Value Analysis Briefs – Presenting Your Technology In Its Best Light

By Edward Black, founder and principal, Reimbursement Strategies

The purpose of this article is to define a Value Analysis Brief (VAB) and how it can be used to communicate the potential clinical and economic benefits of a technology, product, procedure, or service. The article will define and discuss components of a VAB, as well as the audiences to whom a VAB may be presented. 

A VAB presents the results of a systematic review delineating the potential clinical and economic benefits of a technology, product, procedure or service. It is created with the end user in mind, as there may be multiple stakeholders for whom the value of a technology may differ.

Stakeholders

There are multiple stakeholders who may be involved in the decision to use a specific technology, product, procedure, or service, and a VAB can be tailored to their needs.

• Consumers – Health information is readily available from multiple sources: the internet, government publications, online searches of published literature, social media sites, patient chat rooms, and professional healthcare provider society websites, to name just a few. Consumers are becoming sophisticated about finding products that meet their healthcare needs, as well as those that are user friendly and cost effective.

A patient-oriented VAB may emphasize ease of use, insurance coverage, availability from multiple suppliers, low-cost options, and online trouble-shooting. Examples include devices indicated to manage chronic diseases, such as blood glucose monitoring devices, insulin pumps, and blood pressure equipment.   

• Healthcare providers -  Many times, providers look to device manufacturers to supply up-to-date information about new technologies to improve patient care at reduced costs. Providers may wish to incorporate the technology into their own private practices, or to work through their local hospital/healthcare facility to present the technology to a Technology Evaluation & Assessment Committee, which will decide for the system. This audience will be most interested in how the technology benefits patients, the continuum of care, and potentially the cost of use, as well as the physician and facility reimbursement rates for use.
• Healthcare facilities/hospitals – Most healthcare systems have a process for introducing new technology into the system, usually through evaluation by a committee that reviews the need for the technology, compares the technology to existing practice and other products, and reviews the economics of adopting the technology. A provider may present the clinical benefits of the technology to the committee, while a financial representative may review the costs of use, potential reimbursement, etc. A VAB for this group must look at how the new technology impacts treatment and how departmental budgets may be affected.
• Administration/financial professionals – Hospital administrators and the finance department may look at the adoption of new technology with more emphasis on the costs of using – or not using - the new technology. For example, will a new infection control product reduce urinary tract infections, or reduce the rate of readmissions for post-operative surgical infections? Does the cost of this product compare favorably to the reduction in costs associated with the infections?

Another aspect is the cost of capital equipment: initial purchase price, amortization over several specialties or procedures, depreciation over 5-7 years, effect on staffing ratios, etc. The VAB for this group still will present the clinical benefits, but also will emphasize how the clinical benefits impact the bottom line.

• Payers – Most payers state their goal in covering new technology is to provide the most clinically effective and up-to-date patient care. In today’s healthcare climate, the issue of cost-effectiveness may also be part of the coverage equation.  In a previous article, we discussed the need for a good clinical dossier that presents published clinical evidence to support the use of a technology, as well economic evidence that demonstrates cost-effectiveness.

What Are The Components Of A VAB?

A VAB should be presented succinctly and structured in a scientific format, rather than proffered as a marketing piece. The components may vary based upon the nature of the technology or the audience, or to follow existing company processes. Here are suggested VAB components:

• Introduction – A brief description of the technology, as well as potential clinical and economic benefits associated with its use.
• Background – Explain the health problem being addressed, important factors in treatment, any unique terms or acronyms, and departments that can use the technology.
• Burden of the disease – Present the incidence rate, typical patient vignette, long term sequelae, and societal impact.
• Methodology – Briefly state how the clinical evidence was selected. For example, a MEDLINE review of published studies, with key words used to search and types of articles reviewed
• Continuum of care – State how this technology fits into the current continuum of care. Does it replace an older technology, drug, or surgery? Does it provide a new treatment within the algorithm of care that did not previously exist, or fill a previously unfulfilled need?
• Facility quality measures and quality improvement programs – Healthcare facilities may examine how the technology can assist them to achieve better quality outcomes. For example, can the technology lower infection rates, lower readmission rates, or lower adverse incidents, such as burns from use of monopolar cautery? Note that hospitals must report hospital-acquired conditions (HACs) and they may receive penalties from the Centers for Medicare and Medicaid Services (CMS) based upon their annual HAC score. 
• Clinical evidence - Review the published clinical studies that support the technology’s clinical benefits and the incidence of adverse events, or the reduction of adverse events from using the technology. Look at published studies or public data on similar technology, and use the combined data to create a comparative chart: specification on devices, clinical results, adverse events, costs, etc.
• Product information – Present how the product works and features that are important to the audience, such as easier handling, on-site training, intuitive user interface, and similarities/differences versus existing technology.  Avoid turning this into a marketing presentation, but do present all the facts.
• FDA clearance or approval – The regulatory status of the device is important, especially for Technology Assessment & Evaluation Committee presentations.  Include copies of the FDA clearance letter, 510(k) number, PMA, and the FDA-cleared indications.
• Technology assessments – Include links to any existing technology assessments or a brief summary of conclusions. (Learn more about the importance of health technology assessments in today’s healthcare environment.)
• Economics – Review the direct and indirect costs of using the technology, and the costs if this technology is not used. For example, a recent VAB examined the medical malpractice costs for nerve injury – the number of cases filed, settlement amounts, litigation costs, etc. — to show that the use of new technology to prevent nerve injury was cost effective. Include both Medicare’s and private payers’ reimbursement rates for the technology for each site of service in which the technology may be used.
• Conclusion – Make a brief concluding statement that summarizes why use of the technology is clinically and cost-effective.
• Citations – Include all references used to review the clinical evidence.          

A VAB can present a product in its best light from a clinical benefit perspective, as well as demonstrate cost-effectiveness.  It can provide important product information to key decision-makers — at the right time and in the right format. Consider creating a template that can be tailored to the needs of the various stakeholders you will encounter in order to optimize customers’ perceptions and understandings of the clinical and economic value of your products.