October / November 2018 by Healthcare Sales and Marketing Magazine

™ OCTOBER/NOVEMBER 2017

the publication for healthcare sales & marketing leaders™

THE TOP 100 HEALTHCARE COMPANIES IN THIS ISSUE

healthcare companies

Patient Centricity wisdom from Sanofi, Admedus and more Velano Vascular CEO Eric Stone Pfizer, BI and others Using Video Games The Real Launch Numbers— $, Patients, NBRx and more UCB’s David Fortanbary Compliance = Profits

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the publication for healthcare sales & marketing leaders™

TABLE OF CONTENTS healthcare companies

Publisher’s Letter..............................................................................................................................................4 Editor’s Letter.....................................................................................................................................................5 Editorial Board....................................................................................................................................................7

ARTICLES Executive Spotlight: Eric Stone, CEO of Velano Vascular....................................................................9 Roundtable: Patient Centricity, with execs from Nestle Nutrition, Sanofi, Admedus and more.......................................................................................................................... 17 The Top 100 Healthcare Companies........................................................................................................ 29 The Real Launch Numbers—$, Patients, NBRx and more................................................................. 37 Industry Trends: By The Numbers............................................................................................................ 47 UCB’s David Fortanbary on Commercial Performance.......................................................................49 Motivideos: To Use in Your Meetings...................................................................................................... 51 Why I Work in Healthcare............................................................................................................................ 55 Pfizer, Boehringer Ingelheim and others Use Video Games............................................................ 59 Better Compliance. Better Outcomes. Better Profits......................................................................... 63

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Publisher’s Letter

We’re Pleased to Announce Good News It seems rare these days to find something positive and encouraging in the news. Even within our dynamic industry, many of the headlines are about the bad actors and unfortunate incidents. So I’m glad to be able to inject some sunshine into the mix. Surveying the financial progress across the healthcare territory, we are pleased to report that all signs are go within the Top 100 companies. It’s no surprise that J&J took the top spot again, cari kraft and you’ll see in our By the Numbers article that it also scored high on the list of Fortune’s Most Admired Companies, joined by several others in their own Top 100. Also cheering is the news that 78% of our list saw revenue increases, compared to 62% last year and an anemic performance under 50% the year before. Also notable is the significant growth of the medical device sector. A full 93% of these companies showed higher revenues, and Medtronic’s acquisition of Covidien under Medtronic plc has vaulted it into the top ten. Other continuing trends include the emergence of a broad coterie of companies from around the world. Just in the top ten, the US, Germany, Switzerland, France, England and Ireland are represented. Of course Japan appears often on the list, and is joined by Israel, the Netherlands, Denmark, Canada, Spain, India, Sweden and South Africa. The total revenue added by medical device was $42B, $16B by pharma and $6B by biotech. Going back to the headlines elsewhere, we can see that healthcare still has a lot of work to do to advance its many goals: improving care, reining in costs, fostering better communication among all interested parties, and of course continuing to focus on outcomes. But from where we sit, the industry as a whole is healthy, energetic and aimed in the right direction. And always, please keep the feedback coming. It all goes to making the magazine better for all of us.

Cari Kraft, Publisher Click here to get Top 100 healthcare companies

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HS&M OCTOBER/NOVEMBER 2017| 4

Letter from the Editor

Aunt Anomaly Our family recently celebrated the 100th birthday of my Aunt Ruth. This makes her an anomaly in two ways. The first is that she has reached an age very few of us will achieve. While the number of American centenarians has been on the rise—up 44% in recent years, from 50,281 in 2000 to 72,197 in 2014 (the latest year for which I could find statistics), that’s still a minuscule portion of the population, a fraction of a fraction of one percent. The second anomaly is more relevant to our industry. It’s a widely-accepted fact that a vast amount of our healthcare dollars are spent on patients in the last few years of life. But Aunt Ruth is not one of those putting pressure on our healthcare system. Until recently, she lived on her own, without regular help of any kind. It was only just before her hundredth birthday that she moved to an assisted living facility because her blood pressure is low and she occasionally gets dizzy. Still, Aunt Ruth refuses to take medications (and please don’t tell her I revealed her age, which she strives to keep secret). neil greenberg

Of course, the shift in dollars toward end-of-life care is due to several factors. One is the enormous advances that have been made in medical treatments of all kinds that extend life. Some of these just put off the inevitable for a few months at most, but others stave off the end indefinitely, and many add to quality of life as well. Then there’s the burgeoning industry of hospice, in-home nursing, assisted-living, ‘round-the-clock care and other services that tend to our physical and emotional needs as we decline. This is a tribute to the innovation and energy of our industry. It brings with it some controversy, of course. How long do we really want to extend the lives of people who have no discernible quality of life anymore, or little hope? To use another example from my family, take my father-in-law, who was a physician. At 88, he was found to have a type of cancer that would require aggressive treatment. Knowing the odds, and declaring “I’ve lived a good life,” he refused nutrition, gathered the family for a last goodbye, and died rather peacefully a couple of weeks later. What does all this tell us? I guess that, along with the miraculous forward march of medicine, we still have choices to make. And that, I think, is part of the patient-centricity topic we discuss in this issue. After all, what’s more patient-centric than becoming educated and taking more control of our own healthcare? As always, we continue to look for the value of your contributions. Let us know if you have an idea for an article—the people we write for are the people who write for us.

Neil Greenberg, Editor To become an HS&M contributing author or provide feedback, please email me at ngreenberg@hsandm.com.

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There are some things people just won’t tell you But they’ll tell us in confidence. And we’ll tell you. There are a lot of opinions people never offer you about your company. What the pain is. What you could be doing better. What they think of your competition. How to talk to them effectively. Big corporations get these answers through expensive research. Small to medium-sized companies don’t have that luxury. That’s why we created the Private Process . It’s a quick, cost-effective way of compiling information that people will offer us in complete confidence. Then we assess the results and give you the insight you need to adapt your sales and marketing messages accordingly. ©

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™

Editorial Board

the publication for healthcare sales & marketing leaders™

Chris Bergstrom Publisher Cari Kraft Editor Neil Greenberg Contributing Editor Jill Donahue Creative Director Hedy Sirico Digital News Rick Cataldo Digital News Chris Manning Sales Director Andrew McSherry Editorial Board: Kristen Sharron-Albright Head of Marketing at Noven Pharmaceuticals Chris Bergstrom Associate Director, Digital Health Expert at Boston Consulting Group Sebastian “Sebby” Borriello Vice President, Chief Commercial Officer SK Life Science Lewis Chapman Vice President, Global Commercial Operations AllCells, LLC Maria Finlay, MBA Associate Director of Oncology Marketing, Teva Oncology Nick Gurreri Vice President New Products at Alexion Pharmaceuticals, Inc. Bob Roda VP and General Manager at BD © 2017 CL Media Inc., Philadelphia, PA CL Media is not responsible for any unsolicited contributions of any type. Unless otherwise agreed in writing, CL Media retains all rights on material published in HS&M for a period of one year after publication and reprint rights after that period expires. Email ckraft@hsandm.com.

To advertise in HS&M, please contact Andrew McSherry at amcsherry@hsandm.com

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Associate Director, Digital Health Expert at Boston Consulting Group Chris brings almost two decades of commercial expertise as an entrepreneurial executive at large medical device and high-growth digital health companies, and he provides “on the ground” advice for implementing digital health solutions. He currently serves as the expert on digital health at The Boston Consulting Group (BCG). Before joining BCG, Chris was the chief commercial officer (CCO) at WellDoc, a pioneer in digital health. He also held progressive roles at P&G, Roche, and Becton Dickinson. Chris was a senior advisor to several digital health innovators, including MyOwnMed, LiftOff Health, HelpAround, Heart Beam, iSageRx, and Alere Home Monitoring. He also advised the Leona Helmsley Charitable Trust and the Saatchi & Saatchi Wellness Board. Chris holds two digital health patents and has won multiple awards.. Chris holds a Bachelor of Science degree from the Kelley School of Business at Indiana University and earned his MBA from Columbia University.

Sebastian “Sebby” Borriello Vice President, Chief Commercial Officer SK Life Science Sebby is currently service as the Vice President, Chief Commercial Officer at SK Life Science. Sebby’s career has included executive sales and marketing positions at Cempra, Mentor Worldwide LLC, Johnson & Johnson Healthcare Systems Inc., Ethicon, Inc. and OrthoMcNeil Pharmaceuticals, Inc. Sebby received his B.A. in Public Administration from St. John’s University in ‘81, and received his M.S. in Organizational Dynamics from the University of Pennsylvania in 2001.

Maria Finlay, MBA Associate Director of Oncology Marketing, Teva Oncology Maria has over 20 years of commercial marketing, sales leadership and operations experience. She has led multiple sales, women’s leadership, and cross-functional teams at Johnson and Johnson, AstraZeneca, and Teva Oncology. Maria has experience collaborating to launch and grow small and large molecule products across seven different specialty therapeutic areas.

Bob Roda

Editorial Board

VP and General Manager at BD Bob Roda is a Senior Commercial executive with extensive experience in delivering business growth and profit in the Medical Tech and Diagnostics Industries. He currently serves as VP and General Manager at Becton Dickinson where he is responsible for the global infusion therapy business. Prior to his role at BD, Bob held a variety of roles of increasing commercial responsibility within the MD&D sector at Johnson & Johnson. His diverse background included positions in Sales and Marketing at Johnson & Johnson Medical, Inc, Ethicon, Inc and Ortho-Clinical Diagnostics. While at J&J, Bob also served as the Executive Sponsor of the Commercial Leadership Development Program as well as the Chair of the VP Marketing Council for all of MD&D. He has a proven track record of delivering results and leading teams in competitive and diverse business environments. Bob is a highly respected and successful global leader. Bob holds a Bachelor of Arts degree in Economics from the University of Rhode Island.

Lewis Chapman Vice President, Global Commercial Operations, AllCells, LLC Lewis Chapman is currently the Vice President, Global Operations at AllCells, LLC.Â He has spent over thirty years in health care management. He served as VP of Global Strategic Marketing at BioMarin Pharmaceutical from 2007 to 2012, where he was responsible for strategic marketing and product portfolio analyses, and implemented medical education, brand enhancement and sales support programs on a worldwide basis. He oversaw the global launch of Kuvan, which in the U.S. was 112% to budget in 2008, the first year on the market.Â Previously, he worked with Alpha Inntech Corporation as Vice President Global Sales and Marketing, where global sales grew 26% in 2004 and 22% in 2005 under his leadership. Lewis started his career with Eli Lilly & Company, with roles at Syntex and Genentech, where he was responsible for the global commercial launch of Activase (t-PA), the largest biopharm product launch in the history of the industry up to that time (first year sales $187 million).

Nick Gurreri Vice President New Products, Alexion Pharmaceuticals, Inc. Nick Gurreri is a business leader and General Manager with over 25 years of consistently achievinghigh performance and profitability through strong leadership and cohesive team building in the biopharmaceutical and medical device industries. Nick has held executive positions at Medgenics, Insmed, Pfizer, Pharmacia and Bristol-Myers Squibb. Nick received a BS in Mechanical Engineeringfrom the University of Delaware, and also acquired a Master of Science in Information Assurance at Carnegie Mellon University.

Kristen Sharron-Albright Head of Marketing, Noven Pharmaceuticals Kristen Sharron-Albright, the current Head of Marketing at Noven Pharmaceuticals, was until recently VP Sales and Marketing, Anti-Infective Marketing and Institutional Sales Specialty Care Business Unit at Pfizer. She is an experienced business leader with 20 years of experience in the pharmaceutical and biotechnology industries. She has a strong track record of delivering results in highly competitive and complex markets. Starting her career in sales at Eli Lilly, she then held positions of increasing responsibility at Lilly, Neurogen, and Pfizer, where she was responsible for sales and marketing in a franchise business model. In her spare time she volunteers, serves on the leadership committee for her church, and enjoys hiking.

HS&M OCTOBER/NOVEMBER 2017| 8

executive spotlight

Getting Your Medical Device from Prototype to Commercialization Wisdom from Eric Stone, CEO of Velano Vascular Adapted from an interview by Scott Nelson Eric Stone, co-founder (with Dr. Pitou Devgon) of Velano Vascular, has been referred to as “the Steve Jobs of drawing blood.” Velano’s first device, PIVO, enables needle-free blood draws directly from peripheral IV catheters. Velano Vascular is backed by a series of wellrespected investment firms, leading U.S. health systems, and dozens of health industry veterans. Before starting Velano Vascular, Stone served as VP of Sales and Marketing for MolecularHealth. Prior to that, he helped launch the world’s first bioabsorable stent for Abbott while working out of their California and Belgium offices. He was also a founding member of Model N’s Life Sciences division and began his career in software marketing with Trilogy. Eric has accomplished an amazing amount in his still relatively young life. We interviewed him to discover what drives his success and what insights he might offer to others. He and Dr. Devgon founded Velano early in 2012 and have since racked up a series of accolades, including the Frost and Sullivan 2016 New Product Innovation Award. He modestly describes the experience as “a journey of exceptional people and this overarching commitment to a vision that is human-centered

at its core.” Velano grew out of questions asked by a patient to Dr. Devgon. It has stayed true to its goal of human-centered design, with both the patients’ and the practitioners’ interests in mind. The “family” at Velano includes hospital partners and clinical collaborators, investors, advisers, and employees. Eric says “I see and view every one of those individuals and institutions as taking a bit of a risk, personally, with respect to their role and their organization and association with Velano by respectfully challenging the status quo of an extremely entrenched practice.” MILLIONS OF PROCEDURES, LITTLE INNOVATION Their first technology is related to drawing blood from hospital inpatients, a fundamental aspect of clinical care. Seventy percent

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of medical decisions are based on the data that comes from this blood draw, yet Eric points out that they’re done at four AM and five AM when everyone is supposed to be sleeping and healing. Velano set out to respectfully challenge that status quo for how hospitals are drawing blood. With limited human and financial resources, it has received three FDA clearances and a European approval, or CE mark. They’ve conducted tens of thousands of blood draws on hospital patients with their first marketed product, PIVO, at some of the leading hospitals in the United States. They’ve identified a host of opportunities for enhancement and innovation in the hospital, all patient-centered and practitionercentered in nature and all related to the vascular access domain, which has been, in Eric’s words, “a pretty under-appreciated space. Which is

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executive spotlight a bit ironic because our patients are becoming increasingly ‘DIVA’ meaning difficult venous access.”

