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Highlights from ExL Pharma's 2nd Pharmaceutical Managed Markets

  1. 1. Highlights from ExLPharma’s 2nd Pharmaceutical Managed Markets Insight and Marketing<br />February 9-10, 2010<br />Philadelphia, PA<br />
  2. 2. The Providers Perspective<br />
  3. 3. Provider’s Concerns<br />Quality of Care<br />Patients Access to Drugs<br />Compliance/Costs of Readmits or unnecessary ER visits <br />Free up Capacity<br />Reduce Denials<br />Getting Paid<br />
  4. 4. What can you do?<br />Keep us informed of expensive drugs and how do we get paid.<br />
  5. 5. ExampleCoverage for Drug X in Local Market<br />
  6. 6. Convince the Medical Directors of Health Plans<br />Instead of just paying for one drug among a whole class of drugs, focus on patient-centered care<br />Help to finance for “Off-label” use if justified <br />Streamline Charity Care Guidelines<br />
  7. 7. Bottom-line: Everyone Wins<br />Patients – gain access to drugs for individualized treatment<br />Insurers - May pay more for drugs which will more than off-set by avoiding unnecessary ER visits, readmits and patient compliance. <br />Hospitals – Provide quality care to patients & actually get paid<br />
  8. 8. And YOU?<br />More Sales<br />
  9. 9. Keys to Developing a Medical/Value Managed Care Strategy to Achieve Competitive Advantage<br />
  10. 10. 10<br />The Evidence Continuum <br />APPLICATION OF EVIDENCE-BASED MEDICINE <br />Population Based<br /> Local & Customized<br />EVIDENCE GENERATION<br />EVIDENCE TRANSLATION<br />EVIDENCE APPLICATION<br />Safety<br />Efficacy<br />Effectiveness<br />Efficiency<br />Proof of Concept<br />Tolerability<br />Best Value ? <br />Risk /Benefit ?<br />Real World Benefits ?<br />CONTROLLED CLINICAL STUDIES<br />REAL WORLD STUDIES<br />Process Improvement <br />& Quality of Care<br />Initiatives <br />Practical Clinical Trials<br />Quasi Experimental Studies<br />Observational Studies<br />Economic / Cost / Utility Studies <br />Systematic Reviews <br />Population Management Programs<br />Quality of Care Initiatives<br />Point of Care Decision Support<br />Consumer-Centric / Directed Care <br />Placebo Comparator<br />Agent Comparators<br />Rigor <br />Generalizability<br />
  11. 11. Supporting the Evidence Continuum <br />Evidence Gap:<br /><ul><li> Unmet Medical Needs / Value Perception
  12. 12. Market & Customer Insights
  13. 13. Coverage & Reimbursement Decision Making</li></ul>Evidence <br />Generation:<br />Safety, Efficacy & <br />Real World <br />Effectiveness <br />Research to support <br />product value <br /> proposition<br />Evidence<br /> Translation:<br />Development <br />of Customer Centric <br />“Toolbox” to support <br />Access , Coverage <br />& Process <br />of Care Activities <br />Evidence <br /> Application:<br />Customized Solutions <br />to support<br />Preferred & Appropriate<br />Utilization of<br />Portfolio<br />
  14. 14. Evolving Customer Needs<br />Evolving Customer Needs<br />Traditional Customer Needs<br />Evidence-Based Medicine<br />Broad Business Acumen<br />Ability to Lead Transformation<br />Clinically Effective, Safe, and Tolerable<br />1.Cost Effective<br />2.Improves Quality<br />3.Easy to Adopt<br />1. Clinically Effective, Safe, and Tolerable<br />2. Cost Effective<br />3. Improves Quality<br />4. Easy to Adopt<br />Adapting to an Evolving Customer Environment<br />
  15. 15. Customized Solutions Approach<br />A P P L Y<br />Population- Based<br />Evidence- Based<br />Local and Plan Level- Based<br />Measurement-Based<br />T O<br />Identify and treat appropriate patients<br />Promote evidence-based best practices<br />Improve patient outcome and quality of life<br />Manage total cost of care<br />D E L I V E R V A L U E<br />
  16. 16. Redefining the Value Equation<br />What is it?• Efficacy• Safety• Tolerability• Clinical trials<br />Who else thinks it’s valuable?• Thought leader support• Patient organization support• Healthcare provider advocacy• Quality organization support<br />Clinical Profile<br /> Influence<br />Plan Net Cost<br />Related Value<br />What’s in it for me?• Outcomes • Cost effectiveness• Cost offsets• Quality improvement<br />How much will it cost?• Discounts• Rebates<br /><ul><li>Proves real-world, customer- and patient-centric value
  17. 17. Historically underutilized
  18. 18. Changes the value equation</li></li></ul><li>Optimizing the New Customer Engagement Model<br />Align internal resources and customer needs with real-world field experience and feedback<br />Patients<br />Payers<br />Providers<br />EBM<br />Outcomes Data<br />+<br />Customer Solutions<br />
  19. 19. Evidence Translation Toolbox <br />Knowledge Transfer<br />Population Health<br />Support <br />Point of Care<br />Support <br /><ul><li>Publications
  20. 20. Monographs
  21. 21. Slide Presentations
  22. 22. Dossiers
  23. 23. Compendia
  24. 24. EB Synthesis
