cost, no one is capable of properly analyzing those situations. The other main challenge I see with hospitals is the rise of the physician-owned facility. No longer is a hospital likely to be the only location a patient can receive surgical intervention, even complex intervention.

Understanding the impact on a local hospital/system is paramount in maintaining a relationship that is mutually productive.

ERIC STONE: Many of the challenges in working with hospitals and systems today are the same that have existed for decades. This continues to be an industry largely averse to change that, while evolving to “keep up,” must also focus on the day-to-day demands of its primary mission – providing crucial medical support for the com-

munities they serve. So it can be difficult to break through to find a receptive audience for new ideas – ideas that require effort, change and resources. Even when successful, the path to commercialization or process change is long and slow – two endeavors that do not align inherently with innovation and entrepreneurial thinking. And those projects that finally do make it through are subject to friction ranging from staff turnover, exhaustive oversight, to increasingly harsh financial realities.

Of course, the truth is that any changes in medical delivery or care must be approached with caution. It’s simply challenging, and at times frustrating, for change agents to bake these realities into their formula or path to success – particularly in the early stages of disruption and transformation.

RAMIN MOUSAVI: The main challenge when working with hospitals and hospital systems is that many if not most of the hospitals face appropriate resourcing issues and therefore are unable to adopt and appreciate disruptive technologies and changes at the appropriate pace. This is not good for anyone, especially not good for patients. When hospitals are slow to adopt meaningful innovation, they unintentionally stop patients from benefiting from disruptive technologies. This, at its core, is at odds with physicians’ desire to help patients.

How has the role of Value Assessment/Value Analysis Committees changed over the past few years and how are you responding to their new requests?

BRETT JOHNSTON: Many companies have adapted by adding personnel resources directly to service this growing need. It is almost

a requirement to have designated people to gather, sift, prepare and respond to the growing number of Value Committee requests and even RFPs (Request For Pricing/ Proposal) that companies now field. The VAC groups vary wildly between hospital systems and try and balance the finance side of the table with the clinical side.

Through the years, the balance point has definitely moved from the clinical side to the finance side, but varies from location to location, sometimes vastly.

ERIC STONE: VACs and truly breakthrough innovations oftentimes experience friction, as neither is typically organized to coexist peacefully with the other – despite what both parties say. The more progressive VACs staffed by true change agents who can dutifully fulfill the hospital or system’s mission while maintaining financial stability are where innovators need to start. With a few of these groups and reference customers as champions, the subsequent VAC processes can become much less daunting. The data has to come from somewhere, start somewhere, and so getting that “first chance” with VACs and progressive hospitals can go a long way towards revolutionizing medicine. We’ve been fortunate to have finance (in the form of VACs and/or finance leaders) engaged since the earliest stages of collaboration. This is a must to transition our efforts from innovation to clinical and operational reality.

AL CONCEMI: Some hospital systems are outsourcing the value analysis process to consultants.

As the number of stakeholders increases, and their backgrounds and interests become more varied, it creates a challenge to medtech

VALUE ASSESSMENT COMMITTEES

KEEPING UP WITH CHANGE

HOSPITAL CONSOLIDATION

STAYING COMPETITIVE

companies on how to get their value proposition understood and accepted. Medtech companies continue to adapt in many ways. One way is to structure your message with a core theme that addresses all stakeholders while still having the ability to tailor the message to the individual decision makers.

RAMIN MOUSAVI: As we have experienced a large number of consolidations over the past decade, VACs have become the necessary step to introduce any new technology to the hospital. It used to be your physician champion who decided what new technology can get into the hospital. Now, in addition to strong physician champion(s), you need strong support from administration, supply chain and IT. This is not necessarily a negative change, especially for innovative technologies that successfully check the box for the triple AIM of quality care, population health and cost effectiveness.

However, the internal bureaucracy and resourcing issues within hospitals can turn VAC to a slow and painful process. In order to get ahead of this, we try to proactively identify key stakeholders and meet

with them and answer all of their questions and concerns. Current VAC setting puts a lot more pressure on us as marketers on how we introduce our product and convey the value proposition. Luckily, with the CathWorks FFRangio SystemTM, we have a strong value proposition that is interesting to both clinical and administrative stakeholders. We have found it is essential that we successfully answer all the non-clinical key questions in advance of a VAC meeting, and then our physician champions always do a great job to speak about the clinical benefits for patients.

JAY GRAVES: The whole idea behind value-based care has had a significant impact on our healthcare landscape. When I speak with hospital administrators, there is a real struggle to attain the level of care desired and mandated while maintaining revenue goals. This is requiring medical companies to think about how they can contribute to the value-based goals of their customers. This might mean adding ancillary programs or research on how their products and services can help their customHS&M JULY/AUGUST 2019 | 16

ROUNDTABLE ers while addressing the financial restrictions of a capitated payment system.

As large multi-national medtech companies continue to make acquisitions and expand their product portfolios, do you believe hospital systems respond favorably to this type of value proposition?

JAY GRAVES: Decision makers in hospital systems have limited time and have often commented to me in the past that they would like companies to have a single point of contact for multiple offerings from their companies vs. several sales representatives. In theory, with consolidation, many companies would be able to bring a more holistic portfolio to customers from one representative. Some device and diagnostic companies have reorganized themselves to have this single point of contact for hospitals and large customers. Interestingly, I was speaking with a key opinion leader from a large hospital system recently, and he stated that many hospitals use medtech as a way to attract more patients but that the solutions aren’t better than cheaper alternatives. The example he used was how robotics are marketed by hospitals as superior vs. manual surgery, but studies have shown this is not always the case. This leads me to believe that system administrators appreciate the efficiency of consolidation but are also wary of the high cost of some solutions if they are not truly better than current treatment, especially with tight budgets.

RAMIN MOUSAVI: Hospitals expect good technologies that produce consistent results, with the right level of service. Medtech acquisitions further the reach of smaller companies and make 17 | HS&M JULY/AUGUST 2019

meaningful innovations available to a much broader patient population. There are also economic benefits to hospitals when dealing with these companies, because given the breadth of their portfolio, they can offer things that smaller or single segment focused companies simply cannot offer. From experience, I know that hospitals like and appreciate the service they receive from smaller companies and those companies that only focus on specific areas AL CONCEMI: I believe that many hospital systems like the ability to reduce the number of suppliers that they work with, and see value in getting more of their product portfolio from fewer vendors.

There is certainly an economy of scale that can be achieved to create value for both the hospital and the company. Hospitals are now looking beyond just the cost savings that such a relationship provides and seeking additional value-added services.

ERIC STONE: I think systems are of two minds about this consolidation and the resulting expanded product portfolios. At a time when hospitals are increasingly caught up in patient backlash over pricing and transparency, having to deal with large conglomerates with monopolies on devices, procedures or medicines puts them in an awkward position. But at the same time, working with these large, familiar organizations makes it easier to conduct day-to-day business because they are comfortable with one another’s teams and procedures, and the larger companies by their very scale can make doing business easier than dealing with a litany of small firms.

BRETT JOHNSTON: My personal opinion is the hospital system only cares in so much as it gives them fewer people to work with. If scale for the sake of scale worked, Johnson & Johnson would have buttoned up the medical device business 50 years ago. That is not to say that a company providing tools for hip replacement for example would not benefit from offering all the tools necessary to perform a hip replacement. Those things make sense. In my experience, the larger the medtech company, the more difficult it is for them to even communicate cross functionally.

Do you feel that new technology and/or partnering with hospital systems on clinical studies influences your relationships in those settings?

JAY GRAVES: Yes, there is a bias.

It is in our nature that we get familiar and comfortable with a particular brand or technology and tend to stick with it. If you are using a product and gaining familiarity in it during clinical studies, then you are more likely to use the same product in your practice. Medical companies are counting on this muscle memory when partnering with clinical studies.

RAMIN MOUSAVI: There are many ways to build credibility with hospital partners, but ultimately they judge you based on three simple factors: Is your technology offering real and impactful innovation that can help providers and patients? Do you have reputable and reliable clinical data supporting your technology? Does partnering with you make things better and easier? For example, as we have commercialized CathWorks FFRangio in the US, we stood on strong clinical data from FAST FFR study that showed FFRan-

gio has a high concordance with invasive FFR technologies and is very accurate. Well, FAST FFR, combined with FAME and FAME II studies that had already demonstrated significant reduction in the composite rate of death, nonfatal MI and urgent revascularization when FFR was used (vs. coronary angiography alone), gives us a lot of clinical credibility. We also benefit from the fact that our system is very easy to use and gives comprehensive analysis within few minutes.

ERIC STONE: We’ve found collaboration or partnership to be an important part of the innovation cycle with new hospital partners.

