buggy whips and driverless cars: how pharma needs to engage … · pharmaceutical industry at...

Buggy Whips and Driverless Cars: How Pharma Needs to Engage with IDNs

Speakers

April 29, 2015 Buggy Whips and Driverless Cars: How Pharma Must Engage with IDNs 2

Elizabeth Powers, Senior Principal, IMS Consulting Group As a senior principal in the Market Access practice of IMS Consulting Group, Elizabeth specializes in consulting on changing global Market Dynamics, including payers, integrated delivery networks, distributors and specialty pharmacies. She has more than 13 years of experience in the biotech and pharmaceutical sector, including prior experience at Booz & Company. Her broad experience includes successful engagements in designing and implementing innovative US and global commercial model strategies, capabilities and organizations, including payer and IDN collaborations. Elizabeth has been published in Harvard Business Review, Financial Executive and InVivo.

John M. Daly, Senior Principal, Healthcare Solutions, IMS Health In his senior principal role, John provides strategic leadership and expertise for next-generation commercial solutions. John leverages his extensive industry and IMS Health expertise to help life sciences companies drive improvements in commercial effectiveness, strategic business planning and execution. With more than two decades in the pharmaceutical industry at industry leaders Bayer, Schering-Plough and Merck, John gained diverse experience in leading traditional sales teams and provider network account teams, as well as product launch planning, launch execution, national business planning and field development processes.

Contents

April 29, 2015

Attempts to break out of the traditional

model

Assessment of the journey so far

Redefining the future U.S. go-

to-market model 1

2

3

Buggy Whips and Driverless Cars: How Pharma Must Engage with IDNs 3

The objective of today’s webinar is to discuss IMS Health’s capabilities and point of view


1 Introductions and market conditions

2 Review how pharma has engaged IDNs

3 Discuss IMS Health’s point of view on successful IDN engagement

Meeting Objectives

IDN influence will only increase as they transition from acquisition to integration and consolidation

Next wave will intensify control • Integration – next 1-5 years − Full EMR integration = ranked as

extremely important for 60% of IDNs interviewed

− Control expanded to new TAs,

e.g., CNS, Gastro, Women’s Health

• Consolidation – 5 years+ − Increased margin pressure will

drive regional IDN consolidation

Acquisition - the end is near

• 2004-2010 ~750 IDNs = 125% increase

• 2010-2014 ~1,000 IDNs = 30% increase

• Own or affiliated with at least:

− 80% of hospitals − 60% of group practices − 70% physicians affiliated -

nearly 50% directly employed

5

Source: IMS Heath / IMSCG secondary and primary research

April 29, 2015 Buggy Whips and Driverless Cars: How Pharma Must Engage with IDNs

IDN engagements predominately pursued through KAMs and commercial resources, with increased investment plans

Source: IMSCG Pharma IDN 2015 Engagement Survey; n= 9

Physician Educators

HEOR

Payer AMs

Medical

Sales Reps

Hospital KAMs

IDN KAMs

6

5

2

1

7

2

5

4

= No change

+ Increase

- Decrease

Changes in IDN KAM Field Force

Next 6-12 months Past 6 months

IDN Engagement Resources


Presenter

Presentation Notes

Voice over: There has been a proliferation of KAM-type or B2B account teams across the industry, ranging from hospital and IDN KAMs, to TA-specific B2B teams and “cross portfolio” support teams. In some large firms, there may be multiple B2B forces in the market, with 3-4 “KAMs” all calling on the same account. In most cases, the KAM or B2B representative has multiple accounts, making it difficult to invest significant resources in any one account. The emerging literature on best practices in KAM suggests that there is an optimal number of accounts, maybe 20-35, in which a firm can realistically hope to invest resources sufficient to develop a deep relationship, and that the managers of these relationships cannot have more than 1-2 accounts for which they are responsible. Pharma’s experience to date has been mixed…

Companies vary in total number of KAMs and accounts covered while effectiveness is measured mostly by sales

