Brian Lewis, president and CEO of MEDEC, speaks towards the importance of building a strong medical device ecosystem and the association’s collaboration with industry stakeholders to push advancements in terms of value-based healthcare to not only improve the overall quality of patient care but also to ultimately support the sustainability of the Canadian healthcare system.
What are the current main challenges and opportunities for your members?
There is great opportunity in terms of moving Canada’s medical technology industry forward in a number of ways. First of all, there is opportunity in terms of leveraging medical devices to actually support healthcare system sustainability and better patient outcomes, this involves not just the medical device but also the utilization of that device. Secondly, there is ample ability to build a strong medical device ecosystem. Canada is a highly sophisticated marketplace and one of the things that we need to do is to leverage this aspect to create a stronger medical device community.
It is a well-known fact that that the Canadian healthcare system is stressed, due to the expense of our public system as well as an aging population that is consistently growing. While the focus has predominantly been on cost control, we need to shift this focus and ask ourselves how we extract value that adds to system sustainability and limits the total cost.
These efforts involve collaboration with Health Canada, discussions around how we can get to a better place in terms of approval times, what industry can do better in regarding application quality and ultimately, what can government do better in terms of investing in a regulatory structure to enhance approvals not only for medical devices but also for the approval of doing research. The end goal is really to not only become more efficient and effective as a system but also to make Canada more attractive and competitive globally.
Canada has always been known for our great research, but an area where Canada is lagging behind significantly is the commercialization of products. Most, if not all Canadian-based companies generate their sales outside of Canada because the Canadian environment is inhibitory of getting products onto the market. That is, why we as an association have dedicated a lot of time towards creating a complete ecosystem that spans across product research, development, manufacturing and commercialization.
In the most recent performance evaluation of the Health Canada Medical Device Bureau (MDB), it seems that Health Canada is lacking substantially in capacity to reduce the backlog of applications for medical devices, which has resulted in delayed market access for innovative technologies. How can MEDEC work with Health Canada to find solutions to avoid such issues?
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We are actually working with the MDB right now to ensure continuous quality improvement of our members’ submissions. On the other hand, we are evaluating what the MDB needs to do in order to increase efficiencies on their side. However, currently only 83 people work at the MDB so the resources on their end are significantly limited. Taking a step back, as an industry we have actually evolved the term ‘medical technology’ to ‘medical solutions’, due to the fact that some of the new technologies are so rich and so complex that it will require new capabilities to even review these products. Thus, we are heavily advocating for the appropriate level of resourcing for the MDB to be able to cope with this evolution.
How do you demonstrate the value that medtech brings to patient care, health system sustainability and the overall economy?
The healthcare system in Canada is very strained on a financial level. However, it is important to understand that only three percent of the total healthcare expenditure is effectively dedicated to medical devices and historically, the focus has always been on price and not on the value of outcomes, which commoditizes the industry to some degree. If we want to shift this focus to the actual value of outcomes medical solutions can bring, we have to be able to assess those values. At a policy level, people are slowly starting to understand the concept of value-based healthcare but the expertise, skillset and capabilities to be able to implement this concept is definitely lacking and there is need for development and training in order to act on it.
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Part of the issue is that with medical devices no one size fits all in terms of outcome value. The way you measure outcomes may differ significantly depending on a given device. One of the key areas we have been working on is to create an understanding that a medical device needs to be treated differently compared to a pharmaceutical because it always depends on the context of utilization. The use of a medical device always involves multiple entities: the patient, the medical technology and the clinician, the latter of which plays a great role in the utilization of a product. We believe that the right principles are starting to develop but we need to find a way to move more strongly towards the measurement of health outcomes.
The medtech sector in Canada is dominated by SMEs by number, and by foreign-owned global companies by market share. How important is the nurturing of a local medtech industry?
We want the overall medical device ecosystem to grow, which is important for two main reasons. Firstly, we want Canadian owned companies to stay in Canada. What happens oftentimes is that our local companies get acquired by multinationals and subsequently leave Canadian soil. That is why developing a holistic ecosystem that includes, research, development and commercialization is so important as well. Secondly, we want to attract multinational investment in Canada. There are many countries in the world now that render more attractive for R&D investment and I can only reiterate that we need to make commercialization a key focus in our efforts to have a home-grown market; not just to generate sales in Canada but to understand that Canadian-grown utilization and commercialization will support exporting our technology to foreign markets. After all, one of the key questions we often hear is “Why is your home country not using it?”
As the leading association for medical devices, is there an industry consensus about the role that Canada should be playing within the global life sciences landscape?
The consensus is that we need to develop the whole ecosystem. We need to make sure that we look at the whole picture, including our great research and innovation, strong universities and research capabilities. Right now, Canada is among the countries ranking lowest in the world in terms of purchasing innovative medical devices.
Having said that, we are witnessing attempts to change the situation. For example, we have the supply chain review panel in Ontario that is responsible for evaluating how the entire supply chain can better enable the adoption of innovation. In addition, we have the Alberta strategic clinical networks that are working on the integration of patients, manufacturing companies, hospitals and clinicians to find better solutions for patients. All the systems and enablers are in place if you will but the adoption and diffusion has yet to happen.
Everyone still seems to be looking for more money to be put into the healthcare system, which will simply not happen. Instead, we need new leadership to create efficiencies with the existing resources. This leadership needs to come from senior hospital administrators who can navigate through this period of change and execute.
What are your key priorities for 2018-2019?
We want to continue the work we have been doing to move the system towards action. We want to promote a community of leadership that will use the systems in place to start adapting value-based healthcare approaches to not only enhance the overall quality of patient care but to ultimately support the sustainability of our healthcare system.
