Laura Boland - Excel in Health
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Presentation by Laura Boland, Programme Manager - Product Management, Innovation Agency at Excel in Health: developing your innovation for business on Tuesday 12 March 2019 at the Innovation Centre, Daresbury.
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Laura Boland - Excel in Health
- 1. @innovationlaura Building your Value Proposition Laura Boland and Jen Kohan
- 2. The Principles of building a Value Proposition Understanding NHS need Evaluating your Value Planning your Value Proposition What makes a good (and bad!) value proposition
- 3. A promise of value to be delivered and acknowledged and a belief from the customer that value will be delivered and experienced (Wikipedia) A statement that proves I know what they want and need, why they want and need it, and why they should believe I will provide it to them (Boland) The value proposition should be a credible and coherent set of claims that demonstrate the value of the product or service to health and care providers and patients The financial director and other decision makers of a Trust or a CCG will want to see a good value proposition before they commit to your innovation.
- 4. Brexit – The Uncivil War LEAVE: ‘Take Back Control’ NHS/ £350 million Turkey (It’s riskier to stay in than to leave) REMAIN: ‘Britain Stronger in Europe’ @innovationlaura
- 6. The NHS is a risk averse organisation – they need to feel it is riskier to maintain the status quo than to make a change Lead your Value Proposition with the Case for Change
- 9. Matching Benefit to Need NHS Needs Product benefits
- 10. 1. Is the problem Unworkable? 2. Is fixing the problem Unavoidable? 3. Is the problem Urgent? 4. Is the problem Underserved? If you don’t fully understand what their problem is and how they’d manage it without you, you can’t isolate your UNIQUE VALUE.
- 11. • Is the need in Primary, Secondary Care or Social Care? • What is the burden of that disease or condition? • Why isn’t current practice sufficient? • Which professionals will prescribe, recommend or implement your product? • Who is going to pay for it? • What are the higher level strategic drivers as well as operational need? • How does the problem impact the lives of the patients? • What is the cost to the system of both the disease and the current standard of care?
- 13. *Coming Soon* NHSX –New Digital Unit Leading on NHS Digital Strategy Matt Hancock: NHSX would lead on creating an “unashamedly open” relationship with the health tech industry LOCAL Strategic Plans Annual Reports Quality Accounts The Model Hospital BIGGER PICTURE Rightcare NHS Efficiency Map Public Health Dashboards GRIFT COMPETITION Guidelines National Primary Care Prescribing Systematic Literature Review VALIDATION Procurement Innovation Agency Influencing and Decision Making Professionals
- 16. “Our ultimate objective, as NHS England and central government, is the provision of better care and improved health outcomes” “Focusing on the monetary value of the challenge risks missing the real essence of the task facing the NHS, which is about getting better value from the NHS budget. This means maximising the outcomes produced by the activities the NHS carries out, while minimising their costs. Framing the debate in terms of efficiency and costs also risks losing the opportunity to engage clinical staff in the challenge of changing the way in which care is delivered.” (Kings Fund)
- 18. Does your product offer transformative benefits over the status quo? Is your product unique? What measurable value does your product deliver? Is it cost-effective compared to the alternatives? What resources will the buyer need to implement your solution? What are the risks? Find out if your breakthrough product or service is unique and compelling
- 19. Value = Outcomes/ Cost Any cost-effectiveness analysis should relate back to your core value proposition: • What is the need? • Which outcomes can you deliver to address that need? • How much will it cost?
- 21. VP Burden of Disease Data Evidence of Unmet Need Clinical Trials Cost-Models Economic Evaluations Case Studies
- 22. • Digital Health Technology (DHTs) are classified by function and stratified into evidence tiers • Stratifies evidence need (based on level of risk) How much evaluation is enough?
- 24. • NHS is Risk Averse • SME’s must offer a higher Gain/Pain Ratio • Non-Disruptive Innovation is easier to adopt
- 25. Relative Advantage * Low Complexity Compatibility / Interoperability Observability Trialability Potential for Customisation Ease of Use
- 27. Are not: • Visions or mission statements • A list of product features • Catchy slogans (although they can feature) • A data dump • A Positioning Statement They are: A statement that proves I know what they want and need, why they want and need it, and why they should believe I will provide it to them
- 28. Talking about a benefit that isn’t of any benefit Taking the wrong message to the right people, or the right message to the wrong people So many messages…and so much data…and cost models…and some more evidence….and what were you saying again?!
