January / February 2019

™ JANUARY/FEBRUARY 2019

the publication for healthcare sales & marketing leaders™

TOP 100 HEALTHCARE COMPANIES IN THIS ISSUE

HEALTHCARE COMPANIES

The Top 100 Healthcare Companies Smith & Nephew Sr. VP’s Five Principles for Success Pfizer, Syneos, Aktana, Veeva Execs on Artificial Intelligence Otsuka, GSK, Bayer and other execs on Multi-Stakeholder Strategy Pfizer’s Regional President on How Patient Centricity is Vital to Our Future Cleveland Clinic’s Top 10 Innovations What Docs are Saying: A Survey by the Physicians Foundation Deloitte: Global Life Sciences Outlook

FINDING EMOTIONS IN EVERY MOLECULE, CELL, PATHOGEN, AND ANTIBODY At AbelsonTaylor, we get emotional about science.

For us, there’s real emotion buried in everything from molecules to K-M curves. So we get down to the cellular level to find emotion in the science that lets us tell a human story. One that HCPs will connect with. Because we’re not just inspired by science— we feel the data.

the publication for healthcare sales & marketing leaders™

TABLE OF CONTENTS Publisher’s Letter..............................................................................................................................................4 Editor’s Letter.....................................................................................................................................................5 Editorial Board....................................................................................................................................................7

ARTICLES Spotlight: Smith & Nephew’s Sr. VP Alain Tranchemontagne and his Five Principles..............9 Roundtable: Pfizer, Syneos, Aktana, Veeva Execs on Artificial Intelligence............................. 13 Otsuka, GSK, Bayer and other execs on Multi-Stakeholder Strategy.......................................... 25 Top 100 Healthcare Companies................................................................................................................. 37 Deloitte: Global Life Sciences Outlook.................................................................................................... 47 Cleveland Clinic’s Top 10 Innovations..................................................................................................... 55 Industry Trends: By The Numbers.............................................................................................................61 Pfizer’s Regional President on How Patient Centricity is Vital to Our Future........................... 63 Motivideos: To Use In Your Meetings..................................................................................................... 67 What Docs are Saying: A Survey by the Physicians Foundation..................................................... 71 New Feature: Agency and Consultants Directory.................................................................................81

3 | HS&M JANUARY/FEBRUARY 2019

Publisher’s Letter

You Chose the Right Profession If there’s one thing that distinguishes our editorial point of view, it’s pride in our profession. We don’t make devices or drugs here, but we’re happy to report on them, because there’s always so much good being done by our colleagues in the industry

CARI KRAFT

In this issue, we feature both the Top 100 Healthcare Companies and the Cleveland Clinic’s ten most promising advances created in healthcare. Together, they are strong indicators of both the financial health of our industry and the improving health we deliver to populations worldwide.

Revenue total for the Top 100 was $1.207 trillion dollars, with 78% of Top 100 revenues increasing as compared with 62% last year, and less than 50% the prior year. While a few top positions have changed, Johnson & Johnson, Pfizer, Roche, Novartis , Sanofi and Medtronic, among others, continue to be leaders in the field. These are companies that not only generate robust revenues, but also continue to be innovators with vision and integrity, creating advances on a regular basis. And all three sectors—pharma, medical device and biotech—are growing revenue at levels far above most industries.

And let’s look at some of the innovations cited by the Cleveland Clinic. Following are some of the inspiring quotes attendant to these breakthroughs. For alternative pain therapies for fighting the opioid crisis: “hope comes by way of pharmacogenomic testing, which uses a patient’s genetic makeup to predict an individual’s metabolism of drugs.” For artificial intelligence (which we cover thoroughly in our roundtable this issue): “changing the game…in decision support, image analysis and patient triage…smarter decisions at point of care…reducing physician burnout.” For acute stroke intervention: “an expanded window for treatment [which could] lower the risk of disability and provide opportunity for recovery to an increased number of future stroke patients.” For advances in immunotherapy for cancer: “uses the body’s own immune system to fight cancer…life-changing new cancer treatments through the concepts of joint therapy and engineered T-cells.”

Wow. And that’s just the handful we have room for here. There are many more, on that list and emerging every day. And consider the impact. Not only is healthcare one of the few industries continuing to post growing revenues overall, it’s also the one that we all depend on for the amazing quality of life innovations it provides.

Yes, you chose the right profession. And we’re delighted to continue bringing you news of what it does.

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 JANUARY/FEBRUARY 2019 | 4

Letter from the Editor

A few words from our favorite biologist

NEIL GREENBERG

In December of 1983, the great science fiction writer (originally trained as a biologist) Isaac Asimov made a few predictions about what the world would be like in 2019. We thought would make a nice companion to our artificial intelligence article, since this was the man who wrote extensively about robots and created the Three Rules of Robotics. He chose 2019 because 1983 was 35 years since the publication of George Orwell’s 1984, and so he wanted to look another 35 years into the future. It turned out that Asimov was more perspicacious than Orwell, but still missed on a few points. Some of his observations:

• Computerization has already made itself essential to industrial nations, and it is now beginning to make itself comfortable in the home • The mobile computerized object, or robot, is already flooding into industry and will, in the course of the next generation, penetrate the home • [Nations] will clamor for computerization as they now clamor for weapons • Computerization will create more jobs, involving the design, the manufacture, the installation, the maintenance and repair of computers and robots, and an understanding of whole new industries that these “intelligent” machines will make possible • Entire populations must be made “computer-literate” and must be taught to deal with a “high-tech” world. The next generation will be one of difficult transition as untrained millions find themselves helpless to do the jobs that most need doing • Efforts to prevent overpopulation by encouraging a lower birthrate will become steadily more strenuous and it is to be hoped that by 2019, the world as a whole will be striving toward a population plateau • We will enter space to stay, with planned settlements on the moon and beyond • Human irresponsibility in terms of waste and pollution will become more unbearable with time and attempts to deal with this will become more strenuous. Advances in technology will place tools in our hands that will help accelerate the process whereby the deterioration of the environment will be reversed • He hoped that quarrels between and within nations will diminish, to be replaced by increasing co operation among nations and among groups within nations, not out of any sudden growth of idealism or decency but out of a cold-blooded realization that anything less than that will mean destruction for all • The world will seem more and more to be “running itself,” and more and more human beings will find themselves living a life rich in leisure You can see a video on the rest, with a link to the original article, here. It’s a fascinating augury by one of our most respected scientists and authors.

We try to keep up with all this, and bring you the people who have a grasp on change. We hope that it will be informative, and assist you in furthering the work you do every day. Let us know what topics will be most useful to you!

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

5 | HS&M JANUARY/FEBRUARY 2019

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For details on how the Private Process works, and the kinds of answers you can get, contact us now at ngreenberg@hsandm.com.

™

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 Associate Publisher Natalie Newcamp 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 © 2019 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 Natalie Newcamp at nnewcamp@hsandm.com

7 | HS&M JANUARY/FEBRUARY 2019

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

President and CEO, Menarini Silicon Biosystems Bob Roda is a senior commercial executive with extensive experience in delivering business growth and profit in the medtech and diagnostics sectors of healthcare. He currently serves as the President and CEO of Menarini Silicon Biosystems, where he is responsible for driving the commercialization of novel cancer diagnostics. Previously, Bob held a variety of roles of increasing commercial responsibility at Becton Dickinson. Most recently, he was VP and General Manager of the MPS business unit as well as leading the commercial integration of the CareFusion acquisition. Bob also had a successful career within the MD&D sector at Johnson & Johnson. His diverse background includes positions in business development and senior leadership roles 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. Bob is a highly respected, successful global leader with proven abilities in diverse disciplines. He holds a Bachelor of Arts degree from The College of Business Administration at 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. 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. 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 JANUARY/FEBRUARY 2019 | 8

EXECUTIVE SPOTLIGHT

Smith & Nephew Sr. VP Alain Tranchemontagne: The Five Principles

Alain Tranchemontagne Smith & Nephew Sr. VP

For more than 25 years, Alain Tranchemontagne has spent his career driving success for some of the biggest names in the medical device sector of healthcare. Through stints at Ansell Healthcare, Covidien and now Smith & Nephew, he has navigated positions in sales, marketing, general management, strategy and commercial development.

At Smith & Nephew, he is currently responsible for MarCom, DTC, SEO, tradeshows, pricing, contracting, surgeon education, sales rep training, commercial excellence, surgeon-led innovation, grants, fellowships, professional affairs, employee trust, risk management, several customers, and he chairs the Andover facility for the $2.5B business.

At a large and successful company, with competition from the likes of J&J, ZimmerBiomet and Stryker, how much upside can you achieve? In Alain’s case, a lot.

Three years ago, the company had decided on a significant restructure. It wanted to integrate its various businesses, which include adult reconstruction, robotics, sports medicine, trauma and extremities, advanced wound management, and ENT, into a single U.S. entity.The objectives: to accelerate growth, deliver efficiencies, and de-risk the business.

As of November 2018, Smith & Nephew released its Q3 results.The U.S. business would deliver another quarterly sequential improvement and its highest 9 | HS&M JANUARY/FEBRUARY 2019

growth in many years.Representing half of Smith and Nephew’s revenue, the U.S. performance was critical to meet analyst expectations.And it did.It lifted the stock almost 8% in a single day, setting expectations for future performance.

What kind of leadership do you have to provide to achieve results like that?

FIVE PRINCIPLES Like many successful leaders, Alain has articulated certain key principles that work together to create and maintain success.

1. Create a culture of accountability Alain told us “Most people asking for accountability mean ‘get rid of someone who presumably failed to deliver.’But all this exhibits is a situation of failed accountability. If individuals are to be accountable, they need the engagement and support of the company. How do you teach employees to measure their own progress, be empowered, and take responsibil-

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EXECUTIVE SPOTLIGHT ity? In other words, how do you communicate that it’s their initiative that will make the difference?

Alain’s prescriptions: • Set a process supported by metrics, transparency and collaboration to build commitment and accountability • Define the metrics, such as surgeon adoption • Review the metrics regularly, as often as weekly for the most critical ones, identifying those that are “at risk” • Link these reviews to personal aspirations, interests, challenges or any other topics deemed personally important by individuals on the team. This creates a connection between the personal and the business goals, reinforcing commitment.

He says “When I took over the MarCom team during the integration phase, I put in place a new leader and we started to review the performance of our DTC investment.We knew patients helped pull products through the channel.

However, the data soon revealed that we generated $1 of revenue for every dollar spent.As a result, the team proposed to reduce the investment by 90% and change the formula to a more targeted, SEObased program.” The SEO-based program is more focused on social media vs. mass media. They are able to measure the response of patients and look at specific geographies and messaging.Alain told us “Over the course of 18 months, the team fine-tuned the program with the help of metrics, continuously raising the return on every dollar invested from $10 initially to $18 today.”

11 | HS&M JANUARY/FEBRUARY 2019

2. Overcome your market position In the case of Smith & Nephew, this is quite a challenge—to move the needle on a $2.5B business. Alain says business wisdom proposes that “relative position in the market dictates your strategic options to compete.”

But how do you use that viewpoint to inspire new approaches?Alain says “Explore possibilities.Then estimate outcomes and compare to your aspirations.Invariably, aspirations exceed expectations.Use this performance gap to formulate actions intended to bridge the gap without necessarily following the prescription.In other words, don’t do more of the same.Instead, add something different.”

For instance, S&N has not historically been a leader in adult reconstruction. So the need was to create a uniquely differentiated— and valuable—solution to establish a beachhead.“One of our technologies in this space fits the bill: it is proprietary, demonstrably superior to competitive offers, and offers immense value.However, it was insufficient to overcome the share gap because payers and providers aren’t aligned on value creation.

Therefore, we created a series of solutions that capitalized on different technologies in other spaces to create a broad set of value propositions related to the core business.These multiple actions created strong growth in a number of ways, thereby also de-risking the business.” One example was showing how a more expensive combination of S&N devices was really cost-effective vs. the cheaper competition because it afforded more protection against possible

infections that would result in high-cost revisions.

3. Drive all dimensions of innovation Alain says that, while we all know innovation propels growth, we need to apply innovation to processes and business models as well as products.

Why do we resist change in process? Because it puts more of the onus on people’s behavior. But he says “Ensuring an on-going dialog at this level builds muscle memory even while making change more gradual.”

To exemplify this effort, he offered their experience with surgical implants, “The second most expensive market development tool for surgical implants is surgeon training.Moreover, adoption rates across the industry are not stellar.

In order to meet our growth and efficiency objectives, we could not rely on this model.Therefore, we shifted the focus from the traditional, course-based model, which I liken to undergraduate training, to a surgeon-based model that parallels what a PhD student would experience.This initial change triggered an on-going evolution of our education model that today exceeds industry standards 2-to-1.”

4. Manage the portfolio “At S&N, we organize innovation by business and technology.

However, a number of technologies are similar across businesses,” Alain told us.To make this more efficient, they assembled an independent team of engineers focused on iterative innovation across a number of portfolios.“We put in place a process to ensure align-

ment at the business unit level with metrics and regular reviews.” This enhanced the focus on bold programs. And it created a predictable flow of solutions to market.

The change paid off significantly. It yielded an 18:1 return on invested dollars, a growth rate roughly 6 times the growth rate of the overall portfolio, and a vitality index similarly higher.Alain doesn’t recommend this practice across the entire business, but he says it helps smooth out the growth curve of the overall portfolio. ”We implemented separate teams and review processes for different groups of innovation.We coordinate efforts through the business units to ensure alignment.However, by keeping resources independent, we avoid funds drifting due to circumstances.”

5. Create a learning culture Alain points out that we spend a significant portion of our young lives learning in school, and a significant portion of our careers applying those lessons. But learning—especially in these rapidlychanging times and in this profession—of necessity should be a lifelong pursuit.

With his business teams, Alain institutes stretch targets so people are always reaching beyond their abilities and improving their skill sets.Second, he exposes them to a diversity of experiences that fall outside of their traditional focus at a professional or a personal level.

To accelerate growth, he has to raise the performance level of the sales organization.The S&N sales training program used to be limited to an initial course in product familiarity, so that the staff could

explain it properly to customers.

Rinse and repeat with new products or upgrades. But now sales has to face Value Analysis Committees, which are much more demanding of all aspects of performance, price and efficiency.

He says “We identified seven different areas where training was needed.We mapped four levels of mastery, broke down the content into bite-sized learning modules, and digitized and gamified the material.Finally, we set to evolve it continuously, making every micromodule certifiable.The outcome has so far earned us six national and global education awards in the past year.More importantly, it has pushed the team to explore different industries, learn about psychology, and introduce practices from outside the industry.”

This change in tactics also shows up at their National Sales Meeting. There is no product training conducted there anymore: that’s done as needed during the year.

Instead, the NSM features digital competition, role-playing and other activities aimed at fostering engagement, collaboration and certification.

TURNING THE BATTLESHIP AROUND As we noted above, with 16,000 employees and a large portfolio of products, plus competition from other big names, it’s not easy to restrategize a company like S&N for significant growth. Yet Alain and his team have managed to do just that.S&N, J&J, ZimmerBioment and Stryker together represent about 90% of the market in adult reconstruction.But S&N led the

market in hip reconstruction, with 4% growth globally and 6% in the U.S., and was the second fastest growing knee reconstruction business at 4%. Their knee implants franchise continues to perform strongly, delivering 4% revenue growth driven by their differentiated technologies: the VERILAST bearing surface; JOURNEY II, LEGION and ANTHEM knee systems and the LEGION Revision Knee System.

Revenue from hip implants was up 4% globally, with the U.S. producing its best growth for a number of years. This performance was driven by a renewed focus on the POLAR3 total hip solution and its class-leading survivorship data, as well as demand for the REDAPT Revision System.

And all of this is a result of concentration not on product innovation, or sales training, or any other single factor. It grew out of a multi-layered strategy on all the areas that affect a business.

Ultimately, leading an organization to meet the street’s expectations is not an easy task.However, if you can instill in all of your employees a sense of entrepreneurship by letting them own their portion of the business, support them with tools, process and engagement, and challenge them to develop their skills along the way, you will be successful.Otherwise, you are just pushing water up a hill, with a fork. •

HS&M JANUARY/FEBRUARY 2019 | 12

ROUNDTABLE

Real Expertise on Artificial Intelligence: Views from Pfizer, Aktana, Veeva and Syneos Health Executives Our thanks to Lisa Barbadora of Veeva Systems and Izzy Gladstone of eyeforpharma for their help in bringing this panel and content together.

Artificial intelligence is already a well-worn phrase, but few of us really understand what it means and how it will affect the conduct of our industry. Veeva execs Arno Sosna and Paul Shawah, Senior Vice President, Commercial Strategy, offered some background on AI.

Our panel of experts: CHRISTOPHER BOONE Vice President, Head of Real World Data and Analytics Center of Excellence Pfizer

DAVID EHRLICH President and CEO Aktana

13 | HS&M JANUARY/FEBRUARY 2019

ARNO SOSNA General Manager Veeva Systems

AJ TRIANO Senior Vice President, Engagement Strategy GSW, a Syneos Health company

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ROUNDTABLE “Machine learning is gaining broader traction in commercial operations, transforming the way the industry collects, synthesizes, and uses data.”

In 2016, a stunning $8 to $12 billion was invested in artificial intelligence (AI), or machine learning, according to a report by McKinsey.

The report also stated that healthcare is one of three industries seeing the greatest profit margin increases as a result of AI adoption, while Reuters reported that “the world’s drug companies are turning to artificial intelligence to improve the hit-and-miss business of finding new medicines.”

There are 9,500 drugs now in Phase One through Phase Three clinical trial development. This is a pretty remarkable number, but what’s more impressive is that it’s growing at a rapid pace, about 20% over the last five years: threequarters of what’s in the pipelines are considered potential to be firstin-class, and that is often where you see some of the step changes in bringing new, novel drugs and therapies to the marketplace. AI will help us get there even faster.

Early business uses of AI have proven successful in drug discovery, particularly in predicting molecule-target bonding, identifying new biomarkers, and uncovering new drug indications.

Now machine learning is gaining broader traction in commercial operations, too, transforming the way the industry collects, synthesizes, and uses data.

New industry standards and development frameworks are making 15 | HS&M JANUARY/FEBRUARY 2019

it easier and faster for software developers to build solutions for machine learning. As well, advanced computing hardware such as graphic processing units (GPUs) and chipsets are processing vast amounts of data faster than ever before—so much so that they are being characterized as bionic.

Actionable insights help brand managers, field reps, and medical science liaisons improve decisionmaking and take smarter actions to personalize their engagement with healthcare professionals and, ultimately, achieve greater commercial success.

