How Cardiac Rhythm Management – Medtronic’s `original business’ – fuels innovation companywide while finding its own new growth

September 22, 2021

Mike Marinaro, president of the cardiac rhythm management business, explains why CRM employees feel a special connection to Medtronic’s core mission. He also details how the big revenue business is developing new technologies in pacemakers, defibrillators and connectivity to help the business grab market share.

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Tom Salemi (00:00):

This is Tom Salemi of DeviceTalks. Welcome to our newest member of the DeviceTalks podcast family. It's called MedtronicTalks.

Tom Salemi (00:09):

Our constant search to find new ways to bring you insights in the med tech industry led us to the fine, fine folks of Medtronic. They've agreed to make their senior leaders available to us and you. In each episode, we'll discuss the opportunities and challenges facing one of med tech's clear leaders, so you'll have an inside view on what makes Medtronic go.

Tom Salemi (00:29):

We'll ask the questions. Medtronic will provide the answers and our great network of sponsors makes it all possible. Sit back, hop on a treadmill, take the dog for a walk; whatever you do when you listen to a great podcast and let's listen to how Medtronic is getting the job done. Let's go.

Tom Salemi (00:46):

This is Tom Salemi of DeviceTalks. Welcome back to the MedtronicTalks podcast. Our guest this week is Mike Marinaro. Mike is the president of Medtronic's Cardiac Rhythm Management business; aka CRM, aka Medtronic's original business. This is what got it all started many decades ago. Mike and the CRM team take a lot of pride in that fact. They also take a lot of pride in being one of Medtronic's larger businesses, providing the revenue needed to support other higher growth businesses, but also finding their own opportunities for new growth and innovation. We'll talk specifically about pacemakers and we'll hit upon some other areas as well. I'm sure you'll enjoy this conversation with Mike Marinaro.

Tom Salemi (01:32):

Before we begin, let's hear from this episode's sponsor. Our sponsor is Donatelle. And we're going to talk to Mike Kaiser. Mike's the vice president of business operations at Donatelle. Mike, tell us a bit about Donatello's

Mike Kaiser (01:48):

Donatelle was founded as a tool and dye company in 1967. Today we provide medical components and devices worldwide; operate under ISO 9001 and 13485 certified systems, and are FDA registered as a contract manufacturer. We offer product development, rapid prototyping, 3D printing, filmmaking, and a variety of molding options; micro molding, insert molding, [polar 00:00:02:13] molding, liquid silicone molding, bio resolvable molding, and metal injection molding.

Mike Kaiser (02:20):

We also offer precision machining of metals and plastics, [amplement 00:02:24] and device assembly as well as process validation. Whether the need is to lower supply chain risk, make sourcing easier, or manage bottom line more efficiently, partnering with Donatelle brings our customers a competitive edge.

Tom Salemi (02:38):

I will hear more from Mike Kaiser and Donatelle a little later in the podcast. If you want to find out more information about Donatelle, go to donatellemedical.com. Donatelle spelled D O N A T E L L E, donatellemedical.com.

Tom Salemi (02:57):

Now let's begin this episode of the MedtronicTalks podcast.

Tom Salemi (03:03):

Mike Marinaro, welcome to the podcast.

Mike Marinaro (03:05):

Thanks, Tom. Appreciate you having me on.

Tom Salemi (03:08):

It's great to get the backstories of folks at Medtronic, and I wanted to learn a bit about your path to the company. I know you went to a neighboring college. I went to Boston University at the same time you were at Boston College. You were on the football team. Football was clearly a big part of your life. Did you anticipate being part of your life post-college was it to a degree?

Mike Marinaro (03:29):

I think everyone that goes through and plays some sort of athletics in college hopes to continue. But then the reality is that it ends at some point for all of us. And while I'm still a fan, and my kids are actually both playing collegiate football.

Tom Salemi (03:47):

Oh, neat.

Mike Marinaro (03:47):

I happily transitioned into the workplace after my college career was up.

Tom Salemi (03:52):

And what was your first job in med tech?

