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Monthly Archives December 2014

Merck’s Weight Management Business – A Patient Centered Model

The future of healthcare dictates that in order to survive, life science companies need to figure out ways to become more patient centric. In a prior article, I equated patient centricity not with a patient-oriented digital strategy but with non-drug/device products or services that complement the therapies. These business lines take into consideration such aspects as lifestyle, culture, accessibility and convenience with the goal of optimizing the therapies’ benefit and adherence.

Many companies in our industry are actively exploring means to redefine offerings and even their corporate identity so that they are viewed as providers of “solutions” rather than treatments. No matter how much product manufacturers want to believe that a given therapy is the solution, research has kindly reminded us that a multifaceted approach is often required.

One example of a company that has made the leap beyond therapy is Merck. In December of 2013, Merck announced that they were launching a weight management business through the acquisition of Health Management Resources Corporation (HMR). HMR is a 30 year old company which according to its website is backed by research and provides diet and activity counseling through clinic and web-based support. Looking at Merck’s product portfolio which includes anti-diabetes, anti-hypertensive and lipid lowering agents and with the experimental agents for atherosclerosis and heart disease, this makes perfect sense.

The direct correlation is well known between weight loss along with the required lifestyle changes, and the various parameters treated by these agents. Therapies that treat such chronic conditions are more often than not, indicated along with diet and exercise. However, adherence with diet and exercise is commonly poor which then results in poor control of metabolic parameters thus requiring an increase in medication dose. Patients may experience poor tolerability to the elevated dose and fail to adhere to therapy.

Once more, this is why this business line makes perfect sense. In essence, for diabetes and comparable conditions, Merck is offering an integrated plan which incorporates all elements of management. Products such as Januvia lower blood glucose but effective diet and physical activity help to ensure success. Even if there is such success that the patient can eventually wean off of the medication (which really should be the goal), Merck may still have a customer as weight maintenance should be a lifetime focus.

As expected with any novel endeavor, some in the industry did not know what to make of it. The reception to Merck was in fact mixed with some indicating that it is a distraction from true innovation and others essentially dismissing it. Additionally, as HMR is still considered a subsidiary and not branded as Merck it may not quite be considered an integrated solution. It is a start though.

Snowfish will continue to follow Merck and others who are moving to a true patient-centered model. Please check for our next article which features another interesting example of corporate and product redefinition.

Posted by Melissa Hammond  |  Comments Off on Merck’s Weight Management Business – A Patient Centered Model  |  in Management Consulting

New Paradigm: Patient-Centered Care

“Patient-centered care” when I originally heard that this is where healthcare is headed, my knee-jerk reaction was health care has always been about the patient, how is this any different? I questioned whether this was a new term or someone stating the obvious. As a former clinician having worked in multiple clinical settings, I was intimately familiar with how care is delivered. The focus was the patient or so I thought. Moreover, I instantly thought pharmaceutical and medical device companies develop products for patients. Why the need to become more patient-centric?

Delving down further (both into the literature and my own history), it becomes quite apparent that traditionally health care has not been about treating patients but rather managing physiologic systems. When a drug, device or procedure relieves the signs and symptoms and the patient’s “numbers” look good, the patient is declared to be “managed” or “under control”. This is even if the patient is less than satisfied about the treatment due to issues of adverse effects or inconvenience.

While many in health care value the team approach, ironically most often the most critical team member, the patient, was missing. How therapies impact the patient’s lifestyle have been largely ignored as well as non-medical approaches to disease management. These interventions have long been assumed as necessary components of proper care for a variety of conditions both chronic and acute. Physicians were not compensated to discuss things like diet and exercise (and did not really know how to guide patients anyway), and therapy companies did not want to take the attention off of their products. Lifestyle choices tended to fall by the wayside across the spectrum of the industry. For example, it has been shown that diet and exercise is often the most effective treatment for controlling diabetes when patients exhibit a sedentary lifestyle and obesity. Furthermore, most large corporations even those which have no direct business in healthcare have implemented fairly extensive in-house wellness programs are realizing the value of lifestyle interventions. Through on-site fitness centers, dietitians, health assessments, and weight loss and smoking cessation programs companies such as Verizon and Apple are helping their employees to live healthier lives. There are financial benefits to companies having active and healthy employees. Many large corporations self-insure and are keenly aware of the costs versus benefits.

According to the Institute for Health Care Improvement, practicing patient-centered care puts “the patient and the family at the heart of every decision and empowering them to be genuine partners in their care”. This includes consideration for their cultural traditions, personal preferences and values, family situations, and lifestyles. It ensures that transitions between providers, departments, and health care settings are respectful, coordinated, and efficient thus potentially reducing unnecessary services. This translates to a collaborative relationship between the provider and patient. Here, the primary provider is not just the “gate-keeper” who shifts the patient to multiple specialties in an uncoordinated fashion, but a true partner who can call upon members of a team (including specialists) to make certain that the patient not just the disease, is effectively treated.

