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Confused by Recent Wound Care Digital Health Developments and Their Implications?

In many ways, the pace of innovation in advanced wound care can feel slow compared to other areas of medtech. As a result, many from across the spectrum are understandably confused by recent digital wound care news and developments. Relative to the rest of the sector, this segment is evolving at light speed. Many wound care firms are at various phases of formulating, testing, and executing their digital health strategies. Others are waiting on the sidelines a bit longer before determining if and how to become involved, and whether to develop that competency in house, outsourced, or via partnerships. Investors are wondering if this is the next major growth opportunity for wound care, especially due to the interest from payers, healthcare IT, and other tech stakeholders, beyond the product and service providers already engaged. Since there is significant interest in this topic, Diligence Wound Care Global and Tissue Analytics have created an overview of this space and its potential, published on Wound Source at the following link: https://www.woundsource.com/blog/wound-care-devices-apps-integrations-and-analytics-digital-health-platform-overview-industry The content is indeed sponsored (in order to increase its reach). However, it absolutely does reflect the state of wound care digital health opportunities. It also highlights recent choices made by players in the space, as well as the legitimate potential manifestations and implications for the management and delivery of advanced wound care. We researched and authored the piece and stand by the overview and outlook as presented as of publication.

Confused by Recent Wound Care Digital Health Developments and Their Implications? Read Post »

Diligence Wound Care Global Managing Director Rafael Mazuz Joins Tissue Analytics Board as Independent Director

We’re thrilled to share this important announcement (read the official press release here). But even before getting into the details of the features and capabilities of the Tissue Analytics (TA) platform, it’s important to convey why we decided to stake our reputation on this particular innovative skin and wound care company in the digital health space. After all, we serve top wound care brands, from dressings and compression therapy, to negative pressure wound therapy (NPWT), to cellular and tissue products (CTPs), to pharmaceuticals, and everything in between. We work diligently to raise the bar for every client, for every product and service, across every market. Then why, when it comes to the mobile assessment, integration, and analytics segment, have we aligned with a specific firm? Because we see firsthand what they have delivered for our clients. Over the course of several years, we have had a chance to evaluate most of the solutions in this space, visited and worked with hundreds of facilities and clinicians, and advised scores of leading and rising product firms. This allowed us to see the platforms–and the teams behind them–operating in the real world of wound care business. Some companies had great teams but were clueless about market needs or security requirements to protect sensitive health data. Other solutions were overly cumbersome and expensive. Some simply lacked the honesty and integrity standards that are critical to our institutional investor, MNC / SME / startup, and trusted healthcare services partners and their brands. In contrast, Tissue Analytics is well-liked and has consistently delivered for wound care stakeholders, including real-world use cases such as: Objective, accurate, fast, and cost-effective multi-site clinical trials (obeservational + interventional; pre + post-market) resulting in faster and cheaper go-to-market execution Marketing strategy execution and long term brand value for a major global distributor launching new products across multiple markets simultaneously Turnkey full integrations across major EMRs (almost unheard of in the healthcare industry), resulting in faster deployments and fewer IT (expensive!) resources Exponential ROI from reduced operational, regulatory, and compliance expenses and penalties Connecting data from digital and smart diagnostics (perfusion, temperature, pressure, moisture, infection, etc.) seamlessly with EMRs, care navigators, and clinicians Empowerment of field-based, non-wound-certified clinicians via virtual wound care services (telemedicine) 3D rendering of wound depth and surface models without the need for external hardware attachments Best-in-class analytics capabilities, which opens up machine learning (ML), artificial intelligence (AI), risk sharing, and many other “holy grails” of wound care (and healthcare overall) As our clients increasingly dealt with forces and developments such as: Expiration of IP and (perceived) commoditization / lack of differentiation across multiple product categories High costs and enrollment periods for even small (<100 patient) trials at a small number of sites Difficulty for less-established players to penetrate the market Increased influence by healthcare systems, MCOs, and wound care management firms over purchasing and treatment decisions Reimbursement pressures and documentation scrutiny (in the US) Lack of options for treatment and usage data insights from across the continuum of care …we simultaneously observed and interacted with the TA team as a result of our normal business activities. It became clear that in the midst of such a turbulent era in the industry, TA is a hi-tech engine to help deliver the captain, crew, and passengers to their destination faster and more efficiently. It’s also the best solution to connect all of the new digital-enabled and smart devices, diagnostics, telemed services, and other emerging wound care innovations (and the data points they generate) with the providers and other stakeholders. Without a seamless conduit for that information, those solutions will struggle with real world adoption. TA is the front-runner to be that conduit. In the coming weeks and months, many more industry collaborations will be announced. They involve some of the most cutting edge companies in this space partnering with Tissue Analytics on impressive, next-generation initiatives that are raising the bar for the development and delivery of advanced wound and skin care. Many of the innovations in development and launching are great ones to integrate with the TA platform, too–removing obstacles to adoption of such solutions. In fact, multiple companies we work with are already eyeing TA as the cornerstone of their new product commercialization plans. Rest assured that regardless of whether wound care stakeholders leverage Tissue Analytics, another digital solution, or shy away from this dimension of the industry completely, Diligence Wound Care Global will remain a radar and GPS to guide them safely and with confidence. Update: As of April 2020, Tissue Analytics, Inc. has been acquired by Net Health, Inc. Become a keener wound care executive. Are you a health care, services, and/or medtech executive involved in skin and wound care? Do you have strategic, operational, R&D, or marketing goals that might be executed in a more successful, cost effective, and agile manner by leveraging new digital health platforms such as Tissue Analytics? Get in touch to discuss your unique wound care business challenge and whether Tissue Analytics might be part of the solution.

Diligence Wound Care Global Managing Director Rafael Mazuz Joins Tissue Analytics Board as Independent Director Read Post »

What We’ve Been up to in 2018 Q3 – Q4 and What It Means for the Global Wound Care Business Outlook

