Industry leaders are experimenting with the components of a portfolio that will drive success. Now they must pull it all together.
When a person becomes a patient, biopharma answers the call with innovative medicines. From HIV to cancer, the industry has shifted the very notion of what’s possible from acute interventions to chronic care, to programmable biology and increasingly—potential for cure. As one leader shared after the industry delivered unprecedented speed for COVID-19 vaccines, “In many ways, we have answered the moment, but what is next?”
The answer lies in how industry leaders start to blend traditional strengths in medicine manufacturing with new strengths that deliver outcomes far beyond today’s expectations.
Why talk about more than medicine?
Research indicates that the traditional model of healthcare delivery (procedures, hospitalizations and pharmaceuticals) can only affect health outcomes by around 10% to 20%. The rest is influenced by other factors, including individual behavior and attitudes, along with social and environmental factors (see Figure 1). This equation changes the notion of what’s possible with health outcomes.
The movement toward a health-outcomes-focused future is by nature a broader definition of the outcomes that biopharma typically focuses on today. Medication outcomes, the outcomes a patient experiences from medical intervention, are the basis of approval, value assertion and increasingly provider contracts. These outcomes are critical, as are the surrounding efforts biopharma makes to support patients in their journey. But the next steps to advance health outcomes are disease-area outcomes in a more holistic sense.
Think quickly to diabetes, where the goal post has moved from lowering A1C to identifying and reversing pre-diabetes or even bringing those with type 2 diabetes into remission through interventions that address behavioral and environmental factors. The focus is prevention first, to control the disease or change its course entirely. The same idea is prevalent in areas like multiple sclerosis (MS) where new disease-modifying therapies have shifted the goal from reducing the rate of recurrence to preventing disability accumulation.
With bold ambitions, global health systems are directing their investments toward disease-area outcomes with a focus on different disease states and prominent comorbid risk factors. For example:
- The Canadian Diabetes Prevention Program has increased funding for individuals with high risk factors for diabetes and has led to a reported 58% reduction in developing type 2 diabetes following one year of intervention.
- The UK’s NHS Long Term Plan aims to deliver tailored help for tobacco addiction, alcohol and obesity, with treatment to reduce the risk of early ill health and diseases such as cancer, alongside cardiovascular disease, stroke, respiratory disease and mental illness.
- The Australian Government invested an additional $5.8 million in 2021 on top of its current world-leading screening programming, which has already halved the local incidence and mortality of cervical cancer. The country’s goal is to eliminate cervical cancer across its population by 2030.
Patients are calling for a focus on health outcomes, too. In a recent ZS survey of 4,000 U.S. adults and doctors, 72% say they want healthcare to focus more on prevention and 76% want more focus on long-term health. They feel stifled by their current healthcare options, and they want faster, more convenient solutions, including connected care devices to expand access to doctors and improve their care. Public interest is rising for a more digitally connected healthcare model to advance trust, transparency and equity between health providers and the people they serve.
Some interesting statistics from the same survey show why people want more from their healthcare than what they’re currently getting:
- In the U.S., patients are only half as likely to feel cared for than their doctors think. (The figure is worse for women than men).
- More than 50% of U.S. adults want a role in designing their care.
- Both consumers and doctors believe that if doctors could see a patient’s full health history, the outcome would be better with faster diagnoses (83%) and earlier detection of health issues (78%).
- Nearly eight out of ten of U.S. adults are willing to share vital health statistics in a connected health system if it would affect outcomes, with some populations focused on achieving better personal outcomes, and others on better population outcomes.
One of the most striking things in our consumer research is that while 83% of consumers believe in the promise of connected health and want to engage with their doctors more easily, only 25% regularly use online health portals, health tracking apps or devices. For some, it is an access issue, which clearly needs to be addressed in the drive for health equity. But for many, it is a choice to not engage.
Industry leaders often think of the patient journey as a path, the moments that matter when someone engages with the healthcare system. It’s where our products meet a health need. What we often miss is that 89% of Americans and 55% of Europeans turn to “Dr. Google” or another internet browser before even engaging in the health system. And many factors, particularly affordability, can prevent people from engaging in the first place. In fact, 42% of Americans are concerned about affording their healthcare this year.
Patients are leading their engagement today, and sometimes that means a choice to not engage. With an outcomes-focused mindset, biopharma needs to meet people where they are, wherever they are on their own journey. Increasingly, this mindset will lead biopharma into wellness and prevention. To succeed there, leaders will need to be customer-focused in designing experiences and enabling better disease outcomes in addition to medication outcomes. The industry can create more value by identifying and filling the gaps that lead to better disease outcomes, even if people are not patients yet.
A more outcomes-focused world raises fundamental questions: How should biopharma use its strengths to create value? How can we build competencies that advance the entire journey, not just when people are sick?
