Patient Access: Getting to YES
-
Upload
curo-consulting -
Category
Health & Medicine
-
view
8.660 -
download
1
Transcript of Patient Access: Getting to YES
Mapping needs and high impact solutions Establishing mutuality and securing commitment
Patient Access: Getting to YESDriving Patient Outcomes
Market Access is about getting Payers to say yes, when no is the easy option. This white paper explores the components of getting to yes and some simple
guidelines for helping Payers see why saying no might be the easy option but it is not in their best long-term interests.
Driving Patient Access
Driving Patient AccessA Sustainable Rationale for “YES”
Payer Archetypes
have Rx choices
Show Performance vs SoC
(Value and Cost)
Access: creating
the“YES”
Driving Patient Access
To achieve this, Pharma needs to:
• Demonstrate understanding of the issues around an SoC
• Know the key players and be aligned with their priorities
• Help build and install pragmatic, high impact solutions to drive improved KPIs and outcomes
• Commit to bi-party MEAF which require the commitment of both parties
• Track how a new SoC has delivered better healthcare outcomes
Driving Access – Driving Outcomes
…and needs to be leading the Payer solution.Pharma needs to be a partner not a vendor…
Driving Patient Access
Understand Funding Flow
Map Inefficiency
Integrate Into
Agreement
Identify High Impact
Interventions
Driving Outcomes - A Staged Mechanic for Building Mutual Success
Driving Patient Access
Understand funding flow
Map inefficiency
Integrate into
agreement
Identify high impact
interventions
A partnership must be built around mutual benefit.Many healthcare environments are complicated. The first step in understanding where a therapy might add value is to know what value means for the provider – this will typically be found in what they measure.
Key questions in this phase are:
• What are the KPIs?• What are the issues?
Facilitated discussions with key and representative stakeholders will allow both sides to understand the stakeholders’ objectives and how these can be translated into measures and KPIs.
Mapping Inefficiency
Key outcomes from this process:• Clear background to the therapy in terms of issues and the measures
historically employed• A matrix of measures and KPIs that are understood (even if not
employed) by the various stakeholders• A clear representation of the issues felt by the stakeholders• A summary of how this will drive activity in the next phase
Driving Patient Access
Where does a therapy impact?
• Provides scalable mechanics to map the KPIs and Disease Management KPIs for different disease areas and align these with each Payer Archetype
• A Payer Archetype framework will support this process by identifying all levels of stakeholder and facilitating an understanding of their likely KPIs
• All aspects of performance (financial, clinical, etc) will be incorporated into the matrix
Potential Disease Management KPIs
Payer
Patient
Prescriber
Improved QoL
Better Adherence
Less Hospitalisation
Less Relapse
Reduced Symptoms
Reduced complications
Easier Administration
SimplerTreatment paradigm
Slower Disease
Progression
Fewer Adverse EventsPayer
Patient
Prescriber
Improved value
Societal Burden
PublicHealthPolicy
Drug cost
Driving Patient AccessPathway Inefficiencies: Focusing on Value Opportunity
• Tools can be used in different TAs to capture the interventions and economics associated with current or new SoC
• A simple mechanic is essential as it structures the activities and helps to identify recurring areas of high cost intervention
• Without a tool, there is no structured basis for comparing different treatment paradigm
Capturing Inefficiencies:
Driving Patient AccessPathway Dashboards: Making the Value Opportunity Transparent
• Capturing activity is not enough; it is essential that the key outcomes are presented in a way that is relevant to key stakeholders
• The aim is to help them see the potential impact of changes in the treatment paradigm
• It is the basis of a rationale for committing to new ways of working
• It can include pharmacotherapies as well as other changes to the disease management process
Visible Outcomes:
Driving Patient Access
A partnership is not a nebulous concept with poorly defined stakeholders, for whom success is also not clearly defined.
Equally, changing the SoC will require people to do things differently; to achieve this requires an approach to change management which proactively drives new ways of working and new decision making.
To move to action, commitment is needed from real people who make real decisions based on funding flows and performance vs. outcomes (clinical and economic). Identifying these people and the key influencers is critical to the success of a project of this nature.
Funding Flows and our Key Partners
Understand funding flow
Map inefficiency
Integrate into
agreement
Identify high impact
interventions
What are the key stakeholder’s main priorities?
