Transcatheter technologies transformed the treatment of coronary artery disease. From the first  percutaneous balloon angioplasty in 1977, to the first self-expanding stent in 1986 and first drug-eluting stent in 1999, to the biodegradable and bioresorbable stents we have today, many millions of patient lives have been saved and billions in economic value created.


The common theme here is the relentless focus and grand successes of product and feature innovation. Back then, the leading companies competed fiercely to improve stent delivery, materials and coatings. Eventually, though, it became hard to differentiate on clinical and procedure value improvements, and the basis of competition increasingly shifted to price.  


This brings us to transcatheter 2.0: transcatheter valve repair and replacement. These new technologies are game-changing for patients. Addressable patient pools are expanding as mitral valve solutions have emerged in addition to the aortic valve offerings. Competition is intensifying, but how will it play out?

We believe that winners in the transcatheter valve market will proactively drive innovation beyond product features to create sustainable competitive differentiation by:

  1. Understanding patient journeys beyond the procedure experience: The study of the patient journey shouldn’t be limited to the time the patient arrives on the operating table to the time they are taken to the recovery room. We recommend expanding beyond the needs of the surgeon or interventionalist and looking holistically at the patient experience to uncover new ways to improve.

    For example, Boston Scientific’s Neuromodulation Learning Institute was the first to bring comprehensive clinical education to healthcare providers that manage patients with chronic pain to help them understand how spinal cord stimulation devices fit into treatment options and facilitated interaction and access to experienced pain specialists and spine surgeons.

    By determining what would compel a physician to choose your therapy, you can offer unique value where the competition is sparse. For example, medical device company Vascutek offers a case rehearsal service and customizes their AAA stent grafts to patients’ anatomies to improve procedure planning and tailor the device to the individual patient, thereby reducing risk and improving outcomes.

    Figure out what would convince a hospital or IDN to choose your solution and create value propositions that appeal to that. For example, Cook Medical’s healthcare business solutions group provides tools and services to optimize supply chain costs for hospitals. This addresses the total cost of delivery for their customers, including solutions for sterilization, materials and inventory management.
  2. Selecting key moments in the journey where a solution can create a big difference: As you evaluate the holistic journey maps, ask yourself two questions:
    Will your solution improve patient and stakeholder satisfaction, and is it better than what’s available today, or what anyone else might offer? Determine how many stakeholders experience this problem today, and what an effective solution is worth to them. Critically evaluate and test concepts vs. alternatives to find compelling evidence of their superiority. 

Is there an attractive economic return to be earned by solving for this need, and if so, what business model is needed? Relying on traditional reimbursement and incremental price uplift for new features is no longer sufficient. Instead, determine the economic impact of the therapy and build and test the value story and payment models to support it. This is the one step that companies neglect most often, and it’s arguably the reason many innovative solutions don’t deliver the impact and returns that companies expect. For example, Medtronic Integrated Health Solutions partners with health systems to manage specialized care settings such as the cath lab or ICU. Medtronic offers vendor-agnostic managed services offerings to meet health and operational outcome targets, with shared risk business models that were new to the company and among the first from a medtech manufacturer.


3. Capitalizing on insights and relationships to build a differentiated and sustainable portfolio strategy:  A successful transcatheter valve franchise will have incredible assets and knowhow like technology platforms, medical knowledge and clinical and regulatory pathways as well as deep, trusted relationships with KOLs, treating physicians and referral networks. Companies instinctively mine these resources to serve the full set of addressable conditions via transcatheter therapies. Already, these include aortic, mitral and tricuspid valve repair and replacements, atrial appendage closure, thoracic and abdominal aortic aneurysms, percutaneous ventricular assist devices and treatment of thromboembolism and aortic coarctation.

However, companies rarely prune the garden of products that are outdated or superseded by newer and better innovation. Leveraging the same relationships and know-how to rigorously evaluate the pipeline is key to ensuring appropriate, fact-based investment decisions. Consider the impact of the pipeline decisions on the in-market portfolio. Conduct rigorous analyses of the competitive offerings and business performance of each in-market offering, including the total cost vs. incremental economic benefit, to ensure optimal health and future prospects of the franchise.


These success principles apply to other therapy areas as well. Look for ways to add value beyond the procedure itself, and shift from a product to a customer and patient-centric mindset. Setting your sights on technology platforms and insights to build successive wins will help you achieve a sustainable and formidable competitive advantage.