Accounts Covered by Each KAM


1

8

<5

6-10

2

1

3

3

<5

6-10

21-40

40+

Number of KAMs at Launch

IDN satisfaction surveys

Sales force access to Physicians in IDN

Account manager calls on IDN C-suite

Number of collaborations established with IDNs

IDN prescribing volume

Affiliated physicians prescribing volume

KAMs account knowledge and ability to apply

KAM Effectiveness Key Performance Indicators


Presenter

Presentation Notes

IMS Expertise: Best practices in KAM suggests there is an optimal number of accounts a firm can realistically invest resources Managers of IDN relationships should not have more accounts than they can successfully build partnerships with

In fact, pharma reports limited direct activity to support this, despite stating enhanced patient outcomes as a priority

2

2

5

6

6

6

Access to IDN data

Field representative access to physicians

Patient support partnerships

Treatment protocol / pathway

Increased product sales

Enhanced Patient Outcomes

Top Objectives for Engaging with IDNs

Key Activities when Engaging with IDNs

1

1

2

2

4

8

Operational support aligned to pharma value proposition

Incorporate IDN into pricing strategies

Operational support for customer priorities

Disease area analytics, physician education programs

Incorporate IDN into launch strategy

Local Market Coordination



Presenter

Presentation Notes

IMS Expertise: Ensure goals are aligned across the entire organization to promote follow-through in key activities

Despite gaining valuable IDN insights and enhanced positioning, pharma is unable to measure IDN impact

1

2

3

4

8

Other

Increased sales

Sales rep access

Enhanced positioning

Insight into unmet needs

Value Realized from IDN Engagement


1

2

5

5

6

8

Limited understanding of IDN priorities and stakeholders

Others

Lack of focus on brand value

Engagement mindset (e.g., transactional)

Lack of clear transaction (e.g., contract)

Inability to measure IDN impact

IDN Engagement Hurdles


Presenter

Presentation Notes

Voice over difference between early engagers and later adopters

Figuring out the right new model is becoming critical as traditional sales force productivity continues to decline


Affiliated to a mature IDN

Unaffiliated

Affiliated to a large medical group

Physician detail equivalents

Ret

urn

per

tar

get

pre

scri

ber

Sales Force Productivity

But how can pharma-IDN engagement overcome the many constraints?


Constraints to IDN - Pharma Collaboration

0

1

2

3

4

5

Lack of common

goals

Lack of mutual trust

Mis- matched

capabilities

Interoperability of data

Lack of communication

Lack of internal

motivation

IDN perspective Pharma perspective

Source: IMSCG IDN Pharma Engagement Survey 2015; n=10, IMSCG Pharma IDN Engagement Survey 2015 n=9

Not Important

Very Important

As part of this, pharma has invested in moving from promoting products to providing products + services


“I’m not a big fan of pharma’s value-added services. If I were them, I would simply build relationships based on their expertise with products.”

– Executive Director, IDN w/advanced analytical capabilities

But these investments are not resonating with IDNs…

Presenter

Presentation Notes

We often here that pharma needs or wants to pursue the IBM model of adding value by providing services We hear questionable results