In a typical hospital network, there are perhaps a million blood draws a year. What else do you imagine a hospital is doing a million times a year? This includes obese patients, the elderly, diabetic populations, and even patients like Eric who suffer from chronic illness and experience repeat hospitalizations. These are one of the fastest-growing coteries of inpatients in the hospital, an estimated 30% of hospital inpatients. The blood draw is arguably the most common invasive medical procedure conducted in a hospital every day. Yet, in Eric’s experience as a Crohn’s patient over the last 25 years, and his observation of the medical field, it’s “overwhelmingly under-appreciated by hospital administration and even in many respects by clinicians or practitioners.” In a typical hospital network, there are perhaps a million of these procedures a year. “What else do you imagine a hospital is doing a million times in a year?” Eric asks. An average patient may have one or two blood draws a day, and in a critical care setting, three, four, or five. Yet the innovation in this area has been negligible—until Velano was founded.

How does Velano draw blood without sticking patients repeatedly with needles? “It comes down to the technology that has been around for quite some time that nearly every hospital inpatient has in their hand or their arm called the peripheral IV catheter,” says Eric. These are short, roughly one-inch pieces of plastic, they’re placed into the body over a needle upon admission to the hospital or entrance to the emergency room, primarily for introduction of fluid into the body to infuse drugs, nutrients, and saline. The clinicians refer to this as “access” and it’s used in emergency situations for rapid infusion of fluids, but it’s also used for daily antibiotics, saline introduction, etc. Those IV catheters are extremely effective for infusion of fluid, their primary purpose. It’s possible to used them for blood draw, but “most hospitals have policies not to do that because those IV’s lose their integrity for aspiration of nonhemolyzed lab quality samples very quickly,” Eric points out. “So they become a one-way conduit to the vessel, but if you try to pull blood back off of them, it’s either difficult to get blood back or, if a practitioner is able to get blood back, often times it’s hemolyzed. The red blood cells are torn, or sheered, and the laboratory will then kick the sample back to the floor, or to the ER and ask the practitioner to redraw. You can imagine that it’s difficult for the practitioner, it’s difficult for the patient, it delays care, delays treatment, delays decision making, etc.”

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Velano came up with the idea of utilizing a single-use disposable device called PIVO, which very simply is a tube in a tube. It attaches to the peripheral IV catheter. On the back of it, you attach either an evacuated tube holder or a syringe, depending on what your preferred mechanism is for drawing blood and advance the PIVO, pushing a very small soft, flexible tube through the IV catheter. It overcomes the reasons why IV’s fail to aspirate nonhemolyzed lab samples back over time. “The first is kinking, or collapse of the IV, when you suck back and our tube goes through and unkinks or uncollapses the IV,” Eric says. “The second is that you’ll get debris at the end of your IV catheters. Particularly if they’re not frequently and well maintained by flushing with saline. Our tube goes past the end of the IV past any debris into the vein or the vessel. The third is you may be up against the vein wall, or the vessel wall, or up against some type of anatomical structure that precludes you from pulling blood back. With PIVO, the practitioner very simply draws the number of tubes required for that blood draw and then retracts our device back, un-attaches it, flushes the line and moves on to going about their day.” PATIENT, PROFESSIONAL, MARKETER, ENTREPRENEUR Eric’s background as both a patient and professional explains a lot. He was diagnosed with Inflammatory Bowel Disease (IBD) 25 years ago as a teenager. Right out of school, he got into marketing with a software company in Austin,

Texas called Trilogy. He describes his luck “to serve in an extremely entrepreneurial culture in a particularly entrepreneurial role where I learned a great deal about marketing and a great deal about building a business.” It was there that he became acquainted with a University of Michigan professor, Noel Tishi, who coached the Trilogy CEO, among many other prominent executives. “I became enamored with the world of organizational psychology; the intersection of business and psychology, all coming back to human behavior. Studying human development at Harvard enabled me to fashion my own master’s program in human development and leadership studies. From that experience, I was exposed to really unique approaches to thinking about building and sustaining organizations. That experience, those studies, those professors helped provide me with some of the frameworks for critical thinking that I use today.” These became the building blocks for Eric’s success in “this melting pot of functions ranging from finance to marketing, to operations, to developing products, to selling, and of course, the human behavior side of it. Everything really does come back to people, team members, customers, partners, investors. It has carried forth a lot of the value that we’re creating at Velano today.” After Trilogy, Eric followed a colleague of his to the Bay Area to work for an Accel-Kohlberg Kravis Roberts (KKR) funded company called Model N added to Eric’s education. “I was quite enamored

with the leadership team at Model N. Serial, successful entrepreneurs and exceptional backers. I was really able to learn from a group that I would call true rock stars.” Model N was a platform technology company providing solutions to the construction industry and the beef, pork and poultry industries, two spaces Eric knew nothing about. But “I was fortunate enough to be placed on a project by our CEO to assess the life sciences market and the utilities market. I was charged with putting together an assessment of the market opportunity over a few months’ period.” His team was designated to develop a life sciences business, specifically software applications for life science companies. He served as the head of marketing and business development alongside the head of products, and head of sales, and the general manager. “The four of us went out and built aspirational solutions and sold to our very first customer, a division of Johnson & Johnson called Ortho Clinical Diagnostics.”

“It’s really a pretty exciting opportunity to show those individuals you look up to that, ‘You know what? I too am able to achieve something that’s significant, just as you have.’”

The investors and clients from those years became relationships that helped Eric advance his career. “I fell into the space at the intersection of software and healthcare. I’ve always been passionate and motivated to find a way to give back and to participate in healthcare as a patient and do feel really fortunate how it’s all worked out. I do believe that change and impact and innovation, it’s really all based on people. We wouldn’t be able to do what we’re doing without those folks that took a risk and a bet on me 15 plus years ago and are doing it again today. It’s really a pretty exciting opportunity to show those individuals who you look up to that, ‘You know what? I too am able to achieve something that’s significant just as you have.’” His next move was to Abbott Vascular, from 2007 to 2011, being involved in their launch of the bioabsorbable coronary stent. “It presented many opportunities and a real air of excitement. At the same time, there was a lot skepticism around whether the product was truly differentiated. Is this product truly viable and necessary, and is there a true market need? I think that the verdict is still out, but it very much forced us on a daily basis to think through our commercialization, planning, and strategy.” During his Abbott stint, he lived in Europe for a year and traveled throughout Asia, giving him valuable perspective on a global scale. “It was a remarkable experience in understanding that not only is every country around the world quite unique in how they deliver healthcare, but even to the level of the hospital, there was HS&M OCTOBER/NOVEMBER 2017| 12

executive spotlight a whole host of distinctions. One size definitely does not fit all.” It influences him to this day. Building a growing business, with limited resources, Eric and his colleagues struggle with bringing the personal relationship and customization to their approach in delivering healthcare. THE CO-FOUNDERS MEET AND CONNECT At Molecular Health he met Dr. Pitou Devgon, and thus began the relationship that led to Velano’s founding. Eric knew he had an idea that was in the vascular access domain but was relatively under wraps. “I think back to that first meeting with Pitou in a bar in Philadelphia where he took out a prototype that he had fashioned in his kitchen from products from the hospital where he worked. “Right away in listening to him talk through the unmet need and the genesis for his idea, it dawned on me that this truly was a game changer. And not only would this be a great medical device, but this would eventually touch the lives of every human being on the planet—talk about impact. I believe it then and I now know it will in fact be the case.” Eric was impressed by the concept, but also by Dr. Devgon’s intellectual curiosity and his ability to “tug at the thread of statements and perceived facts, which really at the end of the day is folklore made by clinicians, made by patients, made by industry and the large medical device manufacturers. That intellectual curiosity and that unrelenting desire to challenge the status quo, along with his creativity, was the foundation for our company.”

Eric is confident that that first meeting in a bar in Philadelphia is going to result in a better standard of care nationally and globally, one that will touch every single person on the planet. We will all spend time in a hospital in our lives and we will all need our blood drawn. “And whether the product is called PIVO or it’s called something else, the new standard of care even just five years from now will be doing exactly what we have developed.” Then, of course, came the challenge of getting funding for their company. Four retired Abbott corporate officers became investors in Velano. “During the course of roughly a three-month period, I pursued an approach to founder dating. That’s how I refer to that period in my life where I met with inventors and ideators all over the country, all of whom were introduced through my personal network.”

“I think back to that first meeting with Pitou in a bar in Philadelphia where he took out a prototype that he had fashioned in his kitchen from products from the hospital where he worked. Right away in listening to him talk through the unmet need and the genesis for his idea, it dawned on me that this truly was a game changer.”

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It was a long journey. Over two years, the founders had day jobs and raised only $150,000 from 10 individuals. “But it was a purposeful fundraising strategy and a very cautious strategy of a crawl, walk, run, fly, and to this day we still follow that model,” says Eric. “Those individuals almost exclusively had backgrounds in the healthcare domain, from an interventional radiologist to a device company, to an executive at Medtronic, to a senior executive at Boston Scientific, to an executive at Abbott, to a healthcare venture capitalist, to a healthcare banker. Every single one of those individuals back then, and to this day, provided extensive amounts of guidance and counsel that far outweighs the relatively minimalist dollar figure investment they made in the business.” FOUR MILESTONES During the course of those two years, they set forth to accomplish four milestones to determine if there really was a “there there.” “The first was to prove technical feasibility. Could we build prototypes that could work in a bench setting to draw blood through a peripheral IV catheter? We found a third party prototyping firm and worked quite aggressively with them on fast cycle time iterations. In some respects, an approach we took when I was in the software world of iterating, and iterating rapidly, to get to a point where we felt that from a bench setting perspective, we had accomplished feasibility. “The second was around preclinical functionality. Could we draw blood off of a peripheral IV

THE MILESTONES TECHNICAL FEASIBILITY

PRE-CLINICAL FUNCTIONALITY

INTELLECTUAL PROPERTY

MARKET ASSESSMENT AND DEVELOPMENT

catheter through our device, not through the IV, but our device that was non-hemolyzed in nature, where the lab analysis results were at parity with blood drawn out of a needle—today’s standards of care? We did that, and we were very thoughtful about our work in the animal lab, and we showed results from prototypes that accomplished this milestone. “The third was around intellectual property. This really is the foundation for any sustainable business. Based initially on Pitou’s invention, we had a similar patent in the space issued and then moved on in an aggressive fashion to develop additional intellectual property, and that has been a fundamental pillar upon which our business has been built. “The fourth milestone…is market assessment and market development. If we build it, will they come? A lot of great medical technologies have been developed that are laying in a barren desert right now because there wasn’t a market for them, or the founder under-appreciated the uphill battle to move towards regular use and reorders.”

During those two years when they still had day jobs, they spent nights and weekends with hundreds of stakeholders, from patients to nurses to hospital administrators, and built a list of reasons to do it— and not to do it. “The validation was so great that if you could make this work technically and clinically, that yes, if you build it, they will come. And that’s what gave us the confidence along with these other three milestones to leave our day jobs and raise a series A, and go out and build the business and establish a standard of care.” Their approach to financing the business was similar to their approach to identifying hospital partners, the right employees, advisers and more. Eric says it’s about looking through the lens of the reasons to believe as opposed reasons not to believe. The first two hospitals that invested, The Children’s Hospital of Philadelphia and Griffin Hospital, resulted from conversations with two visionary CEOs of those institutions who both said that “This is interesting, this has an immense opportunity for impact, we would like to be a part of this and can we invest?”

Eric explains that “Those are not hospitals that have venture or investment arms like many of the larger health systems. But just visionary individuals who saw the opportunity for impact and wanted to help us make it a reality.” Since then, they have gained the support of larger institutions like Sutter Health, a 24-hospital system in California. “While the investments may not make or break the business from the perspective of the size of the investment, and while a potential return on their investment may not determine the future of that hospital or hospital systems, there is an unbelievable alignment behind the mission orientation of what we’re doing. Which is that they want this product for the patients and practitioners. They want to be able to deliver less painful, safer human blood draws in a way that the hospital can benefit financially, become more efficient, less costly, etc.” Eric believes that their diversity of investors has been crucial. There are traditional medtech investors like Safeguard Scientifics, the hospitals and angel investors who have run large companies like Abbott and Boston Scientific, and insurance companies. “Their advice and counsel is priceless.” PIVO sits at that classic intersection of improving the patient experience, while also helping our healthcare systems achieve a certain amount of financial profitability. So how does Eric think PIVO fits into that equation?

