Cameron Health and the Revolution From Below

But in the broader world of technology development, innovation sometimes runs in the opposite direction, expanding existing markets or creating new ones by making technology less complex and, therefore, more accessible to a larger audience. Think of computers, for example, which have evolved over the past half-century from large mainframes used exclusively by high-powered research organizations, to personal computers and laptops that can now be found even in kindergarten classes. And this simplification doesn’t mean that the technology is less sophisticated or useful; in fact, just the opposite: in its appeal to a broader, less technologically adept audience, the technology almost has to do more on its own and serve a wider range of purposes in order to capture a huge customer base.

Recent history suggests that a fair number of major technologies have followed this model—in addition to computers, think of information technology and consumer electronics like radios and TV. But such a model is rare in medical devices, perhaps because of the assumption that only a highly skilled, technically adept customer has any use for new technology iterations. One device start-up attempting to challenge the historic model in favor of one based on simplicity, is San Clemente, CA-based Cameron Health Inc. Having developed a new implantable cardiac defibrillator that is easier both to implant and program, Cameron is targeting that huge portion of the potential ICD market—as much as 80%—that has yet to be penetrated despite the fact that the ICD therapy is well accepted by clinicians and fully reimbursed by payers.

In fact, notwithstanding the ICD market’s booming growth recently, Cameron officials argue that penetration has remained low precisely because the complexity of the device has turned off a large group of customers—cardiologists, who are reluctant to implant the devices now on the market. Because the Cameron ICD doesn’t require venous access, doctors don’t have to take a lead into the heart, with all of the navigation under fluoroscopy that entails. All they do is make a little pocket just above the ribs in the subcutaneous tissue, pop the Cameron ICD in, and close the pocket with a couple of sutures or some staples. It’s a 10-minute procedure done under local anesthesia without fluoroscopy, compared to a 45-minute to 2-hour procedure, done with fluoroscopy and requiring the physician to transverse the lead into the heart.

And even if the implanting surgeon is comfortable with the procedure, there remains the problem of leads that break or are jammed through the heart during implant. Indeed, faulty or damaged leads remain one of the most difficult issues facing ICD patients and physicians.

Technology complexity is, however, only one reason, says Cameron, for the underpenetration of the ICD market; the other piece has to do with referral patterns. Thus, the largest part of the untapped market, they argue, lies in prophylactic applications, or what they call primary prevention—patients who show signs of being at risk for sudden cardiac death, but haven’t yet had an adverse cardiac event, such as a heart attack. And who sees these patients? Not EPs, who comprise virtually all of the current ICD target customer group, but rather the cardiologists who treat patients before they get to the EP. And currently, there’s no incentive in the system to get cardiologists to turn over to the EP any but the most severely ill patients. If anything, the incentive for the cardiologist is to hold on to the patient and continue other, non-ICD therapies, until the patient has his or her first crisis.

But if there is, in fact, such a huge opportunity as a result of under-penetration in the ICD market, why haven’t the market leaders picked up on it? Cameron officials argue that it’s because they’ve simply been too successful in tapping the higher-end of the market—a market that has had aggregated growth rates of greater than 15% for the past 20 years and, more recently, had seen 50% growth.

More to the point, the ICD market leaders have tapped into this huge market specifically by adding complexity in order to tease out product differentiation among a core group of customers, i.e., EPs. But even if Cameron’s bigger competitors wanted to, they’d have a hard time serving the unpenetrated part of the market. One of the most important drivers of the CRM business over the past decade and a half has been the emergence of electrophysiologists as a key customer group. Avid technology adopters, EPs have constantly pushed companies toward greater and greater technology innovation, and rewarded them greatly for doing so. But Cameron’s greatest innovation may lie precisely in the way the company calls into question the value of this strong dependence on EPs as a primary market target in CRM, in favor of a much larger customer group, the gatekeeper cardiologist.

Not everything about Cameron’s strategy is simple—the devices are, for all their simplicity, highly sophisticated and difficult to make, and selling in the highly competitive ICD market will be tough. But if Cameron is right, there’s a huge market for implantable defibrillators that are simple to use.