Tag Archives: Pragmatic

Shape of Future Pharma Operations – Emerging A Pragmatic Outlook?

Posted on by
Reply

Just as newer reports come almost every day on safety, efficacy, dosage interval or span of immunity of Covid vaccines, similar reports are also reaching us about the possible future shape of pharma sales and marketing operations. Some hardcore optimists, apparently more from India, still believe that current changes in pharma customer behavior are mostly transient. All business processes will eventually fall in their traditional grooves, as the Covid menace disappears from our lives soon.

No doubt, several studies are also bringing out a number of respondent doctors’ preferences on reverting to F2F engagements, programs and events. Nonetheless, most other experts, including several large global pharma majors, believe that the future shape of business operations won’t be quite the same as the past. There are better ways to be more effective, leveraging the changing environment. Accordingly, they have initiated actions, reimagining the pathway of new operational frontiers. In this article, I shall explore the evolving pragmatic outlook in just two of these action areas:

  • The new and unique role of medical representatives
  • Digital health care solutions as a new growth opportunity

New role of medical representatives:

A recent survey published by Reuters Events Pharma on December 18, 2020, revealed that 30% of the respondents still expect that Medical Reps’ (MR) face-to-face access to HCPs would return to the status quo ante of Covid pandemic restrictions. However, a majority of 70% felt that the old normal is unlikely return as such. The study also brought out that the size and disposition of sales teams are under review by many of pharma players and smaller field forces look likely, as the industry moves on.

My personal experience with the Indian Pharma Industry sources suggests, when a Covid pandemic wave starts finding its peak, the feeling of the above 70% prevails. However, when the same wave climbs down from its peak to a transient trough, a large number of Indian companies and experts tend to feel somewhat akin to what the above 30% expressed in the Reuters Events Pharma survey. The process gets repeated with the emergence of the next wave.

Alongside, as the above survey also finds out, most physicians are no longer expecting – brand-driven high sales pitches, during any MR-Doctor interaction or the engagement process. Instead, they are increasingly looking for insights – in an integrated, personalized and value-driven interactions with the Reps.

Considering this as a trend of over last one year or so, it is likely that MR-doctor interactions will now need to be on digital and omnichannel platforms to deliver a personalized and value driven an experience to the customers. In this environment, the field force may be smaller in size than what it used to be in early 2020 but will have a unique new role to play. This process will come with a new challenge, especially to those inbred companies, who are still undecided about the road ahead for business excellence, in the new normal.

Three new pharma leadership challenges:

Apparently, a large number of domestic drug companies, irrespective of size and scale of operations still feel comfortable to be in the old comfort zone that had propelled the business in a growth trajectory. Most pharma sales and marketing staff members, at several levels, have grown within the industry, consistently delivering high performance.

This situation by itself, as the above research paper revealed, poses three fresh challenges for many companies to make their field-staff ready to play a unique and fresh role in e-marketing. Thus, the three new knots to untie in the virtual world, are the following:

  • Currently, most MRs are not proficient in selling in virtually,
  • They are being led by people who have also never sold virtually,
  • They are being trained by people who also have never sold virtually.

MRs will continue to have a role to play even in the digital world:

To overcome the above challenges, today’s reality prompts new L&D needs of pharma’s new e-environment. And from this perspective, I think, they would need professional domain experts’ hand-holding, at least, in the transition phase of digital marketing. Some companies have initiated this process for greater sales force effectiveness, since 2019. A recent example in this area may be quoted from a report on October 01, 2019.

The article highlights, ‘AstraZeneca sales reps have some new help in the coaching department, resulting improved interactions and better development of sales reps’ strengths. While leaders still manage reps, artificial intelligence—in the form of data generated from thousands of field-coaching forms—now adds machine-learned analysis and advice.’

Thus, it is worth noting that MRs will continue to play an important role, alongside remote digital marketing using omnichannel or multi-channel engagement platforms. The same also came out clearly in the latest study from healthcare consultancy ZoomRx, reported on April 08, 2021, where its findings raised an important question - ‘Did pharma overshoot digital sales rep calls?’ This dilemma was prompted by the study charts reflecting a decline in its effectiveness, during this specific survey period.

Thus, in my opinion, a hybrid business model for better performance will be more effective in the new normal. However, ascertaining the right mix of digital and MR’s in-person interactions, may pose a challenge for many pharma marketers.