Key questions in this phase are:• Who are the key stakeholders?• How do they interact with the treatment paradigm in terms of
care provision or funding?• Which decisions are they involved in?• What are their priorities?• Why will they be interested in a partnership?
Driving Patient AccessFunding Flows and our Key Partners
Understand funding flow
Map inefficiency
Integrate into
agreement
Identify high impact
interventions
Outcomes from this phase of the process:
• Payer maps clarifying who is involved
• Clarification of which specific stage each contact is in involved, and what different priorities they may have
• A “change management” summary which proactively identifies what will encourage the required changes to take place
Driving Patient Access
• Moving beyond the patient pathway is a critical step in establishing a partnership; both with the provider, as well as with the patient.
• Understanding the key agents involved in the patient pathway, and the impact of a new therapy on their deliverables and KPIs, is key to understanding the real value of a therapy
• Decision points are often the easiest and most effective points to map, understand and change
Pathway Inefficiencies: Focusing on Value Opportunity
€€€ €€€1o Care Payer
€€€€€€€€2o Care Payer
2o Care Hospital
1o Care Physician
Who has most to gain?
Patient health state
Driving Patient Access
Simple Payer Mapping:Understanding the layers of funding stakeholders.
Funding Archetypes
Cost effective Financial Planning
Stakeholder National Regional Local
Area of interest HTA Regulator Commissioner Insurance Advising Physician
Financial Director
Hospital Pharmacist Clinic
ROI(Insurance/Private) Clinical Value Extended Value Direct Value
Driving Patient Access
Who does a therapy impact?
• Building a template to map disease and care pathways will help to identify the funding archetypes, and whose buy-in could be the most critical to the success of a therapy
Multiple Payer Archetypes
Insurance companies
Driving Patient AccessCan We Create and Show Positive Consequences?
Why will they commit?
• Create a template to map the positive impact of a new paradigm for each stakeholder group:
Driving Patient Access
You cannot know your Payer's priorities; a partnership has to be about what the Payers need as well as what Pharma needs, and so in order to provide a rationale for action we need to establish the following:
• What needs to be done?• Who needs to be involved?• What are the solutions?
And then agreement needs to be reached with Payers:
• What will have most impact?• What is easiest? Quickest? Most cost-effective?• Do you know your Payer's priorities?
Where to Add Value?
Understand funding flow
Map inefficiency
Integrate into
agreement
Identify high impact
interventions
Outcomes from this phase include:• A matrix of Payer preferences and what solutions will be best
suited to achieve listing
Driving Patient Access
If you can show how actions will impact on target KPIs there is a chance that you will be part of the solution
Use pathway to identify stakeholders and their KPIs
• Identify the high impact actions to drive KPIs
Securing Commitment – Understanding Impact
Stakeholder KPI Action Impact KPI Action Impact
Primary care physician Referral levels New SOC M # visits New SoC H
Secondary care physician readmissions New Protocol H # ER visits Support primary
care protocol M
Primary care Payer readmissions New Protocol L Transfer to community Discharge
protocol M
Secondary care Payer LOS 2nd line usage
of therapy H ICU usage 2nd line usage of therapy H
Driving Patient Access
Are your priorities, their priorities?
The pathway will show what each stakeholder experiencesPreferences helps understand what stakeholders want to achieve
The approach is focused on confirming real needs and true wants; mapping actual practice vs. stated policy.
The aim is to confirm which potential actions will resonate and have the highest impact.
Payer Preferences
• What do stakeholders want to achieve?• What do they want to change?
Performance and Outcomes
• Where are the priorities for each stakeholder?• What trade offs are they prepared to accept?Priorities
Driving Patient AccessEstablishing Preferences
Establish a preference model• Sections must reflect Payer, patient and physician relevant needs and outcomes• Use simple tools to capture preferences:
Clinical Preferences• Overall survival• Progression free survival• Controlling/managing common AE• Recued toxicity• Utilities gained, delays
deterioration of QoL & symptoms• Improved control of symptoms • Tumor size• Differentiation to SoC
Process Preferences• Discontinuation• Review of existing drugs• Flow through health care system• Less unplanned events• Efficient use of DRG system• Streamlined decision processes
Policy Preferences • Avoid waste• Disease modifying• Reduction in overall expenditure• Extend life – productivity gains• Personalised medicine• International reference pricing• Equal Access• Use of real world data• Patient registries
Economic Preferences• Adverse event costs• Health Care Resource Use• Extended/indirect costs• Admin costs• Cost-effectiveness• Budget impact – budget certainty• Wastage• Dosing• Over/under prescriptions
Drivers from outside the direct healthcare environment
Drivers relating to Budget Impact (and perhaps Cost Effectiveness)
Drivers based on clinical performance
Drivers relating to the efficient delivery of care and HCP impact
N.B All content is ‘sample’
Driving Patient Access
Integrating Change Into Agreement
Partnerships are not a paper transaction – they are a tangible program of mutually reciprocal actions that change the delivery of health services and associated outcomes.
