Outcomes based measures for Pharma new commercial models
pharmafile | September 29, 2010 | Feature | Sales and Marketing |Â Â Kinapse, White paperÂ
It is now widely recognised that Pharma new commercial models will rely on the principles of account management, working collaboratively across key functions to navigate an increasingly complex stakeholder environment involving payers, providers, patients and other influencers and decision-makers.
The basis of the relationship with customers will also change from transactional to one based on ‘value’. Even though the exact definition of value in this context is still evolving, one thing is clear: there will be the need to demonstrate ‘outcomes’.
The triggers of behaviours, measurements, rewards and incentives will therefore have to be re-aligned from the current focus on an individual sales person’s hard earned results to integrate softer elements highlighting intended team work to deliver benefits to customers.
GSK US signalled a re-engineering of its whole incentive system earlier in the summer, removing sales-based bonuses for customer satisfaction targets and measures.
But this re-engineering is easier said than done. Moving away from factual data and information is likely to involve some degree of subjectivity and a lack of robustness and reliability in measurements.
We believe that looking at payer-driven countries such as the UK, Germany and Sweden will provide the necessary insights and structure to develop the new wave of KPIs and compensation systems for new commercial models. National authorities and HTAs are pioneering measurement frameworks for an outcome based healthcare environment. Successful Pharma companies should use these frameworks to inform their own measurement frameworks, ensuring alignment. This will enable joint working towards common goals and objectives and facilitate win-win relationships between the National Authorities, HTAs and Pharma companies.
This article draws upon information within a recently published whitepaper ‘Transparency in outcomes – a framework for the NHS[i]’ to provide example payer frameworks and discuss possible implications for the Pharmaceutical industry.
Principles and structure of the proposed NHS outcomes framework and opportunity for pharmaceuticals
A cornerstone of the new NHS white paper ‘Liberating the NHS[ii]’, is a new Outcomes Framework, which is being designed to hold authorities and providers accountable for improving healthcare outcomes (it will also be linked to payment). This will be developed jointly with clinicians, patients, carers and representative groups with a view to implementation in 2011/12.
A consultation paper has just been published laying out its principles, proposed structure and possible outcomes indicators.
This has provided Pharma companies with a great opportunity to redesign their own measurement, rewards and incentives systems.
Principles of the proposed NHS outcomes framework
In essence, the framework will measure benefits and outcomes, delivered around three key areas:
- the effectiveness of the treatment and care provided to patients
- the safety of the treatment and care provided to patients
- the broader experience patients and their carers have of the treatment and care they receive
This will guarantee a balanced view of outcomes, looking not only at safety and efficacy of treatments but also at patient experience.
Measurements for each of these three dimensions will cover the structures of care, the processes of care and the outcomes of care with the two former being lagging indicators for the latter.
Accountability for these measurements will also be placed at different level, with realisation of Outcomes being a national priority whilst the provision of structures and processes of care being a local duty.
It is proposed that five ‘domains’ are used to capture the key expected benefits and outcomes around effectiveness, patient experience and safety:
Structure of the proposed outcomes framework
The proposed framework consists of three layers of indicators:
- Overarching indicators will define overall outcomes goals that will provide an indication of the overall performance of the NHS against each of the five domains above.
- These indicators will then be associated with specific improvement measures (about five for each overarching indicator).
- Finally a set of ‘quality standards’ will be published describing how best to deliver improvements against the selected outcomes by working with providers. They will set out the structures and processes of care that the evidence suggests would be most likely to deliver improved outcomes for the overall domain as well as the specific improvements areas within the domain. In the UK over the next five years, NICE is expected to produce a library of approximately 150 quality standards covering the majority of NHS activity.
As described in the above section, Overarching indicators and improvement areas outcome indicators will primarily be the focus for national level authorities, whilst supporting quality standards will be targeted towards providers explaining how best to deliver expected outcomes and benefits.
Embedded in the structure of these three layers is a cause and effect relationship, assuming that providing quality standards will ultimately deliver expected improvements and outcomes.
What would an NHS Outcomes Framework look like?
The following figures provide an example from the consultation paper on the outcomes measurement framework.
Domain 2 – Effectiveness – Enhancing Quality of Life for people with long-term conditions
The overall framework provides clarity on the focus and priorities for outcomes measurement. Transparency is also given on data and information sources used (e.g. PROMS – patients reported outcomes measures)
Specific indicators will be used for the measurement of outcomes and standards.
Example of quality standards
Over time, NICE is expected to develop a library of approximately 150 quality standards covering structures and processes of care.
To date, they have published three for stroke, dementia and VTE (Venous Thromboembolism prevention) prevention[iii]
The following example is for VTE prevention:
VTE prevention quality standards:
- All patients, on admission, receive an assessment of VTE and bleeding risk using the clinical risk assessment criteria described in the national tool. Patients/carers are offered verbal and written information on VTE prevention as part of the admission process.
- Patients provided with anti-embolism stockings have them fitted and monitored in accordance with NICE guidance.
- Patients are re-assessed within 24 hours of admission for risk of VTE and bleeding.
- Patients assessed to be at risk of VTE are offered VTE prophylaxis in accordance with NICE guidance.
- Patients/carers are offered verbal and written information on VTE prevention as part of the discharge process.
- Patients are offered extended (post hospital) VTE prophylaxis in accordance with NICE guidance.
Each quality standard is then detailed into specific measures and expectations for the different stakeholders. The following is the quality standard for ‘Extended prophylaxis’
The way forward
As we are witnessing a change in the healthcare environment to become outcomes driven, some countries have taken the lead to specify and codify frameworks and processes required to provide necessary accountability and transparency.
As key stakeholders in the delivery of care, this is a great opportunity for Life Sciences companies to ‘piggy back’ on these frameworks to develop their own measurements system. By doing so this will provide the necessary focus, alignment with customers, and importantly drive the development of required behaviours for new commercial models.
As the development of such outcomes frameworks is at early stage, there is a great opportunity to engage in conversations with payers and decision-makers.
Finally, beyond the actual use for measurements systems for commercial organisations, outcomes indicators could also be used to guide the development process and the design of clinical trials.
About the Authors
Jean-Francois Delas is a Vice President at Kinapse Ltd. and leads the Marketing & Sales Consulting Practice.
E: jean-francois.delas@kinapse.com
About Kinapse
Kinapse provides consulting and outsourcing services to the life sciences industries, globally.
Our mission statement is: ‘Collaborating with our clients to innovate for exceptional results’. Kinapse clients include many of the world’s leading pharmaceutical, biotechnology, medical device and specialty pharmaceutical companies, government organisations and life sciences service providers.
Our key advantages are:
- Focus on the life sciences industries
- Deep industry experience and technical acumen
- Proven blended onshore-offshore delivery model
- Track-record of innovative solutions and results
For more information please visit www.kinapse.com
[iii] http://www.nice.org.uk/aboutnice/qualitystandards/qualitystandards.jsp
[ii] http://www.dh.gov.uk/LiberatingtheNHS, July 2010
[i] Transparency in outcomes: a framework for the NHS, 19 July 2010
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