By working closely with hospitals on studies and pilots, both teams learn valuable lessons and insights, and the technology benefits – in terms of refinement, enhanced training and education, insights into how to optimize procedures, realization of outcomes in unique settings, and more. Successful pilots help create advocates within a system that can facilitate full adoption and commercialization.

And familiarity by staff during a study or pilot helps shorten the runway to technology/innovation adoption.

In fact, our early success doing this with partners like Intermountain Health for our needle-free PIVO blood draw device convinced us to make this a standard approach with more recent partners like Centura Health and others. Everyone wins through joint exploration – as long as both parties keep an open mind and are willing to explore together. Change is rarely easy, nor is it pretty.

AL CONCEMI: Partnering for clinical studies does seem to help in that the hospital clinical staff

can provide some insight into the benefits and value of the new technology or procedure. If there are doubts about the clinical and or economic benefits, then the hospital has first-hand experiences upon which to base decisions.

As you think about access to hospitals and hospital systems, are direct relationships with HCPs, particularly surgeons or interventionalists, still important? What/who else is important or influential when it comes to access in today’s healthcare climate?

ERIC STONE: Absolutely – it’s important to build those relationships for advocacy, a robust feedback loop hearing and gaining honest insights, and more. A twoway relationship is also critical when working with patient care, innovation, investment, marketing, and other hospital teams. In our experience, identifying an executive champion(s) representing the constituency most impacted, and benefitted (not always the same executives/functions) by an innovation is critical. For Velano, that philosophy has helped us to seek out relationships with nursing, laboratory, quality, finance and other leaders. Also, we’ve increasingly found that hospital systems are building innovation ecosystems led by a Chief Innovation Officer – an important advocate for any change agent seeking to collaborate with health systems.

AL CONCEMI: Relationships will always matter because “people buy from people,” but the number of physician preference items is dwindling. Having clinical and economic evidence to support your products is important because you can then leverage your relationships to share this data

with their colleagues to help communicate your value proposition.

Relationships with supply chain continue to be important, which is why the need for strong health economics data is critical. There is also a growing influence of infection prevention in value analysis decisions, as reimbursement continues to be tied to the prevention of negative outcomes like hospital acquired conditions.

BRETT JOHNSTON: Speaking of access alone, I find direct relationships with HCPs imperative!

In fact, a relationship is just the beginning. You really need a true partnership with your customers.

It is no different from any other kind of service business. The better you know your customer, the better solutions you can offer and the more likely they will be to listen.

RAMIN MOUSAVI: There is no replacement for meaningful partnership with physicians. They are ultimately responsible for the patient care and it is essential that they see benefit in your technology. But, in addition to the physician champions, the administrative team needs to see the economic value of your product. In our case, the IT stakeholders want to know about the security of our system and its ease of integration. This is much more important for disruptive technologies like CathWorks FFRangio, because we are not just another invasive wire. We are changing an entire category, so it’s important that everybody understands the value proposition clearly.

JAY GRAVES: In the past, there was more of an emphasis on HCPs than there is today. Not to say it is not essential to build relationships with key contacts, but a lot of the decisions are made at the C-suite, HS&M JULY/AUGUST 2019 | 18

ROUNDTABLE which is where commercial teams are trying to gain access today.

In terms of your relationships with hospitals and hospital systems, how relevant is valuebased healthcare (VBHC)? What is your company doing to align with VBHC initiatives?

AL CONCEMI: Value-based healthcare is extremely relevant, as reimbursement and potential penalties are tied to outcomes.

Value is not just created by the initial purchase price being lower, but rather by a lower total cost of care. Saving a few dollars up front on a product that may result in hundreds or thousands of dollars of additional costs is just not good economics. Companies need to have the data to show how their products influence outcomes, and how better outcomes drive down total cost of care.

ERIC STONE: Our core mission is to deliver a more humane, patient-centered standard of care that delivers significant quality improvement for one of medicine’s most frequent invasive procedures -- inpatient blood draws.

In today’s industry environment, that focus on the patient not only improves their experience but also can advance a system’s bottom line through satisfaction ratings and reimbursements, competitive differentiation, practitioner satisfaction and more.

We are finding in collaboration with system partners that removing the needle from inpatient blood draws positively “moves the needle” on HCAHPS scores.

As you know, better HCAHPS performance means more dollars for hospitals. It also has secondary benefits, including competitive differentiation within markets. This 19 | HS&M JULY/AUGUST 2019

domain is heavily nuanced, but early insights are proving positive.

JAY GRAVES: I am in a unique position where I work with both hospital systems as well as medical and pharmaceutical commercial teams, so I get to see both sides of the coin. With the hospitals, valuebased healthcare is vital because it is the standard they are measured against. For commercial teams, it is a variable they must consider when developing their sales strategies.

RAMIN MOUSAVI: There is a change of trend towards VBHC. Hospitals want to know that they are adopting a technology that creates real value for everyone involved. With the Cathworks FFRangio System this is a big focus for us. In addition to strong clinical evidence, our product is a non-invasive technology that is a much better substitute for existing invasive solutions. We can help reduce risk, reduce cost AND provide a much more comprehensive physiology information.

our commercial rollout of FFRangio. Our sales team proactively evaluates the requirements at every customer, and develops a comprehensive package of information that focuses on answering all stakeholder questions. We are focused on shortening the feedback loop to respond to our customers ever changing needs.

JAY GRAVES: I have experts on my team who have successfully managed value-based healthcare and population management programs for large hospital systems, which is critical for us to be able to consult with our clients successfully. Without this expertise, we would just be spouting off theory.

AL CONCEMI: The development of clear health economic data and presenting that data in an easy to understand way is important in today’s environment. You need to be able to “connect the dots” of how a product, service, or procedure impacts the outcome being measured, and be able to tie an economic value to the improved outcome.

What strategies has your company employed to adapt to the new environment?

RAMIN MOUSAVI: We have developed a unique commercial strategy that is focused on maximizing adoption. We are constantly working on ways to remove traditional barriers to adoption by being flexible to our customer needs. For example, IT security and integration is a big challenge and concern for hospitals when considering artificial intelligence based technologies. Our product development team in Israel has done a fantastic job taking all of these concerns into account, and has made our system super easy to integrate into hospitals IT, with almost no risk. Another example is

Do you think the next five years will hold more significant changes? How? ERIC STONE: Healthcare is undergoing incredible change driven by changing patient expectations, emerging technology capabilities, new financial realities, and a shifting regulatory and political environment. So there is no doubt we’ll continue to see significant change in how hospitals identify, test, rollout and measure new and innovative technologies. As those influences gain steam and feed into one another, it is going to shape a dramatically different healthcare sector within the next decade, one that is even more patient-centered and experience-focused than today, where financials are transpar-

Moving Forward RAMPING UP YOUR EXPERTISE

REVIEWING AND REFRESHING TECHNOLOGY

MESSAGING THAT MEETS THE HOSPITAL NEEDS

ent to patients and tied to outcomes on the payer side, and that relies on technology and remote treatment for a majority of routine issues. I expect more consolidation to occur and large technology or consumer brands to blur the lines by taking on more of a role within the traditional healthcare system.

BRETT JOHNSTON: I’m actually one that does not think there will be significant changes in the next five years. All sides are responding to pricing pressures in multiple ways. Clinical studies will continue to drive decision making (hopefully). Politicians will continue to both condemn and praise the industry with little coherence on either side. Maybe Trump’s new executive order on pricing visibility will be a positive for the industry and provide some significant change. We will see.

JAY GRAVES: The only way it changes is with payment reform.

If value-based goals continue to be the norm, then that will dictate behavior and investment, but if an administration decides to make changes to healthcare, then those

become the new expectation. We know what we have today and can only speculate what is coming down the road based on what we hear and interpret out of D.C. AL CONCEMI: I do see significant changes in the future. The role of personalized medicine has evolved significantly in the past decade, and I see that accelerating in the future. Technology that can respond real-time to changes in the patient will continue to evolve and provide therapeutic options once thought impossible. There is still a chasm to cross in terms of data that is based on large patient populations and those based on an individual, and medtech companies will continue to work with clinicians to better understand how to utilize this data to maximize patient outcomes.

