engaging with idns & acos - cbinet.com · engaging with idns & acos life sciences and...
TRANSCRIPT
Copyright © 2017 The Exequor Group, LLC All rights reserved.
E X P E R T I S E • C R E AT I V I T Y • A C T I O N • I M PA C T
Engaging with IDNs & ACOs
Life Sciences and Financial Services Consulting
February 2017
Version 1.0
Copyright © 2017 The Exequor Group, LLC All rights reserved.
Table of Contents
1. Introductions
2. IDN Market Overview
3. Capabilities for Effective Engagement
4. Pharma / IDN Collaboration
5. Discussion and Wrap-up
2
Copyright © 2017 The Exequor Group, LLC All rights reserved.
We Have Our Ears to the Ground
Health Systems
Health Plans
3
Over 210 Customer Interviews Conducted:
• 10 CEOs
• 60 C-Suite/VPs
• 35 Medical Directors
• 35 Mid Level
• 10 IT Directors
• 30 Panel Providers
• 30 Case Managers
Copyright © 2017 The Exequor Group, LLC All rights reserved.
Table of Contents
1. Introductions
2. IDN Market Overview
3. Capabilities for Effective Engagement
4. Pharma / IDN Collaboration
5. Discussion and Wrap-up
4
Copyright © 2017 The Exequor Group, LLC All rights reserved.
CMS
Moody’s Reacts
Recognition of emerging trend
towards value
Pilot bundled-payment program
What’s the common thread?
Shared
Risk
AAAHC
First PCMH
Accreditation
Program
HITECH Act
Push for
Meaningful Use
Private Sector
Begin Using
Bundled Payment
CMS Center for
Innovation established
Medicare and Medicaid Reform
• Medicaid demonstration models created
around bundled payments, global capitated
payments, and ACOs
• Medicare payments to hospitals for
preventable readmissions reduced
Historical
IOM Report
Crossing the
Quality Chasm
Medicare
Modernization Act
Crossing the
Quality Chasm
Use of Fee for
Service (FFS) for
all reimbursements
Full CMS
Finalized Domains
and Measures/
Dimensions
Implemented
• Efficiency
• Outcomes
• Clinical Process
• Patient
Experience
of Care
Next Generation
ACO Model
Medicare CCM Billing
Greater financial risk,
more shared savings
rewards
New reimbursement
for chronic care management
providers
Pioneer ACO Model
• Align payment model with value
• Implement: performance measurement,
internally distributing shared savings
payments, and clinical leadership
• Invest in population health and care
management system, and integrate with
EHR
Patient Protection and Affordable Care Act
Transition of Healthcare to Triple Aim
Development of Physicians
to Group Practices
Patient-Centered Outcomes
Research Institute (PCORI)
Established
Health Market Place Exchange
• Coverage begins in state-based
insurance exchanges
• Established Independent Payment
Advisory Board on Medicare
Spending
Comparative
Effectiveness
Research (CER):
CMS grant to PCORI
2000 – 2008 2009 2010 2011 2012 2013 2014 2016 – BEYOND
MACRA QPP - MIPS
BUNDLED
PAYMENTS-APMs
The Changing Healthcare Landscape:
An Ecosystem Focused on Risk…IDNs are the Delivery Vehicle
He who manages the risk, calls the shots
– Craig Samitt, EVP, Chief Clinical Officer, Anthem
5
Copyright © 2017 The Exequor Group, LLC All rights reserved.
• Regional market
dynamics dictate the
speed of the transition
The Dynamic of Shared Risk Aligns IDN and Payer Customers
Shift towardsvalue-based market
continues to accelerate
Provider risk-shifting will move beyond current ACO model
Customersfacing various
disruptive forces
Customers heavilyfocusing on chronicdisease management
• ACOs often serve as
an initial step to help
Health Systems begin
the transition
• Consolidating market,
potential further
reconfiguration
• Growing consumerism
and emergence of
narrow networks
• Changing care models
with expanding retail
sector
• Evolving structural
models dominated by
large integrated and
non-traditional players
• Across chronic
conditions, key
challenges include
preventable
hospitalizations, low
medication adherence,
and suboptimal patient
engagement
• Although population
health management is
considered to be a
critical competency, it is
still in its infancy
Plans and health systems are looking to achieve the same
goal of making the right thing the easy thing.
– David Carmouche , Chief Medical Officer, BCBSLA (regarding Humana Gold program)
6
Copyright © 2017 The Exequor Group, LLC All rights reserved.
