Life Sciences Becoming Part Of A New Care Paradigm

2021-09-29 |  Magnus Franzén-Rossi

Digital first, value-based care is happening

The Royal Wolverhampton NHS trust has teamed up with the healthcare company Babylon to provide care for approximately 55,000 people living in the trust’s primary network.

The partnership will provide ‘Babylon 360’ to the people of Wolverhampton - a digitally enabled, integrated service which allows Wolverhampton and Babylon to operate using a value-based care model.

The service has been shown to increase patient access to healthcare and outcomes, while also improving the efficiency of the system. It’s an approach that shifts the focus away from ‘sick care’ and on to ‘health care’, providing patients and healthcare professionals with the tools to pursue more preventative methods.

At the same time, NHS Wales – which has been recognised by the World Economic Forum (WEF) as a ’Global Innovation Hub’ for value-based healthcare – is building on the experience of the Life Sciences Hub to explore deeper collaborations with Life Sciences companies around new models of care delivery.

Integration is breaking down silos and blurring the lines?

COVID-19 has not only hyper-charged digital trends that were already evolving, it’s also highlighted the inefficiencies and sustainability challenges of many healthcare systems, and will no doubt continue to do so throughout the recovery efforts.

In terms of addressing these sustainability challenges, digitising part of the service delivery is just one piece of the puzzle. Aligning incentives around outcomes and distributing resources more efficiently is another. As Babylon and Wolverhampton have discovered, the two can definitely go hand-in-hand.

A greater challenge may yet be found in how these new models of care redefine the roles of different stakeholders, particularly within traditional silos. A good example of this is the Swedish initiative ‘Hälsorörelsen’ (or ‘Health Movement’) which is a consortium of numerous stakeholders addressing diabetes. The consortium created the foundation for a digital health start-up, Health Integrator, which is now successfully delivering diabetes support to pre-diabetic patients.

A while back we spoke to Fredrik Söder, now CEO of Health Integrator, when he was still driving the Health Movement from within MSD, and he told us: “the technology is out there, that is not the issue, it is creating the model for care and the system for it to work that is the trick”. And that’s where the success of Health Integrator comes from - from integrating different stakeholders around a new value-based care model. To bridge the financial gap for the payer, Health Integrator developed the first Health Impact Bond in Sweden, which also presents new opportunities to share risk and value among stakeholders.

Another good example is Søren E. Skovlund, who has spent the last three years working with stakeholders in Denmark to develop a digital diabetes care support tool, which is now being implemented to deliver coordinated person-centred care.

In the process, Skovlund has applied a new method for systematically involving patients, health professionals and other key stakeholders to achieve a sustainable digital model.

The model brings the patient’s voice to the forefront of all care encounters, and aligns across all sectors towards the same core ‘patient-important’ outcomes. It uses Patient-Reported Outcomes (PRO) which enable the routine measurement of outcomes and the value of therapy for the patient clinically, behaviourally, and psychosocially.

This redefinition of traditional roles in healthcare is an unprecedented opportunity for Life Sciences to not only redefine their own role, but to reinvent the business model to better align with emerging, more sustainable models of care.

Why should pharma care about how care is delivered?

Put simply, the role pharma and Life Sciences in the sustainability of healthcare is hugely important, because the system needs to be sustainable to provide long-term revenue for the Life Sciences industry.

However, we would also argue that there are deeper incentives for Life Sciences to not only care about the overall sustainability of health systems, but also about how different stakeholders are beginning to address the sustainability challenge.

Health system priorities will inevitably focus on where they can get the most bang for their buck. Currently, the focus will be on the three main drivers of illness - poor diet, lack of exercise, and smoking.

All three are matters of lifestyle and behaviour, meaning that the most cost-effective solutions are likely to be preventative. Outcomes-based care models may shift the focus from resource-intensive drug interventions to earlier preventative ones.

This is what Babylon and Wolverhampton are doing. In the words of Babylon’s Dr. Umang Patel:

“The experience of the pandemic has made the case for integrated care even stronger and has redoubled the government's determination to prioritise public health, focusing specifically on preventive healthcare… Babylon 360 [aims] to create a holistic, easily accessible and affordable healthcare option that promotes prevention over the cure.”

