We spoke with Bertrand Hughes, CEO and Delegate of the Board for compliant concept AG, to discuss their innovative product, the mobility monitor, and the challenges associated with developing budget impact models for both hospitals and nursing homes.

Can you tell us about your background?

I live in Switzerland, but originally I’m half Irish and half French. I have almost 30 years of experience in the medical device industry in various general manager functions, mostly covering marketing, sales, strategy and business development.

How did you get involved with compliant concept?

I’ve been with compliant concept as a member of the board since 2011. I met the founder back in 2010/2011, and I thought it was a very exciting opportunity. Having over 16 years in the wound care business, I saw great potential for the mobility monitor to ‘prevent the holes from happening’ so-to-speak as opposed to just ‘fixing the holes’. I knew how important prevention was for the fight against pressure ulcers, and I got very excited about the innovations the founder was working on at the time. One thing led to another, and I joined both the board and as an investor. In 2015 we felt it was time to change management. The founder had moved on and we had an interim CEO, but we decided to change things around again, at which point, I was asked to step in as acting CEO.

How was the transition to becoming the CEO?

It was radically different because it was an operational role. In the past I would come along to a board meeting every second month and give advice while the CEO would tell us how the business was being run. I would in turn ask many difficult questions and now I answer those questions.

Can you tell us what mobility monitor does?

We’re providing data to healthcare providers that help to manage, what we call, the ‘triangle of interactions’ between 1) sleep/pain medication 2) mobility and 3) bed falls. Very specifically, the monitor provides data in a way that helps prevents pressure ulcers and bed falls and helps manage the medication levels that influences these challenges.

The monitor goes underneath the mattress and measures mobility and distinguishes between large pressure relieving movements and non-pressure relieving movements. Additionally, it measures micro-activity, such as very small tremors of the body, which are implications of the tension, agitation and pain the patient is feeling. We can’t truly measure pain, but the nurse can look at the patient profile being monitored and make an educated judgement as to whether the patient is experiencing pain and requires medication. This is particularly important for patients with dementia who cannot express their pain well.

On the other hand, it helps to find the balance necessary for giving the right dosage of medication. If you give too much pain or sleep medication, you knock the patient out entirely and their mobility is such, that they are at risk for pressure ulcers.

In conclusion, the ‘triangle of interaction’ (pressure ulcer prevention, fall prevention and medication) is being managed with the support of data from the measurement of mobility and micro-activity.

What are the benefits of the product to nursing homes and hospitals?

The mobility monitor helps to prevent financial, traumatic and personal consequences.

Psychologically, a pressure ulcer is a very traumatic experience for the patient, but also for the relatives, friends and people around them. They can last between 1 year and an entire lifetime and frequently make patients lose the will to socialize.

Pressure ulcers are also very expensive, ranging between fifteen and twenty thousand euros to treat. In some countries, there is a high cost for the caregiver, especially when they are also required to cover the cost of medication. Bed falls can also be very expensive, ranging in severe cases between twenty and thirty thousand euros to address.

Most importantly, from an ethical perspective, the greatest benefit is that we improve the quality of care for the patient; firstly, in terms of preventing injury but also in terms of the quality of sleep. There are two reasons for that: 1) we optimize the medication dosage and 2) we change the standard of care so that, instead of being checked and turned every second hour, you are only responded to as needed in accordance with the data as being delivered via the monitor.

This last point has been demonstrated in an RCT published in December 2016; we see that the mobility monitor helped significantly to increase the quality of sleep for patients with dementia in nursing homes. This is also a result our customers see in practice each time the monitor is introduced.

What challenges were you facing when you contacted ValueConnected?

It was very easy for nursing staff and nursing directors to use the mobility monitor. They rapidly understood the benefits to improve the quality of care, but we often found that the cost of the product was perceived as prohibitive. We needed to make the overall budget impact more transparent. With a budget impact model, we could show that there was a very positive impact if you consider the cost of the product, the costs being saved and the additional revenue that is being earned by the caregiver.

How did you get in contact with ValueConnected?

We were working together with a consultant out of the industry that had broad pressure ulcer prevention experience and that consultant had worked together with ValueConnected in the past in a different context. They highly recommended ValueConnected, and that’s how we started.

What were the results of the work with ValueConnected?

Overall I would say they were good. In terms of the two DRG models for hospitals in both Switzerland and Germany, we were able to show significant cost savings. However, we are always challenged to understand and determine exactly how costs are incurred.

In general, the models help us to raise the discussion and the issues with hospitals and nursing homes. Even if we cannot nail down the costs to every cent, we can show conceptually where there are cost savings.

We have found more challenges for the model in nursing homes, because the model does not fully represent the way the budget truly impacts the homes. It reflects the actual costs, but not who picks up those costs.

In the case of nursing homes, the costs are mostly being picked up by health insurance. What’s more, the nursing homes are incentivized to have a patient with a pressure ulcer, because they see higher revenues. Fortunately, most nursing homes have the ethical approach to support the patients, but the budget impact model does not support us there. However, this is an indication that we need to approach nursing homes from a different perspective.

How would you describe your relationship with us?

When we came out with the first version of the budget impact model, we went back and forth with ValueConnected to A) fine-tune the model and B) understand the reality of how costs were being born.

Hospitals would say there is no cost for them for bed falls, it’s a new DRG and we don’t lose any money on this challenge. At that point, we went back to ValueConnected for help and they helped us extensively.

We also did some research with one of ValueConnected’s project managers and discovered in 80% of the cases, hospitals do have costs and the hospital controllers simply do not realize them. ValueConnected was very supportive in helping us develop reasons to go back and have good discussions with the hospitals. Previously, our salesforce would have said there is pushback from the hospital controllers, but now they can push back on the controllers as to how the hospital will in fact save on their costs.