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Powerful trends today are dramatically changing the healthcare landscape around the globe, creating a new environment for patients, providers, and other stakeholders in the healthcare ecosystem. The global population is expanding and aging, with each factor increasing the need for healthcare. And as lifespans continue to increase, the incidence of chronic diseases (such as heart disease, respiratory disease, diabetes, cancer, and mental illness) will also rise. At the same time, incredible advances in science and technology are driving a surge of healthcare innovation, something that will not only transform lives, but also raise societal expectations and demand for cutting-edge healthcare services.
Current health systems, however, have not yet evolved to meet these challenges. Today’s healthcare delivery model looks much as it did in the 1950s: big hospitals that primarily focus on providing expensive, reactive care to treat people with acute sickness. With more people living longer and diseases shifting to long-term, chronic conditions, this model is not sustainable.
So a new system is needed, one in which pharmaceutical companies, payers, regulators, and governments are incentivized to work together to eliminate waste and improve the quality and efficiency of care. A healthcare system that focuses narrowly on isolated costs will not be able to reward innovative delivery models, medicines, and devices that make a real difference. We need to shift from a siloed system to an integrated one in which all parties are jointly accountable for achieving a shared objective: a positive outcome for the patient. This can be done, but it will require courageous leadership, a fundamental change in how we keep people healthy, and a focus on financial sustainability. Leaders across all sectors will need to incentivize outcomes, embrace innovation, and improve collaboration.
CONCENTRATE ON OUTCOMES
In today’s financially strapped healthcare environment, it is crucial to agree on appropriate desired outcomes for each disease state. Once that has been done, data can be used to analyze the impact of all interventions along the treatment pathway. This will allow analysts to identify which interventions contribute most effectively to achieving the desired outcomes and thus establish sensible priorities for both care and research. By basing performance metrics on health outcomes, in other words, the disparate players in the health system—including pharmaceuticals companies—can be held accountable for the actual impact they have on people’s lives. With the correct incentives focused on the right goals, the system will be better able to serve the needs of patients and payers alike, simultaneously reducing waste, improving efficiency, and improving the quality of care.
Take Ireland, for example, where heart failure affects about 90,000 people. Heart failure patients there have traditionally been underserved due to limited access to echocardiographs and long waiting periods to see heart failure specialists. As a result, heart failure accounts for four percent of in-patient hospital admissions in Ireland, and at €6,543 per hospitalization, that means that more than €40 million is spent annually on heart failure hospitalizations. A new Novartis drug, Entresto, has shown that it has the potential to reduce hospital admissions by 20 percent in some heart failure patients, thus cutting down on one of the costliest parts of treating the disease. So, following the recent EU approval and expected local reimbursement approval, Novartis Ireland is planning to provide an integrated healthcare solution package, including diagnostic tools and monitoring, remote access to specialists, and educational materials, to support earlier heart failure diagnosis. The project will be set up to measure and optimize various outcomes including mortality, hospitalization rates, and quality of life improvements, and the resulting data will then be able to inform future care and funding decisions.
In Brazil, meanwhile, we’ve started to provide integrated health solutions that focus on outcomes rather than the number of pills sold. Through our Vale Mais Saude Program, for example, we offer patients discounts on the price of Novartis medicines when they fill their prescriptions at selected pharmacies. Through this program, we positively reinforce medication refills in conjunction with educational materials and treatment reminders to help patients stick with their treatment plans, which is important for delivering better outcomes. To date, the program has reached four million patients across 40 products. With the support of over 20,000 accredited pharmacies and more than 65,000 participating physicians, data from the program indicate that participants maintain their treatment regimen twice as long, on average, as compared with those not enrolled in the program.
Other pharmaceutical companies are doing similar things, and as approaches like these spread, healthcare systems in general are expected to benefit significantly. In addition to these more integrated ways of providing medicines, moreover, there are ample opportunities to better integrate healthcare systems so as to improve secondary prevention and reduce hospital visits. For example, community care centers can and should operate at greater scale and alongside primary care centers, with more specialists working in the community and fewer in hospitals. The more all concerned parties are incentivized to deliver care in the best way, as opposed to simply the traditional way, the more improvements in outcomes there are likely to be.
As the healthcare landscape evolves, advances in science and technology have the potential to transform how care is delivered. A shared electronic health record, for example, can help ensure better coordination across the healthcare system. Alternative channels for face-to-face consultations with physicians and other healthcare professionals—including telephone consultations and computerised cognitive behavioral therapies—can help expand care to remote locations. And digital tools such as patient flow management and e-rostering (an electronic way of managing staff) can help the system run more efficiently.
