Digital medical technology can make an important contribution to affordable care and solving the shortage of healthcare personnel. But how do you know if an innovation actually adds net value to the entire healthcare system? Prof. Maureen Rutten-van Mölken uses health economic models - so-called "health technology assessments" - to determine that. "We are working on raising awareness among innovators to think about cost-effectiveness right from the beginning of an innovation process."
Maureen Rutten was already a professor at Erasmus University Rotterdam, at Erasmus School of Health Policy & Management, and one of the scientific leaders of the Medical Delta program ‘From Prototype to Payment’. She has now also been appointed as a Medical Delta professor at both LUMC and Delft University of Technology. "This appointment is confirmation and recognition for the work I have done in recent times," Rutten says. "In recent years I was linking pin between research at Erasmus University, Erasmus MC, the Faculty of Industrial Design at TU Delft and LUMC. By bringing those partners closer together now, we can help developers embed their technology faster and smarter into existing healthcare processes."Â
Can you talk briefly about your expertise?
"I am a health scientist and health economist. With my research, I contribute to making choices about including digital medical technology in our basic health insurance. With a health technology assessment, we examine the burden of disease of the target population, whether the innovation is effective and cost-effective, and what this means for the healthcare budget.
Since the introduction of the drug policy in the 1980s, cost-effectiveness of new drugs must be demonstrated when applying for reimbursement. This whole area has developed significantly since then. This was not yet required in medical technology, but that has been changing in recent years."
What does this mean for the technologists working on healthcare innovations?
"Innovators are usually very focused on the technical or biological side of their innovation, without having to think about what their best proposition is. For which target group is this the most effective? What does this mean for the entire workflow? For example, should I offer training for practitioners? What regulations get in the way of using my innovation? Substantiating that your innovation is effective in daily medical practice is often less known in the system of innovators.
We analyze very systematically. What benefits does it have for the patient and society? And what are the costs? Does it lead to net benefits or not? That's how we ultimately inform insurers whether it's a good intervention. That's the front-end trajectory. The earlier you start with this in the innovation process, the more promising it is to develop good propositions. That can lead to an early decision not to pursue certain innovation routes because there is little chance that it will be cost-effective. For example, because multiple, cheaper alternatives already exist for that route. We are working to raise awareness among innovators to think about cost-effectiveness from the beginning of the process.
Then there is also the other side. When you bring a specific innovation to market, it can have major consequences for healthcare practice. That impact is often much more extensive for equipment and medical devices than for drugs. If you start working with a new digital intervention, it often means a completely different workflow. You have to think about that carefully if it is to land successfully. For this, we can design smart implementation strategies with those involved.
A concrete example is remote monitoring of people with heart failure. Here you have to invest in all kinds of sensors and apps that people use at home. Overall, the evidence suggests that this is high-quality and cost-effective care. Re-admissions are prevented and we see reductions in mortality. However, this also means fewer people coming into the hospital and fewer beds being occupied. This in turn has consequences for the financial position of the cardiology department in the hospital. You then have to think about new funding models, for example, in order to get them to come along after all. There is also a greater demand for other types of care staff. Data analysts and specialized nurses, for example, who look at the alert system based on algorithms. As a result, responsibilities are shifting. We try to paint that overall picture so that an innovation also works well in practice."
What is the added value of Medical Delta to your work?
"The value is mainly in the easier access to a very large network of expert people from different disciplines. These make the work fun and lead us to the most interesting innovations. "
What is your added value to Medical Delta?
"My years of HTA expertise, which I also deploy in the Medical Delta program 'From Protoype to Payment.' Within this, with a large multidisciplinary team of scientists, we do more fundamental research into better evaluation methods and models, incentives in reimbursement models, the impact of technology on the organization of care and healthcare professionals, and promoting rapid access to valuable new technology.
I would like to see more people take advantage of this knowledge. So that we can provide more robust evidence about the value of medical technology to society. By doing so, we can put the technology earlier on the market and implement it more widely and sustainable in healthcare. That's what I want to contribute to as a professor."
What do you hope to have achieved for the patient and healthcare professional in five years?
"That we use the healthcare budget in such a way that we achieve as many health gains as possible and can distribute the budget as well as possible. From a very broad social perspective. In which we look at the effects on health, labor productivity, costs of care and use of informal care.
We all grumble when health insurance premiums have to go up. We also prefer not to spend even more on care, because it comes at the expense of investments in education, climate and defense, for example. The goal is to help as many people as possible with the amount of money we have. In doing so, we can steer towards investing in innovations that yield the most health gains. And thus also ensure that patients have faster access to cost-effective medical technology."
What is your experience with interdisciplinary collaboration?
"Health Technology Assessment is by definition interdisciplinary. I also have experience as a project coordinator in large EU projects around integrated care for people with multiple chronic conditions and personalized precision medicine. In those, you have to work with a lot of partners from different disciplines. It is important to get everyone on the same page. I really enjoy doing that. The secret to good cooperation is a good coordination team, lots of communication, lots of talking about successes and radiating positivity. But also just convincing people, holding education sessions and providing practical support when needed."
Which scientist's work has surprised you and why?
"In our work there is constant interaction with other disciplines. We talk to all kinds of specialists to further develop our health economics models. I also see a lot of innovators working on all kinds of new medical technology. It is incredibly clever what can be done, for example in the field of medical imaging and AI. It's a privilege to be so close to that."
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This article is part of a series in which we highlight the eight new Medical Delta professors. Click here for the other portraits published so far.