How well pharma companies engage with payers within a morphing NHS landscape will determine whether brands succeed or fail.
2019 promises to be a year of action for the NHS where key policy themes such as 'prevention rather than cure' may be given real teeth, and newly formed Integrated Care Systems (ICSs) will start to make some traction. Staying ahead of the curve will be challenging.
But by segmenting payers into groups with similar definable drivers, and providing added-value services that support the NHS's prevention policy, forward-thinking pharma companies can foster mutually beneficial relationships with the NHS that will last far beyond 2019.
'Prevention rather than cure' was the overriding message from Health Secretary Matt Hancock as he set out his long-term vision for the NHS in November 2018. The NHS's goal to give people "five more years of healthy, independent life by 2035" will be achieved through "joined-up care that is centred around individuals", he said. Tackling health inequalities, increasing personal responsibility and improving early intervention will be key in delivering this pledge – and we have been promised more meat-on-the-bones in a Green Paper due in early 2019.
Throughout 2019, ICSs will forge closer links between NHS organisations and local authorities, giving greater emphasis to prevention and population health as well as the integration of health and social care. ICS metrics will also have a heavier focus on prevention. Furthermore, the move towards one bottom line within ICSs (The System Control Budget), with everybody working towards achieving the best outcomes for patients through more efficient spending, should, in theory, enable more early intervention and preventative care services.
Provide added-value with supportive healthy behaviour education packages and complementary wellness programmes. These extra services will help to foster a longer-term relationship as the ICSs seek to fulfil the prevention agenda.
Emphasise preventative elements of therapies in business cases and how they can support people to live healthier lives and avoid expensive secondary care.
Ensure your value propositions complement a wider package of care. Typically, commissioners see the costs of care as falling into three categories: consumables (including the medicine budget); location of care costs; and staff costs. The opportunity here is to define the optimum patient journey that ensures all the appropriate steps are taken and effectively implemented, while reducing unnecessary staff or location costs objectively and defensibly.
Develop Integrated Care Pathways (ICPs) to reflect the new structure. Show how a robust care pathway can help prevent ill-health and help the NHS shift care to the lowest intensity setting to reduce costs.
the new drivers and priorities for payers in 2019, we must not overlook the power of segmentation. Taking a 'back to basics' approach and segmenting the payer audience into groups with similar motivations can help with brand positioning and ensure that messages resonate.
an understanding of the evidence needed to provide each type of payer with a reason-to-believe.
Driven by the desire to be innovative across budget management and project delivery. Evidence required: Past examples of innovative working with other healthcare partners.
Driven primarily by the desire to demonstrate the best possible patient outcomes and experience. Evidence required: Patient experience; Patient reported outcomes (PROMs).
Driven by comparing the value for improved outcomes – either within a therapy area or across therapy areas.
Evidence required: Comparative effectiveness data (including PROM and observational data to inform pharmaco-economic models and cost-effectiveness analyses); Cost per quality-adjusted life year (QALY); Head-to-head randomised controlled trials data; threshold levels of confidence.
Driven by ensuring the budget is optimised across the care pathway. This includes location and staff costs. Evidence required: Medicine wastage; Medicines optimisation; Service capacity; Preventing unplanned hospital admissions; Secondary Uses Service data.
Driven by the ambition to strategically move forward and to leave a personal legacy. Evidence required: Resource allocation model; Service specifications; Medicines optimisation; Joint working with industry; Models of care; ICS.
Driven by a need to show a rational business case to their line manager. This type of payer looks for a 'package' that can be easily implemented, with minimal effort. Evidence required: Integrated Care Pathway; Health Technology Assessment guidance; Consensus views.
It is important to remember that payers are often a mixture of more than one 'type' and so payer engagement should always be aligned accordingly. Profiling and targeting payers in accordance with brand planning – such as defining helpers vs. hinderers and mapping according to the adoption curve to segment early adopters vs. laggards – is also helpful.
2019 will undoubtedly be a year of uncertainty for pharma. We look forward to the NHS providing more detail in its long-term strategy on how it plans to embed its policy agenda – including answering the all-important funding question.
Taking a 'back-to-basics' approach that re-examines payer motivations can help navigate through the new integrated commissioning landscape, and shape your payer engagement strategies, in order to successfully differentiate your brand and ensure cut-through for your value proposition.
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