On the patient side, networks such as PatientsLikeMe can empower people to become more active in their own care and to connect with others in similar situations. Technology is also enabling lower cost, self-service, such as online booking for primary care, with the triage process performed electronically. This may sound mundane, but online appointment scheduling alone is projected to generate $3.2 billion in savings for U.S. healthcare systems by 2019.
As a result of the declining cost of genetic sequencing, genetic testing is becoming more mainstream, and as scientists and doctors further understand the genes that cause certain diseases, they are beginning to explore options for personalized medicine. Novartis, like other companies, is looking into applications for gene-editing technologies that could allow us to modify specific genetic loci for both scientific discovery and novel therapies. We’re also evaluating the utility of combining proteins and T-cells to engineer potential cures for blood disorders such as sickle cell anemia. Similarly, there are potential applications in the genetic splicing of stem cells for the treatment of nerve diseases such as spinal muscular atrophy. These are exciting new areas of innovation that could drastically change lives in ways never before possible. As with any new treatment, such new therapies are likely to be costly, but their comparative effectiveness in treating a problem at its source and preventing future complications could actually contribute to reduced health costs in the long term.
Big data is also enabling the collection and analysis of vast quantities of information in previously impossible ways, potentially allowing the prediction of disease and its prevention through individualized treatment plans. The U.S. Veterans Health Administration, for example, now predicts how likely a given veteran is to be hospitalized and uses this data to coordinate patient care and focus resources, in an effort to make sure that the patients who need the most care get it early and can be spared serious complications and unnecessary hospital admissions.
Big data has numerous implications for healthcare research, development, and treatment. Major technology companies such as IBM and Apple, for example, are using cloud innovation to facilitate the curation of patient data and are expanding the pool of clinical trial candidates. Increasing data transparency could give patients and healthcare professionals access to real time data about the progression of their disease and treatment among other patients with similar conditions, potentially enabling them to make more informed choices about where to seek care and creating incentives for providers to up their game. With the increasing availability of sensors and wearables, moreover, patients will increasingly take charge of their own health. As devices become more interconnected through the Internet of Things, doctors may be able to monitor factors that lead to adverse events more quickly and intervene before a costly hospitalization (or re-hospitalization) is necessary.
In order to focus on paying for outcomes and embracing new technologies, the disparate players within the healthcare sector will have to collaborate more. And pharmaceutical companies, facing their own pressures, have a responsibility to help lead the way.
By partnering with other companies, we can combine our expertise in medicines with innovations in other areas to develop breakthroughs that could change the face of healthcare. Thus Novartis is working with Google[x] to develop and commercialize their “smart lens” technology, which has the potential to diagnose, monitor, and manage diseases such as diabetes. For example, a smart lens may be able to provide a continuous, minimally invasive measurement of the body's glucose levels, reporting any changes to the patient’s mobile device. This kind of technology could reduce the treatment burden and empower patients to take a more active role in their own care, thus helping to reduce costly hospitalizations caused by non-adherence.
In the past, risk-sharing for healthcare innovation hasn’t been very successful, due primarily to the lack of common objectives among different stakeholders in the system. Some payers have found risk-sharing models to be too complex, and the timeline for repayment too long, compared to the commonly used rebate pricing models that guarantee retroactive discounts paid after the fact. So it is important that the stakeholders work together to develop new payment models that work for all. At Novartis, we’re beginning to experiment with such alternate types of payment models—planning, for example, upon approval by the respective health authorities, to test a shared-risk pricing system under which customers would get the chronic heart failure drug Entresto at a modulated price based on the successful reduction of costly hospital visits.
There are many more such opportunities for improved collaboration in healthcare, and the more doctors, hospitals, pharmaceutical companies, and other players in the system can work together to provide coordinated care using best practices and innovative approaches, the more improvement in outcomes we are likely to see.
Changing the healthcare delivery model to focus on outcomes, innovation, and collaboration will not be easy. Many politicians and shareholders are likely to take the short view, questioning the upfront costs and long-term value of such a change. Providers may have financial or other interests in the current system. Within the pharmaceutical industry itself there is bound to be some reluctance to change. There may also be mistrust and a lack of dialogue between industry and payers, and some missed opportunities to experiment and take risks.
All these challenges, however, are natural growing pains to be expected during a major transformation in the system. The building blocks for a new approach are in place, and as healthcare delivery is revolutionized, the result should increasingly be something everyone can agree is worthwhile: improved patient health worldwide.