It brings data together that we have on the commercial side— field data, digital data, patient data, claims data—unifying it to make sense and derive insights. But insights are only valuable if you can connect them with action.

How do you take the mass amount of resources that you have and apply them in a smarter way? How do you shift those resources up and down and turn up the volume and target different sets of customers and change your messaging and do that on a dime? It’s about being more dynamic in your commercial model.

Here’s a deeper dive into how that will happen, with the assistance of AI. Why is healthcare one of the top industries seeing the greatest profit in artificial intelligence?

DAVID EHRLICH: The life sciences industry is a natural hot zone for the application of analytics and artificial intelligence. It’s got an abundance of available data and complex business challenges, such as discovery of new compounds amongst millions of possibilities and a disconnected buying process that lacks typical pricing signals.

Heavy regulation has led to a conservatism reflected in the industry’s belated adoption of new technologies and a reluctance to experiment with new business models or approaches.

During last decade, as blockbuster drug patents expire and as governments clamp down on pricing, life sciences companies face unprecedented pressure to reduce costs and improve productivity, making technologies like artificial intelligence ever more necessary for success. Add to this the shift from small molecule drugs to specialty, oncology, and orphan therapies aimed at smaller populations.

Traditional mass-marketing will just not work in that environment—targeted, more personalized outreach is required.

ARNO SOSNA: There is significant potential for life sciences to leverage AI and drive greater effectiveness in commercializing new drugs and treatments. Life sciences is especially poised to derive value from AI because of the significant volume of data companies store and process—perhaps more than any other industry because of the stringent regulations to document everything. All of this data will be foundational to running advanced statistics and analytics. So organizations are in a tremendous position to use AI for predictive analytics and more data-driven decision-making across their commercial efforts. AI will enable the industry to automate commercial processes to improve efficiency in bringing products to market and keep pace with the investments they are making in drug development.

CHRISTOPHER BOONE: The potential for AI to transform the healthcare industry may be more

DROWNING IN DATA

DRUG DISCOVERY HURDLES

ACCESS TO HCPS

RELEVANCE OF MESSAGE TO TARGET

extensive than any other industry or vertical. There are a several factors priming AI to bring this paradigm shift for healthcare. First, the healthcare industry has always had a large amount of historical data. Providers, Pharmaceuticals, and Government agencies have large datasets often going back at least two decades that are now being leveraged. Furthermore, in addition to this historical data, we are adding and aggregating new sources of data at an exponential rate, such as: electronic medical record, genomic, payer, medication, and patient-generated health data from wearables and smartphones.

Lastly, the ability to structure much of healthcare data and the adoption of data standards allows for the conversion of this data into machine-readable format that can be further interpreted by AI.

With these factors converging and creating large and diverse datasets, researchers and clinicians are strongly positioned to mine and analyze this data to spot patterns in the progression, diagnosis, and treatment of diseases. In addition to monitoring and treating disease, AI is also being used by healthcare administrators and managers to drive efficiencies and optimize processes across each stakeholder.

In the coming years, I predict AI will touch and influence the work of every healthcare industry stakeholder and patients in some way.

AJ TRIANO: Unlike other industries, healthcare is a universal need that is under pressure to increase equitable access while reducing costs which makes it ripe for innovation efforts. Equally, AI has the ability to provide significant value at every stage of the healthcare

continuum. The word “significant” is important. The opportunity for innovation advancements in significant ways serves as a beacon for investment and innovation. As the healthcare AI industry matures, benefits may become more incremental in nature which could slow the influx of investment capital and resources as the perceived ROI diminishes.

What are some of the problems AI solves for us, in terms of efficiency and insights?

AJ TRIANO: We are drowning in data, which is beginning to have an adverse effect on patient mortality rates. Physicians are struggling with staying on top of the data at the patient level and the therapeutic category level. Medical information is projected to double every 73 days by 2020. This isn’t just a matter of inconvenience.

HS&M JANUARY/FEBRUARY 2019 | 16

ROUNDTABLE It is actually a matter of health outcomes and mortality. In fact, the more years a physician is away from their residency, the more staying abreast of the latest data has been shown to contribute to an increasingly higher mortality rate with each year in practice (10.8% increase by 40 years of practice, rising to over 12% by 60). So, this isn’t just an efficiency issue. It is an outcomes issue. AI has the potential to be an automated medical assistant that helps sift through all of the patient-specific data to look for clinically validated markers of risk or disease escalation, flag them for physician review and suggest potential therapeutic options that match the individual patient for the doctor to consider.

CHRISTOPHER BOONE: While it is still early days for the promise of AI to be fully realized, we see some nascent use cases of AI that hold the opportunity to lower costs and a deliver a higher quality of care.

Specifically in the pharmaceutical industry, drug discovery is one area that is ripe for disruption.

There are many aspects of drug discovery where AI can generate insights on large and complex datasets. Using analytics, deep learning, and pattern recognition, researchers can discover new targets, drug molecules or even discover novel uses of current drugs to treat diseases that these drugs were not originally intended for. The influence of AI in each of these areas of drug discovery can reduce the time, resources allocated, and overall cost for the pharmaceutical industry.

Another area of opportunity for AI in pharma is with advancing clinical trials. We see a great opportunity in our Real World Evidence team to use electronic medical 17 | HS&M JANUARY/FEBRUARY 2019

record, genomic, device, and other nontraditional sources of data to match patients to clinical trials.

Notably, AI can increasingly target patients most likely to benefit from a therapy. Equally powerful, we have seen that AI can also help mitigate potential risk and cost by reducing many of the inefficiencies we currently face with clinical trials, such as helping us better identify patients that may not be as well suited for the trial, segment those that may likely drop out of the trial, or work with patients who are noncompliant as soon as possible.

DAVID EHRLICH: Life sciences companies make huge investments in sales and marketing. A lot of this is wasted on communicating with healthcare professionals (HCPs) in ways that aren’t actually helpful or effective, such as holding in-person meetings with HCPs who prefer emails or sharing information that is not particularly relevant to an HCP’s specific patient population. AI helps companies figure out which information is most helpful, at what time and through which channel, for any particular HCP. This 1:1 personalization can generate a huge reduction in go-to-market expense, thereby freeing capital for additional research or price concessions.

ARNO SOSNA: One opportunity is to use AI to help sales reps make better, more well-informed decisions for improved customer engagement. AI can deliver highly relevant, data-driven suggestions, insights, and recommendations in real-time directly in a sales rep’s daily workflow. This empowers sales teams with the right information exactly where and when they need it to drive better execution.

Commercial teams can also use AI

to ensure they are communicating with HCPs through their preferred channels.

Another opportunity for AI is to reduce manual data entry through image recognition. Tasks such as planogram monitoring will become much easier by simply pointing a device’s camera at a pharmacy shelf to automatically identify and log products, as well as quantities. This will eliminate human error and allow field teams can focus on engaging with providers and pharmacists.

How will AI break down silos and streamline data analysis?

ARNO SOSNA: Commercial organizations capture a large volume of data across many siloed, disparate systems. AI will make it easier to identify patterns within large sets of data to streamline analysis and deliver rich insights back to the business. Having the right data foundation is key to leveraging the power of advanced analytics and AI. Machine learning will play a critical role in matching and cleaning data. Once data is cleaned and centralized in one location, crossfunctional teams can work from the same reliable customer data, and AI can deliver deeper, more accurate insights across the organization.

DAVID EHRLICH: Efficient and effective delivery of the right information to the right HCP at the right time requires an omnichannel perspective. Brand managers can’t focus on a marketing campaign without also considering what sales is discussing with their target HCPs and what those HCPs see when they visit the brand’s web portal. In other words, to deliver on the efficiencies required, brand managers must be able to trade off high-cost channels for low-cost

channels in optimizing the channel mix for any given customer.

Unfortunately, in most life science companies today, marketing and sales still report up through very separate organizations, and their activities are rarely well-coordinated. Effective use of AI will require active collaboration across these organizational boundaries.

It’s been reported that 2019 will generate more data than the last 5,000 years. That’s a lot of data to sift through and an impossible task for any human to do so effectively.

AI helps companies analyze all available data and market dynamics to extract and deliver insights about what information an individual HCP wants, needs, and will make use of. Companies can use these insights to deliver the right information in the right way at the right time to the right person, boosting HCP engagement and improving care for patients.

CHRISTOPHER BOONE: AI can only scale with the wide availability of and encumbered access to large datasets. This was a significant problem in healthcare in the past, when these datasets were not readily available and significantly siloed. In addition, there were few data standards that those in the industry subscribed to. However, in today’s environment, the ability to acquire and use data is one of the most important competitive advantages and this is often the driving force behind increased collaboration and efficiencies now seen in the industry. The increased demand for analytics and AI solutions is partly fueling the open data movement and enabling long established silos to finally be broken.

In addition to enabling these large data with increased collaborative efforts and efficiencies, the use of

advanced analytics and AI solutions are also creating a demand for quality data. With data, we often say “garbage in, garbage out.”

With this increased demand for structured, clean data to feed machine and deep learning models, stakeholders now are incentivized to scale their AI solutions by increasing collaboration around data as well (both with internal and external stakeholders) and optimizing and streamlining their operations around how data is stored and shared. This increased collaboration is also helping streamline data analysis by democratizing the data across stakeholders and reducing repetitive or tedious efforts to access, clean, and generate insights from the data.

AJ TRIANO: This is a catch-22.

For AI to work at greatest potential, it must have access to a variety of currently siloed data sources. That will require us to negotiate across P&L, policy and organizational barriers that are not incentivized well to share data.

But, I believe we will see initial success in AI being used as a positive feedback loop to break down those silos in the interest of greater growth.

Beyond its obvious benefit to drug discovery, what are the aspects of AI that are particularly useful to sales and marketing?

CHRISTOPHER BOONE: AI has a powerful opportunity to completely transform the pharmaceutical industry’s long-established commercial model. In the past, this commercial model was based on influencing clinician behaviors through education and by bringing awareness around your product.

Now with many AI tools providing clinical decision support at the point of care, there is a change

in clinical workflow and decision making that will require a shift in how the pharmaceutical industry develops and conveys its value.

Most of this value generation, ironically, will need to be done using AI and analytical tools with real world and clinical trial data to prove the outcome improvement that these clinical decision support tools base their recommendations on.

In addition to a shift in the how sales and marketing channels interact with physicians, the ability for deep personalization and messaging that was not available in the past can also be applied by AI to target and build KOLs. In addition to targeting KOLs, AI can also be used to identify the right patients or physicians with a specific patient base. With this shifting environment and increased capabilities, you will see commercial teams building their AI capabilities (if they have not done so already) and will begin seeing commercial teams using data and the insights generated to further explore value based care opportunities.

AJ TRIANO: We are used to seeing molecules approved with companion diagnostics. We are now entering the world of AI as companion clinical decision support (CDS) tools, with the FDA approving the first AI-based CDS tools this year. In fact, we have now seen the FDA approve 12 algorithms in 2018 for use in-clinic and at-home to help diagnose and manage conditions.

In addition, AI is creating an opportunity for marketing teams to deploy just-in-time marketing materials to doctors who have patients that would benefit from their molecules. Alynylam Pharmaceuticals has used this with sucHS&M JANUARY/FEBRUARY 2019 | 18

ROUNDTABLE cess. Predictably, we are also seeing conversion of customer support materials to automated chatbots across all channel types. Perhaps one of the biggest efforts to deploy AI is being done by Celgene’s Pharmacovigilance team to create a highly automated drug-safety system that allows rapid collection, collation and automated analysis of high volumes of data to identify potential drug safety signals.

ARNO SOSNA: The most significant benefit of AI in sales and marketing is the ability to drive more informed actions with customers. AI captures and analyzes data in CRM, such as customer preferences and sales performance, to deliver recommendations for what a sales rep or marketing team should do next. These customized recommendations can include which HCP to contact, the best channel for outreach such as banner ads on a mobile phone, or the optimal content and messaging.

AI analyzes all of this data so sales and marketing can better understand how to reach and engage their customers in various situations.

Over time, AI technologies will evolve to automate these recommendations to help drive better engagement. As it becomes embedded into enterprise systems, AI will become more intelligent, fueled by increasingly more accurate and widespread data. This will enable commercial organizations to leverage real-time insights, as well as data that is segmented according to each individual customer.

DAVID EHRLICH: AI enhances the ability to target exactly what information is most helpful to which HCP, at what points in time, down to the individual practitioner level. As long as humans are 19 | HS&M JANUARY/FEBRUARY 2019

involved in the information delivery chain, AI can also help individualize a salesperson’s or marketer’s call to action based on their unique behavior and skill set. The implications are that AI can be a powerful change management tool to help commercial teams be more responsive to market changes and evolving strategies.

How will AI improve messaging and demographic targeting?

DAVID EHRLICH: Different people tend to consume information in different ways, from channel preferences to timing to the use of specific language. AI accelerates the ability to learn and ensure the right combination of these elements to achieve the greatest impact with any particular HCP. AI will help companies to shift from segment-based marketing to 1:1 personalization.

ARNO SOSNA: By analyzing massive amounts of data and detecting patterns that humans cannot see, AI can help commercial organizations drive more personalized interactions. Individualized planning and messaging can maximize the chance of engagement with a specific HCP. With AI, commercial teams can segment their data to finely personalize customer engagement based on individual behaviors.

The result is marketing segmentations that take each customer into context and enable systems to predict customer behavior more accurately. In addition, AI can analyze actions taken in the past to determine what worked and in what context. These insights will empower sales and marketing teams to deliver highly individualized information in real-time for better customer engagement.

CHRISTOPHER BOONE: With

the use of AI to improve messaging and demographic targeting, the first and foremost concern for our industry should be to maintain and prioritize security and privacy. With the right consents and permissions from both clinicians and patients, AI can be a powerful tool to help to uncover how demographic features can be used precisely target certain populations and creating what is often referred to as a “digital phenotype.” Healthcare is drastically behind the consumer technology industry in this area. If you look to more sophisticated technology companies in this area, such as Netflix, Google, and Amazon, they have leveraged their easily accessible consumer data to precisely profile their demographics and have specific messaging or recommendations for all segmentations.

To further advance in this area, technology and data sharing partnerships will be essential for healthcare to leverage both the large amounts of data we have historically as well as the data that is currently being generated in biomedical research and care delivery. By doing so, these organizations can redefine and significantly improve their understanding and relationship with their patients or customers. In addition, AI can further be used to increase engagement and create consistent touchpoints to maintain value and a relationship with patients.

Technologies such as chatbots and trained automated messaging, for example, can help maximize engagement, even with limited resources.

AJ TRIANO: Algorithms and advanced analytics practices are being utilized to understand influencer patterns, prevalence and projected under-diagnosis rates

to help better target non-personal and personal promotion to areas of greatest need. We can then engage traditional promotional techniques, such as geo-targeting, lead scoring and multi-channel message personalization to deliver tailored messaging to the right at audience at the right time with efficiency.

How will AI affect things like doctor and patient access, and patient centricity?

DAVID EHRLICH: With the right data behind the scenes, predictive technology can help proactively identify the best care paths for an individual patient, identifying which therapeutic approaches will be most effective and highlighting where access is most needed.

CHRISTOPHER BOONE: AI will be a necessary tool to target and segment patient population moving forward. With this segmentation comes a greater understanding of needs and the ability to deliver more personalized care. In addition to not only delivering a higher quality of care, I believe it can also improve patient access to care. One frequent use case for AI tools has been scheduling, where AI can not only take into account historical no-show rates and busy times, but also factor in conditions such as local traffic and weather.

In addition, with the increased use of telemedicine and remote care, data from these platforms will drive the adoption of AI solutions to bring further value to the patients and clinicians who use them. AI can also contribute to more a patient-centric experience and increase access by creating improved channels of communication, including the use of chatbots in sustaining patient’s engagement, tracking and interpreting signals

from wearable monitoring devices, bringing insight and support to users’ smartphones, providing real-time access to clinical data for physicians, automatically summarizing and visualizing patient’s data. This way, AI may help reaching the ultimate goal of prevention with potential to increase patients’ adherence and compliance rather than just treatment. Also, AI has the potential to both significantly improve and streamline the management of chronic diseases.

AJ TRIANO: We should expect to see validated AI begin to augment the physician at point-ofcare with patient monitoring and clinical decision-making The ultimate goal is to free the physician up to focus more on the humanity of healthcare delivery over the data- and process-heavy practice management today. These tools can be paired with remotecare tools deployed to patients to help extend reach between visits, provide greater access to consistent streams of data and enable AI tools to surface key indicators as flags for physician review. We will not see AI replace physicians, and we know from a study we did earlier this year that patients don’t want that. We may see AI-based triage to expedite patient handling, as the NHS has done with Babylon health. Ultimately, we should see these tools enable the physician to return to a more patient-centric practice.

Innovative programs to mine EHR and lab data can help expedite identification of patients who may be at risk for a condition to streamline diagnosis and look for patients who show markers of disease progression faster for better intervention timing. AI can then help match specific patients to the appropriate list of medicines

most likely to assist the individual, just like it is being used to identify patient and molecule matches for clinical trials now.

What is important to note is there are patient expectations for a change in healthcare interfaces as a result of AI exposure in general consumer interactions. General expectations of consumer-brand interaction are being fundamentally reshaped thanks to AI. Those expectations are carrying over in to healthcare interactions, as well.

Almost 60% of consumers expect that their healthcare interactions today will become more like their shopping experiences with Amazon. This change in expectations of healthcare creates a significant opportunity for companies to rethink how they design interactions with their customers, patients and HCPs alike. We conducted a survey of ~1,000 patients in the US and EU to find out what they thought about AI in healthcare.

We learned that patients understand that there is a role for AI in the healthcare delivery continuum.

64% of respondents are comfortable with an AI triage or nurse assistant, much like what the NHS has deployed with Babylon Health in the UK for over 1.2mm people.

But, they want doctors on the other side of the algorithm making the final decisions. Furthermore, they want doctors playing a key role in the development of the AI tools created—a cautionary message we shared at JPM/Biotech earlier this year with investors seeking to capitalize on AI technology in healthcare.

ARNO SOSNA: AI will have a significant impact on how field teams access customers, particularly hard-to-reach HCPs. AI takes all data into account from previous interactions or communications with a particular HCP and delivHS&M JANUARY/FEBRUARY 2019 | 20

ROUNDTABLE ers real-time insights. These can include why the individual has been difficult to reach, and what strategies or channels have been effective in similar situations. As a result, AI helps improve a rep’s chance of engaging those doctors with a relevant message in the proper channel.

AI technologies will also act as an internal change agent, breaking down siloes between longestablished units in the industry.

