Category Archives: Patient Centric Healthcare

Healthcare is there to help people, yet very often the system is not structured, aligned and incentivised to focus on patients

Building trust with customers is achievable. But is it worth the effort?

It seems that most folks agree that the industry is suffering from a trust deficit and that it needs to change the way it is perceived, but, I think it is important to say that while this is a problem common right across the industry it is a problem that needs to be addressed by each individual company and they should not wait for the industry as a whole to act.

Why? A couple of reasons stand out: it is incredibly difficult to change the perception of a whole industry. There is always likely to be an individual company that ‘lets the whole side down’, and the other reason is that there should be an incredible competitive advantage to the company that changes it’s behavior and is perceived as being different and better than any of its competitors.

I don’t think we need to discuss the economic benefits of being trusted or the compelling benefits of being a trusted organisation, lets take that as a given, and focus on some of the practical measures that can be taken to build trust with customers and stakeholders?

It’s actually not that hard, and contrary to popular belief, it does not take too long and it is not expensive, but it does require change.

So, like most programs this is all about change management and as such requires some basic fundamentals:

  • Clear ownership linked to the executive committee and responsible for installation into the company culture
  • Senior level active sponsorship
  • Articulate the need for change, the burning platform
  • A clear, succinct, well articulated strategy, preferably one that is written down and available across the organization
  • This is not a project, or a pilot, or a test. This is how the organization as a whole will operate from now on
  • Provide tools and training so that people know what to do
  • Align rewards and recognition to outcomes

There is nothing in this list that is new or difficult per sec. The issues exist around implementation and execution.

First, it is important to keep in mind that this requires action, not words. Telling stakeholders that they should trust ‘you’ most often has the opposite effect. When the Chief Executive Officer of Pfizer, Ian Read recently told UK MP’s that they needed to trust him in the potential AZ merger, the message probably did not have the effect Mr. Read intended. Building trust and being trustworthy are built by actions over time.

I think most of us, as human beings know what it takes to build trust. Identifying what needs to be done is relatively easy and most corporations would already have a pretty clear of what needs to be done. Doing it is another issue.

Charles Green, author of Trust Based Selling, identifies the single most important behavour that limits building trust, and for him it is ‘self interest’. When an individual or company is focused on itself first, and has an expectation of reciprocity then it is difficult to be trusted.

In other words, I will only do this because I get a benefit from doing it and I expect something in return.

Pharma have a reputation and track record of being not only internally focused but also self-absorbed so this shift away from self-interest is going to be hard.

So what can a pharma company do today?

My recommendation is to start small, after all it is the little things that have the most power to surprise and delight customers (they expect the big things to work and to be right).

Again, Charles Green’s recipe for building trust is:

  •  Speak more truth
  • Intimacy – take more risks
  • Reliability – do more service
  • Self orientation – think more of others

David Horsager in his book Edge of Truth has 8 foundational pillars:

  •  Consistency
  • Clarity – people trust what is clear
  • Compassion – think beyond yourself
  • Character – do what is right over what is easy
  • Contribution – results are powerful in building trust
  • Competency – staying fresh, relevant and capable
  • Connection – ask questions, listen, establish genuine connections
  • Commitment – stick with it

There is no rocket science here but it takes effort and purpose, and in pharma’s case a commitment to make it happen. For me the biggest hurdles for the industry are twofold; transparency and self-interest.

Let’s look at these two aspects in more detail and while they are obviously closely related it is worth looking at them individually.

Transparency is more than just around clinical trials, although there continues to be a heated debate on this topic as there is around pricing, and while the industry is addressing aspects of both of these they remain major stumbling blocks.

Of course the current approach is usually defended on the basis on commercial sensitivity, and while this is true to some extent, it should not stop the company being more transparent than it is today. And there are other things that can be done.

For example with Account Management, does your company have a clear account plan for each account, is it written down, measured and monitored and most importantly, was it co-created with the client and shared with them and agreed with them. Building a plan with the customer, sharing with them the measures that you will use and the success measures you will both be comfortable with is an amazing way to build trust. If you want to build trust – and build fantastic relationships, building account plans like these are very powerful tools.

Self-interest is perhaps more complex. Today, many folks look at the industry and see ‘profits before patients’ and this perception is reinforced with pricing policies, the single minded focus on the company’s brands, the aggressive push around adherence, the approach to side effects and more.

In a trusting relationship, customers do not need to be convinced by companies that they have their best interests in mind, they know it. Pharma has a long way to go before its customer base is convinced that they have their best interests at heart.

