Archive for the ‘Patient Engagement’ Category

Pharma…at the moment of truth

There is a moment of truth between a doctor and patient when a diagnosis is made and a treatment regimen is determined. It might be a routine ailment with a simple standard of care protocol. Or it could be a complex or difficult diagnosis that leads to referrals, more testing, and life-changing decisions about life style and treatment options.

But in either case, it’s a moment of truth that summons the best analysis from the professional and the most transparency from the patient.

Given how complicated and busy the typical physician’s schedule has become, it’s unlikely that most doctors will have convenient and timely access to the latest in clinical research or knowledge of the newest therapies. There are valuable tools for quick reference of drug interactions, but getting access to relevant content like the pathophysiology or mechanism of action behind a new class of drugs takes more time.

Could pharma be a resource? Manifesto 4

Could pharma help HCPs help patients at the moment of truth?

Yes, but only if pharma rethinks its brand and value proposition.

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Making Pharma “Fit for Purpose”

While in London recently for a series of meetings, I repeatedly heard the English phrase “fit for purpose.” It’s become a cliche for many in England, but I was struck by its syllabic crispness and brevity.

DarwinThe idea of “fit” makes me think of Charles Darwin’s theory of “survival of the fittest.” The fittest are those who are best able to adapt to changing environments, or in the case of a business, a changing market. Successful companies survive, transition, evolve, exploit and pivot over time. They are fit for purpose.

It is not the strongest of the species that survives, or the most intelligent. It is the one that is most responsive to change.

Motorola as a cautionary tale
Recently, there was media coverage about how Motorola has essentially died. It was slowly broken into pieces and sold off to various other companies. Google bought its cellphone business, Motorola Motions, for $12 billion a few years ago, and just unloaded it to Chinese PC manufacturer Lenovo for $2 billion. Ouch.

At one point in time, Motorola owned 60-70% of the cellphone market, had 150,000 employees and was one of the leading tech innovators in the world. They’re the ones who brought the mobile phone to the masses. They invented the police radio. They invented the car radio. They commercialized independent satellite communication.

There was a lengthy period of time during which everyone would have assumed that Motorola would be around forever. Until they weren’t.

There was an era when Motorola was fit for purpose. Until it wasn’t.

Motorola was a product company with a legacy of good R&D and solid commercialization, but they lost touch with what customers wanted. It’s an important cautionary tale for all of us.

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Pharma: Build “Around the Pill” not “Beyond the Pill”

For several years, pharma has attempted to move “beyond the pill” to offset declining product pipelines. The dream is to find new revenue opportunities. New business models.

But as we’ve seen, these new products and service experiments are rarely commercialized. If you study the revenue mix on any pharma P&L statement, you’d be hard pressed to find any real revenue beyond pills.

So, what’s the problem?

Well, it’s not just pharma. Successful new businesses that launch in the shadow of large legacy product portfolios are rare in any industry.

$100 Million or Bust
A few years ago, I was working with a global CPG company with a vibrant innovation team. But the success bar for moving a new idea or business model out of the lab was having visibility to least $100 million a year in revenue. Soon.

This meant that only the most obvious, non-risky ideas got the capital needed to grow. Promising but speculative projects were left to die on the vine.

So the challenge of commercializing innovation is not unique to pharma, but that doesn’t let us off the hook. There is an urgency to figuring this out.Around the pill

The Urgency has Changed
A few years ago the focus was on finding new ways to backfill declining revenue from the patent cliff. But now the product pipelines for biologics and new orphan drugs for rare diseases could not be more robust. Revenue is growing again.

The real reason for today’s urgency is not revenue, it’s the changing customer environment. We now have the need to not only prove outcomes but to improve the patient experience. Soon.

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Big Pharma Makes Moves To Manage Disruption

What I liked most about a recent HBR article was what wasn’t mentioned.

The recent Harvard Business Review article, “How Merck is Trying to Keep Disrupters at Bay,” is all about disruption, and anyone who reads HBR on a regular basis knows that anything written about industry disruption or disrupters owes at least a tip of their hat to Clayton Christensen.

Christensen, a Harvard professor, has written extensively about disruption, innovators and the innovator’s dilemma, highlighting the fact that most large companies, including pharmaceutical companies, are not great at innovation or staying nimble enough to respond to changing customer needs and expectations.

Often it’s the small startup companies who aren’t respected by big companies that wind up disrupting the marketplace. They upend the value proposition in the marketplace, and by the time large and established companies can see what’s happening, they’ve lost market share – or maybe even the entire market.

I think it’s interesting and very compelling that Merck – a large and established company – recognizes this threat and is trying to work from both the inside-out and the outside-in to keep disrupters at bay.

babarThe HBR authors reference another large company, IBM, and how it essentially remade itself 20 years ago under the leadership of Louis Gerstner, who wrote his own best-selling book, “Who Says Elephants Can’t Dance?” on the IBM journey.

