Category Archives: What’s not working in healthcare

What are the issues and challenges facing the healthcare eco system in evolving to a more sustainable and patient centric model

Why the current approach to Commercial Model innovation won’t be successful.

“In a 2015 survey, a majority of executives believed their companies would be restructuring their commercial models over the next two years”. That’s how the recent EyeforPharma whitepaper on Integrated Commercial Models began and continues by highlighting the lack of certainty and direction across the industry.

But the reality is that Pharma has spent years and years, and tens of millions of dollars attempting to innovate, improve, renovate and more often than not, restructure its commercial model. And this recent and renewed enthusiasm and focus on developing a new commercial model is nothing new, it’s being bubbling along for more than a decade.

And what has the industry to show for all this effort and expense?

Not a lot, in my opinion. The model stubbornly refuses to change significantly and as an industry, pharma seems content to milk the cash cow that is the current model, albeit with some relatively minor tweaks and changes.

Why is this the case? Why have strategic innovations such as Customer Focus, Customer Experience and more lately Patient Centricity failed to deliver the breakthrough they promised. For me, the issue is pretty simple.

Pharma is clearly resistant to change, but apart from that, it is looking for tactical solutions to a fundamentally strategic problem.

Whatever has been done to the existing commercial model in recent times, ends up only a weak attempt to restructure, develop an integrated sales and marketing function, change the sales model or some such tactic. While the basic, underlying problems are that the model is fundamentally broken, and can only be ‘fixed’ if one understands and address 2 critical issues:

  •  The reasons why the broader business model is broken and what that means for the commercial model
  • What aspects of the business model need to change – either stopped, amended or started

And then, and only then, one needs a strategic change of direction first and then design a commercial model to deliver on that strategy.

I take my hat off to GSK, perhaps the highest profile pharmaco to take serious action on their commercial model beyond merely restructuring it. But even the highly ‘controversial’ approach of not rewarding reps on product sales, is neither truly innovative nor strategic, and certainly won’t solve the many issues that face GSK, but at least it will help address a particular tactical issue.

Today, as it has been for decades and decades, pharma is focused on selling products (I won’t call them brands). That has been, and it still mostly is, still the main motivation for the industry. It is all about the products.

The old model has been pretty effective in days gone by and it is hard for the industry to leave it behind, either though most would agree that the model is broken, but moving away from a successful model to something else is frankly, perhaps, a bridge too far for most of pharma.

Sending reps out to deliver product messages to primarily physicians remains the essence of the current model. OK, supplement it with some multi channel, add in some new roles, KAM and the like, but it is still about products.

Patient Centricity has the potential to drive a strategic shift across the industry but the reality is certainly more rhetoric than action, and again, more tactical in practice. Take a look at how resources are allocated across pharma today. The percentage of people and money dedicated to Patient Centricity is miniscule compare to traditional product sales and marketing. You are either Patient Centric or you are not – its like pregnancy – you can’t be piloting Patient Centricity or learning to be patient Centric, it is a strategic decision. I’d say pharma is not pregnant with Patient Centricity.

The recent whitepaper even says in the conclusion “pharma finds itself with a broader arsenal of weapons with which to talk about the value it brings”, which pretty well sums up pharmas approach to selling. Pharma continues to want to talk about ‘the value they bring’, while customers determine value for themselves. If the industry needs to continue to upsell the value then perhaps that is a big issue, and no amount of ‘education’ from the manufacturer will convince customers.

The conclusion of the report is spot on “many of those now running pharma organisations have come through the ‘golden age’ of pharma and so may be reluctant to change”.

But it is more than simple reluctance. Most do not see, or believe, that there is a better alternative to the traditional approach, and that there are new business strategies that will provide significant benefits over the old model in terms of revenues, costs, customer engagement, trust and sustainability. Yet, for the most part, they remain unwilling to confront the risk of change.

 

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What do you KNOW about your customers?

No, this is not going to be about segmentation and targeting, we’ll save that for another day, what I want to do is focus on what ‘we’ the pharma industry know about our customers.