What We’ve Been up to in 2018 Q3 – Q4 and What It Means for the Global Wound Care Business Outlook A tour around the wound care world The past few months of 2018 have been quite packed and exciting for us at Diligence Wound Care Global. We wanted to share some of what we’ve been doing and learning during Q3 and so far in Q4 this year (while keeping in mind that most details of our business activities are highly confidential). Most importantly, we’ll highlight relevant insights along the way which will help empower you to be confident in your wound care business decisions. Kicking it off with education, networking, investment, and innovation in the US… Following an educational yet fun conference during The American Podiatric Medical Association (APMA)‘s national meeting in Washington, DC, we were tapped for multiple wound care due diligence cycles throughout the mid and late summer. In between, we found time to contribute to the September edition of Today’s Wound Clinic. We also conducted strategic advisory sessions with a relatively new client in the Midwestern US to assess and consult on their commercial strategy and next moves. With the availability of so many different wound care products for treating etiologies and symptoms, a new-to-wound-care, Asian client who once attended a conference with me joked, “It’s like a night market! So many options!” He may have been new to wound care, but his assessment was spot on. Even for experienced wound care clinicians, the options can seem overwhelming. But with the right strategy, positioning, and execution, it’s possible for a strong product to rise above all the noise. Taking that approach, we’re excited to be working with this new American innovation to get it in the hands of as many clinicians–and in the wounds of as many patients–who might benefit from it. …to Europe for a new perspective on an old problem… When we conduct portfolio assessments, advisory sessions, and workshops for our corporate strategy and business development clients, we stress that the focus should be on solving stakeholders’ clinical, operational, and financial needs, as opposed to purely filling gaps based on traditional product categories. It was with this principle in mind that we traveled to Europe to meet with a very early stage startup client in the university incubator/fellowship environment. One of the things that is most exciting about the need their new solution is addressing is that it helps to solve one of the areas of wound care delivery that has not received much attention or innovation for many years. As we work with them to hone in their development and commercialization life cycles around the true market needs, we can tell that by the time it’s ready for launch, it will be very much on point. We’re looking forward to sharing more details in the coming months. …then Eastward to Asia… Those who know and follow Diligence Wound Care Global’s work are aware that aside from North America and Europe, we are heavily involved in the evolution of wound care across Asia Pacific, with engagements throughout the region at any given time. Q3 (and Q4) this year was (and will be) no different: Internal and external stakeholder competency development We began this leg of the trip by supporting a well-respected, MNC industry client in building and developing their wound care competencies across multiple markets. This included the creation of best-in-class training assets, face-to-face facilitation of “zero to hero” wound care ecosystem training, and interactive role playing and similar exercises. We delivered this for both the sales and marketing teams (field and corporate), as well as the key support roles involved with each market such as medical affairs, training, and regional leadership. Yet our planning and groundwork activities do not end there. At the same time as we’re delivering value for internal stakeholders, this particular client has the foresight to also drive value for its external stakeholders. In other words, beyond simply selling the “features and benefits” of its products (which are great ones), our role is to support our client in “raising the bar” on wound care services management and delivery throughout the region. Important everywhere, but especially in this part of the world, the goal of creating long-term relationships and partnerships has been at the core of their success. To further that goal, we met with C-Suite executives, physicians/surgeons, and nursing staff in every market we visited. The internal stakeholders we trained each morning and afternoon duly benefited from joining for the external stakeholder meetings in the evenings–via both a deeper appreciation of their customers’ ecosystem and pain points, as well as the stronger rapport that goes along with that. Although unrelated to the above engagement, this vision of furthering the clinical-operational-financial delivery of wound care was also articulated to us during a recent meeting with the CEO of a leading global product firm. In fact, from where we sit, most of the top-performing wound care executives are viewing the future of the industry through this trend (though the road maps they are each developing are unique). These and other concepts for wound care global success will be presented and discussed in greater detail during our session at SAWC Fall 2018 (see below for details and a registration discount code). “Raising the bar” for wound care delivery One particular activity during this recent trip was especially memorable and instructive: Participating as faculty for The Philippine Orthopedic Wound Care and Diabetic Limb Society, which is the newest of 12 sub-specialty groups under The Philippine Orthopaedic Association (other sub-groups include sports medicine, spine, trauma, hand, shoulder, and pediatric ortho). What I experienced there left me with a sense of optimism about the future of wound care in this part of the world: From the effectively delivered presentations from interdisciplinary perspectives, to the motivation of attendees to setup their own wound care centers, the prospects are indeed bright. …and full circle back to the United States (around the globe). By mid-September, some crucial M&A scouting, exciting

What We’ve Been up to in 2018 Q3 – Q4 and What It Means for the Global Wound Care Business Outlook Read Post »

Urgo’s M&A of SteadMed: Here’s What You Need to Know

There has just been another significant wound care acquisition. French MNC Urgo Medical just announced the M&A of Texas-based SteadMed Medical. The resulting entity will be known as Urgo Medical North America. If you’re an advanced wound care stakeholder inside North America, you may be wondering, “Who is Urgo Medical?” If you’re an advanced wound care stakeholder outside North America, you may be wondering, “Who is SteadMed?” Most importantly, the executives and investors reading this are likely wondering, “How will this affect the market?” Who is URGO Medical? Attend almost any major wound care or surgical conference in EMEA, APAC, and even LATAM in recent years, and you’re likely to have seen an Urgo booth side-by-side with other major international players such as Mölnylcke, Convatec, Smith & Nephew, 3M, Acelity, Coloplast, Medline, Integra LifeSciences, BSN Medical (Essity), HARTMANN, L&R, and B. Braun (and depending on the market, larger booths than the others). Likewise, Urgo products can frequently be found in healthcare facilities and pharmacies across those markets: Many–perhaps most–wound care companies have their own “algorithms” or slogans (the difference between the two is often blurred) which typically map out to corresponding products in their portfolio. Urgo is no different, with their, “Prepare–>Clean–>Accelerate–>Close” marketing, correlated to product packaging: Specifically, Urgo manufactures and distributes about 40 advanced wound dressings, prevention, compression, and related products across most of the major categories, including: UrgoClean and UrgoClean Ag UrgoStart UrgoTul UrgoCell UrgoK2 (compression) TRIACT technology (had been licensed by Hollister and used in the Restore brand) Multiple other tapes, films, gels, etc. Notably, Urgo is not currently involved in the “active healing” segment: As of this writing, they have no NPWT, allografts, oxygen enhancers, etc. Whether they introduce one or more active healing “anchor products” into their portfolio remains to be seen. In Europe particularly, they are considered one of the market share leaders across certain care sites (France, where they are headquartered, being one of the larger European wound care markets). Who is SteadMed Medical? SteadMed is a Texas-based wound and skin care product distributor who has over the years become a major player in the US, with operations in Canada and Mexico as well. As they have over 40 employees and a presence in virtually all major US regions, in addition to their activities in Canada and Mexico, we at Diligence Wound Care Global have sometimes referred to them as “the most significant North American distributor who is not also a principal” (in other words, they license products developed and/or produced by other companies for sale within a specific geography). SteadMed has historically not attempted to develop a full-line of advanced wound products (foams, alginates, collagens, allografts/xenografts, etc.), instead focusing on certain niche products. They especially established themselves with Drawtex (hydroconductive dressings), and a few years ago launched Vashe (hypochlorous acid cleanser and wipes), which they quickly grew to the overwhelmingly top US cleanser by market share–across a diverse range of clinical care sites. For several years, they distributed XPansion, a single-use split thickness skin grafting kit, which they recently relinquished to the Maryland-based acellular matrix producer, ACell. And just this summer, they announced that they are taking over distribution of Hollister’s Restore and TRIACT lines since the announced wound care divestment. The impact of the Urgo acquisition on distribution of Restore and TRIACT is to be seen, as there is significant overlap between those brands. Following are the brands distributed by SteadMed pre-acquisition: Drawtex hydroconductive dressings Vashe hypochlorous acid cleanser and wipes Resta moisturizer and antimicrobial moisturizer TRIACT and Restore (some of which were actually tech licensed from URGO) XPansion autografting kit distribution passed on to ACell earlier this year Clearly, there is some overlap between some of the the Urgo and SteadMed / Restore product lines. However, this is a bit misleading, since Restore TRIACT products were actually leveraging an Urgo technology. So in essence, the Restore brand’s transition to SteadMed was more of a stepping stone than anything else. Urgo products will need to move through the FDA approval process, inventory must make its way into the supply chain, and the sales and marketing teams will need to understand the new products and how they fit in with the existing ones, too. This will all need to be sorted out for the rest of 2018 and into 2019. As a result, the portfolio is likely to be fluid during the integration period, with changes to be expected. SteadMed Founder, President, & CEO Michael Steadman will continue to lead the firm, and its main office will remain in the Dallas-Forth Worth, Texas area. Why is this significant? Although Urgo is a major global wound care player, they were clearly latecomers to the largest market in the world, The United States. US wound care sales channels can be especially difficult to navigate, and customer intimacy has traditionally been a key success factor for firms in this space. Beyond the unique sales and marketing considerations, the healthcare payment and reimbursement systems in the US are complex and evolving. Finally, the regulatory landscape can be challenging, though for Urgo’s current portfolio this should not present much of a challenge (though it may be for future products in their R&D and M&A pipelines). For Urgo, the acquisition of SteadMed allows them to play “catch-up” in the US. They’re gaining access to a relatively sizable and competent sales force with existing relationships and channels spanning advanced wound centers, physician offices, the operating room, inpatient wards, home healthcare, and skilled nursing facilities. On the one hand, breaking into new accounts with primary and secondary wound dressings is difficult. On the other hand, adding them to the “bag” of existing sales teams (and their existing relationships) can exponentially decrease cost of sales and boost sales force effectiveness and ROI. Recently, there have been trends of renegotiation and consolidation of contracts as well as increased movement towards alliances and consortia, which we have analyzed as well. Most importantly, just like with Integra’s acquisition of DermaSciences, this news means the landscape has gotten all the more

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Were You Caught off Guard by the Healogics iSupply Announcement This Week?