- 30. • Estimates suggest that around 216,000 individuals are chronically infected with the hepatitis C virus (HCV) in the UK. Hospitalisations, inpatient days and mortality linked to HCV diagnoses are all increasing. • Management of HCV-related end stage liver disease (ESLD) and hepatocellular carcinoma (HCC) can be very expensive. Could the cost of managing patient illness be better invested in preventing disease progression? • Achieving Sustained Viral Response (SVR) with medication improves clinical outcomes for people with HCV by reducing morbidity, mortality and liver transplants. • SVR rates for treatment-naïve patients with Peginterferon alpha + Ribaviron (PR) are less than 50% and less than 22% in treatment-experienced patients • In treatment-naïve and treatment-experienced patients, an INCIVO-based regimen offers the potential for significantly higher SVR rates, even in patients with advanced fibrosis or cirrhosis.
- 31. 1. The modern data capture platform patients love to use 2. Consent, capture & engage - the leading platform for real- world and observational research
- 32. A value proposition has so many words that you need to read it twice - or worse, you stop reading and move on If the VP does not provide clarity about the offering to the target market, then it isn’t providing value. The target customer should understand exactly what is promised. The value proposition for an offering mimics the value proposition of a competitive offering.
- 35. 1. The Issue 2. The Solution 3. The Gains (benefits over the product or service alternative) 4. The Value Make it Specific: Tailor the language and the need to your audience and the supporting cost-effectiveness data to the patient group/ trust/CCG/ region
- 37. Not identifying a real problem Not identifying a real patient or system benefit Right person, wrong message Lacking evidence Too much emphasis on minor details Getting too creative with the numbers Blinding them with science Being vague or too complex
- 38. Articulate your VALUE clearly. Always recognise the constraints of the system into which the innovation is to be introduced (the IMPLEMENTATION CHALLENGE) @innovationlaura Understand Evaluate Construct Test
- 39. Good Luck Laura Boland and Jen Kohan
Notas del editor
- A value proposition tells the NHS why they should do business with you rather than your competitors, and makes the benefits of your products or services to them and their patients crystal clear from the outset.
- Leave campaign had a strong value proposition and remain did not.
- 4 step process – helps to break the task of creating your VP into a logical process and prevent you going astray before you waste lots of time and energy finding out that you are focusing on the wrong features of your innovation
- The bigger picture Before approaching anyone in the NHS, or even starting to develop a solution, SMEs and entrepreneurs need to be aware of the current situation in health and social care. Research the overall market and understand how it all works. Consider the growing population and associated costs, declining budgets, and limitation of resources; remember that although the NHS has a huge budget which provides great opportunities, it is a highly challenging market with expenditure and requests for time and resource challenged at every step. This is why it is important to make sure claims about improving care and cost savings can be evidenced.
- As this simple Venn diagram shows, your VP should focus on where the NHS need matches your products benefits. A good VP is 50% understanding the NHS need and 50% mapping that to your story
- Don’t make the mistake of diving headlong into the solution before really understanding the problem you’re looking to solve. Start by asking yourself these questions ( the 4 U’s): Is the problem Unworkable? Does your solution address deficiencies in and/or fix a broken healthcare delivery process where there are real, measureable consequences to inaction? Are patient outcomes and experience currently being compromised due to the lack of a solution? Is fixing the problem Unavoidable? Is solving the problem driven by a mandate with implications driven by fundamental requirements associated with regulatory body requirements (CQC/NICE/MHRA) or is it driven by a fundamental requirement for better resource efficiency? Is the problem Urgent? Is it one of the top few priorities for the NHS? In selling to the NHS, you’ll find it hard to command the attention and resources to get a buying decision if you fall below this line. Is the problem Underserved? Is there a conspicuous absence of valid solutions to the problem/unmet need you’re looking to address? Focus on the whitespace in a market or segment. If the answer is yes – then you know the market is primed for the solution You have to be in position to articulate the problem to your customer to get their attention. If you don’t fully understand what their problem is and how they would solve it without your product, you can’t find your value to them.
