Almost a decade ago, PwC predicted that by 2020, no pharmaceutical company would be able to ‘profit alone’. Success, it said, would require companies to join forces with other organisations and swim upstream into the health management space to preserve the value of its products.
Published in 2009, Pharma 2020: Challenging Business Models argued that pharma would need to collaborate with academic institutions, hospitals and technology companies, as well as providers of services such as nutrition, health screening, compliance and wellness to deliver meaningful value beyond medicine. With the 2020 milestone almost upon us, evidence suggests that the central prediction of the PwC report has proved to be correct. Pharma has recognised the need to change its traditional business model and explore more collaborative ways of working. But how far have we come? Close, but no cigar.
The rationale and drivers for change remain the same today as they were a decade ago. The cost of healthcare is soaring as populations age, with the growing burden of disease placing intolerable pressure on global health systems and economies. As governments explore new ways of finding efficiencies in the public purse, many are introducing value-based models that reimburse medicines based on the outcomes they deliver.
In the process, the focus on demonstrating value has now reached fever pitch. The intensity has reinforced the need for pharma companies to look outside their businesses and partner for profit.
Collaborating for value
“Europe is in the grip of a sustainability and transformation phase that’s forcing us all to think differently about the future of healthcare, how to best shift from a sickness to a wellness model,” says Dr Vernon Bainton, Chief Medical Officer, Havas Lynx Group. “Health systems are stuck in a costly and untenable situation with chronic diseases and so we’re striving for new approaches to keep people well for longer. This ambition is at the heart of the complexities around value. Pharma has been talking about value for many years. But different stakeholders can’t agree on what value is because of differing viewpoints and perspectives. Moreover, it is not even a static concept.
Collaboration is key. If we don’t engage with diverse groups – patients and carers, healthcare providers, research, regulators and policymakers, pharma or tech – we’ll never be able to agree and fully communicate that value over time, unlocking better outcomes for patients, health systems and society as a whole.”
The emphasis on partnering appears crucial. Despite PwC’s forecast, there’s little yet to suggest that pharma has swum upstream into new waters of health management. Rather, companies are sticking to their own swim lanes and collaborating to harness specialist skills and perspectives. “Pharma’s expertise is very niche,” says Nicky Walsby, Managing Director, PR, Syneos Health Communications. “As diseases become more complex, patient care is not just about the pharmaceutical intervention it’s also about taking a holistic approach to supporting an individual. That skill set is often outside the remit, comfort and experience of pharma. So if we’re going to find solutions that go beyond medicine and help patients live with their disease, companies need to partner with patients, academic centres, health techs and start-ups because they can’t easily replicate those skills themselves. This is exactly what we’re seeing.”
Collaboration with academic organisations is, of course, not new. The industry has built strong relationships with the scientific community over many years and these have proved instrumental in the development of breakthrough innovation. But today’s collaborations appear broader than a rigid focus on the science. For example, J&J’s worldwide Chairman of Pharmaceuticals said that most of its 16 new medicines in the past five years are the result of diverse collaboration with academia, start-ups, healthcare providers and pharma peers. There are similar examples right across the sector.
And it’s not just pharma that’s adopting a more holistic approach – regulators are trying it too.
For example, the European Medicines Agency has established a framework to develop its interactions with the academic community, aiming to leverage its experience of working with stakeholder associations, patients, HCPs and pharma to help start-ups ‘translate their discoveries into patient- focused medicines’. Similarly, in a move away from paternalistic models of healthcare delivery, HTA bodies are beginning to involve patients in assessments to establish and enshrine the factors that matter most to them in the decision-making process. The collaborative approach is a direction of travel we’re seeing right across the health arena as prescribers, providers, patients and commercial organisations – motivated by health inequities, variation in care and access challenges – recognise the value of working together for mutual benefit.
Integrating for value
So how is pharma, schooled in a traditional transactional model that’s focused on ‘profiting alone’, faring in the partnership era where value has usurped volume? “As an industry, we’re getting better at collaborating,” says Nicky Walsby. “However, although pharma is clearly embracing more partnership-based models, we continue to see those relationships and collaborations held by so few people internally. The challenge of silo working persists. For example, a company may appoint a Patient Innovation Lead, only for their work to be in parallel with – and separate from – the broader marketing, medical or market access teams. So while there’s a greater acceleration of partnerships within Europe, it’s still not fully integrated and the true value of those collaborations isn’t necessarily being realised through the ongoing brand plan. There’s room for improvement.”