Mike Marinaro (03:58):

So First job in med tech was with Boston Scientific. But of my almost 30 years now as a professional, 28 and a half have been in healthcare. I also worked at Pfizer when I got out of college. And then took a quick jaunt outside of the industry, then in the Boston Scientific. And I've been here at Medtronic about 21 years.

Tom Salemi (04:20):

Let me guess, it was probably during the late nineties, right? When everybody saw some opportunities elsewhere.

Mike Marinaro (04:27):

It was.

Tom Salemi (04:28):

I like to delve into the CRM business at Medtronic and just sort of the role of it. I've been talking with Geoff Martha, sort of about the various operating units. Some are clearly slated for high growth in summer, are identified as the revenue sources of money that are going to produce ample revenues, quarter after quarter. Where does CRM sort of fall into all of that?

Mike Marinaro (04:51):

We like to think of ourselves as certainly a revenue generator for the company, but one that is also growing. There are... of course we're the original business at Medtronic. And it's an important position to be in. Most people still attribute the pacemaker to Medtronic's sort of founding, and it's still critical to what we do every day. It's in fact our highest share product. There are three businesses in Medtronic that really form sort of the center of the company that are the largest businesses; ours, the spine business and the surgical innovations business.

Mike Marinaro (05:31):

It's important that we're all performing well. And the extent to which we are all driving growth, really then provides more of a tailwind for the company.

Tom Salemi (05:42):

I heard you say that you had an online call earlier this year with you and two of your colleagues. And I heard you say the original business, and it hadn't really occurred to me before that that would be a way to identify the group. And it certainly is. Does that carry a special meaning to be the flagship, so to speak?

Mike Marinaro (06:00):

Certainly to the people inside of our business.

Tom Salemi (06:04):

Yeah.

Mike Marinaro (06:05):

It's a critical part of our heritage. The people at Medtronic hold the Medtronic Mission central ever to everything we do. It was written here as Earl was sort of running our business, what was CRM at the time, our pacemaker business at the time. And we all identify with that, and we hold it as important to what we do. And we know that it's important for the company, for this part of the business to be doing well. We identify that way, and it's important to us.

Tom Salemi (06:37):

That's pretty neat. For those outside of Medtronic, what are the primary products that fall under your business?

Mike Marinaro (06:48):

The business is separated into really four major segments. One that we call Cardiac Pacing Therapies, which would be where the traditional pacemaker would reside.

Mike Marinaro (07:03):

Another we call Defibrillation Solutions. That is both our ICD and CRT, the Cardiac Resynchronization Defibrillator devices.

Mike Marinaro (07:14):

We have a fast growing segment inside of our business that we call Procedure Innovations. And that's where our infection control business, our TYRX™ product is housed.

Mike Marinaro (07:26):

And then we have another portion of our business called Patient Management. And Patient Management is responsible for the ecosystem that all of our devices plug into. And it is essentially the infrastructure on which we run.

Tom Salemi (07:41):

What does growth look like for CRM, and where do you gain market share? Is it growing this market? Is it seizing market share from competitors? Probably a combination of both.

Mike Marinaro (07:54):

It really is both. Medtronic CRM has been performing well over the last several periods. We've turned into a low to mid single digit grower for the company. And we see that opportunity, moving forward. As we think about it, there's two ways to get there.

Mike Marinaro (08:17):

One is through our innovation and driving share, really. Just by trying to out innovate the competition.

Mike Marinaro (08:24):

But the other is to really understand where we can disrupt our technologies and create new opportunities for growth. An example of that is a leadless pacemaker, which allows us to treat a full segment of pacemaker patients who are unable to be treated with traditional therapy. And so you start to open up parts of the market.

Mike Marinaro (08:45):

Or our infection control product in the TYRX™ product. This is a whole new opportunity, a real need in the area of implantable cardiac devices, or really implantable devices to prevent infection. But not one that was well-served. And you identify these adjacent opportunities as well as new areas of growth.

Mike Marinaro (09:08):

It really is share, plus new products, new opportunities, disrupting ourselves and opening up new vectors of growth.

Tom Salemi (09:17):

Let's delve a little bit in the advances in pacemakers. Where are you moving forward in this area?

