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Interview with Leo Nherera, Health Economics Manager at Woundchek Laboratories

Interview with Leo Nherera from Woundchek

First of all, thanks for taking the time to talk to us. Can you tell us a little bit about yourself and your role at Woundchek?

I’ve been doing health economics for the past nine years. I was working previously for National Collaborating Centers which are commissioned by NICE to develop Clinical Guidelines, and later for BMJ Technology Assessment Group which is also commissioned by NICE to appraise new technologies.

I’m now a health economics manager at Woundchek Laboratories. We were part of Systagenix before, and we have been carved out into Woundchek. We build models in Excel mainly and upload them to BaseCase, which is interactive, and pass them on to the sales team for use in the field.

Can you say a bit about the challenges of communicating health economics - either within the company or to payers and providers?

Working with Excel is a bit challenging. There are challenges that are associated with model building in Excel, and while people want to use Excel they feel a bit intimidated with Excel files and files that have loads and loads of cells and tabs. To build a complex model and then try to present it in a meeting using Excel, you would find it a little bit challenging and demanding.

Is that something that BaseCase has helped you with?

Yes, I would say that with BaseCase, you are trying to simplify that - to start from a complex model and present it in a simplified, user-friendly way.

The other thing about BaseCase is that you don’t have all this front loaded material, Excel-type information in front of you. You end up with just the main assumptions, the main data points that you want to quote or call out, and that simplifies everything, even though we know in the back end there is something happening in Excel.

What it does is simplify things, make it user-friendly at the point of use, with the main data points. Whatever is happening ‘under the bonnet’, the end user is looking at a screen and all they see are the main numbers that are being called up, and the main results you have generated.

Leo Nherera, Health Economics Manager at Woundchek Laboratories

How has BaseCase been used at your company?

We have been using it for the past year now. The way we’ve been using it is that we build the model - a generic model - and then we instruct our sales team how to use it when they go to a hospital or a clinical commissioning group (CCG).

In the UK we have mainly used it for the CCGs - so the sales team or the business development managers will go with their iPad to these groups and input local data they give them. As a generic model, it is flexible enough to allow the user to say “well in your case, with your prevalence data, your current cost is X, but with our product the cost would be Y”.

It provides the flexibility for the main data inputs to be changed at the point of use and to generate tailored reports. We have used it to support business cases for our customers - for example a customer such as a commissioning manager who may want to use our product, but has to convince his superior. We will get the local data from him to input, the name of the hospital etc., and after you have inputted everything, the final report has everything pertaining to them, including the name of the hospital, at the front of the document.

Have you had any feedback from your sales team about how they use it?

They do appreciate it. In some cases I have attended with them. For the first rounds I have been going out with the sales team myself, and I have seen it in use. It is quite user-friendly, to the extent that the clients that we talk to understand and appreciate it. It’s based on the simple input data that they know, so it’s their local data, and it produces a result that they can appreciate. It has been well received by the sales team as well as the end users, who are the hospital people, the clinicians, the main people that we target.

So, you are dealing with the new CCGs now, is that your main audience?

The way our meetings with the CCG have been structured, we request a meeting with them normally around the time that they have a board meeting, or just after a board meeting. At this time almost every important member of the CCG is present - from purchasing, to budget, to formulary.

We have been lucky so far, in the sense that we’ve been able to get all these guys together in one room. That’s how we have been doing it and we have been successful. We’ve managed to get almost all the key important decision makers in one place and then we talk to them in one go and that kind of makes our life a little bit easier.

Read article Engaging with budget holders in the new NHS Clinical Commissioning Group

Was that a deliberate strategy?

Yes, that was from the company. We were aware of a situation that can arise, where you talk to one of the team members, and he appreciates something, but when that team member goes to sell it to the rest of the committee, the CCG members, things start falling apart, with one person supporting, one person not supporting.

So we designed the strategy of getting these guys together in one room, in a single day. If there is something to discuss, we would want all the key members in there. Obviously we have one champion, one person we will be talking to and then this person makes sure that when we visit we have everyone in the room. It has worked for us so far.

