Medsider: Learn from MedTech and HealthTech Experts

The Biggest Mistakes Medical Device Companies Make When Commercializing in Europe: Interview with Michael Branagan-Harris, CEO of Device Access UK

March 07, 2017 Scott Nelson
Medsider: Learn from MedTech and HealthTech Experts
The Biggest Mistakes Medical Device Companies Make When Commercializing in Europe: Interview with Michael Branagan-Harris, CEO of Device Access UK
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Medsider: Learn from MedTech and HealthTech Experts
The Biggest Mistakes Medical Device Companies Make When Commercializing in Europe: Interview with Michael Branagan-Harris, CEO of Device Access UK
Mar 07, 2017
Scott Nelson

Michael Branagan-Harris is the CEO of Device Access UK and has been involved in the marketing of medical devices to the National Health Service (NHS) for the last 27 years. Products he’s commercialized range from simple wound dressings to the introduction of the Lap Band for obesity, endovascular graft repair, endo laparoscopic surgery, and the...[read more]

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Show Notes Transcript

Michael Branagan-Harris is the CEO of Device Access UK and has been involved in the marketing of medical devices to the National Health Service (NHS) for the last 27 years. Products he’s commercialized range from simple wound dressings to the introduction of the Lap Band for obesity, endovascular graft repair, endo laparoscopic surgery, and the...[read more]

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Scott Nelson:   0:08
Welcome to Med Cider, where you can learn from experienced medical device and med tech experts through uncut and unedited interviews. Now here's your host, Scott Nelson. Hey there, ladies and gents, welcome to another edition of Med Cider Radio brought you from the W. C. G studios here in Minneapolis. If you're new to the program meant side of radio is where we learn from med tech and other health care thought leaders through uncut and unedited interviews. Just a few quick messages before we get started. First, I sent out a free email newsletter about once per month, highlighting my favorite med tech and or health care related stories, the one that I personally get a lot of value from. I don't send the newsletter out very often, but when I do, I really try to make sure it's valuable. So if you're interested, head on over to met cider dot com and enter your email address as a bonus, I'll send you a free e book on the strategies I personally used to make connections at conferences. 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Reach fire digital. I know Pan optic stacking. It sounds sophisticated, right? Well, to be honest, it sort of is. But let me try and explain. First, they validated some of my messaging in real time and developed an automated customer pathway based on my audience. Your bedside, then utilizing something called eco marketing. They're using behavioral targeting to move that same audience through a customized online journey. After executing my personalized pan optics back, I'm already seeing a really nice impact, and I'll share some of those results in future episodes. So if you're interested in learning more about the system, the team over reach fire. Digital has agreed to build a custom pan optic stacking blueprint for the 1st 15 men cider listeners that respond to this message. We normally charge 2500 bucks to build one blueprint, but because they're big fans of med cider, they're giving it to our 1st 15 listeners for free. So go to reach fire. Digital dot com Ford slash med cider again US. Reach fire digital dot com Ford slash med Cider Grab that blueprint okay onto the upset. Michael Brannigan Harris is the CEO of Device Access U K and has been involved in the marketing of medical devices to the National Health Service, or N HS, for the last 27 years, from simple wound dressings to the introduction of the lap band for obesity endovascular graft repair into laproscopic surgery in the Da Vinci robot. Since incorporating device access U K in 2010 that Michael and his team have helped over 180 medical device and diagnostic companies navigate their way into the N HS. The clients range from small startups toe large multinationals for across the world. In 2014 Device Access was granted a unique commercial license from N HS England Tax ES over 750 million sued anonymous patient health records. This data allows device access to examine diagnosis procedure and spin data, national ing and by N HS hospitals, and in turn, enables them to do three things. See how the client's technology could affect the current patient pathway number to assist in building a value story with Nice in three. Develop a solid business case for local and national in HS hospital adoption. In this interview with Mike, Here's some the things we're gonna cover what has changed since my last interview with him some 4 to 5 years ago, especially as it pertains to the N. H s nice and then I see or National Innovation Center the current and pretty significant need for med tech innovation in the UK, The biggest mistakes med tech companies make when commercializing in Europe. The ideal process medical device company should follow when launching their devices in the UK, including Mike's PICO framework. That's P I. C E O and Connect four methodology, which are, I think you'll find really interesting and lastly, Mike stocks on Brexit and what it means for med Tech in the UK So without further ado, let's get to the interview. Mike, welcome back to med cider in recent sort of offline conversation between the two of us, I know we were were kind of discussing that it's been probably a good four or five years since your first go around. And I think actually, you may be the first repeat guest here on med cider. So for what that's worth, Congratulations,

Michael Branagan-Harris:   4:36
E. What happened?