• Quality Improvement
• HIT Adoption and
Rollout
IDNs/Organized Customers Areas of Focus:
The Quadruple AIM
IMPROVE HEALTH OF
POPULATIONS
REDUCE PER CAPITA COST OF
HEALTHCARE
IMPROVE INDIVIDUAL EXPERIENCE
OF CARE
IMPROVE CAREGIVEREXPERIENCE
• Real-world data
• Increase Revenue
• Improve efficiencies and
reduce costs
• Standardized Care
• Patient/Provider
Relationships
• Patient Engagement/
Adherence
• Enhance HCP
Development &
Leadership Skills
The focus of health systems today goes beyond
quality and encompasses value and efficiency
– Corporate Care Management, UPMC
7
Copyright © 2017 The Exequor Group, LLC All rights reserved.
Lack of understanding amongst manufacturers on how to address reduced prescription of branded drugs
The IDN landscape has resulted in several challenges for
Pharma companies; Pharma is responding
Restriction
of Access
Major hospitals and health systems are
restricting samples, gifts, meeting the
residents, and pharmaceutical
representatives access
• Creation of new IDN facing roles: Create new positions
beyond sales representative and medical liaison roles
• Use of non-traditional venues: Utilize new innovative venues
such as e-detailing, video conferencing, etc.
Reduced
Prescription
Of Branded
Drugs
Three-tiered prescription coverage in major
IDNs, upheaval of Comparative Effectiveness
Research (CER) and patent expirations will
reduce prescription of branded drugs with
little therapeutic efficacy compared to
generics
• Provision of evidence based data beyond trials: Collect Real
World Data (RWD) and additional Phase 3P trials data
• Alliances for clinical trials: Collaborate on trial design, site and
protocol
• Alliances with PBMs: Partner with PBMs observed to have
some success in educating prescribers
Meet
Changing
Sales
Dynamics
Pharma has been faced with the changing
healthcare customer segments, and
emerging new key decision makers in those
segments
• Identification of key stakeholders: Identify and target
stakeholders within IDN (CMOs and Service line directors)
• Adoption of newer sales force mix: Create separate IDN-
focused sales force within hospital sales force; use hybrid and
account executive models for targeting IDNs
Provision of
Drug/Service
Across
Continuum
of Care
Difference in IDN priorities over independent
hospitals are requiring Pharma to improve
their relationship with IDN through expansion
of their products and services
• Changing marketing focus: Portfolio approach in comparison to
product/brand focus for independent hospital
• Expansion of product portfolio and services: Expand into
diagnostics and devices, generics, nutraceuticals and health
management, and value added services—for overall wellness to
meet the basic IDN priorities
The Pharma Approach to Address IDN Challenges
Pharma Approach to IDN Customer
8
Copyright © 2017 The Exequor Group, LLC All rights reserved. 9
• Networks of health care providers, hospitals and organizations which through ownership or formal agreements, align health care facilities to deliver integrated healthcare services by improving quality and reducing costs
• Cater to healthcare needs of a population in a specific geographic area; and could cater to single or multiple TAs
• Involve multiple entities in the healthcare value chain which enable them to provide services across the continuum of care
Definition
Integrated Healthcare Networks ('Account') –Definition and Structure:
Integrated Healthcare Networks are associations of multiple entities that
aim to provide a continuum of care in a defined geography
Pa
tien
ts
Need for IDN Goals of 'Account'
I
D
N
Producer
Payers
Government
Employers
Individuals
Insurers
HMOs 1
PBMs 2
Hospitals
Physicians
Pharmacies
Wholesalers
Mail-order
distributors
GPOs 3
Pharma
Device Mfg
Companies
Increase buying power
Provide better health to
more population
Reduce cost
Facilitate patient
satisfaction
Better time utilization
Increased market
Larger customer base
Accessible network
Access to large
customer base
Integrated service
Fiscal
Intermediaries
Providers
Purchasers
Cost
Inflation
Staff
Shortage
Health
Quality
Stakeholders Motivations to adopt an IDN IDN Attributes
Care Across
Continuum
Patient Focus
Geographical
Coverage
Clinical Care
Integration
Quality
Improvement
Financial
management
Governance
Note: 1. HMO – Health Maintenance Organization
2. PBM – Pharmacy Benefit Managers
3. GPO – Group Purchasing Organizations
Increase
competitive
edge
Improve quality
of care
Share financial
risks
Improve cost
savings
Eliminate
cost-shifting
Copyright © 2017 The Exequor Group, LLC All rights reserved. 10
Integrated Healthcare Networks – Decision Making Models
IDNs exist with varying levels of decision making in drug selection and
treatment guideline policies
Notes: 1. Based on sample case studies
2. Policy Making – Guidelines set by the organization for treatment and care protocol
3. Drug Selection – Policy surrounding contracts and agreements with pharma for specific drugs
4. Prescription – Final prescribing decision that the HCP undertakes
Centralized
Model
Association of entities that are financially and clinically
integrated across regions
Single, centrally integrated formulary
Leading practices shared across regions - system wide
Clinical Practice Advisory Group reconciles protocols
from entity-based clinical committees
Sample and access restrictions exist at certain level
Decentralized
Model
Associations of financially independent entities which
are not integrated clinically as well
Multiple formularies across the 'Account' with one
formulary within an enrolled facility/region
Sharing of leading practices across regions may exist
Sample and access restrictions may exist
Hybrid Model
Association of smaller 'Account', grouping financially
independent entities, along with some clinical integration
Multiple formularies (inpatient and out-of-'Account' health
plan)
Sharing of leading practices with guidelines set by
system-wide Clinical Practice Advisory Group
Sample and access restrictions exist at certain level
Policy making
fully
centralized
Mayo Clinic
Health Care Entities (Hospitals, Med.