RAMIN MOUSAVI: Innovation forces change and that’s a good thing. Non-invasive and less invasive technologies will replace more invasive solutions, and hospitals will continue to demand strong clinical evidence, economic benefit and seamless integration. The

COLLABORATION

increased focus on healthcare cost and efficiency will create an opportunity for technologies to disrupt each category and become the standard of care. Another change we all need to be prepared for is the increasing awareness among patients and caregivers. With the expansion of social media and digital platforms, patients are becoming and will be empowered to demand better care. Patients are the best ambassadors for good patient care. Increased awareness about different therapies means that the patient education will play even a bigger role 5 years from now. Social media already has enabled patients to make their voice heard, but I think there will be a significant increase in that in the coming years. Meaningful innovation can positively impact patient care and we are all very lucky to play small role in our space. •

HS&M JULY/AUGUST 2019 | 20

ROUNDTABLE MODERATOR SCOTT NELSON Co-Founder, Joovv Founder, Medsider

Scott is a self-described medtech enthusiast. He cofounded Joovv in 2015, a fast-growing photobiomodulation startup, and currently leads all of their commercialization efforts. Prior to Joovv, Scott held sales and marketing leadership positions for some of the largest medical device companies in the world, including Medtronic, Covidien, Boston Scientific, and C.R. Bard. In addition, Scott is the founder of Medsider, which helps ambitious doers learn from proven medtech thought leaders. His work with Medsider has been featured in publications like Forbes, Mass Device, MedCity News, and MD+DI. Scott is also an advisor to the Medical Devices Group, which includes over 300,000 members worldwide. scott@medsider.com

PANELISTS AL CONCEMI

JAY GRAVES

Former VP, Surgical Marketing Mölnlycke Health Care

Founder and CEO Pathfinder Business Consultants

Al is a commercial leader in medical devices with a foundation in product development and biomedical engineering. He began his career as an engineer at Advanced Cardiovascular Systems, Spectranetics, Schneider and Global Therapeutics. Al became Intervascular’s R&D Manager, then Product Specialist for W.L. Gore & Associates, and CEO at Forge Medical.

After serving as Director of Business Development at AngioDynamics and Director of the NICU New Business Development at Medela, he moved on to Mölnlycke Health Care in 2015. alconcemi@gmail.com

MÖLNLYCKE HEALTH CARE is a Swedish medical device company headquartered in Gothenburg and active internationally. The company manufactures and sells wound care and single-use surgical products and is a service provider to the healthcare sector.

21 | HS&M JULY/AUGUST 2019

Jay previously served as VP Sales for US Roche Diabetes Care, where he was responsible for leading all field sales and sales operations functions. At Roche, he also was Physician Field Sales Representative, Region Business Manager – Health Care Provider, Region Business Manager – Managed Care, Retail and Distribution, Area Business Director for the Central and Western US and Product Marketing Director for the Blood Glucose Portfolio.

Jay began his professional career in 1998 as an Intelligence Officer in the United States Army, where he held multiple leadership positions and global deployments, including tours in South America, Central America, The Caribbean, South Korea, The United Kingdom, Jordan, and Iraq. jay@pathbcs.com

PATHFINDER BUSINESS CONSULTANTS provides commercial leadership excellence training for executives with a focus on transformational and strengths-based leadership fundamentals, empowering a diverse organization, and developing winning teams.

BRETT JOHNSTON Regional Sales Manager Abbott Neuromodulation

Early in his career, Brett was a Senior Sales Representative and Sales Trainer for Ethicon Endo-Surgery. He moved on to Guidant CRM, and then joined Abbott in 2002 as Cardiac Surgery Territory Manager and West Region Market Development Manager. After a stint as District Sales Manager at Bard Peripheral Vascular, he rejoined Abbott as Regional Sales Manager in 2018. brett.johnston@abbott.com

ABBOTT NEUROMODULATION offers specialized devices for people suffering from chronic pain and movement disorders through solutions that deliver stimulation to the spinal cord, dorsal root ganglion and the brain. Their portfolio of therapies help people move and feel better, allowing chronic pain patients to reduce or stabilize the long-term use of opioids and get back to living their lives. This includes devices designed to deliver spinal cord stimulation (SCS) for the treatment of chronic pain, and dorsal root ganglion (DRG) stimulation for patients seeking relief from causalgia — nerve pain following surgery or injury — and complex regional pain syndrome (CRPS).

RAMIN MOUSAVI Vice President – Global Marketing & Strategy (Chief Marketing Officer) CathWorks

As the Chief Marketing Officer for CathWorks, Ramin is responsible for the development and the execution of the global strategy for the company, including oversight of commercial and clinical global launch and adoption of CathWorks FFRangio™ technology. Prior to CathWorks, Ramin was the Sr. Director, Marketing of Transcatheter Heart Valves (THV) division for Edwards Lifesciences, supporting over $1.5B of revenue and a sales and marketing team of ~300 people.

Prior to that, he held various roles in Global Marketing, Global Strategy, Product Portfolio Management and Product Development with Edwards Lifesciences, Panasonic and Rockwell Collins. He currently serves on the Boards of the Beall Center for Innovation and Entrepreneurship at UC Irvine as well as Council on Aging, Southern California. https://www.linkedin.com/in/raminmousavi

CATHWORKS is a medical technology company focused on applying its advanced computational science platform to optimize PCI therapy decisions and elevate coronary angiography from visual assessment to an objective FFR-based decisionmaking tool for physicians. FFR-guided PCI decision-making is proven to provide significant clinical benefits for patients with coronary artery disease and economic benefits for patients and payers. Their current focus is on the CathWorks FFRangio™ System, which provides quick, precise, and objective intraprocedural FFR guidance that is practical for every case.

ERIC STONE Chief Executive Officer & Co-founder Velano Vascular, Inc.

Before starting Velano Vascular, Eric served as VP of Sales and Marketing for MolecularHealth. Prior to that, he helped launch the world’s first bioabsorable stent for Abbott while working out of their California and Belgium offices.

He was also a founding member of Model N’s Life Sciences division. He formed Velano Vascular in 2011 with Dr. Pitou Devgon. For their development of PIVO, they received the Frost and Sullivan 2016 New Product Innovation Award. Velano challenged the status quo for drawing blood, identifying many opportunities for enhancement and innovation, especially with patients who have difficult venous access. eric.stone@velanovascular.com

VELANO VASCULAR is transforming the inpatient experience with PIVO™, a breakthrough needle-free blood collection device. PIVO aims to reduce painful needle sticks for inpatients, to improve practitioner safety, and to provide hospitals with a smarter financial solution for vascular access.

Velano is backed by leading U.S. health systems including Sutter Health, Griffin Hospital and The Children’s Hospital of Philadelphia, as well as First Round Capital, Kapor Capital, White Owl Capital, Safeguard Scientifics and dozens of heath industry veterans. Velano collaborates with innovators in patient-centered care, including Planetree, Intermountain Healthcare, Brigham & Women’s Hospital and more.

COMMENT

HS&M JULY/AUGUST 2019 | 22

MEDICAL DEVICE

CLICK HERE TO GET TOP 50 MEDICAL DEVICE COMPANIES

MEDICAL DEVICE COMPANIES

MEDICAL DEVICE TOP 50 The medical device sector is seeing the most gains we have ever seen in our report. The sector comprises medical device, medical equipment, capital equipment and medical technology companies. The total income this year across the sector was $413B, up majorly from $329B in 2017. This 20% rise follows the 11% revenue uptick from 2017 – almost double the growth! All but nine of our Top 50 companies experienced a revenue increase from 2017. Thermo Fisher was added to the list in the third position this year as we had missed their equipment arm in our last year’s listing.

Medtronic and Johnson & Johnson remain at the top of the list this year. This was the year of remarkable organic sales growth, and a five year low for device acquisition activity. The biggest deal of this year was Boston Scientific’s purchase of BTG for $4.2B. Other notable deals include Johnson & Johnson selling its LifeScan business to Platinum Equity for $2.1B, Roche’s acquisition of Flatiron Health for $1.9B, Medtronic’s pur-

23 | HS&M JULY/AUGUST 2019

chase of Mazor Robotics for $1.6B, and Stryker’s acquisition of K2M ($1.4B) Here is a snapshot of the Top 50, ranked by 2018 revenue. As always, we have tracked movement up and down the list with regard to both ranking and revenue changes as compared with 2017.

Companies are ranked by their 2018 medical revenue as furnished by their annual reports and publicly available sources, Edgar and

Morningstar stock information websites (figures of non-U.S. companies were converted to U.S. dollars from various currencies using end of the year exchange rates for 2017 and 2018). Medical device, equipment, and medical technology revenues were extracted from reports to create an equal playing field. We also revised 2018 earnings to align “apples to apples” revenue reporting with 2017 figures.

