1 Competing in An Outcomes-Oriented Healthcare World Presented by Chris Bogan, Chief Executive Officer
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Competing in An Outcomes-Oriented Healthcare World
Presented by Chris Bogan, Chief Executive Officer
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What We See Influences How We Act! How Many Faces Do You See?
Source: Three Faces at http://www.mindfake.com/illusion_41.html
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Which Figure Is Largest In This Optical Illusion?Do We React To Healthcare Stakeholders In This Same Way?
Source: Three Faces at http://www.mindfake.com/illusion_41.html
“We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next ten. Don't let yourself be lulled into inaction.”
– Bill Gates
We Overestimate The Pace Of Change And Underestimate The Long-term Impact Of Change: Consider Health Outcomes
NATIONAL STRATEGY FOR QUALITY IMPROVEMENT IN HEALTH CARE.‘‘(a) ESTABLISHMENT OF NATIONAL STRATEGY AND PRIORITIES.—‘‘(1) NATIONAL STRATEGY.—The Secretary, through a transparent collaborative process, shall establish a national strategy to improve the delivery of health care services, patient health outcomes, and population health. . . .
- Excerpted from the Patient Protection and Affordable Care Act, 2010
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Increasingly Doctors Consider Cost as Part of the Treatment Algorithm – Affecting A Product’s Launch & Growth Potential
Cost & Insurance Plan Become A Critical Consideration
Stent Patients Can Clot Post Surgery
“Do you have good insurance?” That’s critical to ask your patients. If you have any concern, then you wouldn’t want to put them (stent patients) on prasugrel. The higher co-pays could mean they don’t fill their prescription or they miss starting or taking their medicine. With stent patients, you just don’t want to take that risk.”
-- Cardiologist & Epidemiologist, Duke University Medical Center
Post-Mortem Analysis of A Disappointing Launch for Effient
Page | 5Source: BP,LLC Field Research
Memorial Sloan Kettering Cancer Center Now Believes Cost Is A Legitimate Criteria By Which To Assess Treatments
“AT Memorial Sloan-Kettering Cancer Center, we recently made a decision that should have been a no-brainer: we are not going to give a phenomenally expensive new cancer drug to our patients. . . .”
NY Times OpEd Column
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For 2400 Years, Physicians Have Tried To Heed The Words of Hippocrates
“First do
no harm .
. . . .”Hippocratic
Oath
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Is A Physician “Doing Harm” If He / She Knowingly Prescribes Treatments That Increase Patient Risk Of Personal Bankruptcy?
Number of Americans Struggling Under Medical Bills
35 MillionPursued by Medical
Collections1.7 MillionBankrupt
by Medical Bills
56 Million: Trouble Paying
Med Bills
17 Million: Credit ratings hurt by Med
Bills
15 MillionDeplete savings to pay Med Bills11 Million:
Run Up Credit Card Debt to pay
Med Bills
10 Million: Skimp on food, rent & heat to pay Med
Bills
Medical Bills Are Greatest Single Cause of Personal Bankruptcy in U.S.
Source: Stats from Nerdwallet Health - http://www.nerdwallet.com/blog/health/2014/03/26/medical-bankruptcy/
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Our Field Research Picks Up Many Market Signals That Companies Are Accelerating Their Investments Into Outcomes Research
Effective Outcomes
Research is Increasing in 7 of 10 companies in next 24 months
N = 32
Page | 9Source: BP,LLC Field Research
“WHAT IS YOUR ORGANIZATION’S EXPECTED INVESTMENT FOR HEALTH OUTCOMESRESEARCH DURING THE NEXT 24 MONTHS?”
Michael Porter Has Conceptualized The “Hierarchy Of Outcomes” -- But They Reflect Only Clinical Outcomes
Sustainability of health or recovery and nature of recurrences
Tier 1Health Status Achieved or
Retained
Tier 3 Sustainability
of Health
Tier 2Process of Recovery
Survival
Degree of health or recovery
Time to recovery and time to return to normal activity
Disutility of care or treatment process (e.g. , diagnostic errors, ineffective care, treatment-related discomfort,
complications, adverse effects)
Long-term consequences of therapy (e.g., care-induced illness)
Recurrences
Care-inducedillnesses
Source: Michael E. Porter, What Is Value In Health Care?, N Engl J Med 2010; 363:2477-2481December 23, 2010DOI: 10.1056/NEJMp101102
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Outcomes Innovation Is Another Strong Signal As New Technologies Transform Many Conditions & Therapeutic Areas
Innovative Outcomes
Research is Increasing in nearly 6 of 10
companies next 24 months
N = 32
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“WHAT IS YOUR ORGANIZATION’S EXPECTED INVESTMENT FOR HEALTH OUTCOMESRESEARCH DURING THE NEXT 24 MONTHS?”