Mike Marinaro (09:24):

There's two areas. The most well known is in the leadless pacing segment. Our Micra™ pacemaker was introduced to the market now about five years ago, and has really been a novel technology that has taken a strong hold in a large and growing segment of the market.

Mike Marinaro (09:45):

It was first introduced as a single chamber pacemaker device. And the real value of this technology is it's miniaturized. And we're able to essentially put the entire device into one capsule-size technology that really allows us to avoid complications traditional devices while being able to deliver the therapy. And we're now on our second generation Micra™ device, and we're working to build out now the next generations of what leadless pacing will be. Today we can serve about half of the pacemaker disease states. There's still about half that go unserved that we have to innovate into. And we're working on that.

Mike Marinaro (10:34):

The other area in pacing that's emerging is in the area of His bundle pacing or conduction system pacing, which is sort of an old concept that's now coming to life. It's seen as a more physiologic way to deliver pacing. And we, by way of where you place the leads, we lead in this area because of our lead technology, because of our delivery systems. And it's been an area of interesting growth. If you look at the overall pacing market, it's actually one that has accelerated in growth here over the last several years. And it's in large part because of that innovation.

Tom Salemi (11:16):

Let's take this break from our conversation with Mike Marinaro, the president of Medtronic's CRM business, to bring back Mike Kaiser. Mike Kaiser, once again, is the vice president of business operations at Donatelle. Mike, tell us, how does Donatelle work with med tech companies?

Mike Kaiser (11:36):

Donatello is a hundred percent dedicated to the medical industry. We have a solid history of success with design for manufacturability being the cornerstone in our development process. Whether we're working on a single component or a complete device, we leverage the expertise of our technical team members in our manufacturing processes, and toolmaking. We work very closely with our customers to optimize their product designs.

Mike Kaiser (11:58):

Through consistent growth and diversification, Donatelle offers all the capabilities our customers need at one location and under one roof. Our proven performance track record along with our solid financial position and ongoing improvement initiatives provide the basis for why Donatelle's the best choice and lowest risk supply chain partner.

Tom Salemi (12:19):

That's great, Mike. And I know you're excited to be sponsoring this CRM focused podcast. What is Donatelle's history with the cardiac market?

Mike Kaiser (12:29):

Donatelle has supported the top OEMs of the cardiac market for more than 50 years. We've helped by providing high volume, low complexity components, complex components and complete devices. We're also actively committed to manufacturing components and assemblies for various implantable pulse generators, IPGs. Over the past 30 years we have helped design and develop more than 280 unique and complex hetero assemblies for various IPG applications. And we've manufactured and shipped almost 6 million headers.

Tom Salemi (13:02):

Fantastic. Finally, Mike, I understand you have some news to report.

Mike Kaiser (13:05):

Yes, some of the newer technologies developed at Donatelle over the past couple of years, include the addition of micro metal injection molding, bio resolvable injection molding, and continued enhancements and upgrades to our micro manufacturing and metrology capabilities, allowing us to further miniaturize the components for the medical industries we serve.

Mike Kaiser (13:24):

Several years ago, Donatelle developed patents for various connector systems used within our customers IPG devices. Those systems are used in both the cardiac and neuromodulation markets and have the reference trade names Smart Stack and Neuro Stack. These were developed to meet an unmet need within our customers and devices.

Tom Salemi (13:45):

Great. Thanks for joining us, Mike Kaiser. And thanks for your support, Donatelle. Once again, if you need more information about Donatelle, and want to reach out to Mike and the team, go to donatellemedical.com. That's D O N A T E L L E. donatellemedical.com.

Tom Salemi (14:06):

Now let's get back into this conversation with Mike Marinaro, the president of Medtronic's CRM business.

Tom Salemi (14:17):

With the leadless, the safety comes in the fact that you don't have leads. You don't have that extra bit of connection. Are the benefits of that something that is sold primarily, or marketed primarily to the providers, to the hospitals; maybe for reducing complications? Do you actually have an opportunity to reach out to patients and let them know about this particular innovation, and perhaps it makes them more comfortable with the procedure? What is the marketing... who is the marketing director?