The solution to both lack of transparency and self interest are action orientated – pharma needs to be proactive and look for opportunities to engage stakeholders and, as you look down this list of some of the things one can do to build trust, it is remarkable how similar the list is to what needs to be done to be more customer or patient focused. Indeed, it is hard to be patient focused without having a level of two way trust established, and this is clearly one of the reasons that such past initiatives have failed to produce the promised impact.

17 things you could start doing today that would help build trust:

  • Conduct meetings as if the customer was sitting at the table with you. How would that change your meetings?
  • Share objectives and plans with customers – not just brand plans. Be transparent!
  • Co-create account plans
  • Measure what is important to customers and share the results
  • Access your metrics for success and ensure right balance between long and short term objectives
  • Look beyond ROI to customer lifetime value and return on customer to ensure you are actively increasing customer value by building trust
  • Talk about customers, often and everywhere
  • Learn about customers, be curious, and share customer stories
  • Invite customers to become involved in customer advisory boards to have input into company strategy and planning (not brands)
  • Begin every problem solving discussion by asking what would be in the customers best interest
  • Provide easier access to clinical trial data
  • Stop pushing brand messages through marketing detail aids and truly engage customers in discussions that are more relevant to them
  • Encourage customer feedback – they don’t all want to talk to you about side effects, they have other concerns that you could help them with if you bothered to ask.
  • Engage the legal department and involve them in what needs to change – get them involved early with a clear expectation that their role is to help make this happen.
  • Be clear about expectations. Just because some of this is hard, don’t let it get derailed.
  • Dare to be different.
  • Involve all customer types not just HCP’s. Building trust with patients, payers, hospitals is critical.

Most important though is to stop doing things that do not actively build trust. Pharma does a lot of ‘stuff’ with customers, and like customer centricity and it’s newer relative, Patient Centricity, it is often thought of as doing something else, on top of what you have always done before. This is not an additive model, indeed, often doing less is more effective and in the case of building trust it is imperative that the company stop doing things that do not build trust.

And for most of pharma this is incredibly difficult to do.

Accenture wrote about the need to build trust and the importance of ‘aligning business strategy with customer values’ where company vision, messages and offerings are aligned with their customer’s core values. This alignment demonstrating to customers that the company is not merely focused on generating a profit.

How well aligned is most of pharma’s strategy with customers, for example payers? In simple terms payers want to improve patient outcomes and reduce the costs of healthcare delivery while maintaining quality and they want their customers to be satisfied with the healthcare they are receiving. And while pharma can clearly align with better patient outcomes, for pharma, that can only come at a price.

Marilyn Carlson Nelson ex CEO Carlson Companies summed it up very well ‘trust reduces transaction cost, it reduces the need for litigation and speeds commerce, it actually lubricates organisations and societies’.

Sounds like a whole lot of effort, but is it worth it? For me, I am not sure how you can become patient centric or customer focused or continue to be successful when so many of your customer don’t trust you and don’t see your company as trust worthy.

Only time will tell.

 

 

 

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What’s it going to take to ‘Rethink Pharma’?

What does that even mean?

Patricia Seybold, Founder of Customers.com, once wrote “fasten your seatbelts!……Why? Because we’re in the midst of a profound revolution. And it’s bigger than the internet revolution or the mobile wireless revolution. It’s a customer revolution.

Customers have taken control of our companies destinies. Customers are transforming our industries. And customer loyalty – or lack thereof – has become increasingly important to executives and investors alike”

And now, even Pharma, once seemingly uncaring and impervious to customer feedback and dissatisfaction is feeling the winds of change. The long held practice of ‘staying below the radar’, not adding to the public debate and keeping a low profile, which worked so well for the industry for so long, seems out of date and a strategy long past its used by date. Public debate, dissatisfaction and lack of trust are plaguing the industry, drawing an ever more serious and growing voice of criticism of big pharma. But, what’s changed over the years is that the power and influence in healthcare has shifted, and the voices that could once be ignored are now dismissed only with potentially serious consequences.

A Patient Centric Revolution is taking place across healthcare, in every corner, in every sector, patients, healthcare consumers and you and me are taking more responsibility and control of healthcare. And pharma can no longer afford to ignore it. Or should I say, they can continue to ignore it, but at their peril. Pharma needs to rethink how it fits in this new changing landscape, a landscape that they will no longer be able to control and shape to fit their objectives as they once did.

So when we say ‘rethink pharma’ for me, it is really ‘rethink around healthcare consumers’ and ‘patient centricity’.

Most other industries now recognize and accept the power of consumers. Not just in whether they buy their products, but also how they buy them, through which channels, how much they pay, the things they like and don’t like and much more. Power lies with consumers. Most industries and organizations recognize and accept this.