IDNs are most interested in comprehensive approaches to engagement


Diverse portfolio aligned with IDN’s priority TAs

MEDIUM Educational materials

Mutually beneficial partnership during clinical trials

Isolated services for each product

Attributes critical for meaningful IDN-Pharma engagements

Level of IDN interest

Integrated solutions

HIGH Multiple products across a single priority TA

Long-term relationship building strategies

Brand-specific marketing efforts LOW

Source: IMSCG IDN Pharma Engagement Survey 2015 n=10

Low Medium High

Presenter

Presentation Notes

#2 – If a manufacturer has a dpp4, a dpp4+metformin combo, and an insulin – it has products in 3 out of the 5lines in T2D (multiple products within a prioritized TA) #4 – If T2D, RA and other immunology diseases, and asthma/COPD are 3 of the top5 Tas in an IDN, specific manufacturers who have established products in each of these TAs, will be more favorable for a collaboration than others Long term relationship strategies – a) If your product does not get a place on the formulary, then do not simply close the line of communications – instead continue building the relationship , trying to understand what was required to be successful etc. b) Really understand how a certain initiative is going to align to not just the pharma needs but also overall IDN strategies. c) Understand and engage with physicians on a partner level (to understand what a specific therapy area needs are and how can these be addressed)��Knowledge and responsibilities during clinical trials (Heard from one respondent) – If pharma wants to carry out clinical trials that are ultimately generating data for their product, they should also provide more scientific/technical and disease management support – through which the hospital can better understand the drug profile and anticipate/manage adverse effects better. Education materials (could be reworded as Education Initiatives) : refers to a) continuous collaboration between pharma and hospitals to invite doctors to attend conferences and training programs and b) pharma developing unbranded educational content (either on paper or via electronic media) that provides more information on a specific disease, advantage of each line of drugs, adverse effects associated etc.

However, even the highest ranked pharma companies generally rank strongest where IDNs care less


Diverse portfolio aligned with IDN’s priority TAs

Educational materials

Mutually-beneficial partnership during clinical trials

Isolated services for each product

Attributes critical for meaningful IDN-Pharma engagements IDN Leading

pharma

Pharma 1

Pharma 2

Integrated solutions

Multiple products across a single priority TA

Long term relationship building strategies

Brand specific marketing efforts

Source: IMSCG IDN Pharma Engagement Survey 2015 n=10

Low Medium High

Presenter

Presentation Notes

Pharma 1 and 2 are representative of NNI and MRK respectively #2 – If a manufacturer has a dpp4, a dpp4+metformin combo, and an insulin – it has products in 3 out of the 5lines in T2D (multiple products within a prioritized TA) #4 – If T2D, RA and other immunology diseases, and asthma/COPD are 3 of the top5 Tas in an IDN, specific manufacturers who have established products in each of these TAs, will be more favorable for a collaboration than others Long term relationship strategies – a) If your product does not get a place on the formulary, then do not simply close the line of communications – instead continue building the relationship , trying to understand what was required to be successful etc. b) Really understand how a certain initiative is going to align to not just the pharma needs but also overall IDN strategies. c) Understand and engage with physicians on a partner level (to understand what a specific therapy area needs are and how can these be addressed)��Knowledge and responsibilities during clinical trials (Heard from one respondent) – If pharma wants to carry out clinical trials that are ultimately generating data for their product, they should also provide more scientific/technical and disease management support – through which the hospital can better understand the drug profile and anticipate/manage adverse effects better. Education materials (could be reworded as Education Initiatives) : refers to a) continuous collaboration between pharma and hospitals to invite doctors to attend conferences and training programs and b) pharma developing unbranded educational content (either on paper or via electronic media) that provides more information on a specific disease, advantage of each line of drugs, adverse effects associated etc.

However, most IDN engagement efforts to date have missed the mark

Past Mistakes • Over investment without clear sense of value

• Misalignment of priorities with proposed partner

• Inability to bring the right capabilities and resources to the table

• Focus on immediate outcomes vs. long-term commitment

• Missing the “sweet spot” due to: − Excessive brand promotion focus − Inversely, efforts are too customer

focused with little leverage of brand and TA expertise

• Application of successes to all brands and geographies

Pharma’s Efforts to Engage

• Addition of B2B field force in addition to physician promotion

• Value demonstration through cost and quality metrics

• Partnership attempts through clinical trial input, joint analytics, patient support, contracting


Managed Care Plan 1

Managed Care Plan 2

Managed Care Plan 3

Brand Advantaged

Brand Parity

Brand Disadvantaged

Payer Brand Influence Drive Brand Access

IDNs Therapeutic Influence Drive Class Preference

Provider Prescribing Manage Patient Treatment

“Even though we have our own plan, those patients are only a small percent of our book of

business. We have to accommodate plan formularies”