What happened? The latest wound care development is the new Healogics iSupply program, announced this week. Highlights of the initiative include: Special pricing on many/most categories of wound care and related regenerative medicine products. Leverage of outcomes and utilization management data. Quarterly product/supply reporting initiatives. Potential for future evolution based on the Healogics database and economies of scale. Participating brands (not all products from each brand were included): Integra LifeSciences (NASDAQ:IART, up about 5% as of 48 hours since the announcement), BSN Medical, Solsys Medical (TheraSkin), Hydrofera, and a new advanced dressing private label line launched as part of the initiative: Healogics by DermaRite. Three types of wound care executives This development caught many in the industry off guard. This is unfortunate, as deepening collaboration with product firms has been openly discussed by Healogics leadership for quite some time now. In fact, it was shared as a corporate strategic initiative for 2018. We have always encouraged product firms to keep a finger on the pulse of wound care management and services trends, not to simply look to what other product firms are doing. The good news is that for many of our scenario planning and business war gaming strategy clients, the ability to participate in the Healogics iSupply selection process–or choose not to–was a conscious one. Executives reading the iSupply press release this week can be grouped into three categories: Wound Care Product Executive Type 1: Prepared and Active Participants Those participating went in with confidence about the unique needs of wound care management firms and their healthcare facility partners, more effectively conveying their portfolio’s proposition. Wound Care Product Executive Type 2: Confident Decliners On the other hand, strategy, sales, and marketing executives who decided to not participate (or to only explore at the early stages before pulling back), did so with confidence that the costs–both direct and indirect–of such a partnership perhaps would not have best served their stakeholders. Such clients then were able to develop and stress test plans and contingencies from product pipeline, to international expansion, to sales call points, to digital health strategies and of course partnerships with other wound care services providers that they believed would be the best focus for their firms. Most importantly, both of the above groups who adequately planned and prepared for the iSupply reality are not losing any sleep over the announcement–they either navigated the process and joined the initiative, or moved on with confidence and a clear path forward. Wound Care Product Executive Type 3: Caught off Guard and Scrambling Unfortunately, there exists a third group: Executives who neither anticipated nor prepared for the iSupply scenario. This includes those who did not consider the option of a Healogics-branded private label competitor emerging from the process (which is precisely what happened). Such individuals do indeed have cause for concern of how to answer the inevitable grilling that will come from senior leadership and the board of directors (if not already). At least one major US wound care firm has already laid off a significant chunk of its strategy and marketing managers. More casualties may be on the horizon… The stakes were high and on the table… About ten months ago, as the new Healogics CEO stepped into the role, I published an article entitled, What the Recent Healogics Developments Can Teach Us About the Future of Wound Care. After briefly summarizing the history of Healogics and US wound care overall, I posed a series of questions–from the hypothetical perspective of their management team–including (quoted from the original article): What value can we [Healogics] extract from our wound outcomes data, and to what extent might we share / sell that to others (product firms, payers, regulators, hospitals, SNFs)? To what extent should we be open to partnering with product firms (the product firms are extremely open to that idea), and if so, should that be an R&D/clinical outcomes partnership, a monetization one (they currently monetize just one product: HBOT), or another model? Should we focus on other management firms…product companies, payers, other specialty service companies…mHealth/telemedicine firms, wound care provider firms, or other partners and structures? Would our interests be better served by proactively renegotiating our contracts…or do we focus on driving operational and other efficiencies to better compete within the existing model? Can and should we provide more product selection and formulary streamlining advisory to our hospital partners to potentially offset the expense incurred by us managing their wound center (and if so, should we contract with specific product companies, or keep such an initiative to within the hospital’s decision making system)? Both before–and especially after–the article was published, there was tremendous interest from several well-known wound care product companies about the merits and drawbacks of participation in specialized group purchasing organization (GPO)s, clinical data/outcomes registries, and how to maneuver the changing wound care landscape to capitalize on opportunities, without placing too many chips on a single bet. The above questions I floated nearly one year ago are as relevant as ever. They are indeed playing out, not only this week with the Healogics iSupply brand, but throughout the advanced wound care space. As wound care business models evolve, the dynamics will cascade to other companies and alliances. Be confident in your wound care business decisions Were you or your colleagues caught off guard from the announcement, or did you have the proper plans and contingencies in place to capitalize on it (regardless of whether you were part of the partnership)? Are you… …a product executive tasked with exploring collaboration with services or other product firms? …a services firm interested in providing a product or technology suite to your stakeholders? …an investor trying to sort this all out? Don’t get burned by your next wound care business decision. Tell us your unique wound care business or investment situation. We’ll give you confidence in your path forward.

Were You Caught off Guard by the Healogics iSupply Announcement This Week? Read Post »

