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Proving Patient Centricity Impacts the Bottom Line
Buying into it is one thing - convincing others of the benefits is something else entirely.
Pharma is keen to embrace patient centricity but faces a number of barriers to doing so – not least in terms of knowing what metrics to use to prove its worth and worries over perceived regulatory problems. These were among the main findings from an eyeforpharma webinar – ‘Prove it: Measure, Analyse and Communicate the Value of Patient Centricity in your Company’ – which saw senior executives from Sanofi, Merck, Grünenthal and Roche offer their insights on how a ‘patients first’ business model can positively impact the bottom line.
Despite the current volume of chat about patient centricity, it is a nascent movement in the industry. It is instructive that, when webinar participants were asked to identify their biggest barrier to becoming truly patient-centric as an organization, 43% of them said it was due to legal or regulatory issues making their companies risk averse, and 24% said it was a lack of training or understanding of what is required.
Meanwhile, internal attitudes and culture were cited by 31% of respondents as their biggest hurdle. Chairman, Paul Simms said this chimed with eyeforpharma’s own research, which demonstrated a ‘them versus us’ attitude in companies: those who have bought into patient centricity feel they face a number of barriers – chiefly around demonstrating profitability – before they can implement their projects.
A patient-centric contradiction?
At the heart of this debate is a conflict of opinion thrown up by a previous eyeforpharma conference, eyeforpharma Barcelona. Webinar participants were asked to vote on whether they agreed with Dominic Limet, CEO of Viiv Healthcare – who said at Barcelona that pharma needs to cut back on short-term profitability to achieve patient centricity (8% agreed) – or David Epstein, former CEO of Novartis, who claimed that patient focus and profitability go hand-in-hand and we should not choose between them (59% agreed).
Interestingly, 31% agreed with both statements – and this did not surprise Anjali Trasy, Global Head, Patient Engagement Strategy, Sanofi who will be presenting at Patient Summit Europe in October. “I’d have picked both of them,” she said. “Patient focus is a target but profitability is an outcome dependent on the effective implementation of the journey.”
Jennifer Muszik, Director, Commercial Excellence, Roche also concurred that both views were right: “There is still going to be a focus on profit and that doesn’t have to be to the detriment of the patient.”
David St Denis, Head of Strategy and Commercial Operations, Europe & Canada, Merck, added “significant value” is being created already through education and information for patients. “Being oriented towards patient outcomes doesn’t necessarily cost us more,” he added. “In the long run, it will help us thrive and grow.”
Taking up the argument, Emma Sutcliffe, Consultant Director, Patient Engagement, Grünenthal, who will also speak at Patient Summit Europe, insisted that there is no disconnect between pharma and profit – but that pharma needed to work harder to educate patients: “We don’t communicate to patients what it costs to develop a product, the cost of R&D, of lack of compliance or adherence.”
But Simms countered that no-one understands how much it costs to make an iPhone either – yet we do not hear the argument about consumers not knowing the cost of R&D from Apple or indeed from other industries. He questioned why we should hear it so often from pharma.
Muszik said that since branded prescriptions in the US account for less than 20% of the market, there was an obvious case to clearly articulate the value of a medicine, “what patients are being treated for, why a brand makes sense and how to help them manage that disease”.
The next webinar poll saw a significant split in audience reaction. It asked whether currently the best pharma performers commercially are also those who have the most patient-centric values: to this, 32% said yes, there was a strong correlation while 38% said the opposite and 26% were not sure.
Simms said that many in pharma are happy with the why and what of patient centricity but want help with how to introduce patient-centric programs. In short, how do we work with people in R&D or market access, for example, and how do we measure and reward patient-centric initiatives? He asked the four speakers to give an overview of what their companies were doing on this.
Sutcliffe informed the audience that Grünenthal was creating patient portals so that patients can talk to each other, enabling people to voice their concerns and get help. She believes it is important for patient-centric projects to raise trust between patients and pharma. “Just saying you’re patient-centric isn’t the point – patients won’t be fooled by that,” she said. “What do you do to help them communicate and increase discussion around medical conditions?”
