2012: A Health Odyssey
2012 is meant to be a tumultuous year on many counts—for politics, for astrology, for Tiger Woods—and, I suspect, for the future of our national healthcare model. A perfect storm is brewing and the forces at play are familiar to most transformations in history— technology, legislation, and economics.
The impact of electronic health records goes well beyond convenience and accuracy in the intrinsic technologic ability to collate real-world longitudinal data on conditions, treatment, patient compliance, and outcomes without having to run clinical trials. Memorial Sloan-Kettering Cancer Center in New York is working with IBM to build a tool for cancer treatment that will draw on patient histories, the center's clinical knowledge, and molecular and genomic data.
The most obvious impact of the 2010 Affordable Care Act will be around health exchanges and the desired alignment of payers and providers in optimizing cost and quality of care, but it also includes $3 billion in funding for a patient-centered outcomes research institute. All of this has the potential to reshape the role of patients in their treatment journey from being relatively passive to someone who chooses health plans, providers, the level of coverage, and actively participates in making treatment choices and measuring outcomes.
The trend toward consumer empowerment started awhile ago with high adoption of tools such as healthgrades.com, which is a consumer-submitted doctor report card. The next trend is ratings sites that include cost and quality of care data such as castlighthealth.com, a fast-growing venture-funded company that enables comparison shopping of health plans and provides visibility into what different providers charge for procedures, lab tests, etc. Especially when it comes to routine tests and procedures, visibility into actual costs (beyond a co-pay) could reshape how we as consumers balance what we directly pay for (say, through HSA plans) and what deductible level we insure ourselves at.
Of the $2.6 trillion tab for healthcare in the United States, about three-quarters of it is spent on chronic diseases; the top chronic diseases are heart disease (especially coronary artery disease and congestive heart failure), stroke, diabetes, chronic lung disease, cancer, and mental illness (especially Alzheimer’s disease). One commonality of each of these diseases (beyond the idea that there are risk markers that are likely genetic) is the fact that lifestyle management and behavioral intervention can significantly reduce their incidence and severity. Physicians and nurses have always ranked patient education and management tools as the greatest area of need. And now, as the cost of care, outcomes, and physician compensation become a singular equation, they’re bound to value these even more.
The challenge for pharma manufacturers: drive better outcomes through differentiating patient (pill plus) support programs or fight commoditization against generics
For healthcare providers, the most desired area of engagement is around patient education and disease management tools. There are some notable examples of companies that provide physician-centric patient education content, including uptodate.com from Wolters Kluwer and 360-5.com from Cleveland Clinic. And while the larger hospital systems typically have the ability to develop and implement such offerings, the greatest opportunity lies in supporting community clinics where the majority of chronic diseases are treated that have neither the funding nor the technologic infrastructure for personalized patient support programs.
And support tools developed by software or content providers typically focus on a few features (runkeeper.com or the calorie tracker on livestrong.com), whereas the realities of managing most chronic diseases have multiple needs—identifying and logging symptoms and patient-reported outcomes, avoiding contraindicated drugs or foods, adapting diet, developing an appropriate exercise regimen, getting pill and refill reminders, accessing a nurse hotline, co-pay coupon, receiving targeted adherence and side effect management messages, etc. Pharma companies are uniquely positioned to enable physicians as well as support patients in these areas and most have started to develop platforms that go beyond traditional brochure-oriented informational kits for physicians, nurses, and patients to provide customized tools for patient management (e.g., nsidernurses.com from Eisai Pharma).
Never before have we, the consumers, been as involved in our healthcare choices and in tracking and reporting outcomes; moving forward, we'll be increasingly so. According to the Patient Collaborative Chronic Care Network (c3nproject.org), Americans receive only 50% of recommended care and typically perform only about half of the "self-management" procedures and behaviors necessary to keep them healthy. Physician-patient integrated outcomes management programs could likely become a de facto treatment process, and patient-reported outcomes could routinely be integrated into electronic health records in order to drive lower costs and better health outcomes. 2012 is the year that pharma manufacturers must embrace this opportunity and invest in custom patient support programs that provide differentiating value at the point of care and prove that a pill plus model that drives better health outcomes is also a better business model.