Groups, LTCs, etc.)
Treatment Guidelines
Drug selectionDrug selection
highly
integrated
Kaiser PermanentePolicy making
partially
centralized
Drug
selection
in each regionRegion A Region B Region C
Policy making
highly
centralized
North Shore Health System
Medical Groups
Drug selection
not integrated
Hospitals
Greater
collaboration
Consistent
care
Increased
economies of
scale
Hostility
issues from
physicians
Centralized
policy may
ignore facility
specific
issues
Greater policy
flexibility
Effective
formularies
based on
facility needs
Financial
independence
fail to capture
economies of
scale
Inconsistenci
es in care
delivery
Potential for
greater co-
ordination
Clinical
practice
consistency
across
system
Financial
independence
fail to capture
economies of
scale
Model Type Indicative Representation2,3,4Highlights of the Model1 Pros Cons
Copyright © 2017 The Exequor Group, LLC All rights reserved.
Table of Contents
1. Introductions
2. IDN Market Overview
3. Capabilities for Effective Engagement
4. Pharma / IDN Collaboration
5. Discussion and Wrap-up
11
Copyright © 2017 The Exequor Group, LLC All rights reserved.
Why engage? • Give voice to unmet need
• Produce evidence of value (e.g. time to complete
regimen; higher CAHPS scores)
Opportunity • Transform the HEC patient experience
• Differentiate on patients
Which ones to engage? • Buy and Bill %
• Skews low on SoC for HEC patients (claims)
• New option for delayed
onset CINV
• Misunderstood prevalence
• Well-established standard
of care
• Yet…large unmet patient
need
Why IDNs Matter: Value of Engaging at Launch
IDNs as Value Proposition Generator
12
Copyright © 2017 The Exequor Group, LLC All rights reserved.
Decision-Maker Access
Account Prioritization
Value-Focused Channel Strategy
Account Patient Experience
Joint Sales & Account Operations
Evolved KPIs & Reporting
Account Collaboration
Beyond profiling; identifying high-response
segments
Seeing patients / therapy area thru eyes of
the account
Beyond getting meetings: ensuring right
topic with right stakeholder
Right resources to offer account segments
Field & KAM deployment / pull-through
Metrics & incentives alignment
How to partner and implement for value
1
2
3
4
5
6
7
Evolving commercial capabilities for successful engagement
Evolving capability: What’s different:
13
Copyright © 2017 The Exequor Group, LLC All rights reserved.
Beyond Profiling: segmenting / mapping IDNs to understand
their operations and engagement opportunities
ABD Healthcare (INS00000091)
Medical Dir.: William Clay Dunagan, MD
15 Home Health
sites
Physician/Hospital Org.
76 Group Practice
sites
2 Outpatient
Clinics
2 Dialysis Centers
1 Distributor
sites
9 Pharmacies 4 Imaging
Centers
5 Work Place
Wellness sites
3
Neurosciences
sites
11 Long Term Care
sites
3 Surgery
Centers
17 Acute Care
Hospitals
1 Rehab Hospital
Novation
VHA GPO
Managed
Care
A Business Ecosystem Servicing Group Practices:
- McKesson (e.g., Electronic Health Record System Companies)
- Cerner (e.g., Practice Management System Companies)
- Sage Software, Inc. (e.g., Patient Flow Companies)
- Call-A-Nurse (e.g., Patient Service and Health Information Companies)
…..creates opportunity space
for “strategic partner” value to Barnes Jewish
understanding related business ecosystems …..
Formulary: Closed
14
Copyright © 2017 The Exequor Group, LLC All rights reserved.
