Beginning with the publication of Crossing the Quality Chasm in 2001 through the ACA-mandated measures of quality of care and up to today, pharma and the healthcare industry have put significant effort into implementing patient-centered business growth into their plans. For pharma, patient-centeredness promised to be a business growth platform.
Nearly two decades in, what value has patient-centeredness delivered to pharma?
The Origins of Patient-Centered Business Growth
In its seminal report Crossing the Quality Chasm: A New Health System for the 21st Century, the Institute of Medicine argues for a patient-centered approach to healthcare. Patient-centeredness is seen as a key element in solving the problem of a healthcare system that doesn’t consistently deliver high quality care to all people – a system that, sometimes, even harms patients.
The Institute of Medicine pointed to a number of causes for this failure. During the 20th century, medical knowledge and technology developed at an unprecedented rate. People are living longer and experience more chronic (and fewer acute) illness.
In dealing with all these changes, the healthcare system grew into an uncoordinated hodgepodge, leaving gaps in access, coverage, and communication. For pharma, these changes disrupted its established R&D and marketing practices.
The Institute of Medicine argues for patient-centeredness in Crossing the Quality Chasm: A new Health System for the 21st Century – Source
Nothing less than a fundamental, sweeping reinvention of the healthcare system, the Institute argued, would foster the innovation and create the improvements needed for reliable, effective care delivery.
Characterized as revolutionary, patient-centered care would:
- Have a deep respect for patients as unique living beings
- Be obligated to care for patients on their own terms
- Listen to, inform, respect, and involve patients in their care
- Honor patients’ wishes (but not mindlessly enact them)
- Not be at odds with evidence-based care since good outcomes must be defined in terms of what is meaningful and valuable to the individual patient
- Move away from “physician-dominated” dialogues
Patient-Centeredness & Business Growth: Can Pharma Have Both?
After 50+ years of relying on a marketing model based on blockbuster drugs, incremental change, and physician preference, pharma faced new challenges to its continued business growth. Pharma in Europe began to see stagnating sales growth. Price gouging scandals in the US, like the one involving the EpiPen, undermined the public’s trust and raised the threat of pricing regulation.
In the white paper, Patient-Centered Culture by Design, the authors proposed that a change in pharma’s corporate cultures was needed to ensure continued business growth. This new culture would have the needs of the patient drive every aspect of the business – from drug discovery and development to hiring staff.
As with any major change, the shift to patient-centeredness has been met with resistance in some quarters. Some doubt that patient-centeredness will match the profitability and productivity of the traditional product-focused “push” sales and marketing model.
Those supporting the move to patient-centered cultures in pharma, like EngageRx co-creator Jill Donahue, argue that “when the patients’ needs are our primary priority, business flourishes.”
While accepting the difficulty and complexity of moving toward patient-centered business growth, Ms. Donohue, in the white paper, Patient-Centric Profitability: Pharma’s Global Survey & Analysis, pointed to a way to reconcile the apparently competing interests of pharma, the patient, and the provider. There is a point where the combined interests of business and patients overlap. She refers to it as the “sweet spot.”
The “sweet spot” reflects the place where the interests of pharma and the patient overlap – Source
Four strategies for getting to the “sweet spot” were identified:
- Listen to patients
Work directly with patients and patient organizations throughout the organization. Invite patients to play a part in product development. Involve patients in designing clinical trials.
- Provide patients with tools and education
Make relevant product and medical information easily available to patients. Establish and maintain informational websites. Use call centers to provide information lines.
- Emphasize organizational culture
Communicate the value of the patient in company-defining documents and company communications. Be mindful of the language used to describe patients and their illnesses and consider the patient’s perspective first.
- Increase accessibility
Access to and the affordability of drugs are key issues for patients. Establish affordability programs for those who need them. Work with patient support groups to make drugs more easily accessible to patients who need them.
What Patient-Centered Business Growth Looks Like in Pharma
Even though the shift toward patient-centered business growth presents many challenges, the vast majority of pharma leaders attribute business improvements and growth results to patient-centeredness.
