Product Value: Are you thinking about it enough?

The pharmaceutical industry is flooded with talk of value; value dossiers, the value story, value messages, value demonstration and value-based pricing. Value is now even more pertinent with the new NHS value-based pricing system launching early next year. This follows the expiration of the current Pharmaceutical Price Regulation Scheme in January 2014. The new scheme aims to have a greater focus on the value medicines offer to NHS patients and the wider community.

The Government’s response to the latest report from the Health Select Committee states that suggested changes to the pricing system appear modest and there are yet to be any final decisions as to how the new system will be used in practice. The Government report advises any such uncertainties should be resolved by the end of this month (March 2013).

What is value?

As value is strongly linked to the price of a new treatment it is important to fully understand what value means in this setting. When assessing the overall value of a medicine, clinical, economic and patient factors must be considered.

Clinical value is defined by the product’s efficacy data from clinical trials and how these compare to existing and future competitors. The safety profile, method of administration and effect when used alongside other treatments are also important.

Economic value can be demonstrated using cost-effectiveness analyses, such as a budget impact model. Indirect costs or out-of-pocket expenses for the patient may also be evaluated.

Value to the patient and carers includes the impact on quality of life, adverse events and ability to perform daily activities. Patient reported outcome tools, such as the EQ-5D, can be used to measure these end-points.

Real world value is a new concept, where the product is evaluated in practice – Do doctors prescribe it? Do pharmacists recommend it? Do patients prefer it? Data from real world studies will help payers re-assess the value of products that are already available.

What does this mean for pharma?

Pharmaceutical companies have an enormous challenge ahead – products will have to demonstrate value in early clinical trials to prevent high research and development costs which may not be able to be recovered. It is also no longer enough for a new medicine to display similar properties to existing products – innovation and an increase in efficacy, reduction in cost, or improved quality-of-life evidence is required.

References

1. NICE. NICE “central” to value-based pricing of medicines. 22 March 2013. Accessed 24 March 2013. Available at: http://www.nice.org.uk/newsroom/news/NICECentralToValueBasedPricingOfMedicines.jsp

2. HM Government. The Government’s Response to the Health Select Committee’s Eighth Report of Session 2012-13 on the National Institute for Health and Clinical Excellence. March 2013 Available at: http://www.officialdocuments.gov.uk/document/cm85/8568/8568.pdf ISBN: 9780101856829

ARE DOCTORS GETTING SMARTER?

Statistics show that in the UK there are a staggering 83 million mobile subscribers, which represents a market penetration of 130%.  Of these, 43%, or 36 million, are smartphones and this percentage is expected to increase to 75% by 2016.[1] Doctors are already ahead of the curve; 80% own a smartphone, 31% own a tablet and many regularly purchase apps to enhance their working lives.[2]

Opinion is divided over whether proactively increasing and encouraging the use of ‘smart’ tools in a medical setting is a good thing or not. Some of the potential pitfalls include the potential for risk of infection, the lack of regulation around their use and the creation of a barrier (leading to reduced credibility) between doctor and patient.  The level of accuracy is also a cause for concern, although apps being used for diagnostic purposes, such as a dosage calculator, may be considered a medical device. These tools must be registered with the Medical and Healthcare products Regulatory Agency (MHRA) to ensure that all the relevant checks have been undertaken.

Putting these concerns to one side, it’s easy to see the potential for apps as an information resource for doctors and patients alike, particularly as mobile technology becomes more sophisticated.  App-enabled accessories new to the market, such as the Nike+ Fuel Band and the iBaby Monitor (controlled from your iPod touch, iPhone, iPad or Mac mouse), have proven to be incredibly popular and an estimated 40% of all new apps are being developed in the health and wellbeing space.

To-date, there has been a lack of national guidance on the use of mobile technology by the medical profession, with decisions taken at a local level. However, the government’s campaign to encourage doctors to ‘prescribe’ smartphone apps, to help patients manage conditions ranging from diabetes to depression, will help to fuel a shift in this area.  The aim of the campaign is encourage patients to take more responsibility for their own health, reducing visits to doctors and thereby ‘putting them in the driving seat.’ For example, the Diabetes UK app reminds patients to check their blood sugar levels and to take their medication, with information sent electronically to the patient’s surgery or clinic.

This initiative will no doubt drive the debate about the use of smartphones in a medical setting up the healthcare agenda, but ultimately the technology will only benefit patients if the content is accurate, responsible and engaging.

Tracey Carey
Director

1. Smartphone Futures 2012-2016, 2012, Portio Research.
2. Doctors.net.uk and T. Ringrose Mobile technology: pharma companies struggle to engage with doctors on the go. 2012.

“Do you want us to start turning away patients and leaving them to die?”

This was a question, posed in frustration last week by a lead clinician in a London hospital to his NHS Trust bosses. It was in response to being told to save £500K in the next 12 months or they would “find the savings for him”. In a therapeutic area where treatment is a life or death issue, therapy is life-long, and where the patient pool continues to grow in a short-staffed department, this is a tall order.

