Rocco De Bernardis, managing director for Johnson & Johnson Medical Devices in Spain offers his insights into the company’s local footprint, assesses the situation for value-based healthcare implementation in Spain and, explains how Johnson & Johnson maintains patient-centricity at the heart of its operations.


Can you introduce yourself to our international audience?

I began my career as an engineer 20 years ago. After a short experience in the automotive sector, I moved into developing medical devices in the orthopaedic field. Close proximity to the surgeons and the opportunities to learn from them provided me with an understanding and a passion for how technology can impact the lives of patients. This is one of my best memories of my professional experience, progressing through the ranks of several multinationals and living in five different European markets, plus two periods in the US. Finally, I moved to Spain to assume the role of Managing Director in 2015.


What is the footprint of Johnson & Johnson Medical Devices in Spain?

Johnson & Johnson is composed of three divisions, one of which is medical devices. Johnson & Johnson has the largest portfolio of medical devices in the market. We are attaching an incredible number of patients, pathologies, and up to 15 specialities within the same hospital. At the same time, we recognize that we need to advance in science and technology to truly make an impact on the healthcare system. Therefore, we have identified a few areas of unmet medical needs, where we understand that treatment is still insufficient in those pathologies.

Spain has seen increasing importance within the EMEA region. We are one of the top five European markets and have delivered a number of years of sustained above-market growth.

We have a special focus on obesity and very focused on bariatric surgery as a means of treatment. We are also concentrating on surgical oncology, mainly for lung and colorectal cancers. These are two important areas for us and are complemented by other areas of Johnson & Johnson. In addition, there are few cardiovascular diseases, such as atrial fibrillation, and ictus where we are devoting greater attention. Finally, in the orthopedic sectors, we see opportunities to bring value in the fields of osteoporosis and osteoarthritis.

As Managing Director, it is my role to ensure that we serve the specialities within hospitals properly, while at the same time ensuring that we make an impact in those new areas of unmet medical need. Moreover, hospitals and institutions are not only expecting that we develop the best products, but also expecting that we contribute to increasing their efficiency and clinical outcomes, alongside improving patient experience and satisfaction. Thus, we have developed a program called CareAdvantage which focuses on value-based healthcare to drive value results and better patient satisfaction at a lower cost. With the ageing population and subsequent healthcare burden, it is part of our responsibility to help to make health systems more sustainable.


What opportunities does Spain possess, following the corresponding issue of obsolescence after the financial crisis?

In respect to our CareAdvantage program – delivering value above and beyond the products that we provide – Johnson & Johnson Medical Devices sees opportunities in Spain. First of all, the issue of obsolescence of capital equipment has been identified by FENIN as one of the main issues in Spanish healthcare. While we are not in capital equipment, unlike firms such as GE, Siemens and others, we foresee the potential for collaboration with hospitals, using new methods of interaction, such as value-based healthcare, to improve their access to technologies.


How easy is it to articulate the benefits of value-based healthcare to the key stakeholders?

We are on a journey. There is still a lot to learn around how value is going to be measured. Therefore, we are conducting pilots to better understand how to engage with public healthcare institutions and how to support this transition.

One challenge that remains is the ability to use real-world evidence to measure this “value”. This is not a widespread capability but is linked with specific hospitals in specific regions. There is a general recognition that this is the way forward, and there is a desire to be more involved and to pilot these value-based healthcare tenders in Spain but is still very much concentrated in key institutions.

In terms of Johnson & Johnson’s role in expanding Spain’s capabilities in measuring “value”, we do have big investments in terms of educating surgeons and healthcare professionals. Our initial investments have been in the field of patient safety and educating surgeons on the proper usage of our products. We also see an opportunity to help surgeons increase their understanding of value-based healthcare and to generate a positive momentum around that.


There have been large changes at the global level for Johnson & Johnson, led by CEO Alex Gorsky’s optimization post-2016, such as the divestment of LifeScan and the acquisition of Auris Health. How have these global changes trickled down to the local affiliate?

Johnson & Johnson is constantly looking at potential acquisitions and always considering whether parts of the portfolio are no longer aligned with the company’s strategy. This is part of portfolio management. When it comes to Auris Health, this is a US company that has no presence in Spain, thus having no immediate impact. Nonetheless, there is a consistent and sustained investment around digitalization and digital surgery that you will be seeing in the near future. Auris health is a piece of that puzzle in helping ensure that these technologies will be available as soon as possible to Spanish patients.

There is a lot of attention to investments by Johnson & Johnson. For example, we made a strategic acquisition of a company called SPI (Surgical Process Institute). This is a German company we acquired just over a year ago which is helping public and private hospitals to standardize surgical processes to reduce the variability of clinical outcomes. Across the 17 regions, there is not just variability of access, but also the variability of clinical outcomes. SPI focuses on amending this issue. It has a digital system being implemented in the operating room, which is digitalizing the whole surgical process. We are launching this into the Spanish market, which will prove an important market in this regard.


How do you best bring patient-centric solutions to your operations in Spain?

Most specifically, we are ensuring that patients with a specific disease get the best access to treatment. To give an example in one of our focus areas, obesity and bariatric surgery, in Spain we have one of the highest rates of obese children in Europe. Nineteen percent of boys and 17 percent of girls are obese. There is increasing evidence on the benefits of bariatric surgery, coming from NICE and from other scientific studies. It has been proven that bariatric surgery reduces the burden of chronic diseases, however, only five percent of potential patients receive access to this surgery in Spain.

Obesity has a financial impact on the healthcare system: seven percent of all healthcare spending in Spain is related to obesity. Obese patients also have 20 percent higher costs than other patients in the healthcare system given the fact that they require more medicines to treat related conditions such as hypertension and cholesterol. Patient centricity means that we do not only look at how we can treat those patients undergoing surgery but in how we can increase access for the best possible treatments for those patients.


What are your next ambitions to achieve with Johnson & Johnson?

We have a great and highly talented team in Spain. We have made great progress in how we work together as an organization, and in the way that we partner with public and private hospitals in Spain. We are still early in our journey and there is so much more that we can do for our employees, developing opportunities for them, but also most importantly for the patients we are serving in Spain.

I would also like to see continues investment in our Care Advantage project and ensuring that we really make that shift to a value-based procurement outlook, bringing the best products and best solutions in one single offering for our institutions. We are also trying to be a catalyst for ensuring equal access to healthcare across the 17 regions through our contribution to reducing variability in clinical outcomes across Spain.