The good ones even embrace it and benefit from their close relationships with customers.

This global phenomenon is not a trend, or a fad, or something that can simply be ignored. Pharma has struggled against it – and continues to fight against it, for example with its amazing lack of transparency and pricing policies, but, in the longer term, they will not be able to overwhelm consumer power. We are seeing the reaction to pharma’s continuing internally focused strategies with the steady decline of public trust in the industry and the growing barrage of negativity about the industry’s behavior.

We know the current pharma model is under huge pressure to change. It has been this way for perhaps as much as ten years, but the pressure is really building now. At least it seems that way.

Most senior pharma industry executives would agree that the model is not sustainable, but do not articulate what this actually means and being not sustainable is quite different from being broken.

Not sustainable can be code for; our cost base is too high, our prices are under attack with declining productivity and effectiveness. Therefore, we need to drastically cut costs and slash jobs in order to maintain our profitability. We need to keep working hard to discover and commercialize new products to replace older products coming off patent. We need to hang on, stay focused and weather this storm until things go back to normal and we discover new blockbuster products and boost our pipeline. None of this speaks to significant model change.

 

But many industry watchers do not believe this is going to be enough. Many commentators and consultants would say the model is indeed broken and needs fundamental and significant change. The old model is dying and a shot of innovation in the arm is not going to be enough. Wholesale, fundamental change is going to be required.

There is however a significant lack of agreement in how broken the model is and indeed, what aspects of the model are broken. And that leads to divergent opinions about why the industry needs to change today and not some time in the future.

A true burning platform, al la IBM’s financial position in the 80’s, does not exist for big pharma today and the potential risk to current financial performance is perhaps the major limiting factor in attempts to reform the industry.

How to preserve financial performance is at the heart of the resistance to change, with many people believing that any change in focus away from core business and current focus will adversely impact results, and getting into other non-core business areas will negatively impact the business. There remains a strong attachment to the current business model, with senior executives having limited confidence that alternative business models would be as good as, let alone better than, the current one, and therefore any change away from the traditional approach is seen as downside rather than upside benefit, so the inertia favors the old model with a clear focus on efficiency.

After years of pilots and tests, and a powerful load of PowerPoint presentations, pharma has not advanced much in terms of rethinking its business model. And despite the flurry of mergers and deals either underway or being contemplated right now, the model does not look like changing much anytime soon. Indeed, from past experience, we have seen that megamergers derail business model innovation as the company intensifies its focus on integrating the 2 organisations and eking out the efficiency gains that are required to justify the merger in the first place.

Sure, there have been advances and the industry is much leaner than it was, but the core of the business, it’s underlying thinking, many of the processes, the structures, sales and marketing tactics, approaches to customers, many of these things remain virtually unchanged.

The time for change is now. However, no one would suggest a big bang approach to organizational change in this industry, but there are things that should and could be changed today that would both positively impact short-term financial performance while better positioning the company for the future.

If you would like to contribute to this discussion or you have particular point of view you would like to explore, please let me know. Together we can help the industry take concrete action today and Rethink Pharma to become more patient focused.

Doctors are telling, but patients aren’t hearing

I found this great post entitled ‘People who find doctor’s advice confusing don’t manage their diseases, why is this so hard to correct’.

It really spotlights the big gap that exists in how healthcare professionals communicate with their patients.

Every time I see that statistic – ‘Only 12% of U.S. adults have proficient health literacy’ I get angry. How arrogant for the industry to think that the fault lies with ‘others’. How about 95% of professionals in healthcare can’t make themselves understood by their patients?
Communication is made up of two parts; sending the message and the other receiving the message. HCP’s are sending messages that people have trouble understanding. The fault is with the sender!
The whole industry seems to think that patient education will fix many of the problems of the system when really we need to speak with patient (notice with and not to) about the things that are important to them, in a way that is meaningful to them to reach health goals that are relevant to them. It’s called patient centric healthcare.
Sorry but this health literacy thing really does make me mad. When you last found yourself with a medical emergency in a hospital did you understand, and probably more importantly remember, everything that was said to you?

The article rightly speaks to humanizing the language of health but, my point is that for too long healthcare professionals and pharma have bemoaned the failure of patients to take control of their health while at the same time the industry has failed to learn how to communicate effectively with them.

Here is the full article.

http://healthexperienceproject.com/teaching-healthcare-to-talk-like-us/#!

 

 

Is this the New Pharma Commercial Model in action.