The way Merck is doing it really impresses me. Merck recognizes that as a firm it already has certain core attributes, capabilities and priorities that it isn’t going to throw out. But by creating an internal Emerging Businesses (EB) group, it’s also inviting a high level of innovation.

Merck has tasked this small group to look outside the firm, but also, and more importantly, within the firm for new ideas for both products and services. EB created a Strategy & Innovation Council to identify and scale new internal initiatives and a Global Health Innovation Fund to find external partnerships.

Fundamentally, Merck is a products firm. They’re a drug manufacturer, but they recognize that innovation extends beyond new Rx products and into the entire customer experience, which can include other revenue opportunities like services and technology.

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The Last Mile in Healthcare Delivery

Lately, I’ve been thinking about the impact of the changing healthcare landscape on the people who actually deliver the healthcare – the healthcare professionals -  as millions and millions of more Americans now have health insurance coverage.

There’s been much written about how there won’t be enough primary care physicians available to handle the increase in patients. Some primary care physicians are overloaded, and in some cases are not taking on new patients because their capacity is maxed out, but so far most practices are handling the increase in insured patients.

Nevertheless, the predictions are that the US will have a shortfall of 50,000 primary care physicians in the next decade.

I’ve already written about the primary care physician as an “endangered species.”

This emerging situation highlights the important role of Nurse Practioners (NPs) and Physician Assistants (PAs), those professions that are often lumped under a category called “Healthcare Extenders” or HCEs. Sometimes they’re known as the “Allied Professionals” within healthcare. There are currently 150,000 nurse practitioners in the US.

city on hill 2The Last Mile in Healthcare Delivery
I often consider these HCEs or allied professionals as providing the “last mile” in healthcare delivery.

Physicians have traditionally done the tasks of diagnosing the illness, writing the prescriptions and monitoring the patients, but as primary care physicians are called on to see more patients, they are able to spend less and less time in the exam room. And that’s where the “last mile” comes into play.

For example, some patients may ask, “Now that I have this disease, how do I manage it?” For them, the last mile is patient education. Others may be encountering drug side effects. For them, the last mile is patient support or discussion about an alternate therapy.

Lifestyle changes? Coaching is the last mile.

All of these support requirements will fall more and more squarely on the shoulders of the allied professionals.

What’s more, the HCEs and allied professionals aren’t just doctors’ helpers – they have the education and authority to prescribe medicine and educate patients.

-       79% of NPs and 69% of PAs provide or recommend patient support resources for patients

-       NPs are able to legally prescribe medications in all 50 states

-       PAs can prescribe in 48 of the 50 states

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Is Your Doctor an Endangered Species?

I recently attended the American College of Physicians’ (ACP) Internal Medicine Meeting, the annual national conference for internists and primary care physicians. It was well attended and offered a mix of clinical presentations on new advances in medicine, seminars about the practical side of running a primary care practice, and policy updates on the Affordable Care Act.

Quarterback InternistThe Internist as your Healthcare Quarterback
This group of physicians is arguably the most important in the field. Primary care physician keep our health history, coach us on healthier lifestyle choices, and they are often the first to diagnosis a life-threatening problem.

These are also the clinicians who have to triage the millions of newly insured patients while at the same time dealing with declining reimbursement rates. There is a reason why internists are considered an endangered species.

Yet there was no hand wringing or complaining at the ACP conference.

Given the challenges for this group of doctors, I expected to hear a lot of moaning and complaining, but the reality is that physicians are already moving forward with the new ground rules to build and maintain their practice. They’re embracing the changes despite more complex and tedious record keeping. Ultimately, physicians want to get everything settled so they can get back to their patients.

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Wrapping Services Around Products: The New Pharma Model

“The home is ultimately going to be the major site of care for all but the sickest patients.”

This from an interview with George Halvorson, CEO of Kaiser Permanente, in which he expounds about healthcare reform and the vertically integrated model that is Kaiser.

Essentially, he’s saying that we will move from the traditional office-centric model to a new approach using technology like e-visits, e-connectivity, remote patient monitoring and smart phone apps to support home-based healthcare. Technology will be the backbone of patient care in a world in which more people are covered by health insurance and there is a shrinking population of primary care physicians

Technology and Patient Empowerment

Halvorson’s remarks suggest that the trends we’re seeing in patient empowerment, like The Quantified Self and websites like Patients Like Me, are all part of a future in which we won’t spend time in a hospital unless we are really sick. And we may actually be spending less time in a doctor’s office, too.

This brings up many questions. What does this mean for prevention? For treatment? How do we use technology to enable people to live healthier lives so that they don’t even need to use the healthcare system? And, ultimately, when we do need the healthcare system, how do we support the home environment to provide for effective treatment?