Marketing and sales can come together, which will trigger better service for HCPs as well as patients in the long term. Since the number of patients is higher than the number of HCPs, the data challenge around improving patient access will be even greater. But the reward is clear—delivering new, life-changing treatments to patients faster.

What are some of the best examples you’ve seen of the application of AI in the healthcare marketplace?

ARNO SOSNA: Next best action recommendations and greater channel utilization are two examples of applying AI in the healthcare marketplace. For example, one pharmaceutical company used data science with CRM to improve the efficiency and effectiveness of using email. AI identified HCP channel preferences and guided reps on what message to communicate, when, and through which channel. The company not only increased rep usage and adoption of email, but also doubled the channel’s performance.

CHRISTOPHER BOONE: Today, part of the challenge with evaluating AI solutions is separating reality from the hype. When 21 | HS&M JANUARY/FEBRUARY 2019

realigning AI expectations and capabilities, we have seen the best examples of AI are when you use these solutions to augment—not necessarily replace-- the work of clinicians, researchers, or administrators. This augmentation is seen in multiple ways. First, we see it through the automation of repetitive or extensive work that models can be trained to do easily.

For example, in Pfizer’s Real World Evidence team, we are exploring natural language processing and learning techniques to mine large electronic medical records, device, and payer data to make insights on disease. Likewise, in a clinical setting, adminsitrators could use AI to detect medical record mistakes, automate data input, improve scheduling, etc.

In terms of detection or diagnosis of disease, this is still quite early.

However, one of the areas we have seen AI to be promising is with visual pattern recognition, particularly with medical images. There are many examples of using CT, MRI, and retinal images to diagnose a wide range of conditions from cancer to diabetic retinopathy to hypertension—all with varying accuracy. While most early examples of successful AI applications are in augmenting current workflows, processes, or decisions, it is not unreasonable to except total automation of their work as well once the models become more refined.

Where are we currently with AI, and where will we be five years from now?

CHRISTOPHER BOONE: Healthcare AI adoption is still in its early stages, but unlike other technology adoption curves, AI receptivity

seems to be moving at an accelerated rate-- only limited by what is technically feasible today. A few years ago, the lack of freely available data and insufficient data infrastructure made the adoption of AI solutions unscalable. Today, we have more access to diverse sources of data and advanced supporting technologies, such as more hosting capabilities and analytical tools. As a result, all healthcare stakeholders are increasingly beginning to evaluate their own strategies, opportunities to adopt AI solutions, and opportunities to bring value to the data they own. In addition, companies are grappling with how much of a leadership position they would like to take in this area.

With the more visionary executives, you will see new projects that will explore a wide spectrum of use cases and how AI can be used for end-to-end drug development and commercial purposes.

Five years from now, I believe some of our learnings and successes from these early AI projects and will be further applied and implemented at scale. The trends today favoring AI development and adoption will continue to accelerate and the hope we now have around the impact AI can bring will be much closer to reality.

ARNO SOSNA: We are currently in the era of specialized AI— meaning that while AI performs one task, it cannot execute any other tasks. To achieve more general AI that can complete a variety of tasks, every industry—not only life sciences—has a long way to go.

Over the next five years, we will continue to see specialized AI applications become more embedded in enterprise business software of

Moving Forward MORE INFORMED ACTION

BETTER POC MONITORING AND CLINICAL DECISIONS

ACCELERATED ABILITY TO LEARN

all kinds. We see this happening already with Google Mail suggesting and pre-populating answers to emails—a capability that is pervasive and built within the application. Once this functionality becomes ubiquitous, companies will be able to automatically complete manual and repetitive tasks with built-in AI capabilities that have endless scalability.

DAVID EHRLICH: One of the most successful scenarios we have seen is a significant increase in the consumption of information based on simply changing the order in which the information is offered to an HCP. There are millions of possible permutations of messages, and companies can use AI to determine which ordering will result in the highest HCP engagement.

AJ TRIANO: We will see a concerted effort by both the healthcare

industry and outside groups to push for regulation and agree upon rules of engagement. The Partnership for Automation and Innovation in Healthcare (PATH) formed in 2018 with an inaugural meeting focused on developing co-created guidance and governance to ensure meaningful AI application to healthcare. We will continue to see the rise of AI-based clinical decision support tools. I predict some of these will be created by pharma companies to support their molecules in the same way as we have seen companion diagnostic tools. We will see investment in AI to help expedite diagnosis and progression detection by both private industry, physician-coder entrepreneurs and healthcare giants. We should also expect to hear some resistance expressed out of concern for privacy and intended

MORE SPECIALIZED APPLICATION

use. But, my hope is that the proactivity we are seeing to create governance will allow us to keep focused on the potential benefit, instead of becoming mired in theoretical risk.

DAVID EHRLICH: We are fast approaching the “Trough of Disillusionment,” as expectations for AI’s impact have grown rapidly beyond its capability today. Many people think you can simply throw a bunch of data into a bucket, layer AI algorithms on top, and get all of the answers you seek. We may have the ability to do that five years from now, but today’s most effective use of AI requires investments in data preparation, clear framing of questions to be addressed, and painstaking model-building.

HS&M JANUARY/FEBRUARY 2019 | 22

ROUNDTABLE

MEET OUR PANEL OF EXPERTS CHRISTOPHER BOONE Vice President, Head of Real-World Data and Analytics Center of Excellence Pfizer

The Global Real-World Evidence Center of Excellence is responsible for expanding the strategic use of real-world data across the enterprise, enabling effective real-world data access and flow throughout the organization; increasing real-world data innovation; improving data quality, reliability, and availability; and establishing RWD governance models. Previous to his tenure at Pfizer, Christopher was a health informatics professor at the University of Cincinnati, VP of Real World Informatics and Digital Strategies at Avalere Health, National Director for Outpatient Quality and Health IT at the American Heart Association, and a senior consultant at Deloitte Consulting.

Christopher.P.Boone@pfizer.com

PFIZER is a leading global healthcare company, with a large suite of products focused on internal medicine, rare diseases, vaccines, inflammation and immunology, and oncology.

DAVID EHRLICH President and CEO Aktana

David is a seasoned Silicon Valley veteran who’s helped start, grow, and lead numerous successful technology companies. He has helped organizations of all sizes establish business models, build product/ marketing strategies, and meet their go-tomarket challenges. Prior to launching Aktana, David was executive in residence with Mohr

23 | HS&M JANUARY/FEBRUARY 2019

Davidow Ventures, and before that served as CEO of ParAccel, an early pioneer in the field of analytic databases. David also held senior level positions with NetIQ Corporation, Visual Networks, Inverse Network Technology, and McKinsey and Company, where he played a leadership role in the firm’s Asian telecommunications, electronics, and media practice. https://www.linkedin.com/in/davidjehrlich/

AKTANA empowers life science sales and marketing teams to provide beneficial information to the physicians they serve, using data-driven suggestions and insights,.

ARNO SOSNA General Manager Veeva Systems

After working in IT roles at Cap Gemini Ernst & Young, and IDS Scheer, Arno joined Veeva in 2011 as product management director for Europe. He move on to positions as Senior Director, VP and General Manager of Product Management CRM and is currently General Manager of CRM and Nitro for the company. Arno has also served since 2017 as CTO of Align Biopharma, a life sciences industry standards group, established to make it easier for healthcare professionals (HCPs) to work with life sciences.

Arno.sosna@veeva.com

VEEVA SYSTEMS’ industry cloud solutions provide data, software, services and an extensive ecosystem of partners to support critical functions from R&D through commercial. Veeva helps companies of all sizes bring products to market faster and more efficiently, and maintain compliance.

AJ TRIANO Senior Vice President, Engagement Strategy GSW, a Syneos Health company

AJ has a 15-year career history in healthcare technology and communications with a track record of delivering innovative technology pilots in healthcare. His understanding of how to navigate the tension between leading-edge innovation and regulatory compliance achieves results for clients and their customers. Leveraging his passion for UI/ UX and connected health technology, AJ spent the last two and half years working closely with Apple and major academic research institutions and hospital systems to deliver mClincal research using Apple’s ResearchKitTM and remote care programs using Apple’s CareKitTM frameworks. aj.triano@syneoshealth.com

GSW, A SYNEOS HEALTH COMPANY, is a full-service healthcare communications agency that creates personalized brand experiences that involve, inspire, educate and activate people through ongoing brand journeys. It is one of the world’s ten mostawarded healthcare advertising agencies, and builds partnerships with pharmaceutical, biotechnology and health-and-wellness clients in 18 major markets around the world.

Read more at https:// syneoshealthcommunications.com/globalnetwork/gsw#mOQ2qAGQ2xDdgpAD.99

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INDUSTRY

Otsuka, GSK, Bayer and other execs on balancing payers, patients and physicians An integrated, multi-stakeholder approach

By Paul Simms, Chairman eyeforpharma and Dr. Wolfgang Lippert, Senior Director, Healthcare and Life Sciences, SalesForce

Who is the most important stakeholder when it comes to ensuring patients gain access to new, innovative medicines? Trick question—they all are

25 | HS&M JANUARY/FEBRUARY 2019

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INDUSTRY Companies today need to engage with an almost bewildering array of influencers and decisionmakers. As well as patients, payers and prescribers, there are health insurers, healthcare providers, HTA bodies, regulators… the list is almost endless.

All companies need to adopt a truly multi-stakeholder approach as the basis of their commercial models. Many are making radical changes to their organizational structure, integrating their approaches towards stakeholders.

However, a revolution is not required. What is needed is a re-orientation of an outdated commercial model to encompass enhanced cross-functional activities and digital know-how—as only then can our industry face the challenges of the new multi-stakeholder model.

The organizations that adapt best to the demands of this new ecosystem will be those that thrive.

EXECUTIVE SUMMARY Successful companies are seeking to understand the needs of each group of stakeholders, and create solutions to meet them.

Now recognized by most pharma companies as the principal customer, patients are engaged across the drug value chain. With a clear model for engagement now defined, meaningful collaboration with the end-user has become the hallmark of successful trials and product launches.

While the importance of patients in the development, approval and commercialization of innovative new medicines rises, companies 27 | HS&M JANUARY/FEBRUARY 2019

have a long way to go before fully understanding and delivering on the full range of patients’ needs.

Healthcare professionals, principally physicians, remain a central stakeholder and customer for pharmaceutical companies, however, their relative influence has declined over time. As the importance of patients rises and HCPs are increasingly seen as collaborators in patient care, the way companies interact with them is evolving rapidly.

Technology—which is already reshaping not just the relationship between pharma and HCPs but between HCPs and patients—will continue to do so. In the near future, decision-support systems harnessing AI and machine learning will support HCPs, leaving pharma to influence not so much what a physician prescribes but how they prescribe it.

The role of payers, policy makers, HTA bodies and other influencers has grown hugely in recent years, with involvement in every stage of the product lifecycle.

Tackling the challenge of healthcare affordability, companies are searching for new engagement paradigms that focus on the holistic value of a medicine—not just to the patient but the wider healthcare ecosystem.

Clear links between health outcomes and payment will see medicines coming to market that are well-differentiated and which address unmet needs. However, aligning the development process to ensure appropriate data are available—especially when goalposts may move over time—remains a challenge.

How to integrate the interactions of all these stakeholders is a question many companies struggle to answer today. Internal alignment is essential; to deliver a consistent commercial approach, functions from Medical to Marketing, Market Access to R&D, must break out of their silos and work together in new ways. Focusing on the needs of patients and leveraging the potential of technology are key.

PART 1—PATIENTS The growth of patient-centricity has been something of an earthquake for the industry. Identifying the patient as the ultimate beneficiary has been the catalyst for some of the biggest changes made to the traditional pharmaceutical model.

Companies are now engaging with patients at all phases of the drug lifecycle, and meaningful collaboration has become the hallmark of successful trials and product launches.

“It used to be the physician was the learned intermediary who had all the information.

The patient was totally dependent. Today with unprecedented access to information online, patients have become direct consumers of healthcare.”

—Bob Oliver, CEO and Chairman of V ClinBio, and former CEO and President of Otsuka

Markus Kosch, VP Oncology Portfolio at Pfizer Oncology, across Europe, Japan and developed Asia, highlights the success of a non-branded app for breast cancer patients, developed in conjunction with patients and patient advocates. It’s a good example of effective co-creation in this space.

“The app is not branded and is completely free of product references, but it allows patients to interact with physicians, their loved ones, and their social network, helping them to monitor their emotional needs and status. It’s a very smart app, and it’s in use in 16 countries across our international developed markets.”

“We have moved from speaking to patients or even over patients, to including them when we are putting things together, so we engage patients early on in order to identify their needs.”

—-Markus Kosch, VP Oncology Portfolio at Pfizer Oncology, across Europe, Japan and developed Asia

Jane Griffiths, Global Head at Actelion, notes that the patient voice has strengthened considerably. Patient advocacy groups now understand what they can ask of the industry and vice versa, she

says. “Over the years, they have become much more professionalized. They have strengthened their reputation such that their involvement in regulatory body reviews, pricing and reimbursement reviews and inputting into clinical trial protocol development is really valued. A lot of the patient groups are so well-informed [on these topics], which wasn’t the case 20 years ago.”

Greater patient education and disease awareness should be a huge priority for the industry, says Griffiths. “For us, there is a clear model for engagement, because patients are essentially at the center of what we do when we innovate new medicines for areas of unmet needs.” This extends into all areas of development, with Pfizer now insisting on collecting patient-reported outcomes in all their clinical trials, as well as reporting back to patients on the outcomes of trials, says Kosch.

This also includes support programs developed with patient input, whether it is a patient diary or app or a monitor. Patients are even being consulted about packaging and dosing administration.

“Where appropriate and permitted, we are consulting with patients a lot more. We have a desire to understand how patients feel about the medicines we produce.

It’s only natural that, as an organization, we would like to hear how they’ve benefited. If they haven’t, we want to hear that too.”

IT’S THE JOURNEY, NOT THE DESTINATION Barrett Madrigal, Senior Director at Eli Lilly Japan, says one stakeholder group doesn’t take precedence over the other, rather “they are linked by a common underlying objective—of achieving the best possible outcomes for patients. At Lilly Japan, our slogan is Patients First, and we try to make all our decisions based on what’s best for the patient. We ask ourselves, ‘Would a patient be happy, satisfied or relieved to know that we are working on a particular thing or engaged in that specific kind of activity?’”

The company has developed a number of customer support programs, completely independent from its commercial arm, adds Madrigal. “We can’t do direct-toconsumer advertizing, but we have what we call disease awareness campaigns where we talk about the incidence and prevalence of disease, the signs and symptoms, and we provide resources for patients to better understand their affliction and how to seek treatment appropriately, including working with scientific societies.”

Patients’ unmet medical needs are at the forefront from the beginning of Lilly’s development strategy. “We look at areas that intersect and we try to identify tensions within those journeys. We try to prioritize those moments of truth based on the frustration level and where we can help,” he says.

Filtering the vast swaths of online resources is essential not only for

HS&M JANUARY/FEBRUARY 2019 | 28

INDUSTRY patients, but also for their wider support system. Kabir Nath, CEO of Otsuka North America pharmaceutical business, explains that his organization has been engaged with advocacy groups and patient groups for some time. As his company primarily works in areas of mental health and neurodegenerative conditions, he sees engagement with families and caregivers as critically important. “For instance, for somebody suffering from schizophrenia to be cared for adequately, it is absolutely a collaboration between the patient, physician and family members or caregivers. And, as we start to look into Alzheimer’s disease, where we have drugs being studied to possibly deal with agitated behavior, again we recognize that the spouse, child or even professional caregiver for a patient with dementia is a really important part of the equation.” To this end, listening techniques around the patient and caregiver community are a high priority for Otsuka.

research and development and continues right through the value chain. “We systematically involve patients as early as possible in the drug development process. We bring them in and they help us ensure that the trial design meets the real-world needs and patient expectations. In market access, we continuously expand direct patient engagement within legal and compliance boundaries.” In the commercial space, Bayer is focusing on improving health literacy, allowing patients to make informed decisions in order to ultimately achieve better outcomes.

We do a lot of ethnographic research to develop a patient journey and we map out a physician journey, as well as a payer journey.

—Sebastian Guth, Chief Marketing Officer, Pharmaceuticals, Bayer

—Barrett Madrigal, Senior Director at Eli Lilly Japan

According to Sebastian Guth, Chief Marketing Officer Pharmaceuticals at Bayer, responsible patient engagement begins at

“Very few patients clearly understand the message. We have a very strong drive to evolve the language into being more simple, relevant and understandable.”

Most of this work within Bayer comes under the auspices of a systematic initiative called PIE—Patient Insights and Engagement. “It is very much embedded into our company’s activities and guides us in everything we do in order to truly understand the patient’s needs, preferences and what matters to them.

29 | HS&M JANUARY/FEBRUARY 2019

“More than in the past, patients are the driver for our marketing plans but we are recognizing we need to go through the HCP. That has been the biggest change.”

—Hans Gilhuys, Global Multichannel Director, GSK

“At this moment, the percentage of patients who have their medical records to hand is probably in single digits. My firm belief is that the paradigm will continue to change rapidly and that, in the future, technology will ultimately help us to determine the best next intervention for each individual patient much faster and much more efficiently.”

Patient journey mapping is becoming more sophisticated, says Hans Gilhuys, Global Multichannel Director at GSK. “Within those patient journeys, we recognize the points where HCPs play a role for patients but also what other sources they use for getting their information. More than in the past, patients are the driver for our marketing plans but we are recognizing we need to go through the HCP. That has been the biggest change—before, we just focused on HCPs and thinking of what information and services they need but now we provide information and services that enable HCPs to support their patients and achieve improved patient outcomes,” says Gilhuys.

At a time when pharma is working overtime to build relationships with patients, trust is a major issue, another executive told us.

“Some patients will still see us as greedy and money-hungry; there is still a lack of understanding out there when it comes to drug companies. I don’t know why industry doesn’t invest more in changing that perception.”

While acknowledging that the complex regulatory landscape limits how organizations can reach the patient, he says companies’ attempts at patient engagement have been poor. “I see a lot of lip service when it comes to patientcentricity; companies are failing to live up to their mission statements.

The reality is that very few pharma companies are losing money because the patient doesn’t like them. We want to know our end users are happy and that things are working, but that’s not who buys from us,” he says.

“Our stakeholders have different preferences from the past.

Face-to-face interactions are less wanted and so more difficult to achieve, but we are now realizing that they are also possibly less effective in driving uptake of a medicine.”

—Markus Kosch, Pfizer Oncology

PART 2—HCPS AND PROVIDERS The diminishing influence of the physician in healthcare decisionmaking has been one of the main factors for the widespread reorientation of stakeholder priority by industry. The traditional model of face-to-face calls between sales reps and HCPs is also coming under scrutiny—is this approach redundant or still a vital component of the multi-stakeholder model?