Scott Nelson:   4:38
I think they will for sure, especially as it pertains to European commercialization from med tech companies, especially there in the UK. So let's go and die right in and and we'll start with our last conversation that we recorded back in, I think 11 4012. Can you help us understand a little bit about what's changed over the past four or five years, especially as it pertains to Nice.

Michael Branagan-Harris:   5:00
Absolutely. Yeah, so just so that we can get this. There's gonna be lots of acronyms going on with this interview, and I'll make sure that everybody knows what we're talking about that we have. The National Health Service, which is publicly funded health care system, has been around for decades. Andi, it's privately funded

Scott Nelson:   5:18
on.

Michael Branagan-Harris:   5:18
It means that we get health care provided through paying tax on basically free at the point of care. So it is a national, nationally funded healthcare system you mentioned Nice Nice is a body, which is the National Institute of Health Care Excellence, which is a body burn it by the UK government. That's put there to on understand the benefits and the risks on the economic around, new medical technologies on diagnostics, so that the body in and I was described. Nice is when I'm talking to people in America, it's almost like J D Power, your consumer organization that tells you which type of deep bio or cries lit by. I mean, it's really their job is to inform the National Health Service on best practice. Best technology that's really getting over What? What has happened since I last A number of years ago, we talked about the national innovation. The National Innovation Center is now no longer have changed and followed up by some other organizations within the National Health Service. Then what happened in you know about five years ago was that the National Health Service commissioned Nice to do some new programs around the evaluation off medical technologies and diagnostics. And those two programs were designed to help promote the uptake off new, innovative technologies for the benefits of the N. H s and patients both quite exciting, because before then, there are only two programs that were available to look at medical devices. One of them only lifted Spacey and efficacy off a new procedure. A new invasive procedure on the other One was an older program, which is still running. But for pharmacological product, which would evaluate technologies around cost effectiveness and qualities, you know it has changed. The approach used by Nice has changed significantly since then, and so well, what we have now is a couple of excellent programs which are able to have any weight products on back off six medical technology, which can result in on dancing from Nice to the N H s and two others about adopting new technologies and encouraging them to use them. That's very powerful when you get that happened. When they mentioned the brand it for this as well, because they actually evaluate single names technology through these new programs.

Scott Nelson:   7:51
No, no, that's a great recap. Just to review you got the N hs, which is, you know, is still the still the same governing body as you know as before. You know, based on the last time we spoke, Then you've got nice, Of course, which I think that analogy that you used is is a great one in the sensitive sort of service is a J D. Power or almost like the consumer, you know, consumer reports, so to speak, in forming the N h s on what technologies to adopt, etcetera. But the one sort of them the major organization, If you want to call it that, that's changes the National Innovation Center, which we discussed at length in our previous interview. But that's no, that's no longer in place. And now you've got you've got a couple of new programs that have sort of in Conjunction with Nice. That's sort of have taken its place. Die that right?

Michael Branagan-Harris:   8:35
Absolutely. Exactly. Yeah, I mean the end. The other thing that's changed. It's changed in many health care system, and certainly I know your own. And all of them is that we're in a situation where we have a massively growing elderly population on. Interestingly, back in 2014 there was some work done that the N Hs needs build. We need to build 20 to 800 Bennett hospitals on by 2022. Now that's a lot of hospitals, a lot of bed, and it's a lot of staff, and it's a lot of costs on you. No man for months here on your the N. H s is is under increasing demand on it. Either has to build the hospitals or it has to adopt a new technology. I don't think there's a better time than there is now for companies considering us activities. T look of coming to help soul problems with very clever technologies designed out in the U. S. And come to this country is that the opportunities that

