A Need For Closer Collaboration
With its sharp focus on the total cost and quality of care, the current healthcare landscape requires all stakeholders – including biopharma companies, providers and payers – to operate in a new type of business relationship. To date, relationships have tended toward opposition, where the biopharma sector has been perceived as aiming to maximize sales, and payers as reimbursing the lowest possible amount. If one party won, the other lost.
This sounds familiar. The recent government shutdown played out a zero-sum game, with considerable fall-out for each political party. Biopharma and payers can potentially avoid a similar pitfall by working toward alignment and convergence around a common interest in patient health and the cost and benefits of achieving it. Patient-centricity becomes a true north in an environment complicated by massive changes in Medicare and Medicaid structures, new biopharma commercial models, and evolution of risk-bearing entities.
For patient-centricity to work, we need more “systems thinking,” considering both the goals of individual constituents and the overarching goals of the entire healthcare system. At its core, this requires coordination and data and information sharing. Several data sets with different origins will be critical – clinical data about the patient, cost data in terms of healthcare resources used, research and trial data, genetic and protein expression data, and patient reported outcomes data.
This pressing need for collaboration is confirmed by the Collaboration Mandate, based on independent surveys of 300 healthcare executives in the U.S., Italy, France, Germany, Spain and the United Kingdon. The surveys found that two-thirds of executives expect to forge long-term agreements with payers, and nearly 80% anticipate strategic alliances with healthcare systems.
There have been some encouraging business arrangements between biopharma and payers that bring greater alignment. Humana and Boehringer Ingelheim formed a partnership earlier this year aimed at improving healthcare and reducing costs for people affected by chronic obstructive pulmonary disease, cardiovascular disease, and other chronic diseases. Humana and Pfizer are exploring ways to improve the quality, outcomes and costs of healthcare delivery for senior citizens and others. Wellpoint and AstraZeneca aim to determine the most effective and economical treatments for chronic illnesses and other diseases. The results of these arrangements can provide further evidence for the value of partnerships to improve real-world use and outcomes.
Providers and biopharma are in the act, too. Geisinger Health and Merck entered an agreement in 2012 to improve patient adherence to medications, an issue that currently costs the U.S. an estimated $100 billion per year. Vree Health, wholly owned by Merck but independently operated, is providing post-discharge services to Griffin Hospital in Derby, Conn., to manage 30-day readmissions. Sharing of anonymized, real-world patient data between providers and biopharma may also inform better development decisions, give biopharma companies greater insights on the commercial value of new products, and support development of products that help reduce total cost of care.
Systems thinking encourages payers and providers to share information about treatments and outcomes, with the joint goal of improving care for the patient. For example, in August, Cigna announced a plan to collaborate with Saint Francis Healthcare Partners on an accountable care initiative to improve patient access to health care, enhance care coordination, and achieve the “triple aim” of improved health, affordability and patient experience. The program could be a model for the biopharma sector to follow.
With the growing challenges to improve the quality of care while managing costs, there is a strong need for improved collaboration among stakeholders, based on systems thinking and patient centricity. Promising examples of innovative relationships point the way for solid improvements in this area, to the potential benefit of all stakeholders.
Patrick Jordan is Vice President and Head of Operations of Quintiles Payer and Provider Solutions, a division of the organization that partners with hospital systems, payers and health authorities to improve the quality and cost of healthcare delivery.