- Large US Integrated Payer / Provider

“Of course we can only manage at a class level. If we tried to manage at a brand level,

90% of our patients wouldn’t have their prescriptions covered”

- Large US IDN


IDNs and payers have reached equilibrium in how they manage prescribing

IDN Impact can identify which IDNs can significantly impact your performances


Actions 5,344

Local Corporate Parents (2,801 IDNs & 2,543 Corp Providers)

712

Innovative Treatment

573 High Control (>.25)

108 TRx Volume >25K

89 Driving CLIENT CLASS Utilization

19 Not Yet SGLT2

TRx Volume <25K

Low Control (<.25)

Cost Conscious Insulin Variable

4.2MM TRxs Innovative CLIENT Favorable

Corporate Providers with high prescribing influence

Corporate Providers driving new branded class

prescribing

Corporate Providers with significant volume and

contribution

Understanding class influence within an MSA is key to aligning the engagement approach


IDN Favorability to Class (or Not)

How IDNs exert control over class preference


Protocol Systems Care Coordination

No protocols or protocols suggested but not enforced

No systems integration – low protocol integration in EHR

Patient experience & Initiatives: i.e., medication adherence

Protocol deviation possible no penalty - Requires CMO justification or pharmacy resistance

Protocol embedded EHR recommendation and analytic tools to ID key patients

Provider education on standards of care, guidelines and care coordination services

Physician alignment to protocol tied to financial incentives

Fully integrated EHR capabilities

Computerized Physician

Order Entry predefined

Population management metrics measured or tied to incentives for TA specific goal attainment, ED utilization, readmission rates

INDIRECT LOW CONTROL

DIRECT HIGH CONTROL

.21 control score

.56 control score

.38 control score

IMS Health Confidential - IDN Impact Patent Pending

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&ved=0CAcQjRw&url=http://lowninstitute.org/partners/&ei=J784VdexM8XYoASAmoHACA&bvm=bv.91427555,d.cGU&psig=AFQjCNFMg0MGvvvMRfXesUUudSW3Aju2pg&ust=1429868699433143

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRw&url=http://www.imedicalapps.com/2011/10/baylor-healthcare-system-launches-enterprise-health-information-exchange-hie/&ei=W202VYOHNcr1oAS9t4GQDA&bvm=bv.91386359,d.cGU&psig=AFQjCNH8ppmXStO_SuiIk7_XB884sZj5WQ&ust=1429716695507553

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRw&url=http://www.startanesthesia.org/moodle/course/info.php?id=59&ei=WsY4Vbn0DILHogTav4CIBw&bvm=bv.91427555,d.cGU&psig=AFQjCNGN9SS6zGIVMpK0_bR4da4hdMUsVw&ust=1429870545940333

Driving stakeholder and geographic aligned impact


Immediate opportunities: Favorable Markets / Payer Access / IDNs

Group C

Group B

Brand Performance (e.g., Payer Impact)

Cla

ss F

avor

abili

ty

Outlier: Learn Accelerators

• Understand brand performance in context of: −IDN control & product class favorability

−Payer access −Class favorability is “wind at your back” for brand-of-choice

“top performers”

ILLUSTRATIVE

Risk: misalignment driving accounts away

from product class

move to top performers

Group A

How to advance the class in Group A? Toolkit inventory and fill gaps, test and refine messaging, align to IDN segments


ER utilization reduction “Using next practices in *therapy area* to achieve your quality goals”

“Achieving patient satisfaction and well-being through the challenge of *therapy*”

“Chronic *disease*: the next source of population health efficiency and outcomes”

Next practices ambulatory

Hard to treat patient transitions

Patient education Instrument

Long term care

Discharge counseling & case support

Value Theme 1

Value Theme 2

Value Theme 3

Segment 1

Segment 2

Segment 3

Value Propositions Toolkit and alignment to CBSA / account segments

Case Study: a chronic disease brand – IMS Health built, messaged, and aligned value props to segments

Buggy Whips and Driverless Cars: How Pharma Must Engage with IDNs

How does the traditional marketing mix change in Groups B and C to capitalize on class favorability?