Needless to say, pharma does not currently prioritise either lifestyle changes or prevention. As such, the industry faces an uphill battle to stay relevant.

On top of that, for pharma to realise their strategies, they often need to incorporate more innovative commercial arrangements, partnerships, and healthcare systems. Skovlund explains:

“There are multiple avenues through which Pharma may contribute as well as benefit from the establishment of sustainable digital health innovation. Pharma is an indispensable partner to ensure sustainable digital solutions are fully leveraged to optimise the use of medicines and health technology across the entire patient journey. The continuous collection of PRO data enabled through such digital solutions generate invaluable real-world data which are key to accelerating therapeutic innovation and new value-based partnerships for improved access.”

Pharma needs to seize the opportunity, to redefine its role within these new models of care. This most likely means looking more holistically at its offering, beyond just the medicine.

Pharma can take a seat at the table – and maybe even show the way

No pharma company, nor health system for that matter, has fully figured out the route forward. Instead, multiple initiatives, learnings and ambitions are being explored – which makes this an exciting time. It’s an open playing field.

One potential option for pharma is to take holistic ownership of the patients. If you look at something like COPD, the average COPD patient has one or more other chronic conditions, be it hypertension, osteoporosis, depression, diabetes, renal disease, or lung cancer. And even though COPD can cause weight loss, 65% of patients are overweight or obese. A value or outcomes-based business model focusing on patient-relevant outcomes could include using pharmacological intervention to alleviate the symptoms of COPD. But why stop there? Why not achieve even more value and better outcomes by providing holistic support to the patient, including for some of their comorbidities?

Some of these services may seem like they should be provided by the doctor, but there’s no guarantee that they will be. Others might be categorised more as wellness than traditional healthcare, but the pharma company does not need to be the sole provider. In fact, in many cases it may be more about coordinating different kinds of support rather than providing it outright (like connecting the patient to a dietitian or pulmonary rehab), just so long as you have the right model in place to drive revenue from your efforts.

We have seen pharma companies making moves

We see multiple companies moving in this direction. And perhaps even more excitingly, we see healthcare systems expressing a desire to collaborate with Life Sciences on these new models of care.

As a stand-out example, Diane Bell, part of our team, worked within the NHS to set up one of the first value-based care models in the UK. The integrated musculoskeletal service pivoted care away from relying on hospitals, and instead boosted patients’ ability to both choose and self-manage options for care that reflected their ambitions.

Having more proactive and informed patients resulted in, for example, fewer surgical outpatient appointments, but with more of those appointments leading to successful operations. Overall, the integrated system from Diane and her NHS team has demonstrably improved patient-reported quality of life scores and bent the cost curve for musculoskeletal care in the county.

Another member of our team, Hans-Peter Frank, has worked in different companies developing a range of value-based care solutions. One of which was a once-yearly infusion drug for hip fracture in menopausal women, which launched in Belgium. The company developed a risk-sharing agreement in which they would cover the cost of any hip fractures in fully adherent patients. The arrangement generated a win-win-win scenario, and the company saw market shares soar within the first twelve months, from 0 to 95%.

At the same time, healthcare systems experienced a reduced number of hip fractures in the target population, reduced healthcare utilisation and costs of treatment, and reduced social expenditure – saving millions of euros in the process.

Another time, Hans-Peter worked on a multiple sclerosis (MS) drug, which, in certain patient sub-populations, could cause bradycardia after the first dose. This led regulators to restrict the label and mandate that the first dose be given in an emergency room.

To improve the patient experience and reduce the impact on healthcare utilisation, the company developed a wearable solution. A three-led EKG wearable device, connected to a monitoring centre during the first dose administration, allowed the patient to receive the initial dose in a GP practice instead.

And Magnus Franzen is currently leading multiple teams across different clients looking at how services and solutions can integrate into care delivery, ultimately creating the foundation for more elaborate value-based care arrangements. One approach we are exploring involves collaborating with healthcare providers to design more patient-centric pathways, and then offering the healthcare system the technological tools to manage patients through that pathway. In the process, the pharma company’s services and solutions can be integrated in a way that was previously impossible, while keeping control of the pathway in the hands of the public healthcare system.

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