HS&M OCTOBER/NOVEMBER 2017| 14

executive spotlight “We tell [our hospital partners] how many [blood draws] they did, what percentage were between the hours of two AM and seven AM, what percentage of their patients had two, three, or more in a given day. The insights… are quite profound. Hospital CMO’s and CFO’s look at one another almost in shock. It’s really gratifying to be able to help them recognize what’s happening…and provide them a solution.”

are direct dollars from value-based purchasing associated with that patient experience and patient loyalty. A procedure that can be safer for the practitioner, by removing the needle from the equation, that can potentially be safer for the patient, there truly is direct and indirect dollars and cents.” He also explains that efficiency is a factor, particularly with respect to the “DIVA” patient. A practitioner, or more than one, can spend 30 minutes to an hour trying to get a proper blood draw. Considering that 30% of inpatients are DIVAs, and the potential million blood draws in a hospital system, the dollars and cents quickly add up. “The first thing we do with our hospital partners, and our customers, is access every inpatient blood draw that they did in a given calendar year. We slice it, we dice it and we come back, and we tell them how many they did, what

“There is a sea-change for valuebased purchasing and the democratization of information, more competition amongst hospitals. Patients have more choice now with their insurance plans and they have the internet, which gives them more information. And I think that’s why in part you see hospitals increasingly marketing themselves, and why you see billboards that suggest ER wait times in a city or a community that has more than one hospital. I think it is hospitals that are vying, in many respects, for their own survival. That’s why it’s valuable to have a technology that is better for the patient, that enhances patient experiences where we know there 15 | HS&M OCTOBER/NOVEMBER 2017

percentage were between the hours of two AM and seven AM. What percentage of their patients had two, three, or more blood draws in a given day. I think the insights, irrespective of our innovation, are quite profound. You see hospital CMO’s and CFO’s looking at one another almost in shock. It’s really gratifying to be able to help them recognize what’s happening in their hospital, and then very quickly provide them a solution to some of those opportunities.” As a final thought, we asked Eric what advice he might give his 25 year-old self. His answer: “Probably be patient. Be patient personally, professionally and even from the perspective of having an impact. Good things will come.” •

Scott Nelson is a self-described medtech enthusiast. He cofounded Joovv in 2015, a fast-growing photobiomodulation startup, and currently leads all of their commercialization efforts. Prior to Joovv, Scott held sales and marketing leadership positions for some of the largest medical device companies in the world, including Medtronic, Covidien, Boston Scientific, and C.R. Bard. In addition, Scott is the founder of Medsider, which helps ambitious doers learn from proven medtech thought leaders. His work with Medsider has been featured in publications like Forbes, Mass Device, MedCity News, and MD+DI. Scott is also an advisor to the Medical Devices Group, which includes over 300,000 members worldwide.

COMMENT

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Roundtable

How Sales and Marketing Can Advance Patient Centricity Experts from UCB, Sanofi Pasteur, Admedus, Nestlé Nutrition and WAVE offer their views With moderator Jill Donahue Principal, Engage Rx

Our panel of experts: Dirk Abeel

Wendy Erler

Global Head Performance Development Training and Field Force Effectiveness Nestlé Nutrition

Vice President, Patient Advocacy and Market Insights WAVE Life Sciences Ltd.

Dominique Côté

Kasia Hein-Peters

Vice President & Head of Global Marketing Excellence UCB Pharma

Global Commercial Leader in Biopharmaceutical Industry Sanofi Pasteur

David St. Denis Chief Operations Officer Admedus

17 | HS&M OCTOBER/NOVEMBER 2017

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Roundtable If you want to see better outcomes for your company, yourself and the patients you serve—or if you are wondering how you make patient centricity work in sales and marketing—then this roundtable is for you. When I was 35, I lost my father to an avoidable prescribing error. As a professional in the pharmaceutical industry, I asked myself “What if my Dad’s doctor’s rep had been able to access and influence him more effectively?” I’m a firm believer that the greatest outcomes will be achieved when we shift from being script-centric to patient-centric.  How does patient centricity apply to sales and marketing? There is ample evidence that when you focus on your purpose (the difference you make to patients) you will be more successful in reaching your targets! This roundtable incorporates ideas from around the world, from different companies and different departments. We showcase examples of how they are bringing patient centricity to their commercial teams. What about outcomes? Can you be both patient focused and business focused? How? What are examples of patient centricity working in commercial pharma? What are the barriers? These are just some of the questions we discuss.

Why should sales and marketing execs care about patient centricity? What does it mean to them? David St. Denis: We should all care about patient centricity. As average life expectancy increases, we will all be patients one day. We want a great experience for ourselves and our loved ones. Patients are becoming more empowered and are getting more say in their healthcare options. As they inform themselves through their own research, we want to ensure they have access to the best informa-

tion, tools, and services to ensure they can make the best choices, along with their healthcare providers. If we don’t engage them correctly and provide a great experience, they may not find their way to the best solutions. Kasia Hein-Peters: For marketing and sales teams, patients are the ultimate end-users of products that they commercialize. Medicines don’t work and don’t sell if they are not taken by patients. For this to happen, patients must want to take them, be able to manage

19 | HS&M OCTOBER/NOVEMBER 2017

side effects and remember to continue therapy as prescribed by a doctor. So it is critically important for sales and marketing to ensure that patient’s needs are taken care of in the process of drug prescribing and administering. Wendy Erler: We are responsible for getting patients what they need, when and how they need it. This latter piece sometimes gets lost in the patient centricity discussion. While it is true that drug discovery and innovation is the first step, delivering the medicines in a way that is feasible for patients and ensures compliance along with access and coverage is as important. Thinking all the way through the patient experience is crucial to successful launch, market trajectory and commercial returns. This approach creates a continuous feedback mechanism which provides further input on unmet medical needs which can help a company focus its development initiatives or for life cycle management of a product. Dirk Abeel: If you want to be true to our mission there is no other way than being truly driven and interested by what patients are facing, struggling with, looking for and expecting from us. What does it mean to them? All that you do as an organization should circle around the question: how can we improve the quality of life for our patients on the short-, mid- and long-term, together with a positive impact on our communities and

NON-ADHERENCE UNMET NEEDS SALES OBJECTIVES REGULATIONS

environment and in line with our business goals and responsibilities? It also requires a shift from short term to long term outcome and impact planning (which also affects how you will have to manage your investors). Dominique Cote: Executives should care about patients because they are our purpose. I joined the pharma industry and left genetic research for the same purpose, to

have an impact on patient lives and be part of working to find a solution for devastating diseases like cancer. It should be at the core of what marketers plan and their strategies to really create partnership with healthcare professionals for these patients that we serve. What about outcomes? Can patient-centric commercial people still meet their mandates/sales targets?

Kasia Hein-Peters: In my opinion, a patient-centric approach helps to achieve sales objectives, because it supports patients in taking the right medication and staying on it. Patient-centric marketing solutionsâ&#x20AC;&#x201D;if developed and implemented wellâ&#x20AC;&#x201D;can improve treatment adherence, remove access barriers, increase understanding of the disease and associated risks, help in disease management etc. As a result, medicines will be used more often and longer. HS&M OCTOBER/NOVEMBER 2017| 20

Roundtable Wendy Erler: A patient story does not start at diagnosis. It starts with symptoms and their journey to diagnosis. For sales and marketing to have all of these data points to inform product profiles, positioning and messaging leads to immediate impact, and this is ultimately relevant to sales success because you are meeting the true needs of your patients. Taking a patientcentric approach ensures that marketers highlight key considerations for decision making and plan programs and education that matters. If the entire commercial organization is truly focused on doing the right things (activities, pricing, messaging) for the right reason, then patients and caregivers will always be at the center of the mission. When sales teams are formed and new sales representatives join the organization, their first training should be focused on patient centricity and how this is incorporated in their objectives and expectations for job performance. Moreover, the advocacy strategy must be flexible to take advantage of unexpected opportunities or unforeseen challenges. Dominique Cote: I believe the good commercial people have never lost their patient purpose. Commercial people, by having the discussion and communicating with the patient in mind, have the greatest opportunity to really partner for a better solution with their physicians and of course still meet their targets. Traditional ways of establishing sales tar-

gets should change and be more patient-driven and account-driven based on needs versus solely being numbers-driven. Dirk Abeel: As you deliver expected value and even extended value, adding service offering to all of your key stakeholders (customers and patients, governments, etc.) you will achieve your business goals in even a more solid and sustained manner. David St. Denis: Yes. We are moving increasingly toward a system where healthcare providers, payers, and the life science industries will work in a collaborative fashion around the patient to provide the best health outcomes. By creating an excellent patient experience, the demand for medical products and services will go up. This will happen because physicians will have more satisfied and informed patients; and patients themselves will be able to drive utilization from an informed and differentiated point of view. What are some of the best examples/stories youâ&#x20AC;&#x2122;ve seen of healthcare companies being more patient centric and seeing better outcomes for all (patients, HCPs, etc.)? Wendy Erler: The Biogen (now Bioverativ) Humanitarian Aid Hemophilia campaignâ&#x20AC;&#x201D;providing free factor to the developing world. Dominique Cote: We all have stories of commercial people recommending competitor products for the benefit of the patient in

21 | HS&M OCTOBER/NOVEMBER 2017

the right time , but throughout my career the best examples have been when really the commercial groups have gotten beyond the medications to really help with problematic situations. Some examples have been working on ethical problems that the physicians were treating when AIDS therapy started , or working on a program to support the integration of schizophrenic patients back into society when stabilized, to avoid the return to ER and help them live outside of institutions. Another one would be helping understand the needs of the cancer patient and representing them. David St. Denis: Over the years I have seen some amazing solutions designed by truly understanding the patient need, and providing a significant benefit in helping them do well on their treatments. These are tied to product lifecycle, and often devolve when the product is in latter stages. I think for this to become part of the DNA of a company, it needs to be a priority of the board. And here I donâ&#x20AC;&#x2122;t mean make a corporate program with a slogan. I mean a consistent and methodical review of how we bring products and services to market, how we embed patient centricity into them from the design phase, and how we build execution engines that can deliver solutions in a sustainable way. This kind of approach is at the heart of what we are trying to do at Admedus. Kasia Hein-Peters: At Sanofi Pasteur, we have been busy studying

declining confidence in vaccines, which is happening mostly in developed countries. This phenomenon has many demographic and socioeconomic reasons and leads to delaying or skipping some pediatric vaccines and generally low vaccination rates for adult vaccines. As a result, we observe occasional outbreaks of diseases that had almost disappeared in the past and insufficient prevention of deaths and suffering that could be avoided, such as widespread use of flu vaccination. By analyzing a process of patient decision making and influence of providerpatient interaction, we were able to develop a set of communication principles, which help healthcare providers to recommend vaccination more successfully. The difference in outcomes is stunning—a provider is able to increase the success of their recommendations by almost ten-fold. We have been able to distribute this knowledge through medical education programs and partnerships with medical and advocacy organizations. So far, a few thousand healthcare professionals took this training in the US alone and we have seen a very positive impact on flu vaccination rates. Why aren’t others doing this? What do you think are the greatest contributors and barriers to creating patient-centric sales and marketing teams? Dirk Abeel: The industry has been built on a traditional push model. Patient-centricity requires a com-

pletely different approach mainly based on pull. This means a complete change in how we develop and bring products, solutions and services to patients. Easier said than done, as we need determination at the highest level and change management approaches in order to be as least disruptive as possible for the existing organization. A great contributor is embracing the purpose of the company at all levels in the organization prior to acting on it, followed by a clear leadership role modeling approach, taking time to explain the need behind a shift from being solely product focused towards being focused on what patients, HCPs, society are expecting from us. Biggest hurdles: a volatile environment with huge pressure on margins and profitability. Both marketing and sales have to leave their trenches and rebuild together their HCP and patient engagement model, supported by a lot of other functions such as medical and scientific affairs, regulatory affairs etc. Dominique Cote: I believe we focus on short term shareholders targets and hide ourselves behind regulations. In many countries you cannot promote or talk about a product directly to a patient but that doesn’t mean that you cannot speak or integrate the patient needs in your day to day activities. We see our industry regulations being the biggest barriers , I believe that often we are our own barriers and need to challenge our internal status quo. We need

to overcome resistance or fear of change. David St. Denis: There are internal and external factors. I have been focused more recently on the internal factors, as I believe these are the greatest inhibitors of our move toward patient centricity. In some companies, there is a legacy model regarding who “owns” certain customers. This is often manifests in compliance-related discussions in terms of how much commercial and medical can work together. But I also see it between sales and marketing. I think at the core, it’s about building relationships and overcoming “status quo” resistance and fear of change, as Dominique says. Until we all work together with a common purpose, which is about providing the best service to ensure patient outcomes, we can’t engage externally in that manner either. Wendy Erler: The biggest challenge for organizations is taking the time to figure out how to do this and work with compliance and regulatory to make it work. If sales teams are incentivized only on generation of prescriptions it can be hard to tie in patient-centric objectives. Progressive pharmaceutical organizations embed patient centricity in their culture from the top all the way through the field organizations. To build a patient-centric focus that crosses all departments often requires institutional change and, in some cases, risk. Systems, communications, core competencies, rewards

