Building Bridges: Ethical Partnerships Between Pharma and Healthcare
Steve Wild, Institutional Specialist in Pulmonary Arterial Hypertension Division at Gildead Sciences, tells eyeforpharma about the role of pharma in best practice transfer from academic centers to community hospitals, so that academic guidelines become clinical practice.
A report published in September 2012 by Institute of Medicine of the National Academies called for American healthcare to become a learning system in four areas: increasing access to knowledge, empowering patients, introducing full transparency, and embracing culture of learning.
Americans would be better served by a more nimble health care system that is consistently reliable and that constantly, systematically, and seamlessly improves. The country needs health care that learns by avoiding past mistakes and adopting newfound successes. By one estimate, almost 75,000 deaths could have been averted in 2005 if every state had delivered care on the same level as the best performing state. In 2009 alone, US$750 billion was wasted on unnecessary health spending. In recent years, healthcare – whose costs constitute 18% of the American GDP – has experienced an explosion in knowledge, innovation, and capacity to manage previously fatal conditions, but translating discoveries from bench to bedside has proven tricky.
“There’s a huge gap in the transmission of knowledge from academia to the health system, depending on the available resources. What we’re seeing in the U.S. is a lot of systems that have already adopted [a new] model of care, others who are striving to achieve that, and small hospitals that don’t have the resources to implement the changes recommended by new guidelines,” Wild explained.
There’s often a lag between when medical guidelines are published and when they’re put into clinical practice. In the U.S., the government collects all the information about diagnoses and treatment, summarizes the questions that have been addressed and flags new ones that need to be researched further. This sort of roadmap makes it easier to apply what’s published in the academic journals and guidelines.
Pharma has the motivation, the resources, the margins and all the other pieces to help.
Steve believes that the pharmaceutical industry can further assist with adoption of good practices. “The healthcare system has infinite variability in the patient populations that it has to manage, the disease state, comorbidities, genetics, etc. Pharma have an incentive to participate. This is ethical partnership that payers would welcome, rather than the current state where systems are shutting pharma out as a variability,” Wild said.
A potentially big role for pharma is in filling quality care gaps, e.g. finding patients, keeping them compliant, and transition of care. For example, during Wild’s time at Sanofi, the company had US$6-9 billion in hospital-initiated products, one of which was medicine that, when delivered to eligible patients, decreased the 30-day mortality rate nine times. “There was a huge incentive to close that quality of care gap, and deliver the drug to all the patients,” Wild commented. “Pharma has the motivation, the resources, the margins and all the other pieces to help.”
You have to get over the barrier that you're ‘just pharma’, you have to show that you bring some value.
The reason for pharma to get involved is getting a foot back in the door. Forty to sixty percent of physicians don't want to have any relationship with pharma, so getting in means offering added value to physicians, which is worthwhile, as successfully closing quality care gaps guarantees increase in revenue.
“If you initiate patients earlier, increase compliance, and have them stay on their meds longer – if you happen to have drugs that reduce mortality – the longer patients live, the longer they take your drugs, the bigger your revenue. You have to get over the barrier that you're ‘just pharma’, you have to show that you bring some value. It has to be patient-driven and patient-focused; if you follow that advice that you'll always be on the right path,” Wild said.
Despite the industry’s assurance of its good intentions, the medical community remains unconvinced. “We come with an inherent suspicion, so you can assume that there will be a lot of skepticism from institutions. That’s a high barrier to overcome, but if you do it in the right way, if you find the right model, a lot of institutions are open to hearing it. You can't let the fear [of a bad reputation make you] miss the golden opportunity to partner with systems that need your help.”
But how do you engage a system? “You definitely need to find a person who has the pressure on them for the outcomes. If you speak the language that they speak, they will be open to it,” Wild stressed that as accountability pressures increase, and while resources are being squeezed, pharma can be an ethical partner moving forward.
“For the past five years providers have been shutting us down, but I think the pendulum is now swinging the other way. We learned our lesson, we self-police, and the task at hand is so difficult, the systems can only benefit from partnerships.”
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