With New Gene Therapy, Novartis Assumes 'Total System Leadership'
Solving insurance churn is Blue Ocean for payer and pharmaceutical markets to cohere and collaborate on health system innovation. The principal challenge isn’t technical, but conceptual: working with a new mindset and set of ideas to find mutual understanding on shared business objectives, and then reorganizing the behavior of a system of markets within a new health context.
Per new data from the Bureau of Labor Statistics, more than 2 million workers and their families lose or transfer to new commercial health plans every month in the United States. The average person has about a dozen jobs in their lifetime.
Alternative payment models -- e.g., outcomes-based reimbursement for orphan drugs and new gene therapies, such as Luxturna from Spark Therapeutics, which is priced at $425,000 per eye, and now Zolgensma from Novartis -- fall apart practically when treatment longer than a year is key to the value story.
Who “owns” the patient experience?
Who Wins the Manny for Health System Value?
MedAdNews is a trade publication covering the business of pharmaceutical marketing. It’s somewhat like Advertising Age, in that it’s focused on serving and celebrating the subsystem of marketing and communications agencies and media buyers who create the content to position and promote prescription drug brands directly to consumers and health care professionals.
It’s big business.
In 2016 alone, according to the Journal of the American Medical Association, the pharmaceutical industry as a whole invested somewhere around $30 billion on drug advertising, promotion, public relations and sales across audiences and therapeutic categories. The overwhelming majority of the content looks like this:
Overload and Boredom as Points of Innovation in Health Care
"Awareness" campaigns are a new category of waste in health care.
Most of us accept administrative complexity, inefficient workflows, obsolete care standards and ample fraud as root cause for around $1 trillion in waste floating throughout the current system(s).
In a Harvard Business Review piece not long ago, a group of authors spanning government, economics, entrepreneurship and strategy consulting got together “to assess what we already know we can save in our system and where policymakers, entrepreneurs, investors, and health care leaders need to focus their attention.”
"Value" in Healthcare is a New Market to Design
During a visit to the London School of Economics as the 2008 financial crisis was reaching its climax, Queen Elizabeth asked the question that no doubt was on the minds of many of her subjects: "Why did nobody see it coming?"
The response, at least by the University of Chicago economist Robert Lucas, was blunt: Economics could not give useful service for the 2008 crisis because economic theory has established that it cannot predict such crises. As John Kay writes, " Faced with such a response, a wise sovereign will seek counsel elsewhere.
And so might we all.
For Health & MedTech @SXSW - It's The Outcomes, Stupid
The means of creativity are endless. It's new ends that are in short supply.
The 2019 SXSW Conference & Festival is officially underway. Organizers behind the coming ten days of innovation theater are promising "a whirlwind of inspiring sessions, film screenings, meet ups, early morning tacos, showcases, exhibitions, competitions, late night tacos, and ample opportunities for networking."
There's even a SXSW bot affectionately called "Abby," who you can bond with and personalize to deliver a casual, fun and easy-to-follow experience to help navigate the event, and indulge in all the raw and boundless possibilities on display.
We're being carried away on a vessel of quasi-religious longing. There is a mythology that shrouds the system
Note to Pharma: Your Marketing is Showing
The problem that's arrived for the pharmaceutical industry is that its marketing is showing. If only it worked.
For more than a century, most Western companies have been working under a Fordist model of mass production and consumption, where industrial capitalism places the idea of 'promote-and-push product' as the center of commerce. The purpose put into the machine is managing "brand".
It's an entrenched mode of being and thinking.
Prelude to #HIMSS19 — Technology Isn’t Healthcare
It's about output, not input.
Competing on outcomes is the story behind all other stories about what it means to "transform" healthcare. It's a different kind of big for an $18 trillion global health economy that's moving to a new logic.
The transformational remit for strategic leadership is the ability to creatively explore new market space, quickly assemble a unique intellectual viewpoint, then design the new infrastructure -- the nervous system -- to own the space.
New business development is new market development.
The Problem That’s Arrived for the Pharmaceutical Industry
It has less to do with "drug."
