Triducive’s Tim Warren explores how pharma can succeed within the newly emerging integrated commissioning landscape, in the September issue of PharmaField.
A SEAT AT THE TABLE
As Prime Minister Theresa May promises £20 billion more funding each year for the NHS for the next five years, Sustainability and Transformation Partnerships (STPs) morph into Integrated Care systems (ICSs) and healthcare commissioning becomes more strategic – how can pharma ensure the successful marketing of its brands? The Prime Minister’s June funding announcement, which was partly paid for by a ‘Brexit dividend’, was branded a 70th “birthday present” by ministers
It didn’t, however, go unnoticed by think tanks and senior NHS managers that this beautifully wrapped and headline-grabbing birthday gift could impact spending elsewhere – for example squeezing public health and social care budgets. And with recent cuts to public health budgets, and social care funding still unconfirmed, early warning signs suggest this may be true.
SHIFT IN FOCUS
One way that the NHS is planning on balancing growing clinical demand, rising costs, a retiring workforce and finite budgets, is the establishment of ICSs, previously known as accountable care systems (ACSs).
How commissioning will change in the wake of ICSs remains to be clearly seen, but commissioners will undoubtedly need to take a more strategic role and a longer-term view – with their focus shifting to defining and measuring outcomes, establishing capitated budgets, and using longer-term contracts and more stringent service level agreements.
What is sure is that pharmaceutical companies have a critical and unique role to play in the development of ICSs, with the new value-based environment calling for a greater emphasis on pharmaceutical management.
Formularies may be ICS-wide with one committee making the decisions for the whole territory and powerful NHS Trusts will become key organisations for market access. Whilst opportunities for larger scale deals may result from this larger footprint, the flip side is that pharma also risks a rapid reduction in market share if unsuccessful.
Either way, the changes required by ICSs will go ‘beyond the pill’, with pharma needing to show healthcare payers how their brand adds value to patients – through wider packages of care that the market perceives as having value and is willing to pay a premium for.
KNOWLEDGE IS POWER
10 top tips from Triducive on how pharma can maximise opportunities and succeed within this new integrated commissioning landscape.
1. Find out who is driving the changes in your area – Clinicians are not in the driving seat regarding ICSs; it’s senior managers that have the best overview of what the future will look like. Find out who is driving the change in your area and secure meetings – make sure they are structured, relevant and wellprepared. This will help to gather insight on trends, gaps or inefficiencies in patient care in a variety of priority and non-priority disease areas. Having an early seat at the table with these decision-makers will help establish beneficial relationships going forward.
2. Develop integrated care pathways to reflect the new structure – The NHS will be looking to develop new care pathways to reflect its new structure and make the most of integrated resources. A survey carried out by the European Pathway Association found that integrated care pathways are being used in two ways: as a multi-disciplinary tool to improve the quality and efficiency of evidence-based care, and as a communication tool between professionals to manage and standardise outcome-oriented care.1 Providing care in the lowest intensity setting to reduce costs will be a priority, as will developing the pathways alongside patients. Understand where, why and how your brand fits in the local care pathway.
3. Align your brand position to resource allocation – With the ICS model resulting in new people, roles and patient pathways, the narrative in your value propositions needs to be tailored to a new audience and reflect their rapidly changing priorities and how they best allocate finite NHS resources. Medicine management tends to just look at intervention (consumable) costs whereas commissioning (and custodians of the System Control Budget) see the costs of care as falling into three categories: consumables, location costs and people costs. Pharma has the opportunity to support the ICS to define the optimum patient journey that ensures all appropriate steps (such as resource allocation modelling) are taken and effectively implemented, while reducing unnecessary staff or location costs objectively and defensibly.
4. Be flexible – There will be huge variation across different ICSs, and the pace of change is rapid. Market access teams will be working within a landscape filled with great uncertainty, and information may initially be sparse. Make sure you’re the first ones to see the information – websites, meetings and documents – that will gradually become available. Knowledge is power, and this information will help inform your payer education initiatives. Be ready to respond rapidly and ensure teams are well supported and given flexibility to tailor for their locality.
5. Show how resources can be used more effectively – While it is hoped that the ICS model will save the NHS money, the rhetoric focuses on enabling resources to be used more effectively, so make sure your narrative matches this.
6. Don’t see social prescribing as competition – ICSs will deliver on wider health benefits for patients. Social prescribing is part of this package and the benefits are clear. Ensure your value propositions complement this wider package of care.
7. Don’t just focus on cost-effectiveness – While ICSs will continue to look for cost-effectiveness, they will not be led by health economists. Instead, ICSs will have a heavier focus on quality and resource allocation because their financial rewards (and future sustainability) will depend on their ability to meet certain quality metrics.
8. Take a preventative approach – ICS metrics will have a heavier focus on prevention. Emphasise the preventative elements of therapies in business cases and if possible show how they can support people to live healthier lives. Providing data is key to this more preventative approach and an area where pharma can assist.
9. Differentiate – Meaningful clinical and budget impact differential is difficult for pharmaceutical manufacturers to achieve quickly. The role of branding has its place, but differentiating HOW you engage with ICSs will help to drive brand access. Being expert, relevant and appropriate can be a huge differentiator compared to competitors who place a superficial emphasis on ICS engagement. Extensive joint working initiatives may be ambitious in the short-term with many ICSs in very early stages of development, however positioning your brand as a credible solution in your given therapy area is vital for developing strong relationships for the future.
10. Communicate simple and coherent value – There is an opportunity to align brand messages in a simple and clear way, and a deep, confident understanding of the audience will help achieve this. Communication should not solely be about being understood, but rather avoiding being misunderstood. Align your brand messages across clinical and non-clinical audiences and have a clear and specific call-to-action.
EXPERIMENT TO INNOVATE
Integrated care reforms are in their infancy, and they involve a wide range of healthcare organisations, populations, and starting points. The lack of a blueprint for integrated care means that systems are able to experiment with new ways of working to deliver care, allowing them the freedom and flexibility to innovate. While this change in structural status quo creates a level of uncertainty for pharma, proactive companies are riding the changes and moving beyond being just a supplier of products and shifting into the role of partner, sharing risk and data to drive successful health outcomes. Communicating to newly emerging stakeholders in an authentic way will drive trust, affinity and loyalty, both throughout this time of change, and into the future.
The above article was published in the September 2018 issue of Pharmafield. For a pdf of the article go to Pf Magazine_Sept2018_TimWarren_Final_Proof
1. Kris Vanhaecht et al., Prevalence and use of clinical pathways in 23 countries – an international survey by the European Pathway Association (www.E-P-A.org), 2006, Journal of Integrated Care Pathways, 10, 28-34