Scott Nelson:   9:38
that's a great point is I think a lot of folks, especially in pure play. Med tech companies and I could maybe maybe making a wrong assumption here. But they look a at commercializing in Europe for a couple reasons. One is to get, you know, establish a regulatory pathway, you know, in hopes of potentially commercializing in the U. S. With an FDA clearance or secondarily, you know, something that Ted Lambs and mentioned in a recent interview I did with him. He's the founder of Neo Track. They commercialized in Europe, a couple different reasons. One is they really They didn't have another choice. Do the FDA environment at the time. And then, you know, as it turns out, it really it really behoove them to commercialize in Europe because it gave them really help them mature in their commercialization strategy and help them prepare for an eventual launch in the US But those you're basically bringing up the third point, which I think is really, really valid in that there's a huge existing need to fill in the UK with that that program. I'm not sure if that program has a specific name, but there's this huge need to build all of these new hospitals to serve that elderly population. And so a lot of metal companies would, you know, if they just viewed, you know, commercializing in the UK and Europe through those lenses to serve that existing need That would be sounds like a pretty good potential business toe. Commence there. Would you greet

Michael Branagan-Harris:   10:50
it? Absolutely. I mean, you're absolutely right. I mean, cos I work with 200 companies, which is a lot of companies. A lot of people that will already know me from this Anyway, on, you know, lots of products and lots of therapeutic areas. You know, we were extensively in some areas, but I can't think a single part of the body that we've no actually worked on in terms of a product. And it's been really interesting number of years, but yeah, you're right. I mean, the opportunities are here to to come. Oh, us on developed clinical evidence on to get perks establish, you know, create value along the way, which is still important when you're south of company, demonstrate to the investors and others that you are making progress on. Do you have a key milestones along the way? So it's important. Most companies and I worked with a network of reimbursement consultants from across the world. I've got somebody that's just relocated recently to Los Angeles. He's gonna be helping me. Andi, you know, I have people in Australia and people in Berlin, I mean, literally, all over the place. But but most companies actually consider this Germany and the U. K Market Spurs when they look at, you know, making global progress on their benefits with Germany, there's great places, great places to go and have a, you know, very clever. Reimburse insists that some of the drivers and I mean, I think one of the examples only just mentions are near track. I mean, you know, if you look at the n hs in the UK health care system compared to the German one, and it's a good example, actually, I mean, one of the benefits off having something like near track done it, that you can have it in an ambulatory setting on that means you come in, you have under local and you go out and you don't take a bed there. You don't take up much O. R time. It's quick. It's easy. You know, you avoid the risk of problems in hospital because you're in a night so quickly. Where is in Germany? They actually encourage patients on the system to be in the hospital for at least know tonight stay. And that doesn't make sense from a productivity per cent. And I think you'll agree in in the U. S. As well that, you know, the ambulatory office based procedures are growing area. It means the doctor's more productive and to drive a difference. I think so. You know, you have to consider that. So what's the benefit for the health care system? You know, it might be the incentive, a different in each country on so different. So you need to really work on how to gather the evidence around each of those scenarios

Scott Nelson:   13:35
to

Michael Branagan-Harris:   13:35
build value and a one of Anne's story in a value to your business.

Scott Nelson:   13:40
Yep. No. And I think that makes a ton of sense. And I definitely want to dive right into that. Use this part of the conversation to die right into that. That aspect of the discussion because you work. You know, Mike, with the with the time a CZ, you know, I'm preaching to the choir here. You work with the Tana early stage Med tech companies, in order to help them, you know, begin to commercialize in Europe and really the broader globe. From that perspective, I think you're you're kind of being humble, but you're pretty well known. And in this space on that note, a lot of early stage. But tuck companies come to you and you see them. You know, follow this sort of, you know, traditional process, if you will. That sort of laden with with mistakes. You know it's not. It's not the ideal process to follow, and it ends up kind of looking like they're trying to put a, you know, a square peg in a round hole, so to speak. Can you tell us a little bit more about like the process that you see a lot of that tech companies following that isn't really the best pathway to go with