Entry into digital health solutions – an opportunity for growth: 

Before Covid pandemic, digital therapeutics or digital health solutions were not an unknown area for several pharma companies, as a growth booster in the modern world. But, it wasn’t explored so intensively as it is being discussed today, for the same. A recent paper titled, ‘Digital health during COVID-19: lessons from operationalizing new models of care in ophthalmology,’ published in The Lancet on February 01, 2021, vindicates this point.

The paper emphasized, due to Covid pandemic ‘the traditional face-to-face patient–physician care model has had to be re-examined in many countries, with digital technology and new models of care being rapidly deployed to meet the various challenges of the pandemic.’ It further highlighted, these new models incorporate digital health solutions such as telehealth, AI based decision support for triaging, besides clinical care, and home monitoring.

Global pharma majors, such as Novartis, have publicly acknowledged on January 21, 202 that ‘digital innovation looks set to dominate the 2021 healthcare agenda.’ The statement said, COVID-19 was a catalyst for change in healthcare during 2020 and an accelerator for digital health. Similarly, 2021 looks set to continue the revolution – exploiting ‘an explosion of interest, traction and scale’ in the potential for digital solutions. These would not only support remote working, but also keep the very fabric of business, healthcare, education, and essential services in operation.

Other important and recent examples of digital health care solutions: 

Witnessing the COVID-19 pandemic pushing more people toward virtual doctor visits over the last one year, AstraZeneca, as reported on April 06, 2021, is preparing for it in the new normal, through a novel project with Massachusetts General Hospital. The Company is now in the process of establishing and validating its ‘recently launched digital health platform, designed to help patients with chronic illnesses manage their conditions without stepping foot into the academic medical center’s clinic.’

Similarly, several other companies, are also investing to be early entrants with user friendly state of the art technology in this space. Interestingly, many of these ventures were reported during March and April 2021.

Conclusion:

Arthur Miller’s play ‘Death of a Salesman,’ broadly addressed the loss of identity and a man’s inability to accept change within himself and society. Although, the book depicts a larger philosophical perspective of life – many pointed out similar issues in the drug industry perspective, as well.

Nonetheless, many studies have established, pharma MRs have been effectively delivering, since long, the endpoint deliverables, as expected of them – sales. However, the question that still haunts many – can this core process be re-imagined for greater efficiency and effectiveness at a lesser cost, harnessing modern technology. An article, published in the Pharmaphorum on March 11, 2011, has also suggested – ‘in the wake of the COVID-19 pandemic, there is an even greater need to re-examine the rep’s role. How can a field force evolve to deal with current challenges and be future-fit for the way we will be working in the post-pandemic world?’ 

There is no confusion today that MRs’ will have a key role to play in pharma’s digital endeavor. However, the key purpose of having them has evolved during the pandemic. Such as, from being an efficient way to achieve personal communication objectives – to be an orchestrator for physicians to navigate the difficult landscape, providing them a differentiated service. For this purpose, I reckon, a hybrid business model for better performance, will be more effective in the new normal, while quickly adapting to digital transformation. However, arriving at the right mix of digital and MR’s in-person interactions, may pose a challenge for many pharma marketers, as it will be a company-specific need.

Similarly, the criticality of leveraging opportunities to provide remote delivery of digital health care solutions to patients, has also come onto the radar of many pharma players, during this difficult time. Several players have already added this area as a lucrative business expansion platform – many more are expected to follow. Thus, in my view, the fast-evolving data-based trends are now giving a pragmatic shape to future pharma operations – especially on the new and unique role of medical representatives and the relevance of digital health care solutions, as a growth opportunity.

By: Tapan J. Ray   

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.

Pharma ‘To Endeavor More To Be What It Desires To Appear’

Posted on by
Reply

Reputation is one of the most fundamental requirements for long-term sustainability of any business, without facing too much of avoidable distraction, or even a tough headwind from any hostile business environment. This fact is, of course, no-brainer. We all know it, yet continue faltering – often not so very infrequently.

Before proceeding further, let me recapitulate, how has the Oxford Dictionary defined reputation? It says, reputation is ‘the beliefs or opinions that are generally held about someone or something.’ Or in other words, it is ‘a widespread belief that someone or something has a particular characteristic.’

The subsequent logical question then arises – how to gain reputation? Again, this was very aptly captured long ago by none other than Socrates, when he said: ‘The way to gain a good reputation is to endeavor to be what you desire to appear.’

Taking a leaf from this quote, in today’s article, I shall focus on whether pharma is making enough endeavor to be what it desires to appear in the eyes of its stakeholders, and the public at large. If not, what are the ways forward.