Bob Oliver says “[The doctor] used to be the one who made all the decision in terms of diagnosis, what they prescribe, and how the patient would follow their instructions. Now you have health insurer algorithms telling them what to prescribe and how to prescribe.

You also have patients who have a strong voice in their own care. All these stakeholders mean the voice of the physician has diminished over time.”

As the needs of patients take precedence over those of HCPs, companies are increasingly seeing HCPs as collaborators in patient care. For GSK’s Hans Gilhuys: “Reaching HCPs isn’t our main objective anymore—it helps us, in connecting with patients, and then we can work together to help them.” He believes sales calls still have their place in the overall commercial model. “We want to help HCPs make decisions when they have specific questions about individual patients and that role is still there for the sales rep. It is also a very powerful way of engaging—you are face to face and

you can look them in the eye… you get clarity on what HCPs are expecting of us and also what we can provide. It remains a critical element of what we do.”

According to Pfizer’s Kosch, while physicians continue to be very important stakeholders, what has fundamentally changed is how pharma interacts with them.

“What we have learned is that our stakeholders have different preferences from the past. In many countries, face-to-face interactions are less desired and so more difficult to achieve, but we are now realizing that they are also possibly less effective in driving uptake of a medicine.”

In Pfizer’s experience, physicians are “going fully digital” so they wish for pharma to engage with them in a digital way. “They want high quality medical education and orientation and a heads up on our data before it becomes visible in print media. Oncology is a good example—it is super complex and fast-moving—and it is very difficult for a treating oncologist to quickly learn and adapt to changes, so they expect guidance from us.”

Reaching the physician is now not just the job of the sales rep—sales force, medical affairs and HCP websites all act as the interface between industry and medics.

The role of medical scientific liaisons (MSLs) has increased tremendously, as have health outcomes and other roles that work to help physicians determine the return on their efforts, explains

HS&M JANUARY/FEBRUARY 2019 | 30

INDUSTRY Madrigal. He is adamant, however, that sales calls to individual physicians are not a thing of the past.

Lilly is also redesigning many of its traditional tools; Madrigal says destination websites have not proved to be that popular with physicians, “especially if they are very glitzy”. These have been toned down. The organization is also working on e-medical liaison, so that physician requests are answered remotely and thus more quickly—and cheaply.

“This is working really well here so far—we have had hundreds of these calls and the feedback to date has been pretty good.”

NO LONGER IN THE DRIVER’S SEAT? Otsuka’s Nath sees the same trends shaping the way pharma interacts with HCPs.“What’s changed most from a physician’s perspective is that the traditional ways of providing information via sales reps and physical materials are evolving very rapidly. You have generational change amongst physicians, you have many ways to reach them, a much better understanding now of how people like to learn, use social media and so on. Physicians still have the same expectations—they want safer and better products— but the way we engage with them has changed very much.” Otsuka is thus engaged in much more active listening with physicians than before, he adds.

However, Nath believes the model of engaging physicians is poised to evolve. “The idea that we have

31 | HS&M JANUARY/FEBRUARY 2019

literally hundreds of reps out there making inefficient calls on HCPs will be out, at some point in the next 10 to 15 years. I don’t think it’s sustainable from an industry perspective, given the cost pressures we are going to be under from a pricing perspective and the challenges the payers are throwing at us.

He emphasizes the changing nature of the relationship between patient and physician. “Many patients use technology to self-triage before they make a medical appointment and are a lot more conscious in deciding which practitioner to visit so that is producing new competition into the field and changes the relationships between physicians and patients.”

“Whether or not technology will replace physician autonomy remains to be seen—it will very much depend on the regulatory paradigm.”

He believes technology will eventually enable decision-support systems that will allow physicians to decide the best intervention for a particular patient. “Whether technology will replace physician autonomy remains to be seen—it will very much depend on the regulatory paradigm.”

—Kabir Nath, Otsuka

“That is still our primary medium of interacting with physicians, and that has to change, but in terms of how that’s going to change and how we’re going to substitute for it, the ideal evolution is yet to be identified,” he says.

Physicians have a clear sense of the role they see themselves playing in the multi-stakeholder model, explains Sebastian Guth. “They don’t see themselves as customers but rather as partners in driving innovation.” He agrees with Madrigal that the role of medical-scientific liaisons is increasingly important, “not necessarily for all physicians but for those who are interested in driving future science.”

Bayer is experimenting with a program for use in chronic thromboembolic pulmonary hypertension, a relatively rare disease that is often not diagnosed or diagnosed at a late stage.

“We are working with machine learning to automatically assess data and help physicians to diagnose much earlier or to identify patients at risk. If it works, it will be pretty powerful.”

“It is not difficult to look forward to how the pharma industry and payer could interact with an AI platform, and that will determine how the patient is treated, either directly to the patient or by telling the HCP this is the regimen you need to start them on. The decision-making capacity is taken away from the HCP. Some people may think it’s ridiculous and the wider industry view is that it’s not going to happen, but I see it as a matter of time.”

PART 3—PAYERS, POLICY MAKERS, HTA BODIES AND OTHER INFLUENCERS With healthcare systems increasingly cash-strapped, and significant medical innovation emerging from the development pipeline, pharma has been experiencing significant pushback from payers in recent years—more than ever before.

The new reality of healthcare—rationing at worst, limited access at best—means that pharma must be far more creative in how it engages payers and regulators. Once the preserve of Regulatory Affairs and R&D, successful companies must now adopt a clear, integrated and commercially-aligned approach to engaging regulators, both proactively and early, to ensure a medicine clears the first hurdle and actually reaches patients.

“There is no doubt about it; we are facing very significant healthcare affordability challenges across societies and geographies, which is starting to limit access to innovation.”

—Sebastian Guth, Chief Marketing Officer, Pharmaceuticals, Bayer

Payers now come into every stage of the product lifecycle, and their influence has grown exponentially, says Bayer’s Guth. “Like many other companies, we have started to engage much earlier with payers and this has evolved in the same way that it has with regulatory agencies—it is less a paradigm of finalizing development and then throw a dataset over the fence and have payers or regulatory agencies look at that. Rather, we work across the whole development cycle jointly with regulatory agencies and payers to seek input and guidance and to some extent co-develop the program that we ultimately take into clinical development. We are seeking real relationships, optimizing dialogue and with that, outcomes and access,” he says.

Guth admits that while pharma is trying to think outside the box when it comes to new strategies of engaging with payers, the concept often does not translate into practice.

“Performance-based agreements are good in theory but in practice are a lot more difficult to get to.

That is not necessarily our unwillingness, but it is just the evolving landscape where better access to data will ultimately increase the joint ability of payers and ourselves to come to agreements that make sense and are practical in their implementation.

“What the payers do is not easy, it is just a fact of life that resources in healthcare systems are limited and at the end of the day, we have

a joint interest to bring the most innovative medicines that have the greatest impact on the wellbeing of a population in a specific geography…our experience is that there is a genuine openness to look at how programs can best be designed to ultimately provide the evidence that is required for a particular payer to then take the appropriate decisions,” he says.

CHANGE IS GOOD Actelion’s Jane Griffiths says “It is no secret that payers have developed a very strong muscle in terms of the impact they are having on patient access to new medicines and, of course, that has an impact on the industry. We are being required to put together much more detailed dossiers for pricing and reimbursement approval. It’s not a bad thing that we are being asked to become more outcomesfocused in our health economics dossiers. That’s what we should be wanting for patients—if we are being judged on patient outcomes as per our value documents then that can only be a good thing,” she says.

“You may finish your clinical trials but then a particular payer may request other evidence, which... can significantly hold up the access process.”

—Jane Griffiths, Global Head, Actelion

HS&M JANUARY/FEBRUARY 2019 | 32

INDUSTRY Historically, clinical trials were powered to look at clinical efficacy and whether a medicine was safe or not. “That is still important but now we are looking much more at active comparators—are we better than what’s in the market already and what outcomes are we bringing for patients?” says Griffiths.

about a lot of tactical marketing and a lot of face-to-face interactions but, on the payer side, it was also about rebating and volume negotiation. In the value-based model, we see more pay for solutions, pay-for-performance, and we see risk-share models and agreements.”

While this should ultimately ensure that medicines coming to market are well-differentiated and addressing unmet needs, it can sometimes feel as though payers are continually moving the goalposts, particularly when it comes to health technology assessments (HTA).

Payers across these markets do appear to be open to innovative agreements that could include specific caps, or models that involve pay-for-performance, and even models that go beyond simple risk-sharing, where the first stage is given for free, he notes.

For Pfizer’s Kosch, while the idea of payers as key stakeholders in bringing the medicine to patients is not a new one, as economic pressure increases, their position becomes more influential.

Here, Pfizer endeavors to focus on payers and potential HTAs early in the development process—an approach that brings its own challenges, he explains. “To choose the right endpoints, to come up with the right data packages, which is not always easy or not even always possible as HTA assessments and payers vary by country.”

Payers are still the most important stakeholder in terms of making sure that a company’s innovations translate into patient value, he says. “If you don’t convince the payer and get reimbursement then that’s it, the medicine may never reach the patient. We still see the volume-based model in the classical primary care business; it was

33 | HS&M JANUARY/FEBRUARY 2019

A DATA-BASED RELATIONSHIP The effort needed from companies to deliver payer needs is increasing. “The payers are demanding more. It’s no longer a spreadsheet with a few numbers on it; they want a lot of analysis,” says the head of commercial excellence at one company. “Common over-the-counter medications such as paracetamol would not be available with today’s rigor as they wouldn’t be deemed safe enough—the same goes for many antidepressants as they don’t have clinical benefits shown through gold-standard placebo-controlled multi-centre trials. This is fantastic rigour, but it has translated into payer expectations as well.”

In the US, the importance of the payer is increasing significantly, a relatively new phenomenon, notes Otsuka’s Nath. “Historically the payer has played a much less cen-

tral role in the US than in other markets around the world, so historically we have spent less time with them. Absolutely the role of the payer is increasing dramatically in the US. The rise of drug costs has opened the door for payers to be much more aggressive in how they manage formulary, how they delay formulary, how they impose specific requirements and how, in a few rare cases, they try to class price and use competition to drive down their costs, like we’ve seen with the hep C virus medications.”

Bob Oliver agrees, but points to slow uptake of European-style HTA. “For us, it is still about efficacy and safety. Our relationship with payers is more adversarial than it needs to be.”

Contrary to Europe, he sees payers and industry as having “mis-aligned” interests. A crisis may be needed, in order to make stakeholders more objective, he believes. “If we ever get a breakthrough for Alzheimer’s disease, would the world be able to afford it? That’s a question we shouldn’t have to ask in the 21st century, but it’s something that would impact the entire globe.”

“Integrating digital into the relationship management you have already—that is the key, but it is also the most difficult thing.”

—Markus Kosch, Pfizer Oncology

PART 4—THE INTEGRATED COMMERCIAL MODEL The multi-stakeholder world is incredibly complex. Shifting dynamics see stakeholder groups engaged in different ways, through different channels, at different times and by different customer-facing functions.

Organizations face an ongoing challenge to integrate these contacts into a consistent, joined-up commercial model and approach, covering all groups and touchpoints, and across all internal functions.

Pfizer Oncology is moving away from the traditional sales and marketing model towards an integrated multichannel model, says Kosch, who explains that the organization has been aligning its business functions, including commercial, medical affairs and R&D, around a patient-first paradigm for almost two years.

“Patient First means that value to the patient should be the key driver for decision-making internally. We really try to translate that into our operational processes.”

The company is going further by setting ‘patient targets’, he adds.

“These are not necessarily revenue targets; obviously, there is a correlation, but there is still a difference in what you ultimately call it and what you base your targets numbers on.”

Unsurprisingly, digital is a major component of any multichannel, multi-stakeholder approach, underpinning the changes made organizationally. “This is not simply adding one or two digital channels, rather it is true integra-

tion of the organization’s different functions. Digital channels only become truly valuable if they are embedded into the whole process,” says Kosch.

This is particularly important when it comes to maintaining or building relationships with physicians. “Integrating digital into the relationship management you have already across medical and commercial colleagues in the company—that is the key, but it is also the most difficult thing,” he says.

For Kosch, a major challenge is ensuring full buy-in from employees. “We need them to understand sub-specialty planning, integrating channels, and the addition of channels, and how this helps us meet the digital needs of the customer, so that they understand they are enhancing their role and making them more valuable.”

The shift from volume to value will continue to drive these changes in the alignment of functions, making certain functions “more meaningful”.

“It is more than a reshuffle, it is looking more and more like a major shift,” he says. “I think it will dramatically affect organizational business unit functions. That will look different from company to company but it is those organizations that are better adapting to this new paradigm that will continue to do better and the others will ultimately vanish.”

In contrast, Otsuka’s Nath says that pharma is “not changing fast enough” when it comes to the realities of the multi-stakeholder model.

“Not only are all those stakeholders becoming more important but increasingly our interactions with many of them will be more digital, depending on the area we are working in. Part of what we are doing at Otsuka is investing in capabilities that are going to be common across all areas. We are working very hard to build a common set of data and a common set of analytical capabilities that allow us to answer questions that relate to all of physicians, payers and patients and really integrate insights from all those in a way we haven’t done before.”

It’s still early days, he cautions.

“Part of the challenge is continuing the balance between promoting brands because that is still ultimately that drives our revenues, but again trying to break down some of those barriers so we look at more common capabilities, as opposed to everything just sitting in brand teams.”

“Having all those disciplines joined up along the continuum of drug development, licensing, pricing and reimbursement is making companies really solidify their longitudinal approach.”

—Jane Griffiths, Global Head, Actelion

HS&M JANUARY/FEBRUARY 2019 | 34

INDUSTRY Actelion is also committed to the idea of an integrated multi-stakeholder model. A fully integrated approach right through from Phase II to approval is essential, says Griffiths. “It impacts the entire way you approach your drug development—you need an integrated approach from drug development and our access and reimbursement team. Having all those disciplines joined up along the continuum of drug development, licensing, pricing and reimbursement is making companies really solidify their longitudinal approach.”

She agrees that the historical autonomy and independence of pharma functions is a thing of the past. “Rather than people working in silos and disciplines, they are all very much dovetailing into each other.” As this new paradigm evolves, one of the challenges is employee engagement, developing and retaining “great people”, she adds.

Madrigal and Lilly see a definite commercial benefit to accepting and addressing the complexities of the multi-stakeholder model.

“We use the net promoter score, which is factored around loyalty.

We focus first on making sure that we provide excellent leadership to our employees, we engage with HCPs, we try to create an unparalleled customer experience, and if we do those three things really well then, we believe the results will come. Many companies start with the results and work backwards from there, but that’s not the model we use here in Japan. We

35 | HS&M JANUARY/FEBRUARY 2019

call this the service value chain—it is the right thing to do.”

Lilly’s systems have undergone “tremendous” change as roles begin to meld and overlap, he adds.

“We had to build a new platform and strengthen our core functions but also move from just the IT functions to customer analytics teams. Without good data flow and reliable information systems none of this can really work. We need to really focus on multichannel engagement and put experts in place that really understand the values of each channels, the channels that are effective for particular kinds of products. We also need to bring our medical affairs group on board because, historically, technology and IT has not been their priority.

“Their priority has always been about the quality of science and medical information but now they are becoming much more in tune.”

Brand teams have had to adapt to these new channels, perhaps most significantly; “While the sales force is still the biggest and the most important channel, other channels are becoming increasingly important and we have got to get the sales organization to play more of a coordinator role, learning how to leverage and empower these different resources, rather than being the primary actor themselves.”

At Bayer, the development of cross-functional teams has allowed the classical structure to stay largely in place but become much more integrated, Guth explains. “We today still have a

functional organization with the traditional functions, but we have layered across that a very strong focus on cross-functional teams that have true and genuine accountability. These, in many ways, supersede the traditional organizational structure and work to bring together market access, medical, commercial, and patient advocacy, among others, to really reflect the different stakeholder groups and their interests, needs and expectations, in not only the strategy development but also more importantly in subsequent execution.”

Integration is also a key priority at GSK, according to Gilhuys. This is part and parcel of recognizing the differing needs of the main stakeholders and working to serve them equally.

“We are going through quite a big change not just from a multistakeholder perspective, but also from a ‘multiple options to engage with stakeholders’ perspective. We need to bring back the marketer as the conductor of the orchestra, working very closely together with different functions who are specialists in different areas.”

Connecting the patient journey with the HCP journey is the key to understanding what patients need and want, and what pharma can give them, adds Gilhuys. “We have clearly identified that we are reaching patients through HCPs and nurses so that means that these people are a primary point of contact for us, but we also want to reach the patients themselves.”

This allows for consistency across stakeholder engagements and

customer experience, he adds. Despite the complexity of the model, providing value to patients is the common denominator across the different stakeholders. “Adding value to patients is continually our main aim and that is where we try to understand better and better the position of the other stakeholders, so we can work closely with them to do just that. It is about partnering with the other players in the healthcare system in order to deliver value for patients.�

basis of their commercial models.

Balancing stakeholders across payers, patients and physicians will lead the way towards an integrated multi-stakeholder approach. This collaboration is essential for the industry ecosystem to thrive. •

COMMENT

What emerges is that all companies need to adopt a truly multi-stakeholder approach as the HS&M JANUARY/FEBRUARY 2019 | 36

HEALTHCARE

CLICK HERE TO GET TOP 100 HEALTHCARE COMPANIES

HEALTHCARE COMPANIES

TOP 100 HEALTHCARE COMPANIES Pharmaceutical, Medical Device, Biotechnology Combing through our previous lists of the Top 50 Pharmaceutical, Medical Device and Biotechnology companies, we have compiled 2018’s Top 100 Healthcare Companies list.

This year we find 40 pharmaceutical companies, 46 medical device (medtech) companies, 14 biotech companies and some new entries, including United Therapeutics and Hoya.

Johnson & Johnson and comes in strong again at #1, with Pfizer, Roche, and Novartis holding their positions, and Sanofi jumping into the top 5, while Bayer has dropped a few positions to below GSK. The big news is a medical device company appearing on the top 10 again this year, as Medtronic takes the #8 spot, up two from last year.

Pharmaceutical companies in the Top 100 continue to dominate in terms of revenue, but represent 62% for a total $747B, about equal to last year’s percentage. Revenue growth trends are a little off, with 73% up (compared to 78% last year but only 62% the year before).

Four entries stayed the same, and four more were new to the list.

Overall revenue total for the top 100 was $1.207 trillion dollars.

