VALUE-BASED HEALTHCARE GLOBAL EVOLUTION PERSPECTIVES
An article from the Insights Series
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Medtronic, Inc. (“Medtronic”) offers RemoteView, which permits a user (“Programmer User”) of the Medtronic CareLink® 2090 Programmer (“Programmer”) to allow the viewing of information presently displayed on the Programmer screen with one or more individuals in remote locations anywhere in the world (“Remote Viewer”), including remote health care professionals or Medtronic representatives.
Limited License Grant. You are hereby granted a nonexclusive, nontransferable, terminable, nonassignable, nonsublicensable, limited license to install and use a copy of the Licensed Software solely for authorized and legitimate purposes. You may not otherwise copy, use, modify, reverse engineer, decompile, disassemble, create derivative works based on, or integrate with other systems or programs the Licensed Software without the prior written consent of Medtronic. You shall have sole responsibility for any fees or charges, including service or data charges, incurred by you in connection with your use of the Licensed Software. You shall not remove any proprietary or other legend or restrictive notice contained or included in the Licensed Software or other documentation associated with such Licensed Software. You agree to maintain any and all copyright, trademark, and other notices on the Licensed Software and any associated documentation.
Licensed Software Functionality and Data Use, Collection, Viewing, and Transfer.
“Active Remote Viewer” as referred to herein shall mean a Remote Viewer that has installed the Licensed Software and has at the relevant point in time an active network connection to a Medtronic server via the Licensed Software.
By installing or using the Licensed Software or clicking any acceptance button in connection with this Agreement, you acknowledge, understand, agree to, and consent to all of the following, including when you are an Active Remoter User:
) Registration. To obtain access to the Licensed Software, you must register at the Medtronic RemoteView website and establish a user name and password. All information that you provide in connection with such registration must be complete, accurate, and truthful. The user name and password are personal to you and must not be shared with anyone else. You will also not attempt, directly or indirectly, to disable, bypass, or defeat any password protection associated with the Licensed Software. Medtronic reserves the right to deny or disable any user name or password or request for any user name or password.
) Your Personal Information. Medtronic will collect information in connection with your registration and installation and use of the Licensed Software, including your first and last name, your email address, a selected security question(s) and your corresponding answer(s), your address, and your telephone number. You agree that Medtronic may store this personal information about you on a Medtronic server, including a server located in the United States of America.
) Session Key. To view the information on the Programmer, the Remote Viewer must generate a Session Key that must be shared with and entered by the Programmer User. “Session Key” as used herein means a unique token active for a limited period of time generated by the Remote Viewer. You agree not to share this Session Key with anyone other than the Programmer User who has initiated the specific session.
) Logging of Session Activity. Each time you log in to the Licensed Software, Medtronic will collect information about your activity, including in an aggregated log or database, regarding you and your session, including your name, username, computer name, IP address, operating system details, and session details (including transferring and sharing activity, start and end times, view only or control activity, and any chat messages between or among any Active Remote Viewers. You agree that Medtronic may store any personal information about you on a Medtronic server, including a server located in the United States of America.
) Active Remote Users. When you are an Active Remote Viewer: (1) you will be able to view the name and/or user name of any other Active Remote Viewer who is logged into the same Medtronic server; and (2) any other Active Remote Viewer who is actively logged into the same Medtronic server will be able to view your name and/or user name. The Licensed Software also permits one Active Remote Viewer to share the information being viewed to any other Active Remote Viewer. You must not share any information from the Medtronic programmer, including with any other Active Remote Viewer, absent the express permission from the Programmer User that is allowing you to view the information.
) Availability. Medtronic has limitations on the number of users that can concurrently log in to the Licensed Software at any given time. Thus, installation of or accessing the Licensed Software does not guarantee that it will be available to you for use at any time.
Permissions. By installing and using the Licensed Software, you represent that you have permission to do so from any associated clinic, hospital, or medical practice and that your use of the Licensed Software complies with any policies or requirements of such associated clinic, hospital, or medical practice. You are also responsible for confirming that the Programmer User has obtained any necessary patient consent before allowing you to view any patient information via the Licensed Software.
