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Partnership in practice

Joint working: Patient-centred alliances formed along the value chain can bring mutual benefits to industry, governments and end users of healthcare
Joint working gears

The theory that pharmaceutical companies and their healthcare customers should work together more collaboratively is gathering momentum across Europe. However, progress remains slow. Stakeholders from across the health spectrum agree that the development of partnerships between pharma companies and global healthcare systems should be a high priority, but more needs to be done to ensure success.

Health policy across Europe, and beyond, indicates a widespread intent to develop partnership strategies. Examples of joint working are more advanced in the UK, where the challenge to generate efficiencies while delivering improved health outcomes is dictating a more collaborative culture. But equally, the need to make improvements in quality and productivity within a turbulent economic climate is driving all parties towards partnership.

Naturally, much of the discussion is focused on building collaborative relationships between the pharmaceutical industry and healthcare providers to optimise patient care. However, this is only one component. The bigger picture dictates the need for a wider matrix of partnerships that allows every part of the health economy to be optimised. The value chain of getting the drug, the service and the care to the patient includes many elements, from product R&D, through reimbursement and into the care pathway and includes all points in between. At some time, everybody will need to partner with someone else to optimise this value chain. So whether it is pharmaceutical companies partnering with governments to optimise funding, industry partnering with clinicians to accelerate clinical trials and get drugs to patients quicker, or companies collaborating with commissioners and providers to improve care pathways, success depends on developing a matrix of partnerships that all have the patient at the centre.

Drivers for partnership

There are five central drivers for partnership across Europe:

1. Reimbursement
Partnership with payers
Arguably, the two parties that should most want partnerships are the pharmaceutical industry and governments. Reimbursement is a hot issue as without it a drug is worthless. In a tough economic environment, governments across Europe are driving down the price of drugs. At the same time, drug companies are seeking market access for their products. This has led to an increase in the number of risk-sharing models between industry and payers, representing partnership at its crudest level.

Engagement between drug companies and governments (and payers) is essential. While the healthcare systems across Europe differ from country to country, the power of government in making health spending decisions is consistent. There are insurance-based health systems across Europe but in each case, with the exception of Germany, the government makes the ultimate decision on which drugs are reimbursed. Germany's system is similar to that of the US, giving decision-making responsibility to its six employer-based health insurance funds.

Product partnerships
Governmental pressure on pricing across Europe is forcing the industry to reassess its R&D model. Reducing development costs and accelerating speed to market have been industry objectives for years, but the added challenges of securing reimbursement and achieving early market access to maximise commercial potential have increased the scrutiny.

Securing reimbursement depends upon effective clinical trial design and efficient patient recruitment. Companies must bring a broader customer focus to the early development of clinical trials by engaging with all the key stakeholders who influence the uptake of a drug. Traditionally, the industry has focused its attention on clinicians alone, but increasingly, companies are forging early partnerships with other customer groups, like pharmacists, who can help to create the right evidence-base at clinical trial stage, as well as providing insights into how a product can fit into the care pathway. These groups are also well placed to offer early and important insight into the development of risk-sharing schemes. Such partnerships have clear mutual benefits for the customer, the pharma company and, ultimately, the patient.

2. Clinician accountability
Healthcare systems need to get more for their money and to ensure that decision-making is driven by the quality of care and the efficiency of how it is delivered. Most European healthcare systems use primary care as the gatekeeper. As such, there is now a pan-European movement to improve the quality of primary care, making clinicians more accountable and responsible for their decisions and ensuring those decisions are driven by quality and productivity.

In the UK this is seen not only in the move towards GP commissioning consortia, but also in the Quality, Innovation, Productivity and Prevention (QIPP) agenda that is dominating the National Health Service. However, the trend is not restricted to the UK. At the top line, Europe is focusing on improving quality and the belief that this is achieved by giving greater accountability to clinicians.

For pharma, this is driving an opportunity to develop business-to-business partnerships with customers facing new challenges with limited resources. These customers want to move away from traditional transactional relationships and work together to develop improved care pathways that meet shared goals.

3. Unexplained variation in care
Health inequality and variation in care exist throughout the world, whether through demography, ethnicity or poverty, but some variations are unexplained and unacceptable, between healthcare systems and within healthcare systems, and must be identified and eradicated. For example, why do more people in one health system die from COPD than in another? Why is there variation in secondary care referrals? Why is there huge variation in the results of those referrals? Data shows that unexplained variation in care is often the result of uninformed practices and a lack of shared education and insight.

Almost every developed healthcare system is now investigating unexplained variation in care and trying to find a mechanism to improve it. This is a driver for partnership. The industry must help identify where variation in care exists and work with customers to help develop systems and services to tackle it. Robust and granular analysis of population data can not only identify variation but can also uncover patients who are either being treated sub-optimally or, in some cases, not being treated at all. Again, this is a shared goal with mutual benefits.

4. Focus on prevention
Another aspect is an increased focus on disease prevention. For clinicians this is, of course, diametrically opposed to their traditional clinical paradigm of analysis, diagnosis and treatment. Much remains to be done across Europe to shift a mindset where clinicians appear reluctant to tell patients how they can prevent themselves becoming ill, and engage with them so that they start to do it. Conversely, nurses appear to have more success in this regard.

In specific therapy areas, pharma has begun to develop partnerships in prevention. A key aspect of this, as with variation in care, is in finding unmet need; identifying patients where prevention may be appropriate. Not all patients can be motivated to comply but the outcomes for those that do will benefit the individual, the health economy and, of course, the pharma company. Examples of partnership in prevention include smoking cessation, substance abuse, obesity, osteoporosis and sexual health.

5. Developing primary care
Moving care closer to patients' homes has been a key objective for successive governments in the UK for many years, because it is more expensive to treat patients in hospital. In reality, there is little that can be done in an acute hospital that could not be done closer to home, if the right environment is established. The problem is that most UK acute hospitals are set up to do much more than surgery and procedures. They have out-patient clinics that could be carried out elsewhere, but the doctors and consultants are wedded to the hospitals.

But the driver in the UK, and elsewhere in Europe, is to develop primary care. It is where the accountable clinicians are, where the biggest variations in care are and where preventative methods can best be delivered. Consequently the industry's biggest opportunities for partnership exist in primary care settings. The challenge for pharma is to move away from its historical transactional approach and become smarter with its offerings. Companies need to go beyond 'what can we sell?' to 'what is your problem and where can we help?'

Collaboration is not an exact science. It should be done on a needs basis. Beneath the 'matrix of partnerships' is a set of needs for each party; governments need to get drugs at the lowest possible price, clinicians, faced with increased demands and reduced funding, need to improve health outcomes for their patient populations and pharma companies need to achieve market access for their drugs, ensuring they reach the appropriate patients. Although this is a complicated matrix, it should not dictate a change of model for pharma; success depends upon following the same principles of customer understanding that are rooted in basic marketing. The problem is that too few companies truly address customer needs.

More companies need to adopt an organisation-wide customer-centred approach. Satisfying customer needs begins with identifying who the customers are, understanding what they want and finding some common ground and shared goals around it. The industry has yet to acknowledge that the common theme is partnership. To make it happen, they must work as a matrix internally so that all aspects of the approach join together and are, ultimately, united by the needs of patients

The Author
Claire Gillis is joint CEO, WG Group

To comment on this article, email pme@pmlive.com

21st April 2011

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