The transition of healthcare continues: From transactional, fee-for-service meetings between patients and providers to a more integrated and coordinated approach to care that includes the time periods between provider visits. The degree of integration in a healthcare organization, however, can vary.
For example, it may take the form of a tightly managed arrangement, such as a patient-centered medical home, in which the patient’s care is (mostly) prepaid for the year and healthcare interventions are carefully employed by the provider team of PCPs, specialists, laboratories, therapists, etc. Or, it may be a “narrow network,” in which patients have limited choices for physicians, hospitals, and other providers. While the care is not prepaid, it is discounted because this network of providers has agreed to accept lower rates.
In both examples, provider revenues or fees are constrained, so one of the major operational priorities is cost containment, if not for individual patients then certainly when measured over the patient population. In this type of environment, knowing and using the “right treatment for the right patient at the right time” becomes an important means of success.
For Customers, You’ll Need a Score Card
Solo medical practices are vanishing quickly, and now we have many integrated delivery networks that have many managers, providers, and even manager-providers. All stakeholders in the organization have a common set of goals, namely delivering the highest quality care at the price/cost levels that provide good patient outcomes, patient/customer satisfaction, and profits. However, individual goals of each stakeholder may differ slightly. For example:
- In the C-suite, financial metrics, quality efforts (particularly as they impact financials in the form of incentive payments or penalties), and patient/customer satisfaction ratings are priorities.
- In the D-suite, medical, quality, and pharmacy directors need to develop and provide a standard of care (in the form of pathways, policies, protocols, guidelines, etc.) and also employ the mix of providers, facilities, drugs, devices, and other resources to deliver care for members/insureds in a clinically and financially sound way.
- Physicians still rely on their clinical education to determine how to best use resources for individual patients, while remaining cognizant of population health management issues. So, scientific evidence is still a key item for their evaluations of patients and treatments. Allied providers, who are charged with coordinating patient care in multiple settings, will manage logistical, behavioral, and operational aspects.
There’s No Turning Back
While more efficient care and better patient outcomes are common, rational business goals, the trends toward greater integration and care coordination have been driven in large part by legislation, regulation, and other outside forces. Accountable care organizations were “born” by legislation, with the explicit purpose of saving money for Medicare, a federal program. As the largest payers for healthcare, federal, and state governments have a key interest in efficacy.
So, in addition to “blunt” tools, such as mandatory price discounts on drugs or physicians’ services, governments have adopted the principles of the Triple Aim (from the Institute for Healthcare Improvement), which strives for improving the patient experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita cost of healthcare. A substantial number of healthcare quality organizations have had metrics adopted by governments and other payers.
Additionally, some payers are capitalizing on the power of consumerism to achieve the same goals. The premise: If high-deductible health plans require a higher out-of-pocket contribution by patients for their healthcare, patients will spend their dollars as carefully as they would in other purchase categories. As a result, the payers (insurance plans) gain an ally in eliminating unnecessary or inefficient care.
This Is Not Your Father’s Oldsmobile
In this transformed healthcare environment, we see a divergence between these integrated healthcare delivery organizations and the pharmaceutical manufacturers. While customers are moving toward integration in how they manage risk and healthcare delivery, pharmaceutical manufacturers are assembling franchises, or portfolios, of products and services, but still using multiple (and-not-quite-integrated) sales, account management, and scientific teams to call on these customers.
This structure may have been a logical reaction to the proliferation of customer stakeholders (above), but the risk, and the shortcomings, of this approach with these different interactions by different team members may result in unfocused or incomplete (and sometimes contradictory) messaging. For example, manufacturers have focused on the product (the drug or device) when speaking with physicians, perhaps on contracting when speaking with D-suite, and on quality when speaking with C-suite. However, these separate conversations have addressed only a portion of the customer’s needs and approaches to patient care.
In reality, the customer needs to accommodate more than the drug, because they manage inpatient care, laboratory tests, outpatient care, and caregiver inputs in a way that produces better patient outcomes. Simply, the manufacturer can unify its product/drug message with other services into one valuable franchise offering for the integrated customer that delivers coordinated care.
Focusing on What Matters Most
A critical step in capitalizing on your franchise begins with truly understanding the needs of your customer, and aligning their priorities with the solutions you provide within the context of today’s healthcare environment. Unfortunately some marketers forget these priorities often extend well beyond the drugs or devices they are marketing.
I’ve had the opportunity to serve on the Board of Directors for the Cancer Support Community (CSC), and as anyone who has spent time in oncology quickly learns, the patient is at the “center of the action,” and is the common link to—and ultimate consumer of—healthcare resources and can provide invaluable insights. One recent example from last year was when CSC announced their oncology patient registry across numerous tumor types. One key insight was that the majority of patients eligible to participate in a clinical trial were not aware of how to locate and enroll in the study. On the other side, industry often struggles with patient enrollment in drug trials.
Seizing this shared need, industry and scientists can develop meaningful solutions that address the aligned needs of all stakeholders. So, by understanding and following the patient journey and equipping and informing providers, payers, and patients/caregivers with the right services and solutions (and information) to address the barriers along the journey, manufacturers will provide meaningful value.
A Shared Goal (of Customers and Industry): Improving Outcomes
Merck was one of the first in the industry to embrace the Customer Centric Model nearly a decade ago. When manufacturer access to academic medical centers was rapidly diminishing, they did something really smart—they listened to their customers! The leading institutions were keenly focused on improving outcomes, and this was no different from what this manufacturer was aiming to do. So with this shared focus, they developed the Merck Academy—offering solutions and education on contemporary issues and topics (e.g., biomarkers, statistics, clinical trials) and all represented at an above brand level. It was no surprise that the result was improved access to key institutions and customers who realized that collaboration and partnership were beneficial.
Evolving High Value Solutions to Meet Today’s Organized Customer
Integrated delivery healthcare organization systems are seeking unique solutions aligned with their specific needs and priorities—and manufacturers that effectively partner and deliver such innovation will establish greater value, across their franchise. A few such solutions include:
- Population health tools. How does a population health manager view his/her patient population? Are there segments, and how does the drug perform in each segment? Basically, if manufacturers share their knowledge with providers about responders and non-responders, they can help providers and payers avoid unnecessary treatments and save resources in an intelligent way.
- Improved communications, particularly patient/physician communications. By assisting providers in communicating with their patients about their disease, and the value that a drug brings (e.g., perhaps by using Universal Patient Language), a drug maker can create advocates for its brands.
- A subset of improved communications is shared decision-making tools. Manufacturers can enhance patient engagement by actively involving them in the therapy decision process with their physicians.
- Hub/access services. When drug selection is chosen, assisting patient’s access to a drug, starting on therapy and keeping them on therapy is a key capability of manufacturers. Physicians and payers will appreciate the support, as long as the manufacturer supplements, and does not interrupt, their own efforts in these areas. And let’s not forget the importance of a thorough communication plan around the access service offering.
Opportunity for Pharma Marketers: E Pluribus Unum.
Manufacturers continue to seek ways to improve patient outcomes, differentiate the value of their drugs, and partner with their customers. A unified offering is key. The way to do so is to focus on a few central issues:
- Keep the patient’s outcomes front and center.
- Unify the drug with other service components to offer a complete and valuable resource to address the needs of all stakeholders in the integrated care organizations.
- Measure and report success: Clinically, financially, and in patient satisfaction and quality.