Your Acknowledgements. You acknowledge that the Licensed Software is not the exclusive method of viewing information from the Programmer and that the Licensed Software is not the exclusive method by which to obtain a patient’s implanted cardiac device data, including any data on the Programmer. You also acknowledge that the Licensed Software is not intended to be used as a life-sustaining or interventional tool during medical emergencies. You further acknowledge that Medtronic is not, and shall not be deemed to be, a provider of patient health care services by virtue of its provision of access to the Programmer screen information via the Licensed Software. You also acknowledge that information from the Licensed Software is not an electronic medical record and use of the Licensed Software does not in any way relieve you from using your best medical judgment to determine a proper course of treatment for patients.
Security/Privacy of Patient Data. Your use of the Licensed Software and any Session Keys shall be solely for legitimate and lawful purposes and not for any malicious purpose. You are solely responsible for and will use your best efforts in maintaining the confidentiality and security of any copies of the Licensed Software as well as any user name, password credentials, and any Session Keys that can be used in accessing the Licensed Software, a Medtronic server, or any information from a Programmer. You are solely responsible for and will use your best efforts in keeping any patient information you may receive or view in connection with the Licensed Software confidential and secure, and you will not attempt to capture or copy any patient information you view in any electronic or hard copy format without the express permission of the Programmer User. You will be responsible for any obligations or liabilities associated with any lost, stolen, or otherwise compromised patient information.
Reporting Issues and Feedback. You agree that you will report any issues or questions, technical or otherwise, regarding the Licensed Software promptly and directly to Medtronic. If you submit any comments or ideas to Medtronic, in the absence of a separate agreement regarding such submissions, you grant to Medtronic an unrestricted, royalty-free, irrevocable license to use, reproduce, display, perform, modify, transmit, and distribute such ideas in any medium and agree that Medtronic is free to use them for any purpose. In addition, Medtronic has no obligation to provide continued maintenance and support to you in connection with the Licensed Software. Any maintenance and support services provided by Medtronic shall be at Medtronic’s sole discretion.
Limitations of Liability.
THE LICENSED SOFTWARE IS PROVIDED TO YOU “AS IS,” AND MEDTRONIC EXPRESSLY DISCLAIMS ANY AND ALL WARRANTIES WITH RESPECT TO THE LICENSED SOFTWARE AND YOUR USE THEREOF, INCLUDING WITHOUT LIMITATION ANY IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, TITLE, AND NONINFRINGEMENT. MEDTRONIC DOES NOT WARRANT THAT THE USE OF THE LICENSED SOFTWARE WILL BE UNINTERRUPTED OR ERROR-FREE.
Legal Compliance. You shall at all times use the Licensed Software in compliance with all applicable laws. You shall ensure that your installation and use of the Licensed Software complies with all applicable export and import laws, regulations, orders, and policies of the United States of America and any other applicable jurisdiction. You represent and warrant that (i) you are not located in a country that is subject to a U.S. Government embargo, or that has been designated by the U.S. Government as a “terrorist supporting” country, and (ii) you are not listed on any U.S. Government list of prohibited or restricted parties.
Term, Termination, Modifications, and Support. This Agreement shall be in effect from the date when you first install or use the Licensed Software. Medtronic may modify, amend, or terminate this Agreement at any time, including by providing notices or an updated version of this Agreement on a Medtronic website. Medtronic may modify, disable, or terminate your use or Medtronic’s support of the Licensed Software at any time, including by providing notices on a Medtronic website. All obligations which are ongoing in nature shall survive termination or expiration of this Agreement. At any time upon Medtronic’s request (including via a notice on a Medtronic website), you agree to promptly delete and terminate use of any and all copies of the Licensed Software. In addition, upon Medtronic’s request, you agree to provide written verification that you have destroyed all copies of the Licensed Software together with the manner, date, and time of such destruction.
NayaMed International Sárl Customers: Whether the RemoteView feature shall be used in connection with NayaMed customers or devices shall be solely within the discretion of NayaMed International Sárl. If the Licensed Software is used connection with NayaMed customers or devices, this Agreement shall be directly between you and NayaMed with respect to those uses.
An article from the Insights Series
Dr. Jason Arora, BMBCh, MPH, MA,
director of Value-Based Healthcare, Latin America, Medtronic
No matter where you fit as a healthcare stakeholder, the successful execution of value-based healthcare (VBHC) ultimately requires a focus on two fundamental principles: data and collaboration. This may seem obvious, but it is surprising how many healthcare institutions forget this as they begin to venture down the VBHC ‘rabbit hole’. Payers, providers, and suppliers who want to build a VBHC strategy can simplify their approach — and speak a common language — by bringing everything back to these two core elements. The two are closely interrelated. Data is the key currency, or engine, on which value partnerships need to be designed and executed.