The whole landscape of payers and providers has changed significantly and it’s still changing in the UK. Has that affected your role?

I would say this about the way the system works. The way the health economic market at the national level works, with NICE, is that they’re interested in cost per QALY, and then when you go down to the local commissioning groups, you tend to move away from the cost per QALY concept, to some kind of language that these guys that hold budgets understand.

They want to know: is there any cash released? They want to know how much it costs to avoid events: cost per event avoided. That’s moving away from cost per QALY, but in terms of the way you approach the calculations, it’s still the same thing.

You have to bear in mind that when you’re talking to someone who holds the money and is worried about his budget, he is more concerned about the budget impact, what your calculations mean to his money: is he saving money or not?

It may be cost effective, it may be value for an extra QALY gained - and we can use the app to illustrate that. What we’ve been able to do - we know if something is cost effective, and we take it from there, we ask “what does this person really want?”, and we try to tailor the message to suit what they want to hear, if you like.

They want to know: am I losing cash flow, how much am I saving and how much am I spending at the moment? That’s something that you are easily able to calculate using the app, BaseCase apps, you can say “look, we can visualize it for you on a graph”. You put in that number, look at the graph, and you can say “this is what you’re spending today, and then if you use our products, this is what is going to happen, you’ll make these savings”, and they see those savings, they see the impact graphically. This is what BaseCase can easily do, show them the outcomes in a way they find easy to understand.

Do you think your sales teams appreciate using this technology in the field?

In our company, people are really embracing the technology. Just today we received a number of new iPads. In terms of technology, we are as an organization embracing the idea of using iPads - it works well for the sales team being able to do things out there on the road. It’s been well received and people are quite enthusiastic about new technology.

We’re approaching the end of the year, can you see any challenges on the horizon for next year?

I would say for me, so far so good. The team I am working with, my manager is a champion of health economics. She is a marketing person but she quite likes the health economics, and for me, working with her team, the commercial marketing team, they do listen to what we produce. They are interested in pushing forward the agenda for health economics and making sure people understand what it is doing for them. I am not anticipating any problems as far as the use and appreciation of health economics is concerned - the organization is receptive to it.

Would you say that communicating this kind of health economics at the local level, with the CCGs, is increasingly important?

I would definitely say it is quite important, to communicate health economics. It may be seen as quite complex, it may be seen as intimidating, but it is quite crucial that we try to communicate it and try to simplify it as far as we can.

There’s one area In particular where I think it’s really useful to use health economics when talking to local payers. Most of the time they think, when you’re talking about your product, they only look at the core product. So if your product costs £20, and a rival product costs £5 or £2 that’s all they look at. What we’ve been trying to do is to encourage them to think about the cost of care not just the cost of the particular product.

Looking at all the costs together and seeing the savings elsewhere…

Exactly, so it’s the whole care pathway. The cost of the product is important of course, but then beyond that also the downstream costs: hospitalization avoided, nursing times etc. In wound care, most of the costs are actually accrued by the healthcare professionals: the cost of nursing, the number of visits that have to happen and related costs.

If you were, for instance, to use an advanced wound care product which costs initially slightly more but makes the person heal faster, you avoid the downstream visits that you incur if you were to use a less efficacious product.

We have been trying, in terms of communicating with the local teams, we are trying hard to make the point to them that the costs of care are more important than the costs of a particular product, because it’s the totality of everything that counts.

Would you say that BaseCase helps encourage sales teams to use this kind of HEOR data?

That’s exactly what we have been trying to build in to the models we use in our BaseCase apps. We try to illustrate things in terms of percentages - the cost of this product counts for X percent and then out of the costs of all care it costs Y percent.

We find with BaseCase that we can illustrate that, we can break down the components of the total costs into various small components that we can illustrate to the payers, to say - this is exactly what you’re dealing with, so would you or would you not go for X and Y? We have been able to do that successfully with BaseCase.