What this means to our industry is that it is no longer business as usual, rather:

  • We can no longer just promote therapy alone.
  • Physicians alone (particularly specialists at early stages of marketing) are no longer the only prime target with other clinical stakeholders considered only as “influencers”.
  • The patient must be part of the equation when it comes to product development and how it is rolled out into the market.

A number of forward-thinking companies have been taking the lead. These are the ones who have already spearheaded or are developing programs that concentrating on the value that they as a company can bring to patients rather than how much physical product they sell. Others started or acquired completely new lines of business which complement their product offerings. Case in point, Merck recently launched a weight management company. Being a service, this is a certainly a deviation from what might have been considered their core business, however this offering works quite synergistically with Merck’s diabetes franchise. Weight loss can only help an anti-diabetes agent to work better.

Beyond those examples, there are a myriad of ways that the industry can not only adapt to this positive change in health care, but to use it to successfully evolve.

Please check out our next blog where we discuss some key players in patient-centered care that industry needs to keep an eye on.

Posted by Melissa Hammond  |  Comments Off on New Paradigm: Patient-Centered Care  |  in Management Consulting

Mid-Level Providers: How Much Do You Know?

In honor of National Nurses Week, we thought it would be appropriate to showcase nurse practitioners (NP) as well as other mid-level providers. For a growing number of patients, the clinician in the white lab coat taking their history, examining them, ordering tests, and prescribing their treatment will not be a physician, but an NP, physician assistant (PA), clinical nurse specialist (CNS), nurse midwife, or nurse anesthetist, also referred to as “mid-level providers.” In the U.S. NPs and PAs alone are already 150,000 strong. Outside the U.S., countries such as UK and Netherlands also utilize advance practice nurses such as NPs.

Yet, despite their growing role and influence, even the most sophisticated life science companies are not completely sure how to work with mid-level providers. The result is lack of attention or the wrong types of engagement by industry. Considering that mid-level providers can represent the upwards of 30% to 40% of the Rx volume for a given brand, a solid understanding of this stakeholder group is critical.

Below are some of the misperceptions that we have heard from top industry professionals with a shot of reality based on current information and a survey and interviews with over 400 hundred mid-level providers:

Misperception: Mid-level providers always take direction from the physician when it comes to making a diagnosis.

Reality: Of our respondents, 95% noted they make diagnoses independently of their collaborating physicians.

Misperception: When writing a new prescription, mid-level providers will only prescribe what their collaborating doctor wants anyway.

Reality: 78% percentage of respondents indicated they independently decide which treatment to prescribe for their patients all or most of the time.

Misperception: Mid-level providers don’t write that many prescriptions.

Reality: More than 60% report writing at least 41 prescriptions per week with 45% of the sample noting at least 56 per week. Other sources have cited well over that number. In certain drug classes they represent billions of dollars in power. For example, antibiotics, antihypertensives, antidiabetics, and psychiatric drugs are huge categories and they represent a significant overall sales volume.

Misperception: All mid-level providers work directly with physicians and for NPs, a collaborative practice agreement means direct oversight.

Reality: In the U.S., 18 states do not require a collaborative practice agreement between an NP and physician for NPs to practice. Some states require a number of collaborative hours with a physician and then the NP can practice independently. Connecticut has just passed a bill allowing such independence and a number of other states are on the verge.

In the majority of U.S. states where such an agreement is required, the level of oversight is quite variable. This may range from working in the same office to NPs working off-site with the physician only reviewing a single chart every three months. Therefore, even when working “collaboratively”, many mid-level providers are quite independent.

Misperception: Industry in effectively engaging this key audience.

Reality: There is little engagement strategy implemented specifically for mid-level providers. According to our survey many in fact felt ignored by industry sales representative when a physician is available – noting that many representatives “visit with the physicians and not me”. In general, there seems to be a disconnect between their role and their perception of how they are being regarded by industry

Targeting the Mid-Level Practitioner:

Once we’ve demonstrated the importance of the mid-level provider, the basic question we often receive is can they be targeted by disease state and therapeutic area? The simple answer is yes. We have built very sophisticated and unique means to identify mid-level providers who are the most important to your disease state. We have also created unique programs that are targeted to this very important audience. As one respondent stated, the industry should “provide information, resources for us as equal healthcare providers”.

To learn more about this valuable opportunity, you can request two white papers that Snowfish has written on the topic: In-Depth Analysis of the U.S. Mid-Level Practitioner Market and the Opportunity it Represents, and Mid-Level Practitioners Myths and Realities.

Posted by Dave Fishman  |  Comments Off on Mid-Level Providers: How Much Do You Know?  |  in Management Consulting