Demystifying Spinal Products, Procedures And Contracting Strategy PDF Free Download

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Demystifying Spinal Products, Procedures and Contracting StrategyCindy Jones, Vice PresidentMedAssets, Advisory Solutions 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.

Agenda The Spine Industry: Current State and Trends Plan Your Strategy: Tidbits from the Trenches Speak the Language: Spinal Implants andProcedures–Cervical–Lumbar–Newer Technology–Osteobiologics2 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.

Sg2 ANALYTICSInpatient Spine Volumes are ThreatenedInpatient Spine DischargesUS Market, 2015–2025Outpatient Spine VolumesUS Market, 10-Year 8% 19% 17%500 12% r2020Sg2 IP Forecast–7%40020152025Population-Based Forecast 6%2020Sg2 OP ForecastNote: Analysis excludes ages 0–17 and includes Spine service line only. Inpatient includes discharges; outpatient includes volumes.Sources: Impact of Change v15.0; NIS; PharMetrics; CMS; Sg2 Analysis, 2015.Confidential and Proprietary 2015 Sg242025

Sg2 ANALYTICSInpatient Spine Volumes are ThreatenedConfidential and Proprietary 2015 Sg25

Market Share of Top 5 Manufacturers in Orthopedic 2009201020112012201320148 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.Source: Orthopedic Network News , 2004-2013.Source: Orthopedic Network News, October 2014

Analysis of the 5 Largest Spine Companies’ 7%30%20%29%10%0%Cost of GoodsSoldResearch &DevelopmentSales, General,& AdministrativeEBITDATotal OperatingRevenue9 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.Source: FY 2013 figures are from www.medtronic.com, www.stryker.com,www.jnj.com, www.nuvasive.com, and www.zimmer.com.

Healthcare Sector has the Highest SG&A Ratioof any Industry Sector in S&P 500HEALTHCARE42.0%FINANCIAL SERVICES40.0%INFORMATION TECHNOLOGY37.5%ALL SECTORS26.2%TELECOMMUNICATIONS25.1%CONSUMER DISC23.1%CONSUMER ld & Associates Analysis 2014 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.10

Medical Devices and Pharmaceuticals are one of theMost Profitable Industry Sectors in the S&P 500RBC Capital Markets Research Analysis 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.11

Hospital Operating Margin TrendsCA vs. 9%0.0%2004200520062007All US Hospitals20082009201020112012CA12 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.2014 American Hospital Association Hospital Statistics. 349 Hospitals in reporting.

What Are the Drivers of PPI Contracting Success?Indicators that have been proven to achieve full savingsDRIVERS1. Executives engaged in entire process2. Physicians engaged in the process3. Physicians incented to participate (not necessarily financial)4. Full set of clinical, financial and cost data shared with stakeholders5. Hospital willingness to remove non compliant vendors / make toughdecisionsOther contributing factors: Adhering to an aggressive timeline,communication with physicians throughout process, history of projectimplementation and culture# of Drivers Savings PotentialImplementedAchieved5121%491%385% 359%14 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.Study from 19 facilities

Physician Engagement is Vital79% of physician do not know what things cost80% of physicians want to know what things cost* Establish credibility by sharing accurate data relevant to physicians Use physician input to develop strategies Foster a collaborative environment, making physicians part of the process Various physician alignment strategies can be deployed–Physician employment–Co-management–Bundled payments–Gainsharing–Joint ventures–Professional service agreements15 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.*Source: Healthcare Advisory Board

Implant Strategy ContinuumTraditional ion“Repless”modelIncreased physician engagement requiredIncreased implant savings potential16 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.

Like Products Can Vary in PriceBe Wary of List Prices17 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.17Source: Orthopedic Network News Oct 2014

Cervical Fusion Common procedures Anterior cervical discectomyand fusion (ACDF)Posterior cervical pediclescrews21 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.Source: www.orthopedicnetworknews.comSource: Orthopedic Network News, October 2014

Anterior Cervical Discectomy & Fusion (ACDF) Done in conjunction with a discectomyFuses two vertebral segments togetherto prevent a collapsing deformityAutologous or allograft bone may beused.22 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.