Why Mölnlycke’s Acquisition of SastoMed Is a Big Deal

What happened? Today (2018.07.02), Mölnlycke Health Care announced its acquisition of SastoMed GmbH. Mölnlycke is of course known in the industry as a top global wound care (also wound prevention and surgical) product brand, particularly in Europe and the United States. SastoMed, a much smaller German firm, was a subsidiary of SanderStrothmann GmbH, a company which assesses, formulates, and produces cosmetic, skin, and medical products for hundreds of well-known global brands. SastoMed has developed and commercialized two wound care products at the heart of this acquisition: Granulox, a hemoglobin spray that delivers oxygen from the surrounding air into to the wound bed via facilitated diffusion (see this article for a video + discussion). Granudacyn, a hypochlorous wound irrigation solution for cleaning, moistening, and rinsing of acute, chronic, and contaminated wounds, and 1st and 2nd degree burns. Why is it important? There have been multiple wound care M&A and JV deals in recent history, including: Integra’s acquisition of Derma Sciences Acelity’s acquisition of Crawford Healthcare The formation of Appulse as a JV by the principals of Hollister’s divested key wound care products (Hydrofera Blue and Endoform) …and several others (with more expected!) Yet despite the volume of wound care activity, this deal is unique and significant for a variety of reasons: Innovation Significance Both Granulox and Granudacyn are innovative products beyond what we normally see in the industry. Let’s briefly recap why: Granulox There exist dozens of negative pressure wound therapy (NPWT) devices, over 80 allografts, and hundreds of dressings and pressure offloading solutions. Clearly, not all wound care products in each category have the same levels of efficacy, quality, and cost-effectiveness, yet as a whole, these categories are clearly becoming increasingly saturated and sensitive to reimbursement and other economic factors. But what about solutions for delivering oxygen to hypoxic wounds (most chronic wounds are hypoxic)? Historically, the only options for these patients have been: Vascular procedures (bypass surgery, stents, etc.): These overcome blood vessel blockages and are important procedures not going away anytime soon. Indeed, the other options listed below are not substitutes for improving the underlying circulation addressed by vascular procedures. However, such procedures and are both invasive and expensive, so not every patient is a good candidate. Revascularization benefits also apply primarily to the large blood vessels, often having less impact on microvasculature, which is a key challenge for many types of chronic wounds (such as diabetic ulcers and pressure ulcers). Systemic medications (blood thinners, diuretics, etc.): These are and will continue to have important roles in cardio-vascular management (circulation, edema management, etc.), and they aim to help balance negative impacts of certain co-morbidities. Still, many chronic wounds will require additional oxygen to optimize healing–especially at the wound surface and surrounding microvasculature. Hyperbaric oxygen therapy (HBOT): Thousands of patients receive and benefit from this treatment daily (the vast majority are in the US). However, it requires proper functioning of the patient’s blood vessels in order to be effective (and to be approved for reimbursement in the US), and there is a steep drop-off in perfusion between treatments. The high cost, long treatment time (~2-3 hours per day for ~20-60 days), contraindications, low availability (outside of the US), limited indication coverage, and recently heightened regulatory scrutiny and cost pressures mean that while HBOT is and will continue to be an important wound care tool, it is not enough to meet the large and growing need for wound oxygenation solutions. Topical oxygen devices (besides Granulox): The growth of this category in recent years underscores both the increasing awareness and need for tools to combat wound bed hypoxia. On the other hand, the existing alternatives have the following limitations: Difficulty overcoming the exudate (moisture) barrier: A thin layer of just 0.1mm of moisture, such as is found on most wounds and between the cells, blocks 99% of oxygen diffusion from the air to enter the wound bed (hemoglobin molecules such as in Granulox can break that barrier, which is why the mechanism of action is referred to as “facilitated diffusion [of oxygen]”). Incompatibility with many other treatments: Application of most topical oxygen products limits clinicians’ choices for which dressings can go on top (often, the dressing is part of the delivery mechanism). Granulox can be used together with most standard and advanced wound care products. Granulox is the only hemoglobin-derived oxygen transfer product for wound care. But most importantly, Granulox complements all of the above treatment options. So it does not disrupt clinical practice, but rather is a readily available adjunct treatment to initiate oxygen delivery which overcomes many of the hurdles making wound oxygenation such a challenge. The ~100% reduction in slough buildup and ~50% reduction in pain for Granulox patients across all wound types are two more underserved clinical needs (in addition to the increased oxygenation / 50% faster healing) that make this a very innovative development. Granudacyn Natural and pH balanced: Hypochlorous Acid (HOCl) is produced by the human body as part of the immune system, and innocuously breaks down into water and a salt. As such, Granudacyn can be used inside body cavities and will not impact cellular tissue products (CTPs), which makes it complementary to Mölnlycke’s surgical business in addition to wound care. The importance of balanced pH in wound healing is also well documented. Excellent stability: Many otherwise high potential wound cleansers suffer from a relatively short shelf life. Granudacyn can be stored for a minimum of 18 months, which is plenty for any typical wound care setting. Strategic Significance Prior to this acquisition, the focus of Mölnlycke’s wound care business had primarily been on prevention (offloading, reduction of wound/periwound trauma and irritation) and passive healing (moisture balance, infection management, etc.). Granudacyn of course strengthens their wound management (and surgical) portfolio(s), but with Granulox, it can be said that Mölnlycke has now established a significant position in the field of active healing. Stated differently: Pre-acquisition Mölnlycke had products to optimize the wound bed and surrounding area via the body’s own healing process. Post-acquisition Mölnlycke can now offer its customers active acceleration of tissue regeneration,

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Wound Care in Malaysia and The Emerging Markets: Interview w/ Dr. Mogan Naidu (2 of 2) [Video]

Back for Part 2… Wound care executives, investors, and specialists from all over the world enjoyed Part 1 of our visit with Dr. Mogan Naidu of MediAsia Advance Wound Care & Tissue Repair Center in Penang, in northern Malaysia. I have especially enjoyed witnessing an increased number of our colleagues and clients actively commenting and contributing directly to Dr. Mogan’s LinkedIn discussions since then. At the the recent SAWC Spring and EWMA 2018 conferences, both new and old acquaintances pulled me aside to express appreciation for exposing them to wound care in other settings, or to ask how they might become involved in emerging markets wound care. The conversation turns to wound care services and future plans… Whereas Part 1 of our discussion focused more on wound care product price points, adoption, and usage in Malaysia (and developing markets in general), in Part 2 we shifted to the wound care services ecosystem, the patient journey, challenges, telemedicine / mHealth (mobile health), and investment opportunities. Dr. Mogan also shared with me his team’s plan for a private wound care hospital to treat patients from Malaysia and the surrounding region (Indonesia, The Philippines, and others). I even got a chance to tour the site (the land has already been purchased), and they took me on a buggy tour of the grounds and surrounding village. Although the focus of our conversation was wound care in Malaysia, many of the needs articulated also exist across the emerging–and even developed markets. As such, we are actively synthesizing new business models for global advanced wound care, which is an area of great interest to our stakeholders–wound care product, service, digital health, and investment professionals alike. Topics we discussed included: Although advanced wound care in developing markets does not yet have the same level of awareness or infrastructure as in developed markets (which is not very high, either), the volumes at a specialty care setting such as MediAsia (and other wound centers we have visited in this part of the world) is on par with the top 10 percent of US-based wound care centers. In addition to the challenges faced by wound care services providers globally (clinician education, patient compliance, lack of resources, etc.), Dr. Mogan explains how many patients turn first to traditional healers can further delay the time until a patient arrives to a specialty wound care center (if at all), and will likely use up patients’ funds that otherwise might be used for specialized wound care. This is consistent with what we have seen in our wound care work across many other markets, including Latin America, Africa, and across Asia (and even among some medical tourists and immigrants to the US). We also discussed this phenomenon in our previous article, The Case for Emerging Market Wound Care. Due to the distances traveled for wound care, as well as the international medical tourism component, there are opportunities for telemedicine and mHealth that are equally if not more attractive than those in the developed markets (indeed, we have been deeply involved in many such initiatives at Diligence Wound Care Global). Wound care patients (international and domestic) are prepared to spend cash when they come to receive treatment, which gives providers some more flexibility in terms of the therapies and payment models incorporated. Watch the interview (closed captions available): Become a keener wound care executive. Are you currently considering investing in, launching, or expanding a wound care business in the emerging markets? Get in touch to discuss how we might empower you to reach your goals.

