Measuring Success in Patient Centricity
Defining patient value and the ability to create it through patient-centric objectives and associated KPIs.
Modern pharma is depicted as an industry made up of organizations with a deeply ingrained patient-centric culture. Many big companies involve patient representatives during executive level decision-making. “The focus on the patient is absolutely critical to the future success of companies, and the ones that don't do it will be left behind,” predicts Kinapse Medical Affairs Advisory Lead, Neil Croft, who recently wrote a whitepaper entitled ‘Managing Performance in Patient Centricity.’ Croft poses the question, however: “What is actually going to change and what are you really going to do that's different from what you have been doing?” Such questions arise from the fact that despite so much discussion and advocacy for patient-centricity, there has yet to be an agreed-upon industry definition. Therefore, there is also no agreed-upon vision or definition of success.
Companies need to be able to know that they're driving in the right direction and they're achieving patient-centric outcomes and creating value for patients.
Croft’s proposal is to have a framework for measuring and assessing the performance of an organization in terms of patient-centricity. “Companies need to be able to know that they're driving in the right direction and they're achieving patient-centric outcomes and creating value for patients,” he explains. There must be a systematic and standardized approach to making patient-centric decisions and designing patient-centric treatments.
The Triple Aim of pharma
There is often a perception that discussing financial ROI and patient needs in the same breath is improper. However, patient-centricity is best associated with the Triple Aim of pharma, which Croft proposes is composed of creating patient value, driving scientific innovation, and generating financial ROI. These three components comprise the major goals that can help make patient-centricity sustainable and practical. Recognition and active consideration of all three elements will ensure that companies consider more than just financial factors in their portfolio decision-making and investments.
Financial performance is one of the long-standing measures of success for companies. “We also need a way of understanding and measuring the impact that we have on patients, and seeing that as an equally important part of the success of the organization. Are patients able to do more in their daily lives? Are they able to meet their own personal life aspirations using the treatment that they've been given?” asks Croft.
The concept of placing the patient at the center is not new; however, without an agreed-upon definition for patient-centricity, as well as standardized measures of its success, pharma can’t ensure there is a balance in terms of focus between patient value and shareholder value. The question still persists: How can the Triple Aim of pharma be translated into actionable targets that bring value to both businesses and patients across the industry?
Setting Key Performance Indicators
According to Croft, the answer may lie in first agreeing upon the objectives of the organization. After which, the critical success factors that enable achievement of those objectives must be explored, and then the KPIs defined based on those critical success factors. He says, “People think about KPIs and sometimes think they're just collecting numbers, creating ways to beat people or to define their bonuses by. Really, it’s about having measures in place so that you can understand whether your performance is aligned with or going in the right direction to actually achieve your objectives.”
For instance, a company’s strategic objective is to understand the patient and put that understanding and insight into project strategy in a meaningful way. Critical success factors would then focus on whether or not the company has proper patient insight management. “Are we managing insights effectively? Are we sourcing and analyzing them effectively? And then are we using them effectively to input into project strategy?” asks Croft. KPIs can then be designed around those critical success factors.
“No company that I'm aware of is actually systematically looking at and developing KPIs in patient-centricity, but it is something that is really important and is actually quite high on people's agenda,” says Croft. He is referring to an eyeforpharma poll showing that 80% of pharma executives consider KPIsto be the area of greatest interest in patient-centricity, which was mentioned during the webinar entitled, ‘Engrain patient centricity throughout your company.’
Croft proposes a holistic framework of KPIs that considers both external impact factors and internal company factors. External KPIs include outcomes (clinical, patient-centered, health, etc.), patient experience (including patient feedback), and improvements in access and adherence. Internal KPIs include strategy (e.g. clarity of strategic targeting of patient needs and degree of senior level sponsorship), process (how well the patient voice is incorporated), and capability (level of skills and access to tools needed to deliver on objectives).
However, Croft emphasizes that this framework isn’t prescriptive and requires further input from patient representatives.“The reason I proposed these KPI categories was to try to put something on the table. I think it's quite hard to take that leap from just thinking about ‘What are our objectives?’ to actually ‘What are the areas we might measure?’” According to his whitepaper, these proposed KPIs are not a comprehensive view of all possible measures; however, they provide a starting point for discussion and iteration.