Michael Branagan-Harris:   14:31
Yes, already. Good question. Actually, I think that the biggest, the biggest problem is it is it. It's about not considering reimbursement. It's as simple as that. It's almost like saying, Put another way on, this is a big relevant with recent poems in both of these countries. You can go in to a country you know, as an illegal immigrant, you could go with Visa, or you can go with a full passport, and the same thing happens is Thomas reimbursements concerns you might be the think even go so far without getting reimbursement and having a clear pathway, you can get limited reimbursement, which is like a visa, or you go for full reimbursement, which is like a passport. And I think that it's the same sort of analogy, Really. I mean, the biggest mistake is companies manufacturing product, putting prices on them, getting them, see Mark and then assuming that that that these countries gonna sell that so these countries are gonna be a buy them within the structure of the reimbursement system on certainly within the vessel or the system. You know, most of the time they're there are ways that you can get things paid for, but but you have to consider pricing as well, and how pricing could change considerably between market on. That can have a big difference to the company's strategy if the drivers are so different. So you know there's there's considerable, but it's really a soon as you, you know, It's like designing a Lamborghini or something like that. I mean, you like making a very expensive car, But but trying to sell it in one of the poorest parts of Africa are supposed to go into Monaco. You know where the money gonna be? How easy is it gonna be for that country to buy that product on? It's a simple thing. There's so many assumptions made about, you know? Oh, well, the NHL, you know, 300 also a lot of hospitals. That means they're gonna buy a lot hipper seasons. It probably does, but but it doesn't necessarily mean that all of them are gonna buy them. And it's really understanding activity on how to get the product paid for Andi. Importantly, what evidence you need to get that product paid for And one of the mistakes made is the assumptions that you know that nice might necessarily need very long, extensive, randomized controlled trials because, you know, in a number of the new programs you actually done, so people can be put on the wrong journeys on. They can spend a lot of time in areas they don't need to bond The best thing to do and it's open to possibilities. For this is to come and talk to nice and come and talk to other N hs bodies and ask them what they need and then deliver what they you know what they are doing. What you think that helps to get reimbursed.

Scott Nelson:   17:17
I definitely want to get into that. It is especially considering that, you know, you do this on a day in and day out basis, considering your close relationship with with some of the folks that nice. But going back to this these assumptions, you know, hearing your analogy, that the Lamborghini analogy. And you know what? You wouldn't build a Lamborghini for the poor, the poorest parts of Africa. You don't want to. You want to consider the country that you're eventually want to sell it into on whether they have the bandwidth you know, to afford, You know, a product like that that seems, you know, fairly basic, right? It's like business 101 But to your point, so many med tech companies miss this part. Do you know why that's the case, or do you have any hunt speculations as to why so many police age mid med tech companies miss that mark and why they don't They don't take a step back and sort of consider these, You know, what are what are sort of long term applications with respect to reimbursement and even even the second aspect that you mentioned, you know, you know, the clinical trial regulations and how expensive some of those can be If you don't really need that robust of, ah, clinical trial,

Michael Branagan-Harris:   18:14
Yeah, I think that's a really good question. I think that, you know, the world has moved on from, You know, I'm an ISIS cell, lots of Endor laproscopic products. And I was involved in gastric band being and bringing lots of technologies into the health care here before I started device access. But I think that, you know, the days have been a turn up on itself, something without somebody going into the detail of, you know, why do we want to buy this and you know how they're gonna be paid for it, that the world's really changed. And there's not that there's a big focus on marketing. There's a big focus on regulatory, but it doesn't ever appear to be that much of a focus on your market access and reimbursement, and I think that, you know, globally there. There's a big gap of knowledge here, and we're in extremely busy consultant B. But I think that there's not that many people to go to. And I think that you know where you got that the U. S. Health Texas, Then where your reimbursement means, you know, what can the doctor own for doing a procedure? And how can the insurer pay for it? And you have all your bands of insurance companies, and it's a different system here. I mean, the drivers are so different, and I think maybe sometimes it's the assumptions that it's the same sort of thing, but it's no, I mean, I often describe you know that the difference between N Hs, the National Health Service doctor on the New York fireman on their very similar people both paid a salary on both Don't carry a business card. So, you know, if you go to a New York firm and say to him, you know, how many fires did you put out yesterday? I put 10. How many stupid act there but 15 out and got She did really well you've earned lots of money today, but that's not the case. And you know, that's exactly what what in the nature doctor is as well. And so where is in America? Doctors are remunerated by doing multiple procedures, multiple diagnosis, multiple treatments, etcetera on. They earn money through that mechanism of activity. It doesn't apply here both. There's so many differences, and I think that that's partly why people make mistakes of these assumptions that you can turn up and go to places and just sell. But it's difficult. But at the same time, the difficulty in getting things into the system here really pays off. If you get your device approved, certainly through one of the nice programs have absolute global impact on day. No, it because it's one of the