Here’s a recent headline:

 

‘Lundbeck recruiting 200-plus sales reps for Brintellix launch’

Looks like some good news for Lundbeck with the pending approval of a new product, but with all the talk about new commercial models and stuff, and with the recognition that the ‘old model’ was dying – or dead – why would you go down what sounds like a very traditional approach.

So the old model doesn’t look so old when a new product comes along that has potential to be a blockbuster.

What do you think?

 

 

Beyond the Pill. A new direction for pharma, but any real benefit for patients?

Merely hype or the precursor to real model change for pharma?

When 800 or 900 senior pharmaceutical company and healthcare executives sign up for a webinar you know the topic is really important to the whole industry. Getting that many senior executives to dedicate time to listen to others talk about Beyond The Pill demonstrates a high level of interest.

But is there a real commitment to change or are we still at the ‘I want to understand what all the hype is about’ stage?

Certainly there was diversity in the attendees, from across healthcare, and a diversity of opinion about the importance and intent behind Beyond the Pill and the challenges of executing such a strategy, but there was much better alignment around the potential benefits of this approach in terms of reducing costs, improving patient outcomes and improving revenue opportunities for the industry.

So where does the industry stand and, perhaps more importantly, what will it do next?

I want to look at the two recent webinars and discuss what we heard from the case studies presented and the reactions of the attendees. To look at what conclusions we can draw from these events, where there is agreement and where there is not and to try and suggest some next steps.

But first let’s look at the ‘WHY’.

Why should pharma go Beyond the Pill?

I think we are all in violent agreement that the traditional pharma model is broken, some would say simply unsustainable, but I would prefer broken. We’ve all heard a lot about this over recent years and Christian Isler from Pfizer Integrated Health was very articulate in describing the why from pharma’s perspective.

This isn’t new though. The industry has been talking about the need for commercial model change for probably more than 10 years and, while there have been some positive steps towards a new approach, like Pfizer Integrated Health, in the overall scheme of things the old model remains in tact.

The reality is that the traditional model continues to produce positive results for pharma. The industry continues to make money. And lot’s of it! Probably not as much as it used to and certainly not as much as Wall Street expects them to, but these are discussions for another time. But let’s agree that the model still works but is unsustainable in its current form. So change is a given.

What we seem to have more trouble agreeing on is when the industry needs to change and how much it needs to change. And it is the issue of ‘how much it needs to change’ that will ultimately drive the implementation of a BTP strategy.

For pharma; why go to BTP? Here’s what the attendees said.

So a diversity of opinion here.

If we agree that the ultimate aim is to improve adherence to treatments then we could view this as a tactic – something that the industry could do without significant change to the business. Same with ‘improve the patient experience’ perhaps even ‘achieve higher levels of reimbursement’. Tactical execution even within the current business model.

But if we agree that this redefines the business model, then we have a high impact strategic intent. One that would require significant business model change.

For me, pharma has not made that decision yet, but it is a decision that is central to execution and implementation and what we are seeing today across the industry are trials, tests, projects, toes in the water around BTP but little in the way of strategic implementation.

So, we can agree that this shift is important financially to the industry but the industry is less aligned around scope and impact.

TACTIC OR STRATEGY?

The pharma model historically has been about the pill. Full stop. Great, innovative treatments to address unmet medical needs.

And, as a result, the industry has focused on the product and the disease. Ensuring access to large patient pools, demonstrating the value of the pill, targeting physicians to prescribe, supporting adherence to ensure patient stick to their medications, CME programs and disease awareness and more.

From my perspective even with significant environmental changes the industry remains clearly focused on products even today. Smaller field forces than before but field force non-the less, delivering messages, typically to physicians.

Certainly some improvements but really the business model has not significantly changed from 10 years ago. You may not agree with my assessment but if we look at resource spend and allocation I am sure you will find that the bulk of the budget is spent on field forces seeing prescribers and other healthcare professionals and the budgets continue to be owned and managed by the product or therapeutic franchises (or equivalent). Resources allocated to non-brand work is a very small minority indeed. It is changing but, in my opinion, not quickly or significantly enough.

The key-underlying question that needs to be asked is ‘how does pharma make money?’ Most in the industry would answer by saying they make money from their products. But really, they make money from their customers and patients. This is the huge mindset shift that needs to take place to move Beyond the Pill towards patient centricity. It should be more about patients than it is about products (an external focus instead of the more common inside out view that the industry has).

The industry continues to demonstrate the belief that the traditional reach and frequency, share of voice, product orientated model remains at the core of the business model. If the industry did not believe this approach was the best available model we would be seeing a full-scale charge towards new business models such as Beyond the Pill instead of the ‘steady as she goes’ approach we are seeing implemented.

So what’s next realistically?