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MEDICAL DEVICE COMPANIES

CLICK HERE TO GET TOP 50 MEDICAL DEVICE COMPANIES

RANKING COMPANY LOCATION

2018 REVENUE IN US$B

1

MEDTRONIC

Dublin, Ireland

$30.60

2

JOHNSON & JOHNSON

New Brunswick, NJ

$27.00

3 NEW THERMO FISHER

Waltham, MA

$24.36

4

PHILIPS

Amsterdam, Netherlands

$20.74

5

DANAHER

Washington, DC

$19.89

6

GENERAL ELECTRIC

Fairfield, CT

$19.78

7

FRESENIUS MEDICAL CARE

Bad Homburg, Germany

$18.93

8

ABBOTT LABORATORIES

Chicago, IL

$18.87

9

BECTON DICKINSON

Franklin Lakes, NJ

$15.94

10

CARDINAL HEALTH

Dublin, OH

$15.58

11

SIEMENS

Munich, Germany

$15.33

12

STRYKER

Kalamazoo, MI

$13.60

13 ROCHE

Basel, Switzerland

$13.09

14

BAXTER

Deerfield, IL

$11.08

15

BOSTON SCIENTIFIC

Marlborough, MA

$9.82

16

ESSILOR

Charenton-le-Pont, France

$8.26

ZIMMER BIOMET

Warsaw, IN

$7.93

18

B. BRAUN

Melsungen, Germany

$7.90

19

OLYMPUS

Tokyo, Japan

$7.17

NOVARTIS

Basel, Switzerland

$7.15

21

CARL ZEISS

Oberkochen, Germany

$6.66

22

3M

Saint Paul, MN

$6.02

17

20

23

TERUMO

Tokyo, Japan

$5.36

24

HITACHI

Tokyo, Japan

$4.93

SMITH & NEPHEW

London, United Kingdom

$4.90

25

25 | HS&M JULY/AUGUST 2019

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Companies are ranked by their 2018 revenue as furnished by their annual reports and publicly available sources such as Edgar and Morningstar stock information websites. Figures of non-U.S. companies were converted to U.S. dollars from various currencies.

MEDICAL DEVICE COMPANIES

CLICK HERE TO GET TOP 50 MEDICAL DEVICE COMPANIES

RANKING COMPANY LOCATION

2018 REVENUE IN US$B

26

HOYA

Tokyo, Japan

$4.88

27

SHIP HEALTHCARE HOLDINGS

Suita-Shi, Japan

$4.05

28

DENTSPLY SIRONA

York, PA

$3.99

29

EDWARDS LIFESCIENCES

Irvine, CA

$3.82

30

INTUITIVE SURGICAL

Sunnyvale, CA

$3.72

HOLOGIC

Marlborough, MA

$3.22

NIPRO

Osaka, Japan

$2.99

33

DRÄGER

Lübeck, Germany

$2.97

34

VARIAN MEDICAL SYSTEMS

Palo Alto, CA

$2.92

35

HILL-ROM

Chicago, IL

$2.85

36

SONOVA

Stäfa, Switzerland

$2.81

37

BIOMERIEUX

Marcy l’Etoile, France

$2.77

38

GETINGE

Gothenburg, Sweden

$2.72

39

STERIS

Mentor, OH

$2.62

40 NEW SYSMEX

Cho-ku, Japan

$2.57

41

THE COOPER COMPANIES

Pleasanton, CA

$2.53

42

COLOPLAST

Humblebaek, Denmark

$2.53

43

TELEFLEX

Wayne, NJ

$2.45

44

HARTMANN

Frankfurt, Germany

$2.42

RESMED

San Diego, CA

$2.30

46

BIO-RAD

Hercules, CA

$2.29

47

FUJIFILM

Tokyo, Japan

$2.22

48

IDEXX LABS

Westbrook, ME

$2.21

49

WILLIAM DEMANT

Smørum, Denmark

$2.14

San jose, CA

$1.97

31 32

45

50 NEW ALIGN

27 | HS&M JULY/AUGUST 2019

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INDUSTRY

So all due credit to those who know how to crunch the numbers, examine the trends and regularly provide a fairly reliable view into the future.

Evaluate Pharma has been doing an admirable job of this for over a decade, and we are happy to excerpt the following from their World Preview 2019 and Outlook to 2024.

They cover all sectors of the industry, separately and together, highlighting drug sales, patent risk, R&D spend, global brand sales and market performance by therapy area. They look at how tech is affecting everything from production to supply chain to marketing; what will change with the emergence of gene therapy; what factors will impact pricing; machine learning and AI; the reimbursement vectors; the political winds; everything that makes this industry the roller-coaster ride of the economy. This gives us all a perspicacious insight into how we should direct our own energies, adjust our strategies, and plan for the road ahead.

31 | HS&M JULY/AUGUST 2019

If you were to boil down the trajectory of healthcare into a single word, it would probably be “innovation.” Of course, that’s a risky word, as fraught with risk as it is with promise. Where will all this innovation take us? Will we really reach $1.8T by 2024, as Evaluate suggests? Read on, and fasten your seatbelts. It’s going to be a bumpy flight.

If you’d like to view the full report, click here.

ANALYSIS HIGHLIGHTS • Oncology is the area with the largest proportion of clinical development spending, with 40% of total pipeline expenditure, and close to 20% market share of pharma sales in 2024 • R&D spend is forecast to grow at a CAGR of 3.0% to 2024, lower than the CAGR of 4.2% between 2010 and 2018, partially driven by companies focusing on smaller indications with lower clinical development cost burden • Keytruda is set to be the top selling drug worldwide in 2024, as Humira loses its top spot due to the adalimumab biosimilar entry in the EU and the expected USA biosimilar competition from 2023 • Should Bristol Myers-Squibb complete its intended acquisition of Celgene and forecast projections for a combined portfolio hold, the combined entity would be the 3rd largest pharmaceutical company, based on 2024 prescription sales • Vertex’s triple combination, VX659/VX-445 + Tezacaftor + Ivacaftor, is anticipated to be the most valuable project in the pharmaceutical industry pipeline with an NPV of close to $20B

• Roche leads the way in biotechnology, with a forecasted $38.7B of biologic sales in 2024, despite a decrease in biotech market shareof -5.4% owing to the effect of biosimilars • Johnson & Johnson is forecast to narrowly overtake Roche to be the biggest spender on pharmaceutical R&D in 2024

Worldwide Prescription Drug Sales (2010-2024) Prescription drug sales CAGR for 2019 through 2024 three times that in 2010 through 2018; Orphan drug market to almost double.

Prescription drug sales for 2010 through 2018 grew at a CAGR of+2.3%. This can be compared to the forecast annual CAGR of +6.9% for 2019 through 2024, with expected sales to reach $1.18T. The growth rate for the prescription market in 2019 is forecast to be+2.0%, which depicts a decline in growth rate compared to 2018 (+5.0%). The Trump administration has been in the news for discussions related to changes to the prescription drug policy which could be implemented in early 2020. These changes could be challenging for pharmaceutical drug manufacturers, as it could affect drug prices in one of the largest markets in the world. On the positive side, the industry has seen the launch of Ultomiris (Alexion Pharmaceuticals) and Takhzyro (Takeda). Consensus forecasts indicate that $198B of sales are at risk between 2019 and 2024, with 2023 set to see the expiry of key patents for a number of biologics, including Humira and Stelara.

Figure 1: Worldwide Prescription Drug Sales (2010-2024)

Both of these products are still forecast to retain spots within the world’s top 10 selling drugs in 2024. (Figure 1)

Worldwide Prescription Drug Sales in 2024: Top 10 Companies Pfizer returns to top spot for worldwide sales of prescriptiondrugs in 2024.

As the top three continue to battle it out, EvaluatePharma® finds

that Pfizer has once again pushed ahead of Novartis and Roche for the Worldwide Prescription Drug Sales number one spot in 2024.

Novartis is also due to jump up to the number two spot after exhibiting 2.3% CAGR between 2018-24 as opposed to Roche’s 0.8% CAGR. Bristol-Myers Squibb has fallen out of the top 10 largely due to loss of Opdivo market-share to Keytruda and being beaten to the mega-merger table by Takeda with

its acquisition of Shire in January 2019. As a result, Takeda leaps up seven places in the ranking between 2018 and 2024 with an impressive 10.8% CAGR. Bristol-Myers Squibb is unlikely to be outside the top 10 for too long, however, as on January 3rd, 2019, the company announced a $74B acquisition of Celgene that it is yet to complete.

Figure 2: Worldwide Prescription Drug Sales in 2024

HS&M JULY/AUGUST 2019 | 32

INDUSTRY Figure 3: Top 10 Most Valuable R&D Projects (Ranked by Net Present Value)

AstraZeneca has also shown impressive 7.7% CAGR, long promised by CEO Pascal Soriot, due to breakthroughs in the Chinese market and high sales of its oncology products Tagrisso and Lynparza, rather than M&A. Only Takeda and AstraZeneca are able to increase market share between 2018 and 2024. The Top 10 Pharma companies showed -6.6% market share decline overall, with Roche alone contributing -1.4% to that figure. (Figure 2)

Top 10 Most Valuable R&D Projects (Ranked by Net Present Value) Vertex’s triple combination, VX-659/VX-445 + Tezacaftor+ Ivacaftor, remains the most valuable project in the pharmaceutical industry pipeline.