Not all of it is pharma’s own creation:

The host of reasons for pharma’s adverse public image, may not necessarily be its own creation. Some of these could well be lying miles away from its operational domain. For example, articles such as, what appeared on July 7, 2017 in the BMJ titled, ‘We need to end cut practice in Indian healthcare,’ doesn’t seem to be much related to pharma’s direct business operations. But in many respects, the subsequent unprecedented announcement of the Maharashtra government on enacting a new law called the “Cut practices in Medical Services Act, 2017”, casts a darker shadow, not just on the doctors’ reputation, but also covers the health care industry, in general, including pharma.

Nevertheless, a commonly perceived nexus between the doctors and pharma companies, or for that matter alleged malpractices in many hospitals, also prompts a rub-off adverse perception – indirect though, on pharma’s overall reputation. Such barriers also need to be carefully navigated through.

While moving towards this direction, effective management of consumer perception is also of critical importance. For, reputation is a complex blend of both reality and perception, where perception is believed to contribute around 66 percent, and reality – about 33 percent, in various organizational efforts to gain business reputation.

Changing from a dogmatic to pragmatic approach:

The above area of adverse perceptual impact causing further dents in pharma’s reputation, is understandable, as these are beyond its control, as such. Nonetheless, what is difficult to fathom, why does pharma continue to remain so dogmatic in recreating a make-believe image, that continuously gets negated by its own actions on the ground.

To illustrate this point when I briefly look back, one of the critical themes around which, especially the research-based global drug industry has been trying to gain reputation, over a long period of time, is woven around – ‘innovation’. Concerned pharma players keep trying to gain consumers’ trust and reputation by trying to make them believe that pharma is one of the most innovative industries in the world, thus possibly trustworthy.

The same tradition continues even today. Millions of dollars are being spent through various communication and advocacy campaigns, hoping to drive home this point. Nonetheless, the current reality is that the pharma consumers hardly believe that the industry is particularly innovative today. I discussed that point in my article of July 26, 2017, appeared in this blog.

Therefore, I shall not dwell on that area again. Instead, let me try to arrive at, how is this dogmatic approach going way off the mark from consumers’ expectations, repeatedly. More importantly, why it calls for a rather pragmatic approach from pharma to gain reputation, taking well into consideration – what the patients’ or patient groups’ expectations are from the industry, based on meticulous research findings.

Patients’ recent perception on pharma reputation:

A recent report by ‘PatientView’ – a leading specialist in understanding the patient movement, and its impact on health care, captured perceptions of patient groups on the pharma industry, in this area. The report is titled, ‘Corporate Reputation of Pharma in 2016 – The Patient Perspective.’ The phrase ‘corporate reputation’, as defined in the study, is the extent to which pharma companies are meeting the expectations of patients and patient groups, and was assessed by the following three types of measures:

  • How pharma’s corporate reputation compares with that of seven other healthcare-industry sectors.
  • How pharma’s corporate reputation has changed over the past five years.
  • How good or bad the pharma industry is at various activities.

The results of this study are based on a survey conducted between November 2016 to early-February 2017 on 1,463 patient groups; 46+ specialties in 105 countries. 47 pharma companies were assessed on seven indicators of corporate reputation, as follows:

  • Patient centricity
  • Patient information
  • Patient safety
  • Useful products
  • Transparency
  • Integrity
  • Effectiveness of patient-group relationships

47 companies surveyed include names, such as AbbVie, Allergan, Amgen, Astellas, AstraZeneca, Bayer, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Eisai, Eli Lilly, Gilead, GSK, Hospira, Janssen, Merck & Co, Merck KgaA, Mylan, Novartis, Novo Nordisk, Pfizer, Roche, Sandoz, Sanofi, Takeda, Teva, UCB and Valeant.

Some of the key findings of this survey are as follows:

  • In 2016, just 37.9 percent of respondent patient group thought that the pharma industry had an “Excellent” or “Good” corporate reputation. Whereas 44.7 percent of patient groups had said the same in 2015.
  • In 2016, only 23 percent of patient groups thought that pharma’s corporate reputation had improved over the previous five years. Whereas 28 percent of patient groups had said the same in 2015.
  • In 2016 (as in 2015), pharma continued to be ranked 5th out of eight healthcare sectors (ahead only of generics, for-profit, and not-for-profit health insurers).
  • Patient groups thought that pharma’s ability to conduct activities of importance to them declined in 2016. Patient groups were more sceptical in 2016 even about pharma’s ability to innovate, which is an important patient-group measure of confidence in the industry.
  • Regarding the quality of pharma’s innovation across several geographic areas: patient groups in New Zealand expressed the least confidence in pharma’s ability to innovate; and those in Greece, the most.