Last week I met with four lead clinicians across London. At each meeting I grew more hesitant about asking the question “How are things going?” The response was always the same: a tortured expression and then a torrent of frustration and resignation about the continued financial squeeze and the renewed push towards the new NHS. One clinician revealed that,  in addition to a burgeoning workload, he was now required  to tender for his department to continue to provide the specialist services that he and his NHS team have been doing (rather well) for more than 10 years.

The next 18 months will be interesting, to say the least. As an observer, I wonder how clinicians will deal with the diverse pressures that the Health and Social Care Act will put upon them and their departments. As a member of the public, I look on nervously as the responsibility for care transitions away from the ultimately altruistic and benevolent NHS to the profit-driven, shorter-term motivations of private companies. All this coupled with the government’s target of saving £20 billion by 2015.

So where does this leave the pharmaceutical industry? A big question…with many different factors to consider: a tougher climate in which to make the case for new, expensive drugs; a new approach to evaluate a drug and its worthiness for reimbursement; and a more localised, needs-based formulary decision-making pathway. Big challenges, which won’t be solved overnight.

But what about the everyday challenge faced by brand teams in every pharma company: how to grow your brand, demonstrate leadership in the category and build relationships with healthcare providers in a sustainable way? Well, perhaps the current situation offers the industry an opportunity.

Dr David Pencheon, Director of the NHS sustainable development unit, doesn’t beat around the bush: “When will the pharmaceutical industry stop making chemicals and start managing the health of communities?... The only game in healthcare reform is integration, and if pharma wants to play its part it has to join together with the health service rather than just provide the pills… When I take over as an NHS commissioner, I’ll contract whichever drug company wins the tender to provide a total diabetes service for 50,000 patients.”

The NHS needs help, and the pharmaceutical industry is well-placed to provide that help and meet their own objectives in the process. The long-term outcome will be a stronger and more trusting relationship between drug companies and healthcare providers. There is now an opportunity to really demonstrate that industry can do the right thing, and do things right.

At Mash, we’ve just finished working on one such project: a training programme aimed at increasing testing and diagnosis of a long-term condition. In industry-speak, a market expansion programme; from the clinician’s point of view it is a much-needed resource, which helps them deliver training to their colleagues that has been on their to-do list for months. From a public health perspective, it improves outcomes and reduces the overall cost of caring for people living with the condition. Since its pilot in October in a large centre in London, it has been taken up by over 30 other centres across the UK; in one centre it has increased testing by junior doctors by 60% and shifted earlier diagnosis by 13%. And all this on a relatively modest budget (let’s not forget that pharma companies too are experiencing some significant belt-tightening measures at the moment). It is gratifying for us to see such a positive and instantaneous uptake of this programme and for our client, it delivers against their objectives.

So how did we do it, and how can this be applied to other brand challenges? And in this time of economic strain for all parties, how can it be delivered efficiently?

1 - Listen. Really listen. Don’t just run an advisory board and diligently take notes for 7 hours; go out and visit clinicians, in their departments. See where they work and what they are faced with every day. Let them tell you about their world. And if you’re developing a training resource, pay attention to what it is that’s stopping people from doing what they need to be doing more of; really work hard to unpick the barriers. If you understand their day-to-day challenges you’ll be much better equipped to deliver something of real value.

2 - Collaborate. Don’t just create something and present it fait accomplis to your audience; involve those who are going to deliver, and be the recipients of, your resource. Not only does it mean that you don’t risk losing resonance and relevance during the development process, it also means you have a ready-made promotional vehicle once it’s finished – and the vehicle is a whole lot more credible than some of the alternatives. In our project this meant taking on board feedback about the importance of language and phraseology in our messaging and paring down what we’d previously thought to be key content. To succeed, you really need to be prepared to sacrifice, and you need to be humble. Your collaborators are the experts.

3- Motivate.  This is the easy bit. If you’ve done the first two parts right, the third will come naturally. Your project will already have engaged stakeholders and people prepared to talk about it – they’ll want to shout it from the rooftops. In our case study, this meant a collaborator was prepared to present the oral presentation on the project at an international and national conference, and then offered to be involved in taking the project to the next stage, with a different audience. When you talk about your project to other people in the field, your methodology for developing it will naturally spark their curiosity and encourage them to be involved.

We’re not going to change the world overnight, but by genuinely collaborating with clinicians and by listening to their everyday challenges, we can work with them in small but significant ways to help make their lives easier, improve patient outcomes, and bring credibility and trust into healthcare–pharma relationships.

Louisa Bassant – Head of Planning and Client Services at Mash

View Louisa’s LinkedIn profile: http://uk.linkedin.com/pub/louisa-bassant/13/a70/409

Follow Mash Health on Twitter: @mashhealth

Understanding the human brain to maximise adult learning

People gain knowledge in a variety of ways, but key in any educational platform is that the training is a memorable and rich experience. This is even more applicable for medical education where the content is sometimes intellectually heavy, and dare I say, often not delivered in the most appealing manner. At Mash, when tasked to provide training programmes, we strive to ensure delivery is interactive, entertaining and pitched appropriately to delegates’ everyday lives.