There are, however, companies that are taking a different approach. A good example is UCB, who has restructured around the concept of patient value creation. “UCB organises itself into Patient Value Units,” says Nicky. “Its strategy is built on a belief that it can only deliver lasting value by listening to the real needs of patients to identify how it can contribute to improving their quality of life. UCB’s approach acknowledges that medicine is only a small part of the solution, so everything it does starts with an examination of the patient value it is trying to derive. And it’s pursuing partnerships and collaboration in order to identify and deliver this. It’s a great example of how progressive companies are genuinely pursuing patient-led outcomes and making the move from a product-centred model to a service-based one. They’re looking at the broader value that they can deliver for patients beyond the medicine.”
Innovating for value
Naturally, adopting an outcomes- or value- based approach demands innovation in clinical development and challenges the long-standing reliance (from pharma, regulators and clinical experts) on traditional RCT data. The importance of real-world data is growing rapidly, but its quality, taxonomy and accessibility are not standardised and once again require collaboration to pull it off. Thankfully, progress is being made.
“We’re increasingly seeing pharma working together with health systems and academic institutions to derive shared value,” says Dr Vernon Bainton. “An example is the real-world observational study GSK conducted for its respiratory treatment Relvar prior to regulatory approval. The trial relied on a partnership with academics and health providers in Salford, Greater Manchester, to establish an electronic patient data monitoring system to communicate adverse reactions to physicians. Results from the observational trial showed better outcomes too and were submitted alongside the traditional phase 3 results – a world first back in 2013. The Salford database is now being used by other pharma companies for similar trials.”
The growing willingness to work collaboratively for the greater good gives a strong indication that things are improving dramatically. But, says Vernon, we haven’t reached nirvana yet. “There are still issues around data availability and integration. Certainly, we now have access to more data streams than ever before. We’ve got EHRs, biobanks, registries, social care and occupational health records. Nordic countries in particular excel with open enrolment into public health registries at birth. The real promise of digital and emerging technologies is not only to do things more quickly or more seamlessly but to allow these new business models to flourish, from R&D cycle to outcomes- based payments and incentivising individual people to safely use their own health data for the betterment of themselves and their community.”
An example of what’s possible – an exemplar for cross-healthcare and, interestingly, cross-industry collaboration – is the All.Can project. All.Can was established to identify ways of optimising the efficiency of cancer care to improve outcomes. “All.Can is a true, purpose-driven collaboration. It’s mobilised multiple stakeholders, with around 20 members: patient organisations, policymakers, healthcare professionals, research. Moreover, it’s multi-funded by BMS, Amgen, MSD and J&J to identify inefficiencies and collaboratively develop benchmarks or tools to improve resource allocations towards what matters most to patients, across the cancer care continuum.”
The approach marks a significant cultural shift for business; from a pharma perspective it is not immediately natural to partner with your competition along with other stakeholders. “Groups have historically worked in silos, protecting their assets and ‘knowledge,’” says Vernon. “The old architects of ‘breakthrough innovations’ were incentivised by profits or even Nobel prizes to keep their cards close to their chest. However, when it comes to problem solving differently, a diverse approach is required. You cannot do it on your own anymore. If we want to find solutions to the challenges of 21st Century sustainable healthcare, we must be prepared to work collaboratively, not only with health stakeholders and patients, but also with peers, competitors and mixed teams from outside a narrow siloed field.”
The value story
Beyond finding the right partners to unlock a clear understanding of shared value, one of the biggest challenges the industry faces is around how it communicates that value to a broad range of stakeholders and influencers. How can pharma harness the insight and intelligence of collaborative engagement and bring everything together in ways that win hearts and minds
to change behaviours? “It all boils down to storytelling,” says Nicky Walsby. “How do we move the access story from one that’s economically- led, perfunctory and transactional, to one that’s much more emotive? How do we incorporate the role of the patient into that story to present a first-person perspective of why value is key?
“This is where PR can play an important role in the art of storytelling and the articulation of value. Success depends on collaborating with the patient’s whole network to capture the emotional context; understanding the individual-level value that’s often overlooked. It also depends on taking an integrated approach internally, aligning perspectives from all the various functions and stakeholders to establish a compelling, core narrative. And finally, the best storytelling is human and audience-centric. Too often, companies focus on the stories they want
to tell rather than those their audiences want to hear. The through-line across all of this is the need to collaborate and engage with all our audiences to understand what value looks like to them.”
The journey to value
In the final reckoning, it’s clear that the biggest value for pharma will come through collaboration. Ultimately, its mission to demonstrate patient value is a journey not a destination. In dynamic health systems and therapeutic ecosystems that are in constant flux, definitions of value will forever fluctuate in time with stakeholders’ evolving needs. That’s why, with the most effective interventions likely to rely on co-creation, purpose- led partnerships that help organisations understand and respond to an ever-changing environment will be crucial. If companies are to develop sustainable business models that establish value ‘beyond the pill’, collaboration is the best way forward. It will be a lonely planet for those who choose to travel alone.