Mike Marinaro (14:43):

Yeah. That's a good question. It's increasingly pulling the patient into the conversation. Part of the value proposition is not only that you reduce complications, but you actually implant the whole device into the patient's heart. With a traditional transvenous pacemaker, the device is placed in the subclavian region; up in the patient's shoulder,. And then a lead is fed through their veins, into their heart. With this technology, the entire capsule is placed into the patient's heart.

Mike Marinaro (15:14):

So there's no visible reminder to the patient that they have a disorder or that there's an issue that they're dealing with. They just feel better. And they don't have to, every day, see a scar or see an implant in their chest. And to the patients that's obviously a big deal. It also increases mobility. There are just a number of benefits that you can speak to directly to a patient.

Mike Marinaro (15:42):

But we start with the physician.

Tom Salemi (15:44):

Mm mm.

Mike Marinaro (15:44):

But increasingly we're having more of that conversation with the patient.

Tom Salemi (15:49):

And I have to think that's probably your first opportunity really to market to a patient. This is the kind of product that you normally would sell directly to consumers necessarily earlier before this advance.

Mike Marinaro (16:00):

That's right. In our part of the world, we haven't necessarily taken our technology into sort of a retail setting.

Tom Salemi (16:11):

Not yet.

Mike Marinaro (16:12):

But this is one that has obvious benefits. And so it really is the first big opportunity to start having that conversation.

Tom Salemi (16:18):

Let's move on to the defibrillator space that you work in. Where are you seeing making advances technologically in that, what new products are you rolling out there?

Mike Marinaro (16:27):

There's three areas of innovation here. We've just launched a whole new suite of products that are named Cobalt™ and Crome™. That's the name of the family. But we think about innovation here really in three ways.

Mike Marinaro (16:42):

The first is in the traditional transvenous devices themselves. And there's always advancements in terms of longevity and other capabilities; adding Bluetooth communication, for example. But one of the real opportunity areas for us, one of the areas of strength for Medtronic is in our ability to build algorithms that are getting now closer and closer to what people would think of as AI sort of technologies.

Mike Marinaro (17:09):

We have, for example, in our CRT devices an adaptive capability that really is adapting the therapy on a beat-to-beat basis. Or in our new defibrillators, the ability of our devices while interpreting what is a lethal rhythm coming from the patient to understand the therapy we're delivering and self-correct as we're delivering the therapy.

Mike Marinaro (17:35):

It's not just a rope sort of algorithm, but it's actually adjusting to the feedback it's getting from the patient. Or our capability now with our TriageHF suite of devices, to be able to manage heart failure patients, to hopefully prevent hospitalizations and to risk stratify those patients. here's the algorithmic advancement, which is now really moving into this area of what people would think of with AI.

Mike Marinaro (18:03):

Then there is advancements in lead technology. A couple of years ago we introduced a new lead for our CRT devices called the Attain Stability™ Quad that allows for precise placement of a lead. And our physician customers see that a real advantage. It's the first of its kind. We're innovating our new defibrillation leads to try to get to our most durable defibrillation lead ever. And the way we're getting there, we also believe we can reduce the size by about half.

Tom Salemi (18:35):

Wow.

Mike Marinaro (18:35):

So there's this lead innovation that's been sort of elusive in this space, that we think we will effectively get to now.

Mike Marinaro (18:43):

And then lastly, we're focused on disrupting what we call our high power platform or our defibrillator business with a technology, we call Extravascular ICD.

Mike Marinaro (18:55):

And you may be aware of a competitive device called a subcutaneous ICD. And some of the interest there is in taking the leads out of the vasculature for the patients. And you have an opportunity to treat these patients differently if they're younger, or if you need to remove the leads because of infection or other reasons.

Mike Marinaro (19:15):

And we've taken our traditional transvenous devices and we've adapted the full capability of the transvenous device now to this Extravascular ICD. And the technology is applied by placing the leads under the sternum, but not placing them in the venous system or into the patient's heart.

Tom Salemi (19:34):

Mm.

Mike Marinaro (19:35):

But thereby avoiding some complications associated with that. We've just filed for CE mark and now are moving towards FDA submission here in the next several quarters.