37 | HS&M JANUARY/FEBRUARY 2019

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. Only 19 companies went down in revenue in 2017. The total revenue added by medical device was $42B, $16B by pharma and $6B by biotech.

Companies are ranked by their 2017 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 2017). Companies are categorized by their predominant revenue source and their own characterization per publicly available sources.

HEALTHCARE COMPANIES

Companies are ranked by their 2017 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.

CLICK HERE TO GET TOP 100 HEALTHCARE COMPANIES

RANKING COMPANY LOCATION

2017 REVENUE IN US$B

1

JOHNSON & JOHNSON

New Brunswick, New Jersey 76.50

2

PFIZER

New York, New York

52.55

3

ROCHE

Basel, Switzerland

51.95

4

NOVARTIS

Basel, Switzerland

43.09

SANOFI

Paris, France

42.06

MERCK & COMPANY

Kenilworth, New Jersey

40.12

7

GLAXOSMITHKLINE

Brentford, United Kingdom 36.22

8

BAYER CORPORATION

Leverkusen, Germany

35.02

9

MEDTRONIC

Dublin, Ireland

29.70

10

ABBVIE

North Chicago, Illinois 27.39

11

ABBOTT LABORATORIES

Chicago, Illinois

27.39

12

MEDIPAL HOLDINGS

Tokyo, Japan

27.27

13

GILEAD SCIENCES

Foster City, California

26.11

14

BOEHRINGER INGELHEIM

Ingelheim am Rhein, Germany 26.06

15

ELI LILLY AND COMPANY

Indianapolis, Indiana 22.87

16

AMGEN

Thousand Oaks, California

22.85

17

ALFRESA HOLDINGS

Tokyo, Japan

22.71

18

ASTRAZENECA

Cambridge, United Kingdom

22.47

19

TEVA PHARMACEUTICALS

Petach Tikva, Israel

22.40

PHILIPS HEALTHCARE

Amsterdam, Netherlands 21.34

21

FRESENIUS MEDICAL CARE

Bad Homburg, Germany 21.34

22

BRISTOL-MYERS SQUIBB

New York, New York 20.78

23

GENERAL ELECTRIC

Fairfield, Connecticut 19.12

24

MERCK KGAA

Darmstadt, Germany 18.39

25

NOVO NORDISK

Bagsværd, Denmark 18.00

5 6

20

39 | HS&M JANUARY/FEBRUARY 2019

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HEALTHCARE COMPANIES

Companies are ranked by their 2017 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.

CLICK HERE TO GET TOP 100 HEALTHCARE COMPANIES

RANKING COMPANY LOCATION

2017 REVENUE IN US$B

26

16.20

SIEMENS

Munich, Germany

ACTAVIS

Parsippany-Troy Hills, New Jersey 15.94

TAKEDA PHARMACEUTICALS

Osaka, Japan

15.76

29

SHIRE

Dublin, Ireland

15.16

30

DANAHER

Washington, DC

14.36

CARDINAL HEALTH

Dublin, Ohio

13.50

32

CELGENE

Summit, New Jersey 13.00

33

STRYKER

Kalamazoo, Michigan 12.44

34

BIOGEN

Cambridge, Massachusetts 12.27

35

BECTON DICKINSON

Franklin Lakes, New Jersey

36

MYLAN

Canonsburg, Pennsylvania 11.91

37

ASTELLAS PHARMA

Tokyo, Japan

11.71

38

BAXTER

Deerfield, Illinois

10.60

39

BOSTON SCIENTIFIC

Marlborough, Massachusetts 9.05

40

ESSILOR

Charenton-le-Pont, France 8.99

VALEANT PHARMACEUTICALS

Laval, Quebec, Canada

8.72

42

DAIICHI SANKYO

Tokyo, Japan

8.55

43

B. BRAUN MEDICAL

Melsungen, Germany 8.15

ZIMMER BIOMET

Warsaw, Indianna

7.82

45

TEIJIN

Osaka, Japan

7.43

46

CSL BEHRING

King of Prussia, Pennsylvania 6.92

47

OTSUKA PHARMACEUTICAL

Tokyo, Japan

6.90

48

OLYMPUS

Tokyo, Japan

6.66

49

CARL ZEISS

Oberkochen, Germany 6.42

50

RECKITT BENCKISER

Slough, United Kingdom

27 28

31

41

44

41 | HS&M JANUARY/FEBRUARY 2019

12.10

6.11

65

%

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HEALTHCARE COMPANIES

Companies are ranked by their 2017 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.

CLICK HERE TO GET TOP 100 HEALTHCARE COMPANIES

RANKING COMPANY LOCATION

2017 REVENUE IN US$B

51

REGENERON PHARMACEUTICALS Tarrytown, New York 5.87

52

3M

Saint Paul, Minnesota 5.81

53

UCB

Brussels, Belgium

5.44

54

EISAI

Tokyo, Japan

5.34

55

ZOETIS

Parsippany, New Jersey 5.31

56

GRIFOLS

Barcelona, Spain

5.18

57

PERRIGO

Dublin, Ireland

4.95

58

SMITH & NEPHEW

London, United Kingdom 4.76

CHUGAI PHARMACEUTICAL

Tokyo, Japan

4.75

SUN PHARMACEUTICAL

Mumbai, India

4.74

TERUMO MEDICAL

Tokyo, Japan

4.58

62 NEW HITACHI

Tokyo, Japan

4.26

63 NEW HOYA

Tokyo, Japan

4.26

64

SUMITOMO DAINIPPON PHARMA Osaka, Japan

4.25

65

DENTSPLY SIRONA

York, Pennsylvania 3.99

66

MITSUBISHI TANABE PHARMA

Osaka, Japan

67

HARTMANN

Frankfurt, Germany 3.56

68

ALEXION PHARMACEUTICALS

New Haven, Connecticut 3.55

69

ENDO INTERNATIONAL

Dublin, Ireland

3.47

70

EDWARDS LIFESCIENCES

Irvine, California

3.43

71

ASPEN PHARMACARE

KwaZulo-Natal, South Africa 3.35

72

MALLINCKRODT

Dublin, Ireland

INTUITIVE SURGICAL

Sunnyvale, California 3.13

KYOWA HAKKO KIRIN

Tokyo, Japan

3.12

DRÄGER

Lübeck, Germany

3.09

59 60 61

73 74 75

43 | HS&M JANUARY/FEBRUARY 2019

3.86

3.22

TOP LISTS the publication for healthcare sales & marketing leaders™

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HEALTHCARE COMPANIES

Companies are ranked by their 2017 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.

CLICK HERE TO GET TOP 100 HEALTHCARE COMPANIES

RANKING COMPANY

LOCATION

76

HOLOGIC

Marlborough, Massachusetts 3.06

77

SHIONOGI

Osaka, Japan

3.02

GETINGE GROUP

Gothenburg, Sweden

2.75

79

ILLUMINA

San Diego, California 2.75

80

BIOMERIEUX

Marcy l’Etoile, France 2.75

81

HILL-ROM

Chicago, Illinois

2.74

82

SONOVA

Stäfa, Switzerland

2.72

83

VARIAN MEDICAL SYSTEMS

Palo Alto, California

2.67

84

NIPRO MEDICAL CORPORATION

Osaka, Japan

2.67

85

STERIS

Mentor, Ohio

2.61

86

COLOPLAST

Humblebaek, Denmark 2.50

87

SHIP HEALTHCARE HOLDINGS

Suita-Shi, Japan

88

NOVOZYMES

Bagsvaerd, Denmark 2.34

89

IPSEN

Paris, France

2.29

90

DR. REDDY’S LABORATORIES

Hyderabad, India

2.20

91

VERTEX PHARMACEUTICALS

Boston, Massachusetts 2.17

78

2017

2.35

92 NEW BIO-RAD

Hercules, California 2.16

93

TELEFLEX

Wayne, Pennsylvania 2.15

94

THE COOPER COMPANIES

Pleasanton, California 2.14

95

WILLIAM DEMANT

Smørum, Denmark 2.13

96

FUJIFILM MEDICAL SYSTEMS

Tokyo, Japan

97

RESMED

San Diego, California 2.07

98

BRUKER

Billerica, Massachusetts 1.77

99

CONVATEC

Deeside, United Kingdom 1.76

UNITED THERAPEUTICS

Silver Spring, Maryland 1.73

100 NEW

45 | HS&M JANUARY/FEBRUARY 2019

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INDUSTRY

Global Life Sciences Outlook

by Deloitte Emerging technologies are creating a transformative opportunity for life sciences, and scientific achievements are on a record pace.

The geopolitical climate is ushering in a new era led by the passage of tax reform in the United States and Brexit in the United Kingdom.

In addition to embracing these changes, life sciences companies are looking for ways to meet the opportunities and challenges coming. Forward-thinking organizations will be: n Building an adaptable organization for the future of work n Building a culture of courage to help counter uncertainty n Building data integrity, maximizing the value of data n Building patient trust and centricity, across the journey of care n Building a smart, crossfunctional regulatory approach In order to grow, life sciences companies will need to continue to look for new partnerships and operating models. Alliances and partnerships will be particularly

important for accessing external expertise and technology. And technology companies, both large and small, are already poised to disrupt the industry.

ECONOMIC OVERVIEW “Health life sciences� refers to the application of biology and technology to improve healthcare, and includes biopharmaceuticals, medical technology, genomics, diagnostics and digital health. The sector generates a wide range of products, including drugs, medical technology, diagnostics and digital tools.1

GROWTH TRENDS PHARMACEUTICAL DRUGS On the heels of a slow recovery, global prescription drug sales are forecast to grow at an impressive annual compound rate of 6.5% in the next five years. Worldwide sales are expected to be US$1.06T in 2022 (Figure 1)2. This growth is in contrast to the 2.2% compound-

47 | HS&M JANUARY/FEBRUARY 2019

ed annual growth rate (CAGR) in 2012-2016, but still under the 8.4% CAGR before the global financial crisis in 2004-20083. However, this trajectory could be tempered by pricing pressures and a potential second patent cliff4.

Although not at previous levels, most research-based pharmaceutical companies are reporting an uptick in revenue and profits.

Spending on prescription drugs is expected to increase in every market except Venezuela over the next few years.

Recovery in spending will be fueled by consolidation in generics markets and increased budgets for high-priced treatments, including orphan drugs. Some companies are still struggling with patent expiries, estimated to be a US$194B risk for sales in 20225.

The industry will continue to look to emerging markets for growth, albeit not as aggressively as in the past6. Among the top 20 pharma-

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INDUSTRY Figure 1. Worldwide total prescription drug sales, 2008-2022 Source: EvaluatePharma, 2017

ceutical markets in the world, eight are emerging countries supported by an increasing middle class.

China is expected to reach the top three in the near future. However, constraints could come from government incentives that reduce medication reimbursements and health care costs7.

Worldwide pharmaceutical and biotech R&D is forecast to grow 2.4% per year to 2022, slightly lower than the 2.5% annual growth between 2008 and 2016. Total R&D spend is expected to reach US$18B in 2022, compared to US$156.7B in 20168. Significant innovation is coming from small niche companies focused on discovering new drugs. Less than a quarter of drugs discovered are brought to market by the big pharmaceutical companies9.

The industry is expected to continue to face challenges in R&D returns (Figure 2)10. The cost of bringing an asset to market reached record levels in 201711 and many of the largest drug developers will

continue to be challenged by losses to generics12.

With an increase in the number and speed of approvals13, a new normal in R&D is triggering competition in pricing, leaving less time for a manufacturer to gain substantially for breakthrough applications14. In 2018, the new US administration promises to continue the path towards faster approvals, but the risk in accelerated approvals can be a drug turning into a market disaster15.

ORPHAN DRUGS The orphan drug market is expected to almost double in the next five years, reaching US$209B in 2022. It’s expected that these highcost, specialized drugs have and will continue to face pricing scrutiny by policymakers. Of the top 100 drugs in the United States, the average cost per patient per year for an orphan drug was US$140,443 in 2016, compared to US$27,756 for a non-orphan16.

According to the US Food & Drug

49 | HS&M JANUARY/FEBRUARY 2019

Administration (FDA), 75 orphan drugs were approved in the United States in 201717, compared to a total of 27 in 2016 and 56 in 201518.

The 50 highest-selling orphandrugs each averaged approximately US$637M in sales19. While only about 600 treatments are approved, 7,000 conditions are designated as rare in the United States20.

Major scientific advances will lead to even more rare diseases being identified and even more drugs seeking approval despite pricing pressures21.

The passage of the new US tax law reduces the orphan-drug credits that biopharma companies can claim by effectively 40%22. However, the reduction is not likely to change life sciences companies’ strategies.

The orphan drug market is a strategic market that solves unmet needs.

The key benefits are not just the tax credit, but the other important aspects such as the seven-year market exclusivity, faster FDA review and waived fees, and exception from the ACA branded drug pharma fee for orphan-only drugs.

Figure 2. Three-year rolling average returns on late-stage portfolio, 2010-2017 Source: A new future for R&D? Measuring the return from pharmaceutical innovation, Deloitte Centre for Health Solutions, 2017

BIOLOGICS AND BIOSIMILARS Biologics are predicted to comprise more than a quarter of the pharmaceutical market by 202023.

With their success, the industry’s biggest biologics face revenue threats from biosimilars and another patent cliff24.

Lack of affordability and access to biologics are driving tailwinds for biosimilars, especially in emerging markets. In the European Union (EU), countries are seeing considerable cost savings with biosimilars, even when market share is low25. Typically, biosimilars are around 30 percent less expensive.

The highest impact in US biosimilar sales is expected in the next two years, with an estimated 25 to

35 biosimilars expected to be on the US market by 202026. However, there are headwinds in the United States without a clear regulatory pathway.

The Asia-Pacific region has more biosimilars in development than anywhere else in the world, led by China (Figure 3). China has the potential to become the frontier market for biosimilar drugs27.

The growth of biosimilars could push the industry into an innovative phase, even the potential for increased use of biologics28.

Improvements are being made in the manufacturing techniques used to produce biosimilars. We could see biosimilar manufacturing representing 10% or more of some companies’ global biomanu-

facturing capacity in the next few years29.

GENERICS Global generic drug sales are expected to make up 29.2% of the total pharmaceutical sales worldwide in 2022, compared to approximately 28 % in 2017. Emerging markets and the United States will drive demand for generics as they continue to cut health care costs30.

Generics now make up more than 80% of the volume of drugs dispensed around the world, and that percentage will continue to grow as more drugs lose patent protection. Many of the bigger products coming off patent are biologics.

HS&M JANUARY/FEBRUARY 2019 | 50

INDUSTRY Figure 3. Country rank by biosimilar pipelines Source: Thomson Reuters

THERAPEUTIC FOCUS TRENDS Oncology leads therapy areas in sales (Figure 4) and is likely to account for 17.5% of prescription drug and OTC sales by 2022, more than the next three highest therapy areas combined31. In addition to oncology, the largest CAGR growth in the top 15 therapy categories will come from immunosuppressants, dermatologicals, and anti-coagulants32.

PERSONALIZED MEDICINE The global personalized medicine market is forecast to reach $2.4T in 2022 at a CAGR of 11.8%, more than double the projected 5.2% annual growth for the overall health care sector33. Growth will be driven by advancements in technology and targeted therapies that are more efficient, and can provide more

value. The focus is on prevention and early intervention, rather than advanced disease.

More than 40% of all compounds and 70% of oncology compounds have the potential to be personalized medicines34.

Real-world data and artificial intelligence (AI) technologies are accelerating the development of the most fruitful molecules and compounds35.

MEDTECH Worldwide medtech sales are forecast to grow at an annual compound growth rate of 5.1%, reaching US$521.9B by 2022 (Figure 5).

In vitro diagnostics is expected to remain the largest medtech segment, with annual sales of US$70B by 202236.

51 | HS&M JANUARY/FEBRUARY 2019

Ranking second is cardiology, expected to reach US$62B in sales by 2022, followed by diagnostic imaging at US$48B, and orthopedics, which has been growing slowly at 4% per year to US$44B. The top 10 companies are expected to make up 37% of the medtech market in 202237.

Global medtech R&D spending is expected to grow by 3.7% CAGR to US$33.5B billion by 2022 from around US$27B in 2017. As a percentage of sales, the R&D investment rate is forecast to decline from 6.9% in 2016 to 6.4% in 2022.

The repeal of the US medical device excise tax was not included in the recent tax reform and the medtech industry believes the tax has a significant negative impact on medical innovation38. However, the industry continues to pursue alternative

Figure 4. Top 15 prescription drug & OTC therapy categories by worldwide sales, 2016-2022 Source: EvaluatePharma, 2017

legislative measures to at least continue the two-year moratorium on the tax that expired December 31, 2017.

M&A INVESTMENT TRENDS LIFE SCIENCES 2017 saw a further decline in deal value from2016, resulting from global economic and political uncertainty. Large deals that were announced in 2017 tended to be focused on traditional acquisitions that were within the core competencies of the acquirer.

According to Thomson Reuters data, the largest deal through Q3 2017 is Becton Dickinson & Co. acquiring CR Bard in April, in a deal worth $24.2B. In biotech, Gilead Sciences Inc. acquired Kite Pharma Inc. for$11.1B. In pharmaceuticals, ThermoFisher Scientific, Inc. acquired Patheon NV (99.0066% interest) for $7.2B39.

MEDTECH In 2017, the total value of medtech venture financing deals rose considerably, despite the number of deals falling40. Finding new

technologies to fuel future growth could be a challenge for large, established medtech companies41.

Exponential advances in technology make medtech ripe for innovation. Sensors, analytics, AI, and other digital health technologies are converging with medtech.

Companies have an opportunity to create new business models and pivot from product developers to solution providers. Digital health technologies appear to be attracting more venture capital investment than traditional medtech HS&M JANUARY/FEBRUARY 2019 | 52

INDUSTRY Figure 5. Global medtech sales (US $B), 2016-2022 Source: EvaluatePharma 2017

as well as attracting new types of organizations to invest in the sector.

