The Importance of Describing the Care Pathway to Help Illustrate Value

I’m surprised by how often device and med-tech start-ups fail to adequately describe the care pathway for whatever condition or event their device solution addresses. It’s key to map out how care is currently delivered so that you can clearly demonstrate the gaps in care and how your solution addresses those gaps.

See the figure below for a simple illustration of the care pathway. For any disease, event, procedure, or condition, there is something akin to this figure. If you start at the event, diagnosis, or procedure of interest, then at that point care is delivered. Perhaps it’s an acute event like a stroke or a heart attack, or perhaps it’s the diagnosis of a chronic condition like diabetes or hypertension. Regardless, the full care pathway describes what happens before that point and what happens after.

Once you have clearly described this process, you can talk about gaps in care, where they occur, and how they affect costs and patient outcomes. You can also clearly demonstrate where your solution fits into this pathway. Is it used for assessment, to either help prevent (or delay) the event/diagnosis or identify it early? Is it used in the care delivery at the point of care at the time of the event/diagnosis? Or is it used afterwards, either in a post-acute setting (e.g., rehab) or during the chronic phase, where disease management typically occurs. (Note, something like rehab or physical therapy, which happens during the post-acute and chronic phase, could be considered “treatment”, so you can imagine that there can be some overlap in these phases.) 

Illustrating the care pathway in this way allows you to clearly demonstrate the usefulness and (eventually) the value of your device. But, there are a few things you need to answer when talking to payers or providers about your solution and this care pathway:

Where are there gaps in care or efficiency, or opportunities for improvement?

This relates to “sizing the opportunity” as I’ve described here. Basically, describe where in the care pathway patient care is not yet perfect: are too few patients taking steps to prevent the disease or event (perhaps they are diabetics who are not adherent to diet and medication regimens)? Is the diagnosis often later than ideal and impacting the ability to treat or manage the condition (like in dementia)? Is care delivery inefficient, costly, or associated with costly adverse events? Is post-acute care lacking in a way that results in unnecessary utilization down the road? Is care management during the chronic phase disjointed, inefficient, and lacking in some way? When you identify these gaps within the context of the care pathway, your audience can easily see how it affects patient care, outcomes, and cost. 

Where in the care pathway does your solution apply?

This may not be obvious. You may think that your solution is strictly relevant for the post-acute or chronic phase, but perhaps it’s useful in other phases as well. Or, perhaps its use during the chronic phase could help early in the care pathway of another condition or event (e.g., your solution is a stroke-recovery solution, but also has the capability to assess cognitive decline, which can occur after stroke).

Identifying where in the care pathway your solution applies can also help to demonstrate how current gaps can affect care further along the pathway. For example, in dementia, early diagnosis is not only key to an initial treatment plan, but has implications for the entire care pathway.

Does your solution require that providers change how care is provided?

This really relates to implementation. Implementing a “time-out” in the operating room before starting a surgical procedure helps reduce errors without disrupting the natural flow of the surgical preparation. But, if your solution requires providers to interrupt the usual care pathway and, say, log on to a new portal or app, that may not be as easily implemented. And, once you divert from the original care pathway, all subsequent care may be impacted. For example, if you are proposing a new treatment, perhaps that means post-acute and chronic care will also need to change (see the figure below).

What are the implications of diverting the care pathway? Will providers need to invest in new equipment or implement new policies or procedures? How might that affect acceptance and adoption of your device or solution?

What is the scope of your solution?

After “sizing the opportunity” as described earlier, this relates to “capturing value” (described in that same link). Is it applicable for all patients with this condition? Or just some? Does it fully address the gap or inefficiency you identified as lacking? Or just part of it? That is: how much of the opportunity your specific solution captures. If your solution is applicable for only a portion of the target population, consider how that might, too, alter the care pathway. Perhaps it means that providers will need to introduce an additional step into the pathway for identifying those eligible for your solution. That may be minor, but any changes, additions, or adjustments to a typical care pathway can potentially be a barrier to adoption and implementation. 

How does your solution translate into value for the payer or provider?

Captured value may be a combination of monetary and non-monetary components. But, if you are trying to convince a provider to adopt your solution or a payer to pay for it, then you will likely need to demonstrate some type of cost-savings or efficiency for one or both. Using the care pathway you have described, you can clearly walk through how your solution will avoid unnecessary utilization, increase efficiency, avoid adverse events, improve population health, change the care setting to a less acute one, allow people to age in place, etc. When you’ve already mapped out how patients are cared, where your solution fits into the pathway, and how it addresses current gaps in care, it is easy for your audience to understand the cost savings you anticipate.

Prior to your next conversation with a payer or a provider about your device or solution, take some time to map out the care pathway, and see if you can address the questions raised above. It is likely to help you when speaking with your target audience.