- Whether you are offering a service, a device, digital technology, an app or another product, don’t create it then look for patients. Identify the need and really understand who will use your product and how it will add value, then ideally refine your product in conjunction with the end user to create something that really works. Don’t ignore primary care/ CCGs They may be a less obvious door to start on in the NHS but they can have a lot of purchasing power. Prevention and patient activation are increasing in priority.
- Sketchnote by Karla. Even with this massive simplification, the NHS is a minefield. It might be called a ‘National’ Health service but its actually 10000 separate organisations. Who you are talking to dictates the How. You must know your audience and what motivates them before you begin. Research the overall market and understand how it all works. The customer or end user value proposition can be ignored in these conversations, and yet key to the successful transformation of our healthcare system.
- Lots of ways to do ‘desk research’ online and for free before paying for market research or beginning face to face validation (save yourself time, pain and money): For a bigger picture: The NHS RightCare works collaboratively with systems to look at nationally collected, robust data to identify opportunities and potential threats The website has CCG and STP data packs plus The Atlas of Variation (interactive map produced by public health England showing population health metrics such as end of life care) NHS Efficiency Map; Online tool from Healthcare financial management association. The map is a tool that promotes best practice in identifying, delivering and monitoring cost improvement programmes (CIPs) and quality, innovation, production and prevention (QIPP) schemes in the NHS. The map contains links to a range of tools and guidance to help NHS bodies improve their efficiency. Golden ticket is if you develop an offering that aligns to a cost improvement programme (CIP) and offers incremental value over the current options Public Health Dashboards: Search on Public Health indicators (smoking, obesity etc) to understand burden of disease and local variance. Get It Right First Time: National programme designed to improve the quality of care within the NHS by reducing unwarranted variations. It’s a showcase of best practice with the aim of improving efficiencies. Local Priorities Strategic Plan: Core Strategic aims plus detail on specific trust /CCG challenges in the Healthcare Needs analysis section. Often have a ‘plan on a page’ or a summary infographic that makes life easy when you are trying to understand how they think. (not like days of old when it was reams of tables in the appendix to digest!) Annual reports: You’ll get an overview of achievement within the year, financial achievements and risk plus governance info. (provider and CCG) Quality Accounts: Published by providers annually. You can find performance against national standards, detail on further improvements they need to make, performance against NHS National Outcome Indicators and ‘never events (serious, largely preventable incidents) The Model Hospital; The Model Hospital is a digital information service from NHS Improvement designed to help NHS providers improve their productivity and efficiency. The Model Hospital is broken down into six sections offering different perspectives from which to review hospital activity: board-level oversight clinical service lines corporate services people care settings clinical support services From here you can drill down into any area of your trust to see where you’re performing well and where there are opportunities to improve. Understanding current practice: Guidelines: Help you to find out current best practice across the specific patient pathway you wish to augment or disrupt. Understanding the competition: National Primary Care prescribing data: On NHS Digital website. Spend per practice on medicines/ dressing etc. Useful if you a preventing patients from going on to need drugs/ minor surgery etc and want to understand the demand an cost implications Systematic Literature review: Essential to help you understand the competition and/ or what the current standard of care is. You won’t be selling in a vacuum, so understand what your comparator is and the ‘incremental’ value you add. If you don’t find any competition and the current standard of care is ‘do nothing’ then you still need to understand the implications of that. Once you have an idea of need from desk research, validate it with real people; Procurement: Great way to understand if your suspected need is a real challenge and if your perceived value meets their expectations/ drivers for change. (Already had a sesson from Rachel from SBS) Relevant professionals: eg clinicians in your particular field, digital leads, service or transformation managers. Don’t forget about clinical engagement –it’s very important to determine the real need and patient benefit …even though it might not be them purchasing your solution directly, don’t under estimate the power of a clinical advocate. NHSX – Coming in April, operational by October. Joint venture between NHSE and DHSC and NHS digital will report straight in. Most senior IT leadership staff to join NHSX https://www.hsj.co.uk/technology-and-innovation/hancock-vows-open-door-policy-for-industry-at-new-tech-quango/7024465.article?mkt_tok=eyJpIjoiTm1ZME56Y3hPRGc0TVdReCIsInQiOiJmeWRXNFhqTkJZMndmcmd4aFZCaHduVUkyQ05VeWZxQ3dYcnRHdmhscjNwZHlUK1dISTRKdEMydERxeWZObzFibnE1K081dzYzZmMwSFJaVmhpRE1uZ1U2dUVRRGVTaTRPYnJaVzYvWENhdThkWjZPcmV6ODNoVVBPd0MrZ1pBOSJ9
- Example of infographic from Leeds Strategic Plan : making life simple for you to understand priorities and indicators. May also have a ‘plan on a page’
- A good place to start: All across the NHS they are struggling with these 3 core problems. They pose a great place to begin to frame your VP before you get down to specifics if you don’t identify other strategic priorities that are a better fit
- Remember you are giving them something to vote FOR and not just against (back to brexit example). So cost is important but it’s the patient or staff benefit that will compel them to drive change. Demonstrate how and where the product will add value to people and the health and care system.
