Medsider: Learn from Medtech and Healthtech Founders and CEOs - The Biggest Mistakes Medical Device Companies Make When Commercializing in Europe: Interview with Michael Branagan-Harris, CEO of Device Access UK

Episode Date: March 7, 2017

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]Related StoriesHow Will These 2 Major Healthcare Changes Affect Medical Device Companies?Substantial and Sustainable – 2 Words That Medtech Companies Should Get Used ToSocial Media Best Practices for Marketing Medical Devices 

Welcome to Medsider, where you can learn from experienced medical device and medtech experts through uncut and unedited interviews. Now, here's your host, Scott Nelson. Hey there, ladies and gents. Welcome to another edition of Medsider Radio, brought you from the WCG Studios here in Minneapolis. If you're new to the program, MedSider Radio is where we learn from MedTech and other healthcare thought leaders through uncut and unedited interviews. Just a few quick messages before we get started. First, I send out a free email newsletter about once per month highlighting my favorite med tech and or health care related stories, the ones that I personally get a lot of value from. I don't send the newsletter out very often,

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they're giving it to our first 15 listeners for free, so go to reachfiredigital.com forge slash medsider. Again, that's reachfiredigital.com forwarded slash medsider. Grab that blueprint. Okay, on to the episode. Michael Brenigan Harris is the CEO of Device Access UK and has been involved in the marketing of medical devices to the National Health Service, or NHS for the last 27 years, from simple wound dressings to the introduction of the lot ban for obesity, endovascular graph repair, endo laparoscopic surgery, and the Da Vinci robot. Since incorporating Device Access UK in 2010, and Michael and his team have helped over 180 medical device and diagnostic companies navigate their way into the NHS. Their clients range from small startups to large multinationals from across the world.

In 2014, device access was granted a unique commercial license from NHS England to access over 750 million pseudonymous patient health records. This data allows device access to examine diagnosis, procedure, and spin data nationally and by NHS hospitals, and in turn enables them to do three things. See how the client's technology could affect the current patient pathway. Number two, assist in building a value story with Nice. And three, develop a solid business case for local and national NHS hospital adoption. In this interview with Mike, here's some of the things we're going to cover. What has changed since my last interview with him some four to five years ago, especially as it pertains to the NHS, Nice, and the NIC or National Innovation

Center. The current and pretty significant need for MedTech 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 PICO, and Connect for methodology, which are, I think you'll find really interesting. And lastly, Mike's thoughts on Brexit and what it means for MedTech in the UK. So without further ado, let's get to the interview. Mike, welcome back to Medsider. Thanks, Scott. It's good to be back. It's been a few years since our last discussion. I know. In recent sort of offline conversation between the two of us, I know we 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 Medsider. So for what that's worth, congratulations. I hope people are interested in hearing what's happened in the last five years, certainly in our healthcare system. I think they will for sure, especially as it pertains to European commercialization for MedTech companies, especially there in the UK. So let's go and dive right in. And we'll start with our last conversation that we recorded back in, I think, 2011 or 2012. 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? Absolutely, yeah.

So just so that we can get this, there's going to be lots of acronyms going on with this interview. And I'll just want to make sure that everybody knows what we're talking about. So we have the National Health Service, which is our publicly funded healthcare system. It's been around for decades, and it's publicly funded, and it means that we get healthcare provided through paying tax,

and basically it's free at the point of care. So it's a nationally funded healthcare system. You mentioned Nice. Nice is a body, which is the National Institute of Health and Care Excellence, which is a body that's funded by the UK government that's put there to assess and understand the benefits and the risks and the economics around new medical technologies and diagnostics. So that's the body. And I always describe Nice as when I'm talking to people in America, it's almost like JD Power. Your consumer, you're a consumer. organisation that tells you which type of Jeep to buy or Chrysler to buy. I mean, it's really their job is to inform the National Health Service on best practice, best use of technology. That's really getting over there. So what has happened since our last interview a number of years ago, we talked about

the National Innovation Centre. The National Innovation Centre is now no longer. It was changed and followed up by some other organisations within the National Health Service. And 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 of medical technologies and diagnostics. And those two programs were designed to help promote the uptake of new innovative technologies for the benefits of the NHS and patients. So it was quite exciting because before then there were only two programs that were available. to look at medical devices. One of them only looked at safety and efficacy of a new procedure, a new invasive procedure, and the other one with an older program which is still running,