Large medtech company partnerships are becoming an alternative to traditional venture capital investment. In comparison, biopharma has almost three times the partnership activity as medtech (Figure 6)42 • ____________________________ Bell, Sir John, et al., Life Sciences Industrial Strategy – A report to the Government from the life sciences sector, 2017 1

World Preview 2017, Outlook to 2022, EvaluatePharma, 2017 2

World Industry Outlook, Healthcare and Pharmaceuticals, The Economic Intelligence Unit, June 2017 3

World Preview 2017, Outlook to 2022, EvaluatePharma, 2017 4

Ibid

5

Global Pharmaceuticals & Medicine Manufacturing, World Industry Report, IBISWorld, 2017 6

Ibid

7

World Preview 2017, Outlook to 2022, EvaluatePharma, 2017 8

Global Pharmaceuticals & Medicine Manufacturing, World Industry Report, IBISWorld, 2017 9

A new future for R&D? Measuring the return from pharmaceutical innovation 2017, Deloitte Centre for Health Solutions, 2017 10

11

Ibid

“The class of 2017’s winners and losers: A year of ‘nonstop scientific achievements’ raises troubling issues,” Endpoints, 1 January 2018: https://endpts.com/ the-class-of-2017s-winners-andlosers-ayear-of-nonstop-scientific-achievementsraises-troubling-issues/ 12

53 | HS&M JANUARY/FEBRUARY 2019

“Updated: New Drug Approvals for FDA: 2017 Hits 21-Year High,” RAPS, 21 December 2017: https://www.raps.org/ news-articles/news-articles/2017/12/ updated-new-drug-approvals-for-fda2017-hits-21-year-high 13

14

Ibid

15

Ibid

Orphan Drug Report, EvaluatePharma, 2017 16

Orphan Drug Destinations & Approvals, FDA, 2017. Accessed 24 January 2018: https://www.accessdata.fda.gov/scripts/ opdlisting/oopd/listResult.cfm 17

Orphan Drugs in the United States, IQVIA, 2017 18

Orphan Drugs in the United States, IQVIA, 2017 19

“5 trends shaping rare disease drug development,” BioPharma Dive, 10 Apri l2017: http://www.biopharmadive.com/ news/trends-rare-disease-orphan-drugdevelopment/439866/ 20

Figure 6. Biopharma has almost three times the partnership activity as medtech Note: Strategic alliances include JV, co-development, co-marketing, and licensing deals Source: Out of the valley of death: How can entrepreneurs, corporations, and investors reinvigorate early-stage medtech innovation, Deloitte Center for Health Solutions, 2017

Orphan Drugs in the United States, IQVIA, 2017 21

“Senate, House Agree to Cut Orphan Drug Research Credit in Half in TaxcBill,” RAPS, 18 December 2017: http:// www.raps.org/Regulatory-Focus/ News/2017/12/18/29066/Senate-HouseAgree-to-Cut-Orphan-Drug-ResearchCredit-in-Half-in-Tax-Bill/ 22

Winning with biosimilars, Opportunities in global markets, Deloitte, 2017 23

World Preview 2017, Outlook to 2022, EvaluatePharma, 2017 24

“Biosimilars in the EU: New IMS Report Shows Savings ThroughvCompetition,” RAPS, 9 May 2017: http:// www.raps.org/Regulatory-Focus/ News/2017/05/09/27509/Biosimilarsin-the-EU-New-IMS-Report-ShowsSavings -Through-Competition/ 25

Outlook for Global Medicines through 2021, IQVIA, 2017 26

Deloitte Research Monthly Outlook and Perspectives, Issue XXXI, Deloitte, 2017 27

“Biosimilars: The Pipeline Seams Seem to Be Bursting,” Managed Care, March 2017: https://www.managedcaremag. com/archives/2017/3/biosimilars-pipelineseams-seem-be-bursting 28

“What Are the Key Trends in Global Biopharmaceutical Manufacturing Forv2017?” Life Science Leader, 1 December 2016: https://www. lifescienceleader.com/docpreview/ what-are-the-key-trends-in-globalbiopharmaceuticalmanufacturingfor-0001/22d40354-3424-4802-8dc6340834d3a7a5 29

Global Pharmaceuticals & Medicine Manufacturing, World Industry Report, IBISWorld, 2017 30

World Preview 2017, Outlook to 2022, EvaluatePharma, 2017 31

32

Ibid

The future awakens, Life sciences and health care predictions 2022, Deloitte, 2017 33

The Personalized Medicine Report, PMC, 2017

Cognitive health care in 2027, Harnessing a data-driven approach in personalized health care, Deloitte Insights 2017 35

World Preview 2017, Outlook to 2022, EvaluateMedTech, 2017 36

37

Ibid

“Medical Technology Firms to Trump: GOP Forgot To Ax The Device Tax,” Forbes, 20 December 2017: https://www.forbes.com/sites/brucejapsen/2017/12/20/medical-technologyfirms-to-trump-gop-forgot-to-axe-thedevice-tax/ 38

39

Thompson Reuters

World Preview 2017, Outlook to 2022, EvaluateMedTech, 2017 40

41

Ibid

Out of the valley of death: How can entrepreneurs, corporations, and investors reinvigorate early-stage medtech innovation, Deloitte Center for Health Solutions, 2017 42

34

COMMENT HS&M JANUARY/FEBRUARY 2019 | 54

INNOVATIONS

Cleveland Clinic Top Ten Medical Innovations: 2019 The mission of Cleveland Clinic is to provide better care of the sick, investigation into their problems, and further education of those who serve. Sounds pretty straightforward, doesn’t it? Almost any hospital strives for those goals.

But the Cleveland Clinic is not any hospital. It was named a top U.S. hospital in U.S. News & World Report’s “201819 Best Hospitals,” and ranked in the top five in twelve specialties. Its heart program has ranked No. 1 in the nation since 1995. Three of its regional hospitals ranked within the Top 5 of Cleveland-area hospitals. So when the Cleveland Clinic speaks, it’s worthwhile to listen.

Every year, the hospital chooses ten innovations that are going to prove significant for our future, and for the advancement of medical science. We think these are an inspiration for our industry, and signposts for where we’re headed. Enjoy.

For more information on the annual Top 10 Medical Innovations list including descriptions, videos, and year-byyear comparisons visit: http://innovations.clevelandclinic.org/Summit/Top-10-Medical-Innovations.aspx.

Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. US News and World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey.

55 | HS&M JANUARY/FEBRUARY 2019

1.

ALTERNATIVE THERAPY FOR PAIN: FIGHTING THE OPIOID CRISIS The opioid crisis has been declared a public health emergency. Today, chronic pain is the leading cause of opioid prescription.

Though several clinically validated alternative therapies for chronic pain exist, none have curtailed the crisis. Now, innovation and potential for hope comes by way of pharmacogenomic testing, which uses a patient’s genetic makeup to predict an individual’s metabolism of drugs, including some opiate-based drug. Pharmacogenomic testing can be used to avoid adverse reactions and eliminate unnecessary and ineffective prescriptions, replacing them with more effective medications. Pharmacogenomics can also be used to predict who may have little or no pain relief to some opiate-based analgesics. Such patients might otherwise finish their prescription quickly and return for a new prescription earlier than expected. Pharmacogenomics can reduce or eliminate the stigma of “drug-seeking” that might be unfairly ascribed to such patients and provide the opportunity to tailor medication therapy. In 2019, with increased access to genetic testing, pharmacogenomics is poised to make significant inroads into precision medicine and potentially an end to the crisis.

2.

THE ADVENT OF AI IN HEALTHCARE Once thought as a futuristic threat to humankind, artificial intelligence is now a part of everyday life. In healthcare, AI is changing the game with its applications in decision support, image analysis and patient triage.

Today, artificial intelligence is helping physicians make smarter decisions at the point of care, improving the ease and accuracy of viewing patient scans and reducing physician burnout. For instance, machine learning algorithms have the ability to highlight problem areas on images, aiding in the screening process and quickly making sense of the mountains of data within a physician’s EMR system. With AI’s continued integration into healthcare, caring for patients has become a matter of working smarter, not harder.

HS&M JANUARY/FEBRUARY 2019 | 56

INNOVATIONS

3.

EXPANDED WINDOW FOR ACUTE STROKE INTERVENTION When it comes to stroke intervention, a timely response is critical. Prolonged lack of blood flow following a stroke can cause irreversible destruction, often resulting in disability. In many cases of stroke, intervention methods can be deployed to save tissue. But until now, intervention of a stroke has only been recommended within a limited window of time. Released this past year, new guidelines suggest an expanded window for treatment. This lengthened timeframe is anticipated to lower the risk of disability and provide opportunity for recovery to an increased number of future stroke patients.

4.

ADVANCES IN IMMUNOTHERAPY FOR CANCER TREATMENT Cancer immunotherapy, or biologic therapy, is a technique that uses the body’s own immune system to fight cancer.

While immunotherapies for cancer have existed for some time, the worldwide work toward a cure for cancer continues to highlight new and novel immunotherapeutic targets. Scientists are creating life-changing new cancer treatments through the concepts of joint therapy and engineered T-cells. With the near daily discovery of new immunotherapeutic targets and biomarkers, it is the hope that effective therapies will soon exist for all tumor profiles.

57 | HS&M JANUARY/FEBRUARY 2019

5.

PATIENTSPECIFIC PRODUCTS ACHIEVED WITH 3D PRINTING Utilizing 3D printing technology, medical devices can now be matched to the exact specifications of a patient.

Designed to be more compatible with an individual’s natural anatomy, devices modeled from patient-specific dimensions have shown greater acceptance by the body, increased comfort and improved performance outcomes. The versatility provided by 3D printing gives medical practitioners the ability to provide patients the most advanced care, while simultaneously minimizing the risk of complication in patients that meet specific medical requirements. Currently, the most significant work in this space includes external prosthetics, cranial/orthopedic implants, and customized airway stents for diseases narrowing the airway. Work in prosthetics and other bodily implants is also gaining speed with some cleared for the commercial market. The technology has also been found helpful in surgical planning. To date, the technology has been used for many complicated heart surgeries, and even the Cleveland Clinic’s most recent total face transplant. With its widening healthcare applications, 3D printing is increasing the attention to detail in patient care.

6.

VIRTUAL AND MIXED REALITY FOR MEDICAL EDUCATION Virtual and mixed reality involve the use of computer technology to create simulated and hybrid environments. Popular for their gaming applications, virtual and mixed reality, with their futuristic affect, never fail to dazzle audiences. But VR/MR technology is much more than a game. These reality systems have recently caught the eye of healthcare professionals eager to sharpen their skills. Now popular for medical education, VR/MR programs provide simulation training that serves to enhance traditional medical schooling. With this immersive style of learning, VR/MR training appeals to all types of learners: audio, visual and kinesthetic. Education via simulation is a productive step toward the system’s most adept and confident healthcare providers.

HS&M JANUARY/FEBRUARY 2019 | 58

INNOVATIONS

7.

VISOR FOR PREHOSPITAL STROKE DIAGNOSIS Though less common than ischemic strokes, hemorrhagic strokes – during which blood escapes from a ruptured blood vessel in the brain – are responsible for nearly 40 percent of stroke deaths. Rapid diagnosis is necessary for effective treatment, as uncontrolled bleeding can lead to swelling of, and damage to, the brain. To speed diagnosis, healthcare professionals are using new, advanced technologies such as the hemorrhage scanning visor, which can detect bleeding in the brain. An efficient diagnostic tool, the visor for prehospital hemorrhage scanning serves to speed up diagnosis and the ever-important time to treatment.

8.

INNOVATION IN ROBOTIC SURGERY Most surgeries performed today are the shortest and least invasive that science will allow. This adaptation in surgical methodology is brought about in part by the integration of robotics. Robots in the operating room provide surgeons with guidance for extreme precision in surgery. Today, surgical platforms are highly advanced and are being used anywhere from spine to endovascular procedures. Shortened recovery time and limited pain after surgery are just a few of the patient benefits seen with minimally invasive robotized surgery. Continued advancement in the field has led to more precise and effective surgeries with improved surgical outcomes.

59 | HS&M JANUARY/FEBRUARY 2019

9.

MITRAL AND TRICUSPID VALVE PERCUTANEOUS REPLACEMENT AND REPAIR Cardiac surgery today is less invasive and more routine and effective than its historic counterpart.

Performed percutaneously – via a catheter through the skin – many cardiac procedures no longer require an open heart surgery approach. Two such procedures performed this way include replacements and repair of both the mitral and tricuspid valves. Hot on the trail of aortic valve percutaneous intervention, recent percutaneous mitral and tricuspid valve intervention has yielded significant positive outcomes while filling a void in the field of heart surgery. The exploration of this technology in a greater patient population is ongoing, but with promising post-op results, the innovation has significant implications for the future of cardiac care.

10.

RNA-BASED THERAPIES Akin to DNA-based gene therapies, RNAbased therapies are the newest innovation in labs nationwide and have shown immense potential. Interfering with genetic data at the ribonucleic acid (RNA) level gives scientists the ability to intercept a patient’s genetic abnormality before it is translated into functioning (or nonfunctioning) proteins. Today, the most popular and successful mechanisms of RNA therapy include antisense nucleotides and RNA interference. These new therapies are being explored in a variety of rare genetic diseases such as Huntington’s disease, as well as in cancer and neurologic diseases, with the hope of treatment by way of alternate genetic data. These new mechanisms of action are opening windows for progress and innovation in therapeutics.

COMMENT HS&M JANUARY/FEBRUARY 2019 | 60

INDUSTRY TRENDS: BY THE NUMBERS

2,314

Compiled by Cari Kraft, Jacobs Management Group, Inc.

EXABYTES

Amount of healthcare data estimated to be generated in 2020 Only 153 exabytes (one exabyte = one billion gigabytes) were produced in 2013.

The growth of this data is predicted to be at least 48 percent annually.

Source: Stanford Medicine 2017 Health Trends Report: Harnessing the Power of Data in Health.

$105B

U.S. brand sales expected to face generic or biosimilar competition Ninety percent of all prescriptions in the U.S. are filled with generics today. A report by industry association PhRMA suggests that $105B of brand sales will face generic or biosimilar competition by 2022.

Source: PhRMA, 2018 Profile: Biopharmaceutical Research Industry

$800 Projected U.S. per-person spending on medicines through 2022 Per capita spending on medicines is expected to decline by end of 2018 and stay steady at about $800 per capita through 2022. Figure is adjusted for population growth, rising GDP, and estimates of manufacturer revenue.

Source: IQVIA Institute for Human Data Science, 2018 and Beyond: Outlook and Turning Points, March 2018 61 | HS&M JANUARY/FEBRUARY 2019

12.2%

Percent of Americans uninsured as of 4Q 2017 This figure is down from 16% in 2010, but up from the low of 10.9% in Q3 2016.

SOURCE: Gallup-Sharecare Wellbeing Index

35

Drug shortages in 2017 The FDA helped to prevent 132 drug shortages in 2017, with only 35 shortages remaining. This was down from a high of 251 non-remediated shortages in 2011.

Source: FDA, “FDA is Advancing New Efforts to Address Drug Shortages,� November 2018

18.5 %

Percent of physicians now practice some form of telemedicine Key finding from the Physicians Foundation Survey of 9,000 U.S. physicians.

Source: Physicians Foundation Survey by Merrit Hawkins, September 2018

55% Growth of 65+ U.S. population by 2030 The elder population of the United States will have increased by 55% in the next 20 years.

Source: Source: U.S. Census Bureau

COMMENT HS&M JANUARY/FEBRUARY 2019 | 62

PHARMACEUTICAL

Great Advice From Great Minds: Pfizer Regional President Nolan Townsend on How Patient Centricity is Vital to Our Future At the 2018 eyeforpharma event in Barcelona, we were fortunate to interview Nolan Townsend, who now serves as Regional President for North America, Rare Disease at Pfizer. Nolan moved from investment banking at Lehman Brothers to a breathtaking array of roles at Pfizer over the last decade. He has been Senior Manager of Worldwide Strategic Planning, Director of Business Operations for Asia Established Products, Marketing Director for Pfizer Korea, Country Manager for Pfizer Ukraine & GIP Cluster Lead Central Asia and Caucuses, Country Manager for Pfizer Romania, Regional President for Africa/ Middle East, India, based in Dubai, and most recently, Regional President for International Developed Markets, Rare Disease.

This is a man who has had to negotiate not only numerous corporate positions but also an impressive number of cultural challenges in various parts of the globe.

Nolan has done it all with insight and humility, appreciating the opportunities and growing with the responsibilities.

Nolan considers patients as his most insightful colleagues. Working in rare diseases, he has built a close partnership between patients 63 | HS&M JANUARY/FEBRUARY 2019

and professionals, and he values the on-the-ground testimony he gets from people wrestling with those conditions. Only 5% of rare diseases have a viable treatment today, so there’s a long and complicated path ahead to address all the unmet needs in this area. Nolan says that the patient/industry partnership is vital to developing better treatment options.

Much of that investigation involves risk-taking. Nolan says “The more

risks you take in R&D, the closer you’ll get to treatments. We have to look in areas where diseases are less well understood. Especially in areas like oncology, we’re looking to deliver value.”

He sees this journey as one that inculcates trust. “Society’s trust is our license to operate.” Part of this is supporting the cost of R&D through the price of current medicines. At the same time, we have

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to deliver value for both patients and shareholders, a delicate balance. He believes that the two are aligned—that both value propositions will support each other.

We asked him about the contrast between the number of life sciences executives believing that patient centricity is vital to our future— about 90%—and the number who have confidence that we’re achieving that, which is closer to 30%.

“We’re here for patients. We’re here to listen, we’re here to learn,” he said. From there, you understand how to build a patient-centric culture. He believes we need to re-engineer processes to include patients in a more active way. He’s working to make sure that people all across the organization—R&D, medical, finance, legal, commercial—understand the struggles of patients, which will inspire us to

reach the right goals. “There are certain roles where you’re not typically in touch with these voices, but we have to work to make that connection. Once we see the impact of successful treatment, it motivates and informs us in a significant way.”

Nolan is one of the people driving us toward that kind of motivation—a leader, innovator and creator of a better future. •

Jill Donahue Principal, Excellerate Author, Engage Rx: The 3 Keys to Patientfocused Growth Co–founder, The Aurora Project Jill, HBa, MAdEd, is a keynote speaker, author and thought leader who has authored two books on Influencing in patient-focused ways and co-founded The Aurora Project, a global patient-centricity group. She also serves as Associate Editor of Healthcare Sales & Marketing.

Jill.Donahue@excellerate.ca

COMMENT 65 | HS&M JANUARY/FEBRUARY 2019

MOTIVATION

MOTIVIDEOS

By Cari Kraft, Jacobs Management Group One of our most viewed articles, Motivideos is not all about healthcare, and sometimes not strictly about business at all. It’s a means of kicking off any morning meeting with some education, inspiration and humor. Starting the day with a boost that will activate your endorphins and echo throughout the many decisions you’ll be called on to make. We hope you take something useful away from these selections.

Jokes that Work

Two Blind Sisters See For the First Time

Everyone says, a great way to open a meeting or start a presentation is to begin with a joke. Here is a quick video that takes apart jokes so that you can make sure to choose ones that leave your audience smiling.

Here is a video to use if you are looking for meeting opener to remind people why we do what we do. An inspiring story that makes us remember the patients behind what we do which makes our work in this industry all the more worthwhile.