Important factors for a successful agreement:
• Commitment - this is key to the agreement's success!• Both parties need to commit• The ROI has to be
– transparent for each party– Sufficiently high impact to warrant the associated effort
• Any agreement has to be simple and measurable
Mutual Commitment
Understand funding flow
Map inefficiency
Integrate into
agreement
Identify high impact
interventions
Driving Patient AccessSuccessful Change Requires Commitment to Tangible Actions from Both Parties
Commitment Target Pharma Payer Physicians
Implement new referral process 95%
Payers to communicate to new criteria and
protocol to physicians
Use new SoC in eligible patients 95%
Payers to communicate to new criteria and
protocol to physicians
Provide effective training 95%
Fund protocol development and training for local
physicians
Offer add-on services at first
event95% Funding to be provided Added to protocol
Treat patients in dedicated clinic 95% Change protocol
Reduce indication mortality 95% Rebate? Payers to measure (new
coding required)
Driving Patient AccessTrust is the Driver of Patient Access
The components of the Trust Equation can be managed to help Payers make a positive decision:
• Product Performance – Does the product perform vs. Payer KPIs?• Credibility - If Payers are to buy into an agreement it needs to be clear and simple• Risk - What is the impact to a Payer of the product not delivering on outcomes?
If quality and credibility are very high, and risk is minimised, trust will be higher and the likelihood of a positive Access decision will be considerably increased.
Securing Market Access relies on a Payer trusting that listing and using a therapy will have a tangible positive impact.
Payers do not give a yes, because they do not trust that they will get the promised benefits. Pharma needs to build trust.
Risk=
x CredibilityPerformance Payer Trust
Driving Patient AccessFrom Product to Access
Patient Access starts with a great product that delivers true patient benefit in the form of better outcomes.
But the key to Patient Access is about helping Payers to understand that this benefit will actually be achieved in their Health Economy.
Moreover, given that a Payer must make many listing decisions, it is critical in getting a YES that the product is clearly linked to all important Payer KPIs.
Beyond the patient, Payers have clear disease management objectives and all new therapies need to drive these broader performance goals.
Change requires commitment.
Identifying the inputs from all parties is not about Risk Share or other over-used and misunderstood concepts, it is about mutual commitment to building a revised SoC that will deliver optimum outcomes for all parties – especially the patient.
Driving Patient AccessAuthor
Chris O’NeillCEO and Head of Market Access
Chris O’Neill originally cut his teeth in Sales and Marketing, gaining valuable experience in areas as diverse as food manufacturing, IT and engineering. Always harbouring a rather unhealthy interest in problem solving, Chris decided to take his career experience into the world of Management Consulting; here, he developed valuable new skills that enabled him to understand how to really get ‘under the skin’ of a business.
After almost 10 years of consulting at a senior level, and having a particular interest in Pharma, Chris decided to focus specifically on arguably one of the most important areas of the sector – namely Market Access. .
Understanding how he could use his broader experience to help businesses focus on what really matters, Chris has gained an outstanding reputation for driving positive results and prides himself on his ability to bring a fresh approach to solving sometimes long-standing complex and highly problematic Market Access challenges.
Curo is a global Market Access consultancy and communications agency. We work with the pharmaceutical industry and healthcare funding bodies (Payers) to enable an innovative and collaborative approach to Market Access for new therapies.
Curo can enable you to formulate a solid Market Access strategy by offering honest perspectives on evidence and value. Working with your HEOR data, our analysts can help you to understand the real-world impact of your therapy in a given disease area. Curo helps you to create a narrative that means much more than just numbers on a spreadsheet – we breathe life into your data.