In a recent programme we’ve developed, the training was designed so delegates could discuss, think and report back to each other on the challenges uncovered during tuition, while minimising ‘chalk and talk’ lecturing. Delegates were also asked to step outside their own world and understand the challenges facing healthcare professionals and other members of their team. With the programme now running globally it’s clear from feedback that the different elements of this type of training fuel learning and, more importantly, motivation. The ethos behind the methods used in our training programmes is based on current thinking. At Mash, we believe in science, and that science is fundamental to what we do. A basic understanding of the functionality of the human brain in information retention is critical when we design and deliver any of our training courses, whether that is internally to clients or externally to healthcare professionals.

Some leading neurologists believe stimulation of different areas of the brain during the learning process improves the transfer of knowledge into long-term memory. However, the brain is made up of different areas with different and complex functions. All regions of the brain have different stimuli, so this is where broad-spectrum learning techniques are required to maximise retention of information in what is normally a short period of time.

Take the brain stem for example – responsible for basic vital life functions. If in a training environment, the brain stem is not satisfied and the student is scared, at the wrong temperature or hungry, the brain stem will distract from the normal higher-level learning processes. The retention of information communicated will decrease and the delegates won’t get the most out of the training. It’s of key significance to look at the bigger picture of the environment in which we will be communicating with our trainees.

Colin Rose’s method, outlined in his book ‘Accelerated Learning for the 21^st Century’, focuses on information absorption and we firmly believe this is critical to running a successful programme. Neuro-linguistic programming (NLP) is the process by which, as humans, we absorb information around us. There are only a finite number of ways that information can enter our brain – the five senses, sight, smell, hearing, touch and taste. Essentially, a delegate will remember 95% of what they teach to someone else, 80% of what is experienced personally by them, 70% of what is discussed with others and up to 30% of what they see, read and hear.

In a corporate environment it is not always appropriate to use all of the NLP pathways. However, by maximising the number of senses stimulated, the amount of information passed into the memory will increase. If, simultaneously, you adopt a teaching method that utilises both linguistic and creative regions of the brain to be stimulated concurrently, then training efficacy is particularly enhanced.

Brain-friendly learning techniques are becoming increasingly common and gaining a larger following among educators. It has become clear that in modern society, traditional teaching methods have less of a role to play as science unlocks more information in the psychology of learning. A change of focus in the teaching methods from traditional styles, as well as a basic understanding of how the brain works, could unlock the potential in you and your delegates. 

Daniel Baldwin

Facilitating Better Patient Communication

In my last blog I made the case that poor patient adherence often results from inadequate communication between healthcare professionals and their patients.  So, how can the healthcare industry help support healthcare professionals (HCPs) in ensuring their patients achieve the optimum benefits from products?

Since communication and relationship building are at the core of everything that Mash does, here are some of our top suggestions to maximise the face-to-face time that patients have with their HCP.

Talk the talk – No two people express themselves, or their symptoms, in exactly the same way. This is complicated further by the divergence in communication styles between men and women, and by age and culture. To facilitate discussion, industry can help establish a common language between the HCP and the patient, utilising discussion aids, for example, so the HCP can better appreciate a patient’s symptoms. Patients can then be reassured that they have been a) heard and b) provided with individualised instructions on how best to manage their condition.

A picture speaks a thousand words – Help speed up diagnoses by providing tools that allow patients to express themselves in a way the doctor can access easily. Simple pictorial representations could dramatically improve identification of symptoms from both a HCP and patient perspective. They may also provide a starting point for discussion and, consequently, help to identify how much the patient understands about their condition – enabling more targeted advice from the HCP.

Be clear, be concise – Recognising what is possible within the confines of a consultation is essential to good patient-HCP communication. Overloading HCPs with recommendations on what to communicate to their patients within a 10-minute consultation may put pressure on the doctor and could overwhelm the patient. Instead, industry can help HCPs communicate by identifying the relevant key points of the condition and treatment advice. This allows both patient and HCP to be confident that the essential details have been covered effectively - and, more importantly, been understood - when the consultation is over.

Knowledge is power – The Department of Health states on its website: “more informed patients are more empowered people”. Industry can help supplement the key points discussed above by providing well written, patient-appropriate literature that also signposts to trusted and verified sources, such as patient support groups, which the HCP can provide to help counter patients’ follow-up questions post-consultation. This not only frees up HCP time during a consultation for more effective discussion, but also caters to those patients that learn visually rather than aurally, or who need additional time to process the HCP’s information; in short, those for whom a 10-minute discussion may not be constructive. HCPs can then be confident that, while they have not been able to discuss every aspect of an illness in detail with their patient, they have provided a credible starting point to help patients become more empowered to  self-educate and self-manage.

Self-management and self-education are becoming increasingly important considerations as rising populations and recession put ever more pressure on global healthcare provisions. So, in addition to clear and concise communications, it is also timely to provide patients with the tools to help themselves. This, in particular, provides the pharmaceutical industry with the opportunity to offer sound, evidence-based information in an accessible format that can genuinely help facilitate and improve HCP interactions while encouraging patient empowerment.


Catriona Raleigh