Outcomes are defined as the results that matter most to the patient — the one true 'consumer' in healthcare. Cost is defined as the total costs of developing and delivering healthcare, rather than charges or prices.
Healthcare data exists everywhere. However, not all of it is useful in telling us how well we are doing. We’ve repeatedly heard that we need to generate granular data on patient-centred outcomes and costs, but this doesn’t just apply to payers and providers.
Medical technology companies, such as Medtronic, are now collaborating with providers to pair expertise in technology and care delivery to help achieve better outcomes, and — in the process — to develop value propositions for payers. Without granular value data across all stakeholders, this type of work simply isn’t possible.
Importantly, it becomes difficult to identify ‘value vacuums’ — gaps in care or spaces where outcomes are poor and costs high — where collaborations can provide solutions. Such efforts may be internal — addressing organisational misalignment — or external, addressing stakeholder misalignment. Again, this may seem obvious, but the narrative is often lost, and the line between ‘VBHC’ and ‘not VBHC’ quickly begins to blur.
Should this matter? It should, because we hope to articulate better outcomes, lower costs, and a win for all stakeholders involved. If something is labelled as ‘VBHC’, it needs to tick all these boxes.
Payers, providers, and suppliers need to begin to see outcomes data in this way — as a tool for identifying value vacuums, and to guide the development of collaborative initiatives to address these directly.
So, ask yourself, what is your data strategy?
A very simple example from Chile involves a heart failure care provider who discovered — through simple outcomes data collection — that patients who live furthest away from primary care support were experiencing poor outcomes (e.g., worsening symptoms and multiple readmissions) and high costs (e.g., lengthy transport, longer hospital stay, and re-interventions). The provider has worked with Medtronic and its payers to pilot a program that incorporates remote monitoring for these patients. Whilst the identification of the potential contributors to these outcomes isn’t rocket science, without the right data, it is difficult to articulate the value to all stakeholders involved, and the scale opportunity for the health system — in this case:
The lack of a data-driven narrative that speaks to all stakeholders and provides the scale potential is ultimately what slows down the development of VBHC collaborations. This also applies within institutions — such as a hospital, or within a supplier like Medtronic. Such deep-rooted transformation is tricky, and it requires us to form internal teams that are guided by real-world data on patient outcomes – our ultimate collective goal, and truth.
So, once you figure out your data strategy and have some informative data to begin with, ask yourself: what is our partnership strategy, internally and externally?
We need to deliver healthcare:
That is the industry we are in. The proactive management of quality and resources —outcomes and costs, or value — is therefore an essential component of healthcare. We just haven’t realised it until relatively recently. Unfortunately, healthcare stakeholders have always had very transactional relationships. Stakeholders work largely in their own silos, and then come together to negotiate. Each stakeholder has a different agenda, and supporting data, and that creates misalignment. High-quality value data on patient outcomes, therefore, needs to be the common ‘truth’ on which collaborations are formed, and the currency in which healthcare transactions are undertaken. At scale, this will naturally infuse value into health systems as they evolve to meet changing needs.
Value-based healthcare is widely acknowledged as one of the only comprehensive solutions to the resource, quality, and access issues that we are facing in global healthcare. As we continue to see global initiatives take shape and provide overarching guidance, it is critical that individual healthcare institutions also begin to shape their own destinies, whilst maintaining a common language between themselves. That is, to build independent VBHC strategies around data and collaborations, and when things become complicated, to bring everything back to these two fundamental tenets. If done correctly, this — in combination with global umbrella initiatives — should see us get to the critical mass of movement required to truly revolutionise global health systems at scale.
Jason leads Medtronic’s VBHC work across Latin America. He also serves as a Global Health Expert at the World Economic Forum and a Global Leader at the Center for Health Care Innovation. Prior to this, Jason was a director at the International Consortium for Health Outcomes Measurement (ICHOM) and a practicing physician in the UK. He is the recipient of Harvard’s 2018 Public Health Innovator Award, and was named on Forbes’ "30 under 30 Health Care and Science" list in 2017 and on KPMG’s "Top 100 Asians in Tech" list in 2018. Jason holds degrees in medicine and medical sciences from Oxford, and public health from Harvard, and is a former Fulbright Scholar.
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