We Don’t Motivate Employees Here is an interesting take on Motivation. This video will give you insight you if you are struggling to motivate an employee or a team. It isn’t a “one size fits all.”

Submissions are welcome. If you have one you like, email a link to me at ckraft@jacobsmgt.com.

Body Language: What we Can Learn from an expert in Lie Detection Some of the attributes of leadership are counterintuitive. In this video, a behavioral investigator scientifically takes apart magnetism. These 6:14 minutes provide insight about smiling, interrupting, eye contact, nodding and body movement—and how they contribute to others’ reactions.

Cari Kraft leads a team of master level recruiters at Jacobs Management Group, celebrating 30+ 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 67 | HS&M JANUARY/FEBRUARY 2019

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HS&M JANUARY/FEBRUARY 2019 | 70

PHYSICIANS

How American Doctors See Their Profession: Changes and Challenges Highlights of a survey conducted on behalf of The Physicians Foundation by Merritt Hawkins, September 2018 (Full survey can be found here) Doctors and patients are our primary audiences. Therefore, it’s important to know what doctors are facing, doing and thinking, so we can enter the conversation aware of their concerns, worries and desires.

71 | HS&M JANUARY/FEBRUARY 2019

PHYSICIANS The state of medicine for American doctors is not only changing – it’s becoming more difficult, in terms of technological demands, patient knowledge and advocacy, reimbursement, a shifting landscape for the companies that provide medications and devices, and a host of other factors. The Physicians Foundation conducted a wide-ranging study of what doctors are up against, and how they’re coping. Close to 9,000 physicians answered the survey, providing a sufficient sample size to achieve an error rate of +/1.057% as determined by experts in survey research methodology at the University of Tennessee.

The sample included younger and older physicians, private practice owners or partners, employed physicians, male physicians, female physicians, primary care physicians and specialists.

We think this provides some significant insights into how we can approach our audience and assist them in coping with the present and the future. Here are some of the highlights that came out of the study.

INTRODUCTION: THE POWER OF ONE BILLION Physicians in the United States today handle over one billion patient encounters a year1 in office, emergency room, hospital, urgent care, retail and other settings. A lot happens during these encounters, from the mundane to the momentous, from the comic to the tragic.

Despite the proliferation and importance of many other types of clinicians, physicians remain the indispensable caregivers on

whose shoulders the preponderance of patient care continues to rest. Through the diagnoses they make, the tests they order, the patients they admit, the procedures they perform and the treatment plans they develop, physicians are the primary providers or catalysts of healthcare delivery in the United States.

Because physicians remain the key drivers of healthcare quality, access and cost, we believe how they practice and how they view their own profession is of critical importance to health professionals, policy makers, media members and to the public.

The Physicians Foundation’s Survey of America’s Physicians is conducted on a biennial basis to “take the pulse” of the nation’s doctors.

Our goal is to provide a portrait of America’s physicians: their morale levels, practice plans, practice patterns and their perspectives on the medical profession today.

We believe the survey offers insights and data that will be of interest to healthcare professionals, policy makers, academics, media members and to anyone who has seen a physician or is likely to do so. We encourage all those with a stake in healthcare delivery to read and to reference the survey, and to comment on its findings.

WHO RESPONDED Approximately 37% of survey respondents are primary care physicians (family medicine, internal medicine, pediatrics) while 32% of all physicians are in primary care, according to the American Medical Association’s Physician Master File.

73 | HS&M JANUARY/FEBRUARY 2019

About 63% of survey respondents are in specialty medicine, compared to 68% of all doctors. The survey therefore is slightly weighted toward primary care physicians, who responded at a somewhat higher rate than specialists.

The average age of survey respondents is 52.33 years, while the average age of all physicians is 52.04, according to AMA data. Survey respondents are therefore virtually the same age on average as are all physicians. Responses from physicians in the 35 or younger cohort are somewhat overrepresented.

These physicians represent 11.2% of all respondents though they represent only 5.8% of all physicians, according to AMA data.

The gender of survey respondents also generally matches that of physicians as a whole. 33.9% of survey respondents are female while 34.6% of all physicians are female, indicating females are overrepresented in the survey by a very small margin. The number of female physicians has greatly increased in recent years. In 1981, females comprised only 12% of all physicians and were grossly underrepresented in medical schools. Today, approximately 50% of medical students are female.

Female physicians are particularly concentrated in primary care and obstetrics and represent the future of these practice areas KEY FINDINGS • 80% of physicians are at full capacity or are overextended • 23% of physician time is spent on non-clinical paperwork • 88% of physicians indicate that some, many or all of their patients

have a social situation (poverty, unemployment, etc.) that poses a serious impediment to their health. Only 1% of physicians indicate that none of their patients have a social situation that poses a serious impediment to their health • Physicians indicate patient relationships are their greatest source of professional satisfaction, while electronic health records (EHR) are their greatest source of professional dissatisfaction • 69% are prescribing fewer pain medications in light of the opioid crisis • 18.5% now practice some form of telemedicine • 31% of physicians’ patients do not consistently adhere to their treatment plans • 46% of physicians indicate relations between physicians and hospitals are somewhat or mostly negative

OVERVIEW: THE STAKES ARE RISING Between 2006 and 2016, the number of applicants to US medical schools rose from 39,108 to 53,042, an increase of 35%. Of the 53,042 who applied for the 2016/17 school year, only 21,030 (about 40%) matriculated (U.S. News, Oct. 31, 2017). After reaching an all-time high, medical school applications decreased slightly to 51,680 in 2017/18, but the number of people seeking a medical career remains high by historical standards.

the physician/patient relationship, a fact confirmed by this survey.

The majority of physicians submit to the grueling and expensive grind that is medical education and training primarily in order to play a positive role in the lives of other human beings.

And that is the root of the dichotomy seen in the medical profession today.

Clearly, medicine still has a strong appeal to many young people, for good reason. For those able to complete four years of college, four years of medical school and three to ten years of training, medicine offers significant attractions.

While doctors enjoy secure employment, many of them are experiencing career dissatisfaction, a fact also confirmed by this survey.

Reports of high rates of physician burnout and even abnormally high rates of physician suicide are becoming common. Indeed, physicians have the highest rate of suicide of any profession, more than twice that of the general population (Medscape, May 7, 2018).

What attracts most physicians to medicine is the unique nature of

The Survey of America’s Physicians suggests that one cause of HS&M JANUARY/FEBRUARY 2019 | 74

PHYSICIANS this trend is the fact that many physicians believe that their ability to do what they are trained to do, and what attracted them to medicine initially (that is, care for patients) is being circumscribed by external forces. These external forces may include excessive bureaucracy and regulations, but may also include societal problems facing their patients, such as poverty, over which physicians have little control.

There are, of course, many other attendant pressures to practicing medicine, a high level of responsibility and personal time constraints among them. But it is the inability of physicians to be physicians that is the primary driver of their professional dissatisfaction.

WHY IT MATTERS How physicians feel about their profession, and how they respond to these feelings, has important implications for healthcare delivery in the United States. The shortage of physicians is projected to escalate in response to an aging population and other factors. The Association of American Medical Colleges (AAMC) recently forecasted a deficit of up to 121,300 physicians by 2030.

Doctor shortages already are being felt, even in larger communities where physicians are relatively abundant. In its 2017 Survey of Physician Appointment Wait Times, Merritt Hawkins found that the time it takes to schedule a doctor’s appointment in 15 major metropolitan areas increased by 30% from 2014 to 2017. Physician appointment wait times are even more prolonged in mid-sized communities of approximately

100,000 people, where there are fewer physicians per capita than in larger cities.

An aging population and a variety of societal factors are driving up demand for physicians. Consider: • By 2030, the population 65 and older will grow by 55% (U.S. Census Bureau) • People 65 and older represent 14% of the population but account for 34% of inpatient procedures and 37.4% of diagnostic tests and treatments. Older people see a physician at three times the rate of younger people (Centers for Disease Control and Prevention/ CDC) • More than 70% of adults in the U.S. have at least one of the following unhealthy behaviors: Smoking, excessive drinking, insufficient sleep, physical inactivity and obesity. 12% of the country has three of these unhealthy behaviors. (America’s Health Rankings, United Health Foundation) • 57% of today’s children will be obese by the time they reach 35 (New England Journal of Medicine/USA Today. November 11, 2017) • 63,600 Americans died from drug overdoses in 2016, more than the 41,070 who died of breast cancer (CDC) • The suicide rate in the U.S. increased by 24% from 1999 to 2014 and suicide is now the 10th leading cause of death in the U.S. (CDC) • 43 million Americans live in poverty. Poverty has been closely associated with high rates of diabetes, inflammatory disease, low birth weights, obesity, men-

75 | HS&M JANUARY/FEBRUARY 2019

tal illness and lifespans 10 to 15 years lower than those of wealthy Americans (US News, April 20, 2016).

NUMBER OF EMPLOYED PHYSICIANS IS GROWING It’s no surprise that employed physicians are increasing as a percentage of the total population of doctors. In 2012, 48.5% were independent practice owners or partners. By 2018, this number had fallen precipitously to only 31.4%. In the same period, those who identify as hospital or medical group employees had grown from 43.7% to 49.1%.

Based on 2016 data, the AMA indicates that 47.1% of physicians remain independent, the lowest number the AMA has recorded (Policy Research Perspectives: Updated Data on Physician Practice Arrangements. American Medical Association. 2017).

The consulting firm Accenture has put the number of independent physicians at approximately 33%. The number included in this survey (31.4%) is the most recent data, and based on thousands of annual interactions with physicians and physician groups, is consistent with what Merritt Hawkins sees in today’s market.

WHO PAYS PHYSICIANS? The survey asked physicians if they are “employed by a hospital,” “employed by a hospital-owned medical group” or “employed by a physician-owned medical group.”

Approximately 19% of survey respondents indicated they are employed by a hospital, while another 17.4% indicated they are

employed by a hospital-owned medical group. The survey therefore indicates that more than 36% of physicians receive their compensation directly or indirectly from a hospital.

More than 12% of physicians indicated they are employed by a physician-owned medical group. While these physicians are not practice owners or partners, they receive their compensation from other physicians who own the practices by which they are employed.

Fewer than one-third of physicians (31.4%) indicated they are practice owners or partners, the lowest percent recorded in this survey since it was first conducted in 2012. These physicians are essentially business owners who pay themselves after they have met payroll, rent, equipment and other standard business expenses, just as other business owners do.

These distinctions are important, because who pays physicians may affect their practice patterns and behaviors. Physicians who pay themselves, for example, may be motivated to work longer hours and see more patients than those who receive a check (see Part III below). Physicians paid by a hospital, whether directly or indirectly, may alter their practice patterns to align with the goals and interests of the hospital, ceding some of their clinical autonomy for the security and manageable schedule associated with employment. Physicians employed by a physician-owned group may have their practices patterns influenced or determined for them by the owners of the group.

Younger doctors are significantly

more likely to be employed by a hospital or hospital-owned group than are older physicians. The 2018 survey indicates that 53.1% of physicians 45 or younger are employed by a hospital or hospital owned group, compared to 28.9% of physicians 46 or older. Merritt Hawkins’ 2017 Survey of FinalYear Medical Residents indicates that only 9% of physicians in their last year of training would prefer an independent practice setting such as a partnership or a solo practice.

53.1% of physicians 45 or younger are employed by a hospital or hospital owned group, compared to 28.9% of physicians 46 or older These data suggest that the independent practice model is under pressure in a healthcare system increasingly dominated by large, integrated organizations, whether hospital systems, large medical groups, corporations or insurance companies. All of these entities typically implement the employed physician model to achieve the standardized physician compensation formulas, electronic health records, quality measures and treatment guidelines necessary in an era of global, quality-based payments and population health management.

Physicians seeking to keep their independent status often must do so through partnerships and collaborations in order to participate in population health management

and other large group contracts offered by government or private payers.

DOUBTS ABOUT HOSPITAL EMPLOYMENT OF PHYSICIANS Most respondents (57.5%) do not believe hospital employment of doctors is a positive trend. Interestingly, even many physicians who are employed by hospitals (34.6%) do not believe that hospital employment of physicians is a positive trend.

Of those 45 and younger, 42.7% do not think hospital employment of physicians will result in the dual benefits of enhanced quality and reduced cost, compared to 64.1% of those 46 or older.

Relatively few physicians in either age category indicate they believe hospital employment of physicians is a positive trend. Only 19.8% of physicians 45 or younger agree that hospital employment of physicians is a positive trend as do only 10.5% of physicians 46 or older, with a substantial number (37.6% of younger physicians, 24.5% of older physicians) neither agreeing nor disagreeing.

Most respondents (57.5%) do not believe hospital employment of doctors is a positive trend.

These numbers suggest that many physicians are dubious about the employed practice model even though they have chosen to participate in it, perhaps fearing that HS&M JANUARY/FEBRUARY 2019 | 76

PHYSICIANS employment by hospitals will lead to a loss of clinical and administrative autonomy.

STATE OF PHYSICIAN/ HOSPITAL RELATIONS Historically, the interests of hospitals and physicians have not always aligned and the relationship between physicians and hospitals can be a contentious one. The 2018 survey suggests that despite the widespread integration of hospitals and physician practices, friction between the two parties remains prevalent.

The 2018 survey included for the first time a question asking physicians to comment on the current state of relations between physicians and hospitals. Significantly more physicians (46.4%) indicate that the relationship is somewhat or mostly negative than indicate it is somewhat or mostly positive (31.7%).

PHYSICIAN MORALE AND BURNOUT: A CONTINUING CHALLENGE Since it was first conducted in 2012, The Survey of America’s Physicians has revealed a physician workforce characterized by low levels of professional morale and high levels of pessimism about the future of the medical profession. These findings have important public health policy implications that have been highlighted in each of the reports summarizing survey results.

The primary public policy and healthcare concern attached to low physician morale is the prospect of physicians modifying their practice styles in ways that reduce

patient access, or the prospect that physicians will abandon patient care roles or leave medicine altogether.

There are also economic implications attached to the prospect of physicians reducing their clinical roles in response to low morale or high rates of burn-out. To a significant degree, physicians are the engines of healthcare economics driving this robust sector of the economy.

The extent of the economic contributions physicians make to healthcare is quantified by the January, 2018, AMA-sponsored study The National Economic Impact of Physicians. This study estimates the total economic impact of officebased physicians in active patient care in the U.S., using as barometers physician output, jobs, wages and benefits and state and local tax revenue. Highlights of physician economic contributions from the study include: • The combined economic output of office-based physicians in the United States is $2.3 trillion based on 2015 data, up from $1.6 trillion in 2012.

• Each physician supports a per capita economic output of $3.1 million based on 2015 data, up from $2.2 million in 2012.

• On average, each physician supports about 17 jobs based on 2015 data, up from 14 jobs in 2012.

• On average, each physician paid a total of $1.4 million in wages and benefits based on 2015 data, up from $1.1 million in wages and benefits in 2012.

• On average, each physician supports $126,129 in local and state

77 | HS&M JANUARY/FEBRUARY 2019

tax revenues, based on 2015 data, up from $90,449 based in 2012.

Source: American Medical Association. The National Economic Impact of Physicians. January, 2018 In addition, physicians generate an average of $1.5 million a year in net revenue to their affiliated hospitals, according to Merritt Hawkins’ 2016 Survey of Physician Inpatient/Outpatient Revenue.

Physician professional satisfaction and engagement, therefore, are matters of public concern from a quality of care, access to care, and economic perspective.

A TROUBLING PATTERN The Survey of America’s Physicians has consistently indicated in each of the prior years it has been conducted that the professional morale of physicians is problematic. The same pattern emerges in the 2018 survey.

When asked about their morale, 55.3% of respondents reported it as somewhat or very negative in the 2018 survey. That sounds bad, and it is a majority, but in fact it’s down from the 68.2% of 2012.

There are differences according to employment status. Responses to this question indicate a marked variance between employed physicians and practice owners. A small majority of the of employed physicians (51.5%) express positive feelings about their morale and the current state of the medical profession, while only 36.7% of practice owners express positive feelings.

There also is a marked variance between younger and older physicians. 57.4% of physicians 45 or younger express positive feelings about their morale and about the

medical profession, while only 39% of physicians 46 or older express such feelings.

Younger physicians have been educated and trained in the era of electronic health records and value-based payment models and may not find these and other characteristics of contemporary medical practice to be as irksome as do older physicians.

The experience of younger physicians may be qualitatively different from that of older physicians.

Younger physicians have been educated and trained in the era of electronic health records and value-based payment models and may not find these and other characteristics of contemporary medical practice to be as irksome as do older physicians. Or, they simply may not have been exposed to the stresses of medical practice as long as older physicians and are not yet as affected by them.

Employed physicians may have a higher level of professional morale and optimism than practice owners because they do not have to contend with the challenges of running a medical practice.

However, significant numbers of all types of physicians, including younger physicians at the front end of their careers and employed

physicians, express negative feelings about their morale and the current state of the medical profession. It is not necessarily a positive comment to note that only 42.6% of younger physicians express negative feelings about their morale and their profession.

By contrast, in a national study, the majority of American workers (79%) indicate they are somewhat or very satisfied with their jobs.

Only 15% indicate they are somewhat or very dissatisfied (The State of American Jobs. Pew Research Center. October 6, 2016).

DISSATISFACTION OVER EHRs, REGULATIONS AND LOSS OF AUTONOMY The 2018 survey identifies three primary pain points physicians feel regarding medical practice.

The first is “electronic health record (EHR) design and interoperability,” which 39.2% of physicians identified as one of the two factors they find least satisfying about medicine. They find attention to this detail work inefficient (56%) and a drain on time better spent with patients (65.7%).

A study published in the March 2016 issue of Health Affairs indicates that physicians now spend $15 billion a year documenting quality measures and that primary care physicians spend an average of 3.9 hours per week on documenting quality measures A second, related pain point is “regulatory and insurance requirements” which 37.7% of physicians cited as one of the two factors they find least satisfying about medicine. Medicine is one of the most highly regulated professions in the

United States, with Medicare compliance rules and regulations alone running into the tens of thousands of pages.

The third primary pain point physicians cite as being a least satisfying aspect of medical practice is “loss of clinical autonomy.”

After going through more than a decade of training, 66% said they feel that their practice is adversely impacted by external factors such as third-party authorization, treatment protocols, EHR design and other requirements (although this figure is down from 72.1% in the 2016 survey).

In addition to these pain points, many physicians do not feel that their skills are judged accurately.