Beyond Profiling: Prioritizing High-Impact Engagements
15
UPMC Infectious Disease Division created
an at-home IV clinic in 2013:
• Model enables completion of antibiotic
treatment at home, shortening stays
• Resulted in 1/3 drop in readmission rates,
from 32% to 20-24%
• 3 hospitals; looking to expand
What enabled the program:
• Monitoring protocols created for antibiotics
and infection types
• Deployed nurse visits at least once a week
• Integrated payer-provider focus
• Patient education / support: patients
instructed prior to discharge on use of PICC /
refilling the medication pack
UPMC and Pitt Medical School Launched
National Microbiome Institute*
Potential Areas of Engagement:
• Patient instruction / support materials
• At home copays / affordability
• Consumer technologies for home
monitoring
• Outcomes measurement in greater
detail
• Nurse education / support for
deployed nurses
• Physician engagement to drive
program support / utilization
• Payer support: risk stratification /
patient profile development for the
program
• http://www.upmc.com/media/NewsReleases/2016/Pages
/center-for-medicine-and-microbiome.aspx
Copyright © 2017 The Exequor Group, LLC All rights reserved.
Account Patient Experience – Therapy Utilization
16
Met /
Sulf
Basal -
SA
Basal -
LATZD DPP4 SGLT2 GLP1
IDN All
HCPsAligned Underuse Aligned Overuse
Moderate
OveruseUnderuse Underuse
Endos
PCPs
NPs/PAs
NPs/PAs
Other
Non Afil
Region-Based Clinical Informatics:
IDN patient-factored drug utilization vs. system-issued patient guidelines
Why / how to align
to guidelines?
Copyright © 2017 The Exequor Group, LLC All rights reserved.
Account Patient Experience – SPP Performance
Care Opportunities:
• IDN patients vs. regional / nation
• Build norms / benchmarks to offer information
• Use to create contract incentives
• Help with IDN owned SPP
Example SP KPIs:
• Fill rate
• Days from referral to
onboarding
• Starter kit utilization
• Patient days of therapy
• Copay / voucher utilization
• Brand specific metrics
IDNs
IndependentsMulti-Specialty Practices
Assessing SPP-based care opportunities, based on referring sphere
Account
17
Copyright © 2017 The Exequor Group, LLC All rights reserved.
Value-focused Channel Strategy
18
Analytics Influence &
Risk-Bearer Control
Multi-stakeholder
Influence & Control
Clinician Influence &
Payer Control
Clinician
Control
Differentiating on Product
Differentiating on Portfolio
Differentiating on Patients
Differentiating on Partnerships
• Real World Evidence Engagements
• Population Health and DM Initiatives
• Patient Outcomes and Satisfaction
• Therapy Adherence and Compliance
Need to Mutually Align
Objectives with Key Accounts
• Collaborative engagements creating impact for accounts and Brands
• Metrics to support / drive collaboration and impact
Copyright © 2017 The Exequor Group, LLC All rights reserved.
IDN & ACO Solution Framework
Attention / Awareness Fit
Size Timing Ops Design Work flow
Support for Scaling
MeasureProgram
OfficeEmbed Report
• Significant care need
• Ability to operationalize in
a defined time period
• Solution that fits
the organization
• Post pilot commitment &
effectiveness
Value-focused Channel Strategy – What’s Needed
Health
Systems
Marketing
KAMsMedical
Brands HEOR
Cross-functional
involvement…
…executing an IDN solutions
process:
19
Copyright © 2017 The Exequor Group, LLC All rights reserved.
Joint Account & Sales Operations
20
IDN
Regional Deployment
• Team roles aligned to IDN / local market
• Actions driven by account plan
• Marketing support for aligned offerings
KAM
Medical
HEOR
Rep
RAM
Standard tools / approach:
• IDN stakeholder maps
• Relationship progress reporting tool
• Resources / materials aligned to IDN
• Top partnership concepts pre-vetted
• CRM-based reporting
• KPI dashboards – account vs. national
Resources / offerings for:
• Formulary decision-makers
• Pathways / protocol decision-makers
• KOLs
• Patient satisfaction / experience
• Quality and process improvement
Clinicians
& Pharm.
Managed
Medicaid Patient
Advocacy
Employers
KOLSPayers &
CMS
State
Medicaid
Team
Engagement
IDN Stakeholders
Copyright © 2017 The Exequor Group, LLC All rights reserved.
Joint Deployment – KAM Skills
21
• Transactional
• Highly structured
engagement
practices
• Short / frequent
interactions
• Measured on
activity and
prescribing
• Product and
patient-centric
• Complex navigation
• Listening for
addressable needs
• Analytics recognition;
RWE opportunities
• Aligning /
coordinating cross-
functional team
• Triple aim
understanding
• Value strategies
• Account planning
Traditional Skills Evolved Skills
SKILLSETS ADAPTED FOR COORDINATION AND PLANNING
Recent study: 75+% of
KAMs come from 3
commercial functions:
• Payer account
management
(NAEs, NAMs, RAMs)
• Field sales
management
(RMs, DMs, RDs)
• Hospital and field
territories
Copyright © 2017 The Exequor Group, LLC All rights reserved.