Scott Nelson:   20:46
probably the most respected

Michael Branagan-Harris:   20:48
PH. D. A in the world. So you know, I was recently over at after marriage in Minneapolis talking to many medical device companies and one of them as far away Brazil said, We want nice approval because it's gonna help me get product into into the hospitals in Brazil. I mean, it's wide and far reaching. Yes, it's difficult now that you know it requires. You know what a highly specialized, very reimbursement on market access is. A brand new recognized all should be recognized. Gil.

Scott Nelson:   21:19
Yep, it's It's almost like the function that's becoming so important not just in the UK but if the U. S. As well a sort of this market access function. But it sort of doesn't it loosely exist, you know, But that is sort of a cross between, you know, traditional functions like regulatory, clinical and reimbursement. But market access is sort of almost like a combination of culmination of all three, especially for, you know, for med tech companies that are when they're in their early stages. I'm not sure if you'd agree with that description, but certainly how sort of I kind of see it market access anyway. But on that note, before we go any further, I love the analogy of the New York City Fire Man vs University in H N H s physician. That's that. That's a really good way to sort of help us understand. For those that aren't familiar with the European or the U. K health system, that's a good analogy. So, having said that, let's presume that I am a. It's a CEO of an early stage, you know, med tech company. And we've got we've got, you know, investments. You know, maybe early stage investment. And the slate is clean. I don't I'm not carrying a lot of baggage. Can you walk me through sort of the process that you would you would ideally like to see. You know, med tech companies follow as it pertains to getting nice approval within the UK.

Michael Branagan-Harris:   22:28
Yeah, sure. I mean, you know, we we offer a number of different packages to help companies in base. And the important thing is, we spend a lot of time trying to understand, you know, first of all, primarily what problem this medical device is gonna solve in our health care system on if you can focus on and work on the problem itself and trying to address it with technology, you run a much bigger success. Oh, higher rate of success of getting a product into the system as you would in any health care system. But we have something available in this market in England for sure there isn't available to my knowledge in any other health care system in the world and that is that we have access to Donna Mai's episodes of care from the N. H s database. What that is, is that any patient that goes into an NHL hospital in the last four years we have their activity in a database. The activity is split up into several different buckets. But primarily if you go into a hospital, then your basic information is recorded. Your age specs. How you went into the hospital with a general admission or was it a emergency admission? So we know how a patient go into the hospital. That's all recorded then We have information about patients age and sex on dhe reason for being there. So the primary reason for admission as one of any comb abilities as well. So, for example, you know, you could be in hospital, Could you broke your leg, But you could also have high blood pressure on B gonna benefit. But all that information is recorded, then all the treatments the patient has recorded, whether they lend to intensive care what treatments they had on it could be a primary treatment and could be secondary treatments as well. So, you know, we have a lateral C we have, you know, in the spine we have levels of buying data. We have open laproscopic under image guidance. All that information is recorded, and at the end of the of the episode of care, you have a CD that amount of money that episode costs available. Both were the company have access to 750 million episodes of care going back four years and were able look at them to see where a medical device could make a change to a patient pathway so we can look at patient pathways on an individual patient basis and see what would happen if they have any therapy. If they had a new medical device. When you diagnostic you, what difference did it make ANA local and national basis? And we'll use that information to then build a proper strategy to help companies to then engage with the N HS and particularly nice to then go and say, Look, this is a population of patients we're talking about now. You know what we talk about is the language of which we call PICO P for Population I for indication, Steve Comparator and over outcomes, though population is look, you know population of patients. That product is going to be used for all the population of patients with the actual diagnosis of a disease or for a problem on the population is critical or not. Come back to that in a second indication is what does your device do and how does it work? And how is it you know how to solve problems? See is Comparator that what happens at the moment in our health care system, how those patients treated on We know all about this patient because we can extract the data from our days. Basin examined her patients treated in the N. H s English hospitals on the outcome. What's the difference between the current therapy on your new technology? So we look at this information critically at this early stage of sort of try and see whether there's a valid case Brooke Technology to come into, You know, that would have a successful entry into the election, as well as looking at reimbursement analysis to see whether the technology can fit into the current reimbursement programs. So there that that actually fits into the current coding that it's an existence because it's quite difficult to create news procedure codes at the moment, but so that criteria we will you spend little time and standing, you know, concerning these companies. Product, I'm working out on being a t by looking into this database how our product could make it difference on what ultimately will be beneficial to the patient is going to reduce the length. Hey, is it going to reduce re admission is going to reduce complications, infections time in intensive care. I mean, we can do all sorts of pieces of information on then we look att, the system benefit. But with the hospital, the N hs as a whole benefit from a new technology. I mean, you know, you take him in the top five varicose veins on the call several years ago. You know, 11 or 12 years ago, there was probably in the region of 40,000 days associating with Eric same surgery. Now there's a couple of 1000. I mean, this is a technology that brought this benefit and opened up capacity and are over crowded hospitals so we can go into this information we can We can find how the technology would benefit the whole introducing length of stained FINA capacity and continues that information those two parts of story to support the payer. You know, the organizations that funds the hospitals, the activity on, be able to help them understand the benefits of funding these new products and technologies. And then, obviously, after we've looked at all that, the other important thing is, Is it worth the company coming to the market in the first place? Is there enough money left on the table for a profitable and progressive and value based company to grow and expand in, You know, internationally through the hard work will be done on we basically I don't know if you know of a game called Connect A Board game that's played at Christmas time.

