If pharma was a soul band, Barry White would have made the perfect frontman. Because if the modern-day lexicon is anything to go by, the patient has become The First, the Last, the Everything for the global industry.
From empowerment and advocacy to insight and outcomes, the patient-prefix is dominating the pharma vernacular as patient-centricity continues to shape the industry’s strategic set-list. It’s a familiar tune. However, dig a little deeper and there’s a creeping concern that the balance of power may be shifting just a little too much.
The patient voice, just like that of the Walrus of Love, is causing deep reverberations as patient value takes centre stage. A heavyweight dance-off between patient and shareholder value is simmering. The hypothesis is simple: patient value is important, but how much does it add to the bottom line?
Commentators are beginning to scrutinise the value of patient-centricity, with headlines exposing the commercial conundrum. A recent paper in the US asks the killer question: ‘Patient-Centeredness & Business Growth: Can Pharma Have Both?’ More provocatively, a Forbes comment piece queries the logic of the industry’s approach: ‘Is Pharma’s Focus on the Patient All Wrong? While a European op-ed from 2016 asks: ‘Has the Pendulum of Patient Centricity Swung Too Far?’
Some claim it hasn’t shifted far enough, with a conference round-up from 2018 observing that pharma is
‘still relatively early in the shift towards becoming patient-oriented’. Clearly, patient-centricity is a hot topic that divides opinion.
So what gives? Is there value in patient value? Many in the industry appear to think there is. One of the most prominent advocates is UCB, whose pioneering reorganisation around ‘patient value creation’ put the company at the vanguard of the movement. In 2015, its CEO, Jean-Christophe Tellier, said: “Our challenge is to take patient- centricity – or what I call patient value – to the next level. It involves integrating the patient into every step of our activity chain, from research to marketing and sales, to drive better solutions and meet the patients’ diverse needs more effectively.” The company said the systems it has put in place are ‘a shift from creating solutions for the patient to creating them as the patient’. It’s a subtle but important nuance.
It’s a similar story elsewhere, with companies like Roche, Janssen and MSD ‘partnering with patients’ to understand their needs and identify opportunities for innovation and value creation. AstraZeneca’s values state:
“We put patients first. We play to win. We do the right thing.” It’s a credo that inadvertently encapsulates a commercial tension around patient value that’s challenging the whole industry. Putting patients first is undoubtedly ‘the right thing’, but how do you ‘play to win?’. And how do you strike the right balance between commercial and shareholder value? The rise of patient-centricity is unstoppable, so how can companies harness the opportunity?
A deepening voice
The term ‘patient-centricity’ is widely used but often poorly defined; even Tellier’s 2015 definition conflates it with the now ubiquitous ‘patient value’.
The stampede towards it is an inevitable progression from patient empowerment, with digital advancement providing increased opportunities for people to access information about health. It has become a healthy catalyst for more collaborative engagement.
“Today’s patients have more tools at their disposal to better engage with and understand their health,” said Richard Jones, Managing Director Patient Engagement, OPEN Health Patient & Brand Communications. “This growing empowerment arguably has its biggest impact in the arena of high-value medicines. In a widespread shift from volume to value, around 80% of molecules in development at present are in oncology or rare disease. Patient Advocacy is playing an important role in raising the profile of these conditions, helping to attract research funding and drive reimbursement. The patient voice is increasingly being used to influence payers and encourage them to support high-value medicines. In this regard, patient-centricity – and the emphasis on patient value – is really paying off.”
The rationale is clear: “If you want to demonstrate the value of your medicine, it’s critically important that you’ve engaged patients throughout the journey from drug discovery to treatment in the real world,” said Richard. “If you don’t engage your patients for the duration of your clinical trial, you’ll end up with poorer outcomes and a poorer reimbursement scenario. If you don’t engage patients during registry to prove the value of your medicine in the real world, you could end up with a lower reimbursement price. And if you don’t engage with patient advocacy, you could end up with a lack of voice that impacts your potential for reimbursement when you’re talking to payers. The message is clear: if you want patient value, your patient engagement strategy needs to cover every touchpoint along the journey.”
There are, said Richard, three steps to achieving this. “First is to take an evidence-based approach so that the solutions you’re designing are based on proven methodology. Second, co-create the solution with the entire ecosystem – patients, carers, patient advocacy, HCPs and payers. And finally, make sure it can be embedded seamlessly into the healthcare system that it’s designed to operate in to ensure it works in the real world.”
The first (and last)
Matthew McCarty, Global Head of Patient Engagement, ICON, believes that some of the industry’s solutions are starting to make a tangible difference. “The use of 360° or unified patient support programmes that provide wrap-around care for patients is increasing. Well-designed solutions, particularly for complex high-cost conditions, are going beyond traditional ‘adherence’ tools and instead providing personalised programmes that add value to the patient experience. However, this inevitably leads to the broader question: what exactly is value for the patient? In the past, industry has taken a traditional view of patient value, typically basing it on clinical outcomes and disease progression. But companies are increasingly looking deeper to try to understand what’s important to patients.