  25. 25. CME programs
  26. 26. Advocacy Meetings
  27. 27. Product Information
  28. 28. Budget Impact Models
  29. 29. Cost Effect. Models
  30. 30. Formulary Mgmt Tools
  31. 31. Benefit Design Tools
  32. 32. Risk Prediction Tools
  33. 33. Pt Identification Tools
  34. 34. Population Profiling
  35. 35. Predictive Models
  36. 36. Benchmarking Data
  37. 37. Guideline Translations
  38. 38. Discharge Protocols
  39. 39. Transition of Care Tools
  40. 40. Pt Compliance Support
  41. 41. Self Care Tools
  42. 42. Case Mgmt Tools
  43. 43. ePrescribing Support
  44. 44. Pt Education Support
  45. 45. Medical Home
  46. 46. Information Portals</li></li></ul><li>Summary<br />Generate evidence that is RELEVANT<br />Generate<br />Translate and provide solutions that are VALUABLE<br />Translate<br />Communicate in ways that are MEANINGFUL and ACTIONABLE<br />Communicate<br />
  47. 47. Health Care Challenges—Are there solutions we can trust?<br />
  48. 48. The Ever Changing Landscape<br />Increased price pressures<br />Fewer new unique Chemical entities being brought to the FDA<br />Fewer new Pharmaceutical products being approved<br />Risk Evaluation Mitigation Programs (REMs)<br />Increased pressures to demonstrate health outcomes<br />Medication Adherence and Persistency<br />Patient non-adherence causing costs to rise<br />Politicians desiring to practice medicine<br />Patient satisfaction/Customer service growing more uneasy<br />
  49. 49. Stake Holders searching For solutions<br />Government<br />Healthcare Reform<br />Non-Government Collaborations<br />The California Pay For Performance Program<br />The California Healthcare Foundation (CHCF)<br />The National Committee for Quality Assurance (NCQA)<br />The Pacific Business Group on Health (PBGH)<br />The California Association of Physician Groups (CAPG)<br />Managed Care Organizations<br />Pharmaceutical Manufacturers<br />National Organizations<br />Evidence-based clinical practice guidelines<br />Value-based Benefit Designs<br />Employers<br />Patients<br />Health Care Providers<br />
  50. 50. Searching for Solutions<br />California’s Pay-For-Performance Program<br />Non-governmental physician incentive program<br />Improve quality of care and health outcomes<br />8 Health Plans<br />200 Medical Groups<br />35,000 Physicians caring for 11.5 Million HMO Members<br />Single performance-based set of measures<br />Public report card<br />Aggregation of data from multiple payers for calculating scores<br />Source: The California Pay for Performance Program, The Second Chapter, Measurement Years 2006-2009<br />
  51. 51. Searching for Solutions<br />Patient-Centered Medical Homes<br />Goal: “Relieve the looming crisis in primary care, improve clinical quality and patient experience, and moderate cost increases.”<br />Coalition<br />Major Employers<br />Consumer Groups<br />Patient Quality Organizations<br />Health Plans<br />Labor Unions<br />Hospitals<br />Physicians<br />Source:<br />
  52. 52. Searching for Solutions<br />PCMH continued<br />Pilots in 44 States & District of Columbia<br />Commercial<br />Medicare<br />Medicaid<br />VA/DOD<br />LTC<br />
  53. 53. Searching for Solutions<br />Education<br />Health Coaches<br />Electronic Health Records<br />Patient phone calls<br />Automated Telephone Self Management Support Programs<br />Stakeholder Alignments<br />Health Insurance for everyone<br />Removing soda pop from schools<br />Make healthy foods available at a cheaper price<br />Single Payer Health Care <br />Government/Elected Officials<br />Taxes on Soda Pop<br />
  54. 54. Searching for Solutions<br />Put the healthcare dollar in the consumers hands<br />Allow market forces to drive the delivery of Healthcare<br />Real incentives to the consumer of healthcare<br />Strategic Legislation <br />Malpractice Insurance<br />Reform Worker’s Compensation***<br />Reform Welfare System***<br />
  55. 55. Searching for Solutions<br />Things to Consider:<br />Government’s track record of Program implementation & sustainability<br />“If you put the federal government in charge of the Sahara Desert, in 5 years there would be a shortage of sand.” Morgan Friedman<br />The best of America comes when “These are that tries men’s souls” Thomas Paine<br />“What we obtain too cheap, we esteem too lightly” Thomas Paine<br />The Wizard is Fraud!!<br />The entrepreneurial spirit is alive and well in America<br />When incentives are appropriately aligned America’s citizens will rally and find ways to succeed<br />‘Rome was not built in a day and it did not fall in a day’<br />
  56. 56. There is no magic quick fix solution<br />When we are sick we take sick days to heal ourselves or we go to the appropriate Physician—the Government doesn’t treat fevers <br />
  57. 57. Still have any questions? For additional information on ExLPharma’s Pharmaceutical Managed Markets Insight and Marketing Conferences, please<br />