Wound Care in Malaysia and The Emerging Markets: Interview w/ Dr. Mogan Naidu (2 of 2) [Video] Read Post »

Key takeaways from the 2018 European Wound Management Association Conference (EWMA 2018)

EWMA 2018 (9-11 May) has just come to a close in beautiful Krakow, Poland. This annual global wound care conference is wonderful, bridging scientific, clinical, and industry stakeholders from around the world (most other annual wound conferences tend to draw from relatively regional audiences). Here are four key takeaways: 1. Less influence from reimbursement dictates With a global audience, the relative importance of product reimbursement diminishes (but doesn’t disappear), and there is a higher emphasis on product innovation, practicality, and cost-benefit trade offs. Clinicians visiting the exhibition booths were interested in many less-conventional treatment options than we typically see with those focused on North American and Western European settings. For example, I observed an in depth discussion between a group of Indian clinicians and a vendor at the booth of a new technology that is struggling with reimbursement in the developed markets. Since all of their patients pay cash for advanced wound care–whether a cleanser, advanced dressing, NPWT, allograft, or this particular new therapy–the value proposition to these clinicians was on a relatively level playing field with other treatment options, and they therefore demonstrated considerable interest. Even Poland (where the conference was hosted this year) is an emerging market, with many similar cost considerations. Accordingly, there was an abundance of Polish wound care providers and distributors attending, and I spent a lot of time learning from their discussions and which clinical, operational, and financial challenges and solutions had their attention. I often find that observing interactions between clinicians and vendors yields more valuable insights than discussing with each party separately. 2. What’s on industry’s mind… For those of us who know senior management and investors in the industry, it’s always enlightening to pay attention to which sessions and booths they show up to (and their level of interest / engagement). When one looks around the room and sees key decision makers from several major companies attending the same session, it reveals an implied interest in particular clinical solutions, therapies, or companies. This was apparent in Krakow this year. Wound care executives were also eager to learn how to better commercialize existing products internationally, especially in the emerging markets–with a renewed openness to new business models. 3. Creative approaches to existing and new technologies Dr. Huei-chun (Josephine) Tang, Chief of both Plastic Surgery and Wound Care at An-Nan Hospital in Tainan, Taiwan presented a very compelling e-poster series of patients with PAOD (peripheral arterial occlusive disease) who received KCI’s VAC NPWT at the regular -125 mmHg pressure setting after revascularization. In my experience, some wound care providers I worked with are concerned about using NPWT in PAOD patients–and that’s quite understandable, as ensuring adequate oxygenation is a top clinical goal and many worry that the various NPWT components or mechanics might interfere with local perfusion or create minor skin injuries that can deteriorate into complex wounds. But as Dr. Tang demonstrated in her series, together with revascularization, debridement, and especially an emphasis on good multidisciplinary communication among the care team, certain patients with arterial ulcer diagnoses may still benefit from NPWT at the normal pressure setting. None of the patients in the series had a major amputation after receiving the therapy. Dr. Colin Krueger, Head of Surgery and Robotic Surgery and at Immanuel Klinik in Berlin, Germany discussed a novel use for hypochlorous acid (Granudacyn). While it’s most frequently used as a wound cleanser solution, he has also been applying it during cases of necrotizing pancreatitis. Since the solution turns into water and salt, he creatively uses it as a lavage during laparoscopic surgery, and in doing so has seen the mortality rate for his patients drop from around 30% to 0%. He walked the audience through a recent, complex case, including the diagnostic, medical, and surgical approach taken to achieve the positive outcome. The audience was impressed by the innovative yet sensible use of the product beyond just open wounds. Likewise, Dr. Borripatara Wongpratchum (“Dr. B”), plastic surgeon at World Medical Center in Bangkok, Thailand impressed the audience by demonstrating how aggressively yet holistically treating necrotic toes in a very complex patient, he was able to regenerate virtually all of the tissue! The audience was in awe, because even “top” wound care clinicians would accept as fact that the necrotic regions of the toes must be totally amputated (hopefully addressing the underlying causes in parallel), with the actual wound care only beginning post-amputation. Yet with debridement, moist dressings and NPWT, application of hemoglobin spray (Granulox), IV antibiotics, offloading, PRPs, and an acellular dermal matrix, Dr. B and his team were able to “resurrect” the dead toes, eliminating the need for amputation. I didn’t believe it until I saw it–so for those who missed the session, I’ll let the photos speak for themselves: 4. The Innovation Symposium At Alira Health’s Advanced Wound Care Innovation Symposium, one of my favorites among all global wound care conferences, all four companies participating presented innovative solutions to key wound care challenges–from practical usage to gene editing and other novel microbiological approaches. After the presentations, a round of questioning by the judges, and deliberations, the €20,000 first place prize was awarded to SastoMed, who presented their Granulox hemoglobin spray (used on over 65,000 patients in over 40 countries, but not yet registered in the US). If you missed Alira Health’s EWMA session, you can get the flavor of the first-place winner from my interview with SastoMed Founder and CEO Michael Sander at SAWC Fall 2017 below: We’re already looking forward to EWMA 2019 (5-7 June, 2019…not next month!), which will be held in Gothenburg, Sweden.

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Wound Care in Malaysia and The Emerging Markets: Interview w/ Dr. Mogan Naidu (1 of 2) [Video]

Do you feel confident in your command of global wound care? This video may cause you to reconsider… Much of our time at Diligence Wound Care Global is spent with wound care product and services CEOs, CMOs, CCOs, VPs, directors, and managers for global strategy, busdev, marketing, finance, R&D, and other functions related to commercial planning and execution. More often than not, these individuals are based in a corporate office in an established market, yet have responsibility for large geographies such as APAC, EMEA, LATAM, or even titles which include words like, “emerging markets” or “global.” True, they may indeed visit these markets, such as to attend a company-sponsored event, industry conference, or to meet with a distributor. And true, they’re typically sharp, experienced, accomplished executives from across the scientific, biomedical, healthcare, and commercial spectrum. But do they truly understand where and how their wound care solutions are evaluated and used? Unfortunately, if they have not really invested the time and resources on the ground (in actual patient care settings), the answer is usually, “no.” The opportunities and challenges for emerging market wound care are well documented. Increasingly, both clinicians and industry have been gaining interest in these regions. I’ve already been invited to speak on the topic on Nov 3rd, 2018 at SAWC Fall in Las Vegas, and will present at events in the developing markets themselves between now and then. Yet overall, most outside stakeholders are still lacking a true grasp of how to offer solutions to wound care needs in such regions. I recently visited with Dr. Mogan Naidu, a very passionate wound care provider, head of MediAsia, and founding chairman of The Malaysian Diabetic Limb Salvaging Society (MDLSS). Part 1 (below) focuses on wound care products, and Part 2 (to be released later) focuses on wound care services, including a new private wound care hospital planned for the region. Although Malaysia is just one of many emerging markets, and each market is unique, many of the themes and lessons can be applied to other regions, as well. Here’s the interview (closed captions available): Some of my key takeaways from the discussion: Despite all the talk about moving to “value based health care” in the developed markets, in many ways, Dr. Mogan and his team have already implemented a version of it: The patients are directly involved in the cost of care, but the pricing is determined by the severity level of the wound (which they divide into zones: red, yellow, green). Rather than charge the patient for each piece of product or procedure, they bill based on zones, which in many ways better aligns the incentives of the parties than either traditional fee-for-service or socialized public health care. Although resources in this environment are lacking, there is indeed access to most categories of advanced wound care products (foams, alginates, etc.). This is consistent with what I have seen across most emerging markets, especially in APAC. Not only based on the interview, but from the entire day I spent with the MediAsia team at their clinic, they do an excellent job of addressing holistic factors in patient care: Diabetes management, cardio-pulmonary status, kidney function, offloading, nutrition, and even the psychosocial status of the patient. They give more attention to these critical healing factors than literally 95%+ of wound care facilities that I have visited–and that includes countless facilities across North America, EMEA, LATAM, and APAC. True, there are certain technologies and specialists their patients cannot easily access compared to markets with more developed healthcare infrastructure: vascular imaging/interventions, HBOT, and others can be problematic–especially for financially challenged patients such as those discussed above. However, many of these are precisely the scenarios and opportunities that innovations such as hemoglobin oxygenizers, disposable NPWT, mobile assessment and analytics platforms, and many more are able to address, resulting in potentially fast adoption in such regions, where leapfrogging entire generations of technology is already the norm. Become a keener wound care executive. Are you currently considering investing in, launching, or expanding a wound care business in the emerging markets? Get in touch to discuss how we might empower you to reach your goals.