I’ve had lots of folks tell me how customer focused their company is; how the company works with customers everyday, and how many resources they allocate to customer facing roles and how much money they spend on customer research and so on. But when you scratch the surface, and I recommend you go and scratch it at your organization, I am sure you will uncover some very interesting insights.

As a start, it is an interesting exercise to ask your colleagues ‘who is the customer’? I’m sure you’ll get a bunch of different answers to this simple question. And, if you can’t agree on who the customer is……..what can I say?

I’ve heard lots of answers, including one that even identified company colleagues as customers, ‘internal customers’. How does that work? Is it still doctors, or does it now include nurses and other HCP’s, what about patients, caregivers, hospitals, payers, pharmacists, healthcare consumers? Clearly, having a good definition is a great way to start, that way your company will be aligned and focused on what matters most.

Pharma is a product-orientated industry. That probably is not going to change, this customer centricity, patient centricity discussion is not about moving from being product focused to customer focused, that is too big a step change for pharma right now, so this is about being more customer inclusive, realizing the importance and value of the customer and ultimately, for most businesses, it is the realization that ‘you’ will sell more product and be more profitable if you become more customer centric. It’s simply a better way of selling!

But, you need to be careful. If all you are doing this for is a cynical strategy to sell more stuff then beware. One of my favourite quotes of all times comes from Martha Rodgers of Peppers and Rodgers fame, she said, “If your goal is to sell more stuff to your customers you will compete on price. If your goal is to add value to your customers, then you’ll end up selling more stuff’.

So being customer focused is a better, more effective and, yes, more efficient way to sell, and it begins with what you know about your customers.

Go ahead and look at your own data, really dig into it, try doing it from a customers’ perspective and you’ll be amazed. Put yourself in the customers’ shoes and ask ‘what does the company really know about me’?

Look at call data. Do you have a single view of a customer, can you see all the interactions across all channels, with a particular customer, start at an individual customer level – don’t be tempted to do the segment average type approach.

Here’s what you are likely to find?

  • You don’t know much about an individual customer
  • You have good call data, but likely not consolidated across all channels and brands
  • You have some contact information, address, business phone etc probably not personal email addresses and other critical business information
  • There will be very little additional customer data – often precluded by out dated and overly conservative legal policies
  • Representatives have more customer information that they do not share with the company
  • Spend a disproportionate amount of time and effort with the wrong customers
  • There is no factual reason one customer is seen more often than another – it could be simply that reps have access
  • Unable to identify your most important customers
  • Some customers are not profitable, you expend too many resources and calls on the wrong customers
  • You don’t treat different customer differently, other than call rate.

Overall, there is very little customer insight to be found.

Most of pharma still, if we are talking healthcare providers, allocate resources according to customer value (their value to us), so a high value customer subset – lets call them A customers, get more calls. This has been around for decades and is still alive and well today.

In primary care in particular, this call rate is usually by brand or in some cases therapeutic area, but when you see the same HCP customer called on by different reps across different channels, you see how much resource is actually allocated to this customer. It’s not a common view; the data is usually not looked at this way.

But go and look at your B Customers. Yes you see them less, perhaps, but the total amount of effort spent on this group will be significantly more that the effort spent with your highest value customers, because when you add it all up, there are more of them, more calls in total, more effort. And it continues to work down your list of priority targets, so that, in the end, the total effort directed at lower value customers is more than your highest value. Why would you do this?

Now lets go back to the individual data and look at what you actually know about your most important customers. I bet you know a lot about their prescribing, particularly if you are in the US and have access to prescribing data, outside the US you may use external services like IMS or others or you may just work on rep feedback to rate HCP’s, either way you will know, or think you know, more about their prescribing than you actually know about them as a customer.

What does your CRM system say about this customer, what facts does it contain? Try asking your reps what they know about their highest value customers and the chances are they don’t know much. Again, probably lots of RX data or impressions and probably a lot of personal stuff, but not much more about them as a customer.

Do you act differently with different customers based on what you know about them, or are you still focused on delivering messages that are important to you?