HS&M OCTOBER/NOVEMBER 2017| 22

Roundtable and recognition, performance objectives, can all be impacted. Moreover, companies need to invest in training to prepare sales and marketing to find the magic where best outcomes for the patients and the company come together. Organizations should not be driven by fear of transparency, but rather driven by the opportunity to be transparent. Kasia Hein-Peters: I think that every company believes that they are patient-centric—I’ve never met anyone who would claim otherwise. Yet companies differ in their focus on patient-centricity. Some don’t do enough research to understand patients’ personas and consumer journeys, and as a result don’t develop solutions that focus on patient needs. Others are confused about what patient-centricity really means, as there is no industry-wide definition. Some marketers still believe that being patientcentric means just lowering prices. In such case, the marketing approach is limited to audiences that they know well, such as healthcare providers, payers etc. or to a very narrow, product-centric consumer advertisement. What cross-industry efforts are being made to assist commercial pharma to become more patientcentric? Kasia Hein-Peters: Several pharma conferences focus on patientcentricity to better define, what it means and how to do it in practice. The Aurora Project, championed

by eyeforpharma, is a good example of promoting patient-centricity. David St. Denis: Companies like 23andme, for instance. Essentially these are not healthcare companies, they are e-commerce companies. Despite their recent challenges, the product was designed to meet the needs of patients. Google is doing amazing things. And there are diagnostic companies such as Illumina. They are working on products and services that provide critical information for patients, and are trying to offer it in a way that is easy to use. And finally, medical device makers are really doing some exciting and innovative things: companies like Stryker, for instance, are changing the way patients prepare and recover from major surgeries. Dirk Abeel: We have started seeing some cross industry collaboration initiatives around a bundled value offer. Products as part of a completely relevant patient experience. Services like monitoring, guiding, educating the patient journey will become even more important than the product as such. Wearables, applications etc bring value to patients and collaborating partners (data gathering), resulting in added value for society, better quality of life. Patient and customer satisfaction will become a key driver for how companies will be judged in the future. Dominique Cote: I believe we can learn a lot from other indus-

23 | HS&M OCTOBER/NOVEMBER 2017

tries on how to do this . I am on the Board of SAMA , a not-forprofit that has devoted more than 60 years of working on customer centricity through strategic account management capabilities and has learned a lot from other industries. Our traditional industry now includes technology as a key player, like IBM Watson AI for diagnostic , or 3D organ printing that could solve immunology challenges in transplants. Technology can help to better predict a seizure in epilepsy. Solutions are becoming more effective with technology and DNA sequencing , allowing us to really help in focusing on more personalized medicine, one patient sub-population at a time. How have more aware/active patients influenced the industry? Dominique Cote: They have been speaking up to share their needs, to be at the table and bring the emotion into decision making. They are the ones that led to broadening treatment and have taught that the way we look at a disease is really different when you live with it. The patient needs can be variable depending on their situation, age, environment and other factors which need to be taken into account. Kasia Hein-Peters: The most important way patient advocates contribute is helping us see patients more as human beings who do other things in life than just manage their diseases, and being able to develop solutions that better fit with their lifestyle.

David St. Denis: In the rare disease space, pharma forms a very close relationship with patients and caregivers. If we look at certain specialty spaces, such as neurodegenerative diseases (MS, Parkinson’s, etc.), patient groups have become an important and truly meaningful driver of positive influence on the industry. Oncology is another area where patient groups and even individual patients are making a huge impact by taking a partnership approach with the industry and helping us to design our R&D efforts better. There’s much more room for more active participation and organization in the large chronic disease spaces (diabetes, for instance). Dirk Abeel: There are many examples of people who were in pharma but understood the negative impact of the old models when they became patients themselves. This has inspired some of them to challenge the model, coming up with alternative solutions and thus putting positive pressure on the industry to change their approach from being self-centered towards being outside-centered. How can the industry move closer to serving patient needs better? Kasia Hein-Peters: As marketers, we should understand patients better, especially patient journeys and personas, and all their needs at different steps of the journey. This will help us to create better creative content, technological solutions

and distribution of content. As a result, our marketing campaigns will be more impactful and will drive better health outcomes. Wendy Erler: Full understanding of the legal and compliance guidelines around interaction with patients and what that looks like is critical. Companies are constantly evaluating risk and this drives a lot of commercial decision making. Truly building a patient-centric organization and delivering products and tools to patients that meet their needs should be the goal. Being a trusted resource for patients and caregivers should not be limited to a small number of people in the organization. David St. Denis: I think we need to start by really listening to what patients tell us they need. I mean really listening, as opposed to confirming our own hypotheses and biases. Dominique Cote: By having them at the table, by having them part of governmental decision on healthcare, by always seeking better understanding of their journey and needs and by challenging our own internal way of doing things and stop hiding behind regulations or comfort zones of how we have done things. Dirk Abeel: By talking and listening to the patients, involved care-givers, payers, governments, patient groups, NGOs. Then by processing the gained insights. Define what is part of your purpose to begin with. Bring this into

practice into context with your external key stakeholders, take the learning points and move on to the next stage of your patient centric journey. How can commercial pharma people better connect with patients? Dominique Cote: I believe that we can all become closer to the patient. I came to this industry because of a personal loss to cancer that made me want to make a difference. We have all been patients, parents, caregivers, and if we connect to these emotions and real purpose , we can become better at what we do in commercial. David St. Denis: If we orient ourselves in our roles toward a single purpose—i.e. we are here to provide great health outcomes— then it can change the way we engage with our internal colleagues and our healthcare practitioners. Remembering what we do as an industry and why we do it can really be powerful in shaping the way we engage. Kasia Hein-Peters: The simplest way is through social media listening, to understand better and respond directly to patient’s concerns. Also, different online forums, patient communities etc. can help us to engage. And, last but not least, working directly with patient advocacy groups on mutually beneficial projects. Wendy Erler: Organizations can bring patient speakers inside and

HS&M OCTOBER/NOVEMBER 2017| 24

Roundtable commercial team members should be required to attend external advocacy events and fundraisers where engagement with patients is organic and meaningful. Dirk Abeel: This is a sensitive topic as you need to make sure that you do not manipulate patients for your own sake. I believe that patient-industry interactions should be moderated through non-direct -industry related third parties. Commercial people could learn by observing these kinds of discussions. What is commercial pharmaâ&#x20AC;&#x2122;s role in helping to educate patients? Dirk Abeel: It is critical as long as

the information which is given is unbiased, factual and open about pros and cons while referring to branded solutions. It should focus on the whole journey and experience rather than solely on product usage. It should also be validated by recognized KOLs and other experts. David St. Denis: For me this is clear, both for pharma and medtech. Alongside continued pursuit of innovation and the development of new treatments, I believe education will become our main product. The knowledge the industry has is immense. Until the day where we can directly educate our patients, we need to make our efforts in providing high qual-

ity medical education even more prominent in our mix. Commercial cannot necessarily educate healthcare practitioners directly, but we can make every effort to ensure our partners know what we have to offer and that it is being fully utilized. Kasia Hein-Peters: We have run many disease education programs in the past. Now, through social media, we can engage with patients around disease understanding and its management in a more impactful way. Wendy Erler: Commercial pharma has access to a wealth of data that can often come in in real time. As patient experience with a par-

Moving Forward COLLABORATION

EXTENDED VALUE

INDUSTRY PERCEPTION

25 | HS&M OCTOBER/NOVEMBER 2017

education

ticular therapy expands, more and more information is gathered. This information includes disease awareness and improved care. Commercial pharma has a responsibility to continue to provide education for the broader patient population as we learn more. Dominique Cote: This is interesting as it has always been hard in light of regulation and the change in perception of the industry that some unfortunate stories have been created in the media. There are more and more companies starting to use patients, for example, in arthritis to educate physicians on the impact of an examination. We need to understand the patient journey and deliver better solutions to help each patient achieve their personal goals. In a world where technology is everywhere , where the amount of information is overwhelming and hard to discern right from wrong information, people want to have human contact and be listened to. This will help us have better focus from R&D to commercialization on what matters to patients, healthcare and us, finding the right sweet spot. •

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Roundtable

MEET OUR panel of experts Dirk Abeel

Dominique Côté

Global Head Performance Development Training and Field Force Effectiveness Nestlé Nutrition

Vice President & Head of Global Marketing Excellence UCB Pharma

David started his career at Nestlé Nutrition in 1988 as a medical sales rep where he got bitten by the medical rep microbe and saw how important genuine engagement with the HCP is in driving sustained business growth. As District manager and National Sales Manager he developed leadership, organizational and management skills. His biggest adventure started when he went to Africa for 5 years, building a winning medical field force strategy strongly embedded in the local realities with local people. Eventually, he came to Nestlé Nutrition Headquarters, where today he leads the global medical field force effectiveness team for both Wyeth and Nestlé Infant Nutrition. dirk.abeel@nestle.com

Nestlé Nutrition is the global leader in Infant Nutrition focusing on the wellbeing of infants during first 1000 days of life (starting from conception onwards). Purpose: Enhancing quality of life and contributing to a healthier future. Nestlé is part of the FTSE ethical index.

COMMENT

27 | HS&M OCTOBER/NOVEMBER 2017

Dominique is an international executive recognized as a chief architect of global account program set-up, leading corporate changes and cultural shifts for customer-centric innovation and patient value. She has been a panelist as well as a keynote speaker in Europe and the US in the area of customer centricity/ engagement, global account management programming and pharma commercial excellence as a subject matter expert. She joined the pharma industry in 1990 and worked in roles of increasing responsibilities in sales, marketing and country management (P&L ). She then moved to global roles in learning & development as well as key account management centricity . She spent the last 6 years in global commercial operations/business effectiveness roles with Pfizer emerging markets , leading teams in more than 26 countries and Pfizer animal health (now Zoetis ) building commercial operations. She joined UCB Pharma in September 2016, as Global VP & Head Marketing Excellence practice. She was elected in 2011 to the Board of Director for the Strategic Account Management Association (SAMA), as well as serving on the steering team of the HBA (Healthcare Businesswomen’s Association) globalization project. Dominique.Cote@ucb.com

UCB is a global biopharmaceutical company with a focus on neurology and immunology. Total revenue grew to €4.2 billion in 2016. UCB has more than 7,700 people in all four corners of the globe, inspired by patients and driven by science. It has a solid platform for continuous growth with core products Cimzia®, Vimpat®, Neupro®, Keppra® and Briviact®, and is preparing the launch of a potential medicine to help patients with osteoporosis.

Wendy Erler Vice President, Patient Advocacy and Market Insights WAVE Life Sciences Ltd.

Wendy leads the early commercialization and advocacy teams responsible for Wave’s pipeline products. She has worked with professional advocacy organizations, patients and caregivers within diverse communities including Huntington’s Disease, Duchenne Muscular Dystrophy, Hemophilia and ALS. Prior to joining Wave, she spent 15 years at Biogen and Shire gaining experience in patient advocacy, commercial execution, and program management across therapeutic areas including oncology, hematology, and neurology. Throughout her career, she has had sales and marketing roles in ten unique drug launches. werler@wavelifesci.com

Wave Life Sciences is a biotechnology company focused on delivering transformational therapies for patients with serious, genetically-defined diseases. Its stereopure chemistry platform enables the creation of highly specific, well characterized oligonucleotides designed to deliver superior efficacy and safety across multiple therapeutic modalities. Its pipeline is initially focused on neurological disorders and extends across several other therapeutic areas. Kasia Hein-Peters Global Commercial Leader in Biopharmaceutical Industry Sanofi Pasteur

Trained as a medical doctor and innovation consultant, Kasia Hein-Peters, MD has more than 20 years of experience in pharmaceutical industry, in both developed and emerging markets. She specializes in launching new medicines and vaccines, managing product life-cycles, and developing integrated stakeholder communication and engagement campaigns. Through mentoring and coaching, Kasia builds highly performing, diverse, international teams. She frequently speaks on global brand management, multicultural marketing and human-centric approach to pharmaceutical marketing. Currently, Kasia is preparing launch of a new hexavalent vaccine as a Marketing Head within MCM Vaccine Co., a joint-venture between Sanofi Pasteur and Merck & Co., Inc.

Sanofi Pasteur, the vaccines division of Sanofi, provides more than 1 billion doses of vaccine each year, making it possible to immunize more than 500 million people across the globe. A world leader in the vaccine industry, Sanofi Pasteur has a broad range of quality vaccines to help protect against a number of infectious diseases. The company’s heritage, to create vaccines that help protect life, dates back more than a century. Sanofi Pasteur is the largest company entirely dedicated to vaccines. Every day, the company invests more than €1 million in research and development. David St. Denis Chief Operations Officer Admedus

David St. Denis is an accomplished senior healthcare leader with a systematic and metrics-driven approach spanning 20 years of proven business results at the regional and global levels within the life sciences and pharmaceutical sectors. Most recently at Merck in Germany, he headed commercial operations for Europe and Canada. He has an extensive track record in charge of complex cross-functional and multi-cultural teams that have achieved impressive business objectives in both mature markets (US, Europe, Japan) and developing markets (China, India, Brazil, Russia, Mexico). His core competencies include operations management, strategy development, marketing and sales, new product introduction and launch excellence, market access and pricing. dstdenis@admedus.com

Admedus (ASX:AHZ) is a medical technologies company delivering clinically superior solutions that help healthcare professionals create life-changing outcomes for patients. Its focus is on investing in and developing next generation technologies with world class partners, acquiring strategic assets to grow product and service offerings and expanding revenues from our existing medical sales and distribution business. The company has assets from research and development through clinical development as well as sales, marketing and distribution.