Tom Salemi (19:51):

And is that something else that ultimately will be appealing to patients? Or really the marketing would be directed to patients? Or is that more of something that's directed to physicians and clinicians?

Mike Marinaro (20:01):

The benefit to that will be more obvious to the physicians.

Tom Salemi (20:03):

Yeah. Interesting. And I know in all areas connectivity is a huge part of what you're doing going forward. Explain how you're connecting these devices. What sort of data is being transmitted and how is it being read by both clinicians and I believe patients, too? I think you have apps that people can access to monitor their own health.

Mike Marinaro (20:28):

We do. Yeah. We like to think of the work we're doing here as real digital health. I mean, if you think about digital health and cardiology, digital health in this area really started with connected cardiac implantable devices. Medtronic invented this capability early on. And it was this ability to understand what's going on with a patient's device, and to be able to read a patient's device remotely, so that we can understand if there are any issues that patient is experiencing, or any alerts that the physician should be aware of, or therapy has been delivered. We can better understand that.

Mike Marinaro (21:09):

And that sort of information gets communicated back through our network, into physician's offices. And the physician can look at that at a moment's notice, anytime they wish. And this became of course, more important as we got into the pandemic.

Mike Marinaro (21:25):

We have about 2.5 million patients on our CareLink™ infrastructure. And that's growing at a clip of about 250,000 patients a year. Our data says that by managing patients remotely, we're able to reduce mortality, keep patients out of the hospital, reduce ER visits. So there really is very strong data-based evidence that remote management of patients matter.

Mike Marinaro (21:55):

You mentioned now we also have app-based monitors. A traditional monitor for a patient is what we call a bedside monitor. It's a hardware device that sits on the patient's bedside table. And that's what the device communicates to at night.

Tom Salemi (22:10):

Mm mm.

Mike Marinaro (22:11):

And we've changed our capability now some years ago with our pacemakers and now with our new defibrillators, with Bluetooth connectivity to be able to put the monitor right on the patient's phone. And what that does is it actually increases what we call the attachment rate or the effectiveness of attaching the pacemaker to the monitor, or the defibrillator to the monitor.

Mike Marinaro (22:32):

And then it also gives patients some sort of activity, data, battery, life, other sort of basic information that now starts to allow us to really engage the patient and have the patient engaged in their care, which of course, as the world evolves here, I think we're all going to want more and more and more of .

Tom Salemi (22:53):

Sure. And speaking to the evolving world, how did the connectivity sort of come into play during the lockdown last year? I understand you had physicians who were able to deliver care from California to Hawaii, I believe there was.

Mike Marinaro (23:04):

Yeah.

Tom Salemi (23:05):

Talk a bit about how connectivity played out during the pandemic and during the lockdown.

Mike Marinaro (23:10):

Yeah. The importance of it accelerated. The way we like to think about it is, really up until the point of the pandemic, we saw our connectivity in some quarters as a differentiator or something that could really drive usage of our devices. But it really was an enabler of our technology. And then we saw and kind of extracted the full value as we got into the pandemic.

Mike Marinaro (23:38):

Just the sheer ability to monitor patients became more important. We saw in regions around the world that weren't high utilizers of monitors. In Europe, for example, or other parts of Asia where the monitor usage just increased dramatically. Something as simple as the patients having to come in several times a year, now the patient can only need to come in one time a year, because the physician knows what's going on.

Mike Marinaro (24:02):

What you're referring to is our ability to remotely program devices. And this is a capability that we had developed prior to the pandemic. But frankly, some of our physicians were quite satisfied with the service we provide. And there wasn't a level of interest in learning something new.

Mike Marinaro (24:23):

And what we learned during the pandemic is that we could remotely program devices. We literally had our technicians in remote locations. Most frequently, we would have them sitting out in the control room. They weren't in the care setting. They weren't being exposed to the virus or other issues.

Mike Marinaro (24:43):

But sometimes, like you're describing, we were able to do long-term, or rather long distance remote programming, Hawaii to California, or Alaska to Seattle. And these were normally scenarios where we would fly people in to go do cases. But now we can be much more efficient, get the same job done and avoid risks.