This situation is the result of the fact that pharma has not wanted, or felt it needed, to know about customers and has fears about the legality of gathering and storing this type of information. But now, it is critical to better understand customers.

This all sounds simple and obvious but the changes required to be more customer or patient centric are significant and it should not be thought of as something you only need to do with HCP’s.

Indeed, how do you become more customer focused with newer customer types like payers? I’d begin asking the same question –‘what do you know about this customer beyond Rx?’

Being more relevant to your customers is key; building trust, being trustworthy and delivering value are going to be significant differentiators in the future and I don’t know how you do this without knowing about what matters to your customers.

Things you can and should do starting today.

  • Establish as sense of urgency.
  • Build a team of passionate patient advocates
  • Become more customer curious. Ask customers about their business, their challenges, what’s important to them and more.
  • Collect customer data. Try at every interaction to come away knowing something about your customer that you didn’t know before.
  • Store factual information, share it across the business, analyse it and then act on it.
  • Develop a comprehensive customer view – monitor and measure the collection of relevant, factual data.
  • Use your CRM system as a source of insight not just call reporting.
  • Build customer advisory boards not for brands but to better understand customers, get customers involved.
  • Segment not based solely on value to the company and Rx
  • Be open and honest about the data you gather. Would you be willing to share what you know about customers with that customer? You should be!
  • Focus on your most important customers and deliver differentiated services and offers to them in response to their needs.
  • Identify the top 6% of customers that generate around 40% of your sales and build an individual customer plan for each of them.
  • Demonstrate that this is not only for the field force – anyone touching a customer should enter data
  • Reward the right behaviours. Senior leaders should review customer data on a regular basis – not just sales managers
  • Review and change attitudes to customer data, engage the legal department in the change.

Of course, the next big challenge, once you’ve begun to better understand your customers is ‘what are you going to do with that knowledge?’ But lets take one step at a time.

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

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?

Big pharma’s pricing strategy for new medications continues to put profits before patients.

OK.

I know the dust has not settled yet, and there is no concrete decision in this latest example of profits before patients. But there is a lot of discussion right now in healthcare circles about pharma’s continued poor behavior in this area.

The latest example comes from our friends at Sanofi and their rare disease division Genzyme.

Global headquarters of Genzyme.

Global headquarters of Genzyme. (Photo credit: Wikipedia)

Seems there is a drug on market, branded Campath, used in the treatment of leukemia and blood cancer. But has been successful in the treatment of MS patients.

Good news I would say.

But, it seems that there is more money to be made in MS, and so Genzyme is looking at a new pricing structure for Lamtrada – as it is going to be called. One that is 20 – 30 times more expensive than it is today. It is only scuttlebutt, but one would need to question the thinking process behind this.

Why would Genzyme even be contemplating such a move? I can only think of one reason, and it has much less to do with patient outcomes than it does with profit.

Healthcare providers, and, I guess, patients as well, are very unhappy about this. And so they should be. It is not wonder the motives of big pharma are so often challenged and they suffer from a severe case of ‘lack of trust’ by their customers.

Two things need to happen.

The first. Pharma needs to take a long hard look at itself and address this type of thinking that seems so ingrained within the industry. There is nothing wrong with making money, but I guess they have not heard of the concept of ‘bad profits’.

The second thing is that the regulators need to take clear and decisive action to stop this behavior.

I wonder which will come first?

Everyone is talking about Patient Adherence

OK. Maybe not everyone.

But certainly all of pharma! And then much of healthcare – payers, insurance companies, private medicine, even some doctors, although not all.

Notice what’s missing?

Patients! Patients aren’t talking about adherence!

So what is going on here? We all know big pharma is facing a very uncertain future. Lots of big – read profitable – products going off patent, and, of course, the rise in the use of generics, so where to go to continue to grow profits. Of course, everyone is looking to emerging markets, but even there it is becoming clear that the future is not as promising as it once appeared to be, with strong price pressures from governments, massive competition from within big pharma and a market that does not want to be dominated by big international players. So patient adherence is growing in importance.

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