I wrote this for the ExL Pharma blog.
Next week, I’ll be managing the 3rd Managed Markets Insight and Marketing Summit Wednesday and Thursday in Philadelphia. The content development job of a conference producer is to take a broad theme and reduce it to the practical challenges and issues that face the industry professionals who focus in these areas. That’s the work part. The fun part is when I get a conference topic whose content serves as a framework to analyze broad, “big idea” concepts. Managed Markets is a part of several such larger themes.
Last year, much of the national dialog revolved around healthcare reform. It was an ideological and most often abstract debate. I felt as though each side was impassioned about something somewhat intangible. Broadly speaking, folks on the Left were greatly concerned that people have adequate access to healthcare. On the Right, there were fears of Socialism. With the Left, I felt as though the case rested on the problem – people without healthcare – and that this justified whatever solution could be described as the most comprehensive.
Comprehensive seemed to encompass any plan that covered as many people as possible, with no true consideration as to the quality of that care, or, more important, how to define or measure quality (except, perhaps to ask for “more”) Of course, true health oughtn’t be measured by how much access one has to a specific array of treatments, but how well one’s body functions as a system. There are those who would argue that lifestyle choices have a far greater effect on a person’s health than access to medical treatments.
One of the themes I’ll be listening closely to next week is that of patient-centric treatment decisions on the part of doctors. Behind the scenes of both ideologies was the harder-to-discuss issue of rising costs. Of course, this very real concern was politicized in last year’s discussion. The Left was concerned that individual people should have insurance that was affordable – subsidized if necessary – so they could afford approved treatment options. The Right was concerned about creating a new entitlement program – increasing the cost of the Federal budget. Either way, increasing the efficiency of how Americans use treatment is key.
Whatever happens in coming years, pharmaceutical companies who can prove that their drugs will reduce the chance of future illness will have more success than those who cannot. They will compete to prove that their medicines are more competitive than similar treatments in reducing further complications and keeping the patient out of the hospital down the road. Treating patients as individuals should add to this efficiency. Beyond medicine, patients will increasingly look to lifestyle choices as a first line of intervention for health.
The Right’s fear of Socialism was similarly abstract to me. Increasing government intervention wasn’t unquestionably going to lead to some sort of totalitarian invasion of our private lives, in my view. I still think focusing on the extreme possibilities was overreach on their part, because now that the PPACA has passed, it seems clear that not only will free market competition be restricted (and this seemed to be the thrust of the arguments I heard last year – a difficult argument to put up against people’s lives) but it also seems that individual choice will be limited, along with the fluidity of the doctor/patient relationship. If viewing each patient as an individual is an answer to reducing costs, increasing the management of healthcare markets creates a barrier, adding layers of approvals to acquire some treatments, and eliminating some choices all together.
Some of the folks in charge of marketing to the insurance system fear that the cost saving managed care methodology will become more exaggerated and restrictive under a cost conscious government controlled regime. This may be the case. I still think fears of an overly restrictive healthcare environment are overreach because people will vote for change if they feel they are not getting the care that they’re used to. There are far more currently insured people who will feel that pain than the margins who will be happy to get any insurance. Equilibrium will be reached. Either way, I look forward to hearing more about it next week.
Pharmaceutical companies invest great resources in developing medicines that will treat diseases including therapeutic options and medicinal cures. If they want to reach the populations who can most benefit from their effort, they will need to understand the new mechanics and rules for getting approved for insurance formularies. It’s a big investment for insurance companies to develop a new drug, and if they can’t prove that they will help the patient, they are through. Demonstrating individualized value to patients will require first and foremost identifying the patients who can best benefit from their medication, followed by getting buy-in from the physicians and educating the patients about what will work best for them.
If you haven’t registered for the 3rd Managed Markets Insights and Marketing Summit, you still have time. The conference runs next Wednesday and Thursday, March 23-24, at Le Meridien in Philadelphia. Click here to see an agenda, and here to register.