There are 3 options or alternatives in the development of BTP:

Option1 as a way to add extra value to the pill with services, solutions and resources that customers find useful in helping improve patient outcomes and pharma finds helpful lifting product sales.

I would call these ‘product plus services’. Typically most adherence programs would fit in this category, as would patient support programs and disease awareness. Things that pharma has been doing for years. Certainly an increased use of new and emerging technologies, alternatives channels to communicate more effectively but founded upon what the industry has typically done in the past.

The next option, Option 2,  could be to sell these services and solutions instead of providing them for free. But still the connection to products.

The other, more exciting, game changing opportunity area could go to the sale of services and solutions that help improve patient outcomes and reduce healthcare costs that are independent of products.

This last option, Option 3 speaks to the objective to change the business model and requires significant change.

David Doherty co founder of 3GDoctor, spoke about Beyond the Pill in terms of a disruptive change and I think he is absolutely correct in this. This is so far away from pharma’s past approach, requiring new skills, a new mindset, new solutions separate from the medicines business that it is hard to see anyone taking dramatic steps to leap frog away from the core business into something so new and full of risk. So we are seeing a much more considered approach to developing this new capability.

THERAPY AREA OR BRAND SPECIFIC

Can we agree that we are seeing lots of activity in the first 2 spaces. Good work being done by many pharma companies though still in the learning phase but with the risk of, as Matt Bonam from AstraZeneca called ‘the path to disappointment’.

One of the case study by AZ highlighted an adherence project that was not tied to an AZ brand but aimed at improving patient outcomes independent of a particular brand, but, for me, still brand focused (across all products available to treat this condition), but a patient adherence program none the less.

Pharma has a brand view of the world. It is in the very DNA of most pharma organisations. Historically structured and aligned around products, so the temptation is to look at Beyond the Pill in the same way. After all, the funding is still within the brand teams so it seems to be logical that the approach will be by therapy area or brand specific.

The downside of this thinking is that it automatically reinforces the product focus. How can it do anything other than that? Even if, like the AZ example, the initiative is not aligned to a particular product it is aligned to ‘products’ nonetheless and I think Matt was right in describing this as Intelligent Pharmaceuticals.

The challenge is to genuinely move ‘Beyond the Pill’.

So how do we break away from being product focused and do we want to anyway?

All of the speakers have spoken about being ‘patient centric’, putting outcomes and patients at the centre, so it seems that the starting point should be patients.

WOULD PAYERS BE PREPARED TO PAY?

There is an openness today to payers partnering with pharma that has typically not existed for many years. In part this is due to the tremendous pressure all the stakeholders in healthcare are under, but it is also due to pharma’s openness to trying something different.

But, and it is a big but, the pharma industry is still regarded with a high level of distrust and caution by most of the healthcare industry. History has demonstrated and reinforced the industry’s focus on relentlessly pushing its brands – putting its best interest in front of other stakeholder needs. We can discuss this until the cows come home, but reality is that there is still a low level of trust in healthcare towards the pharma industry and this remains one of the biggest challenges for the industry as a whole. Mark Wilkinson Chief Officer, NHS Barnsley CCG spoke to this point and reinforced the need to build more open, trusting relationships between not only pharma and payer but also with the other stakeholders too. Including patients.

For me, it is a question of ‘intent’.

As David Doherty mentioned if all pharma wants to be is a medicines manufacturer and marketer and compete in a commoditized market then it will need to compete on price and see strong downward pressure on prices. But, if it chooses another path then it needs to reposition itself to add more value to stakeholders and moving Beyond the Pill is one of the options available.

Given the lack of trust, selling to payers is not going to be easy and may not be possible at all unless pharma can clearly demonstrate that services are not connected to products. Selling a service or solution to payers that drives up product sales is a terrific double win in terms of revenue growth for the industry but less attractive to payers.

Today we see payers more willing to partner with pharma to develop solutions and services but are usually only willing to pay if these services are disconnected from pill sales.

Historically pharma has provided services to stakeholders in support of their products and there remains a high level of expectation that pharma will continue to develop these services and solutions and provide them for free to the various stakeholders. This seemed an appropriate expectation given that these value added services support a company’s products and stakeholders were generally accepting of this happening.

On the downside though, the value of many of the services that pharma brought to stakeholders were seen as background noise in many cases and did little to drive additional business for pharma beyond some level of differentiation or add much value to customers. Of course, there have been exceptions, but these are certainly in the minority.

Over the last few years we have seen most, if not all of the big pharma companies talk about becoming a ‘leading healthcare company’ – they are saying that they are moving from being a research and development, drug sales, manufacturing and marketing company to a healthcare company. A part of the system and not solely a provider to it. If that is the case what needs to change?

