Friday, February 14, 2014

Moving Beyond Numbers: How Pharma Can Add Value to Outcome-Based Medicine

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Today's guest post comes from Catherine Price. She participated as a panelist at ePharma Summit 2014, is a freelance consultant, journalist and diabetes advocate who’s been living with Type 1 diabetes since 2001. You can find out more about her and her work at diabetesetcetera.com. Follow her on Twitter at @catherine_price.

It was an honor to have the chance to give a patient’s perspective at yesterday’s ePharma panel, “Pharma’s New Value Proposition” with fellow panelists Brian Sweet from AstraZeneca, Dave Moore from Cempra, and Jeffrey Farber from Mount Sinai (and moderated by Healthgrades.com’s Brad Graner). Once the conversation began flowing, I found myself overwhelmed by ideas and examples, based on my own experience living with Type 1 diabetes, of how pharma can provide much-needed value to its customers in our evolving healthcare environment.

We started the discussion with the Affordable Care Act – or, more specifically, how the switch from fee-for-service to more outcome-based treatment model might affect pharma’s interactions with patients, and what new kinds of “value” can be added as a result. As someone living with an incurable and chronic disease that requires my attention around the clock, I am happy to hear that – at least in theory -- the focus of medical care will be shifting toward long-term outcomes rather than just one-off treatments and appointments. But at the same time, I fear that basing reimbursements on outcomes will create an additional barrier between doctors and the very patients they’re trying to serve – and I’d like to see pharma try to help.

The reason for my concern is that most outcome measures are based on numbers (in the case of diabetes, hemoglobin A1c values), not on the patient’s emotions or overall wellbeing. This makes sense, given that numbers are the easiest, most concrete things to measure – but it does not take into account that emotions affect those numbers (for example, you are much less likely to stick with a treatment or drug if you are depressed and frustrated), or that emotional wellbeing is an important part of overall health, whether or not it can be quantified on a graph. (If you’d like to learn more about how this applies in a condition like Type 1 diabetes, please read this piece I did for the New York Times.)

The problem as I see it is that most doctors are already overscheduled, with an extremely limited amount of time to spend with each patient – much of which is already being consumed by entering information into a computer. If doctors know that their payments will be determined by outcomes, and if those outcomes are measured by numbers, then it is those numbers – not the person behind them – that they will focus on.

In some cases, perhaps that’s fine. But in a chronic and exhausting condition like diabetes, the last thing I want from a doctor’s appointment is to be judged by the very numbers with which I’m already judging myself every hour of every day. I want my doctor to listen to my concerns, to see me as a person, not just a mathematical problem that needs to be solved. That’s hard enough to achieve in a 20-minute appointment, let alone if my doctor is under pressure to achieve a specific numerical outcome. As a result, I fear that the idea of an outcome-based payment model might, in some cases, harm the very patients that it’s meant to help.

So what can pharma do?

I think there is a huge opportunity for pharma to provide emotional and educational support that doctors don’t have the time to provide themselves. Diabetes device companies provide some great examples (that pharma can learn from) of how this can be done, such as:

-Medtronic Diabetes recently launched a StartRight program for patients who are starting on its insulin pump and continuous glucose monitoring systems. Patients are automatically enrolled in the program and paired up with a specific representative who will guide them through the first six months of insulin pump therapy, beginning with motivation and preparation (in many cases, the representative is actually on the phone with the patient when the pump/CGM arrives and they open the box), training and educating patients about how to use their new systems, and periodically touching base to provide emotional and technical support. Yes, it’s an expensive initiative. But imagine the benefit from a patient or physician’s perspective: patients know that they can pick up the phone and speak to a familiar, knowledgeable person who knows –and cares about – them as individuals. And physicians know that when they start a patient on a Medtronic insulin pump, their own workload will be reduced, since Medtronic is providing a source of education and support that, despite their best intentions, they likely don’t have the time to provide themselves. (And as an added bonus, Medtronic has an easy way to gather patient feedback and keep track of possible problems with their products.)

-Medtronic also has a team that monitors its Twitter interactions. If patients tweet that they have a problem or concern with their insulin pump or supplies, a Medtronic representative will respond to the tweet – and in many cases, the pati
ent will actually receive a phone call from customer support. This makes patients feel like Medtronic is listening – and responding – to their concerns, and helps them avoid the aggravation of having to call the company and be put on hold.

-Tandem Diabetes includes its customers in its product development process from the ground up. Rather than create an insulin pump and present it to patients, it talked to its patients about their concerns and needs, and then built an insulin pump for them. Pharma could take a similar approach in figuring out how and where to add value. Simply ask customers and patients where in the process, from doctor’s appointment to receiving a prescription to taking the medication, they feel that their needs (especially emotional) are not met – and then figure out a way to meet those needs. Again, the more direct interaction a company can have with a patient (without crossing regulatory and legal boundaries), the better the patient will feel, the more likely they’ll be to stick to their treatments, the better their outcomes will likely be, and the easier it will be for the company to keep track of potential problems and side effects with its products.

-Lastly, Sanofi has created a truly impressive suite of online resources for people with diabetes that has nothing to do with their brand. I write for their DX site, which is an online magazine of sorts that shares tips and real-life stories about diabetes without any mention of Sanofi’s products. This non-branded approach is a great way to approach and help patients – we don’t want to feel like you’re selling us products, but we do need a trusted source of information about our condition or disease (and, in the case of many of the stories on the DX, a source of emotional support). Again, most doctors simply do not have the time to provide these things, and I believe there’s much room for pharma to help.

I could go on, but hopefully this gives at least a small sense of what sorts of value pharma might be able to contribute from a patient’s perspective – and might inspire some additional creative thoughts. Thanks again for including me – and please feel free to reach out directly if you want to talk more!


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