but for pharmacological products, which would evaluate technologies around cost-effectiveness and qualities. You know, it has changed that the approach used by NYIS has changed significantly since then. And so what we have now is a couple of excellent programs which are able to evaluate products and diagnostics and medical technology, which can result in an announcement from NICE to the NHS and to others about adopting new technologies and encouraging them to use them. It's very powerful when you get that happen when they mention the branded products as well because they actually evaluate single-names technology through these new programs. I'll say, yeah, no, that's a great recap. And just to review, you've got the NHS, which is, you know,

is still the same governing body as, you know, as before, you know, based on the last time we spoke. And then you've got nice, of course, which I think that that analogy that you used is, is a great one in the sense that it sort of serves as a JD power or almost like the consumer, you know, the consumer reports, so to speak, informing the NHS on what technologies to adopt, etc. But the one sort of the major organization, if you want to call it that, that's changed, is the National Innovation Center, which we discussed at length in our previous interview, but that's that's no longer in place. And now you've got a couple new programs that have sort of, in conjunction with Nice,

that sort of have taken its place. Do I have that right? Absolutely, exactly. Yeah. I mean, the other thing that's changed, it's changed in many healthcare systems. 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. And interestingly, back in 2014, there was some work done that the NHS needs to build or we

need to build 22, 800 bedded hospitals by 2022. Now, that's a lot of hospitals. It's a lot of beds and it's a lot of staff and it's a lot of costs. And, you know, month on month, year on year, the NHS is under increasing demand and it either has to build the hospitals or it has to adopt new technologies. And I don't think there's a better time than there is now for companies considering old US activities to look at coming to help solve problems with very clever technologies designed out in the US and come to this country because the opportunities have never been better really. That's a great point because I think a lot of folks, especially in pure play, MedTech companies, and I could maybe be making a wrong assumption here, but they look at commercializing

in Europe for a couple of reasons. One is to get, you know, to 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 Lambson mentioned in a recent interview I did with him, he's the founder of Neotracht. They commercialized in Europe, well, a couple different reasons. One is they really, they didn't have another choice due to the FDA environment at the time. And then, you know, as it turns out, it really, it really behooved them to commercialize in Europe because it gave them sort of really helped them mature in their commercialization strategy

and help them prepare for an eventual, you know, launch in the U.S. But those, you're basically bringing up a third point, which I think is really, really valid in that there's a huge existing need to fill in the UK with 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 med tech companies would, you know, if they just viewed, you know, commercializing in the UK or in Europe through those lenses to serve that existing need, that would be, sounds like a pretty good potential business to commence there.

Would you agree? It is. No, absolutely. I mean, you're absolutely right. I mean, most companies, and I've worked with well in excess of 200 companies now, which is a lot of companies, a lot of people that will probably know me from this anyway, and, you know, lots of products and lots of therapeutic areas. You know, we've worked extensively in some areas, but I can't think, Scott,

a single part of the body that we've not actually worked on in terms of a product. And it's been a really interesting number of years. But yeah, you're right. I mean, the opportunities are here to come, oh, US and develop clinical evidence and to get products established, you know, create value along the way, which is so important when you're a startup company. It's being able to demonstrate to the investors and others that you are making progress and you have key milestones along the way.

So it's so important. So most companies, and I work with a network of reimbled, consultants from across the world. I've got somebody that's just relocated recently to Los Angeles who's going to be helping me. And, you know, I have people in Australia and people in Berlin, I mean, literally all over the place. But most mettech companies actually consider the Germany and the UK markets first when they look at, you know, making some sort of global progress. So, and there's benefits. You know, with Germany, there's great places and great places to go. and they have a very clever reimbursement system there.

But some of the drivers, and I mean, I think one of the examples, I know you just mentioned near tract. I mean, you know, if you look at the NHS and the UK healthcare system compared to the German one, and it's a good example, actually. I mean, one of the benefits of having something like near track done is that you can have it in an ambulatory setting. And that means you come in, you have it under local, and you go out. and you don't take up a bed day, you don't take up much OAR time, it's quick, it's easy,

you know, you avoid the risk of problems in hospital because you're in and out so quickly. Whereas in Germany, they actually encourage patients under the system to be in hospital for at least an overnight stay. And that doesn't make sense from a productivity perspective. And I think you'll agree in the US as well that, you know, the ambulatory office-based procedures are a growing area, is it means the doctors more productive and the drivers are different. So I think that, you know, you have to consider that. So what's the benefit to the healthcare system, you know, and it might be the incentives are different in each country and so different.