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Do you manage, invest in, or work with a challenged wound care program? This is for you…

A quick update… We’ve been super busy empowering clients’ wound care businesses so far in 2018: Engagements in Hong Kong, Malaysia, coast-to-coast in the US, and now gearing up for some groundwork in Mexico and both Eastern and Western Europe, to name just a few. In between, we’ve been attending and prepping for key industry events, including Diabetic Limb Salvage (DLS) in Washington, DC (ending today), SAWC Spring in Charlotte, North Carolina (26-29 April), followed by EWMA in Krakow, Poland (9-11 May). The rest of the year shows no signs of slowing down, either! But when Today’s Wound Clinic (TWC) Managing Editor Joe Darrah asked me to contribute to this month’s edition (April 2018), I just couldn’t turn him down. That’s because the theme of the entire edition is, “How to Fix Your Failing Wound Clinic.” It’s a topic of great interest to me, since managing wound centers forms the cornerstone of my wound care experience. In other words, it’s an important lens through which we provide our clients insights, guidance, and confidence. As such, I’m proud to share with you the finished article, Diagnosis & Treatment of The Failing Wound Care Center: 2 Underappreciated Considerations. Free print copies of the entire April TWC magazine will be distributed at SAWC Spring later this month, too (usually near the entrance to the exhibition hall). Organizational and Management Wound Care Center Challenges I urge anyone with an interest in this topic to check out the full article and share it with colleagues who might find it of value. Following is a quick summary of the issues covered. Today, there are more resources available than ever for getting a struggling (or new) wound care center on the right track. These include medical and product training, clinical documentation courses, mobile assessment platforms, specialty electronic health records (EHRs), and revenue cycle management and supply chain consultants, to name just a few. In fact, when hospitals and wound centers partner with a wound care management company, the goal is often to pull together several of those “tools” together into a single package. But I had yet to come across a fair (unbiased), third party look at the “big picture” options available. As such, the article focuses on two considerations: Organizational: What is the reporting structure (if any) of the wound care center? Is it a good fit for the size, needs, and challenges / aspirations of the team? How can the right balance be struck so that wound care services receive enough attention and resources, yet don’t suffer from micromanagement or apathy? The article weighs the relative advantages and drawbacks of the following structures: Reporting to hospital C-Suite Reporting to hospital VP/director-level Independent/owner reporting structure Management: Although there have recently emerged an increasing number of flavors of wound care management, for the sake of this discussion, we divided them into three categories: Full service outsourced Flexible outsourced Insourced If anyone tells you that one form is superior to the other in all cases and for all wound centers, they’re either not being genuine or they simply do not have a full command of the wound care services space. Although a deep dive into wound care management approaches goes way beyond what can be communicated in a single article, the goal is to expand the reader’s horizons when considering options. Are you facing similar challenges? Executives and investors facing wound care services challenges such as those mentioned in the article are always encouraged to reach out. We have worked on both sides of the equation, and our interest is to help clients choose the best path forward for their current situation–whatever shape that may take. If you’re involved with: A struggling or new wound care center, A program seeking to deliver at a higher level, or Discovery or due diligence on a potential wound care services investment Get in touch or seek us out at one of the upcoming major industry conferences.

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Illustration of the challenging incentives for implementing value based advanced wound care

What the Recent Healogics Developments Can Teach Us About the Future of Wound Care

The situation Last week (15 Nov 2017), David Bassin (Healogics’ former CFO), was appointed as the company’s new CEO. As the world’s biggest wound management firm and provider of wound services, Healogics has both a massive network and a huge volume of wound care and outcomes data. Understandably, healthcare executives, analysts, and investors watching this space have been very eager to know about what this and other recent developments mean for the future of wound care. This is similar to how major moves by Boeing would be of interest to those working and investing in the aviation industry. Stakeholders know that change at Healogics, and other wound services firms to some extent, leads to new opportunities. At the same time, it can also expose their business models to new vulnerabilities. Since leaving Healogics to focus on Diligence Wound Care Global, dozens of clients have turned to us specifically seeking to better grasp strategies and initiatives related to wound management firms (how to react, or what to avoid). From investors and bankers, to startups, to product executives, to healthcare facilities–and to even payers and other wound care services firms–all realize that without understanding how Healogics and other wound management firms prioritize and make decisions and especially how that might affect their short term tactics as well as long term planning, they may be caught off guard. Bassin is taking the helm during a challenging and unique period in the company’s history: Healogics’ traditional business model is under massive pressure in recent months. Many facilities whose wound programs partnered with Healogics (or its pre-acquisition predecessors) to launch wound care programs five, ten, or even twenty years ago have recently chosen to not renew their wound management contracts due to cost-cutting and other pressures. While a normal churn of contracts won and lost has always been part of the business, Healogics has recently lost significantly more contracts than it has gained–the first major contraction in the history of a company which was otherwise characterized by impressive growth for most of the past decade. Today, US healthcare facilities have more options than ever for outsourced wound care management–from clinical training and certifications, to clinical-operational flow consulting, to revenue cycle management, to wound care service line marketing, to EHR vendors and mobile health–offering à la carte options in addition to the full-service management approach on which companies like Healogics, Restorix, and others have traditionally focused. Many–perhaps most–hospitals that do not renew their Healogics wound center management contracts are actually content with the overall services provided. But the ability to, with the stroke of a pen (or more precisely, the lack thereof), cut an annual expense amounting to hundreds of thousands of dollars becomes easier when there are multiple firms that will fulfill specific wound management needs on an à la carte basis. For most US hospitals who are struggling to squeeze even a one or two percent operating margin, the potential savings are material and quite tempting. At the same time, let’s not discount that Healogics managed nearly half of the hospital-affiliated outpatient wound care centers–though that number is now closer to one third. Centers run by management companies tend to have higher patient volumes and better healing outcomes than their independently managed peers, so it’s quite reasonable that close to 50% of US patients treated in specialized, outpatient hospital-affiliated wound centers are seen in a Healogics facility. Healogics also has a relatively small but potentially growing influence in the inpatient, skilled nursing facility (SNF), and related landscapes. Perhaps the most significant asset that Healogics has is its healing data. While the à la carte solutions can help solve certain problems, not a single one of them has the A-to-Z depth and quantity of clinical, operational, and financial data that Healogics does. This is important to keep in mind when considering the future dynamics of Healogics, its wound care services/management competitors, and the industry overall. On the other hand, there exist other players with fewer data points but claiming more precise and actionable data such as automated wound measurements. So although the title of “best wound care data set” is yet to be claimed, Healogics is surely a top contender. The Past: A Brief History of Healogics from 2006 to Today In 2006, Diversified Clinical Services was born, becoming the largest wound management company following the merger of three smaller firms: Diversified Therapy, Curative, and Praxis Clinical Services. With over 260 hospitals under management, the newly integrated firm had a presence in around 40 US states. When I joined the company as a wound care center director in early 2011, the Jacksonville, Florida-based company had somewhere around 400 centers under management and was considered one of the fastest growing healthcare services firms in the US at the time. The growth plan was quite clear: Due to factors such as aging populations, rise in chronic disease, and related lifestyle problems, patients will continue to develop wounds that need advanced treatment. Particularly with all of the baby boomers retiring, the business outlook was strong as long as they were served. Many even believed that within a few years, virtually every hospital in the US would have some sort of formal wound care program. For the most part, they were right. Although the number of difficult-to-heal wounds in the US has skyrocketed to between 6-7 million, the majority are still not treated in a specialized, outpatient wound care center. The opportunity for growth was substantial back then, and still is today. The following infographic, produced by Healogics (and which is consistent with what I have seen working with the industry from other angles, too) visualizes this breakdown: Another merger with major competitor National Healing Corporation in 2011, and rebranding as Healogics, Inc. in 2012 brought the total to “more than 500 centers” and close to $300M in annual revenue when large private equity player CD&R purchased the firm from Metalmark (another PE firm that had owned it for a few years) in mid-2014 for $910M. By this point, Healogics centers were treating over 200,000 wounds

