Adherence and the empowered patient
Peter Mansell explains how patient access to new technologies and new data could impact everything from compliance to cost-benefit analyses.
By on Jun 28, 2010Peter Mansell explains how patient access to new technologies and new data could impact everything from compliance to cost-benefit analyses.
If healthcare data, and the new technologies through which those data are collected, analyzed and distributed, are fast becoming the backbone of a more outcomes-driven pharmaceutical market, this trend places patients firmly center-stage.
Of course, drug companies have talked for years about putting the patient first, about riding a wave of patient empowerment and meeting the demands of an assertive new generation of health consumers.
But the entrenched structures of healthcare provision and culture, resistance to letting industry engage directly with patients, and industrys own aggressive marketing focus on healthcare professionals, have too often made that sound like empty rhetoric.
Now, though, a number of related developments around product awareness and access are reshuffling traditional interactions between pharmaceutical companies, healthcare professionals and patients.
New channels of access
These include the explosion of healthcare information online and the new relationships forged through social media and online pharmacies; new drug compliance and monitoring tools; the proliferation of market access stakeholders and payer restrictions; the shift towards personalized medicine; rationalization and restructuring of pharmaceutical sales forces; and increased scrutiny of industry alliances with patient groups.
Industry urgently needs new channels of access that provide a counterweight to health technology assessments, let patients make up their own minds about what constitutes value and innovation in a price-sensitive environment, and allow companies to pursue cost-effective marketing strategies not dependent on sales force muscle or huge advertising budgets.
And it must do this without giving regulators a platform to argue that building relationships with patients is just about pester power or cultivating brand champions by stealth.
Yet the confluence of patients, data and new technology does seem to hold the key.
One reason is that the general public, and particularly a generation for whom Web 2.0 tools and mobile communications are a fact of life, have proactively and enthusiastically embraced these tools without many of the qualms preoccupying regulators and holding industry back from a leap into the future.
Grappling with the service transition
The debate over electronic health records and data privacy typifies this disconnect.
As Michael Schwartz, vice president of global business planning and administration for Bayer Healthcare, comments in Ernst & Youngs Progressions: Pharma 3.0 report, there seems to be a generation gap between those currently in management positions in pharma and those likely to be the next generation of management in how far digitization [of health data] can go and on when we are pushing the boundaries of data privacy.
With their love of social media, the younger generation publish personal information on the Internet without misgivings, Schwartz notes. This generation is already market-ready and will have fewer concerns about sharing health data.
Some of these technologies, such as the growing suite of medical applications available through Apples iPhone, are undoubtedly empowering doctors, giving them the mobility and flexibility to transmit patient data, access health information or even take readings and perform diagnoses at locations far removed from office- or hospital-based care.
By the same token, though, a chronic disease patient equipped with a home or mobile monitoring system, which not only manages drug compliance but keeps a close eye on long-term health outcomes and flags up any need for therapy adjustment, has less use for intervention by a healthcare professional and a more direct relationship with the product and/or service provider.
As industry grapples with what George MacGinnis of PA Consulting Group describes as a complex service transition, one that locates the product itself as just one component of a more holistic healthcare offering, this provider could well be a pharmaceutical company, whether alone or in partnership.
More personalized medicine
PA Consultings Bob Damms sees all this as part of a broader definition of personalized medicine that goes beyond technical advances in patient stratification to address issues of patient responsibility, public health, and lifestyle choices.
At the same time, he adds, realizing those concepts will require societal changes, including, in some cases, different systems of health coverage.
Where healthcare is free at the point of use, people tend to take it for granted and health is not valued in the same way as, say, looking good, he explains.
Personalized care also marks a reversal of the centralization trend in medicine driven by previous technology advances.
Doctors who used to diagnose and treat patients in their own homes have become increasingly office-bound and wedded to large, expensive technologies operated in hospitals, Damms notes.
If industry can redesign its business model so that it is an active participant in the personalized medicine landscape, the interactions, conversations and data exchange that define Web 2.0 and other new media could be central to this transformation.
The power of social media
Of course, there is a commercial logic to all of this.
Industry may not itself be generating the data or steering the conversation, but direct patient experience and feedback will be invaluable as regulators and HTA agencies increasingly focus on real-time outcomes throughout the product lifecycle.
Then there is the impact of those conversations on patient attitudes to choice and access.
Patient groups have in the past (e.g., Herceptin in the UK) proved a useful source of leverage when high-priced new drugs have come under cost-benefit scrutiny.
This is something regulators, health systems, and industry critics are all too aware of.
As a result, some pharmaceutical companies are now nervous about getting too close to the patient lobby, at least at a formal level. PR and media coverage is another matter.
These companies may be tempted to see the still untamed landscape of social media as an easier and cheaper way of participating in conversations that could in the long run give them a distinct commercial edge.
At a recent digital marketing forum in the UK, one industry speaker referred to patients and the general public as the new key opinion leaders.
The social media landscape may be hard, and potentially treacherous, to navigate in an uncertain climate of legality that has yet to catch up with the speed of technological change.
But the informed, data-rich patient could be the empowered health consumer pushing for your medicine.
It is estimated that health 2.0 consumers are twice as likely as the average e-health consumer to request a prescription.
Whichever way you look at it, that piece of data is hard to ignore.
For more on empowered patients, see Patient power and marketing.