It is hard for many to see a more meaningful role for biopharma in health outcomes like prevention when the business model to date has been focused on treating people who are already sick. That said, biopharma has the strengths to create value few other stakeholders have, including incredible science, deep relationships across the healthcare ecosystem to enable scale and the means to shape supply networks, treatment pathways and education for the medical community.
Look at what the industry has achieved in rare diseases and, most recently, in the highly interconnected autologous cell and gene therapies. Biopharma has shown great potential to move its role from a provider of medicines to one that provides better patient experiences and outcomes.
What would it take for biopharma to bring these strengths to bear? To deliver value in both broader outcomes and the role they can serve in the health ecosystem?
Perhaps the largest adjustment needed is a mindset shift from helping doctors find patients to helping people engage in ways that would truly change outcomes. This is a big shift, but if leaders aim for it, the industry would build portfolios and engage with the health ecosystem much differently than it does today (see Figure 2).
Biopharma leaders are taking early steps toward this future by expanding the definition of services and solutions toward non-pharmacological interventions that go far beyond traditional education and support programs.
For some time, we’ve seen a shift in investments to developing treatment for earlier stages of disease, but we’re now seeing opportunities in three other categories: clinical decision support, population health management and the development of services and solutions to get a more comprehensive picture of a disease or the factors that keep people on care paths.
Not every company will or should pursue every opportunity. While there are many examples, here are a few:
Moving the goal of treatment
Roche is collaborating with the Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) to digitally detect cognition and motor function changes for people living with MS. Not only can a better understanding of the subtle changes in disease progression help patients and their caregivers, but the data also can be analyzed to generate a more comprehensive picture of the disease.
Novo Nordisk has shifted its GLP-1 class drug semaglutide as a treatment for obesity after first bringing it to market in type 2 diabetes to help manage blood sugar levels. The company is pairing the drug with lifestyle coaching to help more people prevent complications from obesity as a means of preventing other health issues.
Clinical decision support
Machine learning algorithms are starting to help predict when a patient will drop a therapy before it happens. The goal is for automated interventions to reduce the number of hospitalizations each year. Studies suggest that a simple text message can double the chances of medication adherence, raising the overall rate from 50% to 67.8%.
In another example, Israel-based researchers are testing a machine-learning-based algorithm for use in primary care settings with the aim of shortening the time to diagnosis for psoriatic arthritis (PsA). After being trained on medical records of 2,000 PsA patients, the algorithm searched a different set of medical records and identified that 32% of confirmed patients in those records were discovered by the AI four years prior to the diagnosis by a clinician and 43% one year before a recorded PsA diagnosis by a clinician. When rare disease patents on average take seven times as long to be diagnosed, the benefits of such clinical decision support become even clearer.
Population health management
As part of the Memphis Breast Cancer Consortium, Amgen has sponsored a care pathway initiative to conduct baseline quality metrics of variation in care for Black women. In the Memphis region, Black women die from breast cancer at approximately three times the rate of white women. The effort aims to get to the root causes of healthcare disparities and provide intelligence to more than 36 different community partners who now work together in a community-based approach.
Services and solutions
Digital health company Notal Vision is using AI to support home-based retinal optical coherence tomography (OCT) scans to support the management of patients with wet age-related macular degeneration (AMD), the leading cause of blindness in the U.S. At-home scanning removes the burden on the patient for frequent visits to their doctors for in-office OCTs, providing both patients and physicians with a positive healthcare experience. In the first U.S. study, Notal’s AI-based analyzer was in 95% agreement with primary markers for AMD based on a comparison of in-office scans.
Each of these opportunities highlight the possibilities in the disease area and require a new mindset and approach for demonstrating value in the market.
Most biopharma companies have some efforts underway that are already designed to deliver more than medicine. But what makes up a targeted portfolio of investment isn’t straightforward.
Each leadership team will need to make strategic choices related to the company’s identity and participation in health outcomes more broadly to drive success and create value.
Looking across biopharma, we see a spectrum of identity emerging in this new world.
On one end of the spectrum, companies are strengthening their core identities as medicine manufacturers. On the other end, companies are leaning into a more connected, health-outcomes-focused future, by bringing medicines and non-pharmacological interventions together.
They’re embracing the idea that more people want to use connected health solutions and the fact that three out of every five U.S. adults are willing to trust biopharma companies with their health data, if they get something beneficial in return.
With that identity defined, it’s important to ask: “How can we bring more value to our customers and other stakeholders through a broader definition of outcomes?”
The answers will change where you invest in your portfolio of solutions and challenge how you shape your strategic partnerships and potentially how the internal and the field organizations operate.
Both ends of the spectrum are important and needed. But like all great leadership stories, clarity of purpose is a hallmark of success.
The future of health is already here and expanding. It is outcomes-focused, connected, and increasingly consumer-led. Leaning into this future now gives biopharma new and important ways to define what’s next for the industry and shape healthcare for everyone.