33 | HS&M JULY/AUGUST 2019

Despite a wide spread of therapeutic areas represented in the top10, oncology has the highest number of candidates. Daiichi Sankyo prepares for its first regulatory submission of its HER2-targeting antibody drug conjugate, DS-8201 (backed by a collaboration agreement with AstraZeneca) – and this joins Liso-cel and sacituzumab govitecan in the most valuable oncology projects.

With Vertex Pharmaceuticals already dominating the cystic fibrosis space, its therapy combining ivacaftor (available as Kalydeco) and tezacaftor (available in combination with ivacaftor as Symdeko) withVX-445 or VX-659, another cystic fibrosis transmembrane regulator (CFTR) corrector, is looking to further reinforce the company’s position.

The list is dominated by largecap pharma companies, however, a couple of other projects from mid-cap companies join Vertex’s triplet. Immunomedics is looking to put its stamp on the oncology market with its antibody-drug conjugate sacituzumab govitecan.

Meanwhile, the FDA has agreed to an accelerated approval pathway for GlobalBlood Therapeutics’ oral therapy, voxelotor, for sickle cell disease.

AbbVie is pushing its own JAK1 inhibitor, upadacitinib, into the rheumatoid arthritis and ulcerative colitis markets, and Eli Lilly its novel dual gastric inhibitory polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) receptor agonist combination, LY3298176, into the crowded diabetes drug market.

In contrast, Novartis seeks return on investment with Zolgensma’s

launch into the spinal muscular atrophyspace – Novartis gained the gene therapy (previously AVXS101) when it acquired AveXis in May 2018. Novartis also eagerly awaits the approval of its wet agerelated macular degeneration (AMD) project, brolucizumab; the FDA is set to decide later in 2019.

maceutical revenue to reduce.

Two of Celgene’s acquired assets make it to the list: ozanimod, an immunomodulator in development for multiple sclerosis, ulcerative colitis and Crohn’s disease, and Liso-cel, its CAR-T cell therapy. They originated from Receptos and Juno Therapeutics respectively, however these projects look likely to change hands again if Bristol-Myers Squibb closes its acquisition of Celgene. (Figure 3)

2010 and 2018, with an average proportion of R&D spend to pharmaceutical revenue for the same period of 19.8%, compared to 20.2% for 2018-24.

Worldwide R&D Spend

by Pharma & Biotech Companies 2010-2024 Forecast worldwide R&D CAGR lower in 2018 through 2024, and proportion of R&D spend to phar-

Worldwide pharmaceutical R&D spend totalled $179B in 2018, representing an increase of +6.5% on the previous year. Going forward, R&D spend is forecast to grow at a CAGR of 3.0% between2018 and 2024. This is comparable with a CAGR of 4.2% between

Despite an initial peak in 2019, the proportion of R&D spend to pharmaceutical revenue falls quickly in subsequent years. This reduction in R&D spend could be an indication that companies are investing now to improve their future R&D efficiencies. Use of real world data combined with machine learning techniques in addition to collaborative R&D programs, are a few of the initiatives being employed by companies to help them stay one step ahead in an era demanding more patient-targeted

drug development. Similarly, this reduction in R&D spend could be an indication that less revenue is being directed towards replenishing pipelines. (Figure 4)

Worldwide Prescription Drug & OTC Sales by Therapy Area in 2024 Merck & Co. expected to remain largest oncology player in 2024 with Keytruda.

Oncology prevails as the leading therapy segment in 2024, with a 19.4% market share and sales reaching $237B, driven in large by the PD-1 inhibitors Keytruda and Opdivo, as well as Pfizer’s Ibrance and AstraZeneca’s Tagrisso. The immunosuppressants space also continues to see a high level of growth, with the market’s largest CAGR through 2024 of 16.9%, driven by an increase in the incidence of chronic diseases and the use of immunotherapeutic agents in clinical development for other therapy areas. Elsewhere, biosimi-

Figure 4: Worldwide R&D Spend by Pharma and Biotech Companies 2010-2024

HS&M JULY/AUGUST 2019 | 34

INDUSTRY Figure 5: Worldwide Rx Drug and OTC Sales by Therapy Area in 2024

Figure 6: Top 10 Selling Products in the World in 2024

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lars are beginning to make their mark on the anti-rheumatic segment, which is expected to see a decline in its CAGR as we enter 2024, with sales dipping to $55B despite the high drive in sales from JAK inhibitors; upadacitinib and Xeljanz. (Figure 5)

2024: Top 10 Selling Products in the World

the publication for healthcare sales & marketing leaders™

Keytruda knocks Humira off the top spot; Revlimid falls out of top 3.

A $1.5B increase in sales for Humira ensured AbbVie’s blockbuster remained the top selling product worldwide in 2018. However, following a number of biosimilar launches in Europe and biosimilars set to hit the US in 2023, the 2024 EvaluatePharma® consensus forecast for Humira has decreased by $2.8B compared to last year’s report. This decrease, coupled with a strong year for Keytruda in product sales, positive data from ongoing clinical trials and further FDA approvals, will allow Keytruda to take the number one spot for 2024 forecasted sales. As a result of this, Keytruda is forecasted to widen the sales gap between its competitor Opdivo to over $5B in 2024. Sitting just outside of the top 3, with predicted 2024 sales of $11.3B, the checkpoint inhibitor Opdivo continues to have strong sales in the anti-neoplastic MAbs segment, despite contrasting analyst views with regards to its trajectory as we move towards 2024.

Falling out of the top 3 and down the rankings, worldwide sales of Revlimid are expected to fall with a CAGR of -3.2% between 2018 and 2024 to $8.1B, with generic versions expected to hit the US market in 2022. Gilead’s Biktarvy continues to outshine all other HIV medications and climbs a place to sit in the top10 this year, boasting an impressive CAGR of +34.4% going into 2024 and sales of $7.0B. (Figure 6) •

COMMENT

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HS&M JULY/AUGUST 2019 | 36

INDUSTRY TRENDS: BY THE NUMBERS Compiled by Cari Kraft, Jacobs Management Group, Inc.

$75,500

The cost of a bad marketing hire The cost of hiring the wrong marketing person is on average $75,550, and sometimes exceeds $100,000.

Source: Jacobs Management Compensation and Hiring Report 2019

105,000

69%

Patients who think healthcare companies are not transparent about costs While 78% of patients report that drug price transparency is “extremely” important (and another 19% say it’s “somewhat” important), they have little faith that the companies offering these medications are forthcoming in stating price information.

Source: WEGO Health Patient Leader Survey on Drug Price Transparency, May 23, 2019

Registered clinical trials in U.S. The United States is by far the leader in clinical trials, with over 100,000 being conducted currently. There are 300,000 clinical trials being held worldwide.

Source: WebMD, “How Precision Medicine is Changing Clinical Trials,” June 2019

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1 ZETTABYTE

Amount of healthcare data generated annually A zettabyte is a trillion gigabytes (also expressed as 1021 or 1,000,000,000,000,000,000,000 bytes). This is how much data the healthcare industry is accumulating every year. And it’s expected to double every two years.

While this holds much promise for patients of all types, it’s also a significant challenge for healthcare IT professionals to analyze and make actionable.

Source: Datavant, “The Fragmentation of Health Data,” July 2018

89%

20

Biotech IPOs in 2Q 2019 Biopharma flotations have rebounded from a slowdown in late 2018, and reached 20 in the second quarter of this year, up to the levels of early 2018, which were a significant bounce from the lows of 2016 and 2017. .

Source: Evaluate Pharma, Biotech IPOs By Quarter on Western Exchanges, July 2019

Consumers using at least one digital health tool In 2018, 89% of surveyed consumers used one or more digital health tools. This was up from 80% in 2015. The major category was online health information (80%), followed by online provider reviews (64%), live video telemedicine (34%), wearables (33%), and mobile tracking (28%).

Source: Rock Health, Digital Health Consumer Adoption 2018

36%

Healthcare companies reporting >20% salesforce turnover There is significant turnover among sales staff across the industry, according to a new report from Beghou. 36% of companies said they had greater than 20% turnover, 45% had 11-20%, and only 19% had 10% or less.

Source: 2019 Emerging Pharma Pulse Report, “What To Do With All This Data,” Beghou Consulting

COMMENT HS&M JULY/AUGUST 2019 | 38

PHARMACEUTICAL

Great Advice From Great Minds:

Working With, Not Just For, Patients Jill Donahue interviews Allergan’s International President Marc Princen At eyeforpharma Barcelona in March, we were fortunate to be able to sit down with Marc Princen, President, International, for Allergan.

Marc held several positions for Schering Plough – General Manager, Senior Director, Regional VP – all over Central and Eastern Europe, the Middle East and Africa, before moving on to Merck as their President of Diversified Brands and President of Mid Europe Region. He then went to Takeda and led their European and Canadian business operations from Zurich.

