When I first read through the 65 performance metrics outlined in the ACO draft proposal from CMS (Table 1, pages 174-194) it was easy to imagine how drug treatment could help healthcare providers in an ACO meet or exceed some of their performance expectations. Based on studies that have already been done, including regulatory clinical trials, it is clear that making sure patients are getting the right drug, in the right dose with supportive patient education and adherence programs could have a dramatic impact on improving clinical outcomes while reducing overall healthcare costs. But pharmaceutical marketers will want to look beyond just matching and aligning their products’ regulatory claims with these performance metrics to find the hidden opportunities to deliver maximum value and patient benefits.
Healthcare failure statistics (e.g., hospital related infections, treated but uncontrolled diseases, lack of responsiveness to treatment, complications of multi-drug treatment, and patient non-adherence to treatment) while disconcerting, have often been ignored or just taken for granted. But, these types of numbers can give clues as to where prescription drug treatment could help healthcare providers in ACOs (or other healthcare provider systems) improve the quality of care and clinical outcomes in cost effective ways.
Across healthcare, the list of failure statistics seems never ending from clinically inappropriate drugs or dosing being prescribed to adherence related issues, outright medication errors, and patient disappointment with the explanation about discharge medications. Even a cursory internet search of product relevant disease states will yield a wealth of failure statistics that could potentially be improved, many simply with the appropriate use of prescription drugs.
Don’t be discouraged by the variability of the statistics for any given problem. The precision of specific numbers is not important because at this stage you are looking for clues for where you might be able to make an improvement. You’ll get real world hard numbers from the healthcare provider sites you work with to develop your baseline data.
You should be able to put together a disease and treatment statistical profile for each of your products. What I am suggesting is going beyond the global numbers of patients and market shares traditionally used for determining opportunities and driving forecasts. You need to dig deeper to find the performance improvement opportunities, the types of patients or situations that represent less than satisfactory healthcare performance. Here are a couple of examples:
There are plenty of safe and effective prescription drug treatments available, including generic drugs. When you take a quick look at the overall average numbers there might not seem to be much of an opportunity for significant performance improvement. After all, 68% of adult hypertensive patients are being treated with anti-hypertensives and 64% are achieving blood pressures less than 140/90mm Hg (controlled). But a closer look reveals that the percentage of treated patients is much low in younger patients (age 18-59), especially men (47%) and Mexican Americans (50%). The percentage of controlled hypertension is also lower in older patients (58%) than in younger patients (72%), in general. Insurance coverage has also been identified as a factor with 71% of uninsured hypertensive non-elderly adults uncontrolled. More striking is that 52% of those with private and 45% with public insurance remain uncontrolled.
Again, at first glance one might find it hard to suggest there is an opportunity for performance improvement when you read that over 60% of elderly patients receive pneumococcal vaccine. But a closer look reveals that the percentage of adults aged 65 years and over who had ever received a pneumococcal vaccination was 39.8% for Hispanic persons, 64.9% for non-Hispanic white persons, and 44.5% for non-Hispanic black persons. More importantly, despite vaccinations and effective antibiotics there are still 52,000 deaths related to pneumonia in the US every year.
While there may be considerable opportunities realized by encouraging more patients with signs and symptoms of depression to seek treatment, here are some statistics that would suggest there are even opportunities within the treated patient population. Only 24% of depression patients recover following 16 weeks of drug or psychotherapy and remained well during 18 months of follow-up and 50% of depressed patients treated by medication relapse within two-years.
My intent here was not to provide an exhaustive statistical profile for these diseases but rather to demonstrate that previously ignored or taken for granted healthcare failure statistics, especially those related to treatment failure may represent new ways to help healthcare providers achieve their quality and clinical outcome performance metrics. It may take some investigation into the reasons behind some of these numbers but if they are patient selection, dosing, or adherence related, you could be onto something.
Developing a useful value proposition and supportive data will require identifying the specific failure-based statistic opportunities and then determining with provider systems which improvements will make a difference for them and what data could be developed to demonstrate meaningful improvements. Keep in mind, healthcare provider systems will now have electronic medical records to help track and follow interventions (e.g., education and adherence programs) and patient responses to treatment.
Again, this goes beyond marketing your regulatory claims for safety and efficacy. It also takes some research beyond traditional market profiling in a marketing plan. It will require creativity to interpret the ACO performance metrics in the context of how your products will be assessed and how your product might be able to improve some of the relevant healthcare failure statistics. These healthcare system improvements in quality or clinical outcome performance metrics not only benefit patients but could have significant financial implications for healthcare providers. email@example.com