Example: Favorable IDN Marketing Mix

Marketing KAM FIELD

Account Selection

Mutually beneficial objectives, ensure value, quality and patient resources

Collaborative commitment, invest in initiatives and capabilities

Broader or deeper provider targeting

Goal Continue Driving Class

& Differentiate Brand Value

Class Preference & Quality Value Brand-of-Choice

Resources Beyond-the-Pill Aligned Quality &

Patient Initiative Value

Quality and patient focus

Tactics Measure and Monitor

Segment Initiative Improve Payer Access

Create Rep Access Value Solutions

Align messages and resources to IDN initiatives

Leverage IDN Influence

Adherence Solutions Adherence Initiatives Adherence Resources

Certain high-value Group C IDNs warrant a more tailored approach


“A truly integrated operational model is something Pharma’s been dancing around this for sometime, but hasn’t made a sufficient, extended commitment to any one effort for us to believe it. This is an idea whose time has come – the question is, who will be brave enough to lead the way?

– Senior Executive, Regional IDN

Presenter

Presentation Notes

When Boeing delivers a plane, they have worked hand in hand with their customers to make sure the final product meets their needs. Once delivered, Boeing and the airline continue this close collaboration to ensure successful aircraft operation Would be good to talk with someone from an airline or Boeing to make sure we have our story straight

What this means…


• Working with a few critical customers to tailor a broad product framework during development Think showers in first class on Emirates

• Supporting the customer in product use and on-going improvement Boeing doesn’t leave its customers when

they deliver the product: Engineers and mechanics are behind the scenes, supporting optimal operation and

continuous improvement

Product Development Product Delivery

The capabilities needed to successfully execute

New engagement mindset Physician and

patient education

Data-driven quality

Investment in patient access

• Patient assistance programs in high- cost disease areas

• Payer access in targeted communities

Evidence and support leverage product expertise – without formally promoting the product

• Analytics and evidence to drive continuous improvement

• Fast-turn analytics and engagement with relevant providers

• Patient support tailored to the TA and treatment, administration adherence / compliance, lifestyle


This insight enables differentiated local deployment essential to capturing value from IDNs Traditional Model:

Max SOV

• PDE-intensive • Reach & frequency

Reps

Early Change: Regional deployments

• KAM pilots • One-off partnership • Multi-channel initiatives • Continued traditional brand promotion

Emerging Future Model: Operational Integration

• Medically-based engagement • Evidence-based contribution to protocol development

• Cross-functional outcomes support

Medical rep Patient advisor

In-field HEOR

KOL ambassador

Integrated infrastructure Legacy, siloed data, tools, technology, optimization approach