Evolving KPIs, Aligning Metrics, Account Reporting
22
• Increase in access – formulary, protocol, CPOE
• Expansion with C / D levels
• Collaborations in play
• Involvement in care process planning / innovation
• Adoption of content / services
• Team coordination, account planning, customer communications, other factors tied to the engagement model
• HCRU savings attributable to brand
• Time from Dx to 1st fill / adherence
• Defined outcomes performance
• Patient satisfaction improvement
• Net sales growth
• IDN growth vs. community
• % HCPs prescribing / penetration
Patient Access Customer Relationship
Organization Effectiveness Triple Aim Improvement
Portfolio Value
EXAMPLE
Copyright © 2017 The Exequor Group, LLC All rights reserved.
Capability assessments – diagnostic
23
New Value
Propositions
Strategies for
IDNs
Target Patient
Experience
Ecosystem
Access
Diagnostic as
first step
Need: Develop non-
product
differentiators / full
solutions to
engage non-
traditional
decision-makers
Need: Enable brand
teams to develop
and manage IDN
strategies,
aligning with
Managed Markets
on execution
Need: Set regional /
ecosystem
priorities for
contract
innovation, new
roles, and
resources to drive
access
How to start:All four project
capabilities
evaluated to
determine areas
of improvement
focus
Need:End in mind:
Design the ideal
experience using
patient & disease
KPIs to better
manage the
optimal
experience
4 areas to initially evaluate to improve your engagement strategy:
Copyright © 2017 The Exequor Group, LLC All rights reserved.
Table of Contents
1. Introductions
2. IDN Market Overview
3. Capabilities for Effective Engagement
4. Pharma / IDN Collaboration
5. Discussion and Wrap-up
24
Copyright © 2017 The Exequor Group, LLC All rights reserved.
In a survey of 52 IDNs, Over 92% of health systems are willing to collaborate with the
industry to address care gaps and improve the process of care delivery.
Source: Health System – Pharma Survey, The Kinetix Group (2015) n=40
IDNs / Organized Customers Are Interested in Partnering
with Industry
“Our goal is to work with industry within
different arms of health economic
research to pull real-world data and
evidence to demonstrate efficacy and
cost benefits”
“We look to collaborate with manufacturers of our
preferred products”
“Presentation of an unbranded disease
management program would definitely
take our interest”
“We regard this type of research
[pragmatic trials] as very
valuable”
“Diabetes is our main
focus for collaboration
with industry”
25
Copyright © 2017 The Exequor Group, LLC All rights reserved.
Copyright©2016TheExequorGroup,LLCAllrightsreserved.
Technology
Strategy
People Processes
Provide Institutional
Approach
• Process
• Tools
Ensure Alliance
Management
Skills
• Expert
• Practitioner
• Aware
Manage Knowledge Capital
• Capture
• Refine
• Provide
Link to Strategy
• Portfolio
• Capabilities
and priorities
Effective alliance management is an integrated organizational capability.
Copyright©2016TheExequorGroup,LLCAllrightsreserved.
Alliance
Manager
Organizational Design Key Responsibilities:
• Design organizational structure for managing the Alliance
• Establish governance processes
• Interpret contract and charter
• Identify and prepare appropriate team members
Skills / Attributes required:
• Organizational and governance planning
• Contingency planning
• Team development
Conflict Resolution Key Responsibilities:
• Perform alliance diagnostic (reading the environment)
• Manage conflicts and escalation
Skills / Attributes required:
• Strong interpersonal and organizational skills
• Meeting planning, facilitation, and management
• Coaching and morale building
• Self-control
Portfolio Management Key Responsibilities:
• Participate in Therapeutic Class strategic planning
• Advise senior management of alliance's strategic
role
Skills / Attributes required:
• Sound scientific skills and understanding
• Quantitative risk management
• Senior management perspective
• Organizational astuteness
• Efficiency
Reporting and Monitoring Key Responsibilities:
• Support alliance leader’s project
management
• Prepare alliance status reports
• Monitor team workflow
Skills / Attributes required:
• Financial analysis
• Database and software skills
• Personnel assessment
• Adaptability
• Attention to detail
Alliance Strategy Key Responsibilities:
• Maintain understanding of BI, BIPI, and
Therapeutic Class strategies
• Provide up-to-date industry and market
knowledge
• Participate in specific alliance strategic plan
development
Skills / Attributes required:
• Strategic planning--alliance and portfolio
• Competitive analysis
• Tactical planning
• Written and oral communication
• Big-picture thinking
• Self-confidence
Consultation Key Responsibilities:
• Provide counsel and perspective to Alliance
Leader
• Manage culture development
Skills / Attributes required:
• Political astuteness
• Active listening
• Change management
• Relationship building
• Initiative
• Honesty and Integrity
Alliance Manager: Defining the Role (Key Responsibilities, Skills and Attributes)
1
2
3
4
5
6
Copyright©2016TheExequorGroup,LLCAllrightsreserved.
