Drastic change is overtaking primary care. However, how pharma markets to primary care physicians has changed very little. Fewer dinner and lunch programs and increased attempts at web-based marketing are common. But in primary care, the sales rep-physician direct interaction remains central.
However, this model, designed primarily for private practice physicians and primary care physicians, is becoming extinct. Thus, pharmaceutical companies must develop new methods to reach these physicians. That requires some knowledge of how primary care will be practiced in the future. While many would say that primary care’s future is uncertain, definitive new trends virtually predict its future—and therefore might allow companies to adjust accordingly.
If current trends continue, private practice as we know it will cease to exist. During the past decade, the number of independent U.S. physicians dropped dramatically, from 57% in 2000 to 39% in 2012, and that continues. Most physicians are joining large, integrated health systems. With or without forming accountable care organizations, these systems employ large economies of scale that allow them to survive decreased reimbursement and the need for complex data system management to gain promised compensation for reporting (and eventually improving) quality measures.
Also, studies show these systems improving health outcomes. A great of example of an integrated system that improves outcomes despite managing a socioeconomically disadvantaged patient population: The Veterans Administration Health System.
In large systems, the physician/employee follows guidelines and often has limited prescription choices. Industry reps are usually banned from speaking to physicians directly. Since the healthcare system is already moving in this direction, the industry should shift too and focus efforts on partnering with these institutions. Though cost will remain important, reimbursement will eventually be based on quality and outcomes. Thus, decision makers will likely be interested in the value that the pharmaceutical industry can potentially provide their patients.
On the other hand, some physicians (especially in primary care) are bucking the trend and staying private by getting out of the system. Different models exist: Cash only (not accepting insurance) retainer or concierge medicine and direct primary care employing monthly membership fees for substantial access and basic services.
By eliminating insurance, physicians can offer patients access, time and provide a vastly different level of service. While these practices are in the minority, their numbers are growing.
Unlike the high-volume, insurance-based physicians who are typical rep targets these physicians have time to converse about medication options, including somewhat more costly branded medications. Companies would be wise to identify these physicians even if prescription volume is not nearly as high as their insurance-based peers, since they are more likely to change prescribing habits given their time and freedom.
Thus, the future of healthcare is clear: Primary care will be delivered either in large integrated systems or individual and small practices that operate outside insurance reimbursement. What is unknown is what proportion of patients will fall into which model. If the ACA is fully realized with high patient and provider satisfaction, large integrated systems will be the predominant model. However, if long wait times and short visits are the norm, more patients will pay extra for better service outside the system. Whatever model prevails, knowing that these models exist should help pharmaceutical companies plan for the future.