So you need to really work on how to gather the evidence around each of those scenarios to build a value and a, well, a value story and a value to your business. 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 dive right into that, that aspect of the discussion. Because you work, you know, Mike, with a ton, as you know, I'm preaching to the choir here. You work with a ton of 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. And I think you're kind of being humble, but you're pretty well known in this space.

On that note, a lot of early stage bed tug companies come to you and you see them, you know, follow this sort of, you know, traditional process, if you will. that's sort of laden with mistakes. You know, 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 net tech companies following that isn't really the best pathway to go with?

Yeah, that's a really good question, actually. I think, look, the biggest problem is, and it's about not considering reimbursement. It's as simple as that. it's almost like saying, put another way, and this is a bit relevant with recent times in both of these countries, you can go into a country, you know, as an illegal immigrant, you can go with a visa or you can go with a full passport. And the same thing happens as far as reimbursement's concerns. You might be able to think you can go so far without getting reimbursement and having a clear pathway. You can get limited reimbursement, which is like a visa, or you can 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 products, putting prices on them, getting them C-E-marks, and then assuming that these countries are going to sell,

sorry, these countries are going to be able to buy them within the structure of the reimbursement system. And certainly within the NHS or the UK system, you know, most of the time there are ways that you can get things paid for. But you have to consider pricing as well and how pricing could change considerably between markets. And that can have a big difference to a company's strategy if the drivers are so different. So, you know, there's that to consider as well. But it's really as soon as you, you know, it's like designing a Lamborghini or something like that. I mean, it's like making a very expensive car, but trying to sell it in one of the poorest parts of Africa as opposed to go into Monaco. you know, where's the money going to be? How easy is it going to be for that country to buy that

product? And it's a simple thing. There's so many assumptions made about, you know, oh, well, the NHS has, you know, 300 or so odd hospitals. That means they're going to buy a lot of hip processes. It probably does, but it doesn't necessarily mean that all of them are going to buy them. And it's really understanding activity and how to get the product paid for. And 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 don't. So people can be put on the wrong journeys and they can spend a lot of time in areas they don't need to. And 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 NHS bodies and ask them what they need and then deliver what they, you know, what they've asked for as opposed to assuming what you think that the healthcare system wants to get reimbursement. I definitely want to get into that and especially considering that, you know, you do this on a day in and day out basis, considering your close relationship with some of the folks at Nice. But going back to this, these assumptions. Hearing your analogy, the Lamborghini analogy, and you know, you wouldn't build a Lamborghini for the poorest parts of Africa, you don't want to, you don't want to consider the country that you eventually want to sell it into and 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 Medtech companies miss this part, do you know why that's the case or do you have any speculations as to why so many major-aged 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 sort of long-term modifications with respect to reimbursement and even the second aspect that you mentioned, you know, the clinical trial regulations and, you know, how expensive some of those can be if you don't really need that robust of a clinical trial. Yeah, I think that's a really good question.

I think that, you know, the world has moved on from, you know, I mean, I used to sell lots of endoporoscopic products and I was involved in gastric banding and bringing a lot of of technologies into the healthcare system here before I started device access. But I think that, you know, the days have been able to turn up and sell something without somebody going into the detail of, you know, why do we want to buy this and, you know, how is it going to be paid for? The world's really changed. And there's not, there's a big focus on marketing.

There's a big focus on regulatory. But there doesn't ever appear to be that much of a focus on pure market action. and reimbursement. And I think that, you know, globally, there's a big gap of knowledge here. And we're an extremely busy consultancy, but I think that there's not that many people to go to. And I think that, you know, where has you got the US healthcare system where your, you know, reimbursement means, you know, what can the doctor earn 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 not. I mean, I often describe, you know, the difference between NHS, a National Health Service doctor and a New York fireman. And they're very similar people. Both are paid a salary and both don't carry a business card. So, you know, if you go to a New York fireman and say to him, you know, how many fires did you put out yesterday? I put 10 out. How many did you put out today? I put 15 out and say, gosh, you did really well. You've earned lots of money today. That's not the case. And, you know, that's exactly what an NHS doctor is as well. And so whereas in America, doctors are remunerated by doing multiple procedures, multiple diagnosis, multiple treatments, et cetera, and they earn money through that mechanism of activity. It doesn't apply here. So there's so many differences. And I think that that's partly why, people make a mistake because 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, has an absolute global impact. And they know it because it's one of the, or probably the most respected HTA in the world. So, you know, I was recently over at Azamed in Minneapolis talking to many medical device companies, and one of them as far away as Brazil said, we want nice approval because it's going to help me get products into the hostages in Brazil. I mean, it's wide and far reaching. So, yes, it's difficult now, but, you know, it requires, you know, it's a highly specialized area. Reimbursement and market access is a brand new, you know, recognized or should be recognized skill.