It is a significant shift to move away from being seen as a supplier to healthcare to becoming a participant and stakeholder in healthcare.

PATIENT CENTRICITY AND OUTCOMES FIRST

 Attendees agreed that patients were the most important stakeholders followed closely by payers then physicians and the idea of patient centricity is again one that is much talked about. But I am not sure that we all agree what this will actually look like.

While acknowledging the importance of patients moving forward, there seems a bit of a contradiction in play in that most of what we are talking about seems to be aimed more at payers than anyone else. Are we saying that Beyond the Pill is an approach aimed at payers but with benefits for patients and perhaps other players in healthcare. Does that mean that BTP services will not be attractive to hospitals, HCP’s, pharmacy etc?

I remember talking with a pharma company about ‘customer focus’ as it was called at the time. What I heard was ‘that we are already customer focused we talk to customers all the time’.

And that was true. For example, if we generalize for a moment and imagine that a typical representative sees 8 or 9 customers per day, and in the US a total field force of 5000 representatives was not uncommon, then that suggests that the company talks to 45,000 typically HCP customers EVERY DAY.

But what we see is not a company that has deep understanding of its’ customers rather we see that the company really does not know its customer very well, beyond their prescribing. Because, in part, pharma has focused on delivering messages not understanding customers. It still does this today.

It’s the same with patients. One can, and folks do, argue that their adherence program is patient focused and in one respect it is, after all it is about patient behaviour. But if we were to look at the objectives of the program and the measures and metrics, in the past we would undoubtly see ROI as a key measure, together with brand sales lift, market share data etc.

Today things have moved on and we may see some customer data but if you want to see if an initiative is patient centric  or not, take a look at the intent and the measures.

If the adherence program is about improving patient outcomes then that is what should be measured and I am not talking about a patient with a chronic disease staying on medication for an extra three or four months – that does noting to improve their health outcomes – I am talking about measuring the impact on their long term health, Of course there will be some measures around program ROI and sales impact but if these are the primary measure and the ones the marketing team are rewarded for, then this is not a patient centric program. Sorry!

STRUCTURE EATS STRATEGY FOR LUNCH

This is why this is so difficult. Typically the money is held and managed by the product teams, who are focused, measured and rewarded on product performance so they are intent on building the brand. And it is disease and condition orientated.

They know a lot about the disease and the treatment, but not always a lot about the patient. They know about diabetes the disease for example and understand how the disease impacts a patient, but to be patient centric one needs to understand that a patient would not describe themselves as a diabetic rather I am a patient who just so happens to have diabetes (and other co morbidities as well probably).

It does not sound so different but it is.

Traditionally pharma is organized and structure around the products in a series of very insular silos, often competing with each other for the attention of key physician customers.

This siloed structure helps support a by-product view of the world and is a major huddle for significant model change. Where does Beyond the Pill sit within a company today and how important is it in the ‘pecking order’ compared to the major brands?

THE IMPACT OF TECHNOLOGY AND DATA ON HEALTHCARE

3GDoctors’ David Doherty did a great job showcasing some of the disruptive strategies and tools that are beginning to have significant impact with patients and healthcare stakeholders but we have still not reached the tipping point in adoption that will see a paradigm shift in the use of these tools.

Mark Brincat from Exco In Touch reinforced that technology per sec is not the solution and there is a real need to develop solutions that can reach down to perhaps even the individual patient level to deliver appropriate solutions and services to specific patients.

WHAT NEEDS TO HAPPEN TO ENSURE WIDE SPREAD ADOPTION

There are a number of choices that still need to be made right at the beginning. Is this going to be a significant strategic imperative or will it be more of a tactical approach. Whichever, there will need to be a clear and concise strategy that could be agreed and supported by the whole company.

It’s not enough for the CEO is say the company is moving beyond the pill. Indeed most CEO’s are not prepared to even say that publically. Novartis CEO, Joseph Jimenez is one of the few senior executives who has stood up and publically stated the need to move beyond the pill. But this on it’s own is not enough.

There needs to be complete senior level support for the strategy, which should to be clearly and concisely articulated. Resources need to be allocated appropriate to the commitment and people should be measured and rewarded for new behaviours.

Mark Wilkinson’s experience with Pfizer Integrated Health confirms that it probably requires at least a separate division if not indeed a separate legal entity in order to ensure due separation from the core business. The challenge here is the need to change the pharma model. Setting up a separate company allows the core business to continue on its merry way, leaving the responsibility of Beyond the Pill to another division. Getting the balance right is a critical challenge.

