Excel in Health: Proposition

1. Understanding the NHS
2. Relevant knowledge and skills for success
3. Applying your learning and pitching your
innovation
Three day programme overview:
@innovationnwc

Today’s outcomes
By the end of our session today, you will be able
to:
• Use your learning from day one to package your innovation for the
right audience
• Write a value proposition
• Design a business case
• Understand the importance of real world validation
@innovationnwc

Recap
• Greater integration improves sustainability and leads to better outcomes
• Reduce variation, bureaucracy and duplication with a focus on provider
collaboration and commissioning consolidation
• Mobilising populations and a focus on population health improvement and
reducing costs – the triple aim!
The NHS 5 Year Forward View brought the
concept of Integrated Care Systems:
@innovationnwc

What does the system need?
• Innovation
• Stimulation
• Facilitation
• Agitation
There is no lack of awareness of the problems that need to be solved,
or what might need to be done to solve them……but getting to those
solutions is proving difficult.
The system still has old thinking……the art of the possible isn’t always
clear…
@innovationnwc

Problem / Opportunity
• Make it clear that you understand there is a big, important
problem/opportunity (current or emerging) to increase or improve and
reduce or eliminate that you are going to help the customer achieve.
• Demonstrate understanding of why this situation exists and persist,
and why is it that now able to be addressed.
@innovationnwc

Solution
• What specifically are you offering to whom?
• Show how your solution fits into the existing pathway
• Do you complement commonly used technologies, or do you displace
them?
• Do you change the way certain business processes get executed, or
how care is delivered
@innovationnwc

Discuss the VALUE of your INNOVATION in context of what you now
know about NHS structure, processes and culture.
Reflection #4
@innovationnwc

@innovationlaura
Building your Value Proposition
Laura Boland

• 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
@innovationnwc

• Think back to reflection #4
@innovationnwc

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.
@innovationnwc

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
@innovationnwc

Understand
Evaluate
Construct
Test
@innovationnwc

Matching benefit to need
NHS
Needs
Product
benefits

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.
@innovationnwc

@innovationnwc
The need behind the need
• 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?

@innovationnwc
1. Take a few minutes to think through what you know about the
problem you are trying to address. Can you answer the 4 U’s?
2. Work through the checklist to understand the need behind the
need. Gaps = a good place to start your research.

Information sources
@innovationnwc

“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)
@innovationnwc

• 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
@innovationnwc

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?
@innovationnwc

1. Use the EVALUATION CHECKLIST to identify gaps
2. Consider OUTCOMES and COSTS you could measure to demonstrate
your product is a solution to identified unmet need
@innovationnwc

VP
Burden of
Disease Data
Evidence of
Unmet Need
Clinical Trials Cost-Models
Economic
Evaluations
Case Studies
@innovationnwc

• NHS is risk averse
• SME’s must offer a higher Gain / Pain ratio
• Non-disruptive innovation is easier to adopt
@innovationnwc

Relative advantage *
Low complexity
Compatibility / Interoperability
Observability
Trialability
Potential for customisation
Ease of use
@innovationnwc

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
@innovationnwc

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?!
@innovationnwc

• 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.
@innovationnwc

1. The Issue (why it’s risky not to change)
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
@innovationnwc

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
@innovationnwc

• 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

1. A business plan can help you prioritise
2. A business plan can give you control over your business
3. A business plan is vital to helping you get finance
@innovationnwc

• Business plan helps you reach your long-term goals.
• It provides business direction,
 defines objectives,
 maps out strategies to achieve your goals and
 helps you to manage issues.
• Allows you to focus your resources and energy appropriately.
@innovationnwc

• Helps identify what's working and what can be improved.
• Provides a sense of control about the future of your business.
• Writing and researching for your business plan gives you the chance
to:
 learn about your industry, market and competitors
 highlight where you are in the market
 identify challenges you may face and how they can be overcome
 understand your business finances, including cash-flow
 setting goals, timeframes and measures of performance
@innovationnwc