Yeah, it's almost like the function that's becoming so important, not just in the UK, but in the US as well, is sort of this market access function, but it sort of doesn't, it loosely exists, you know, but it's sort of a cross between, you know, traditional functions like regulatory, clinical and reimbursement, but market access is sort of almost like a combination or a culmination of all three, especially for, you know, for MedTech companies that are sort of in their early stages. I'm not sure if you'd agree with that description, but certainly how sort of I, I kind of to see market access anyway. But on that note, before we go any further, I love your analogy of the New York City fireman versus the NHS physician. That's a really good way to sort of help us

understand for those that aren't familiar with the European or the UK health system. That's a good analogy. So having said that, let's presume that I am a, you know, the CEO of an early stage, you know, med tech company. And we've got, we've got, you know, investment, 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, MedTech companies follow as it pertains to, you know, getting nice approval within the UK? Yeah, sure. I mean, you know, we offer a number of different sort of packages to help companies in space. And the important thing is we spend, you know, a lot of time trying to understand,

you know, first of all, primarily what problem this medical device is going to solve in our healthcare system. And if you can focus on and work on the problem, you know, itself and trying to address it with the technology, you run a much bigger success or a higher ratio success of getting a product into a system as you would in any healthcare system. But we have something available in this market in NHS England for sure that isn't available to my knowledge in any other healthcare system in the world and that is that we have access to pseudonymised episodes of care from the NHS database. What that is, is that any patient that goes into an NHS 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. Was it a general admission or was it a emergency admission? so we know how a patient got into the hospital. That's all recorded. Then we have information about patients' age and sex and reason for being there, so their primary reason for admission, as well as any comorbidities as well. So, for example, you know, you could be in hospital because you broke your leg, but you could also have high blood pressure and be diabetic.

So all that information is recorded. Then all the treatments the patient has are recorded, whether they went into intensive care, what treatments they had, and it could be a primary treatment, and could be all secondary treatments as well. So, you know, we have laterality, we have, you know, in the spine, we have levels of spine data, we have open laparoscopic under image guidance, all that information is recorded. And at the end of the episode of care, you have the amount of money that episode costs available. So we as a company have access to 750 million, episodes of care going back four years and we're able to look at them to see where a medical

device could make a change to a patient pathway. We can look at patient pathways on an individual patient basis and see what would happen if they have a new therapy, if they had a new medical device or a new diagnostic use. What difference would it make on a local and national basis. And we use that information to then build a proper strategy to help companies to then engage with the NHS and particularly knife, to then go and say, look, this is a population of patients we're talking about. Now, you know, what we talk about is a language of which we call PCO, P for population, I for indication, C for comparator, and O for outcome. So population is, look, you know, population of patients, the product is going to be used for, or the population of patients with the actual

diagnosis of a disease or a problem. And the population is critical, and I'll come back to that in a second. Indication is what does your device do and how does it work and how does it, you know, how does it solve the problem? See is comparator that what happens at the moment in our healthcare system, how are those patients treated? And we know all about those patients because we can extract the data from our database and examine how patients are treated in the NHS. English hospitals and the OAS outcome, what's the difference between the current therapy and your new technology? So we look at this information critically at this early stage to sort of try and see whether there's a valid case for a technology to come into, you know, that would

have a successful entry into the NHS as well as looking at reimbursement analysis to see whether the technology can fit into the current reimbursement programs that are there that actually fits into the current coding that's in existence because it's quite difficult to create new procedure codes at the moment. So that's the sort of criteria we use. We spend a lot of time understanding these companies' products and working out and being to see by looking into this database how a product could make a difference and what ultimately will be beneficial to the patients.