Source: Best Practices ,LLC Field Research & Analysis
New Genomics Technologies Help Align Treatments With Specific Sub-populations To Improve Health Outcomes
"By combining our expertise in molecular diagnostics and cancer research, we have developed the first genetic test to help doctors prescribe the appropriate treatment for kidney cancer patients based on their tumor profile.“--Executive Director Professor Jackie
Y. Ying, Exec. Director,Institute of Bioengineering and
Nanotechnology (IBN), Singapore General Hospital (SGH) and National
Cancer Centre Singapore (NCCS)
Coloured urogram (X-ray) of the left kidney of a patient with renal clear cell carcinoma (blue). Credit: Sovereign, ISM/Science Photo Library
“FIRST EVER KIDNEY CANCER MOLECULAR TEST PREDICTS PATIENT’S SURVIVAL AND DRUG RESPONSE”
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Patient-reported Outcomes Research Is A Critical Priority – Revealing Patients Often View Successful Treatment Differently Than Clinicians
Patient-reported Outcomes
Research is Increasing in 5 of
10 companies next 24 months
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N = 32
“WHAT IS YOUR ORGANIZATION’S EXPECTED INVESTMENT FOR HEALTH OUTCOMESRESEARCH DURING THE NEXT 24 MONTHS?”
Source: Best Practices ,LLC Field Research & Analysis
When One Examines Investment Along the Patient Journey, You See Many Missed Opportunities
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21%
10%
20%
17%
15%
Average % of Patient Initiatives Budget Invested at Each Stage of Patient Journey
Stage II:Diagnosis of Condition
Stage III:Consideration of
Therapeutic Options
Stage V: Disease Management
Stage IV:Treatment
Stage VI:Patient Empowerment
Phase I:Awareness & Screening
(n=18)
17%
Page | 14Source: Best Practices ,LLC Field Research & Analysis
New Treatment Models Focus on Patient-centered Outcomes –Often By Including Quality of Life and Functional Perspectives
Duke Model:Integrating Palliative Care Into Chronic Cancer Care
Source: Dr. Arif Kamal, MD, Director of Quality & Outcomes, Duke Cancer Institute, “Ensuring High-Quality Palliative Care in Oncology Practice”
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PatientsLikeMe.com Has Created An Open Research Exchange for Patient Reported Outcomes
PLM lets patients drive better reporting, tracking and metrics for improved care, discovery and outcomes.
Page | 16Source: www.patientslikeme.com
Patients & Clinicians See the World Through Different Lenses
Clinical Voice:
“Gait Disturbance” =
Medical term for
reduced walking or
Disturbance in how
one walks
Patient Voice:
“Bump into things,”
“Limping,”
“Walk like a drunk,”
“Foot dragging,”
“Problems with stairs,”
“Stumbling walk”
Page | 17Source: Best Practices ,LLC Field Research & Analysis
Patients – Through PRO Social Media -- Have Helped Reshape Diagnostics for Conditions Like Fibromyalgia & Chronic Fatigue Syndrome
Old Diagnostic Sample:“What’s Your Degree of Pep?”
New Diagnostic Uses Patient Perspectives To Reinvent Diagnostic:
Source: “Pharmacotherapy for fibromyalgia”, published in Frontiers in Pharmacology, 30 March 2011 | doi: 10.3389/fphar.2011.00017, Howard S. Smith1*, Donna Bracken2 and Joshua M. Smith. http://journal.frontiersin.org/Journal/10.3389/fphar.2011.00017/full
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Patient-Reported-Outcomes Via Social Media May Become A “Disruptive Technology” in Healthcare
Founded 2006 Conditions: fibromyalgia,
multiple sclerosis, ALS +
2000 othersConcluded ALS Drug Did Not
Work 18 Months Before Clinical
Trial Concluded, 2010
Among Top 50 Most Disruptive
Companies –MIT Technology
Review, 2012
online network of + 250,000
patients by 2014
April 2014:Genentech
Enters 5-year Subscription to PatientsLikeMe
Database
Page | 19Source: Patientslikeme.com & Best Practices Analysis
“. . . Curing somebody for Hepatitis C has benefits that go beyond the liver. It's recognized now that hepatitis C is a chronic inflammatory condition that over time leads to more diabetes, more heart disease, more CNS disease and you could certainly reasonably argue curing somebody of their hepatitis C infection has collateral benefits that go beyond the liver. And we've actually shown that in our own Phase 3 studies. It's a result that's somewhat underappreciated. We have looked at PRO, patient reported outcomes, and we have shown in a blind fashion that the people in the studies that achieve an SVR, they had much better outcomes than those that didn't. And the better outcomes were they felt better, they had less bodily pain and they had even better mental health status.”-- Norbert Bischofberger - Executive Vice President, R&D
and Chief Scientific Officer, Gilead SciencesQ1-2014 analysts meeting transcript
Patient-Reported Outcomes Spotlight New “Off Balance Sheet” Benefits Of Effective Treatment
Photo Source: Vertex Pharmaceuticals 2012 Annual Report; http://investors.vrtx.com/2010ar/ Page | 20
The Payer Hierarchy of Outcomes Again Looks Very Different From A Clinician’s View