- After you have determined the problem you’re solving and validated its criticality, ask yourself: What is unique and compelling about your breakthrough? Consider which evaluation methods you can use to determine whether each product is unique and compelling and how to measure potential adoption Consider, based on your identified need and market analysis, whether you need to evaluate CLINICAL OUTCOMES, SAFETY, EXPERIENCE, EFFICIENCY
- Is it Faster, cheaper, better, safer? How can you prove this? It’s not enough to be vague about the impact you will have. They want to know exactly what is involved and exactly how you plan to help them. A clear and compelling value proposition is an important precursor to the development of an evaluation model describing the adoption project’s goals
- Assigning a value to health outcomes = difficult Best practise = randomised clinical trials + economic evaluations that look at cost-effectiveness with a Cost-utility analysis. Expensive, not always necessary. It is important to make sure claims about improving care and cost savings can be evidenced. Be pragmatic
- Covert your identified needs/ pains/ gains into measurable value. Stating facts like ‘improves patient experience’ is meaningless unless its evidenced and quantified e.g patient reported outcomes measure scales. If you can satisfy the top part of the value equation, the challenge now is the resources required and specifically the revenue cost of picking one drug over another. The intelligence regarding cost pressures or indeed savings opportunities is key in your value proposition. Savings may occur not only as reduced cost, but also as reduced length of stay, reduced time in theatre or a move of treatment from inpatient to outpatient.
- Don’t make the mistake (a very common one) of thinking as all of your value ‘dossier’ or evidence portfolio as your value proposition. Your evidence are your ‘Core Pillars’ that support your VP. People often use value proposition and value story interchangeably . It helps if you think of you VP sitting above everything else and that it is your guiding proposition and core message to your audience. Everything else is better thought of as ‘supporting evidence’ to help you retain clarity about your VP and your goal. Don’t hand someone a 5000 word VP and expect them to tease out the bits important to them. It just wont happen. VP’s are fed by health economics and cost models and feed into business cases but are different things. The data informs the VP which in turn informs further evidence generation.
- First ever NICE digital framework came out in December 2018– good steer for digital health innovation on how much evidence is enough to demonstrate value. Image showing their evidence tiers (nearly matching brand colours!) 1. DHTs in each evidence tier after being stratified by functional classification 2. Contextual questions to help identify higher-risk DHTs Evidence for effectiveness standards for tier 1 DHTs Also Evidence for economic impact standards: key economic information
- Taken from NICE digital standards but applies to using economic evaluation as supporting evidence to demonstrate value for all VPs Cost consequence + costs vs potential outcomes in natural units. Cost utility = cost vs outcomes in QALYs. Not usually relevant for SME innovation. Robust but expensive NICE website also contains a hierarchy of data sources for parameters in economic evaluation
- You might need to evidence more gains’ for the system to secure adoption as an SME. You can measuring potential customer adoption using the gain/pain Ratio Too many SMEs are so focused on the features they deliver that they sometimes fail to examine how hard it will be for customers to adopt their product and/or service − the gain/pain ratio involves measuring the gain you deliver the customer vs. the pain and cost for the customer to adopt it. Many healthcare decision-makers are looking for non-disruptive disruptions: technologies, products and/or services that offer game-changing benefits with minimal modifications to existing processes or clinical environments. Non-disruptive is critical to SMEs bringing innovative products or services to the healthcare market since the gain delivered will also be discounted by the risk associated with buying from a young company. Remember the NHS is risk averse and you need to make them believe it is more risky to do nothing than to take up your innovation A successful SME will, therefore, need to deliver an order of magnitude improvement over the status quo. If a proposition can’t deliver a 10x gain/pain promise, healthcare decision-makers will typically default to “stick” rather than bear the risk of a procurement decision.