As we optimize the OCC capabilities, key Questions relating to
each of the High-Level Process steps will need to be addressed
1.0
Develop OCC
Road Map
3.0
Evaluate
Opportunities
4.0
Escalate &
Evaluate Deals
2.0
Search for
Opportunities
5.0
Close Deals
6.0
Realize Value
Key Questions:
§ How should BIPI
decide which
markets / segments
are attractive?
§ What are the
criteria by which
BIPI should target
and prioritize
markets /
segments?
§ What are the
criteria by which
BIPI should assess
each Project?
§ How should the
criteria be weighted
in reaching a
priority for each
Project?
- Are these the
same for different
Markets /
Segments?
Key Questions:
§ What does the
search engine
consist of?
§ What resource,
tools databases,
etc. ought BIPI
leverage?
§ How will searching
be organized /
coordinated (geo /
TA, etc..)?
§ Who owns key
relationships and
how are these
managed?
§ How will opportunity
responsibility be
determined?
§ How should
opportunities be
tracked against the
criteria set forth in
the OCC
Roadmap?
Key Questions:
§ How should we
sequence the
various types of
analyses to ensure
efficient use of
resources?
§ Who should
“champion” given
opportunities?
§ How will the
learnings from
opportunities be
logged for future
reference?
§ What is the
threshold for
opportunities to
advance to the next
stage?
§ Who needs to be
involved in these
decisions?
Key Questions:
§ How and when will
the due diligence
process be
initiated?
§ How will BIPI
determine “deal
breakers”?
§ Can we assemble a
standard set of
questions to be
answered through
the DD effort?
§ How will efforts to
structure the deal
link into the due
diligence process?
§ At what point will
BIPI involve Sr.
Management?
§ Will the decision criteria at this stage
differ significantly
from those at earlier
stages?
Key Questions:
§ How will BIPI stay
familiar with trends
in deal shaping?
§ Who is involved
with deal design?
§ Is there a
somewhat standard
approach to
negotiation, or is it
more of an art?
§ At what point do we
need to introduce
those with
responsibility for
implementation to
the process
§ Who needs to be
updated when deal
terms change?
§ How is the final go/no-go decision
made?
Key Questions:
§ Who will be
responsible for
maintaining
relationships with
the partner?
§ How deeply do we
need to involve the
partner in BIPI’ planning and
implementation?
§ How should this
change over time,
and as we
approach key
Project or
Development
milestones?
- Illustrative -
Exequor has experience supporting clients in their journey to Design,
Build and Run their IDN Collaboration Capabilities.
Copyright©2016TheExequorGroup,LLCAllrightsreserved.
Alliance Lifecycle
FIND the
Right Alliance
GET the
Deal Closed
RUN the
Alliance Well
Identify alliances to
fit corporate strategy
Craft clear strategy that
identifies role of
alliances.
Prioritize portfolio to link
strategy and targets.
Maximize day-to-day
alliance performance
Ensure appropriate skills
and tool to manage
alliances.
Share experiences
across alliances.
Ensure clear internal
communication of strategy.
Acquire best alliance partners
Provide easy access to
competitive and alliance
intelligence.
Maximize value of partner relationships
Leverage existing
relationships to develop
new opportunities.
Improve communication
with alliance partners.
Maintain continuous
contacts with partners.
Optimize alliance portfolio
Create broad view of
alliance possibilities from
current portfolio.
Maintain robust and timely
alliance portfolio status
reporting.
Make faster, better-
informed decisions.
Capitalize on assets
created through alliances
Capture and
institutionalize best
practices.
Build on knowledge
gained in alliances and
make information easily
available.
Increase access to
partners’ developments
Monitor existing partners’
portfolios for emerging
opportunities.
Negotiate to build an
effective working
environment.
Create broader potential
for future deals.
These levers highlight different priorities across the alliance lifecycle
Copyright©2016TheExequorGroup,LLCAllrightsreserved.