Cervical ImplantsAtlantis by MedtronicCornerstone PEEKby MedtronicSkyline by DePuySynthesCornerstone (bone) byMedtronicSlimFuse by PioneerEndoskeleton TC byTitan SpineAssure by GlobusTM-S by Zimmer made fromTrabecular metalVectra-T TranslationalPlate by DePuySynthesColonial by Globus23 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.

Interbody MaterialBone or Non-bone? The use of interbody madefrom bone continues todecline. Interbody made from bone isless expensive than nonbone24 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.Source: Orthopedic Network News, October 2014

Cervical Stand Alone DevicesROI-C byLDR SpineCoalition byGlobusStalif-C byCentinel SpinePrevail byMedtronicZero-P VA byDePuy Synthes25 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.

Posterior Cervical Fusion Common brands Vertex by Medtronic Mountaineer by DePuy Synthes Synapse by DePuy Synthes Oasys by Stryker26 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.

Artificial Cervical DiscsSecure-C by GlobusPrestige by Medtronic 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.Bryan by MedtronicMobi-C by LDRProdisc-C by DePuy27

Posterior Lumbar, Transforaminal Lumbar,Anterior Lumbar and Direct Lateral InterbodyFusion ApproachesWordword29 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY. 2007 Medtronic Spinal and Biologics Division

Anterior Lumbar Interbody Fusion (ALIF) ApproachesTransperitonealRetroperitonealAnterior exposure of L5 – S1Lateral30 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.

ALIF Instrumentation and ImplantsPyramid by MedtronicATB (Anterior Tension Band)by SynthesTrinica by Zimmer 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.Aegis by DePuy31

Lumbar Stand Alone DevicesLDR ROI-ASynthes SynfixLRBiomet SolitaireSpinal Elements Magnum Globus IndependenceCentinel Spine STALIF-TT32 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.

PLIF/ TLIF – Posterior/ Transforaminal LumbarInterbody Fusion Utilize a posterior (back areaincision) approach Commonly utilizes pediclescrews, rods and an interbodydevice/ cage as well as sometype of bone graft33 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.33

XLIF - Extreme Lateral Interbody Fusion (NuVasive)Also Called Direct Lateral Approach Anterior portion of lumbarspine is fused from the side. Incision in the side betweenthe lower ribs and the pelvis Instruments pass throughmuscles and to the disc–Lateral muscles are separated,less muscle tearing or cutting34 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.34

Expandable Interbody–Globus Caliber–Spine Wave StaXX–Spineology OptimeshSpine Wave StaXxGlobus CaliberSpineology Optimesh36 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.

Interspinous Process Fixation/ Fusion DevicesBiomet/ Lanx AspenLifeSpine Aileron37 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.Total Annual Spend 691,020

Corpectomy When the surgeon removes the vertebral body as well as the discspace. Could be in any portion of the spine.39 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.

Bone Grafts and Bone Graft Substitutes by Procedure Type BMP usage has dropped from 51% of lumbar cases in 2011 to 21% in 2014. The use of cell-based matrix products is increasing 90% of bone graft spend is for spine cases Some cell-based matrix products are also marketed for trauma and foot & ankle Bio4 by Stryker/Osiris 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.Source:” Orthopedic Network News, October 201442

Sustainability of PPI Costs Data is king–Have a consistent feedback loop–Evaluate metrics on a regular basis–Communicate data to physicians regularly– Seek involvement and input Establish/ keep an active clinical value analysis process–Adopt new technology based on clinical evidence– Procured Health–Seek continual physician involvement Coordinate service line management across the continuum of care–Shared risk/ benefits are coming, if not in your facility already–Prepare for efficiencies across service lines– Adopt an end to end view of patient management43 2015, MedAssets, Inc. All rights reserved. MedAssets . Not to be reprinted without permission. For non-commercial use ONLY.

CONSUMER DISC TELECOMMUNICATIONS ALL SECTORS INFORMATION TECHNOLOGY . Cervical Implants Atlantis by Medtronic Cornerstone PEEK by Medtronic Cornerstone (bone) by . Artificial Cervical Discs Prestige by Medtronic Bryan by Medtronic Prodisc-C by DePuy Secure-C by Globus Mobi-C by LDR