Of course, new skills and new capabilities will be required together with significant training and it may be that the people required to work in this new environment may well not come from within the pharma business.

The challenges are enormous and the difficulty of executing such a significant change on an industry that has demonstrated its resistance to change but what choice does the industry have.

Let’s leave the legal and compliance issues to be addressed by others more qualified.

 At least the industry is on the journey, so well done for moving forward. But. The industry has been on this journey for a long time already probably the best part of 10 years. So it is time to stop patting itself on the back and congratulating itself on becoming a part of healthcare and get on with the task at hand and really change an old, out-dated, and inefficient business model and add more value to all the stakeholders in the healthcare system.

 Article published by EyeforPharma July 2013

Living is much more important than adherence

I came across a great article by Rajiv Mehta, it was his story about the development and evolution of a health app and what they learnt from its use by consumers over time and their response and continuing development of the app.

What I really, really liked was the 3 lessons they learnt from working closely with consumers. I won’t go into them all here, you can read them for yourself using the link below, but this was the key for me:

Adherence is a much lower priority than living life.

http://thehealthcareblog.com/blog/2013/06/18/long-strange-trip-indeed/

OK, in this case the author is talking about adherence to using an app to improve patient health, but the principle applies across medications and other treatments. What pharma and other clinicians fail to appreciate is that they need to understand the total priorities in a person’s life and how they can make adherence fit into the patients life. It is not about getting patients to be compliant and making consumers change their life around their condition. I know taking medications as prescribed is THE highest priority for pharma – for me, that’s what they care about, but for patients it’s about getting on and living life as best they can.

This is a great article. Give it a read.

 

 

Why would anyone think engaging patients is not good for healthcare?

Conversation between doctor and patient/consumer.

Conversation between doctor and patient/consumer. (Photo credit: Wikipedia)

Patient Recognition Month Poster

Patient Recognition Month Poster (Photo credit: Army Medicine)

Almost everyday in the media and on websites around the world someone, somewhere, comments and discusses the importance of engaging patients. As if this is something surprising and new!

What is surprising to me, is that the topic continues to be debated, and commentators continue to try to persuade non believers and key healthcare stakeholders that this has real benefit. And, it’s true, not everyone is convinced it’s a good thing.

The concept has been around for years, and there as many success stories as there are failures, but commentators seem very quick to want to throw out the concept without completely understanding that it is the ‘how’ that is most likely at fault. Clearly, not every patient wants to be engaged, but certainly many of them do. Just look at the number of folks who look at health related topics on the internet – a recent study by Pew Internet found that 80% of internet users, or about 93 million Americans have searched for health related information on line. That is a lot of interested healthcare consumers!

So it is definitely the ‘how’ that causes the problem. Each of us have a different view about how we want to be engaged, be it in healthcare or anything else. So flexibility is the key, and what I see so often is that engagement is clinical code for compliance: ‘we need to educate this patient so that they understand their condition and follow their treatment’. But, to be honest, it simply does not work like that. Clinicians still have that scientific, data driven, clinical view of the world and continue to struggle with the idea that they are working with people, most of who have a strong notion of what health means to them. And it may not agree with accepted clinical thinking. But it is their health and their body, and clinicians need to better understand that a good outcome for one patient may not be good for another in some cases.

So, as with all things in healthcare, when we are speaking about engaging patients it needs to fit the individual patient’s view of what engagement means to them. For some, light touch, for others more information and data, while others may just want to feel heard. Anyway, patient engagement is not one size fits all, and if we are to engage patients in any meaningful way we need to work with all stakeholders to change behavours and rewards, and actively encourage patients to become more involved in their health management.

If we can do this, we will have better health outcomes for patients while driving down the cost of healthcare. For pharma, it may even have the benefit of improving adherence and increasing their profitability.

Would you participate in a clinical trial?

Newspaper advertisements seeking patients and ...

Newspaper advertisements seeking patients and healthy volunteers to participate in clinical trials. (Photo credit: Wikipedia)

It seems that is quite hard to recruit patients into taking part in a clinical trial. And getting harder too.

For those of you who don’t know, these are clinical studies, usually carried out by clinical research organisation on behalf of a pharmaceutical company. They typically involve recruiting patients that match a specific criteria set down by the pharma company, and they are either provided the drug being tested or a placebo sugar pill and the results monitored. Clearly the patient does not know if they are receiving ‘the real deal’ or just a sugar pill. In return the patient receives on going free medical checks, the medication for free and usually some form of fee.

Additionally the patient needs to submit to a series, sometimes quite a rigorous series of tests throughout the course of the trial. And, of course, you may be lucky and receive a new, highly effective new treatment for your condition. Or not!