Kasia.Hein-Peters@sanofi.com HS&M OCTOBER/NOVEMBER 2017| 28

healthcare Click here to get Top 100 healthcare Companies

healthcare Companies

TOP 100 HEALTHCARE COMPANIES (Pharmaceutical, Medical Device, Biotechnology)

Once again, we crunch through the numbers to create a single Top 100 Healthcare Companies list from the Top 50 Pharmaceutical, Medical Device and Biotechnology companies. This year we find 41 pharmaceutical companies, 44 medical device (medtech) companies, and 15 biotech companies. Johnson & Johnson remains #1, with the next four—Pfizer, Roche, Novartis and Bayer—changing positions, but still comprising the top five. The big news is a medical device company appearing on the top 10, as Medtronic (now with Covidien’s revenue) takes the #10 spot. Pharmaceutical companies in the Top 100 continue to dominate in terms of revenue, but represent 62% for a total $720B, which is down from last year’s 68%. Revenue growth brings good news as the trends continue to be on the upswing with 78% of Top 100 revenues increasing as compared with 62% last year, and less than 50% the prior year.

Overall revenue total for the top 100 was $1.153 trillion dollars. Medical device was the big winner in growth, with 93% of the medical device companies showing an increase, 80% of the biotechs’ revenues increasing, and 60% of the pharmaceutical companies. The total revenue added by medical device was $42B, $16B by pharma and $6B by biotech.

29 | HS&M OCTOBER/NOVEMBER 2017

Companies are ranked by their 2016 revenue as furnished by their annual reports and publicly available sources, Edgar and Morningstar stock information websites (figures of non-U.S. companies were converted to U.S. dollars from various currencies using end of the year exchange rates for 2016 and 2016). Companies are categorized by their predominant revenue source and their own characterization per publicly available sources.

Make a move

FROM PATIENT-CENTRICITY TO SOCIAL-CENTRICITY Patient-centricity is an individualistic approach. But, in real life, individual behavior is strongly influenced by context. By highlighting the social influences that impact patient behavior, we can identify forces that directly conflict with the behavior we want to promote and make good on our commitment to support lasting change.

How do we help people act on the health decisions theyâ&#x20AC;&#x2122;ve made for themselves? How do we empower them to be more resilient to try and try again?

Download our two new reports to learn more: COURSE-CHANGING CREATIVITY AT CANNES

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ADVANCING BEYOND PATIENT-CENTRICITY

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Companies are ranked by their 2016 revenue as furnished by their annual reports and publicly available sources such as Edgar and Morningstar stock information websites. Figures of non-U.S. companies were converted to U.S. dollars from various currencies. healthcare Companies

Click here to get Top 100 healthcare Companies

Ranking Company Location 2016 Revenue in US$B

Johnson & Johnson

New Brunswick, New Jersey $ 71.90

Pfizer

New York, New York

$ 52.82

Roche

Basel, Switzerland

$ 49.69

Novartis

Basel, Switzerland

$ 48.52

Bayer

Leverkusen, Germany

$ 48.49

Merck & Company

Kenilworth, New Jersey

$ 39.81

Sanofi

Paris, France

$ 35.59

GlaxoSmithKline

Brentford, United Kingdom

$ 34.43

Gilead Sciences

Foster City, California

$ 30.39

Medtronic

Dublin, Ireland

$ 28.83

Medipal Holdings

Tokyo, Japan

$ 26.87

AbbVie

North Chicago, Illinois

$ 25.56

AstraZeneca

Cambridge, United Kingdom $ 23.00

Amgen

Thousand Oaks, California

$ 22.99

Alfresa Holdings

Tokyo, Japan

$ 22.03

Teva Pharmaceuticals

Petach Tikva, Israel

$ 21.90

Eli Lilly and Company

Indianapolis, Indiana

$ 21.22

Abbott Laboratories

Chicago, Illinois

$ 20.85

Bristol-Myers Squibb

New York, New York

$ 19.43

Philips Healthcare

Amsterdam, Netherlands

$ 18.33

General Electric

Fairfield, Connecticut

$ 18.30

Fresenius Medical Care

Bad Homburg, Germany

$ 17.91

Boehringer Ingelheim

Ingelheim am Rhein, Germany $ 16.73

Novo Nordisk

BagsvĂŚrd, Denmark

$ 15.82

Merck KGaA

Darmstadt, Germany

$ 15.81

31 | HS&M OCTOBER/NOVEMBER 2017

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Ranking Company Location 2016 Revenue in US$B

Takeda Pharmaceuticals

Osaka, Japan

$ 15.45

Actavis

Parsippany-Troy Hills, New Jersey $ 14.57

Siemens

Munich, Germany

$ 14.24

Danaher

Washington, DC

$ 13.19

Becton Dickinson

Franklin Lakes, New Jersey

$ 12.48

Cardinal Health

Dublin, Ohio

$ 12.40

Biogen

Cambridge, Massachusetts

$ 11.45

Shire

Dublin, Ireland

$ 11.40

Stryker

Kalamazoo, Michigan

$ 11.33

Celgene

Summit, New Jersey

$ 11.23

Astellas Pharma

Tokyo, Japan

$ 11.21

Mylan

Canonsburg, Pennsylvania

$ 11.08

Reckitt Benckiser

Slough, United Kingdom

$ 10.42

Otsuka Pharmaceutical

Tokyo, Japan

$ 10.22

Baxter

Deerfield, Illinois

$ 10.20

Valeant Pharmaceuticals

Laval, Quebec, Canada

$ 9.67

Boston Scientific

Marlborough, Massachusetts $ 8.39

43 NEW Daiichi Sankyo

Tokyo, Japan

$ 8.17

Zimmer Biomet

Warsaw, Indiana

$ 7.68

Essilor

Charenton-le-Pont, France

$ 7.49

46 NEW B. Braun Medical

Melsungen, Germany

$ 6.81

CSL Behring

King of Prussia, Pennsylvania $ 6.44

Teijin

Osaka, Japan

$ 6.34

Saint Paul, Minnesota

$ 5.53

Perrigo

Dublin, Ireland

$ 5.28

49 50

33 | HS&M OCTOBER/NOVEMBER 2017

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Ranking Company Location 2016 Revenue in US$B

Olympus

Tokyo, Japan

$ 5.21

Carl Zeiss

Oberkochen, Germany

$ 5.14

Zoetis

Parsippany, New Jersey

$ 4.89

Regeneron Pharmaceuticals

Tarrytown, New York

$ 4.86

Smith & Nephew

London, United Kingdom

$ 4.67

Eisai

Tokyo, Japan

$ 4.61

Terumo Medical

Tokyo, Japan

$ 4.49

UCB

Brussels, Belgium

$ 4.40

Grifols

Barcelona, Spain

$ 4.26

Sun Pharmaceutical

Mumbai, India

$ 4.25

Chugai Pharmaceutical

Tokyo, Japan

$ 4.20

Endo International

Dublin, Ireland

$ 4.01

63 NEW Dentsply Sirona

York, Pennsylvania

$ 3.75

C. R. Bard

Murray Hill, New Jersey

$ 3.71

Mitsubishi Tanabe Pharma

Osaka, Japan

$ 3.63

66 NEW Fujifilm Medical Systems

Tokyo, Japan

$ 3.62

Osaka, Japan

$ 3.52

68 NEW Mallinckrodt

Dublin, Ireland

$ 3.38

Getinge Group

Gothenburg, Sweden

$ 3.28

Varian Medical Systems

Palo Alto, California

$ 3.22

Alexion Pharmaceuticals

New Haven, Connecticut

$ 3.08

Hartmann

Frankfurt, Germany

$ 2.97

Edwards Lifesciences

Irvine, California

$ 2.96

Kyowa Hakko Kirin

Tokyo, Japan

$ 2.93

Nipro Medical Corporation

Osaka, Japan

$ 2.88

Sumitomo Dainippon Pharma

35 | HS&M OCTOBER/NOVEMBER 2017

Click here to get Top 100 healthcare Companies

Ranking Company Location 2016 Revenue in US$B

76 77

Hologic

NEW Shionogi

Marlborough, Massachusetts $ 2.83 Osaka, Japan

$ 2.75

Intuitive Surgical

Sunnyvale, California

$ 2.70

Hill-Rom

Chicago, Illinois

$ 2.66

Dräger

Lübeck, Germany

$ 2.66

Ship Healthcare Holdings

Suita-Shi, Japan

$ 2.62

Aspen Pharmacare

KwaZulu-Natal, South Africa $ 2.58

Actelion

Allschwil, Switzerland

$ 2.42

Illumina

San Diego, California

$ 2.40

Sonova

Stäfa, Switzerland

$ 2.35

86 NEW Dr. Reddy’s Laboratories

Hyderabad, India

$ 2.27

STADA Arzneimittel

BadVilbel, Germany

$ 2.25

Steris

Mentor, Ohio

$ 2.24

89 NEW bioMerieux

Marcy l’Etoile, France

$ 2.21

Coloplast

Humblebaek, Denmark

$ 2.08

Novozymes

Bagsvaerd, Denmark

$ 2.00

The Cooper Companies

Pleasanton, California

$ 1.97

Miraca Holdings

Tokyo, Japan

$ 1.96

Teleflex

Wayne, Pennsylvania

$ 1.87

ResMed

San Diego, California

$ 1.84

William Demant

Smørum, Denmark

$ 1.70

ConvaTec

Deeside, United Kingdom

$ 1.69

98 NEW Vertex Pharmaceuticals

Boston, Massachusetts

$ 1.68

Ipsen

Paris, France

$ 1.67

Bruker

Billerica, Massachusetts

$ 1.61

100

HS&M OCTOBER/NOVEMBER 2017| 36

| Pharmaceutical

The Real Launch Numbers: Revenues, Patients, NBRx Rates and More Recently innovative brands outpaced competition by 3x. Some advice on how they can maintain that lead. By William McClellan, Center of Excellence Leader, Launch Excellence, USBU, QuintilesIMS

The US biopharmaceutical industry is the most R&D-intensive industry in the US economy, and its investment in R&D as a percentage of sales is roughly six times greater than that of all other manufacturing industries. Consequently, over the past 20 years, 667 New Active Substances (NASs) have successfully been discovered, developed, and authorized for use within the US—58% of which have been specialist initiated. Specialty products came onto the scene in dramatic fashion in 2010—as the US economy was pulling itself out of the Great Recession of 2008—and they have delivered strong growth in the years since. Yet, their success has had some unintended and potentially long-lasting consequences for the economics of our health system. Unable to absorb the full cost of specialty products and still meet the needs of the majority of their populations, payers have driven the cost down in contract negotiations and aggressively managed patient access. 37 | HS&M OCTOBER/NOVEMBER 2017

Will specialty brands, which have contributed so much to patient health, be able to retain their value in the marketplace? Will innovation continue to be rewarded to the extent necessary to perpetuate it? The Emergence of Specialty Brands The first few years of the 21st century were productive and promising for the US pharmaceutical industry, which was dominated by primary care brands. In any given year from 2000 to 2006, newly launched pharmaceutical products generated between $3 billion

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Pharmaceutical

and $5 billion in aggregate sales during their first 12 months on the market. From 2000 to 2006, in the “Age of Traditional Products,” 28 brands achieved over $300 million in first-year sales—a threshold for outstanding performance. Then, things changed in 2007. From a launch perspective, the industry entered the “Dark Ages.” Between 2007 and 2009, aggregate sales associated with launch brands dipped below $3 billion, bottoming out in 2008 with just $1.3 billion in sales. During this time, no brands reached the $300 million mark. Several factors accounted for this decline: the fact that there were simply fewer innovative products entering the market, the emergence of electronic prescribing systems that gave payers more ability to control access, and the financial crisis of 2007-2008.