Scott Nelson:   28:36
I don't know if you yeah, absolutely.

Michael Branagan-Harris:   28:38
You have

Scott Nelson:   28:38
the

Michael Branagan-Harris:   28:38
fort before in a rose They're winning strategy for in a row is patient benefit hospital benefits of performing the procedure, pay or benefits for paying for the procedure and the last one being the company benefit for all the hard work doing to get the product to market. So that's a connect ful often talk about when I talk to clients. A lot of research about current patient pathway being her patients treated looking at real numbers on Bennett to apply methodologies. So okay, we put the device into this scenario, What would the benefit be to the system onto the patient and the payer on that is Basically I don't know of another health care system in the world where you're able to do that on. We're very fortunate because of our work with, you know, several n hs bodies on because of a relationship with the U. K government

Scott Nelson:   29:33
and

Michael Branagan-Harris:   29:33
certainly the UK government inward investment organizations that are trying to encourage companies, certainly from the US to come and commercialize bring their products on their ex but on, you know, and the technologies to the health care system Because of this work we've done and certainly helping multiple looks go through nice. Over the last few years, we were very fortunate really work with this incredible database to help to help companies formulate a strategy around how to get the product into the market here on how to take the product successfully through the nice programs or any of the research programs that are available here as

Scott Nelson:   30:11
well. Yep, no, that's That's a great overview, and I let you sort of just riff. I didn't want to interrupt because you're on a roll there. But I love kind of going back to that PICO framework, which is, you know, patient indication Comparator and outcomes. I love that framework. Is that something that you calling there a device? Access your company? No,

Michael Branagan-Harris:   30:28
I'm not going to be credit for that. One of

Scott Nelson:   30:29
the connecting wall

Michael Branagan-Harris:   30:30
with one of mine. But

Scott Nelson:   30:31
now I

Michael Branagan-Harris:   30:31
think PICO PICO is a methodology that there is a nice framework to think about. You know, when you win, you engaging with the NHL, certainly with nice. It's a language that they use, you know, they're being straight the point. They're not interested in the glossy literature. You know who's the population You need to know if you're coming into the market. What is that? Population and come to the N h s in sight? Well, you know, 3.7% of John Hopkins University L a or whatever have this problem isn't gonna apply in our health care system where it may do but were to come in and better articulate the real numbers off cases on dhe numbers of patients And what those outcomes alike is a Farmall powerful way on this information that we are able to work in has been often is presented in published as well. I mean, you know, I can give you a really good another example of a situation we're working with with the wound care company on. We wanted to understand pressure ulcers. You know, when you come into a hospital and you lie around in bed, you don't move

Scott Nelson:   31:33
in

Michael Branagan-Harris:   31:34
and your skin dies. You get tinkled a pressure ulcer. You know, they're very common in hospitals