And what role will pharma play in an integrated healthcare delivery model?

prod serv 2The New Reality for Pharma
This comes back to a theme that I’ve talked about in the past. There is an important role for pharma in this new reality, but it means a change in identity from product manufacturer to healthcare services. Pharma has an opportunity to play a larger role in health services that enhance the value of the products it already provides.

Examples of Products + Services
For example, Google’s basic product, online advertising, provides most of its revenue. But they’ve surrounded it with all kinds of free and interesting analytical, coaching and survey tools. Google offers many of these services for free, like Google Analytics. These aren’t simple “freemium” products, however. They are serious tools. But Google knows that offering them for free enables adoption by the very people they want as customers, thus enhancing the value of their core business.

Brokerage firms make their money on investment products and trading. But they often offer free advisory services and retirement counseling to help clients build retirement models.

Banks are another example. I had a meeting a few weeks ago with a banker who was an also expert in health insurance plans. He had been hired specifically to advise the bank’s clients on innovative health insurance plans and models – advice that I would have had to pay for had I gone to a consultant. But the bank felt this was a service that they should offer their customers, wrapped around the core banking products where they make most of their money.

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The Land of Oz

Dr. Oz and celebrity doctors like him have stirred up the medical community. Regardless of what you think about the accuracy of Dr. Oz’s claims and advice, he has created a huge audience of four million viewers who look to him for medical, health and nutrition advice.

While I don’t have the clinical background to judge the truthfulness of Dr. Oz’s advice, I do know that he’s leveraging media and technology in a very fresh and powerful way to enable and support patient empowerment. His platform puts medical and health information into the hands of millions of consumers. Dr. Oz’s approach is filling an unmet need in the medical community: helping patients to truly learn and understand their health.

OzThe Perfect Storm
It really is a perfect storm of trend, technology and media. Patients really want to understand how to live healthier, and cable television and digital media and apps have made access to fresh content cheap, convenient and ubiquitous. But this shift has upset the natural order of traditional patient-doctor relationships.

Physicians working in the traditional health care system are often overburdened and don’t really have the bandwidth to create new ways of doing things. So along comes a physician, Dr. Oz, who is able to break down health, healthcare and medicine in very simple ways that make it accessible to the population – and consumers are embracing that. The magic of Dr. Oz’s approach is that it’s engaging, accessible, simple and motivating.

What can we learn from Dr. Oz?
While there has been negative press about Dr. Oz’s endorsements of weight-loss products, there are people, particularly those who may not have a primary care physician, who use his advice to make decisions about their health. So before we attempt to silence or disparage him, I think it is better for us to look at what Dr. Oz is doing right and what we can learn from his success, especially at the physician level. What can physicians learn from Dr. Oz’s simple, clear explanations of what’s happening in the body, and how can they incorporate that into their patient relationships?

The patient empowerment movement isn’t going away, and we shouldn’t want it to, so it is important for physicians to embrace the patient’s willingness to learn and understand medicine and how it affects their bodies.

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Is it Digital Marketing or just Marketing?

In a recent article about the future of pharma, Craig DeLarge was quoted extensively about how to organize a “center of excellence” within a pharma company to ensure it is taking advantage of digital tactics and multi-channel marketing. He sees this as the first step in the process of digital transformation for pharma.

marketing dig ageWhat his remarks drive home is the fact that digital and marketing aren’t separate disciplines. “We are marketing in the digital age,” says Craig. This means that marketing and digital marketing shouldn’t be seen as two separate initiatives or even act in a parent-child relationship. Yet very often that’s what happens as evidenced by the typical marketing budget process.

Marketing in the digital age is still marketing, but technology now enables a custom marketing mix that’s appropriate for our product and our audience. It’s not simply a case of adding a few new online or mobile tactics to the marketing mix. That’s just a recipe for adding more promotional noise, without the benefits that we can get from digital.

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FDA Loosens Regulatory Reins on Digital Devices

Over the past year there have been a series of draft letters from the FDA on the approval process for medical devices, particularly in the arena of digital health. After several years of being a hyper-vigilant regulatory agency and effectively slowing down the approval process for new products, the FDA has begun to relax its approval requirements, especially for digital health products.

FDA3Historically, the FDA has divided medical devices according to device classification and risk to patient and user. Class I includes devices with the lowest risk such as an activity tracker like a Shine or Fitbit and Class III includes those with the greatest risk such as pacemakers or implants.

The class indicates what level of premarket approval is necessary. Most Class I and Class II devices are exempt from the 510(k) Premarket Notification application. Most Class III devices require full Premarket Approval (PMA), which generally requires clinical data to support claims. Read Full Article Now »