Improving Care for Non-Communicable Disease (NCD) Patients with Medtronic
Medtronic is the world’s largest medical technology company, operating in 160 countries. The company’s mission statement includes a priority to contribute to human welfare through technologies that “alleviate pain, restore health, and extend life.” Medtronic pursues this mission through its core business and through access-focused initiatives, including its support for the NCD Alliance, a global collaborative of over 2,000 civil society organizations dedicated to improving non-communicable disease (NCD) prevention and control, and Medtronic Labs, an internal start-up incubator created to design and launch businesses that transform healthcare for underserved patients in emerging markets. We spoke to Trevor Gunn, Vice-President of International Relations, and Ruchika Singhal, Vice-President of Global Health and Medtronic Labs, to discuss the origins, achievements, challenges, and future of both ventures.
“At the end of the day, our mission is to get medical technologies to all who need them. That’s everyone — all geographies, all economic classes. And if you can develop a common sense business way to do that, it’s all going to change.”
— Trevor Gunn, Vice President of International Relations
“We’re evolving to focus on a few disease states and looking for end-to-end solutions. We have two metrics for success: (1) maximizing impact through improved access, outcomes & systems strengthening (2) financial sustainability.”
— Ruchika Singhal, Vice President of Global Health and Medtronic Labs
Three insights from Medtronic on creating shared value
1. Emerging markets are a promising and rapidly growing commercial opportunity: Globalization is a key tenet of Medtronic’s growth strategy. We need to adapt our thinking for emerging markets to deliver affordable solutions for the low and middle income population segments — that is one of the biggest untapped market segments.
2. Engaging in systems beyond products is critical for health technology companies: We realized that in order to create solutions we couldn’t just put products on the table; instead, we needed to dig deeply into healthcare systems.
3. Finding the right model takes experimentation and persistence: Initially we were trying to adapt Medtronic products, but that didn’t work for the new markets we were working in. We realized we needed to develop solutions specifically for the large underserved populations in emerging markets — and that’s what we’re doing with Medtronic Labs.
As a medical technology company, what is Medtronic’s unique role in addressing global health challenges?
Trevor Gunn: Here is just one example. We are completely re-designing renal care dialysis technology to move from a 3-week treatment that was largely limited to delivery in cities, to soon having a portable renal dialysis unit that uses one-tenth of the water of normal renal care in a unit the size of an overhead airplane bag. This new system can effectively be brought to rural communities, and that is transformative.
What is Medtronic doing to bring these new products to market?
TG: In the past 4 years, we’ve gone into services, not just products — particularly in emerging markets. We realized that in order to create solutions we couldn’t just put products on the table; instead we need to dig deeply into healthcare systems. We’re doing this in two ways — integrated health systems and public-private partnerships (PPPs). Within integrated health, for example, we’ve bought diabetes and obesity businesses. These aren’t just products — they change the systems around health issues. In our public-private partnerships, we work with governments to first understand and address health challenges — we start by saying “You have X amount of cardiac disease in your country, we can help solve that.” We bring our expertise and technologies, but we also work with a lot of partners. At the end of the day, we want to be held responsible for outcomes — and that’s a very different approach.
We’ve also created Medtronic Labs — a totally new legal structure within Medtronic that took 3 years to create — to look at healthcare problems in emerging markets and develop relevant technologies or other solutions.
Overall, we’ve changed from being a purveyor of products to an organization that can provide economically viable solutions to the healthcare problems that exist within either government or private sector contacts. If you don’t have well-functioning healthcare systems, well-trained healthcare workers, or the financing that goes around it then, as our CEO Omar Ishrak likes to say, “a pacemaker ends up being a fine paperweight.” So with governments, we have to start by asking “what are your priorities and how can we help solve those priorities as a team?”
How has Medtronic leadership supported this work within the business?
TG: Globalization is a key tenet of Medtronic’s growth strategy. We need to adapt our thinking for emerging markets to deliver affordable solutions for the low & middle income population segments — that is one of the biggest untapped market segments. Emerging markets are still a relatively small part of our portfolio, but they’re growing quickly. On every single conference call that Omar [Medtronic CEO Omar Ishrak] has with investors, he highlights emerging markets as the single biggest opportunity for medical technology companies. We’ve also invested a lot more in emerging markets personnel around the world. At the end of the day, our mission is to get medical technologies to all who need them. That’s everyone — all geographies, all economic classes. And if you can develop a common sense business way to do that, it’s all going to change.