Total Cost of Care
Reduction
Cost Avoidance
Reduced Hospital Stay
Lower Hospital Re-admission
Price
Differentiation / Comparative Effectiveness
Non-responders
Quality of Life / AdherenceTreatment
Duration
Hospital Re-admission
Rate
Price
Page | 21Source: Best Practices ,LLC Field Research & Analysis
48%
The Rise of HEOR (Health Economics Outcomes Research) Groups Signals New Emphasis on Outcomes Research for ACOs & IDNs
% Companies Rating Research Partnerships With ACOs and IDNS
Highly & Somewhat Effective• HEOR Leadership Is Ascending
• VP-level execs now often lead
HEOR
• HEOR specific roles emerging for
global & national units
Page | 22Source: Best Practices ,LLC Field Research & Analysis
Bio-Pharma Field Staff Acknowledge Their Companies At Times Send Mixed & Confusing Signals To Thought Leaders
“Multiple people (within our
company) are engaging KOLs on
outcomes”
“Different team members offer / quote different fee rates for KOL activities in
this area, confusing the KOLsand making them distrustful”
“Lack of communication on
learning”
“Lack of communication
regarding strategy”
“Poor coordination across teams”
“Not clear why you are engaging, what is the business need. It can’t
simply be: ‘We’re launching a product’. ” FIELD INTERVIEWS WITH BIO-
PHARMA STAFF CALLING ON KOLSRE: OUTCOMES
Page | 23Source: Best Practices ,LLC Field Research & Analysis
Payers, Patients & Physicians All Seek More Comparative Effectiveness Research (CER) Against Multiple Reference Points
CER vs. Market Leader
“WHAT IS YOUR ORGANIZATION’S EXPECTED INVESTMENT FOR COMPARATIVEEFFECTIVENESS RESEARCH DURING THE NEXT 24 MONTHS?”
Crowded Market CER
N = 32
CER vs. Generics
CER vs. Fixed Dose Combos
Page | 24Source: Best Practices ,LLC Field Research & Analysis
National & Private Payers Are Examining CER to Assess Product Differentiation and Reimbursement Merits
“. . . In an early benefit assessment pursuant to
the Act on the Reform of the Market for
Medicinal Products (AMNOG), the German
Institute for Quality and Efficiency in Health
Care (IQWiG) has examined whether this new
drug for MS offers an added benefit over the
appropriate comparator therapy specified by the
Federal Joint Committee (G-BA). However, no
added benefit can be determined, as no suitable
data are available, neither for the direct nor for
the indirect comparison.”
-- The German Institute for Quality and Efficiency in Health Care (IQWiG)
August 1, 2014
Source: https://www.iqwig.de/en/press/press_releases/press_releases/dimethyl_fumarate_for_ms_added_benefit_is_not_proven.6230.htmlPage | 25
Measuring Outcomes Quality Requires Multiple Metrics Reaching Across Patients, Payers & Providers
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The Holy Grail: Integrated Outcomes Reflecting All Three Perspectives
Family / Caregiver
Satisfaction
Patient Outcomes
Patient Satisfaction
Physician Satisfaction
Cost Containment
Speed of Action &
AEs
Payer Recognition
Cost Avoidance
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Survival, Safety,
Efficacy & Quality of
Life
Source: Best Practices ,LLC Field Research & Analysis
(Efficacy + QOL –Safety Risk Factors – Rehospitalizatiza-
tion – Total Cost)
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(Efficacy + QOL Benefits – Safety,
Side Effects & Risk Factors)
(Efficacy +Daily Function + QOL
Benefits –Safety Factors)
(Efficacy –Price/Cost – CER v.
Generic -Rehospitalization +
QOL Benefits)
Looking Forward, The First Bio-pharma Companies That Produce Integrated Outcomes Research Will Have A Decided Advantage
3 Questions To Compete in An Outcomes Oriented-World
1. Are you conducting research trials focusing on clinical outcomes, payer outcomes and patient-reported outcomes?
2. Do you have a well conceived strategic plan for your scientific publications that includes all four outcomes perspectives?
3. Do your scientific publications report outcomes research findings for Patient, Payer, Physician & ACO/IDN perspectives?
Scientific Publication Audit Factors By Stakeholder
Key Insights To Propel Your Organization Forward
1. Health outcomes is a cresting tsunami.
2. Investment levels are rising for all
outcomes types.
3. Patients, payers, physicians & ACOs/IDNs
use different metrics.
4. Patient social media platforms & ACO / IDN
networks are changing the healthcare
business model.
5. Integrated scorecards will include all
customer perspectives
6. Many companies seem slow in getting
ready to compete in an outcomes oriented
world!
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Best Practices, LLC
Source: BP,LLC Field Research & Analysis
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About The SpeakerChris Bogan is founder & CEO of Best Practices, LLC, a global thought leader in the field of best practice performance improvement for companies in the bio-pharmaceutical. medical device and healthcare sector.
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E-mail: [email protected] (Phone) 919-767-9228
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