“The only way to understand patient value is to talk to patients. Despite common fears around doing so, there are few restrictions on gathering patient insight. Whether you go for more formal research through a quantitative exercise like a patient preference study, or run workshops with patients to understand their motivations and pain points, there’s so much we can do.”
So how can you do it? “When designing programmes, you often start with high-level understanding of the broad patient population to define the need for any such programme,” said Matthew. “However, to engage patients comprehensively you need to really get beneath the surface of who they are and what they value – so that you can start to design studies or programmes that are much more personalised.”
The trick, said Matthew, is to think ‘patients first’. “Whether you’re developing trial protocols
or delivering wrap-around support for commercial healthcare, don’t try to design anything without talking to patients first. Obviously, you’ll need to talk to other stakeholders too – patients may not know the science or what’s going to fit your market access plan. But it’s impossible to define what’s valuable to patients without having those deep conversations. Success is less about being ‘patient-centric’ and more about thinking ‘patients first’. That’s how you deliver value that lasts.”
The everything
So how is pharma faring? It’s making progress, but there’s a long way to go. “We’ve got to get much closer to patients,” said Dennis O’Brien, CEO, Lucid Group. “In a complex healthcare ecosystem where diverse customers have different needs and influences, we sometimes lose sight of the patient value aspect. We need a better understanding of patients. We’re heading rapidly towards personalised medicines, yet we’re still not personalising the value that we – as healthcare communicators – deliver to patients.
To do that we need to be more sophisticated; we’ve got to embrace technology and use it to understand what patients actually want, rather than ploughing forward with things that we think might be helpful. Our analysis and understanding must go to new levels.
“Tech provides the opportunity to analyse what patients look at on the internet – and that gives a good indication of the kind of things they value. On its own that’s not enough – but it’s a starting point. We can use that insight to build the things that patients value, and we can track that value so we can keep improving. We’ve got to think like tech providers and think like consumers. If we can do that, we’ll build trusted communities that provide meaningful value. But we’re just not there yet. For some reason, we’re scared to connect to patients. We need to get over it.”
Progress, said Dennis, may require a fundamental shift in mindset. “There’s a misguided belief that patient value is all about outcomes. It’s not. It’s about improving someone’s life every day. And if we do that, there’s a good chance we’ll improve their outcomes. But just like health is an everyday journey, so too is patient value. Patient-centricity is a relentless pursuit. The best players in this space will be those who understand that patient insight gives them a continual point of differentiation – and can track, analyse and respond to it quickly to deliver better value to patients.”
Adjust the way you are
The rationale for patient-centricity, and the drive for patient value, is clear. But for the greatest business benefits, it’s important to look at the bigger picture. That may require some organisations to rethink their approach. “In the future, companies may not have any choice but to be patient-centric – but it’s all a question of how and where they do it,” said Ed Corbett, Partner, Novasecta. “Doing it well requires proper investment – you can’t just do secondary research or a handful of focus groups. Businesses therefore need to be selective and design strategies that suit their business models. The most tangible benefits of patient-centricity are in R&D. When you’re shaping the product it’s important to ask patients what they want. For example, they might want to be part of a trial but don’t want to go to hospital every time. They may have a life-threatening condition and be willing to risk severe side effects to be part of an early stage clinical trial.
Likewise, early engagement can help you understand which routes of administration work for a patient: do they want pre-filled syringes, an infusion or a once- a-day tablet? These questions are tougher once you’ve baked the product in – then it’s more about how you bring that product to the patient. Knowing what a patient goes through when they’re having an infusion or the practicalities of building it into their life is incredibly valuable. If you get it right and they persist with the therapy, it’s a win-win. However, you can’t do everything. It’s all about identifying areas of mutual value.”
In some cases, said Ed, patients will ask for things that are neither practical nor possible. Companies must be strong and make pragmatic decisions. “It’s no good slavishly following what patients want, because there’s always going to be tension when there’s a disconnect with what a company values. At some level in the organisation,
some will ask: ‘What are we getting for this?’ If the value is unclear, a programme is likely to be terminated. On its own, patient value is nice to know but it’s not always actionable or relevant. By identifying areas of mutual value, you can do some amazing things. Innovation like infusion services, adherence programmes and digital medicine can help everyone – the patient, the health system and the company – get the most value from a medicine. Success requires taking a holistic view and adjusting what you do in line with shared objectives.”
Go deep
In the final analysis, patients will always be The First, the Last, the Everything for global pharma. But managing the tension between patient and shareholder value will be critical to commercial success. Winning requires deep insight, deep focus and deep long-term commitment. It’s time for pharma to channel its inner Barry White.