- Framework that can help when considering pain/ gain ratios and chance of your product getting adopted. Sometimes brilliant innovations fail to get any traction in a real healthcare setting. Why? The innovator hasn’t fully understood the impact of the innovation in a real setting, and spread and adoption is too challenging in reality. In a complex environment like the NHS it can help to have some of these attributes Taken from Trisha Greenhalgh’s book; How to Implement Evidence Based HealthCare. Great read if you want to get under the skin of some of the challenges faced by NHS decision makers when implementing innovation today. But originally taken from Everett Rogers’ ‘Diffusion of Innovation Theory’. The single most important one is relative advantage. If the clinician or buyer does not believe your product is ‘better’ ie. Faster, cheaper, safer, better outcomes then forget it. . It’s worth considering evaluating these attributes and then highlighting the powerful ones in your VP if they are validated as real pain points in the system.
- Ask the decision maker (clinician, manager, policy maker, finance director) : Are they persuaded by your Value Proposition and the supporting evidence AND do they believe that change is possible.
- Without explicitly saying so, Uber expertly highlights everything that sucks about taking a traditional taxi and points out how its service is superior. The simple (yet highly effective) copy above, taken from the Uber homepage, excellently conveys the simplicity and ease that lies at the heart of what makes it such a tempting service: The smartest = You’re clever!! One Tap = it’s simple!! Comes straight to you = you don’t have to even move a muscle!! Cashless = you don’t even need money!! Not convinced? More reasons to ride…
- Clinical audience, traditional layout and not overly designed (although there was supporting marketing materials). Assumes some knowledge that SVR is a good outcome measure and that PR is current NICE recommended, gold standard treatment. Otherwise, its very clear what the product is for and the benefit it can deliver. Question half way through confirms the need is a true need in the mind of the reader.
- https://umotif.com/ Better design? Different style for a different audience An app for activating patients to fill in questionnaires for research and evaluation Tested to show the need was patient activation, a move away from paper and capturing as much data as possible. More eye catching layout deemed appropriate for this modern, app purchasing audience.
- Like a Saville row suit : Sharpen and Tailor for impact. The best VPs are to the point, using careful language that conveys your understanding and the benefits of your product, and tailored to your audience. You DON’T have just one VP unless you have only one decision maker in charge of purchasing and implementing. If you have clinical decision makers as well as financial, you may need to adjust the focus and flow of your messaging and supporting evidence.
- If you can’t explain it simply, you don’t really know what you are trying to say It should be CLEAR, COMPELLING, AND DIFFERENTIATING. Let’s have a go….
- Remember that the value proposition will change depending on who it is presented to….outcomes first or cost-effectiveness first? Core message could be different. If you can quote costs and cost-effectiveness per patient or trust specific value this is even better. It might be worth market research into what each group already knows and believes , what their values and priorities are. Keep it simple: Better, faster, cheaper, safer
- Test your value proposition until you get it right! Validation is essential. You can pre-empt some of the challenges by assessing barriers to entry, readiness for adoption, market potential/market opportunity etc…but you never fully know how it will land until to test it out.
- Is it clear why value proposition is so important? Your whole business strategy depends on it and it will guide your content in business plans/ evaluations and cost models. You need it for everything you sell. It will change with time and as your markets, needs and expectations evolve. Always think and reflect on the two key questions: What promise of value are you offering? Do your customers recognise and believe in that value? These are not easy questions. If you have done your research and you are not sure of the answers, get out and talk to people. Best talk to some customers and potential customers. Otherwise talk to advisors, mentors, non-execs or anyone who will listen. There is no more important question on which to seek advice. By all means avoid the business jargon of the words value proposition. But keep the concept at the heart of your strategy.
- Slide deck available from Indy that can be used to flesh out your core value proposition into a short, evidenced value story ready to take into meetings