The Aurora Project, a global benchmark survey of the pharma industry, reports that 93% of respondents believe that integrating patient-focused strategies has improved overall business outcomes. Respondents identified many specific areas of improvement, including:
- Increased employee engagement (58%)
- Improved patient trust (56%)
- Higher revenues (40%)
- Improved HCP trust (58%)
Respondents to the Aurora Project survey reported significant improvements resulting from patient-centeredness – Source
While statistics show us the broad picture, what results are individual pharma companies themselves seeing?
An early adopter of the patient-centered corporate culture
New principles have been embedded in its corporate culture and employees’ daily work habits as a result. The key operational question at UCB has become “What difference can I make in the lives of people living with severe chronic diseases?”
In its 2015 annual report, UCB presented its employee stats in the context of patient value – Source
This change in focus and approach is most apparent in how UCB conducts product development and service design. Cross-functional teams are in place to focus on a particular therapeutic area, instead of having the company organized by function. Products and services are now designed around the patient’s experience and incorporate the patient’s point of view.
In UCB’s 2015 annual report, its “patient value strategy” is identified as central to its path for sustainable growth. UCB reported € 3.88 billion in revenue (a 16% growth over the previous year) and € 3.5 billion in net sales (a 20% growth over the previous year) in 2015. Looking ahead, UCB expects to continue growing at a rate “above the global pharmaceutical market.”
By focusing on the patient-as-the-customer and meeting their needs, UCB has moved away from the traditional product-focused approach, which not only relies on sales tactics for growth but also defines success only in terms of revenue growth and profitability.
The new aim is to create value for the patient. Bharat Tewarie, EVP & Chief Marketing Officer at UCB, sums up their new definition of success this way: “Success for UCB is when we enable our patients to live the life they choose, rather than one dictated by the disease.”
Patient-centered business growth as a turnaround strategy
AstraZeneca is a company that has experienced its own business growth difficulties. In its efforts to return to growth, patient-centeredness has played a role, most notably in its drug discovery and development pipeline.
Pharma R&D is a long, expensive process. It can take 10-15 years for a new drug to get to market. Less than 12% of drugs entering clinical trial will be approved. And the average cost of developing a new drug, whether it reaches approval or not, is estimated at $2.6 billion. Reforming the drug discovery and development process will have a dramatic, long-term effect on a pharma company’s growth and profitability.
In re-imagining its drug discovery and development process to be patient-centered, AstraZeneca established the 5R framework – Source
By reforming its drug discovery and development process, AstraZeneca aims to focus on the “right” things. In 2011, it instituted a framework of 5 Rs: the right target, the right tissue, the right safety, the right patients, and the right commercial potential.
In January 2018, Nature Reviews Drug Discovery reported that AstraZeneca started to see positive results from implementing the 5 Rs. Looking at their drug development from the nomination stage through phase III trials for the period 2012-2016, AstraZeneca had a success rate of 19%. This was a dramatic improvement over the 4% success rate AstraZeneca achieved in the period 2005-2010, and far exceeds the 5% industry standard success rate.
While these initial results are very promising, for some the jury is still out on whether AstraZeneca has managed a successful turnaround. Given the long lead times required to bring a new drug to market, there is still more of this story to unfold and be told.
Patient-Centered Business Growth: A New Paradigm for Healthcare
While business growth and patient-centeredness are not diametrically opposed, it is clear that a paradigm shift is needed for them to successfully work together. The need for organizational change is obvious.
Perhaps less obvious is the need to change the thought behind how we measure business growth in a patient-centered environment.
Most see patient-centeredness as the key to future business growth in pharma – Source
Performance metrics need to incorporate some measurement of how patients’ needs are being met and reflect their impact on the company’s financials. Patient-centric companies have begun to include patient-centric metrics in their financial and annual reports.
Some of the more obvious patient-centric metrics that have an impact on business growth being reported on are:
- Patient, employee, and stakeholder engagement
- Employee attraction and retention
- Trust, by patients, providers, and payers
- Patient outcomes.
Patience is needed when looking for evidence of patient-centered business growth. Ramona Sequeira, President of Takeda Pharmaceuticals, summed it up this way, “It is difficult to measure patient focus in a mathematical way in the short-term; the increase in revenues are a long-term outcome.”
How does your team measure patient-centered business growth?