26 April 29, 2015 Buggy Whips and Driverless Cars: How Pharma Must Engage with IDNs

Presenter

Presentation Notes

(direct) Key influencers – patients, prescribers, payers, group practices/IDNs (market) influencers – KOLs, employers, benefit design, pharmacy, regulatory (macro) influencers – hc reform/uncertainty, etc.� Increased treatment influence from payers, IDNs, ACOs, and patients New commercial models being implemented; require new strategies and measurement options Continued cost and growth pressure; heightened need to optimize commercial activities Rise in e-prescribing, EMR usage, and focus on value-related metrics Evolving pharma customer profile, including IDNs, ACOs and increasingly engaged patients, who exert growing influence over treatment decisions Pharma market conditions have intensified due to many environmental factors (economic downturn, generic competition, LOE, cost/price pressures, increased gov’t regulation and increasing payer/group influence) Healthcare reform is causing a shift from a cost/benefit model to a value-based and outcomes-based model Pharma needs to more effectively influence the influencers; move beyond a siloed approach to how it does this For example: Providers attempt to block or limit rep access; make treatment decisions. In response, pharma provides information, samples, coupons, vouchers, info on patient resources, and outcomes data, in an attempt to better educate the prescriber as well as incentive patient trial and usage. Group practices and IDNs likewise attempt to block or limit rep access; however, they typically define and manage treatment protocols. Pharma response is typically the same as with independent providers: samples, coupons, vouchers, etc. Patients may request a particular treatment from their physician; it’s up to them whether or not they fill or re-fill a prescription. Pharma has a few levers to stimulate demand … DTC, patient education programs, coupons/vouchers, co-pay cards, etc. Payers establish formulary rules and utilization/authorization requirements; establish and govern co-pay levels. Pharma offers rebates and discounts to counteract these, as well as furnishes outcomes/clinical info to demonstrate value and efficacy. Some also offer disease management programs as method of helping payers to manage cost and patient outcomes. Purchasers may impact formulary design for some patients. As with payers, pharma offers mechanisms to offset costs and demonstrate product value/efficacy. With all these influencers and possible remedies, manufacturers need an integrated roadmap to brand profitability through and understanding of the dynamics BETWEEN and ACROSS healthcare stakeholders at the SUB NATIONAL level … in a HOLISTIC manner … based on an INTEGRATED DATA AND ANALYTICS PLATFORM

Robust KPIs can help monitor market change and impact of IDN engagement

Primary metrics for IDN pilots

IMSCG Astellas IDN overview17 August 26, 2014

Metric Time Period Sutter UPMC Carolinas

Treatment rate with products X, Y, Z

Q2 2013 -Q3 2013

Referral rateQ2 2013 -Q3 2013

Specialist v. Other: treatmentrate

Q2 2013 -Q3 2013

Compliance Q1-Q2 2012;Q1-Q2 2013

Excellent Good PoorAverage

Relative IDN Performance (Top IDN)

KPIs for Monitoring Changing IDN Impact

KPIs for Measuring Engagement Impact

27 Buggy Whips and Driverless Cars: How Pharma Must Engage with IDNs

April 29, 2015

IMS Health’s approach integrates proprietary data assets and tools with expertise in engagement strategy

IMSCG • IMSCG integrates

tools and expertise into engagement strategy, including: − Developing value

propositions and aligning them to the appropriate customers

− Building enterprise-wide platforms and embedding them in brand- or franchise-specific strategy

− Developing engagement processes

IDN Impact


Local Market Model Optimization

IMSCG

Cap

abili

ties

IMSCG maintains well-established relationships with an extensive network of stakeholders, including IDNs

29

We conduct over 800 in-depth interviews annually with prominent U.S. stakeholders, including:

• Managed Care • Medicare B constituents • Medicaid • Hospitals / IDNs • Policy experts

SIGNIFICANT NETWORK OF STAKEHOLDERS

More specifically, we have established contacts with C-Suite/VPs, Medical Directors, Mid Level, IT Directors, Marketers/PR, and Panel Providers at prominent IDNs, including:

Additionally, we invite IDN stakeholders to serve as panelists at our annual P&MA conference

April 29, 2015 Buggy Whips and Driverless Cars: How Pharma Must Engage with IDNs

IMSCG

Cap

abili

ties

Data-driven quality improvement Integrated patient support

We can help you design collaborative solutions designed to optimize your brand’s outcomes

New Engagement Capabilities

30 April 29, 2015 Buggy Whips and Driverless Cars: How Pharma Must Engage with IDNs

Targeted Partnerships

Integrated “Boeing” Model

Please contact us for more information

John Daly Senior Principal IMS Health

[email protected] +1 973 316 4019

Elizabeth Powers Senior Principal IMS Consulting Group

[email protected] +1 917 284 2024


IMSCG

Cap

abili

ties

buggy whips and driverless cars: how pharma needs to engage … · pharmaceutical industry at...

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