KPIs are standardized tools that make objectives not only measurable but ideally some may also be made transparent to the public. These indicators could give patients and other stakeholders the basis for holding a company accountable towards its promise of patient-centricity.“You're showing that you've got a baseline and an improvement in an area. People can see that it's not just a pharma company trying to make money without really caring about whether or not if it makes a difference for patients,” explains Croft.
Creating the balance
KPIs can help align the decisions, actions and resource allocation of pharma towards a harmonious understanding and implementation of patient-centricity. However, a balance must be struck among the components of the Triple Aim. There must be guidelines as to the implementation of the KPIs to ensure value for both the company and the patient.
Aligning the desires of payers and patients
Money is still the most commonly used measurement of success. “Pharma companies have had it in their mission statements for many years that their focus is on delivering for the patient, but actually when you look at how they've assessed success, it's been the traditional business metrics of profit and share price,” observes Croft.
As a result of this financial measure of success, many of the strategies in pharma may be geared towards suiting the payer reimbursement system. Payers and regulators use instruments to evaluate a drug or treatment’s performance and make cost-benefit decisions, but these instruments are generic and may fail to address the specific needs of patients. However, the desires of the payer and the patient should not be mutually exclusive. Studies presented to payers for reimbursement purposes should be designed not only based on traditional cost-benefit analysis, but also on what patients with a particular condition are looking for. According to Croft, “That's a really compelling story to take to a payer, to actually say this is something that's going to have a real impact on a patient. Payers are really open to listening to that kind of argument and are looking to find ways to factor those elements much more in their decisions.”
Much of the alignment of the desires of payers and patients depends on working towards common goals within an organization. “There will be product teams where Medical and Commercial would both sit on those teams,” says Croft. “They need a common understanding of what the targets are. They need to be working together to achieve those. It’s a small part of the puzzle in terms of aligning those two functions, but I think it's certainly contributing in the right direction,” he suggests.
Adherence is an obvious metric for success, both for the company and for the patient. When adherence to treatment and medication is high, the patient has the best chance of achieving positive health outcomes and is more likely to continue using the treatment. However, Croft cites published evidence showing how adherence still averages at only 50% across different conditions.
Another problem with adherence is that many companies don’t have a scientific approach to improving it. “There is science in terms of what drives adherence, and I'm not sure that all companies really make the best use of that,” he observes. For these reasons, Croft includes adherence as one of the external KPIs. Together with treatment access, adherence data can help evaluate improvements in the healthcare system targeted by specific company initiatives, such as those enabling improved patient diagnosis.
Systems level participation
Within the organization, KPIs must be designed, implemented and monitored based on hierarchy. This means that KPIs adopted by each department or individual must be relevant to that department or individual. Croft cites the example of how senior-level executives would need to focus on portfolio-level measures while Medical Affairs managers may focus on the impact of recently adopted physician or nurse educational programs as a part of their suite of KPIs.
By applying metrics appropriately at different levels of the company hierarchy, an organization can ensure that the most relevant metrics guide decisions and actions to benefit the patient. This kind of targeted approach can also help ensure that the cost of implementing KPIs does not exceed the benefits of improved resource allocation and decision-making.
Beyond the organization, adopting an ecosystems perspective can help an organization identify gaps in care delivery that can be targeted by its services. Gaps could refer to a lack of better diagnosis or achievement of best possible outcomes. An example provided by Croft is the Gardner ‘cascade of care’ in HIV that illustrates how many people are infected with HIV, as well as how many have been diagnosed and treated and are achieving optimal health outcomes. Such tools can help identify gaps, which can serve as opportunities for pharma to offer services that strengthen the patient’s link to healthcare and improve outcomes.
By clearly defining patient value and implementing KPIs that monitor the creation and progress of this value, companies will be able to see whether they are truly moving towards their patient-centered vision. According to Croft, “Without well-defined definitions, targets, and roadmaps the culture-shaping process may not lead to the desired outcomes.” He adds, “A robust performance management approach is important for alignment, to ensure that everyone in a company knows they are driving toward common patient-centric goals and outcomes, and that is how they are going to be assessed.”