Mike Marinaro (25:08):

And that really started to accelerate. We have other technologies that take our people out of the care setting that also drive efficiency that our physician customers and hospital systems are adopting as well. And these digital capabilities really are becoming more and more important as we go. And I think, as we all age, they're going to be evermore important. Because we're going to require it. We're going to require that sort of connection, that sort of ease. It just makes sense.

Tom Salemi (25:39):

How is the pace of innovation in this space? How does it compare to past years? It seems as if we're at sort of a tipping point where we're seeing a lot more about smaller items, leadless items, connected items. It seems like we're at a point where we're going to see this whole area; which is, as you mentioned, one of the older ones in med tech, really develop sort of a new shape and a new form and a new function in the next few years.

Mike Marinaro (26:06):

Yeah. It's still a regulated space. The area of connectivity is still regulated. And so that creates the barriers that we're aware of. But I think what software allows you to do is to increase the pace of innovation, to increase, and to iterate more easily. You could put out a software technology that has required viability that you're intending to update on a regular basis, different from an implantable device.

Mike Marinaro (26:37):

And that's one of the real opportunities. Additionally, when you do things like move your whole database to the cloud, you now have a lot more flexibility and computing power that allows us to think about how we bring value outside of the device itself. And again, iterate more quickly.

Mike Marinaro (26:59):

I think we will see the pace of innovation evolve pretty dramatically here; in large part because of our capability. But also the pandemic is forcing us to be more open-minded about it. Where five years ago, we may have heard from some of our customers some concern about putting a monitor on a patient's cell phone. I think we all realize now that, makes a lot of sense to have it there. Every monitor should be on a patient's cell phone.

Tom Salemi (27:29):

That's a great point. And I know we had a conversation with Ann Sheldon talking about cybersecurity. I'm sure that's something that's being built into your product development, has been built into your product development going forward.

Mike Marinaro (27:43):

It's so critical. And I will say that it's an area that we've evolved pretty dramatically. I think that as a medical device company, historically years ago, we thought about device security through that lens. And then now several years ago, we went and hired security experts that were external to medical devices, to really bring in new capabilities. And we built out a whole team around that.

Mike Marinaro (28:11):

The way you communicate matters. Bluetooth helps us actually get more secure than some of the other modalities of communication. So yes, it's essential to the ability to be connected, of course. Security, cybersecurity is everything. And we're very focused there. But it really does require a mindset that's outside of where we've operated historically, as you can imagine.

Tom Salemi (28:38):

I bet. Final area I want to talk about, and you referenced it earlier was TYRX™. Where does this fit into the puzzle and what opportunities does it present going forward?

Mike Marinaro (28:49):

TYRX™ has been such an amazing story. There's this unmet need in our market where some large number of patients, between 1% and 4% of patients who receive our devices and competitive devices, get an infection. When those patients get an infection, they then go on to serious downstream effects up to, and including, high rates of mortality at five years.

Mike Marinaro (29:24):

And what we've seen with TYRX™ as you probably know, Tom, is by way of our data. We conducted the largest study we've ever conducted, 7,000 patients. We see a 60% reduction in the infection rate of our procedures. And so now we're about how we take this technology to other areas in which we operate.

Mike Marinaro (29:50):

For example, the same technology into things like neuromodulation implantables is an area we're already operating. But moving the TYRX™ capability into our surgical business will be another big step for us.

Mike Marinaro (30:02):

And you can imagine all of the places where an anti-bacterial surgical mesh with 7,000 patients worth of data can really be applied to some great benefit. And we're flushing all those out as we speak.

Tom Salemi (30:17):

That's great. And then the final question I've asked everyone is just about the reorganizations. No one's taken the opportunity to criticize the reorganization of Medtronic.

Tom Salemi (30:28):

You could be a first. But I'm guessing this would work well for you. It seems like it really kind of focused your group on a core area. Whereas before, if I recall correctly, your business had a lot of far-reaching elements to it.