Is it going to reduce the length of stay? Is it going to reduce readmission? Is it going to reduce complications, infections, timing intensive care? I mean, we can look at all sorts of pieces of information. And then we look at the system benefit. What would the hospital or the NHS as a whole benefit from a new technology? I mean, you know, you take, I mean, we talked about Varacus Faines on the call several years ago. you know, 11 or 12 years ago, there was probably in the region of 40 or 1,000 bed days associated

with barriciccane surgery. Now there's a couple of thousand. I mean, this is a technology that's brought this benefit and opened up capacity in our overcrowded hospitals. So we can go into this information and we can find how the technology would benefit the hospital in reducing length of stay and free in capacity. And we can then use that information in those two parts of the story to support the payer, you know, the organisations that funds the hospitals for the activity and 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 internationally through the hard work will be done. And we basically, I don't know if you know of a game called Connect 4. It's a board game that's played at Christmas time. I don't know if you. Yeah, absolutely. You have the four in a row, the winning strategy of four in a row is patient benefits, hospital benefit for performing the procedure, payer benefit 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 4 we often talk about when I talk to clients. So a lot of research about current patient pathway,

seeing how patients are treated and looking at real numbers and being able to apply methodologies to say, okay, if we put the device into this scenario, what would the benefit be to the system and to the patient and to the payer? And that is basically, I don't know of another healthcare system in the world where you're able to do that. And we're very fortunate because of our work with, you know, several NHS bodies and because of our relationship with the UK government and certainly

the UK government inward investment organisations that are trying to encourage companies, certainly from the US, to come and commercialise, bring their products and their experts and their, you know, and their technologies to the healthcare system. So because of this work we've done and certainly helping multiple products go through nice over the last few years, we're very fortunate to work with this incredible data. database to help to help companies formulate a strategy around how to get the product into the market here and how to take the product successfully through the nice programs or any of the research programs that are available here as well.

Yep. No, that's a great overview. And I let you sort of just riff. I didn't want to interrupt because you're on a role 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 coined there at Device Access, your company?

No, I'm not going to be credit for that one. The Connect 4 is one of mine. But no, I think PICO, PICO is a methodology that is a nice framework to think about, you know, when you're engaging with the NHS. And certainly with nice, it's the language that they use. You know, they're being straight at the point. They're not interested in their glossy literature. You know, who's the population? You need to know, if you're coming into a market, what is that population?

And to come to the NHS and say, well, you know, 3.7% of John Hopkins University, L.A. or whatever. have this problem isn't going to apply in our healthcare system, or it may do. But if we had to come in and be to articulate the real numbers of cases and numbers of patients and what those outcomes are like, it is a far more powerful way. And this information that we are able to work in has been, often is presented and published as well. I mean, you know, I can give you a really good Another example of a situation, we were working with a wound care company, and we wanted to understand pressure ulcers. You know, when you come into hospital and you lie around in bed, you don't move, and your skin dies, you get a thing called a pressure ulcer. You know,

they're very common in hospitals across the world, really, but we wanted to try and understand, you know, why were patients, you know, what was the number one reason for admission into an NHS hospital that led to a pressure ulcer? And so we extracted every single episode. of pressure ulcer, 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 ulcers. They might have come in with something else, and whilst they're in recovering, developed a pressure ulcer. So we extracted all the information and we reversed it to find out, you know, what was the number one cause of a pressure ulcer, and it's actually pneumonia.

If you come into hospital with pneumonia and you don't have a pressure ulcer, you're in hospital for 11 days. If you come into hospital and you develop a pressure ulcer, you're in for about 23 days. And so you're looking at a much longer length of stay and a much longer, you know, capacity issue for a hospital. And to be able to then, you know, develop a value story around, you know, a new technology which would alleviate pressure ulcers. This is a much easier conversation when you know what the impact of these things is to a healthcare system. And that's probably, you know, one of the interesting ones we did for for that client, but it's really getting into the nitty-gritty of activity and outcomes.

Yeah, no, and it's a great example. And I 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, with that sort of data, that sort of, you know, culmination of data points. But I think, you know, kind of going back to the PICO framework and connect for, you know, listening to you describe it. And I know we've had a couple of conversations, before we hit the record button here. But, you know, the Connect 4 sort of analogy that you described before, I know in hearing you describe that, of course, you know, we're viewing things through the lenses of commercializing in the UK and working, you know, 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 payee benefit, the company benefit, you know, everyone wins, you know, investors win, patients win, you know, healthcare providers win, et cetera. So I think it's a really, really solid, you know, sort of methodology or lens to view things through regardless of where, you know, where you're commercializing. And then the other thing that really, you know, kind of rings true for me in 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 you've access to, it's real, it's real data. It's real numbers.

