Monthly Archives October 2012

Nurse Practitioners and Physician Assistants: Taking a Closer Look

You might meet them when visiting a clinic or hospital ― clinicians who are not physicians, though perform examinations, order tests, make diagnoses, round, write prescriptions, and perform minor office-based procedures. These are nurse practitioners (NPs) and physicians assistants (PAs).

Recent phenomenon? Absolutely not. In the U.S., NPs and PAs have been practicing as far back as the 1960’s and 70’s when the professions were created in response to a shortage of healthcare providers. This has since evolved into more than 150,000 NPs and 74,000 PAs in the U.S. according to the ACNP and AAPA respectively.

Still, despite their history and rising numbers, there is opportunity to learn more regarding how these clinicians fit into the healthcare system. This can impact decisions from business strategy to hiring. I have compiled some facts to shed some light on this area.

  • The influence of NPs and PAs within the U.S. healthcare system is likely to grow. As a result of provisions included in the Healthcare Affordability Act, tens of millions more individuals will likely enter the healthcare system and as stated by an executive within U.S. Primary Care at Pfizer, primary healthcare providers are “already stretched way too thin.” Hence, according to the President-elect of the AAPA, the U.S. government is looking to NPs and PAs to take on a greater role to accommodate this growth, noting the healthcare reform language “talks about the physician, PA, and NP.” This will also further facilitate the shift away from the individual provider model and toward the patient-centered “medical home”, in which a team approach is used to optimize patient outcomes.
  • NPs and PAs practice autonomously. A recent survey we conducted with over 500 NPs and PAs noted that while 81% reported having a physician on-site at all times, they diagnose independent of their collaborating physician 95% of the time. Furthermore, 66% of NPs and PAs reported making their own treatment decisions and 78% indicated that they make this decision independent of physician review 76 to 100% of the time.It is not uncommon to have situations in which there is no physician on-site. “I am the lone provider and work with 8 psychotherapists a nurse,” says a psychiatric NP practicing in Kansas. She adds that her collaborating physician is located an hour and a half from her office. NP-owned/managed clinics already exist and are expected to expand if legislation being considered in 28 states is passed permitting NPs to practice without a physician collaborative practice agreement.
  • NPs/PAs and physicians are not interchangeable. Though she emphasizes the similarity between a NP/PA and a physician “in the responsibility of diagnosis and treatment,” and that “the standard is the same”, a PA from Illinois makes it clear that she is not a physician. “It is extremely important that I am aware of my limitations so that if I either have questions, doubts or suspicions about what I am seeing or hearing, I get in touch with my supervising MD.”

    The length of training is significantly shorter for NPs and PAs therefore they tend to concentrate on the less complicated cases. This is not necessarily a limitation, as noted by the AAPA president-elect, for “it allows the physician to focus on the patient with the complex problem,” and therefore the NPs and PAs can “spend a little more time” with the less complex patients ultimately providing “a better experience” for them.

    NPs and PAs are not exclusive to the U.S. The UK and Canada employ NPs and PAs with the model now being recognized in Japan. The Netherlands began to train NPs in 1970’s as they faced a shortage of providers. NPs are also found in Sweden, Australia, New Zealand, and South Africa. Other nations including Taiwan have recently begun exploring the role.

A top executive at U.S. Primary Care at Pfizer stresses that NPs and PAs are already valuable members of the primary care team. “We feel they are important customers and are seriously considering new ways of engaging them.” Their team is using an interactive model to better understand how they can assist these clinicians obtain better outcomes for their patients and then customize the approach to based upon their practice interests. As put further, it is “not a one-size fits all approach.” As stated by the Pfizer executive, “we’ve always engaged mid-level providers, but we need to ensure we’re having a dialogue with them, not just a one-way delivery of information.”

Feel free to download our free white paper which offers unique insight on the role of NPs and PAs in primary care and beyond.
Melissa Hammond, MSN, GNP is managing director of Snowfish, LLC.

Posted by Dave Fishman  |  1 Comment  |  in Management Consulting

Looking for the Pharmaceutical Product Fountain of Youth? Strategic Repositioning May Be the Answer

The crucial question when determining the fate of a mature product; where do we go from here? From the mid-point of the product lifecycle onward the momentum gained from a very successful launch slowly begins to dampen. New product entries, new data from competitors, generic competition, and changes in practice patterns all contribute to the product assault.

Loss of market share is not inevitable. Careful and critical evaluation of the potential pathways is very important. There are multiple ways that strategic repositioning may be approached. The exact approach will be driven by the unique circumstances surrounding the product, clinical environment and financial resources. In one form, repositioning uses available data to further differentiate the product with upcoming generic competitors and insulate the brand from the most immediate effects of generic competition. This ranges from specific patient subtypes to supporting data which further enhances the product’s unique benefits. This also includes the engagement of new target audiences. Strategic repositioning also may involve the identification of method to improve the molecule or formulation that justifies issuance of a new patent for the product. In the 1990s several examples of this strategy are readily apparent (e.g., Prilosec to Nexium; Albuterol to Xopenex). Finally, new formulation and delivery tactics could be used to develop an entire new product or category. For example, salmeterol plus fluticasone equals Advair and formoterol plus budenoside equals Symbicort.

Which direction to take is guided by an analysis incorporating these four key elements:

  • Fully leverage clinical data to determine key opportunities for repositioning based upon key differentiators.
  • Determine the full potential with respect to labeling, follow-on products, and intellectual property.
  • Using data-mining techniques standardize clinical data into a consistent, accessible, and reviewable format. Potential new indications or delivery methods can be fully explored to extend the exclusivity of a product.
  • A data-centric approach will support patent longevity, novel dosage forms within the standard exclusivity period, as well as line extensions afterward.

Effective repositioning will most certainly breathe new life into a pharmaceutical product. It is the closest thing to the product fountain of youth.

Posted by Dave Fishman  |  Comments Off on Looking for the Pharmaceutical Product Fountain of Youth? Strategic Repositioning May Be the Answer  |  in Management Consulting