Mike Marinaro (30:42):

You won't get criticism for me either. Except maybe to say, it's always painful to go through a large reorganization. That's extra work on everyone's plate. But we had a really talented team and we were fortunate in that we were actually able to send leaders to run other parts of the business at Medtronic. I think the reorganization has had its desired effect, which is to drive focus.

Mike Marinaro (31:09):

You mentioned that in our business, we actually sort of separated out a couple of segments that had previously been as part of Cardiac Rhythm and Heart Failure, and now into their own entity. That allows them to focus. But frankly allows us to focus too. And it's I think driving a lot of the success that you're seeing in CRM. I'd say the single greatest area of focus has come with alignment with our regional partners.

Mike Marinaro (31:41):

They're a direct line of sight, between them and us, with what's required to be successful every day. And we're making quick decisions as to how we go win in the marketplace. And that really is I think an accelerator for our business.

Mike Marinaro (31:56):

No criticism here. I think we've gained from it pretty significantly. And now that we've been in it, almost a year, we've got our footing firmly set and now we're just working forward.

Tom Salemi (32:08):

And just a follow up, the regional partners, do you mean sort of sales organizations, regionalizing global regional?

Mike Marinaro (32:15):

Where we previously had sort of amalgamated Medtronic structures in the region where each one of our businesses had to work through a group sales organization. We now have direct reporting lines with each of the large regions around the world. China, Australia, Europe, for example, Japan, US, they're all directly connected in, and report directly into the business. And it really creates great alignment amongst the team.

Tom Salemi (32:51):

And I think you referenced this earlier, and I know you addressed it in the call that I talked about that you did in April or May. But each region really has its own strategy toward increasing market share in China and Western Europe and Australia, New Zealand. They all sort of have their different sort of pressure points that they're going after. Right?

Mike Marinaro (33:09):

Yeah. The the really important work that we've done has been this evolution in our thinking from starting with the Western developed countries, and exporting our strategies and products elsewhere. And what's become apparent to me in many years now in doing this is that we need to have tension from the regions feeding back in what's required.

Mike Marinaro (33:33):

And then as we think about working with each one of those regions, to have a specific strategy as to what's important to them. what's going to make a difference for them in their region, is critical.

Mike Marinaro (33:45):

And so we don't have one strategy, that's a blanket strategy at the regional level. We say, "We're going to take a specific approach in each one of those markets." And it really does make a difference to have that level of focus.

Mike Marinaro (33:59):

A great example of that is the work that we did in Australia now years ago, around our connected ecosystem. A lot of this remote capability, they saw as a huge opportunity for them to drive efficiency. They led the way for us around the globe, in terms of learning how to do this. They were gaining market share without product launches, just by getting more efficient. Which is pretty amazing.

Mike Marinaro (34:24):

And we went and learned. We invested. We've given them what's required to be successful. And now we've taken that in other parts of the world and we do similar things with other geographies.

Tom Salemi (34:33):

Very cool. Well, it was a pleasure catching up. Pleasure meeting you. Thanks joining us on the podcast, Mike.

Mike Marinaro (34:40):

Yeah, you too, Tom. Thanks for inviting me.

Tom Salemi (34:44):

Well, that is a wrap. Thanks so much for joining us on this episode of the MedtronicTalks podcast. Thanks, Mike Marinaro, for joining us. Thanks again to Donatelle for its support. And thanks again to you, our listeners, for being part of this.

Tom Salemi (34:58):

Please do be a bigger part by sharing this podcast on your social media channels. And when you do, please tag me. You can find me on Twitter @MedTechTom. You can find me on LinkedIn, Tom S-A-L-E-M-I. You could find other episodes of the MedtronicTalks podcast on our website, devicetalks.com. You can also find our DeviceTalks weekly podcast there as well.

Tom Salemi (35:23):

We'll also be putting up information about our upcoming events in 2022. Our first one is in May. We're very, very excited. Finally, please don't miss future episodes of the MedtronicTalks podcasts. You can follow or subscribe to the podcast on most major podcast platforms. They include Apple, Spotify, Amazon, Google. We're out there. Please do follow and subscribe, so we'll have future episodes of this podcast series sent directly to you. That's it. Tune in next time for another great episode of the MedtronicTalks.