How Will Pharma Bring Value to the Evolving ACO?

---Terri Bernacchi, PharmD, MBA,  President, Cambria Health Advisory Professionals, and FOUNDER, SME Systems (this blog also posted on www.smehealthsystems.com)

This is the inaugural post for SME Systems and I will be linking it to others that I post on the web; the issue (especially given my background as a pharmacist with experience in both the clinical and business world in the US) is clear to me:  how will branded pharma and device companies continue to bring value under a retooled US Health Care system? 

The critical changes are removing the traditional parties (doctor and patient) from the buffered world where “someone else will pay for this”.  Risks are being spread, insurance rates are going up and providers are being penalized for what is perceived as “over spending”. 

The new Accountable Care Organization (because it is taking on transferred risk) is unlikely to allow “business as usual” with the pharmaceutical sales machines that have been so successful in the past. 

So how does one INNOVATE and then MARKET in such a different environment? 

In a word, I believe, you can only do these things if you shift your own perspective and become willing to prove value in different ways.  That may be the key mission of SME Systems:  proving Safety as part of compliance and VALUE as part of Medical Effectiveness. 

Tim Norton published a brilliant commentary about the fact that now about 70% of the market is government backed, the meaning of competition, the success of the Medicare Part D program and HHS’ recent attempt to break what worked in that program, too.  HHS has backed off on their most recent plans but the threat to the bounties of a competitive marketplace are clear.   (See the link:  http://blog.pharmexec.com/2014/03/12/close-call-for-american-rx-marketers-on-medicare-part-d/ )

Since I cannot say it better than he did, I hope you read this for yourself.   Here is the most critical part of his commentary and his clarion call to be alert: 

“I believe it’s clear that as the U.S. progresses farther and farther down the road of expansive public healthcare, U.S. pharmaceutical companies are going to face many battles with public entities that will attempt to close their free market channels.

Hopefully, this recent “close call” with Part D is not a foreshadowing of what’s to come. But frankly, as the inevitable cost pressures develop in all these public programs, I would not be surprised to see more of the same, and soon.

In any case, the wise American Rx marketer would do well to fully understand and appreciate the developing mindset of all the new public programs now coming online…A mindset that is definitely not free enterprise oriented.”

Terri is the Founder of SME Health Systems and Cambria Health Advisory Professionals.  She is a Senior Partner at Valiant Health, LLC.  The thoughts put forth on these postings are not necessarily reflective of the views of her employers, clients nor other colleagues. Terri has had a varied career in health related settings including: 9 years in a clinical hospital pharmacy setting, 3 years as a pharmaceutical sales rep serving government, wholesaler, managed markets and traditional physician sales, 3 years working for the executive team of an integrated health system working with physician practices, 4 years as the director of pharmacy for a large BCBS plan, 12 years of experience as founder and primary servant of a health technology company which was sold to IMS Health in late 2007.  She has both a BS and a PharmD in Pharmacy and an MBA. 

Cambria Health Advisory Professionals is proud to publish a new white paper!

Jumping New & Higher Hurdles--How US Pharmaceutical & Device Manufacturers Can Stretch Resources to Achieve Success in Today’s Post Health Reform Environment

---Terri Bernacchi, PharmD, MBA,  Cambria Health Advisory Professionals, Senior Partner, Valiant Health, & Managing Partner at Quo Magis Partners

Introduction

Pharmaceutical and Medical Device Manufacturers doing business in the United States are dealing with an unprecedented level of change. Even for seasoned managers, this requires ever greater attention to operational and compliance details at the very time when innovation and revenues are under extreme pressure.  This demands thoughtful and determined leadership, willing to consider “outside the box” ways to get things done.  This paper is intended to provide practical advice on ways to achieve results in today’s environment by engaging in flexible teaming, using large or small consultancies and service providers.

The Rules Have Changed

With health care reform and today’s economic chaos, factors outside your control are changing the rules of engagement, from how to get your product to market to how to report your results, to how to manage your people. 

Product commoditization and price pressures present critical challenges to the top line.  It’s not just you---it’s your customers.  Today’s health plans, hospitals, and medical communities are plagued with their own versions of “change hell”, with regulations coming out in thousands of pages, impossible to consume, much less to implement, in tight timelines.  Employers and consumers are just beginning to understand the implications of health reform and the regulatory environment.  Nothing was ever this hard before.  Quitting is not a good option for most of us,—and certainly some will find a way to thrive in the “new normal”.

Six Challenges That Rock Your Boat

In order to succeed, manufacturers need to think differently.  Today’s burdens emanate from at least 6 sources:

1)    Pressures on Revenue

2)    Access to the Market

3)    Cost of Operations

4)    Regulatory Overload & Unpredictability

5)    Customer “Shape-Shifting”

6)    Talent Acquisition & Retention

Given Today’s Reality, What Now? 

Manufacturers doing business in 2013 can still take a few steps forward:  

1)    Understand your budgetary certainties

2)    Choose your priorities, streamline operations

3)    Don’t expect miracles 

4)    Identify new ways to partner with each customer segment

5)    Use data to inform your decisions

Recruit talent to your teams.   The last few years may have created too much rapid turnover in some companies; the “old timers” with valuable experience and perspective that informs and trains the younger executives may be depleted.  An alternative way to meet your needs, yet maintain control is to optimize the use of short-term, experienced contractors/consultants or service organizations to get results on an ongoing basis.

Remember the "Fail Fast" Rule   If the project is going to be delayed, has the wrong scope, or is doomed from the outset, don’t pour money down a hole.  Similarly, if the contractor is a bad fit, end it quickly and seek a replacement.

Boutique vs. Big Box Partners? 

You can choose from a variety of consulting or service organizations---large or small, generalist or specialist.  If you are looking for results at the lowest price in the shortest timeframe, you may want to consider mixing it up a little---using both kinds of companies to extend your own teams. 

Included in this paper is a list of some example boutique firms with an edge on talent and experience that may be just what you need to make traction, with some suggestions on how to engage them.    Download the paper here, free of charge:  Jumping New & Higher Hurdles:  How US Pharmaceutical & Device Manufacturers Can Stretch Resources to Achieve Success in Today’s Post Health Reform Environment

Terri is the founder of Cambria Health Advisory Professionals and a Managing Partner at Quo Magis Partners, and a Senior Partner at Valiant Health. Among her current clients: a large health sciences firm serving payers, pharmaceutical and device manufacturers and other stakeholders. a small special needs health plan as a 5 Star Consultant, and several other health related clients. The thoughts put forth on these postings are not necessarily reflective of the views of her employers or clients nor other Health Thought Leader colleagues. Terri has had a varied career in health related settings including: 9 years in a clinical hospital pharmacy setting, 3 years as a pharmaceutical sales rep serving government, wholesaler, managed markets and traditional physician sales, 3 years working for the executive team of an integrated health system working with physician practices, 4 years as the director of pharmacy for a large BCBS plan, 12 years experience as founder and primary servant of a health technology company which was sold to IMS Health in late 2007.  She has both a BS and a PharmD in Pharmacy and an MBA.