Posts Tagged ‘Affordable Care Act’

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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Can Innovation Trump Consolidation in Healthcare?

At the ACA party, there are 15 pharma companies standing around a room with only 10 chairs. Which means that when the music stops, five of them are SOL.Party!

That’s the future for pharma in a world in which all providers are at-risk and outcomes data are more important than volume discount pricing when it comes to therapy decisions.

Right now, the most common business strategy for healthcare companies managing the changes brought on by the Affordable Care Act has been consolidation. Everywhere in the system, players are merging. PBMs are consolidating and health systems are gobbling up every type of healthcare service, from physician practices to labs, urgent care to long-term care facilities and community hospitals in an effort to become large, integrated health networks (IDNs).

And, why? Why are they doing this?

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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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The Two-Edged Sword of Healthcare Reform for Pharma

The Economist recently published a report on the cost impact of healthcare reform in the US.

Healthcare Spending TrendsThe data shows that the fundamental idea of bending the cost curve by changing the way healthcare is reimbursed — moving from a fee-for-service to a fee-for-outcomes — is actually working. Hospitals are actually doing fewer unnecessary tests than they previously did. According to the report, before Obamacare, hospitals did as many tests and procedures as they could, because that’s how they made money.

Now that the focus is on patient outcomes —  keeping patients out of the hospital and feeling better after they’ve been discharged — costs are going down. Bundled payments for procedures is limiting out-of-control expense growth.

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Keeping America Well

The internet has revolutionized retail. In travel, consumers use self-service websites to search for destinations, compare offers and purchase a vacation. Amazon has replaced the knowledgeable bookstore owner with breadth and convenience. Yes there are trade-offs, but most consumers are willing to exchange professional expertise for price and convenience on non-critical decisions.

But not so with healthcare. Yes, consumers go online when they have a health question, but sometimes they leave more confused than before. Convenience yes, but expertise? Questionable.

If you ask Dr. Roy Schoenberg, CEO of American Well Systems, he’ll tell you why. “In the consumer’s mind, healthcare is not online portals or health risk assessment tools. Healthcare is about talking to a doctor.” We receive healthcare when we explain our symptoms to a physician, he or she diagnoses the problem and then recommends a remedy.

There’s still a convenience problem, however. Often at the point of need, many of us can’t get in to see our doctor. It may be 2:00 a.m. and your child is crying, or you are experiencing pain and your doctor’s calendar is booked for the next three weeks.

But what if you could log on to the internet (convenience) and talk live with a physician (expertise)? And what if that physician could call up your health records as the connection was being made? And finally, what if this “doctor’s visit” was covered by your health insurance (price)?

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