Moving to the Next Level
n Deals are created and
negotiated quickly
n Alliance measures exist but
are primarily focused on
financials
n Sharp division between
deal-makers and managers
n Perception that alliances are
formed reactively
n Limited leverage of alliances
Emerging
n Alliances are grouped and
prioritized relative to the
business model
n Excellence in creating 1
or 2 types of alliances
n Best practices are
documented
n Informal knowledge
transfer exists
n Alliance champions are
self-appointed
n Performance measures
are defined
Evolving
n Best practices actively
spread across the
organization
n Alliances integral to
business strategies
n Hierarchy of partners,
corporate policies, toolkits
n Partner-partner
communication mechanisms
exist
n Alliance training program in
place
n Top talent attracted to
alliance management
n Measurement is a core
process
n Perceived as "partner of
choice“
Excelling
Companies must objectively assess their alliance-management level
Copyright©2016TheExequorGroup,LLCAllrightsreserved.
Optimize alliance portfolio
Do the alliances right
Identify alliances to fit corporate strategy
Acquire best alliance partners
Do the right alliances
Maximize value of partner relationships
Maximize day-to-day alliance performance
Capitalize on assets created through alliances
Alliance Management Value Tree
Increase value created through
alliance
Deriving value from alliances requires a focus on key value levers
Copyright©2016TheExequorGroup,LLCAllrightsreserved.
Aligned leadership
• Understand sources of
value
• View the organization as a
network
• Act as alliance champions
• Actively manage portfolios
Effective human resource
management
• Recruit, develop, and
reward based on ability to
manage alliances
Partner-friendly culture
• Demonstrate mutual
respect
• Share vision and values
across alliance
• Maintain collaborative
environment
Institutional process to form
and manage alliances
• Focus on value creation first
• Evaluate alliance options and
targets
• Assess fit of potential partner
• Agree aligned objectives and
shared vision
• Define core capabilities
• Create operations integration
plan
• Create a collaborative culture
• Provide leadership to the
alliance
Firm-wide portfolio
management process
• Evaluate current portfolio and
needs
• Define future capability
requirements
• Plan for capability
development using alliances
• Revisit portfolio choices as
conditions change
Alliance-focused structure
• Organize to create and
sustain alliance
management capability
• Design to complement
parent organization
Clear governance model
• Craft decision criteria and
process to particular
situations
• Create portfolio
management process
linked to company planning
cycle
Supporting technology
interface (Applications &
tools)
• Provide easy-to-use tools to
support local decision
making
Supporting technology
infrastructure
• Support cross-functional,
cross-geographic, and
cross-alliance partner
communication and
information exchange
Process Skills & Behaviors Organization Technology
Critical Partnering Characteristics
Building needed capabilities necessitates a broad perspective.
26
Copyright © 2017 The Exequor Group, LLC All rights reserved.
Collaboration Center of Excellence (COE):
Supporting Customer Collaborations
“Collaboration COE”
Facilitated Activities
“Collaboration COE”
Driven Activities
Projects Owned and
Executed by the Business
Early
Product
Development
Real World
Evidence
Generation
Joint Care
Interventions
Dis-
engagement
Selection /
Initiation
Alliance
Management
Innovation Catalyst (Process and Content)
Organizational Learning and Communication
Collaboration (Alliance) Portfolio Management
Pharma Companies are finding the need to create a COE to effectively select, negotiate, manage,
engage internal participants and realize the benefits of multi-year collaboration initiatives with customers
27
Copyright © 2017 The Exequor Group, LLC All rights reserved.
Partnership
DomainPartnership Description Objectives
Engagement
During Research
& Pre-Market
Development
• Understand unmet needs and evidence
requirements for products in development,
beginning as early as phase 1 or phase 2
• Example: Tri-I TDI (Memorial Sloan Kettering
Cancer Center, The Rockefeller University and
Weill Cornell Medical College ) and Takeda for
early stage drug discovery
• Inform portfolio decisions and shape
development programs based on customer
experiences of critical unmet medical needs,
evidence requirements and market access
considerations
Pre-Market &
Post-Market Real
World Evidence
Generation
• Jointly-designed and conducted research
addressing topics across the product lifecycle
such as: unmet medical needs, current
standards of care, treatment patterns, safety
and efficacy, clinical and economic costs, and
budget impact
• Example: Humana – Lilly in evidence and
outcomes for T2DM
• Inform development programs, demonstrate
clinical, humanistic and economic value of
products and identify expanded product
opportunities
Joint Care
Interventions for
Patient/Provider
Engagement
• Identification, development and implementation
of care models and interventions to address
gaps in care, population health management,
and educational needs
• Example: Sutter Health – Boehringer-
Ingelheim in patient care for COPD
• Develop enhanced patient-focused care
interventions (based on insight into provider and
patient challenges) that can be scaled and
delivered to customers, enhancing cost and
quality outcomes
Illustrative Pharma – Customer Collaboration Areas
28
Copyright © 2017 The Exequor Group, LLC All rights reserved.
