Patient centricity: A unifying theme for all stakeholders
By: John Doyle, DrPH, MPH | August 10, 2016
This is the eighth in a series on trends impacting the biopharma industry.
As patients take on increasing responsibility for choosing and paying for healthcare treatments they expect to be taken seriously as a key decision maker in the treatment process. In response, industry stakeholders including biopharma companies, payers, providers and regulators are implementing patient centric initiatives to engage and accommodate their needs.
Pfizer for example, has used patient centric approaches to recruit for a sickle cell disease clinical trial, partnering with a health care ethnography firm to ‘shadow’ sickle cell patients in order to gather real-life insights. Among payers, United Healthcare announced in February 2015 that more than 11 million people were being cared for by providers paid based on quality and health outcomes. And Humana plans to launch a real-time prescription drug benefit service giving physicians access to patients’ drug coverage during an office visit.
Providers are also increasingly operating their practices as patient-centered medical homes, and looking for new patient centric strategies to drive improvements in outcomes. A recent study for example, found that providing cash incentives to both doctors and patients to lower patients’ cholesterol levels led to modest improvements. The study involved primary care providers (PCPs) working in a Pioneer Accountable Care Organization with a compensation model in which a large percentage of PCP salary is based on quality performance. The authors concluded that ‘most PCPs saw patient behavior as a major obstacle to improving quality and many were frustrated that patient behaviors affected their compensation.’ There is also a trend for hospitals to set up patient advisory councils to work on projects and policies along with hospital staff.
In the regulatory space, the FDA's device arm, the Center for Devices and Radiological Health (CDRH), announced in September 2015 that it was launching a Patient Engagement Advisory Committee to provide perspective on topics such as patient preferences, risk-benefit determinations and device labeling. Meanwhile the ACA-formed Patient-Centered Outcomes Research Institute (PCORI) recently formed a network of researchers, PCORnet, to incorporate the patient perspective. PCORI has also funded 468 studies, and in October 2015 launched phase two of a program to create research networks covering specific diseases and involving millions of patients.
Patient advocacy groups are accelerating and amplifying these initiatives, with many providing direct input into trial design. A conference focused on ‘the trials we want’ held in 2014 in Brussels, brought together melanoma patients from 11 EU countries to discuss with clinicians, industry, regulators and the Centre for the Advancement of Sustainable Medical Innovation (CASMI) ‘how to explore innovative trial concepts such as adaptive licensing to ensure that clinical trials fulfill patients' needs.’ On December 4, the Boston Globe reported that hundreds of parents with children who have spinal muscular atrophy have created a ‘new grass-roots organization called Families for Acceleration of SMA Treatments’ to encourage drug makers and regulators to deliver treatments to patients more rapidly.
Outside of the immediate health care arena, in April 2015, John Hancock Life Insurance Company launched a program for U.S. consumers offering policy discounts in return for sharing of health data. Customers receive a Fitbit monitor and can earn a discount of up to 15% plus other perks. Walgreens also offered new incentives to customers willing to share healthcare data through a loyalty card channel.
Employers such as IBM, PepsiCo and J&J are weighing how to report and measure the health of their workforce. Dr. Kyu Rhee, chief health officer for IBM, says his company has long been committed to a ‘data-driven, evidence- based approach to employee wellness.’ Such ratings would give insight into a company’s success in improving employee health.
In March 2016, the Wall Street Journal reported that employees at a several companies would soon be able to get an Apple Watch for $25, ‘but there is a catch—they must meet monthly fitness goals over two years or pay the full price.’ The deal is offered through the Vitality Group and will roll out in 2016 to employees of Amgen Inc., medical group DaVita HealthCare Partners Inc. and Lockton Cos., an insurance brokerage firm.
What does this mean for biopharma?
Biopharma companies are uniquely suited to provide the healthcare marketplace with patient-centric intelligence. The journey of drug development affords biopharma companies an extended view of disease epidemiology, etiology, treatments and outcomes. The patient is at the center of these wide-angle views.
Now, pharma needs to zoom-in on the patient experience, leveraging the multiple touchpoints in the R&D process. Measuring the patient perception of their end-to-end ‘customer experience’ can drive an evidence-generation cycle where patient perceptions of healthcare states is captured systematically and quantitatively. This approach departs from the linear model of the patient journey where patient insights were captured only qualitatively. Notwithstanding the value of anecdotal patient stories in understanding patient decision-making and perceptions, demand for metrics in an increasingly data-driven healthcare system warrants measurement of patient factors with concrete data in a valid and reliable manner.
Biopharma has the scientific acumen to design these metrics, and the biostatistical/epidemiological firepower to crunch the patient data for a ‘Moneyball’ view on patients, as we do for baseball players. The quantitative view will hinge on technology to enable the appropriate level of integration to aggregate date from disparate data sets and fuel the necessary advanced analytics. Complementing this technology platform and analytics expertise is a set of core processes that facilitate patient-centric decision-making at every touchpoint in R&D, through to commercialization and life cycle management. Patient and product statistics should intertwine and correlate for the life of an asset, and in a quality-based healthcare system, those assets that optimize patient statistics are rewarded.
Looking ahead, biopharma companies should aggregate data into one patient-centric system, enabling them to tell a holistic story of the value and outcomes conferred by their products.