In particular, a substantial majority do not believe that Maintenance of Certification (MOC) tests, as required by their specialty boards to remain certified in their specialties, accurately reflect their clinical abilities (see following chart): SATISFACTION WITH PATIENT RELATIONSHIPS, STATURE AND STIMULATION In each of the national physician surveys The Physicians Foundation has conducted, doctors have made it clear that their primary source of professional satisfaction is derived from patient relationships. In the 2018 survey, the “patient/physician relationship” was identified as a primary source of professional satisfaction by 78.7% of respondents.

Patient relationships far exceed other sources of professional satisfaction cited by doctors, such as the “professional stature of medicine,” “intellectual stimulation,” “professional relationships HS&M JANUARY/FEBRUARY 2019 | 78

PHYSICIANS

with colleagues,” and “income/ compensation,” the latter being cited by only 18.9% of physicians as one of their top two sources of professional satisfaction.

AVERAGE NUMBER OF PATIENTS SEEN Physicians responding to the 2018 survey see an average of 20.2 patients per day, down from 20.6 in 2016, but up from 19.5 in 2014 and 20.1 in 2012. Despite a 2.4% drop in hours worked from 2016 to 2018, physician productivity in terms of average number of patients seen decreased by only 1.9% in the same period. However, given that physicians see close to one billion patients a year in office-based settings, a 1.9% decline equates to close to two million fewer patients seen. Younger,

female and employed physicians tend to see fewer patients than older, male and practice-owning physicians.

THE VALUE-BASED CHALLENGE In recent years there has been a concerted effort in the healthcare industry to move from volumebased payment models, which compensate physicians and hospitals based the number of services they provide and the number of patients they see, to value-based models, which pay healthcare providers based on a variety of quality measures that include patient satisfaction, treatment outcomes, lower hospital readmission rates and others.

The movement has been stimulated by the government through legislation such as the Affordable

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Care Act (ACA) and through government payment models such as the Medicare Access and CHIP Reauthorization Act (MACRA), which revises how Medicare reimburses physicians, putting more weight on value-based metrics. The intent of value-based payments is to reduce healthcare costs thought to derive from the fee-for-service payment system and to enhance the quality of care patients receive.

However, physician participation in value-based compensation models remains limited. Less than half of physicians surveyed (47.1%) indicate that any of their compensation is tied to valuebased metrics such as patient satisfaction, readmission rates, or others. Though this number is up from 42.8% in 2016, it suggests that the movement from volume

to value remains more aspirational than actual where physician compensation is concerned. More than 13% of physicians are not sure if they are paid on value.

The majority of physicians (56.8%) either disagree or strongly disagree that value-based payments will improve care and lower costs, while only 18% either agree or strongly agree that they will.

High patient satisfaction scores, for example, may merely reflect that a physician is compliant to the wishes of his or her patients, while not necessarily acting in their best interests. Favorable treatment outcomes may be easier to achieve with healthy patients and harder to achieve with sicker patients, discouraging physicians from seeing more problematic patients.

In addition, value-based payments may reduce quality of care by reducing access to care. Physicians paid entirely on quality may elect to see a limited number of patients, both because they are not paid to see a high volume of patients and because they can better achieve quality outcomes by focusing on just a few.

As a result, physician compensation models are in continuous flux, as employers seek compensation structures that will reward physicians adequately for achieving quality measures while also keeping them productive and seeing patients. The ideal physician compensation formula has proven elusive, and some healthcare systems, most prominently Geisinger Health System, have abandoned value-based models of compensation altogether and are paying physicians straight salaries.

CONCLUSIONS Several major trends are readily apparent.

The majority of physicians today identify as employees of hospitals or medical groups rather than private practice owners. On average, they are working fewer hours and seeing fewer patients. They spend about one-quarter of their time on non-clinical paperwork. Some are embracing emerging practice models such as telemedicine and concierge/direct pay.

Despite the move away from feefor-service medicine, most physicians are not paid on value. The majority report poor morale and almost all report some feelings of burnout. Many plan to make a change in the next one to three years, such as retire or seek a nonclinical job, which will reduce the number of overall physician FTEs. Since 2012 and every two years thereafter, The Survey of America’s Physicians has indicated that physicians are altering their practice patterns in ways likely to inhibit patient access to their services, due in part to their dissatisfaction with the prevailing medical practice environment. These findings are being borne out by an escalating physician shortage and lengthening physician appointment wait times.

should be considered as a part of any comprehensive policy to ensure patient access to timely, quality care. • ___________________________ Source: Centers for Disease Control and Prevention 1

THE PHYSICIANS FOUNDATION Gary Price, M.D. President Tim Norbeck Chief Executive Officer Walker Ray, M.D. Chairman, Research Committee Russell Libby, M.D. Member of the Board Survey Committee Palmer Jones Member of the Board Survey Committee

COMMENT

As the patient population continues to grow and to age, and as societal problems such as poverty and drug abuse pose mounting healthcare challenges, it is vital that physicians remain engaged and committed to the practice of medicine. Physician satisfaction and physician practice patterns are matters of public health and HS&M JANUARY/FEBRUARY 2019 | 80

NEW! AGENCY AND CONSULTANTS DIRECTORY! Healthcare Sales & Marketing’s New Feature As a value to the industry, we have initiated a project to profile the top agencies so that you have them at your fingertips. We are compiling digitally a searchable single source to give you access to the who’s who, their strengths, vision for the future, leadership and strategies, so that you can get a better feel as to how they work.

We are driven by the input of our readers so please let us know if you have an agency or consultant you would suggest we profile. You will see some of the best with links to all their websites, their philosophy and history, as well as what makes them special. This is all in keeping with our goal of having the hottest industry companies and the top thought leaders in in the pages of every issue of HS&M. Our goal is to constantly expand the value we bring to you.

If you would like to be featured, or have an agency or consultant to recommend, please reach out to our Associate Publisher, Natalie Newcamp, at nnewcamp@hsandm.com.

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AGENCIES & CONSULTANTS DIRECTORY

Company Overview: Catalyst is an insights-driven healthcare communication agency. Our goal is to help you solve your communication needs no matter how complex. We engage your audiences and drive change by providing solutions that serve as a vehicle for sustainable growth.

Address: West Coast 3617 East Broadway, 19 Long Beach, CA 90803 East Coast 4695 Independence Avenue Bronx, NY 10471 Phone Number: 914 318 6351

Website: www.catalyst-agency.com Social Media: fb.me/makingthingssimple https://www.linkedin.com/in/stevekane1/ Leadership: Steve Kane Managing Director New Business Contact: Steve Kane skane@catalyst-agency.com 914 318 6351 Year Founded: 1999 Number of People: 12 Service Focus: Healthcare marketing, communications and technology solutions including Disease-state awareness and Clinical education.

Awards: Areas of Expertise: Branding, Portfolio brand management, Print design, Web design, 3D animation, Web technology, and Business efficiency solutions.

What’s New: Long Beach, CA office

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AGENCIES & CONSULTANTS DIRECTORY

Company Overview: Viscira is an innovative, full-service digital marketing and technology firm. We are all things digital with an exclusive focus on the life sciences industry. We are Digital for Life.

Website: https://medicaltechnologymarketing.com/

Company Overview: There are hundreds of thousands of physicians on LinkedIn, Facebook, Instagram and Twitter. As a successful Medical Device Sales Representative of 8 years, the CEO of MTM knows first hand how challenging it can be to get your product in front of your target physicians. With social media, we can put your product in front of thousands of people in your target audience daily with each sponsored campaign. MTM delivers sales leads to their medical device clients every day, all generated from social media content and strategy.

Facebook: www.facebook.com/medicaltechnologymarketing/

Address: 3056 N. Oakley Chicago, IL 60618 Phone Number: 800-762-6361

Social Media: Instagram: www.instagram.com/medicaltechnologymarketing/

Twitter: twitter.com/medtechmark LinkedIn: www.linkedin.com/company/medicaltechnologyma rketing/?viewAsMember=true Leadership: Jenna M. Griffin, CEO New Business Contact: Jenna Griffin jgriffin@medicaltechnologymarketing.com 800-762-6361 Year Founded: 2018 Service Focus: Social Media Marketing for Medical Device and Pharmaceutical Companies Areas of Expertise: Social media marketing for medical companies, running social campaigns to ensure your target audience sees your product when they log on to their social media accounts, delivering daily physician leads to medical companies.

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AGENCIES & CONSULTANTS DIRECTORY

PHARMAGIN

Company Overview: We provide a complete service for pharma marketing

Website: www.pharmagin.com

Our customizable cloud-based solutions and complete logistic services allow our clients to efficiently scale complex business activities and streamline the planning and execution of speaker programs and similar marketing meetings.

Social Media: https://www.linkedin.com/company/pharmagin/

Our proven platform integrates with all major CRMs, NPI and other client systems. Web and mobile apps manage content and ensure regulatory compliance.

Marketers can access real-time reporting on budget, message compliance, and HCP feedback.

Address: 8275 S. Eastern Ave. Ste 200-548 Las Vegas, NV 89123 Phone Number: (888) 515-6686 (USA)

https://www.facebook.com/pharmagintech Leadership: • Sam Wu – CEO • Charles Yang – COO • Colin Knell – EVP Sales • Darren Montgomery – VP Marketing New Business Contact: Colin Knell info@pharmagin.com (702) 522-1865 Year Founded: 2012 Service Focus: Pharma Marketing Tech Areas of Expertise: Speaker programs, CRM integration, pharma marketing analytics.

What’s New: Pharmagin continues to grow its client base in regular new partnerships, both with life sciences manufacturers and medcomm/logistics agencies.

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AGENCIES & CONSULTANTS DIRECTORY

OFFICES IN SAN DIEGO AND NEW YORK Address: 5780 Brittany Forrest, Suite 1000 San Diego, CA 92130 Phone Number: (858) 775-4273 Website: www.rareexpertise.com Social Media: LinkedIn Leadership: Jack Davis, Founding Partner Jeff Sweeney, Founding Partner New Business Contact: Jeff Sweeney jeff.sweeney@rareexpertise.com, (858) 775-4273 Year Founded: 2016 Number of People: 10 Service Focus: Identifying and activating people with rare disorders Parent Company: Independent agency Areas of Expertise: Extensive rare disease experience (21 different brands).

Patient identification and activation, HCP and patient education, online influencer networks, a database of rare disease patient journeys.

What’s New: In September 2018, Rare Expertise formed a joint venture with SCOUT, a leading healthcare marketing agency focused on orphan drugs and specialty pharmaceuticals, to shorten the time for people with rare diseases to obtain an accurate diagnosis and begin appropriate treatment more quickly.

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AGENCIES & CONSULTANTS DIRECTORY

Address: 55 Bank Street, Morristown, NJ Phone Number: 973-867-6500 Website: www.revhealth.com Social Media: Facebook, LinkedIn Leadership: Bruce Epstein, Brian Wheeler, and Bruce Medd Managing Partners New Business Contact: Bruce Epstein bruce.epstein@revhealth.com 973-867-6502 Year Founded: 2006 Number of People: 151 Service Focus: Full-service advertising agency providing strategic consulting, campaign development, personal and non-personal communication Parent Company: RevHealth, LLC Awards: RevHealth’s creative expertise has been recognized in 2018 with wins from Communicator, Digital Health, RX and PM360. We are also a 3-time Med Ad News Category II Agency-of-the-Year Finalist and MM&M gold winner Areas of Expertise: Strategic and tactical planning; global professional advertising and promotion; US consumer advertising and promotion; provider, patient, and sales representative education; brand naming and lexicon development; digital innovation, development, and implementation; market access strategy and execution What’s New: As we continue to expand our business, we have opened an additional office in Morristown.

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AGENCIES & CONSULTANTS DIRECTORY

Company Overview: We connect pharmaceutical brands to the right consumers from the moment they begin their search for health options in our premier network of pharmacies and continuing to do so wherever their healthcare path may take them. Rx EDGE Media Network is a leader in the healthcare marketing industry with over 18 years of experience delivering hundreds of successful campaigns for pharma brands.

Even as media consumption becomes increasingly dispersed, the pharmacy exists as the single mostoften visited healthcare destination in the lives of Americans, and combined with digital technologies, it produces an exceptionally broad reach.

Address: 111 Water Street East Dundee, IL 60118 Phone Number: 800.783.7171 Website: www.rxedge.com Social Media: LinkedIn: https://www.linkedin.com/company/ leveragepoint-media/ Twitter: @RxEDGE Leadership: Nate Lucht, President and CEO nathan.lucht@leveragepointmedia.com New Business Contact: Michael Byrnes, EVP Sales Michael.byrnes@rxedge.com 610.431.7606 Year Founded: 2000 Parent Company: LeveragePoint Media | LLC 87 | HS&M JANUARY/FEBRUARY 2019

Awards: PM360 Trailblazer Awards PM360 Elite Awards DTC Perspectives Advertising Awards PM360 Pharma Choice Awards Service Focus: Rx EDGE Media Displays: Through our prominent, strategically-placed displayed delivered in a network of 27,000+ retail pharmacies, we help pharmaceutical brands motivate consumers at the most relevant times…when they are actively searching for ways to take care of themselves. Our Media Displays enlighten, engage, and inform.

Rx EDGE Unlimited™: This cross-channel solution combines the power of our brick-and-mortar network with premium digital inventory and advanced analytics to bring pharma brands and audiences together.

Rx EDGE Unlimited delivers exceptional reach, frequency, and influence.

Insight EDGE™: A suite of data resources that the Rx EDGE analytics team applies to every program to ensure that pharma brand messages are seen by the right consumer.

Areas of Expertise: We Maximize Impact: Rx EDGE is the only targeted media platform that uses the pharmacy as a consumer’s gateway to immediate information as well as ongoing connections to the pharma brands that are relevant to their healthcare needs. Brands that use Rx EDGE programs see an average script lift of 12.5%.

We Align the Right People, Places, and Times: Through our relationships with key retailers, we can access data not commonly available through other marketing service providers − making our Insight EDGE™ targeting platform unique in the pharma marketing space.

We Offer Proven Results: Measurement defines the core value we bring to every initiative. Using thirdparty analytics, results are evaluated with a significant level of precision. In addition to a lift in prescription volume, our programs also result in an average return on investment of $8.12.

What’s New: Rx EDGE Unlimited™ is a new cross-channel approach that combines Media Display, mobile, and programmatic digital ad placement to boost campaign effectiveness.

AGENCIES & CONSULTANTS DIRECTORY

SAN DIEGO, ATLANTA, CHICAGO, NEW YORK Address: 12520 High Bluff Drive, Suite 340 San Diego, CA 92130 Phone Number: (858) 538-7777 Website: www.findscout.com Social Media: @scouthc Leadership: Jennifer Brekke, Principal Raffi Siyahian, Principal New Business Contact: Raffi Siyahian rsiyahian@findscout.com (858) 538-7777 x251 Year Founded: 1999 Number of People: 125 Service Focus: Full-service Parent Company: The Stagwell Group Recent Awards: PM360 Trailblazer Agency of the Year Finalist; PM360 Pharma Choice gold award; Humanitarian Awards nominee, Healthcare Marketers Exchange Areas of Expertise: Rare diseases, specialty pharmaceuticals, orphan drugs What’s New: In September 2018, SCOUT formed a joint venture with Rare Expertise, a company with proprietary data-driven tools for identifying and activating people with rare disorders, to shorten the time for people with rare diseases to obtain an accurate diagnosis and begin appropriate treatment more quickly.

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AGENCIES & CONSULTANTS DIRECTORY New Business Contact: Jeff Asada jasada@viscira.com – 415-848-8012 Year Founded: 2007 Number of People: 120 Service Focus: Specialized Digital Marketing Agency for Life Sciences Company Overview: Viscira is an innovative, full-service digital marketing and technology firm. We are all things digital with an exclusive focus on the life sciences industry. We are Digital for Life.

The Company’s key digital solutions include 3D MOD and MOA animations, advanced iPad® and mobile applications, disease education and product websites, interactive tradeshow solutions, and virtual and augmented reality experiences.

Viscira has been a Veeva partner since 2012, and maintains an agency certification Level 4.

Address: 200 Vallejo Street San Francisco, CA 94111 Phone Number: 415-848-8010 Website: www.viscira.com Social Media: https://www.facebook.com/Viscira/ https://www.linkedin.com/company/viscira/ Leadership: Rick Barker, CEO Jeff Asada, Chief Revenue Officer Kimberly Davis Wells, VP of Client Services Shan Jaffar, VP of Production Kane Kaneboughazian, VP of Animation Suntae Kim, VP of Software Development

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Parent Company: WPP Awards: Communicator Awards Telly Awards PM360 Trailblazers Awards Davey Awards Rx Club Awards Areas of Expertise: Advanced iPad®and mobile app development, next-generation web development, cutting-edge digital content creation, including the company’s highly acclaimed 3D animation technology, newmedia convention booth solutions, augmented reality, virtual reality, patient video testimonials, enhanced slide decks What’s New: Viscira has established itself as a thought leader in using XR technologies to offer unique experiences for patients, caregivers and healthcare providers.

The company recently participated in the SF Design Week, and hosted a panel discussion which focused on the opportunities and challenges of storytelling in augmented reality.

Viscira continues to push the envelope in technology by exploring new mediums and hardware platforms like Oculus Go, HoloLens, Leap and MergeCube

AGENCIES & CONSULTANTS DIRECTORY

Address: 133 Prince William Street Suite 801 Saint John NB, E2L 2B5, Canada Phone Number: +1 709 800 94 37 Website: https://viseven.com/ Social Media: https://www.linkedin.com/company/viseven https://www.youtube.com/channel/UCWlpXCeBtfM8GVFf6hOR1Yg https://www.facebook.com/VisevenDigitalContentFactory/ Leadership: Nataliya Andreychuk, CEO New Business Contact: Alex Pustovoytov, Digital Transformation Lead +1 709 800 94 37 a.pustovoytov@viseven.com Year Founded: 2009 Number of People: 300+ Service Focus: Full cycle of services for multichannel content creation and management, from idea to delivery

Areas of Expertise: Viseven is a full-cycle digital agency specializing in Life Sciences multichannel content creation and management. Our comprehensive solution— eWizard content production accelerator—is a robust and easy-to-use platform. eWizard enables quick and effortless creation, update and delivery of multichannel content: eDetailing, emails, microsites, interactive remote call presentations.

Create content once and publish to many channels and CRM systems: eWizard makes it possible.

What’s New: Viseven developed a new way to manage multichannel content: create once—publish to many.

Rather than creating content for each channel from scratch over and over again—mix&match channel agnostic fragments and use content as interactive presentation, email, landing page. No need to adjust and redevelop.

Integrations: Salesforce Marketing Cloud Adobe Experience Manager Veeva Vault Salesforce.com IQVIA OCE

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