Life Sciences becoming part of a new care paradigm

Digital first, value-based care is happening

Recently, the Royal Wolverhampton NHS trust and the healthcare company, Babylon, announced a deeper partnership to provide care for approximately 55,000 people living in the trust’s primary care network.

The partnership will provide ‘Babylon 360’ to the public in Wolverhampton, a digitally enabled, integrated care service and allows Wolverhampton and Babylon to operate using a value-based care model.

Babylon 360 has been shown to increase patient access to healthcare and outcomes, while driving efficiency in the system. The approach tries?to move the focus away from ‘sick care’ to ‘health care’, providing patients and healthcare professionals with the tools to pursue more preventative care.

At the same time, NHS Wales – which has been recognised by the World Economic Forum (WEF) as a ’Global Innovation Hub’ for value-based healthcare – is building on the experience of the Life Sciences Hub to explore deeper collaborations with Life Sciences companies around new models of care delivery.

Integration is breaking down silos and blurring the lines?

COVID-19 has not only hyper-charged a digitalisation trend that was already in motion but has also highlighted the inefficiencies and challenges to sustainability which exist in many healthcare systems, and will continue to do so through the recovery efforts.

Digitising part of the service delivery is only one piece of the puzzle to address these sustainability challenges. Aligning incentives around outcomes and distributing resources more efficiently is another. As Babylon and Wolverhampton have discovered, the two can be linked together.

More importantly however, addressing this challenge is likely difficult within traditional silos and new models of care are redefining the traditional roles of different stakeholders. A good example of this is the Swedish initiative ‘H?lsor?relsen’ or ‘Health Movement ’ which is a consortium of a multitude of stakeholders in society to address diabetes. The consortium created the foundation for a digital health start-up, Health Integrator , that is now delivering diabetes support to pre-diabetic patients with incredible success.

When we spoke to Fredrik S?der, the now CEO of Health Integrator, while he was still driving the Health Movement from within MSD he said: “the technology is out there, that is not the issue, it is creating the model for care and the system for it to work that is the trick”. And that is where the success of Health Integrator is coming from: integrating different stakeholders around a new value-based care model. To bridge the financial gap for the payer Health Integrator developed the first Health Impact Bond in Sweden which also facilitates new opportunities to share risk and value among involved stakeholders.

Another example is S?ren E. Skovlund who has spent the last three years working with stakeholders in Denmark to develop a digital diabetes care support tool, which is now being implemented to deliver coordinated person-centred diabetes care.

In the process, Skovlund applied a new method for systematically involving patients, health professionals and other key stakeholders to achieve a sustainable digital model.

The digital solution brings the patient’s voice to the forefront of all care encounters and align across sectors towards the same core ‘patient-important’ outcomes. The digital solution uses Patient-Reported Outcomes (PRO) which allows for routine measurement of outcomes and value of therapy for the patient clinically, behaviourally, and psychosocially.

This redefinition of traditional roles in healthcare is an unprecedented opportunity for Life Sciences to redefine their own role and reinvent the business model to better align with the emerging models of care that will drive the sustainability of the system.

Why should pharma care about how care is delivered?

Put simply, pharma and Life Sciences generally need to care about the sustainability of healthcare and their role in that sustainability, positive or otherwise, because the system must ultimately be sustainable to be able to continue to provide revenue to the Life Sciences industry in the long-term.

However, we would also argue that there are deeper incentives for Life Sciences to not only care about the overall sustainability of health systems, but also to care about how different stakeholders are beginning to address the sustainability challenge.

Health system priorities will inevitably focus on where they can get the most bang for the buck. Currently, this is likely to be in relation to the three main drivers of ill: poor diet, lack exercise and smoking.

All three of these drivers are matters of lifestyle and behaviour, meaning that the most cost-effective solutions are likely to be preventative. Outcomes-based care models may further shift focus from resource-intensive drug interventions to earlier preventative interventions.

This is what Babylon and Wolverhampton are doing. In the words of Babylon’s Dr. Umang Patel :

“The experience of the pandemic has made the case for integrated care even stronger and has redoubled the government's determination to prioritise public health, focusing specifically on preventive healthcare… Babylon 360 [aims] to create a holistic, easily accessible and affordable healthcare option that promotes prevention over the cure.”

Needless to say, pharma does not currently prioritise either lifestyle changes or prevention. As a result, the industry faces an uphill battle in terms of staying relevant with health systems achieving their own priorities.

