Health Care Provider/Pharmaceutical Collaborations are Key to Bringing Personalized Medicine into Practice

Jeff Elton examines the collaborative, risk-sharing relationships necessary between Big Pharma and Health Care Providers to successfully bring personalized treatments to market.

Moving targeted therapeutics successfully into the marketplace is a complicated endeavor, necessitating communication and collaboration among the different players involved in creating therapeutic value for patients and health care provider systems. In years past, the interests of pharmaceutical companies and health care provider systems sometimes seemed to diverge. Pharmaceutical companies were focused for instance, on growing revenues by maximizing therapeutic price and gaining broad utilization. Health care provider systems on the other hand, placed an emphasis on delivering care that achieved the best patient outcomes facilitated by activities that brought maximum reimbursement.

This is now changing. Most new therapies under development today are specialty therapies directed toward treating the devastating diseases of smaller patient populations. Identifying and treating smaller patient populations is challenging for many health care provider systems as they are often geared more toward addressing the health needs of larger patient populations.  

Specialty therapeutics requires specialized knowledge to determine whether a therapeutic approach is appropriate for a patient and whether the patient is responding. Overall expenses may also be higher: both the direct therapeutic cost and the cost to the health care provider system to initiate and monitor.  Because of the increase in the number of new specialty medicines and the relatively higher expenses inherent in delivering these, health care provider systems are realizing they can benefit from the deep disease knowledge and expertise of pharmaceutical companies to help better deliver the value of these therapeutics to patients.

Health Care Provider Systems Bear Risk

There is almost no industry sector that has emerged in our research where a company that bears significant risk does not seek partners to share that risk. Usually these partners bring significant expertise, which lowers the actual risk.  For example, in petroleum exploration development we find that companies with multiple partners handle specific reserves.

Collaborating with health care provider systems offers more alternatives on how they can receive compensation for the value their innovations bring to patients and the health system

Increasingly, health care provider systems are becoming risk bearers. Part of this risk involves predictably delivering clinical and cost outcomes for specific populations of patients.  Because of the complex nature of some rare and devastating diseases targeted by most specialty therapeutics, health care provider systems are using significant resources to deliver therapeutic value. Further, these providers want to make sure that they have predictable, positive economics. 

Health care provider systems can benefit from the deep disease expertise of pharmaceutical companies that have worked on new approaches to disease intervention and management for a decade or more. For the pharmaceutical companies, collaborating with health care provider systems offers more alternatives on how they can receive compensation for the value their innovations bring to patients and the health system.

Health care provider systems are ever more efficient in the data they can collect on patient response to therapies and the full system cost for providing this care. They design and manage the care management processes, and can collaboratively redefine how new therapies can be brought into practice effectively and efficiently. Together, health care provider systems and pharmaceutical companies can define approaches to measuring and delivering value broadly defined.

Novel Care Management Approaches

Health care provider systems are looking for new operating models as well as new partners willing to share risk. Current health payers are increasingly becoming health care providers.  Health retailers and services companies are now directly providing care.  Across these potential partners, we’ve seen care management approaches evolve to bring together the disease knowledge of pharmaceutical companies with the clinical clarity offered by current and new health care provider systems.

Together these partners drive to a real word perspective on the care and value being delivered.   There will be greater use of analytics, patient population models, tools that define specific patients at risk, as well as new care-coordination approaches. For instance, for certain groups of patients, health care provider systems may run analytic models to define the clinical cohort and associated care management approach potentially most beneficial for the patient. 

These approaches provide additional tools and expertise that complement and enhance the role of the individual clinician provider. To assess efficiency and effectiveness, many new risk and financial models focus on populations of patients, in turn requiring effective use of ubiquitous electronic data available on patient status, clinical resources, and outcomes realized. The changes in reimbursement models, shifting the risk to health care provider systems, the broad availability of data, and new analytic approaches are enabling new operating models.

Personalization through Collaboration and Precision

This new collaboration and risk-shared environment is bringing pharmaceutical companies and health care provider systems together to achieve a more effective personalization of care: providing care to patients for which they can knowingly be the beneficiaries. Personalization is enabling greater precision, where analytics can bring to bear the most relevant evidence and information about an individual patient in order to direct treatment options and treatment response expectations. This approach enhances efficiencies while assuring that the highest value innovations reach the right patients – in contrast to the early quotas and allocation-based models of some national health systems.

Pharmaceutical companies, health care provider systems and patients all can benefit from any new knowledge generated around a disease state

In one instance, a regional health care provider system in the US working with a pharmaceutical company recently announced a collaboration to improve patient health outcomes by focusing on innovative solutions that facilitate shared decision making between patients and physicians, and which improve adherence to treatment plans and clinical care processes. Investigators from both the health care provider system and pharmaceutical company worked together to improve patient adherence, increase the role of patients in making decisions to help manage their conditions, share information among extended care teams, and improve clinical care management processes.

Interestingly, one of the first tools under development from this collaboration is an interactive web application designed to help primary care clinicians assess and engage patients at risk for cardiometabolic syndrome, a clustering of various risk factors that put an individual at risk of developing type 2 diabetes and cardiovascular disease. Together the pharmaceutical company and health care provider system were able to define solutions that were more personalized, more precise, and more efficiently delivered therapeutic services.

In summary, pharmaceutical companies, health care provider systems and patients all can benefit from any new knowledge generated around a disease state. For instance, patient adherence to therapy is a mutual problem. Health care provider systems seek patient adherence to a therapy to keep their disease under control. Pharmaceutical companies seek patient adherence to therapy to assure they fully realize the value of the approach and to assure they have optimized their position in the market.

If you'd like to discuss this issue further, you can contact Jeff directly at

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