There's no doubt that the global medtech market is in a bit of an upheaval. Health care reform in the US, ongoing economic problems in Europe, and slower-than-expected growth in the once-promised land of the BRIC markets have created a tough environment for medtech. But slowly, surely, we've started to see some promising signs of a turnaround.

On February 27th, Head of Research and Operations Ken McLaren presented the top ten trends and events that companies should be paying attention to in order to make sure that they're capitalizing on the changing fortunes in the industry. Below is a brief summary of what he presented.

10. Insurance Coverage Increases in the US
There's been a lot of hype recently about health insurance exchanges (HIEs) and their underwhelming rollout at the end of 2013. Nonetheless, enrolment should pick up through 2014, and the effect of expanding insurance coverage will be also bolstered by Medicaid expansion to more low-income Americans. Because these reforms will allow patients to have better access to preventative care, diagnostic companies in particular should see an upside to this trend.

9. Mobile Apps Empower Patients
Apps have also received a lot of attention in the US, especially with the Food and Drug Administration (FDA) finally issuing their guidance for regulating apps in September 2013. Increasingly, patients are becoming more engaged in their own health, and apps give them a way to be engaged even more than was possible in the past. However, most apps still have pretty limited functionality, so there's lots of room for improvement and development.

8. 3-D Printing Shows its Potential
Throughout the year, we heard some examples of pretty impressive 3-D printing projects, including a custom lung splint for a baby and a research firm using the technology to manufacture customized prosthetic limbs for amputees in war-torn South Sudan. Although this technology is really still in its infancy, down the line it definitely has the potential to be hugely disruptive to medtech manufacturing, and it would be unwise for companies to ignore it.

7. Successes and Setbacks Shake Up the Cardiovascular World
Cardiovascular companies seem to be seeing wildly different growth stories depending what market(s) they're operating in. While Boston Scientific (Watchman left atrial appendage closure device) and C. R. Bard (Lutonix drug-coated balloon) and a host of companies entering the US and European transcatheter heart valve markets are looking pretty good, some others are getting off to a slow start. The most headline-grabbing news was certainly renal denervation's failure in the SYMPLICITY HTN-3 trial, which is bad news for Medtronic. Edwards Lifesciences (TAVR) is also getting off to a rocky start after its innovative technology has failed to get adequate reimbursement and the uptake originally projected.

6. Telehealth Improves Disease Management
Demand for telehealth comes along with the general transition away from fee-per-service payment for physicians. If patients can be monitored remotely, this makes a huge difference in terms of both access to specialists as well as better care for patients in rural areas. The US has significant room for growth in this regard, with the lowest amount of physicians reporting communicating online with patients compared to the major five European countries, Brazil, India, and China.

5. Personalized Medicine Changes Treatment Algorithms
Using a patient's genetic composition to determine the best treatment for a disease will be another hot topic in 2014. Molecular diagnostics are increasingly allowing companies to identify which patients are likely to respond to a particular therapy, and which are not. This is particularly important for cancer treatment, where the best practices for screening have been heavily scrutinized. If these diagnostic tests allow better determination of treatment algorithms, it could have a downstream effect on all the medical devices used in cancer treatment and screening, such as brachytherapy seeds, mammography machines, colonoscopes, and laparoscopic devices, among others.

4. Frugal Innovation is the Path to the Emerging Economies
The BRIC markets haven't proven to be the easy growth path companies were originally anticipating. Stripping the bells and whistles off of devices didn't work out to be an easy way for companies for companies to offer low-cost devices in these price-sensitive countries often the equipment still couldn't handle things like electricity fluctuations, or high levels of heat, dust, or humidity. That being said, companies are now looking to launch second-tier brands that are designed specifically for these conditions. Companies active in this regard include GE Healthcare, Covidien, and Siemens.

3. Big Data Informs Health Analytics
The growing demand for cost-effectiveness data, the high saturation of electronic medical records (EMRs), and the launch of ICD10 codes in the US are all giving rise to growing emphasis on big data. In essence, big data refers to data sets so large that they can't be easily aggregated or processed; however, if they can be aggregated in a meaningful way, they are incredibly robust. To facilitate this demand, companies need to manufacture smart, connected medical devices and health care IT companies need to continue to shift toward a standards-based approach.

2. Purchasing Power Shifts Toward ACOs and Hospital Administrations
One major trend we've noticed is the shift in purchasing power away from physicians and toward accountable care organizations (ACOs) and hospital administrations, which are increasingly using cost-effectiveness data to determine the devices with the best bang for their buck. Some devices that can reduce readmissions and save costs in the long term are primed to benefit from this trend now that the focus isn't on upfront cost examples include postoperative pain management infusion pumps and continuous glucose monitors. In general, devices that target diseases that are a large burden on the health care system (like hypertension or diabetes) will do best.

1. Medtech Companies Completely Rethink Their Business Model
In order to capitalize on all these trends, medtech companies need to rethink how they're selling their devices. Sales forces now need to be able to sell along the entire treatment algorithm, justifying how their device fits in. Some companies have taken this one step further the best example here is Medtronic, whose CEO Omar Ishrak announced in 2013 that he wants Medtronic to be considered a medical technology solutions firm, and taking the step to launch a Hospital Solutions business in Europe in the summer of 2013, helping to run catheterization labs. Look for more companies emulating this strategy in 2014.

Overall, 2014 is a promising year for medtech if they are able to take advantage of these trends and capitalize on the industry turnaround. 2014 will also see further overlap in this top ten list: big data, changing purchasing patterns, changing business models, and telehealth all tie into a trend toward evaluating the cost-effectiveness of medical devices, while a more patient-centric model toward health care will result in trend toward using gene sequences to determine treatment, developing customized devices through 3-D printing, and patient engagement through mobile apps. One thing is for sure: companies that maintain the status quo will be left behind.

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