This blog is part 10 of a series on the MEAT value-based procurement project, an initiative that advocates towards a shift from price-based procurement towards value-based procurement. It does so by defining a Most Economically Advantageous Tendering (MEAT) framework that includes the value of medical technologies, services and solutions in procurement processes across Europe. Read part 1, part 2, part 3, part 4, part 5, part 6, part 7, part 8 and part 9.
The EU Directive on public procurement came into force in Spain earlier this year. It opens the door to applying value-based healthcare in procurement and promises to be a driver of innovation in healthcare.
This is a welcome development. Innovation is not reaching patients in Europe as quickly as in the US or Asia.
The Directive fosters innovation by allowing authorities to call for tenders to solve specific problems without pre-empting the solution and emphasises the importance of innovation partnership.
By encouraging authorities to select the most economically advantageous tender (MEAT), the directive emphasises the need to go beyond price-only criteria. It specifically points to cost-effectiveness, life-cycle costing and the best price-quality ratio as important considerations.
MEAT in hospital procurement
At the recent HTAi conference in Vancouver, Canada, I outlined how our hospital in Barcelona has been testing a new framework for achieving the MEAT. This initiative stems from a project with MedTech Europe, BCG and other procurement stakeholders.
Together, we have been working on an approach that uses a holistic definition of value, based on a scheme with three main layers (outcomes & costs, other benefit for key stakeholders, and broader impact on society). While this approach has some overlap with existing hospital-based-HTA thinking, it goes beyond considering the value to the hospital and looks at the impact on other stakeholders (such as healthcare staff, patients and their relatives) and on wider society.
We piloted this framework to three products: Transcatheter Aortic Valve Implantation (TAVI), diapers and underpads. The year-long projects concluded in March of this year.
Once the technologies were selected, multidisciplinary groups in each product area were brought together to collaborate in the process. Several steps were taken to engage companies, determine what would be measured, assign monetary values to each criterion, and assess the MEAT. It was vitally important to be clear about information we would need from participating companies.
By bringing together teams from various sides of the hospital, the process itself was of value to the organisation. It sparked a change of mindset from all involved in the process, helping us to consider the impact of how products are used and how this may influence the patient pathway in the hospital and after discharge.
Throughout the process we were supported by FENIN, the Spanish medtech association, as well as MedTech Europe.
The process was well perceived by companies and the hospital. Most companies said that the MEAT value-based procurement procedure introduces greater transparency to the procurement process and helps to move beyond considering the price of the product as a main criterion for public procurement decisions. Nevertheless, it was a challenging and time-consuming process that required a learning curve.
In terms of ‘results & outcomes’, the hospital and the companies identified the same criteria under which to assess products. However, in the other layers there was less overlap.
We found that by accounting for the impact on stakeholders and on society, as well as the cost of the product, we were able to achieve the MEAT. Interestingly, the best value product was not the one with the lowest price. This demonstrates that the approach can help hospitals and procurement authorities to identify value.
Using the MEAT Value-Based Procurement framework and tool required time and knowledge. For the hospital and companies, new skills and resources may be used to expand the use of this approach.
However, the framework offers a way for hospitals and health authorities to approach procurement and foster innovation, in keeping with the EU Directive.