So, on a recent trip back to the US I was driving down from New York and on the radio that I was only half listening to, there was an advertisement from a CRO (Clinical Research Organisation) recruiting people to take part in an investigational trial. It sort of caught my attention, so I listened a bit more closely to the last part of the advert. The thing that really caught my attention was the ending. It went something like this ‘call this number today if you qualify and be part of this investigational trial’.

I am sure the advert was better than that, but the way it finished left me feeling like it was a competition, and if you met their specifications you were a winner. I felt like this was a very typical mistake made by companies that work in this area and was a fine example of an internal company view without really appreciating the customers perspective.

What the advert should have said was ‘if you are unfortunate enough to have this condition we may be able to help you’. But this advert was only looking at the benefits for the pharma company. We need test subjects, we will pay them money to participate. They may or may not receive the drug they need, but this will help us bring this drug to market or not.

It’s no wonder people don’t want to participate in trials. Forget the ethical issue of folks not receiving a medication that they need, or even telling them they are taking the medicine or not, but pharma and CRO’s need to understand the patients perspective better.

I know I would not want to participate, what about you?

I thought healthcare was supposed to be about you and me……

Hands up if you are a clinician.

How about a medical researcher or in academia? What about if you are working in healthcare?

Why do I ask? Well I just had something of a ‘lights on’ moment. I was watching a great presentation about health literacy from a very prominent and thoughtful clinician and researcher. She had a great presentation – very thought-provoking and also insightful – a great combination.

But listening to her – and let me say that she really ‘get’s this stuff’ that’s clear. But. She get’s it as a clinician. The way she spoke, the terms she used, and the research driven, data based approach to things made it clear to me that one of the biggest issues we have is that healthcare is more about the science and the healthcare practitioners than it is about you and me.

The big debates. Key issues and questions all led by industry insiders. naturally enough taking a science based approach. Where is the expert input from you and me?

Continue reading

Is this simply all about the money?

 

English: Total U.S. healthcare spending. 1960 ...

English: Total U.S. healthcare spending. 1960 to 2007. Percent of GDP (gross domestic product). Data is from OECD Health Data 2009 – Frequently Requested Data. (Photo credit: Wikipedia)

Healthcare can form a significant part of a country’s economy. In 2008, the healthcare industry consumed an average of 9.0 percent of the GDP across the most developed OECD countries. The United States (16%),  France (11.2%) and Switzerland (10.7%) were the top three spenders (Wikipedia).

In the US, that accounts for more than 2.2 trillion dollars per annum.

This is not one of those issues where clearly the more money you throw at the problem the better the outcomes will be.

Yet what does this huge amount of money the US spends each year on healthcare do for the health of the population. Because it does not deliver the best health outcomes the world has to offer (at least according to many) so what does it deliver?

One answer can be: it delivers huge profits to some of the players. With so much money at stake, in the US, companies are competing to expand their share of the pie. Many corporations return considerable profits to shareholders and Wall Street – yet those profits never seem to be enough! So when it comes time to reform, restructure, realign, reinvent healthcare, then those with vested interests can prove difficult partners. It is this profit driven approach that really contributes to making healthcare reform in the US such a difficult process.

Not that this only applies to the US. In Europe, where a single payer is the norm (government funded model), money, or today, the lack of it, drives much of the healthcare agenda. Governments are desperate to cut the cost of healthcare delivery. Almost it seems at any cost. yet the barriers to change seem to be as mountainous as those in the US.

So, we have more than 50 million people without health coverage in the US, a plethora of corporations making billions of dollars of profit year on year, the rising cost of healthcare, the rise of medications and treatments that can cost up to $400,000 pa per patient and a general debate that the system is not sustainable. In Europe, countries are restricting the type of interventions delivered, delaying new innovations, cutting salaries of healthcare professionals and outsourcing as much as possible…..

And so it goes on.

There is a real perception, both in Europe and the US, that in order to continue to provide good quality healthcare, costs must continue their trajectory skyward. That better healthcare simply is going to cost more.

I disagree!

Foto de David MacKenzie Ogilvy

Foto de David MacKenzie Ogilvy (Photo credit: Wikipedia)

The well known advertising guru from years gone by – David Ogilvy – famously said that he knew 50% of his advertising spend was wasted, but that he didn’t know which half? Seems to me, the same applies. There is so much waste, duplication of effort, competing interests etc that it is hard for some people to believe that better healthcare does not have to cost more money.

This is the challenge for us all today. What do we need to do that will enable us to continue to deliver good health outcomes, or better health outcomes, to more people, without costing more?……….and so the debate continues.