In 2010, the industry emerged from the “Dark Ages” to a renaissance driven by oncology and specialty products. Aggregate sales for launch brands once again passed the $3 billion mark, and several brands distinguished themselves by crossing the $300 million in sales threshold in their first year on the market. From 2010 to 2016, 35 brands accomplished this feat. Figure 1 shows how gross sales of launch brands has changed from 2000 to 2016. The Age of Oncology and Specialty Aggregate sales from launch brands generated more than $18 billion in sales in 2014, an astounding increase over the $3 billion to $5 billion achieved during the Age of Traditional Products. Even excerpting the large contribution of the

39 | HS&M OCTOBER/NOVEMBER 2017

innovative Hepatitis C drugs, average first-year sales increased from $37 million in 2007 to $111 million in 2014 and 2015. In 2016, average first-year sales softened to $87 million. So what has made the difference for these products? Why have they been even more successful than those that launched prior to the “Dark Ages”? The answer is quite straightforward: they are innovative and are meeting a market need. The percent of launches that can be characterized as innovative increased from 15% in 2007 to 24% in 2013. (See: “Assessing Level of Differentiation and Market Need.” in box.) The degree of innovation went hand in hand with the amount of unmet need in the market. Whereas in 2007 only 27% of brands were being launched

into markets with high need, approximately 50% were from 2011 to 2016. (See Figure 2.) Large Benefit for Small Numbers The good news, of course, is that innovation is addressing diseases with high-unmet need such as on-

cology, autoimmune diseases, and central nervous system (CNS) disorders. But, there is a complicating factor in the economic story: the patient population benefiting from launch brands is becoming smaller. In 2007, on average, approximately 180,000 patients were exposed to a launch brand. That number has

decreased year over year ever since. (See Figure 3.) By 2015, only 40,000 patients on average were being exposed to launch brands. This has created the perfect health-economic storm for payers whose budgets are taking the hit. They are now paying four times the cost for products that benefit one quarter of the

HS&M OCTOBER/NOVEMBER 2017| 40

Pharmaceutical Unintended Consequences In this environment, prescriptions written do not come close to equating to sales. Even for traditional products which are not as expensive as specialty brands, prescription fill rates (total prescriptions presented at the pharmacy, minus those rejected and abandoned) are decreasing. While the fill rate was 70% between 2010 and 2013, it dropped to 55% between 2014 and 2015. That means that for every 100 prescriptions that make it to the pharmacy, on average, only 55 get filled. patients. This leaves them with less in their budgets to cover the lion’s share of their insured population. Payers have two tools in their arsenal to address this economic challenge. Either they can negotiate with pharmaceutical companies for deeper rebates, or they can aggressively manage patient access to launch brands. As we shall see, they have been using both tactics heavily. Figure 4 shows that in recent years, payers have been successful in getting steeper price concessions from manufacturers. Consequently, the industry’s net price growth slowed sharply in just three years—from 9.1% in 2012 to 2.8% in 2015. Payers can limit patient access to expensive launch brands in two ways: they can decrease formulary coverage and/or increase the patient’s co-pay. To measure the impact of decreasing formulary coverage, we can track the percentage of prescriptions presented to pharmacists that insurers reject due to lack of coverage. As Figure 5 on the next page illustrates, within commercial plans, pharmacy rejec-

tion rates have soared from 12% in 2010 to 33% in 2015. Similarly, we should be able to quantify the impact of co-pay increases by examining prescription abandonment at the pharmacy. (See Figure 6.) Recently, average co-pays in commercial plans for newly launched products increased by 20% from 2014 to 2015. So, one would expect abandonment rates to also increase. Yet, they’ve remained fairly stable from 2010 to 2015. Why? By triangulating this information with insight into the growing use of co-pay assistance programs, we arrive at the probable answer: the industry’s efforts to help patients with out-of-pocket costs has offset the effect of the co-pay increases imposed by insurers. The average final co-pay that patients paid rose only 14% from 2014 to 2015, while co-pay offset costs grew more than 32%. Thus, launch teams are being hit by a one-two punch. They are granting deeper rebates to payers and paying out more in patient-support programs.

41 | HS&M OCTOBER/NOVEMBER 2017

To understand this in more detail, we looked at fill rates for innovative versus non-innovative brands. As seen in Figure 7, the fill rate for innovative brands decreased by more than 50% in the last two years. And, it is far lower than the fill rate of non-innovative brands. In 2014 and 2015, the fill rate during the first six months of launch was 39% for innovative brands and 57% for non-innovative brands, suggesting that payers are much more aggressive in limiting access to innovative brands. In many brand teams’ experience, payers are delaying their reimbursement decisions on launch brands, and so we compared fill rates for the first six months post launch with the second six months. While the data show a slight increase in fill rates in the second six months for innovative brands, there may be other factors at work aside from payers’ reimbursement decisions. It could be that manufacturers’ are contributing more to patients’ co-pays earlier on, a situation that would mask payers’ delayed decision-making. We do know from

HS&M OCTOBER/NOVEMBER 2017| 42

industry

other analyses that payers tend to change their position up until about four months post launch. But are the Rewards Still There? So, given payers’ pushback, the question becomes: Is the industry’s innovation still being rewarded? We conclude that it is, but, not nearly as much as in the past. And the change is taking place rapidly. From 2010 to 2013, innovative brands generated sales approximately three times the size of sales for non-innovative brands. In 2014 and 2015, that ratio had shrunk to about two times the size. So, while innovative brands still yield higher rewards than non-innovative brands, the differential is diminishing at an alarming rate. What is around the corner? Will this trend continue? Admittedly, the outlook is worrisome as payers’ budgets are finite, and something

must give. In 2016, 25% of launches were categorized as innovative, and 50% were launching into a market of high need. Yet, these launch brands are projected to have the lowest average first-year sales since 2013. (See Figure 8.) What Can Innovators Do? While other QuintilesIMS analyses have revealed that the basic shape of the curve representing launch trajectories has not changed significantly, many other aspects of the launch environment have. Thus, manufacturers must modify their best-demonstrated practices to account for these market forces— most specifically the deepening influence of payers. Faced with payers’ growing restrictions on patient access, manufacturers must adopt more robust demand modeling to improve their forecasting capabilities. By more accurately sizing their asset, brand

43 | HS&M OCTOBER/NOVEMBER 2017

managers can better manage expectations of senior management, shareholders, and industry analysts. Currently, many companies are “paying double” to improve access in that they are offering payers rebates and providing patients with assistance at the pharmacy register. While both are successful strategies, companies should carefully plan how to optimize them and avoid overcompensating. For example, it is probably not necessary to offer a $25 co-pay card to patients who are in plans with just a $25 co-pay—the outcome of the manufacturer’s 50% rebate to the payer. Companies will need to have a multichannel marketing model and a customer team that is fully integrated and enabled within it. Certainly when addressing small numbers of highly important, but difficult to engage specialists, it is

HS&M OCTOBER/NOVEMBER 2017| 44

industry crucial to ensure that all channels are used to their greatest effect. Also, payers’ increased influence is quite regional, suggesting that manufacturers would do well to account for these regional variations in how they allocated their promotional resources across their marketing channels. Companies will also require an intense patient focus. Specialty treatments are mostly geared to relatively small segments of patients with complex, difficult-to-manage diseases. Identifying these patients and supporting their treatment for optimal outcomes will be key to excellent launches. In the long run, in order to sustain their own R&D innovation, the industry will need to be creative in addressing the macroeconomics of medicine, ensuring that the cost of innovation is borne appropriately by all who benefit, not simply by today’s payers and patients. Conclusion Innovation is the lifeblood of the R&D pharmaceutical industry and what distinguishes it from all other sectors. The industry’s contributions to patient health and to advancing medical science are universally applauded. Yet, innovation—more precisely its price tag—captures the attention of payers and is forcing them to aggressively manage their budgets in ways that are dampening revenues for specialty brand manufacturers. Yes, the rewards for innovation are still there, but for how long? The trend is not encouraging. Is 2016 the beginning of the next era in the pharmaceutical industry—the Age of Limitation? • 45 | HS&M OCTOBER/NOVEMBER 2017

William McClellan Center of Excellence Leader, Launch Excellence, USBU, QuintilesIMS Bill is an expert in the field of pharmaceutical launch excellence with over 20 years of experience. He leads the Launch Center of Excellence for the US at QuintilesIMS where he focuses on launch readiness, tracking and performance diagnostics utilizing patient data, statistical modeling, qualitative and quantitative research. Bill leads a team of professionals responsible for developing thought leadership to provide innovative approaches for launching a brand. The research focuses on patient acquisition and prescriber adoption and productivity. The group has examined how launch success varies by market need and product differentiation creating launch archetypes. Findings have fueled offerings that focus on launch strategy, commercialization tactics and performance monitoring. bill.mcclellan@quintilesims.com QuintilesIMS is a leading integrated information and technology-enabled healthcare service provider worldwide, dedicated to helping its clients improve their clinical, scientific and commercial results. Formed through the merger of Quintiles Transnational and IMS Health, QuintilesIMS’s approximately 50,000 employees conduct operations in more than 100 countries. QuintilesIMS provides solutions that span clinical to commercial, bringing customers a unique opportunity to realize the full potential of innovations and advanced healthcare outcomes. As a global leader in protecting individual patient privacy, QuintilesIMS uses healthcare data to deliver critical, real-world disease and treatment insights. Through a wide variety of privacy-enhancing technologies and safeguards, QuintilesIMS protects individual privacy while managing information to drive healthcare forward.

COMMENT

What do over of the top 20 pharmaceutical, biotech, and medical device companies have in common?

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industry trends: by the numbers Compiled by Cari Kraft, Jacobs Management Group, Inc.

$930M

Amount raised for health-related campaigns on GoFundMe from 2010-2016 GoFundMe, the leading crowdfunding site, reported that, of the over $2 billion raised on its site from 2010-2016, $930 million, or about 46.5%, was for health-related campaigns. Source: Nerd Wallet, November 2, 2016

93.11 Index of Italy, rated healthiest country in the world In a survey of countries worldwide, Italy was determined to be the healthiest, based on such factors as life expectancy, causes of death, incidence of high blood pressure, high blood glucose, tobacco use, and physical inactivity. It was followed by Iceland, Switzerland and Singapore. The US came in at #34. Source: Bloomberg Global Health Index, August 2017 47 | HS&M OCTOBER/NOVEMBER 2017

â&#x20AC;Ż$93.7B Oncology market size, largest in healthcare Oncology continues to be the largest therapy area in the industry, due to new advances in treatments and an aging population. It now has a worldwide market share of 11.7%. Source: EvaluatePharma World Preview 2017, Outlook to 2022

27% Percent of US Medical Science Liasons (MSLs) who are pharmacists MSLs can often be PhDs, postdocs or physicians. But in the US, they most commonly have a PharmD degree. In Portugal, 22% are pharmacists, followed by Italy at 9.1% and Spain at 8.8%. Source: FSTP (From Science to Pharma] global MSL salary survey

#13

$59B

Expected 2020 global value of CRO Market The global contract research organization market is expected to reach $59B by 2020, growing at a CAGR of 9.80%. Source: Zion Market Research “Contract Research Organization (CRO) Market for Early-Stage Development Services and Last-Stage Development Services: Global Industry Perspective, Comprehensive Analysis and Forecast 2014-2020” June 2017

Position of Johnson & Johnson among most admired companies in 2017 Fortune magazine rated the best-regarded companies in 51 industries and 28 countries. Johnson & Johnson was the highest-rated healthcare company, coming in at 13 overall, and followed by Roche, Novartis, Merck and Amgen among industry names. Source: Fortune, World’s Most Admired Companies, 2017

17%

Rise in Nasdaq biopharma index H1 of 2017 Biopharma companies did well in the first half of the year, rising 17% over 2016 on the Nasdaq Biotechnology Index. S&P Pharmaceuticals showed the sector up 9% and Dow Jones Pharma and Biotech had them up 11%. Source: EvaluatePharma and Biotech Half-Year Review, July 2017

COMMENT HS&M OCTOBER/NOVEMBER 2017| 48

Pharmaceutical

Great Advice from Great Minds: UCB Puts PatientValue Strategy to Work An interview with David Fortanbary, Head of US Commercial Performance Training, UCB By Jill Donahue, Principal, Engage Rx

One of the great challenges of implementing patient centricity in pharma is creating the culture which supports it. We often miss the crucial role training plays in transforming associatesâ&#x20AC;&#x2122; mindsets. But David Fortanbary has been at the heart of this change, and we were thankful for him sharing his wisdom on it. David spent a number of years at Bristol-Myers Squibb, as a sales director, executive director of US Pharmaceuticals Sales Effectiveness & Training, and senior director of Managed Markets. He built a reputation as a leader in sales learning and training, sales force effectiveness, and capabilities building. In 2013 he became Vice President of Life Sciences Trainers & Educators Network (LTEN), the only professional organization designed by and for life sciences training and education professionals. He retired for a weekend, only to find himself unable to say no to an opportunity to serve as Head of North 49 | HS&M OCTOBER/NOVEMBER 2017

America Commercial Training at UCB. UCB is one of the companies that is truly putting its money where its mouth is when it comes to patient centricity. A couple of years ago, I co-founded The Aurora Project, a worldwide industry volunteer group designed to illuminate commercial pharmaâ&#x20AC;&#x2122;s path to patient centricity. In the 2016 Aurora Project Survey, 2346 pharma professionals, solution providers and patients weighed in on the need for pharma to become patient focused. An astounding 93% believe a patient-focused strategy improves overall business outcomes. One challenge to implementing that is that only 38% agree

Watch Jill’s interview with David Fortanbary • That beginning and ending with the patient in mind is a good value proposition for the company • This ideal has to be built into the culture. Each company needs to find champions who share the vision, and hold them up as advocates • And the tone has to be woven into all levels of the organization If you would like to participate in The Aurora Project’s second annual patient-centric benchmark survey, please do so here. appropriate training is given. And 78% either don’t know what or how to teach or are looking for ways to train their people to behave in patient-focused ways that create better outcomes for all. David knows it’s not easy to understand the world of the patient, and all the daily hurdles they face. He wants to help employees feel what diagnosis and treatment are like. He has involved patients and caregivers in discussions with professionals, even surprising employees in the middle of a meeting to conduct a FaceTime call with a patient. He says that the gratitude expressed by these patients injects new energy into meetings and reinforces employees’ dedication. David has also challenged colleagues to examine key questions about their own beliefs and actions. Who most profoundly influenced your decision to be a life sciences professional? When did you know you had truly made a difference in someone’s life? What

do you want your legacy to be? He and I share a motivation; both of us had parents who had significant healthcare problems. This drives him. David is thankful for what the industry has done for him, and for the opportunity to help patients. Because I know of David’s passion for the topic and experience in creating a patient-focused culture, I sat down with him at the 2017 eyeforpharma Patient Summit to talk about what UCB is doing to move PC from words to actions.