Trasy said that Sanofi was bringing the patient to the center of the business by incorporating their views into R&D, clinical trials, pre-launch and marketing efforts “and really trying to drive our business strategy off the insights we are getting”. Muszik believes there are opportunities to demonstrate patient centricity during clinical trials, looking at the key differentiators of a new branded prescription on the market versus other current standard of care or generic options. St Denis explained: “At Merck, we’re redesigning our business model and processes. We have a focus on how we develop our internal talent to be patient-centric.” He emphasized the importance of collaboration. “Go to patient groups and payers and have a conversation about what’s needed and what should we do,” he said.
Finding the metrics
On that theme, Simms asked what companies should be doing more of when it comes to analysing the results of the various patient programs being talked about. What are the best metrics and KPIs to assess and motivate patient centricity?
We started to change our messaging from purely brand-focused to what is going on in that patient population and how could we go first to better identification and diagnosis. P&L is always important. But the first thing you have to look at is are patients being diagnosed.
Muszik said it was vital not simply to concentrate on brands. Instead, companies needed to look at disease states, population health management, identifying patients at risk and getting them treated – and not always with your specific product. “One of the first ways to measure whether a company is moving towards patient centricity is to focus less on the brand and more on the overall market share and market expansion, seeing if we are moving the needle there. If more patients are diagnosed, then there is a correlation particularly with more of your brand,” she suggested.
This could be done while still looking after profit, she went on, describing how key account managers in the US had been looking at at-risk patients in areas such as smoking cessation and diabetes. “We started to change our messaging from purely brand-focused to what is going on in that patient population and how could we go first to better identification and diagnosis,” she concluded. “P&L is always important. But the first thing you have to look at is are patients being diagnosed.”
By 2020, we’ll have patient-generated data alongside clinical trial data and right now, pharma needs to get itself ready for this tsunami internally.
St Denis agreed that diagnosis is one aspect of it, but thought the pathway and whether patients have access to drugs are also metrics which will drive patient focus. Sutcliffe believes that real-world data will also help pharma companies – so long as they prepare themselves. “By 2020, we’ll have patient-generated data alongside clinical trial data and right now, pharma needs to get itself ready for this tsunami internally.”
“If you’re not ready it’s not going to wash with patients,” she warned. “Patient centricity has to start from what do patients actually need – before we’ve got a product.”
Trasy suggested that the bottom line is patient health outcomes and quality of life. “We’re also measuring patient satisfaction as well, trying to understand how our initiatives fit into patients’ lives and make dynamic changes to the programs we have in place as soon as we hear their insights,” she said.
Getting measurement right
The next webinar poll found that 44% of participants did not know how to measure, establish KPIs and report on performance in patient centricity, 26% said they use it in a few areas and 19% had not started or their measures were not accurate. Only 8% used them to inform everything they did.
St Denis was “a little surprised at the 44%”. He suggested that Merck uses a mix of measures from various stakeholders including doctors and payers. “We have to focus on collaborating more with all stakeholders for the benefit of patients.” Trasy outlined that patient centricity is currently measured and used in a few areas but that Sanofi is establishing guidance for KPIs across the globe, finding out what would be appropriate or permissible in different countries. “We are working on a patient action roadmap,” she continued. “We’re getting very close – our leadership understands the importance of patients – but in middle management, there is a range of understanding on how to incorporate this into our work.”
Patients are not judging pharma on being patient-centric – they are saying ‘are you there when I need you?'
Sutcliffe said that pharma is agonizing over what metrics should be used when they are right in front of us anyway: online, patients talk about the pharma industry, its research and our products – but pharma is scared of talking to them. Yes, the industry is highly regulated “but we are putting ourselves in purgatory”, she insisted. “We need to reset the rules for what patient engagement is.”
Summing up, Sutcliffe said: “Patients don’t walk around saying: ‘I’m empowered’. We need to be visible, present and engaged where patients are. Patients are not judging pharma on being patient-centric – they are saying ‘are you there when I need you?”
Pharma needs to ask patients what they need, Muszik said. Rather than doing things ‘to’ patients we need to be doing things ‘with’ patients by understanding their requirements, she went on. Pharma could also help physicians to analyze data from wearables to help make better patient decisions.
St Denis went back to the idea of collaborating with all stakeholders to bring about the best outcomes for patients. “We need to influence the regulatory environment and have leadership prioritizing this as a company and then make sure that everyone is trained,” he concluded. “We have to do this – what we do really does make a difference in real people’s lives. We have a big responsibility.”
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