Alex Blyth | Article

Payers are human too

I recently attended a meeting at the House of Commons led by healthcare advocates Angie and Tony Russell from Positive Practice in Mental Health, a nationally recognised mental health service user consultancy. It took the form of an information day where MPs could meet with experts, mainly commissioners, to discuss what could be done to improve outcomes for people living with mental illness in England and what future services would need to look like to achieve it.

The attendant MP’s were impressively knowledgeable about the state of mental health services in their own constituencies and shared vivid insight of their personal experiences in dealing with constituents in crisis. The commissioners, as one would expect, were also knowledgeable and brought with them boundless empathy, passion and commitment for improving mental health and the services they procure.

Tony Russell for his part enabled a thoroughly productive discussion to take place, helping political decision makers to gain a sound understanding of current service challenges and over the longer-term, one would hope, develop insightful policies to sustain the UK’s position as a provider of world-class mental health services. It’s little wonder that the Health Service Journal regard him as one of the leading patient change-makers and service shapers (HSJ Patient Leaders 2015).

By way of relaxation this year, Tony published his book ‘Commons People’ (1) in which he writes about getting into the minds of elected representatives. Through his writing, he tries to reveal what’s in their heads, what’s in their hearts and wants to learn of the thoughts that keep them awake at night. He wrote the book because he believes that MP’s get a rough deal in the eyes of the British public. That too many people hold the mistaken belief that they are a ‘bad lot’, only ever ‘in it for what they can get out’. He thinks and says on the front-cover of Commons People, that “MPs are human too”.

The meeting in the House of Commons was illuminating. I wasn’t (and never am) in the least surprised by the deep knowledge MP’s bring along. Being well-versed in the detail of a panoply of issues and debates comes with the territory. The articulation and focus of Tony and his operational team was no surprise either, indeed I’ve never seen an output from them that I didn’t like! The bit that left me gasping for breath, wide-eyed and awe-inspired was the contribution made by the commissioners.

Each demonstrated an incredible depth of understanding for their services and a genuine commitment for those that used them. Of course, like talking Excel spreadsheets, their command of NHS financing and cost was lightning fast, reeling off exacting estimates and data points faster than even the most adept political researcher could put pen to paper. But this wasn’t why they were here. To them, the numbers were ancillary. What mattered most was what mattered to the patient, championing empathy and devotion over pounds and pence. On that day, my lesson learned was that like MP’s, commissioners are human too, and much more than the ‘payers’ our industry often just sees them for.

During the 25 plus years that I have worked in this sector both in the UK and around the world, I’ve witnessed first-hand the enormous impact of health service reconfiguration has had on the fortunes of the pharmaceutical industry. It’s fair to say that much of that change has been driven by public money, or more accurately by the lack of it. We all know that people are living longer and expecting more as advancing technology makes them think they can have better, faster, safer care and treatment (for example access to a 7 day NHS). Increasingly we know the public approach the health service, armed with knowledge of promising new treatments and technologies. During this time, regardless of geography or political party in power, public and political concerns have greatly increased about the sustainability of the NHS. Governments have responded by re-designing health service systems to enable them to do ever more for ever less. Some have devolved, others centralised, some have limited access to high cost services and others have out-sourced whole swathes of it to independent/private providers. The only real truth is that each and every government has attempted to sustain socially funded models of healthcare by exponentially increasing the power of those holding the purse-strings.

In the Pharma industry we don’t seem to be so good at defining the nature and characteristics of this now well-established stakeholder. For the most part we call them ‘payers’. When we engage with other stakeholders, our communications tend to be targeted to specific types of audience. For example, we know that the issues that matter to one type of physician may not be the same as those that matter to another. We research, segment, learn about and map their needs, and then we systematically address their needs through tailored dialogue that then resonate with them directly. We routinely work in this way for other healthcare professionals such as nurses, pharmacists and policy makers. However, the people with the purse strings, the professionals who decide on the success and failure of our pharmaceutical lifeblood, well, we just collectively call them ‘payers!’

It might be simple semantics but according to Merriam-Webster a payer is “one that pays”, nothing more nothing less. The word ‘payer’ describes something blindly transactional. A state where one actor simply hands money over to another actor. It does not describe any sense of purpose or expertise that could be called upon to determine anything like value or return on investment. It most certainly does not describe any government elected this last quarter century, intent on safeguarding the sustainability of its own national health service.

When we use the word ‘payer’ it belies a fundamental lack of understanding on our part. Could it be intellectual laziness, or self-imposed denial of the realities of 21st century health service governance? Whatever the reason, the influence of this type of stakeholder on the health of our industry and the patients we serve is only ever going to increase. As such, we must begin to understand them intimately. Finding a nomenclature that reflects what they actually do could be a good place to start.

I actually prefer the word ‘buyer’. The Dictionary of Business define buyers as: Professional purchasers specialising in a specific group of materials, goods, or services, and experienced in market analysispurchase negotiationsbulk buying, and delivery coordination.” In common parlance we ‘buy’ ideas and stories when we believe them to be credible or true. Buyer, therefore, seems a little closer to the mark, but maybe there’s an even better descriptive?

Economics and demographics dictate that the future of health systems will remain insecure for the foreseeable future. It is both inevitable and reassuring to governments that buyers play a leading role in protecting the effectiveness and efficiency of services through the invention and deployment of public sector innovations. Buyers, at the vanguard of such innovation, will use ever stronger, ever expanding networks to improve governance, practice and outcomes; disseminate information and deliver value for money. For industry the choice is stark, we can either take this journey with them or go it alone.

If we are to prove effective in delivering hope and health to patients and secure the sustainability of our industry, we need get closer to the buyer. We need to find a way to derive exponential value by tapping into their expertise and harnessing their passion for patient well-being. Just like Tony Russell did with MP’s when he wrote Commons People, we need to know what’s in their minds, what’s in their hearts and learn of the thoughts that keep them awake at night. We should do this, not just because it’s a business no-brainer, but also because it’s the right thing to do. Calling them buyers won’t mean much to them, but it will orient us to a place where we recognise and respect the importance of volition and choice in the purchasing transaction. It will help us to understand the opportunities and challenge their roles represent. But in a small way, it adds a touch of consideration and recognises that buyer or payer, they are human too.