Allergan recruited him in 2016 to be EVP and President, International Business, where he is

39 | HS&M JULY/AUGUST 2019

responsible for worldwide markets outside the U.S. With such an impressive resume, what is it that occupies his energies today? “We want to make it real for patients, making it part of our DNA,” he told us. “Let’s find ways to work with patients rather than doing things ‘for’ patients.”

We were pleased to know that someone of Marc’s stature is as committed to patient centricity as we have been for the last several years. He thinks that what’s on

the patient’s mind and what’s part of the patient journey should be integrated in the way you operate.

And, as we’ve noted often, focusing on the patient leads to greater trust, greater engagement, and serving more patients —resulting in greater profitability. Our sustainable cycle starts with this focus on the patient. It is essential.

He sees as part of his job the responsibility to articulate the purpose of the company and the people who work there. “Employees are more intrigued, more

Marc Princen

pany to bring other points of view to the table.

Of course, this is all in service to the focus on the patient. “We have a medical aesthetics department, with products that are much closer to the patients,” Marc says. “We organize awareness and information from consumers and patients. This helps us understand the advantages of the product, how consultations can be done better. It’s not traditional pharma, but it helps us to learn and get closer to people.”

engaged, more excited to deliver outcomes” when they understand the purpose, he says.

“For instance, we have an R&D department. If we make wearables and sensor data more accessible to the R&D people, they will be more in touch with the patient’s daily life, and how to help them.”

This is especially interesting coming from a man who confesses he was “born with two left hands” and was “the last person you would trust your technological or digital development to.” Yet he dedicated himself to learning the vectors of digitizing healthcare. In this search, he was impressed with the “infinite optimism everyone demonstrates” in that sector.

He was “bitten by the digitalization bug” and intrigued by the potential he saw: quantum leaps via technological breakthroughs, transformation that leads to sustainable growth, the unlocking of learning potential throughout the organization, and more. He became an advocate of “listen, learn, experiment.” Experimentation, of course, always carries risks, but it also

leads to those quantum leaps. He says this led to “internal functions [being] enthusiastic and ‘infected’ with the digitalization ‘virus’ so that everyone feels and belongs to this new reality. Undoubtedly integrity and ethics are at the heart of all we do and certainly these values facilitate and advance sustainable progress.” He also became open to co-creation and partnerships – working outside the com-

While he values the science behind all of their products, “chemistry and biology and technology don’t matter if you’re not focusing on making it more visible and practical for patients to cope with their diseases. The human touch helps facilitate all that we do.”

Most inspiring, Marc encourages all of us to “embrace uncertainty, ambiguity and change…And do not forget to wake up with optimistic thoughts every day [to] create a healthier life for patients.” •

Jill Donahue Principal, Excellerate Author, Engage Rx: The 3 Keys to Patientfocused Growth Co–founder, The Aurora Project Jill, HBa, MAdEd, is a keynote speaker, author and thought leader who has authored two books on Influencing in patient-focused ways and co-founded The Aurora Project, a global patient-centricity group. She also serves as Associate Editor of Healthcare Sales & Marketing.

Jill.Donahue@excellerate.ca

COMMENT HS&M JULY/AUGUST 2019 | 40

MOTIVATION

MOTIVIDEOS

By Cari Kraft, Jacobs Management Group That early-morning meeting always needs some rocket fuel to get people excited, engaged and energized. Here are some videos that help you access all different kinds of abilities you may not know you have — or can improve significantly.

OPTIMIZING SOCIAL INTERACTIONS

DREAM BIG

If you’re in a client-facing role, every contact is a challenge to impress, to express, and to get to “Yes.” Here’s a simple way to display the authentic essence of your personality and make that work in any conversation.

Any sales meeting is a study in strategy. How to make your case. How to win over objections. How to incorporate the needs of the person you’re talking to. Denzel Washington has leapt many hurdles in his career, and here’s how he has negotiated a path to winning – think big, and fall forward.

CHUNKING AND OTHER WAYS TO MANAGE LIFE Throughout our career, we run into major projects that can seem overwhelming. But we have to tackle them anyway. This video walks you through some ways to dial down the anxiety and ratchet up the confidence and success rate for these daunting tasks.

SELF-DISCIPLINE: SEVEN EASY STEPS Self-discipline isn’t a simple, single thing. It’s a process. In compensation programs or in performance reviews, you can enhance self-discipline by using these steps – easy habits, rewards and more – to improve the process and increase the progress toward goals.

Submissions are welcome. If you have one you like, email a link to me at ckraft@jacobsmgt.com.

Cari Kraft leads a team of master level recruiters at Jacobs Management Group, celebrating 30+ years of executive recruiting in the healthcare (pharmaceutical, medical device, biotechnology) and high-tech industries, nationally. Prior to joining Jacobs Management Group, Ms. Kraft has held positions as a Senior Sales Executive, Director of Business Development and Director of Marketing. She also has deep knowledge of the technology/startup fields, having been in the industry through the rise of the Internet. Ms. Kraft is a University of Pennsylvania/Wharton alumnus holding a degree in economics and decision sciences. Cari can be reached at ckraft@jacobsmgt.com.

COMMENT 41 | HS&M JULY/AUGUST 2019

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OPTIMIZING SOCIAL INTERACTIONS

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43 | HS&M JULY/AUGUST 2019

DREAM BIG

SELF-DISCIPLINE: SEVEN EASY STEPS

HS&M JULY/AUGUST 2019 | 44

INDUSTRY

Why I Work In Healthcare

If you tried, you could probably come up with a number of reasons not to work in healthcare. People who “don’t like the sight of blood” will never become clinical professionals. Those who aren’t science-oriented won’t enjoy the chem and bio involved. Some don’t find statistics fascinating. And there are those who don’t hold the industry in high esteem. What a shame, because it is clearly one of the most rewarding industries in which to apply yourself, on the sales, marketing, scientific, technical, strategic or patient service areas. We have been witness to this in our continuing exploration of why people choose healthcare. Here are more of those professionals, whom we met up with at the recent Healthcare Businesswomen’s Association (HBA) conference.

45 | HS&M JULY/AUGUST 2019

September 19-20, 2019 Four Seasons Resort & Club Dallas at Las Colinas Irving, TX

WE BROUGHT TOGETHER A GROUP OF DISTINGUISHED PROFESSIONALS THAT HAVE RISEN TO THE TOP OF THE HEALTHCARE INDUSTRY!

Douglas Reding Chief Medical Officer Ascension Wisconsin

Jeffrey Bacon Chief Medical Officer, Divisional Medical Director & Family Medicine Physician Banner Health

A well organized informative and friendly meeting. An excellent opportunity to meet new colleagues, and learn about what’s being used and what’s being offered.

Vice President & Chief Medical Officer Memorial Hermann – Texas Medical Center

Chris Thomson SVP & Chief Medical Officer Centra Health

FJ Campbell Chief Medical Officer Ardent Health Services

INDUSTRY

Why I Work In Healthcare

47 | HS&M JULY/AUGUST 2019

September 19-20, 2019 Four Seasons Resort & Club Dallas at Las Colinas Irving, TX

WE BROUGHT TOGETHER A GROUP OF DISTINGUISHED PROFESSIONALS THAT HAVE RISEN TO THE TOP OF THE HEALTHCARE NURSING INDUSTRY!

Katrina King Chief Nursing Officer Novant Health

Lorie Shoemaker Division SVP & Chief Nursing Officer CHI St. Luke’s Health System

I did not expect to enjoy the speed-vendor visits, but they turned out to be the highlight of the event. No one was pushy in their presentation. I learned about several options that I am looking forward to exploring further.

Vice President & Chief Nurse Executive Rush Oak Park Hospital

Vince Gore Vice President of Nursing Methodist Specialty and Transplant Hospital

David Allen Chief Nursing Officer Methodist Specialty and Transplant Hospital

INDUSTRY

Why I Work In Healthcare

49 | HS&M JULY/AUGUST 2019

COMMENT

MARKETING

The Secret to Growth?

Adapt Your Brand One of our missions at HS&M is to bring to the forefront tools and techniques to bring our readers best practices in the industry. While we usually share lessons learned through direct success stories, we have heard so much about Klick Health’s new Adaptive Brand Playbook that we reached out to see if we could find a way to bring it to our readers.

Klick was gracious enough to allow us to give you an overview of the playbook, its origins and offer it to our readers. With over $30 billion spent on medical marketing in the United States alone, this seemed like a useful service to help make your marketing more efficient.

51 | HS&M JULY/AUGUST 2019

THE ORIGIN OF THE ADAPTIVE BRAND PLAYBOOK We all want to know what’s coming next, what HCPs and patients want, and how to communicate our differentiation to them better than any of our competitors.