Scott Nelson:   31:38
across

Michael Branagan-Harris:   31:39
the world. Really. But we wanted to

Scott Nelson:   31:40
try

Michael Branagan-Harris:   31:40
and understand. You know why we're patients. You know, what was the number one reason for admission into an N HS hospital that led to a pressure ulcer. And so we extracted every single episode of pressure Also, which is recorded in the patient's notes, isn't necessarily recorded when they come in because they don't have it when they come in, they don't have pressure. Or so they might have come in with something else on Boss Aaron recovering developed fresh rolls. So we extracted all the information, reversed it to find out, you know What was the number one cause of a pressure? Lt's when it's actually pneumonia. Do you come into a hospital with pneumonia and you don't have a pressure ulcer. You're in hospital for 11 days. He come in the hospital and you develop the pressure or you're in for about 23 days. So you're looking at a much longer length of stay in a much longer, you know, capacity issue for a hospital on to be able to then, you know, develop a value story around, you know, a new technology which would alleviate pressure off. This is a much easier conversation when you know what the impact of these things is to help their system. And and that's pretty, you know, one of the interesting ones we did for that client. But it's really getting into the nitty gritty of

Scott Nelson:   32:53
of

Michael Branagan-Harris:   32:54
activity and outcomes.

Scott Nelson:   32:55
Yep. No, no, it's a great example. And I don't know when you first sort of told me about this database that you have access to, you know, it was I think anyone would walk away with, you know, feeling feeling pretty impressed with that sort of data, that sort of culmination of data points, but I think, um, you know, kind of going back t the PICO framework and connect for, you know, listening to you describe it. And I know we've had a couple conversations, you know, before we hit the record button here. But you know, the the Connect four sort of analogy that you described before. I know when I, you know, in hearing you describe that, of course, you know, they were viewing things through the lenses of commercializing in the UK and working very closely with nice. But that connect, for example, applies anywhere, you know. I mean, if the U. S is the ultimate goal, I mean, making sure that you nail each of those buckets the patient benefit the hospital, benefit the pay, you benefit the company benefit, you know, everyone wins. You know, investors win patients when you know health care providers when etcetera. So I think it's it's a really, really solid, you know, sort of methodology or lens to view things through, regardless of where you know where your commercializing on the other thing that really, you know, kind of rings true for me and hearing you describe kind of this, you know, This ideal process is just by taking all of these numbers that you know, that database that have access to its riel. It's real data. It's real numbers. They're not assumptions. And so, being able to that allows a med tuck happening to effectively engaged in a really good dialogue with nice, right? Cause you're using their language. And so instead of like a you know, a sales process, it turns into more of a, you know, a sort of a win win type of conversation. So e mean are my Those are kind of my my thoughts and hearing you describe that Is that Is that ringing ringing? True like

Michael Branagan-Harris:   34:34
it is? I mean, it's really you know, we work a lot on a national basis. You know, we have sort of limited bandwidth to start running around the country on individual hospital basis. But ultimately, you know, by being over to go into a health care system on a national basis and understand, you know what value your technology is going to bring to it and, you know, and you know, the patient benefits and really, really be a look. Att. How you can improve things, you know about having the right level of information. You can go in on a local basis on the local hospital basis as well. And we talk about and I don't know. I'm sure that all the U. S hospitals have carpeted areas and non carpeted areas, carpeted areas where, you know, people make the big decisions and write the checks and pay for things. And so I think that you know what we talked about It is better to provide. And we provided for some of the very largest client. I mean, given them information as to what to talk to in the financial part of hospital. And you can only do that if you understand what they're spending, what they're spending it on and what problems they've got. You know, do they have, Ah, a waiting list of 700 patients that are waiting for orthopedic surgery on Do we look in system and realize that you know their length of stay data for certain procedures is very long and they may be using an old piece of technology. I mean, having the information to be able to go on talk on a local basis into these carpeted areas and have a proper strategic and consultative conversation around. Solving a problem and not just a medical device with a nice bit of glossy literature is what we're increasingly doing as well. So we're supporting a lot of companies in this way to be a engage better. And I think

Scott Nelson:   36:17
that,

Michael Branagan-Harris:   36:17
you know, certainly it's knowledge of understanding. The reimbursement system is something that each healthcare system in the world you know every year there's changes, the policies, changes toe amounts of HR, Jeez and D. R G's you know, you've got to be kept up today and where they're fortunate we work with a great network of people that work locally because I don't think, well, I could say, You can't do this. One person can't learn Each healthcare system in the world is so complex that you need have up to date help on the ground on a local basis.