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Is This The Most Innovative Wound Care Product Since Negative Pressure Wound Therapy? [Video]

Like many of my wound care colleagues, I have experienced and worked with hundreds of wound care products. Some are basic yet effective, while others are both advanced and powerful. There are also many complex yet under-impressive options out there. Recently, I’ve had the pleasure of collaborating with a new innovation that really has the potential to disrupt the clinical, operational, and financial status quo: Granulox by SastoMed. At the recent SAWC Fall 2017 in Las Vegas, I sat down with Cofounder and CEO Michael Sander to discuss. Watch the interview below: In summary, there is an unmet need for a product like Granulox: The role of hypoxia (lack of oxygen) in wound healing problems is well documented and affects most difficult-to-heal wounds to some extent. Existing topical oxygen treatments are not effective because even a very thin layer of water/exudate (which covers most wounds) blocks 99% of external oxygen from entering the wound bed. Current systemic and advanced treatments, such as revascularization surgery and hyperbaric oxygen therapy (HBOT) have their own unique risks, costs, and other limitations–though they can still be used with Granulox, which is an adjunctive treatment (and it can be used with almost any other products/procedures like xenografts, autografts, offloading, and most advanced cleansers and dressings to enhance their benefit). By leveraging the body’s natural mechanism of oxygen delivery (facilitated diffusion via hemoglobin), Granulox: Doubles healing speed. Eliminates slough recurrence in virtually all wounds within four weeks (it’s not a substitute for debridement, but it reduces/prevents the formation of new slough between dressing changes). Cuts pain in half without the use of drugs, patches, or gels. Does so for practically any wound etiology (type), is compatible with most other products and procedures, and without the added operational and financial burdens of many other advanced wound products. I also find it fascinating that it has been used on over 60,000 patients and sold in 31 markets (40 including in-process registrations) to date, not yet including the US–traditionally the largest wound care market by sales. When it arrives in the US (by far the largest advanced wound care market), its potential is enormous. As such, I’m very excited for this product to be available in the US as it works its way through the US FDA process. Until then, if a loved one or I were to have a complex wound and were still able to travel, I might even suggest they travel to Thailand, Malaysia, Germany, The UK, Poland, Turkey, Mexico, or the dozens of other markets where clinicians have access to this potential game changer. SastoMed also has some other innovative products and indications marketed as well as in their pipeline, too. The most impressive wound care cases and data I’ve seen in my industry career have come from combining Granulox with other well-known and accepted advanced therapies to “push the boundaries” of what even experienced clinicians believe is possible. Adding effective, easy oxygen delivery to the provider’s toolbox has really begun to raise the bar where it’s available. With increasing HBOT documentation and reimbursement pressures in the US market, additional scrutiny of cost per healed wound, and of course the skyrocketing number of chronic wounds, this reinforcement couldn’t have come sooner. Update: Nine months after the original publishing of this article, SastoMed was acquired by Mölnlycke Health Care, a leading wound care and surgical solutions company.

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The Case for Emerging Market Wound Care

Demographic and economic trends, combined with the sheer magnitude of the unmet needs in the emerging markets represents the largest untapped opportunity for advanced wound care products and services globally. Introduction As the business of advanced wound care in North America and Western Europe has boomed for the past two decades, most major wound care product and services firms, which are overwhelmingly based in those markets, have made comparatively little investment in the developing world. To be clear, the complex wound epidemic in the developed world is far from over, and it will remain a high growth healthcare opportunity for years to come. Yet trends such as new market entrants, insurance consolidation, increasingly cumbersome documentation requirements, and the commoditization and market saturation of certain product types, combined with overall pressures to cut healthcare costs, have at a minimum impacted per-unit/per-patient profitability in the West, even as the total market size continues to soar. Emphasis on prevention, bundled payments, and other risk-sharing trends on the horizon will further challenge the lucrativeness of wound care in the developed markets. At the same time, aging populations, wound-related comorbidities, and increasing purchasing power and overarching demand for advanced healthcare in the emerging and frontier markets have created tremendous opportunities for specialized wound care in these regions. Of course, unique challenges and obstacles exist as well. Still, demographic and economic trends, combined with the sheer magnitude of the unmet needs in the emerging markets represents the largest untapped opportunity for advanced wound care products and services globally. In line with this, greater than 50% of our 2016 engagements and related advisory at Diligence Wound Care Global involved the emerging and frontier markets. This trend has continued into 2017 as well. In this article, we will explore: The current state of advanced wound care across the developing world. Global demographic and financial data, cultural-religious considerations, and real-world, on-the-ground international wound care experience and information I have gathered from my wound care colleagues and during my extensive travels. The reader will gain a keener appreciation of evolving opportunities for wound care (and other healthcare) executives, specialists, startups, and investors. Why look to the emerging markets for wound care? With between 6 to 7 million complex wounds, estimated market sizes of between USD $8bil to $15bil for advanced wound care products, and $40bil to $60bil for wound management-related services in the United States alone (depending on which specific wound etiologies, products, and services are included), why should executives and investors even consider placing valuable resources in the emerging and frontier markets? The following figures provide an answer: 1. Population size and distribution 2. Overweight, obesity, and other malnutrition As if overweight and obesity were not enough of a challenge, due to evolving demographic, economic, and cultural factors affecting diets (e.g. urbanization, a shift to processed foods, etc.), many emerging markets have simultaneously overweight/obese yet undernourished populations. The lack of protein, micro-nutrients, and other consequences–even as average BMIs soar–is yet another comorbidity associated with delayed wound healing. This phenomena is well-documented in the 2016 World Bank paper, The Double Burden of Malnutrition in East Asia and the Pacific: Evidence and Lessons for a Multisectoral Response. 3. Diabetes 4. Kidney disease 5. Smoking Despite an overall reduction in smoking across the developed markets, 80 percent of the world’s 1 billion smokers are in low and middle income countries (WHO), with double-digit increases in smoking rates across dozens of developing nations. Indonesia alone is home to 70 million smokers, a nearly 30 percent increase over 15 years. During the same period, the percentage of Jordanian smokers rose from 25 to 40 percent. Similarly, rates in Bahrain rose from 12 percent to almost 30 percent, and in Cameroon from 7 percent to 22 percent. The CDC reports that overall, smoking in the developing world is increasing at a rate of 3.4 percent annually. As anyone who has worked in wound care services knows, smoking (and the resulting cardiovascular and pulmonary complications) is one of the most difficult clinical challenges faced by the wound care provider. While for most patients (in theory), wound bed moisture can be balanced, microbial counts (infections) reduced, albumin/pre-albumin levels raised, and blood glucose controlled, the damage that years of smoking does to the body’s ability to deliver oxygen required by healing tissue is extremely difficult to reverse in both the short and long terms. Noninvasive therapies to improve tissue perfusion are only effective if there is a certain amount of underlying vascularization. Yet invasive revascularization procedures are both medically complex and financially costly. In this sense, the colossal, growing rates of smoking in many of the world’s developing nations simultaneously contributes to both the clinical challenges and business opportunities for advanced wound care in these markets. The connection to chronic wounds Thanks to firms such as Net Health, it is possible to access real-time data comparing the effects of both individual and multiple comorbidities on wound healing. Such data is sourced from hundreds of thousands of wound outcomes across hundreds of US wound care centers. The following figures show that the chronic diseases and related factors that plague the developing markets are precisely the ones that have the most profound impacts on delayed wound healing: The comorbidities found to have the most acute impacts on patients in the US are also the most prevalent and fastest growing conditions in the emerging markets. Clearly, from the perspectives of both absolute and relative population sizes, as well as factors associated with non-healing wounds, the current and future needs in the developing world are immense. As we will see, despite these figures, specialized wound care in these regions has traditionally been the focus of disproportionately low levels of investment. We will dive deeper into just how massive the opportunities are in future articles and posts. Wound care products and services: “Chicken-and-egg?” Which should come first–emerging market wound care products, or services? Having been first introduced to advanced wound care in the developed markets (as a director for a leading wound management firm), I had always been exposed to a plethora