In addition, for pharma to realise their strategies, more innovative commercial arrangements, and partnerships, healthcare systems often need to be brought along the journey. Skovlund explains:

“There are multiple avenues through which Pharma may contribute as well as benefit from the establishment of sustainable digital health innovation. Pharma is an indispensable partner to ensure sustainable digital solutions are fully leveraged to optimise the use of medicines and health technology across the entire patient journey. The continuous collection of PRO data enabled through such digital solutions generate invaluable real-world data which are key to accelerating therapeutic innovation and new value-based partnerships for improved access.”

Thus, pharma needs to seize the opportunity and redefine their own role within these new models of care. This likely means looking more holistically at their offering, beyond just the medicine.

Pharma can take a seat at the table – and maybe even show the way

No pharma company, nor health system for that matter, has fully figured out the route forward here. Instead, there are multiple initiatives, learnings and ambitions being explored – which makes this such an exciting time. It’s an open playing field with plenty of people interested in kicking around the ball.

One potential option for pharma is to take a more holistic ownership of the patients they serve. Take a disease like COPD. The average COPD patient has one or more other chronic conditions that they are dealing with, such as hypertension, osteoporosis, depression, diabetes, renal disease, or lung cancer. Not to mention that even though COPD can cause weight loss, 65% of COPD patients are still overweight or obese.

A value- or outcomes-based business model that focuses on patient-relevant outcomes could include using pharmacological intervention to alleviate the symptoms of COPD. But why stop there? Why not achieve even more value and better outcomes by providing holistic support to the patient including for some of their comorbidities?

Some of these services may seem like they should be provided by the doctor. That is true, but they may not be and thus leave a void that pharma can fill. Others may be more part of wellness than traditional healthcare, but the pharma company does not necessarily need be the sole provider. In fact, in many cases it may be more about coordinating different kinds of support rather than providing it outright (think connecting the patient to a dietitian or pulmonary rehab), as long as you have the model in place to drive revenue from your efforts.

We have seen pharma companies making moves

We see multiple companies moving in this direction. And perhaps even more excitingly, we see healthcare systems expressing a desire to work with Life Sciences to collaborate on these new models of care.

As a stand-out example, Diane Bell, part of our team, worked within the NHS to set up one of the first value-based care models in the UK. The integrated musculoskeletal service pivoted care away from relying on hospitals and instead built patients’ confidence and skills to both self-manage and choose options for care that fitted with their ambitions.

More activated and informed patients resulted in, for example, fewer surgical outpatient appointments but more of those appointments led to successful operations. Overall, the integrated system designed and commissioned by Diane and her NHS team has demonstrably improved patient-reported quality of life scores and bent the cost curve for musculoskeletal care in the county.

Another member of our team, Hans-Peter Frank, has worked in different companies developing a range of value-based care solutions. One example was a once-yearly infusion drug for hip fracture in menopausal women launching in Belgium. The company developed a risk-sharing agreement where they would cover the cost of hip fractures, if these occur, for fully adherent patients.

The arrangement generated a win-win-win scenario where the company saw market share soar within the first twelve months, from 0 to 95%.

At the same time, healthcare systems experienced reduced number of hip fractures in the target population, reduced healthcare utilisation and cost of treatment, and reduced social expenditure – saving millions of euros in the process.

Another example is where Hans-Peter worked on a drug in multiple sclerosis (MS). The drug, in certain patient sub-populations, could cause bradycardia after the first dose. This led regulators to restrict the label and mandate that the first dose be given in an emergency room setting.

To improve the patient experience and reduce the impact on healthcare utilisation, the company developed a wearable solution to allow for remote monitoring during the first dose administration. A three-led EKG wearable device, connected to a monitoring centre, allowed the patient to receive the first dose in GP practice rather than in emergency rooms.

And Magnus Franzen is currently leading multiple teams across different clients looking at how services and solutions can integrate into care delivery, creating the foundation for more elaborate value-based care arrangements. One approach we are exploring is collaborating with healthcare providers to design more patient-centric pathways and then offer the healthcare system the technological tools to manage patients through that pathway. In the process, the pharma company’s services and solutions can be integrated in a way that was previously impossible, while keeping control of the pathway in the hands of the public healthcare system.

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Magnus Franzen, Associate Partner and Business Model Innovation Expert, PEN

Diane Bell, Value-Based Health Care Expert, PEN

Hans-Peter Frank, Digital Health and Value-Based Care Expert, PEN