• Business plan sets out the basis for why anyone should invest in your
business.
• Any investors (or lender) will only risk their money if they're confident
that your business will be successful and profitable.
• A thorough and well-researched business plan:
 shows that you’re serious about your business
 helps lenders and investors to understand your business
 shows your predicted profits and income streams.
@innovationnwc

• Introduction to the business, the product and the marketplace
• Description of the business and people involved
• Description of the opportunity and the future prospects of the business
• Summary of the individuals to be involved in the business and the funding
to date
@innovationnwc

• Concise summary of the products or services to be offered
• Description of how the products or services are manufactured or provided,
including production lines or manufacturing plants and logistics
• Description of routes to market including sales team (direct or indirect) and
channel partners
@innovationnwc

• Size and geography of market
• Historic and predicted growth rates
• Customers making up the market
• How the market is served
• Competitors, their products and market shares
• Price levels and trends
• Requirements for, and barriers to, entry
• Proportion of the market addressed by the products or services
• Possible routes to entry
@innovationnwc

• How does the company hope to generate revenue?
• A description of competitors and how the company can compete
• A description of customers focussing on the main ones (say top ten
customers)
@innovationnwc

• Who are the key members of our team – brief summaries of background &
experience?
• How will the company be organised
• What will be the key management tasks and objectives?
• How will they be monitored?
• Are there any gaps in the team currently – if so, how will they be filled?
@innovationnwc

• Tabular summary of the profit and loss and balance sheet for the past 3
years
• Description of the major items included within the financial information
• Commentary on the key ratios including gross profit, interest cover,
ROCE and gearing
@innovationnwc

• What cash will the business need over what period?
• How is it proposed that this investment/borrowings should be phased and
structured?
@innovationnwc

• Time
• Technology / functionality
• Competition
• Operational risk
• Legislation / regulation
• Product liability
• Financial risk
@innovationnwc

• Planned method and timing of exit
• Projected value of the enterprise at point of exit
• Prospects/possibilities for further development
@innovationnwc

What exactly are they and how are they useful
Laura Boland and Dr Rafaela Neiva Ganga

• Evidence is essential to prove your product works
• Your Value Proposition must be backed up by robust evaluation
• Why is evaluation of your innovation important to you?
@innovationnwc

Real-World Data (RWD) and Real-World Evidence (RWE) are playing an increasing role in
health care decisions.
• RWE is the clinical evidence regarding the usage and potential benefits or risks of a medical product derived
from analysis of RWD.
• RWD is the data relating to patient health status and/or the delivery of health care routinely collected from a
variety of sources, for example: Electronic health records (EHRs), Claims and billing activities, Product and
disease registries, Patient-generated data including in home-use settings, Data gathered from other sources,
such as mobile devices
• RWE can be generated by different study designs or analyses, including but not limited to, randomized trials,
including large simple trials, pragmatic trials, and observational studies (prospective and/or retrospective).
• Why now? The use of computers, mobile devices, wearables and other biosensors to gather and store huge
amounts of health-related data has been rapidly accelerating. This data holds potential to allow us to better
design and conduct studies in the health care setting.
@innovationnwc

• Real wold Validation is a cost-effective mix-method user inclusive observational study to
assess the impact and benefits to patients, staff and the health economy, in a non-controlled
environment, of an innovation that has already undergone a pilot process.
@innovationnwc

• The ‘so what’ of a particular innovation:
 Analyse the ground-breaking element of the innovation and how it respond to a
problem;
 Scan the market horizon and review the academic literature (e.g. Evidence-
based protocols);
• Measure the impact on health outcomes;
• Realisation of claimed benefits of the innovation;
• Financial impact on the organisation, the NHS, and the wider health economy
• The RWV process is run in partnership by Innovation Agency, LJMU, the
innovator, and health or social care organisations. All parties work together to
deliver a real world validation report at the end of the process to answer the
relevant points above.
@innovationnwc

Think about the perfect Real World Validation to demonstrate the
value of your product:
• What is the setting?
• Who would you partner with?
• Who is implementing it?
@innovationnwc