Leerom Segal, co-founder and CEO of Klick Health, set his agency on the path of helping clients discover those things. “For decades, there’s been a gap between what sales and marketing have wanted to achieve – a highly effective personalized message delivered at just the right time – and

The only Awards to focus on what matters – value for patients and HCPs. December 11th, The Bellevue Hotel, Philadelphia

www.eyeforpharma.com/awards-evening/

MARKETING

the ability to deliver and measure it,” he said. “Over the last few years, technology has helped close that gap, and we wanted to understand marketers’ understanding of current technology, and barriers to using it.”

In their exploration, they discovered that life sciences marketers may know the current state of the art but fall short in building infrastructures and policies that are adaptive based on a single view of each customer. It’s that adaptivity that Klick set out to quantify.

The result was what Klick calls the Adaptive Brand Playbook. What makes an Adaptive Brand? We spent some time with Peter Flaschner, Klick’s Managing Director of Brand Experience, who notes, “an Adaptive Brand is able to rapidly take advantage of the changes 53 | HS&M JULY/AUGUST 2019

in the market, new targeting methods, new channels, new messaging opportunities. One that gets much closer to the needs of the patient and the needs of the physician. It is the opposite of setting a message once and never changing it. It goes in the face of the traditional methods and focuses on building a brand that everything can sit on top of and change without losing its footing.”

The Adaptive Brand Playbook addresses this monumental shift from old approach of one-to-many sales and marketing to the new model of one-to-one. “The Adaptive Brand Playbook outlines the approach we’ve honed over the last 22 years working exclusively with life sciences brands,” says Segal.

It deals with brand identity, target audiences, precision of messaging,

media strategy, pre-commercial activities (like KOL and influencer identification), and more – the entire spectrum of strategic decisions that contribute to successful marketing campaigns.

Key takeaways tell us that adaptive brands: • nimbly evolve • are grown, not built • cost less • are best achieved by starting sooner • go deep and forge new paths • discover new processes and are adaptive in action Building an adaptive brand revolves around answering and reanswering a series of questions.

• What do we know to be true?

• What could we do?

• What should we do?

• What will we do?

• How will we do it?

And it touches the entire process.

How do we develop creative? How do we map out the totality of the ecosystem? What is the experience blue print? How do we orchestrate and execute a launch? What are the benefits? Peter highlighted a few: • Being able to manage a 5 year launch plan and communicate to affiliates in a way that allows them the autonomy to customize messages for their immediate market and still stay on target • Providing a scientific and messaging platform that supports the wide variety of programs, from a scientific conference happening in Berlin to a local marketing campaign or an internal all hands meeting • Incorporating the concept of building a better problem so we understand the world more broadly than in the past and incorporate digital ethnography, behavioral studies, real world evidence, and identify areas to have the most impact • Leveraging the value of storytelling and moving beyond the static patient journey and targeting three to four large segments to creating more precise targeting and individualization WHAT DRIVES BEHAVIOR? “Data is at the heart of the Adaptive Brand Playbook process,” Peter says. “It provides a platform for creativity and connection. So regular feedback on a cadence that can be actioned upon by the organization is critical.” He explains that all the elements in an adaptive marketing ecosystem work as both message platforms and sensors.

“The secret is to collate the data in a single view so that advanced analytics can be performed on the

whole dataset. This is necessary to establish what is actually driving behavior, versus what was the last touchpoint.”

To offer real world experiences while respecting client confidentiality, The Adaptive Brand Playbook contains a hybrid case study on a product Klick calls “Rellyant.”

The Rellyant brand is an amalgam of several different real-world brands their teams have worked with over the years. Other sections cover The Case for Change, Building a Better Problem, Tension Point Brief, Brand Idea vs. Brand Positioning, Moments that Matter More, Orchestrating the Ecosystem for Launch, A Brand Experience Blueprint, and Anticipating New Potential.

EVIDENCE-BASED MEDICAL MARKETING What’s the power of the playbook?

Over the past 18 months, Klick has helped several large organizations adopt an adaptive marketing model. One, in oncology, saw an 11-time increase in year-over-year diagnoses as a result of applying an adaptive model to its DTC program – without changing its overall budget. That’s a metric any client can love.

In sum, the aim of the adaptive approach is to help brands achieve their full market potential. It contains real-world research, insights, and creative in its capacious 230page volume, designed in a sleek plexiglass case with an integrated 21-inch HD video screen to provide a robust multi-media experience. It’s both comprehensive and easy to follow, thanks to a stepby-step blueprint on how to build and activate brands that adapt and thrive in today’s fast-paced, everevolving market.

Having worked with some of the biggest brands in the industry, Klick has had significant experience strategizing, creating and analyzing the trajectory of brand success, as is also evidenced by their mountain of awards and recognition from Cannes Lions, Deloitte and other prestigious watchers of the industry.

Flaschner adds “An adaptive brand is grown, not built. It goes beyond traditional brand planning, medical strategy, and creative inputs because it contains the code necessary to adapt and thrive. An adaptive brand is better on Day One because it is built on better insights and it’s expressed with greater relevancy. It will be better on Day 100, because its systems and platforms will have evolved, and it will be better every day thereafter through its life, because it will continue to outperform expectations.”

EDUCATION AND INSPIRATION The Adaptive Brand Playbook provides clear and actionable insights, as well as practical tools to help life science marketers. But, says Flaschner, as much as the Adaptive Brand Playbook is designed to coach marketers through the adaptive brand building approach, it’s also designed to inspire them with a captivating, creative design and form factor.

We are pleased to be able to offer this playbook to our readers. To request your copy of the Adaptive Brand Playbook, go to brandplaybook.klick.com. •

COMMENT

HS&M JULY/AUGUST 2019 | 54

NEW! AGENCY AND PROVIDER DIRECTORY! Healthcare Sales & Marketing’s New Feature As a value to the industry, we have initiated a project to profile the top agencies so that you have them at your fingertips. We are compiling digitally a searchable single source to give you access to the who’s who, their strengths, vision for the future, leadership and strategies, so that you can get a better feel as to how they work.

We are driven by the input of our readers so please let us know if you have an agency or provider you would suggest we profile. You will see some of the best with links to all their websites, their philosophy and history, as well as what makes them special. This is all in keeping with our goal of having the hottest industry companies and the top thought leaders in in the pages of every issue of HS&M. Our goal is to constantly expand the value we bring to you.

If you would like to be featured, or have an agency or provider to recommend, please reach out to our Associate Publisher, Natalie Newcamp, at nnewcamp@hsandm.com.

55 | HS&M JULY/AUGUST 2019

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57 | HS&M JULY/AUGUST 2019

AGENCY & PROVIDER DIRECTORY

Company Overview: Founded by doctors, engineers and data scientists, COTA is committed to bringing a patient first approach to cancer care through the use of real-world evidence. The Company organizes fragmented, often hidden data from the real world to provide clarity in cancer care. Combining clinical expertise in cancer with proprietary technology and advanced analytics, COTA’s platform helps inform decisions and action in oncology. COTA partners with providers, payers, and life science companies to ensure that everyone touched by cancer has a clear path to the right care. To learn more about COTA and how to make better decisions with the right data, visit cotahealthcare.com.

Address: 100 Broadway, 7th floor New York, NY 10005 Phone Number: 866-648-3833 Website: www.cotahealthcare.com Social Media: https://twitter.com/cotahealthcare https://www.linkedin.com/company/cotainc https://www.Facebook.com/COTAInc/

Leadership: Mike Doyle – President & Chief Executive Officer • Andrew Nordon, MD – Chief Medical officer • Elizabeth Rushforth – Chief Legal Officer • Bernard Chien – Chief Technology Officer • Vivek Kumar – Senior Vice President, Operations and Delivery • C.K. Wang, MD – Senior Medical Director, Clinical Oncology • Elizabeth Lamont, MD – Senior Medical Director, Outcomes Research New Business Contact: Jaimee Ryan 617-733-5509 Jaimeeryan@cotahealthcare.com Year Founded: 2011 Number of People: 100 Areas of Expertise: Cancer care, real-world evidence, real-world data, precision medicine, oncology, technology.

What’s New: COTA recently won the Health Tech Challenge at the eyeforpharma conference in Philadelphia! Our senior medical director, Dr. C.K. Wang discussed how real-world evidence can answer key questions in cancer care. COTA has some exciting news coming down the pipeline, so be sure to check back on our social pages for updates and news announcements including a brand new website!

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AGENCY & PROVIDER DIRECTORY

Company Overview: Experts OnTap – the modern approach to niche industry expertise connect leaders in Medical Device, Pharmaceuticals, Biotechnology and Diagnostics to free lance expert consultants who have “been there and done” experience. Experts OnTap services clients nationwide, seamlessly and effectively ensure they have the expertise when and how they need it most.

