A groundbreaking study among top executives of hospital systems, payers and life science companies in the U.S., Europe and Asia has revealed a pending threat to Pharma’s relevance in the broader healthcare ecosystem. The study, conducted by Prophet – a global growth consultancy, outlines how patient outcome based reimbursement, advances in the secure use of patient data and the shift by healthcare companies to become more consumer-centric are driving pharma companies toward a crucial inflection point. Study participants outlined five key shifts pharma must make to successfully overcome this threat by building consumer-centric experiences.
Consumer expectations, the growth of secure ways to harness patient data, and healthcare price pressures are changing how key healthcare decision are made and the financial incentives influencing these decisions. Choices surrounding the adoption of and adherence to medicines are a focal point for all three of these drivers. Providers, payers and new players are moving quickly to respond in ways that can reduce pharma companies’ leverage and ability to drive impact. If pharma responds quickly risk can be turned into opportunity. The window is open for pharma companies to evolve into broader solution providers through more tailored consumer interactions, partnerships with other healthcare companies and developing sustained consumer relationships.
Patients Are Consumers – They Expect More
Companies like Apple, Sephora, Spotify and Netflix have so successfully put consumers in charge that they’ve raised the bar for everyone else. Healthcare companies are racing to emulate this new breed of technology company because consumers won’t stand for anything less. Evidence of consumer dissatisfaction with healthcare is abundant. The State of Consumer Healthcare, a 2015 study undertaken by Prophet and GE Healthcare pointed out that an alarming 81% of consumers were dissatisfied with their care. Healthcare companies have been slow to respond. That’s no longer the case. Consumerism has arrived in healthcare. It will intensify.
Barriers to the Secure Use of Data are Lower
Utilizing patient data has been a formidable barrier to delivering valuable patient experiences in pharma. As my latest article in Pharma Marketing reports the growing availability of de-identified patient treatment and social data is a game changer. Extensive patient claims data is now finally available at a granular level for many of the largest health conditions. De-identification allows pharmaceutical brands to harness this data without violating the privacy or regulatory requirements that are so crucial to patient trust and the ethical operation of the business.
Cost Pressures Provide Incentive to Change
Rising costs have led to pressures from government and payers on life science companies to lower prices and improve outcomes. Pharmaceutical companies are shifting to reimbursement based on outcomes. 1 in 4 U.S. health plans already have at least one outcomes-based contract with a drug manufacturer, and 30 percent of health plans are currently negotiating one or more such contracts. Outcome based reimbursement places responsibility on pharma companies to enhance the entire experience from initial selection to adherence. Consumers are also increasingly footing more of the bill for their healthcare. In the U.S. alone, worker contribution to health insurance premiums increased 85% between 2005 and 2015. These rising costs are forcing consumers and caregivers to become more willing partners in improving their own or their loved ones’ healthcare experience.
The Imperative is Clear – A Shift Is Needed
Rising patient expectations and outcome based reimbursement mean improving consumer engagement and redefining how people interact with healthcare is no longer a luxury, but a necessity. Pharma companies must change and put the consumer first.
Based on one-on-one conversations with top executives from providers like Mayo Clinic, Geisinger Health System, and United Family Health; payers like Aetna, Cigna, and Blue Cross Blue Shield; and leading life science companies like Pfizer, Novartis, and Eli Lilly and Company, Prophet identified five key shifts to become more consumer-centric in healthcare:
From One-Off Moves to End-To-End Initiatives Tactical moves to improve a specific journey touch point frustrate leaders because they are not delivering sufficient impact. Leaders are shifting investment to organizing teams, establishing metrics, and designing experiences that engage consumers throughout their journeys – even when they are relatively healthy. Patient adherence is an example of the potential to become end-to-end oriented. Narrow, often separate, initiatives to improve access, help patients obtain information or receive guidance about specific medicines can be broadened into cross-indication experiences that build lifelong relationships with consumers based on their goals and challenges.
From Siloed to Integrated Care Addressing the fragmentation of care and the resulting patient confusion, inefficient service delivery and cost shifting incentives is at the very top of healthcare leaders’ priority list. Making partnerships works is a key area of focus for the leaders who participated in the study. However, Pharma will need to catch up. A health system CEO stated “We are increasingly working with payers to deliver integrated care, but Pharma is not at the table. Where is Pharma?!?”
From Populations to People It goes without saying that different patient groups have different healthcare needs. But, understanding patients primarily by pathology and demographics is no longer sufficient. There was almost universal consensus among study participants that healthcare companies must invest in understanding patients as individuals and, when that is not possible because of patient data limitations, to understand them in a larger more human context. Context that includes what frustrates them, how they want to learn, where their aspirations lay. Translating understanding into action is a challenge in this highly-regulated industry. The study pointed to progress particularly among providers, payers and medical device companies driven by more effective use of digital technologies. The gap between pharma other healthcare companies was significant.
From Tactical Gains to Pervasive Renovation The two extremes – continuing to invest in unending lists of tactical improvements or radical disruption of the healthcare system – do not appeal to the leaders interviewed in the study. They pointed to a third way that tackles innovation more quickly and more adaptively. Most aspire to undertake the “agile” approaches of technology companies. Pharma must tread a careful path. The meticulous development of new medicine cannot be comprised at the expense of safety or efficacy. But, that super-meticulous mindset also must not limit more agile innovation in patient experience where agile approaches are more appropriate.
From Departmentalizing Insights to Creating a Customer Culture Researchers and analysts are and should remain the lifeblood of healthcare companies. Study participants extended their sights to turning operational teams into customer obsessed challengers of the status quo. The challenge they face is fostering a consumer-driven insight culture across the organization and turning insight into action systematically. Essentially by thinking through an Insights Operating System (IOS).
The Path Forward
The 38-page study by Prophet has just become available. It explores the five key shifts, provides case examples from the companies who participated and discusses specific ways organizations can shift. The study is unusual because participants reveal what they are doing to create more valuable, consumer centric experiences and how they are working to overcome the barriers inherent in healthcare to affect change.
Click here to learn more about the study and download a copy click here
 https://www.prophet.com/patientexperience/ The State of Consumer Healthcare: A Study in Patient Experience