Overview of Product Development Partnership Framework
Product Development
Product Development Framework
• Objective: To understand unmet needs and evidence requirements for products in development
• Advice and perspectives on key decisions about portfolio and development programs including clinical differentiation requirements, clinical program design, pricing and reimbursement strategies cost impact and outcomes management
“What”Iterative Dialogue
• From Phase I through Phase III
• Long-term process and meeting sequence agreed to upfront
• Triggered by specific events
– Key development or commercial strategy decisions, e.g., clinical program design, pricing and reimbursement strategy, patient / physician support strategies
– ‘New news’ (e.g., competitive information or BI trial release, diagnostic developments, etc.)
“When”Engagement
Timing and Triggers
• Selection criteria for qualifying customer opportunities
• Participants depend on advice and expertise being sought (e.g., medical, scientific, commercial)
• Customer roles and responsibilities
• Pharma: CDMA, Pipeline Marketing, HEOR, Pricing and Reimbursement, Contracting
• Customer: Plan Medical, Pharmacy, Pharmacy Contracting
“Who” Participants
“How”Nature of
Engagement
• Iterative engagement
– Well planned/structured meetings (2 per yr) with a core set of people from Pharma and customer
– Cross-stakeholder meetings at key junctures to create alignment and momentum within a disease area
– Follow up on how input / perspectives were used (or not)
• Based on transparent use of data, while including linkages with other data sources
29
Copyright © 2017 The Exequor Group, LLC All rights reserved.
Customer Real World Evidence Generation (RWEG)
Partnership Framework
Real World Evidence Generation
Real World Evidence Generation Framework
“What”Jointly-Designed
Real World Studies
“When”Timing and Triggers
“Who”Study Development and Execution Team
“How”Study Mobilization
• Objective: Inform development, demonstrate clinical, humanistic and economic value, identify
opportunities for expanded indications, targeted populations, etc. based on real world research with
organized customers
• Jointly designed and executed research with an organized customer to evaluate unmet medical needs, current standards of care, treatment patterns, safety and efficacy, clinical and economic costs, and budget impact using
– Medical and pharmacy claims, clinical data, patient reported outcomes, patient/ provider surveys
– Pragmatic clinical trials and prospective and retrospective non-interventional studies
• Selection criteria for qualifying customer opportunities
• Pharma – HEOR, CDMA, Clinical Ops, Biometrics and Data Management, Pharmacovigilance, Epidemiology and Brand Marketing
• Customer – Pharmacy, Medical, Informatics / Analytics, IT
• 3rd Party – Research / Analytics Vendors, Data Services Vendors, Medical Societies, Advocacy Groups, AMCs
• Study execution – hypotheses and research objectives, study protocol and synopsis, implementation
of RWEG study and evaluation of study results, examination of real world implications
• Governance structure including decision rights (such as ownership of data/results) and scope of
activities
• Metrics to monitor study progress/results and identification of linkages across other partnership types
and internal functions
• Throughout the product lifecycle to understand unmet clinical needs, gaps in care, drug effectiveness, etc.- built into development and / or brand plans
• Triggers: Questions in product development, value proposition development for Pharma product, evolving disease guidelines, new competitive market entrants, need for confirmation of Pharma value proposition, etc.
30
Copyright © 2017 The Exequor Group, LLC All rights reserved.
Customer Joint Care Interventions Partnership
Framework
Joint Care Interventions
Joint Care Interventions Framework
• Objective: Develop patient-focused care interventions that help improve patient outcomes
• Aligned to customer priority areas and manufacturers products and services
• Addresses needs and gaps in care beyond safety and effectiveness
• Types of intervention programs: Adherence, population health management, quality support, value based benefit design and pay for performance, and transitions in care
“What”Collaborative
Care Intervention Program
• Account and / or brand plan driven• Opportunistic events (e.g., account team opportunity identification, customer request and / or market
event)
“When”Engagement
Timing and Triggers
• Selection criteria for qualifying customer opportunities
• Participating Functions:
– Pharma – Managed Care Marketing, HEOR, CDMA, Account Manager
– IDN/Payer – Medical, Pharmacy, Care Management, IT
– 3rd Party - Disease Management Vendors, Data Analytics/Informatics, Academic Medical Centers, etc
“Who”Participants
“How”Nature of
Engagement
• Jointly designed and executed care intervention
• Identification of unmet needs and pain points
• Generation of intervention objectives
• Selection of patient cohort and intervention components
• Implementation of care intervention
• Evaluation of patient outcomes and examination of implications for future programs
31