They're not assumptions. And so being able to, that then allows a med tech company to effectively engage in a really good dialogue with Nice, right? Because you're using their language. And so instead of like a, you know, a sales process, it turns into more of like, you know, a sort of a win-win type of conversation. So, I mean, are my, you know, those are kind of my thoughts in hearing you describe that. Is that, is that ringing, you know, ringing true for you, Mike? It is. I mean, it's really, you know, we work a lot on a national basis. You know, we have sort of, you know, limited bandwidth to start running around the country on individual hospital basis. But ultimately, you know, by being able 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 be able to look at how you can improve things, you know, by having the right level of information, you can go in on a local basis, on a local hospital basis as well. And we talk about, and I don't know, I'm sure that all the US hospitals have carpeted areas and non-carpeted areas. The carpeted areas, the carpeted areas, the carpeted areas are 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 talk about is being able to provide, and we provide this for some of the, you know, our very largest clients. I mean, giving them information as to what to talk to in the financial parts of the 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 a waiting list of 700 patients that are waiting for orthopedic surgery? And do we even, you know, look in system and realize that their length of stay data for certain procedures is very long, and they may be using an old piece of technology. I mean, by having the information to be able to go and 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 able to engage better.

And I think that, 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 to policies as changes to amounts and HRGs and DRGs and, you know, you've got to be kept up to date. And we're fortunate we work with a great network of people that work locally because I don't think, well,

I can say you can't do this. One person can't learn each healthcare system in the world it's so complex that you need to have up-to-date help on the ground on the local basis to do this properly. Couldn't agree with you more. I couldn't agree with you more, Mike. And I just want to thank you again for coming on the program now twice and sort of describing not only that changes, you know, that are going on in the UK with respect to, you know, nice and the NHS, but also kind of detailing out process that, you know, an ideal process that you like or you prefer bed tech companies to follow in order to get the results or see

the results that, you know, that I think everyone wants to see realized. So I appreciate you coming on. And then as we sort of wrap this up, I want to ask you one last question that's a little bit off topic. But before we go there, where's the best place to, you know, for MedTech 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 database that you have access to, where's the best place for them to find you? We have a website which is deviceaccess.comco. at UK. We've recently got the domain of market access.co.com. So there is a link on there. The website is going to be updated. We've got a number of new

images and things going on that shortly. But if anybody does want to reach out, then feel free to through that website, marketaccess.com.com.com.com.com. Got it. So either deviceaccess.com or market access.co.uk. They probably go to the same place. But well, I'll make sure to link that, link to that 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 Medsider.com and 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 I've normally, you know, over the past, you know, several episodes sort of ended, ended most of my interviews with with three sort of rapid fire questions. But, you know, you're in, 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 or med tech specifically? Yeah, I think I'm very positive about the future for us as a country. I think that, you know, we've been in this area of the world, which hasn't been growing as much as others, you know, other countries like America and India and China and Asia-Pacific areas. And I think it's time, you know, I'm excited about the future for us as a country going forward in being over to trade with who we want to, when we want to, and how we want to.

And then at the same time attract, you know, businesses into this country with a very fair tax regime and, you know, and be able to offer certainly the METEC industry, the U.S. METIC industry, a fantastic place to start on their OUS strategy. And I think we're in a great position having this single healthcare system called the NHS that, you know, many other countries look up to into how they treat people in the system, how it's funded, and the credibility of the system. nice and also and I haven't touched on it much is the opportunity for research is outstanding in the country with some of the leading university so my view is excited about the future you know we have a massive opportunity and a real desire to adopt new technology so you know encourage encourage people to have a look at at this market in Europe definitely yeah no that's great it seems like you know you anytime you you know you read pieces of information online it's how the Brexit is going to lead to you know massive

failure and disruption and whatnot. So I think it's really valuable to get your take on it, considering your local, right? And you work with, you know, a lot of, a lot of these big name organizations in institutions like the NHS and Nice and other, you know, med tech companies that are trying to, you know, sort of navigate through the system. So it's refreshing to hear your take on Brexit and the fact that, you know, there's a ton of opportunity and it could be really, really beneficial for everyone. So good stuff. So Mike, I'll have you hold on the line here. But just thanks again, you know, for your time and walking us through sort of best. practices as it applies to working with the NHS, Nice, and sort of the ideal sort of process or

pathway or framework, if you want to call it that, to use when trying to make some headway in Europe. Great. Thanks, Scott. It's really great to be into it again. Appreciate it. All right. Sounds good. And thanks everyone for your listening ear. And until the next episode of Mensider, everyone, take care. Thanks again, ladies and gents for listening. This episode has been brought to you from the WCG studios here in Minneapolis.

And don't forget to grab your panoptic stacking blueprint by visiting reachfiredigital.com for slash medsider. Again, that's reachfiredigital.com forward slash medsider. Okay, bye for now.