How does the NCD Alliance help Medtronic improve access to its products?
TG: The Alliance was created to raise the profile of NCDs with ministries and governments. If governments don’t know what’s killing their population, let alone how NCDs are connected to that, it’s impossible to address the problem. We’ve been fighting to do away with misperceptions and a lack of understanding around NCDs for a long time. For example, people believe all NCDs are preventable. In reality, only about one-third of NCDs are preventable.
Having dealt with NCDs for 12 years, I am flabbergasted that we haven’t been able to make more progress. At one level, people are starting to see the issues with NCDs more clearly, but the problem is funding and resources. Less than 1% of global health funding is focused on NCDs. The evidence is overwhelming, but the funding and resources just haven’t followed.
Switching to Medtronic Labs, what was the inspiration for setting up the Labs?
TG: Ultimately, for us, it was about being much more involved in solving the complex problems and opportunities that lie in emerging markets. Traditionally, we developed technologies and then marketed them to the world. The Labs inverts that process. They start with an emerging market need and then try to solve the problem. It’s a relatively new structure, but it is getting us there.
How does Medtronic Labs work?
Ruchika Singhal: We have tried a few different models. The first model was creating external partnerships on each part of the process, from design thinking to clinical practice. The second model we tried was a volunteer model where we didn’t have a dedicated team, but engaged employee volunteers and had an open source model where anyone in the business with an idea could approach Labs. That was good for employee engagement, but it wasn’t the most efficient model.
Now, we’re evolving to focus on a few diseases and looking for end-to-end solutions. The Labs’ initial focus is on: (1) NCDs like diabetes and cardiovascular disease and (2) acute care / emergency situations, specifically heart attacks, trauma, and stroke.
Within systems, we find or acquire partners, technological products, and other resources as needed. We’ll also look for the other players needed in the ecosystem to build infrastructure and care pathways that don’t exist for our target populations. For example, there is no shortage of companies doing diabetes screenings, but very few do systematic follow through to ensure patients are getting optimal treatment. This isn’t helpful for the patients or cost-effective for the health system. So, one thing we’re thinking about is a platform system with integrated diagnostics for diabetes, blood pressure, EKG, and more that can manage large cohorts of patients from screening and diagnosis to medication adherence and complication management, and in a lot of cases detecting complications before they become serious. That’s the vision — to build these platform-level system solutions for major chronic diseases.
We have two metrics for success — (1) maximizing impact through improved access, outcomes & systems strengthening (2) financial sustainability. We’re still clarifying what those mean, but we do plan to re-invest any extra profits beyond break-even back into the Labs so we can consistently increase our impact.
What do your partnerships look like in practice?
RS: Great question, I’ll use one of our projects, Project Shruti, as an example. Project Shruti focuses on chronic ear disease management in India. We’ve built out the ecosystem of care and figured out the economics of the system. We partner with ENTs on the ground. They hire the health workers and we train the workers, provide support for the ENTs to monitor and continue training the community health workers, and provide telemedicine solutions.
Because so many people struggle with inner ear infections, the economics work out and we actually hope to break-even in a few years. This program allows ENTs on the ground to significantly grow their business, expand access to inner ear treatment for their communities, and cover the costs of Medtronic’s assistance. We currently work with 32 ENTs, all in the private sector, and they have hired 100+ community health workers. We think if we can make it work with the private sector, we can make it work with the public sector as well.
Do you anticipate opportunities for reverse innovation — taking something developed for India or Ghana and bringing it back to developed markets?
RS: We think about that a lot. We’ve had multiple interests and requests for a Project Shruti product in Canada and Latin America and it is a service we could provide at a reasonable price. That’s exciting for us, but we need to have the right business model before we expand. Our leadership is great and committed to staying true to the mission without trying to get us to break-even too quickly. Our focus right now is very much on figuring out how to solve the problem of products and delivery in emerging markets.
And that’s not a small problem to solve. What do you see coming up next for you and Medtronic Labs in the next 5 years?
RS: We’re still trying to figure that out! Over the next 5 years, my hope is that we get a number of programs kicked-off, complete pilots, do commercial roll-outs, and at least break-even on two or three of these programs so that we can ensure Medtronic Labs is self-sustaining. Once we get to sustainability on a few programs, then we can start thinking about others.
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