For more than a century, pharmaceutical companies -- and the armies of vendors and advisors they buy and deploy to create capabilities and operationalize plans -- have been working under the Fordist model of mass production and consumption. It's a deeply entrenched mode of being, a view of identity and approach that prevailed for much of the twentieth century, where industrial capitalism achieved a relatively benign balance among the contending interests of business and customer.
It's the logic of the past, though, an outmoded way of thinking that's baked a kind of strategic atrophy into the system. And it will be on full display this week.
Healthcare Needs a Punk Rock Vision
It’s December 1, 1976, and the Sex Pistols are being interviewed on live television.
Appearing on the British Today show at the supper hour, the Pistols' frontman John Lydon (Johnny Rotten) responded to interviewer Bill Grundy’s command, “Say something outrageous,” by calling him a “dirty fucker” and a “fucking rotter.”
The newspapers put the Sex Pistols on the front page for a week with screaming headlines like “TV Fury Over Rock Cult Filth” and “Punk? Call It Filthy Lucre”. Members of Parliament denounced them.
“Anarchy in the U.K.” entered the charts at Number 43, but record company executives refused to handle it as EMI was fast buckling under the public pressure. The Pistols added to the outrage by refusing to apologize, and by doing long interviews in which they denounced the entrenched system of music ratings and sacred luminaries like Mick Jagger and Rod Stewart. They went on tour, traveling around the United Kingdom in a bus, arriving at gigs only to discover that they had been banned in the township. Out of twenty-one scheduled dates, the Sex Pistols played three.
Transformation Isn’t Strategy
Poor strategy is expensive.
General Electric paid more than $6 billion in fees to a galaxy of strategic advisors since the turn of the 21st century, even as its market value collapsed 80 per cent over the same period. (For more context, see GE’s Dealmaking and Outlay to M&A Advisers Called into Questionin the Financial Times).
The company said in October it would write off $23 billion from the value of its power division alone, following the disappointing performance of businesses acquired in the 2015 takeover of Alstom, a French energy company that was one of the largest acquisitions ever by GE, ultimately weighing in at about $10 billion.
Announcing the takeover in 2014, John Flannery -- one of the deal's chief architects as GE's head of business development at the time (and now the company's former CEO) -- called it "a highly strategic acquisition" in a power sector that "has excellent long-term growth prospects."
Why Digital + Drug Discovery = Status Quo
The first transformation to make is in how you think about it.
The future of strategy and competition in the pharmaceutical industry is broader than pharmaceuticals; it also lies in servicing health. More specifically, it lies in transitioning away from an industrial-era view of 'market' bounded within the context of discovering, pricing, manufacturing and promoting the technical merits of a physical product (i.e., drug brand), to a model based on embedding "drug" within entirely new systems of health engagement.
You compete by creating a new dominant context.
It's the story at a system level that becomes the locus of innovation. The narrative transcends online, offline and the line in-between, solving multiple problem spaces, reshaping everyimportant kind of relationship among all businesses, vendors and people. Health system strategy deals in quantity of effects; not one thing, many things simultaneously and interactively.
Our Psychic Disintegration in Healthcare
U.S. National Health IT Week begins TODAY and I’m pumped at the prospect of helping “spread awareness of the value of health IT” in supporting “healthcare transformation.” My digital surfboard is primed to ride the multi-dimensional flow of eternal sunshine and technology’s transcendent promise that will emanate from the four-day event in our nation’s capital (October 8-12).
They have a blog where champions of information technology from across the industry are uniting to share their voices on how health IT is catalyzing change in U.S. healthcare. Ron Ritchey, MD, chief medical officer, eQHealth Solutions, posted his view that Health Information Technology and Business Intelligence Possess the Power to Transform an Entire Population’s Health:
“Reflecting on National Health IT Week has made me think of how far the industry has come in the effective use of health data and technology to reshape the way we deliver care to patients. The explosion of innovation and growth over the last 35 years, since I began my practice, has been miraculous to see and be a part of. In fact, I was reminiscing not so long ago — the capabilities we now have at our fingertips would have been thought to be out of a futuristic cartoon, and today, they are commonplace.”