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Assessing and selecting medical device distributors in the emerging markets requires a unique approach.

Assessing and Selecting Wound Care Distributors in the Emerging and Frontier Markets

The following is an excerpt from the original article, published in MedTech Intelligence on 3 Apr 2017: The attractive opportunities for medtech product firms to drive growth in the emerging and frontier markets are well-known: Rising disposable incomes and an expanding middle class, aging populations, and chronic disease prevalence (diabetes, cancer, obesity, hypertension, etc.), combined with increased access to healthcare diagnostics and services, all feed demand for advanced medical technologies in those regions. However, despite the strong desire of firms to capitalize on these trends, the precise strategies and tactics to achieve their goals are elusive to most executives seeking to do so. In recent quarters, corporations seem just as likely to fall short of earnings goals due to missed targets in the emerging markets as they are due to slowdowns in the developed markets. Therefore, a key question that clients ask is: How might we quickly yet sustainably capture and grow our market share in the developing markets?… Click here to continue reading the full article… Also check out or sister company, Advanced Wound Care Global, which focuses on equipping and delivering advanced wound care services in the emerging markets.

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The Top 10 Mistakes Wound Care & Regenerative Medicine Sales & Marketing Executives Make (& How to Avoid Them)

Why are so many intelligent, sharp, knowledgeable, and articulate wound care and regenerative medicine professionals unable to gain customer trust and drive product adoption and usage? Introduction Years managing advanced wound care centers and advising investors, device, and services firms in the industry have given me countless opportunities to be on both sides of sales and marketing activities. Sometimes, I’m on the buying side of wound care: Deciding which dressings, offloading devices, allografts, negative pressure wound therapy (NPWT), and other consumable and capital medical devices to budget for and purchase, like when I was a director at Healogics in the US. Or when working with international healthcare services firms and investors considering adding a wound care service line to their existing or planned hospitals, clinics, or rehab centers (and if so, how to proceed). Other times, I’m on the selling side: Assessing and negotiating with medical distributors, facilitating a business war gaming workshop for a new wound care product launch in the US, or training wound care and regenerative medicine sales and marketing professionals on how to drive product adoption and usage from the customer perspective. In both situations, I frequently asked myself: Why are so many intelligent, sharp, knowledgeable, and articulate wound care and regenerative medicine professionals unable to gain customer trust and drive product adoption and usage? In search of the answers, I compiled my experiences and spoke with colleagues and industry professionals. It turns out that I was not the only one interested in this answer. Demand was so strong that I began to offer a specialized workshop for sales, marketing, product specialist, and leadership teams in the industry. In the training program, we focus on the user and customer perspective, demonstrating actionable methods for improving commercialization effectiveness. Following are ten of the most common and devastating mistakes made and some ways to avoid them: 1. “Showing up and throwing up” (instead of asking questions I’m not talking about the rep running to the bathroom and vomiting during a product in-service (though I’ve witnessed that, too). “Show up and throw up” is a behavior most sales and clinical education professionals are guilty of at some point–especially when in a new role or right after in-depth product training. Often due to nervousness, or simply being eager to demonstrate their newly acquired knowledge, a sales rep (and often the manager or VP) will arrive for a meeting, blurt out a quick introduction, then launch into a rapid fire barrage of product features and technical specifications, regardless of the audience and their unique pain points. “Asking nurses and doctors questions rather than lecturing them about your product or what to do, is key,” says Isaac (all names have been changed), clinical nurse manager at a leading outpatient wound clinic in the mid-Atlantic US. A sales professional fresh out of an intense week of training is likely to want to talk about how their company’s antimicrobial foam line has more silver molecules or absorbency than the competition, or that their tissue-based product has a higher percentage of living cells or a thicker extracellular matrix (ECM). It’s understandable behavior, but it’s ineffective. Rather, establishing a relationship and learning your audience’s pain points by asking questions yields much greater success. Ron, a mentor and sales executive I used to report to, is currently a Senior VP of Business Development for a leading wound care services firm. He quotes one of his favorite sales analogies: “Questions to the sales professional are like a scalpel to the surgeon. It’s the primary tool for doing your job well.” Asking the right probing questions will both effectively build rapport, as well as help you determine which of your products and their features will solve real problems for your client. When I deliver a workshop for wound care sales, marketing, product, and leadership professionals, I review the call points and personality types involved in wound care purchasing decisions in detail. Participants leave understanding the most powerful questions that can stimulate a valuable wound care dialog to drive more sales than “show up and throw up.” 2. Not having a basic understanding of a facility’s clinical quality, operational, and other metrics (and which ones your customers are most focused on) The products you sell probably solve one or more real wound care problems. Adhesion, elasticity, wicking, and fluid retention are all examples of important characteristics of wound care products. But of equal importance, can you competently carry on a discussion with your customers about their key clinical and operational metrics and goals that your products supposedly help them achieve? Can every wound care product manager, account executive, clinical specialist, and executive in your firm or on your team answer (or know how to find out) the following questions that directly affect your customers’ clinical and operational goals and challenges?: What are the most common wound etiologies treated by your customers, and which ones present the greatest challenges (and why)? Do you know how to define key clinical metrics such as MDH, outliers, and others (which can vary across management approaches and care sites) that your stakeholders are evaluated on? Do you understand your clients’ key operational metrics, such as staffing and patient ratios, cancellation rates, average supplies per encounter, and clinical flow metrics (see #3 below)? While an effective NPWT product manager or CTP (allograft) account executive does not need to know all of these points for each customer, a big mistake that many of them make is not attempting to learn more about them when planning or discussing. Strategically, corporate executives can use this knowledge to drive future direction of their R&D efforts and product portfolios. Tactically, field-based professionals can use it as a tool to gain customer trust, and to select which of their product’s features to focus on. Unfortunately, most employees at all levels of most wound care and regenerative medicine firms are unable to articulate these critical considerations, much less incorporate them into their daily sales, marketing strategy, and clinical education activities. 3. Not understanding and adapting to the clinical flow

The Top 10 Mistakes Wound Care & Regenerative Medicine Sales & Marketing Executives Make (& How to Avoid Them) Read Post »