Jill Donahue HBa, MAdEd Associate Editor, HS&M Jill is on a mission to lift our industry, building purposedriven, influential people. Through her keynote talks, workshops and awardwinning mobile-learning programs, she is helping pharma people build trust, open doors and make a bigger impact.

We talked about: • How the pharma industry has moved from a transactional model to a patient-focused model • How training can help build a patient-focused culture • The role of purpose in bringing value to patients • How highlighting the people who have the patient-centric mindset can drive your culture

COMMENT

HS&M OCTOBER/NOVEMBER 2017| 50

motivation

MOTIVIDEOS By Cari Kraft, Jacobs Management Group It’s 9 a.m., time to get the team excited about the day or week ahead! What can you do to spur their interest, generate energy, and have them perform at their best? Kick off a meeting or motivate yourself with one of these videos! Get the Energy Started by Laughing

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Cari Kraft leads a team of master level recruiters at Jacobs Management Group, celebrating 20+ years of executive recruiting in the healthcare (pharmaceutical, medical device, biotechnology) and high-tech industries, nationally. Prior to joining Jacobs Management Group, Ms. Kraft has held positions as a Senior Sales Executive, Director of Business Development and Director of Marketing. She also has deep knowledge of the technology/startup fields, having been in the industry through the rise of the Internet. Ms. Kraft is a University of Pennsylvania/Wharton alumnus holding a degree in economics and decision sciences. Cari can be reached at ckraft@jacobsmgt.com.

COMMENT 51 | HS&M OCTOBER/NOVEMBER 2017

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53 | HS&M OCTOBER/NOVEMBER 2017

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HS&M OCTOBER/NOVEMBER 2017| 54

INDUSTRY

Why I Work In Healthcare

Attendees at the DA4S proudly display their pride

Everyone looks for purpose in their careers, and healthcare provides us with numerous reasons to feel useful: advancing the cause of science, being in a vibrant and high-tech industry, and especially delivering help and relief to millions of patients. Earlier this year we attended the Woman of the Year event held by the Healthcare Businesswomenâ&#x20AC;&#x2122;s Association (HBA) in Manhattan. It was there that we kicked off our effort to visually represent the many ways in which people celebrate their work in healthcare. We provided attendees with signs on which they could write their feelings, and we ran photos of those people in our June/July issue. 55 | HS&M OCTOBER/NOVEMBER 2017

The response was enthusiastic enough that we followed up with a second series of photos taken at the Diversity Alliance for Science (DA4S) in Newark, NJ. Here are just some of the positive statements we gathered from a very dedicated crowd, proof of the pride we all feel to be associated with this great work.

Why I Work In Healthcare

HS&M OCTOBER/NOVEMBER 2017| 56

INDUSTRY

Why I Work In Healthcare

57 | HS&M OCTOBER/NOVEMBER 2017

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How Pfizer, Boehringer Ingelheim and Others Are Using Video Games to Drive Results How healthcare companies can up their game and their profits This industry gets a lot of criticism for the price of medications, mostly based on the few examples that end up in court and make headlines. But are price hikes, in fact, a common way of preserving profitability? Recent articles have shown that Pfizer (just to take one example) has raised the price of nearly 100 drugs by an average of 20% in the past year. While Pfizer answered queries by saying that the average net selling price, after discounts and rebates, is only 4%, this still points to a trend that needs to be addressed. The issue is made more pressing when US costs are compared to other industrialized countries, such as those in Europe, where pricing is typically lower. As we know, this often leads to consumers buying prescription drugs from a source outside of the United States. There are many factors that affect the trend. One, of course, is the sharp spike in non-adherence. According to the latest Truven Health Analytics-NPR Health Poll, as many as 67% of patients are non-adherent, up from 50% as reported in 2011 by the National Center for Biotechnology Information. Why is this becoming more of a problem? In a sort of circular pattern, cost is cited as a reason for not filling—or not refilling—a prescription. Clinical impacts, such as side effects, are another. Some patients don’t think the medication is working, and others just forget to stay with the program. As we’ve reported in these pages, non-adherence has been estimated to cause as much as a $637 billion loss for the industry. Keeping prices down may be one way of increasing adherence, and companies have pledged to do so. But how can they deal with the other issues?

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The Fun Factor One way is by understanding the psychological and emotional resistance to taking medications, so that we can develop techniques for encouraging better compliance. Many companies are turning to gaming to accomplish this, on the same theory that moms use in getting kids to take their cough medicine: “Here comes the airplane—open up the hangar!” To return to Pfizer, that company recently launched Hemocraft, based on the wildly successful Minecraft series of video games. Hemocraft is aimed at younger hemophilia patients, between 8 and 16. Pfizer’s Chief Medical Officer Kevin W. Williams said “These new digital innovations can be integrated into everyday routines to help empower people with hemophilia to learn about and track different aspects relevant to their disease so that they can have informed conversations with their health care providers.” Hemocraft was created in partnership with the Entrepreneurial Game Studio at Drexel University and representatives from the hemophilia community. Players meet a village doctor to learn about their treatment plan, and face challenges to control factor levels. Will it work? Hemocraft was introduced only in June of this year, so the results aren’t yet in. But other examples serve to show that gamification is a worthwhile therapy. One of the leaders in this space is HealthPrize, which has a long list of case histories showing the success of the technique.

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One project for Boehringer Ingelheim was a support program for patients taking Spiriva Respimat, its COPD treatment. It was called RespiPoints, and offered rewards through a free online site. Patients would report taking Respimat, read educational information, and earn points which could be redeemed for gift cards. (If they failed to refill, they could no longer earn points.) There were also quizzes and surveys, which provided valuable feedback to BI about patient understanding, beliefs and activities—how they used the product, what they knew about their condition, how much they understood of nutritional information. The platform also tracks use of the Respimat inhaler so that each patient can see how it affects their daily life. It’s part of BI’s—and the industry’s—goal to go “beyondthe pill” into such areas as “edutainment.” Injecting Incentive Into Diabetes HealthPrize was also engaged by the manufacturer of an inject-

able diabetes medication to test the impact of applied behavioral economics, patient education and rewards on diabetes patients. The project was adapted in an iframe (a website within a website) to reside within an existing CRM program. Members received daily prompts via text message or email to report their medication taking. They earned points for selfreporting medication injections, refilling their prescriptions, taking weekly quizzes and surveys, and reading daily health tips. Points were redeemable for a variety of health-related merchandise in the Rewards Mall. Members were also eligible to win monthly leaderboard competitions and weekly sweepstakes based on their levels of engagement. All prescription fills were verified through the platform’s proprietary verification system. A total of 2,305 patients registered for the program. • The average member logged in 5 times per week and spent two minutes on the site each visit, for

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a monthly average time on site of 43.6 minutes. • Over 75% of all members completed the quiz and survey each week • Approximately 60% of patients read the daily health tip each day. After only eight months, the program demonstrated an incremental fill rate of 2.9 fills. At the conclusion of the program, the mean prescription fill interval (number of days from one fill to the next) was found to decrease from 57.5 days pre-enrollment to 35.1 days post-enrollment. Wiping Out Acne A leading prescription acne brand wanted to educate and engage patients to improve adherence beyond the brand’s baseline prescription fill rate of 1.3 fills per patient. The strategy was to suit the brand’s topical delivery, allowing for the variable fill intervals that result from different dosing amounts. All prescription fills were verified through the platform’s proprietary verification system. The designs and messaging were also styled

for a younger demographic and included an integrated mobile application for both Android and iOS users. Members earned points for selfreporting daily medication application, refilling their prescription, taking weekly quizzes and surveys, and opening daily “Fortune Cookies” (educational tips and trivia). Points were redeemable for a variety of gift cards and merchandise in the Rewards Mall. Members were also eligible to win monthly leaderboard competitions and weekly sweepstakes based on their levels of engagement. Various customizable prompts via email, text, and push notifications were set to keep the brand and medication-taking schedule top of mind for the member. Following an initial 30-day trial period, members were required to prove they were on therapy by using the prescription verification system.

A total of 7,800 patients registered for the program, curiously with an average age of 24 years.

learning about acne helps them to be more compliant with their medications

• The mean number of prescription fills per member for those actively engaged in the program was 4.0, nearly 3 times the brand’s baseline fill rate

• 41% of members stated that their tube lasts 3 to 6 months, longer than anticipated by the brand

• The mean fill rate for all verified members was 1.8 fills per member, a 39% increase over the brand’s historic baseline • The average member logged in 2.7 times per week and spent over 2 minutes on the site each visit • A third of all members completed the quiz each week and more than 200,000 survey responses were collected from patients confirmed to be on therapy, leading to valuable insights for the brand In addition, there was interesting feedback on patient education and product use: • 73% of members believe that

• 36% of members reported that they received 3 to 5 or more product samples from their physician, which prompted the brand to review their sampling procedures. Patients with many samples demonstrate longer delays in filling the initial prescription Healthcare companies today face a Pandora’s box of challenges to profitability, from the patent cliff to the staggering costs of launching a new medication to regulatory and other stumbling blocks. Improving adherence is a promising area to pursue if we are to support a more robust industry. Wouldn’t it be interesting if fun proved to be one way out of this dilemma? •

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| Patient-centricity

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Better compliance. Better outcomes. Better profits. Understanding patients’ lives leads to everyone’s goals By Kathleen Starr, Ph.D., Managing Director, Behavioral Insights, inVentiv Health Commercial

Healthcare companies and consumers are being held to greater levels of accountability than ever before for health outcomes. Third-party payers routinely scrutinize outcomes when making decisions on access and reimbursement. Competitors point to outcomes when differentiating value. Consumers are being told that they are largely responsible for their own health outcomes and must now do more than simply take their medicine—they must make serious lifestyle changes, such as eating better and exercising more. But the best outcomes often depend on changing habits and behaviors that are hard to change, even briefly, and many of the required changes must be sustained over years. The pharmaceutical industry recognizes that consumer behavior is a key to both better individual health outcomes and greater business success, and has created a wide range of programs to engage and support patients who are taking prescribed medication. Patient needs, desires, and interests have become the focus of a sweeping movement toward greater patientcentricity at every stage—from drug development through launch and adherence—all designed to improve outcomes. But life is messy. And helping people make and sustain behavior change, and engaging patients as they want to be engaged, means working within this context of messy lives. For instance, we spend millions of dollars promoting medication adherence by empowering patients with information about their

medicine. Yet, it is well known that up to 30% of patients with chronic conditions don’t even fill their first prescription. Of those patients who do get to the pharmacy that first time, another 30% fall off their medication within 30 days, and up to 60% stop taking their prescriptions within six months.1, 2 The result: increased illness, sometimes leading to death, and nearly $300 billion lost in additional avoidable medical spending each year.3 To enhance engagement and improve outcomes, the pharmaceutical industry now must move beyond the standard patientcentric approach that focuses on individual knowledge and motivation. We must now take a “socialcentric” approach that takes into account the differing contexts that shape individual behavior.

medication adherence, taking a social-centric approach will have enormous value in positively impacting the complex interaction of factors that impede patient behavior change. This new approach has been validated by our own ethnographic research that revealed how the social context of everyday life creates a bumpy road for behavior change. By understanding the obstacles in a deep and detailed way, we are able to create social-centric programs with a far higher probability of success. This paper explores some of the key elements of socialcentricity. Identifying real-life influences of health behavior

Whether working to develop a new drug, launch a product, or increase

Health in America, a recent ethnographic study completed by Behavioral Insights, a strategic solution

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Patient-centricity within inVentiv Health Communications, suggests new ways to promote sustained change by leveraging the contributing influences of the family, the healthcare system, and society. This extensive study, conducted in two phases over two years, took us into 30 patient homes to observe behaviors as they unfolded over time and social patterns of influence that could be harnessed for positive change. Our observations “in the wild” allowed us to gather data on actual

patient lives, which, when combined with our expertise in behavioral science, provided insights that cannot be gathered through any survey, interview, or literature review.

illness to infertility and cancer. Our research brought into focus how and why programs that are “one-size-fits-all” and designed for an “ideal” social context are bound to have limited impact.

Over the course of our research, we witnessed job changes, unexpected medical bills, family members moving in and out of a household, and even one patient dying. In the midst of near constant change, families dealt with medical issues from diabetes and mental

Study methodology

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Participants in our research represented a wide range of ages, socio-economic backgrounds, and illnesses. They included families with small children and teen-agers, empty nesters, families deeply engaged in caring for elderly parents,

as well as families relatively isolated with no relatives nearby. They lived in Portland, Kansas City, Shreveport, and Boston, providing a look at differences by region. Every quarter, we visited families in their homes to allow researchers an intimate look at family dynamics and typical routines—carpools, snack and meal preparation, as well as paying bills. Between visits, our participants recorded video diaries that captured daily habits such as blood glucose monitoring and exercise sessions, as well as unexpected events, such as trips to emergency rooms. More than 600 hours of video was collected and analyzed for the study. This study gave us a real-life view of three primary forces within the social environment that have the greatest impact on patient behavior: the family, the healthcare system, and American culture. Healthy behaviors can be swept away by the reality of today’s family life Even families devoted to healthy living were not immune from the impact of a lack of structure. An absence of predictability in daily life often translated into weekly or daily variations in attention to healthy behavior changes. We observed individuals often struggling to consistently manage a chronic condition when faced with the many twists and turns of the modern family. And when healthy patterns did emerge, such as preparing healthy snacks for work or monitoring blood glucose, the behavior tended to be shortlived because of needing to focus on family.

