Cello Health | Article
Toward an outcome
Disrupting the product-centred development cycle
Anyone working in the pharma industry over the last 15 years will have heard the phrase ‘power beyond the pill’ – a way of saying that drugs need to deliver clear and sustainable value to patients and healthcare systems through improved outcomes. Despite the longevity of this view, many people struggle to see the concrete meaning of the phrase and it has become a cliché.
Let us step back and look at why such emphasis has been put on this concept.
Healthcare systems respond to financial pressures by focusing on delivering the best outcomes for their investment, regardless of product, format, novelty or strength of marketing. Pharma is challenged by these constraints: firstly, it struggles to provide convincing evidence that novel medicines improve outcomes sufficiently enough to justify increased investment; secondly, when successful, it runs against the ticking clock of patents. Once patent protection is lost, any reasonably competent compounder can make up biologically identical medicines and offer substantive price reductions.
To address this shortfall in profitability, companies aim to recoup their investments rapidly during their ‘monopoly’ phase. This becomes a vicious cycle: with shorter patent protection and fewer blockbusters, the ability to recoup investment is stretched. This leads to higher prices for novel therapies, puts pressure on the overall healthcare system and magnifies investment risk for pharma companies, prompting difficult decisions around identification of viable targets and routes to market.
To escape this cycle, pharma companies need to refocus their development away from conventional products and towards creating solutions that somehow improve the treatment journey – for example, by speeding up diagnosis, improving patient experience or delivering better outcomes to more patients. Importantly, pharma must be able to identify, highlight and quantify these improvements, and ultimately the care advancements they bring to health systems.
At present, most pharmaceutical companies do analyse treatment journeys and unmet needs when developing new products. They do explore ‘power beyond the pill’, they do offer services to support patients and providers and they do attempt to quantify the improvement in patient outcomes and health economic impact of their new products.
If ‘power beyond the pill’ has become a cliché it is because pharma has been looking for power seemingly only when it comes from a pill.
What is required is to shift from a product-centred development paradigm to an outcome-centred one. In a product-centred paradigm, the thinking is, ‘We have this molecule. How can it improve patient outcomes?’ In an outcome-centred one, the question will be, ‘How does the treatment journey need to change to improve patient outcomes? What can we do to help to change it?’ Only once these questions are answered should a pharmaceutical company think, ‘We may be able to develop a molecule…’
So what can pharmaceutical companies do to prepare for this evolution?
To start: knowledge is power, so reinforce evidence gathering, storage and analytical power. In complex environments like the healthcare system, the ability to connect the dots and see patterns is key to being able to address challenges and develop solutions. Big data, artificial intelligence and similar technologies have enormous potential to help pharma target opportunities that would have previously been nearly impossible to identify.
Second: ramp-up relationships with providers, patients, payers and trade partners. Get into their lives and businesses, understand their challenges and work with them to find solutions. This will also feed an evidence-gathering capability. The way that digital and communications technologies have become integrated into virtually everyone’s lives makes supporting these relationships much easier. For example, whereas in the past MSLs spent most of their time with a small number of ‘important’ physicians, now telepresence and AI mean that pharma companies can reach a larger number of physicians at a much lower per-contact cost.
Lastly, when it comes to solutions that offer an improvement, be willing to take calculated risks. Gather the evidence and build the model needed to demonstrate value, demand share and be confident and willing to wait for it to deliver. Clinical effectiveness and outcomes-based commercial models are on most payers’ agendas, and providers are feeling most of the pinch. A pharma company looking to pilot a pay-for-outcomes solution will likely find willing counterparts somewhere in the world.
The more success a pharmaceutical company has developing solutions in this way, the stronger its ability to cultivate more solutions: It develops more impactful evidence and even deeper relationships, builds a track record of delivering value through improved outcomes, and gains confidence in its ability to assess the risk of investment decisions. And the vicious cycle is replaced with a virtuous one.