Leveraging a network and elite identification strategy from 30+ years in the industry, our clients know that the specific expert they need is only a phone call or email away Address: 1309 School Lane Rydal, PA 19046 Phone Number: 215-383-3013 Website: ExpertsOnTap.com Social Media: https://www.linkedin.com/company/experts-ontap/

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Leadership: Pierce Kraft – Founder and CEO New Business Contact: Pierce Kraft pkraft@expertsontap.com 215-383-3013 Year Founded: 2018 Service Focus: “The modern approach to niche industry expertise”- Connecting industry leaders with freelance expert consultants in Medical Device, Pharmaceuticals, and Biotechnology.

Areas of Expertise: Business Development, Clinical, Commercial, Engineering, Marketing, Market Research, Manufacturing, Product Development, Project/Change Management, Research and Development, Regulatory, Sales Growth and Turnaround, Scientific, Supply Chain, Technology, Trade Compliance, Quality What’s New: Experts OnTap will be releasing a brand-new survey in the coming weeks detailing how companies are utilizing freelance consulting expertise specifically in the Life Sciences.

AGENCY & PROVIDER DIRECTORY

Company Overview: LIFT is an independent healthcare research, design, and marketing communications firm serving the life science space—particularly the pharmaceutical, biotechnology, and medical device industries. Headquartered in Chattanooga, Tenn. with offices in West Palm Beach, Fla. and Raleigh, NC, LIFT approaches its core competencies of insights, branding, storytelling, and content marketing through the lens of design thinking—leveraging the practice of anthropology, ethnography, and extreme stakeholder empathy to generate truly human-centric results at all stages of the consumer and product development lifecycles. To learn more, visit www.lift1428.com.

Address: 600 Georgia Ave, Suite 1, Chattanooga, Tenn. 37402 Phone Number: 423-509-6721 Website: www.lift1428.com.

Leadership: David McDonald – Founder and CEO Diane McDonald – Founding Partner and COO Brian Shakley – Executive Vice President and Partner Dave Chlastosz – Executive Vice President and Partner Chris Snell – Executive Advisor Of-Counsel New Business Contact: David McDonald David@lift1428.com 423-596-2635 Year Founded: 2012 Number of People: 12 FTEs + Expanded Roster of Contracted SMEs Areas of Expertise: Stakeholder Research (Qual/Quant), Design Thinking, Organizational Development, Stakeholder Education/Activation Strategy (Pre- and Post-Marketing), Custom Content and Publishing, Documentary Film Production, Commercial Marketing and Advertising

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AGENCY & PROVIDER DIRECTORY

Company Overview: McCann Managed Markets is a strategic health care communications agency specializing in managed care marketing. We develop customized solutions across the managed markets value chain for a range of customer segments, including payers, health systems, organized provider groups, employers, pharmacists, office staff, and patients. Guided by our expertise in strategy, launch execution, and innovative solutions, we are well equipped to help clients navigate the complex and evolving managed markets landscape. As an integrated part of McCann Health, a global network of companies across 6 continents, we work on multiple cross-portfolio deliverables for our clients.

Address: 49 Bloomfield Avenue Mountain Lakes, NJ 07046 600 Battery Street San Francisco, CA 94111 Phone Number: 973-917-6623 Website: www.mccannmanagedmarkets.com Social Media: www.facebook.com/McCannManagedMarkets/www. linkedin.com/company/mccann-managed-markets/ www.instagram.com/mccannmanagedmarkets/

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Leadership: Kim Wishnow-Per President New Business Contact: Roshan Rahnama roshan.rahnama@mccann.com 862-777-0742 Year Founded: 2002 Number of People: 66 Parent Company: The Interpublic Group Awards: 2016 Healthcare Network of the Year—Lions Health 2017 Healthcare Network of the Year—Lions Health 2018 Med Ad News Best Managed Markets Campaign Areas of Expertise: Market access, above-brand solutions, patient access and reimbursement, pharmacy, and integrated pull-through.

What’s New: We have an additional office in California Brand/initiative wins: 12

AGENCY & PROVIDER DIRECTORY

Company Overview: We connect pharmaceutical brands to the right consumers from the moment they begin their search for health options in our premier network of pharmacies and continuing to do so wherever their healthcare path may take them. Rx EDGE Media Network is a leader in the healthcare marketing industry with over 18 years of experience delivering hundreds of successful campaigns for pharma brands.

Even as media consumption becomes increasingly dispersed, the pharmacy exists as the single mostoften visited healthcare destination in the lives of Americans, and combined with digital technologies, it produces an exceptionally broad reach.

Address: 111 Water Street East Dundee, IL 60118 Phone Number: 800.783.7171 Website: www.rxedge.com Social Media: LinkedIn: https://www.linkedin.com/company/ leveragepoint-media/ Twitter: @RxEDGE Leadership: Nate Lucht, President and CEO nathan.lucht@leveragepointmedia.com New Business Contact: Michael Byrnes, EVP Sales Michael.byrnes@rxedge.com 610.431.7606 Year Founded: 2000 Parent Company: LeveragePoint Media | LLC

Awards: PM360 Trailblazer Awards PM360 Elite Awards DTC Perspectives Advertising Awards PM360 Pharma Choice Awards Service Focus: Rx EDGE Media Displays: Through our prominent, strategically-placed displayed delivered in a network of 27,000+ retail pharmacies, we help pharmaceutical brands motivate consumers at the most relevant times…when they are actively searching for ways to take care of themselves. Our Media Displays enlighten, engage, and inform.

Rx EDGE Unlimited™: This cross-channel solution combines the power of our brick-and-mortar network with premium digital inventory and advanced analytics to bring pharma brands and audiences together. Rx EDGE Unlimited delivers exceptional reach, frequency, and influence.

Insight EDGE™: A suite of data resources that the Rx EDGE analytics team applies to every program to ensure that pharma brand messages are seen by the right consumer.

Areas of Expertise: We Maximize Impact: Rx EDGE is the only targeted media platform that uses the pharmacy as a consumer’s gateway to immediate information as well as ongoing connections to the pharma brands that are relevant to their healthcare needs. Brands that use Rx EDGE programs see an average script lift of 12.5%.

We Align the Right People, Places, and Times: Through our relationships with key retailers, we can access data not commonly available through other marketing service providers − making our Insight EDGE™ targeting platform unique in the pharma marketing space.

We Offer Proven Results: Measurement defines the core value we bring to every initiative. Using thirdparty analytics, results are evaluated with a significant level of precision. In addition to a lift in prescription volume, our programs also result in an average return on investment of $8.12.

What’s New: Rx EDGE Unlimited™ is a new cross-channel approach that combines Media Display, mobile, and programmatic digital ad placement to boost campaign effectiveness.

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AGENCY & PROVIDER DIRECTORY

Address: 12809 Mirabeau Pkwy, Spokane Valley, WA Phone Number: 509-242-0767 Website: www.NextIT.com Social Media: www.linkedin.com/company/verint/ twitter.com/Verint Leadership: Michael Southworth, GM Tracy Malingo, SVP Product Strategy Joe Dumoulin, CTIO Mitch Lawrence, SVP Commercial Sales New Business Contact: Nick Genatone ContactNextIT@Verint.com Phone 509.242.0767 Year Founded: 2002 Number of People: 270 Service Focus: Conversational AI, Intelligent Assistants Parent Company: Verint Awards: AI Breakthrough, Best Overall AI Solution • NextGen Innovation of the Year • eyeforpharma Most Valuable HCP Initiative • Fierce IT Healthcare Fierce Innovation Award • PM360 Innovator, Product Pick • PM360 Marketing Initiative of the Year 63 | HS&M JULY/AUGUST 2019

Areas of Expertise: Verint Next IT, a division of Verint, is the team the life science community counts on for intelligent solutions to modern healthcare problems. We unlock the value of human relationships with the power of conversational AI. Verint Next IT has delivered the broadest portfolio of AI-powered, conversational Intelligent Virtual Assistants configured for Diabetes, Multiple Sclerosis, Parkinson’s disease, and Women’s Health, with several more launching in the coming months. The technology is configured to improve health outcomes, provide access for patients and caregivers to product and health literacy, connect physicians to patient data, and improve the overall experience for patients, healthcare providers, and consumers. To learn more, visit www.NextIT.com.

What’s New: • “Ask Sophia’, Novo Nordisk’s new online and smart speaker intelligent assistant, available 24/7 on Cornerstones4Care.com and Amazon Alexa via “Ask Digital Sophia” for diabetes questions • UCB’s New PD Coach App “April” launched to support those living with Parkinson’s Disease, available in Apple and Android app stores. April address specific challenges that Parkinson’s patients and their caregivers may face – including the ability to learn and adjust to language and vocabulary for patients with dexterity and speech issues.