Scott Nelson:   36:52
Couldn't agree with you more, couldn't agree with you more. Mike and I just want to thank thank you again for coming on the program now, twice in, sort of describing not only that changes, you know, that are going on in the UK with respect, you know, nice and N hs, but also kind of detail ing out process that in an ideal process that you like or you preferred that tuck med tech companies to follow in order to get the results or see the results that you know, that I think everyone wants to see realize so appreciate you coming on. And then as we as we sort of wrapped this up, I want to ask you 11 last question that's a little bit off topic. But before you go there, what where's the best place toe? You know, for med tech companies that are interested in this conversation and want to learn more about, you know, commercializing in the UK or in Europe in general, or this this database that you have access to, Where's the best place for them to find you?

Michael Branagan-Harris:   37:37
We have a website which is device access code, a UK. We recently got domain of market access dot co dot UK. So there is a link on their website is going to be updated. We've got a number of new images and things going on that shortly, but if anybody just want to reach out and feel free to you, through that market.

Scott Nelson:   37:59
So either device access dot co dot UK or market access dot co dot UK that they probably go to ST the same place. But we'll make sure the link that link to that in the in the show notes. So if you're if you're listening to this on the on the road, just go to the show notes with On med cider dot com You'll you'll find a link to Mike's website. So So the last question I wanted to get to real quick is is abnormally, you know, over the past, several episodes sort of ended ended most of my interviews with with three sort of rapid fire questions. But, you know, you're you know, you're in the UK, Mike right in the heart of the Brexit. So I just I wanted to get your take on Brexit and what that means, maybe for healthcare. MedTech specifically

Michael Branagan-Harris:   38:34
Yeah, I think I'm very positive about the future for this country. I think that, you know, we've been in the area of the world which hasn't been growing as much as others, you know, as a country like America and India and China and Asia Pacific areas on. I think it's time. You know, I'm excited about the future for us country going forward in, you know, to trade with who we want when we want to you and have it once and at the same time attract businesses into this country with a very tax regime on. You know, Andrea offer certain domestic industry US medic industry a fantastic place to start on the U. S. A. U s strategy. And I think we're in a great position having this single healthcare system called the NHL that you know, many other countries, the cup to into how they treat

Scott Nelson:   39:25
people

Michael Branagan-Harris:   39:26
in the system, how it stands it on the credibility of nice. Andi also and I haven't touched on it matches. The opportunity for for research is is outstanding and country with some of the leading university. Mind you excited about the future? You know, we have a massive opportunity on a real date to adopt new technology. So, you know, Terry encourage people to have a look at this market in Europe.

Scott Nelson:   39:51
Definitely. Now that that's great. It seems like you know you Anytime you you know, you read pieces of information online and see how the Brexit is going to lead to a massive failure and disruption and whatnot. So I think it's really valuable to get your your take on it, considering your local right and and you work with. You know, a lot of a lot of these big name organizations in institutions like The N Hs and Nice and another in a med Tech companies that are tryingto serve navigate through through the system. So it's refreshing to hear your take on Brexit and the fact that you know there's there's a ton of opportunity and it could be really, really beneficial for everyone. So good stuff. So, Michael, have you hold on the line here? But it just thanks again for your time and walking us through sort of best practices as it applies toe working with N. H s Nice and Mr the the ideal sort of process or pathway or framework. If you want to call it that to use when tryingto make some headway and Europe

Michael Branagan-Harris:   40:42
right back

Scott Nelson:   40:43
stop

Michael Branagan-Harris:   40:44
really gracefully into it again, appreciate it.

Scott Nelson:   40:46
All right. Sounds good. Thanks, everyone for your listening year. And until the next episode of men's side, everyone take care Thanks again, ladies and gents, for listening. This episode has been brought to you from the W C. G studios here in Minneapolis. And don't forget to grab your pan optic stacking blueprint by visiting reach. Fire digital dot com for slash met cider Again that's reached fire digital dot com forward slash met side. Okay, bye for now.