Technology Isn't Innovation
Three non-Apple and non-Amazon events caught my divided attention this past week. In no particular order:
We are now in the fiftieth year of the official US health care "crisis." For more than half a century, ballooning health care costs have been a source of concern, confusion, complexity and impending catastrophe to the American economy and employer operating margins when, on July 10, 1969, President Richard Nixon, proclaimed, “We face a massive crisis in this area.” Without prompt administrative and legislative action, he added at a special press briefing, “we will have a breakdown in our medical care system.” Michael L. Millenson, an adjunct associate professor of medicine at Northwestern University’s Feinberg School of Medicine, marked the milestone with an excellent piece this week in Health Affairs. Here's the link: Half A Century Of The Health Care Crisis (And Still Going Strong).
A "summit" was held to discuss the future of pharmaceutical pricing and market access in an evolving healthcare environment. That's the event's description from the Financial Times, host of the day. Topics on the agenda included the politics of drug pricing, the rise of real-world evidence, the role of pharmacy benefit managers and what "value" means to different stakeholders. Department of Health and Human Services Secretary Alex Azar delivered the keynote, where he said he isn't banking on the pharmaceutical industry to fix the rising cost of prescription drugs in the US.
Do "Patients" Still Matter?
Ever since The Innovator’s Dilemma was published more than twenty years ago, everyone has either been busy trying to disrupt, or scrambling to avoid being disrupted by, a pack of ravenous hyenas from Silicon Valley.
Jill Lepore, writing recently on the gospel of innovation in the New Yorker (from which the above image comes), says “the rhetoric of disruption — a language of panic, fear, asymmetry, and disorder — calls on the rhetoric of another kind of conflict, in which an upstart refuses to play by the established rules of engagement, and blows things up.”
There are disruption consultants, disruption seminars, and disruption conferences, where you can “hear from people who are not only setting the rules but also changing the tech game.” (TechCrunch is hosting “Disrupt SF” in September; you can get your pass here).
To be sure, structural change has occurred. Deep, inevitable forces have re-configured how the world thinks, interacts, creates, communicates…and in what has value.
But the “technology” part is a commodity input to this story. Tech is essentially free.
Apple, Amazon and the New Health Infrastructures
Anyone surprised that Apple considered buying a network of primary care clinics is misreading the $20 trillion shift happening in healthcare worldwide. All the money is moving to a new form of competition based on outcomes delivered through a consumer-grade experience.
The industry re-organization is happening in different ways and at different rates in different markets. But it has progressed to the point where the global trend is clear and rapidly accelerating: the center-of-gravity for health system strategy is on entirely new value propositions and enabling (if not guaranteeing) better outcomes.
Winners will be those who can navigate this transition space with leadership and a superior understanding of outcomes-based innovation, at scale.
China Has a Vision for Health System Strategy. What This Means for the U.S.
We are essentially linear creatures.
Whether this is the native mode of humanity, or whether it is the result of acculturation, is open to question. Western society fosters and rewards linear behavior and performance from kindergarten on. Our educational system teaches and grades on it; our social programs are designed and executed on it; and it drives decisions throughout most government, nongovernment, and commercial settings.
The strategic context for business has changed radically, though, with old patterns of power fracturing along new lines.
Culture itself is passing through a new time, and the journey promises to be more transformative than the industrial revolution at the turn of the century, and the agrarian revolution sparked by the development of agriculture in the Neolithic Age.
The Magic Leap to New "Value" in Pharma
The transformation train is leaving. Powered by the promise of technology and design thinking, companies worldwide are scrambling to find a seat before disruption disrupts; across industries, somewhere around $2 trillion is going to be invested in "digital transformation" before the end of 2019 (here's the data point). Two years, $2 trillion...that's roughly the size of India's GDP. That's a very big spend.
Structural change has occurred. It is not a “happening” so much as it is a “now.” Deep, inevitable forces have re-configured how the world thinks, interacts, creates, communicates…and in what they value.
The bleeding-edge of the next generation expectation – Amazon, Tesla, Uber, Netflix, Zappos, AirBnB, Alibaba, Google – understand how to shape the future because they understand how to harness these new forces within organizational culture and business strategy. These companies are hybrids guided by a new type of thinking – part human, part machine – embedded in an engine of constant flux. Legacy industries, including (but certainly not limited to) the global healthcare system, are struggling to adapt.
Said better by William Gibson in 2003, “the future is already here; it’s just not evenly distributed.”