Point of care flu testing in emergency departments
• Using the test in the emergency
department enabled quicker
treatment decisions and faster
patient turnaround, leading to
better patient flow and
management during a time of
intense pressure.
• After evaluating a different test in
each hospital over the winter of
2017/18, the preliminary health
economics showed that average
lengths of stay were halved, and
there was a saving of roughly
£200 per patient tested.
@innovationnwc

The gold standard in the context of clinical
guidelines and the typical gateway to becoming
part of standard health care practice.
Real world validation is informed by regional and local
NHS needs. It seeks to provide the information and
evidence needed to enable adoption of the innovation
in a variety of settings.
RCT are time and resource intensive and
should only be used in cases in which other
previously forms of evidence support the
necessary investment.
Strengths:
• Effective in confirming causality.
Limitations:
• Lack of generalizability;
Strengths:
• collecting verifiable, reliable data concerning human
behaviour;
• explore associations between the innovation and
the expected outcomes.
Limitations:
• Can not establish causality.
They apply standardised health
interventions to patients selected based on
strict inclusion and exclusion criteria and
are typically restricted to evaluating
specific interventions one at a time.
RWV generate insight, foresight, and
explorative findings to bring a product to
the healthcare market and to ensure its
significance in clinical practice, grasping
up with the principles of health economics
and outcome research, thereby exhibiting
the value of real-world insights in
healthcare decision.
@innovationnwc

It can help to break evaluation down into an evaluation pathway. The
pathway is made up of four evaluation stages:
1. Setting outcomes
2. Collecting evidence
3. Analysing & reporting
4. Acting on your learning
@innovationnwc

What is a logic model?
A logic model presents a picture of how your intervention or initiative is
supposed to work. It explains why your strategy is a good solution to the
problem at hand
@innovationnwc

Inputs
Your time
My time
Venue &
travel costs
Activities
Presentation
Questions
Worksheets
Groupwork
Outcomes
Under-
standing of
real world
validation
First drafts of
a logic model
Ability to
make a start
on your real
world
validation
Impacts
The
programme
is a
success.
You can
demonstrate
the value of
your product
to the NHS
@innovationnwc

Logic models capture and summarise your validation project.
There are different approaches, but all share core elements*
Inputs
Resources
used
Activities
Things
done
(measured
by outputs)
Outcome
s
Effects of
activities
Impacts
Broader
societal
‘goods’
Typically broken down into
initial / intermediate and final,
or short- and medium- term
* Terminology may vary, but the
basic concepts remain constant
@innovationnwc

• Visually engaging approach
• Brings together existing evidence (and identifies gaps)
• Logically links activities and effects:
• Identifying barriers
• Clarifying assumptions making success more likely
• Provoking thought and triggers questions
• Builds understanding and promotes consensus
• Provides a common language
• Provides common point of reference
Why use a logic model approach?
@innovationnwc

• Have a go at a logic model. Think about the inputs, activities and outputs
that would best validate your innovation.
• Use the Nesta Standards of Evidence to guide your reasoning.
@innovationnwc

RWV aims Data Quality
(high/low – reason)
The ‘so what’ of your
innovation
1. Ground-breaking element of the innovation;
2. How it respond to a problem;
3. Scan the market horizon (competition);
4. Review the academic literature (e.g. Evidence-based protocols);
Measure the impact on health
outcomes;
1. Define the health outcomes you want to validate;
2. Do you have pre and post intervention data?
3. Which type of data do you have?
Financial impact on the
organisation, the NHS, and
the wider health economy
1. Which type of data do you have?
@innovationnwc

• Our Health Matters programmes help businesses to demonstrate the
benefits of their innovation by supporting real-world validations.
• The programme, which is part-funded by the European Regional
Development Fund (ERDF), aims to catalyse businesses to become
market leaders in health, wellbeing and care by encouraging the
development of products, services and solutions.
• Validations are carried out by our respected academic partners: Liverpool
John Moores University, University of Chester and UCLan.
• Companies who aren’t eligible for the Health Matter programmes can get
support from our AHSN network colleagues.
@innovationnwc

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