This study gave us a real-life view of three primary forces within the social environment that have the greatest impact on patient behavior: the family, the healthcare system, and American culture. But not all the impacts of constant change were negative. We observed that big family disruptions, such as a move, a new job, or summer vacation, often prompted individuals into positive action. For example, people restarted a vegetarian diet, limited their TV time, and resumed adhering to medications. The social-centric view of the American family shows us that maintaining any type of healthy behavior often falls victim to a circle of constant interruptions and the hectic pace of daily life. Given this reality, we observed that even additional “minor” health-related problems can be overwhelming for a family, further promoting the cycle of disruption. The needs of family systems are more powerful than individual intentions All of our participants had health concerns they intended to address. The intentions changed, however, based on the needs of other family members. In fact, families are made up of lots of “patients” with health issues that arise at one time or another and require attention. The health issues don’t always require professional help, but they do pull time from other family members. This creates a situation of “patient-of-the-day,” where the focus of attention to health

and priorities constantly shifts to whoever has the greatest perceived health need. As a result, we saw that family members with chronic conditions often had an easier time giving priority to their own health goals when their health issues became full-blown “problems,” such as a new diagnosis or change of medication. Acute conditions, such as the flu, bronchitis, and broken bones, trumped chronic conditions. Attending to the health and medical needs of children took priority over adults. Parents had a more preventive mindset when it came to children than they had concerning themselves. They often fretted about how medical decisions today might impact a child’s health later in life, but adults didn’t take the same “long view” of their own health behavior. They tended to emotionally minimize their own health risk and prioritize their responsibilities as a parent, caregiver, or breadwinner rather than patient.

Families are made up of lots of “patients” with health issues that arise at one time or another. [They] don’t always require professional help, but they do pull time from other family members. This creates a situation of “patient-of-the-day,” where the focus of attention constantly shifts to whoever has the greatest perceived health need.

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Patient-centricity American family life is extremely kid-centric, with decisions often dictated by the wants and desires of the children. As a result, family activities are geared towards accommodating the schedules of children, and food choices often are dictated by likes and dislikes of the younger family members. The happiness of children strongly influences decisions that adults make about their own health. We also observed families constantly reallocating and prioritizing time and money based on the needs of the family unit as a whole. For example, the need for testing strips and their cost were weighed against how these purchases impacted a family budget. Families calculated health-related costs against other priorities, such as entertainment or even groceries. Taking a social-centric approach to considering patient behavior helps generate awareness and, possibly, empathy. We can understand that in pushing patients toward certain behaviors—from paying for a prescription to taking time off work for treatment—we may be putting them in an untenable position, and possibly at odds with family expectations. Understanding the family dynamic can help us find new ways to encourage patients toward healthier behaviors while still feeling positive and in control of a family’s multiple, shifting priorities. Where are patients getting their health information? The healthcare system is made up of many stakeholders trying

to influence patient behavior. The obvious stakeholders, such as drug manufacturers, providers and insurance companies, all have business motivations for weighing in on decisions regarding diagnosis and treatment. But our study revealed influences coming from unexpected sources, as well. For example, we saw teachers and school officials sharing their expert opinions on ADHD treatment. Employers are offering health screenings, weight loss, and healthy eating programs, gym memberships, and health coaches—with employees rewarded for taking part and penalized for nonparticipation.

Participants looked for opinions and counsel not only from their physicians, but also from acupuncturists and massage therapists, grocery store dieticians and pharmacists, from celebrities, such as Dr. Oz, and from friends, or even strangers. Moreover, Americans seem to be inviting even more influencers into the decision-making mix. In our study, participants looked for opinions and counsel not only from their physicians, but also from acupuncturists and massage therapists. They took counsel

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from grocery store dieticians and pharmacists. They got recommendations from celebrities, such as Dr. Oz, and from friends, or even strangers, who shared experiences online and off. The expansion of the social network was not just on lifestyle subjects such as weight loss, but also on the management of diseases and conditions such as Crohn’s disease, depression, and asthma. Meanwhile, there often was little thought given to telling physicians what they have learned or tried and so no health professional had insight into the decisions being made. Conflicting advice leads to confusion In short, they are caught in a healthcare system riddled with conflicting messages. Nearly everyone in the study struggled, at one time or another, to reconcile a physician’s treatment recommendations and the treatment actually covered by their insurance plans. The messages on the right course of treatment often conflicted. Participants particularly struggled with implementing wellness and prevention recommendations. When it comes to preventing illness, the do’s and don’ts seem to be in constant flux. An employer might subsidize gym memberships, but not yoga classes. Participants might be eligible for an employer discount to Weight Watchers, but their insurance plan wouldn’t cover a medically supervised weight loss plan prescribed by a physician. Even within the confines of a physician’s office, diagnosis and

treatment information are not always as clear as we might imagine. Many study participants spoke of having multiple diagnoses and how the ideal treatment for one condition might contradict treatment for another. Participants also struggled to make sense of diagnostic definitions and changing treatment guidelines. Such basic questions as “Am I diabetic or not?” and “Do I start medication now or wait to see if losing 10 pounds makes a difference?” received conflicting answers. Such dissonance led to questions of trust among participants who questioned the motives and influence of the healthcare industry. “Who do I believe?” “Who is looking out for me?” With so many sources of information available, study participants still wanted and felt they needed a trusted physician to help them effectively manage their health. They

are looking for providers who “know” them –their health status, values, and competing demands. The hallmark of nearly all of the positive doctor-patient relationships in our study was compassion and a genuine interest in the patient’s life. But the study showed how difficult it is to get what they want. For example, a single chronic condition may require the opinion and care of several specialties, and no single provider seems to be in charge, acting as a trusted center of care and keeping track of all information. Beyond the structural obstacles, there were matters of individual quality of care. Trust is built on communication and our study revealed that communication with physicians is a big part of how participants measured quality. It was the area where they felt least satisfied.

Trust is built on communication and our study revealed that communication with physicians is a big part of how participants measured quality. It was the area where they felt least satisfied. One obvious issue is that providers and patients don’t speak the same language. Healthcare providers talk in percentages, statistics, and risks, while patients think in terms of value in their day-to-day life. While providers track objective measures like weight or blood pressure, individuals measure health by how well they can take care of themselves, their ability to interact with their family, and their ability to work. Participants often

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Patient-centricity felt that communication was one directional with healthcare providers talking a lot but failing to listen and deliver what they needed. Patients want their healthcare providers to listen and offer feedback on what they are actually doing to manage their health.

• Reduce the friction that managing health can cause by supporting the entire family system

They need our help. Here’s how to provide it.

• Reframe healthy living so that it is no longer considered “work” but rather part of being “plugged in” to what really matters—family, work, personal well-being

Taking a “social-centric” view brings into focus the extent to which the healthcare system itself sets up patients to fail. Understanding the social context enables stakeholders to begin coordinating and connecting messages and actions in a meaningful language that enhances trust and mitigates the very real possibility that patients will eventually tune us out altogether. Ultimately, the healthcare industry may need to work with other industries, institutions, and stakeholders to help change social norms and make healthy living easier. More immediately, viewing patient behavior within the wider social context will further our understanding that patients are not merely “lazy” or “lacking in willpower” but are under enormous societal pressures to do the unhealthy thing. Understanding the forces of socialcentricity allows us to deploy strategies that fit in better and work far more effectively within the realities of life. Focusing on the wider social context also allows us to “peel the onion” to reveal a deeper set of patient needs that industry has yet to address. This single study revealed new opportunities for us to:

• Rebuild trust in the healthcare system by educating physicians and other stakeholders on how to talk with patients in the language of family needs and social values

• Increase our impact by developing coordinated and connected messages that can be delivered by various healthcare providers during contact with patients at different points in time • Stop pushing patients down a linear path toward behavior change and instead create solutions that help patients and families build the resiliency needed to routinely restart efforts toward better health How do we accomplish this? Four key actions that will get us a long way to the goal: Bring a social-centric view to claims data analysis, so brand managers get the full picture on pharmacy costs of patients before badgering them on medication compliance. That inexpensive $10 copay the brand company considers to be such a minor cost for patients is, in fact, just a tiny fragment of what patients with comorbidities actually spend each month at the pharmacy. Claims data analysis through a social-centricity lens would tell the brand owner the average monthly costs faced by

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patients/health plan members in a particular demographic or geographic area. Today, most brands aren’t mining such data to learn what percent of monthly household spending those pharmacy bills represent to the average family, and where the brand’s co-pay fits into the bigger picture. Incorporate social-centricity regimens into primary care settings, so doctors know what’s going on in the patients’ lives, and patients know that doctors actually care. These regimens don’t have to be anything elaborate. It could be just a 5-item questionnaire asking such things as: Has there been a recent death in the family? Are there serious difficulties at work, either for you or your spouse? Are your children doing okay in school? Based on the answers to the questions, a doctor, nurse or administrator would conduct a 10-minute interview eliciting a bit more information, if that’s necessary. One purpose is to assure the patient that the medical practitioners understands trade-offs the patient is juggling, and may be able to help prioritize medications or provide advice on patient support programs. Take a page from successful health-and-wellness public service campaigns—the kinds of multi-platform messages designed to curb smoking, promote safe sex, improve hygiene and promote road safety. Social-centricity research tells us the different cultures that form America’s social fabric feel differently about healthcare institutions, authorities and practices. Use multicultural

clues derived from social-centric research to target DTC messages, allowing African American, Hispanic, Indian or Chinese-American populations to get brandrelated information that resonates with them.

patient behavior followed a neat marketing funnel. It challenges us to leverage all the factors influencing behavior—the family, the healthcare system, society, and more—to toward more effective patient engagement.

Use socially-centric insights to make artificial intelligence algorithms smarter and more sensitive. Left to its own devices, the AI software is going to act on marketing priorities with a blind eye to cultural values. Most famous 2012 example: Based on recent purchases, Target’s marketing algorithm sent coupons for baby clothes to the mailbox of a Minneapolis family. The head of the household—the father of a teenage daughter—was outraged. He didn’t know his daughter was having sex, let alone that she was pregnant. The algorithm is just doing its job. What’s missing is a socially-centric view of social/cultural contexts that informs algorithmic logic and kicks in before marketing AI does any damage.

Taking such an approach ultimately leads us to a host of opportunities, strategies, and tactics that will be far more successful at achieving a healthier end. And that’s good for everyone, including healthcare businesses, patients, and the social

Taking a social-centric approach changes everything. It leads, inevitably, to an understanding that a medical risk, or even a diagnosed condition, may not be the primary driver in patient behavior. People live within social environments that often override individual needs, intentions, and attempts to change. Social forces create a very bumpy road for patients, whether they are trying to stay healthy or manage a serious condition. Rooting patient engagement solutions in a social-centric approach requires that we move past delivering information as if consumers were focused only on their individual health. Socialcentricity tells us to stop planning communication touch points as if

environment in which we live. • 1 Primary Medication Non-Adherence: Analysis of 195,930 Electronic Prescriptions: J Gen Intern Med. 2010 Apr; 25(4): 284–290. 2 Ready for Pick-Up: Reducing Primary Medication Non-Adherence. A New Prescription for Health Care Improvement. A NEHI Issue Brief. October 2014. http://www.nehi.net/writable/ publication_files/file/pmn_issue_brief_10_14_ formatted_final.pdf. Accessed July 25, 2016. 3 Medication Non-Adherence: A $290 Billion Unnecessary Expenditure. The HealthWorks Collective, Posted April 13, 2015. http:// www.healthworkscollective.com/ashishvarshneya/300471/medication-non-adherence290-billion-unnecessary-expenditure. Accessed July 11, 2016.

Kathleen Starr Managing Director, Behavioral Insights inVentiv Health Commercial Kathleen leads a cross-functional team at inVentiv to translate deep insights and the science of behavior change into health communications that drive behavior to advance healthcare clients’ business objectives. She sets strategic direction for proprietary thought leadership initiatives to advance innovation and the development of service offerings, and collaborates across business lines to identify, prioritize, and amplify new business growth opportunities. She has also been managing director and SVP of the behavioral insights group at Adheris Health, an inVentiv company, and principal of Starr Health Strategy Group. Kathleen.Starr@inventivhealth.com inVentiv Health is a global, top-tier, clinical and commercial professional services company that combines the best strategic brains in the biopharmaceutical industry with the latest technologies, eliminating the roadblocks, territories, fences, hand-offs and gaps that can hinder the efficiency and speed at which products are brought to the marketplace. It has more than 15,000 healthcare professionals servicing clients in 90 countries, and has helped to develop or commercialize 80 percent of all new drugs approved by the FDA and 70 percent approved by the EMA over the last five years.

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October / November 2018

Articles inside

Why I Work in Healthcare

Better Compliance. Better Outcomes. Better Profits

Industry Trends: By The Numbers

Pfizer, Boehringer Ingelheim and others Use Video Games

Editorial Board

Motivideos: To Use in Your Meetings

Editor’s Letter