What should pharma do?

Keeping the above findings in perspective, the consequent question that arises in this area is, what should pharma do to improve its patient centricity, and thereby to gain trust and reputation?

It is interesting to note that pharma companies should ‘consider the cost of drugs’, has featured as one of the top three, in the 14-point plan proposed by the 460+ patient groups in the above study, as follows:

  • Partner with patient groups
  • Provide more or better patient services
  • Consider the cost of drugs
  • Try to understand patients
  • Develop better medicines
  • Be transparent
  • Involve patient groups in the design
  • Look at continuity of care
  • Listen to patients
  • Help patients in a holistic way
  • Increase participation in clinical trials
  • Offer training
  • Concentrate on safety
  • Tailor services to individual patients

Conclusion:

Thus, the bottom line is, among various stakeholders, patients and patient groups, play a critical role in pharma to gain reputation. Winning their trust is widely considered as the substratum to get this process rolling, effectively. In that sense, pharma players individually, and the pharma industry collectively, need to have innovative, and game changing strategic plans to win the patients’ trust, for a long-term gain in reputation.

Repeatedly trying to communicate that life-changing medicines exist, because of pharma’s years of efforts in painstaking research and development that are hugely expensive and time-intensive, doesn’t seem to be working much, any longer. Patients are increasingly expecting improved access to drugs for various treatments, coupled with related value added services, from the drug players.

In such a scenario, many top drug companies, on the other hand, publicly express: ‘we are patient-centric’. This creates a logjam, as it were, to take pharma’s ‘patient centric’ endeavors from this point to where the patients’ expectations really are. Thus, I reckon, it’s time for pharma to deeply introspect and act on what Socrates had advised a long time ago, ‘‘The way to gain a good reputation is to endeavor to be what you desire to appear.’

By: Tapan J. Ray

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.

 

Pragmatic intervention of all the states for Preventive Healthcare could significantly reduce the burden of disease of ‘We, the People of India’.

Posted on by
Reply

Overall disease pattern in India is showing a perceptible shift from the age old ‘Infectious Diseases’ to ‘Non-infectious Chronic Illnesses’. As reported by IMS, incidence of chronic ailments in India has increased from 23% in 2005 to 26% in 2009.

It is estimated that chronic illnesses will be the leading cause of both morbidity and mortality by the next decade in the country, significantly increasing the burden of disease across the socio-economic strata of the nation. It goes without saying that poor people will be hit harder, if corrective actions are not undertaken right now.

As a consequence of such changing disease pattern, healthcare needs and related systems of the country should undergo a paradigm shift together with the emergence of a carefully planned concept of ‘Preventive Healthcare’ for the entire population of the nation.

It is a myth that non-infectious illnesses are more prevalent in higher socio-economic strata:

There is a common perception that Non-Communicable Diseases (NCDs) are more prevalent within higher socio-economic strata of the society. However, a national survey done in India shows that diseases related to misuse of alcohol and tobacco are higher in the poorest 20 percent quintile of our society.

However, a research recently study done in 1600 villages, spanning across 18 states of India and published on the September 27, 2010 edition of the British Medical Journal (BMJ), reported that the risk-factors of non-communicable diseases are high in rural India, which is the home of over 70% of the population of India. (Non-communicable Disease Risk Factors High in Rural India.

As this population has limited access and affordability to healthcare in general, the situation demands greater importance and focus.

Risk-factors of NCDs in rural India:

The above BMJ study highlighted prevalence of the following key risk-factors for the vulnerable population:

• Tobacco use (40% men, 4% women)
• Low fruit and vegetable intake (69% men, 75% women)
• Obesity (19% men, 28% women)
• High cholesterol (33% men, 35% women)
• Hypertension (20% men, 22% women)
• Diabetes (6% men, 5% women)
• Underweight (21% men, 18% women)

Current healthcare system in India:

Currently with appropriate disease treatment measures, alleviation of acute symptoms of the disease that a particular patient is suffering from, is the key concern of all concerned, starting from the doctors to the patients including their families. The process of the medical intervention revolves round treatment protocols and procedures based on the diagnosis of the current ailments and not so much on preventive measures for other underlying diseases, except with the use of vaccines for some specific diseases.

Developing a protocol for ‘Preventive Healthcare’ for non-communicable diseases is very important:

In the above process, while addressing the acute problems of the patients’ current ailments is very important, proper risk assessment of other underlying diseases, if any, which the patient could suffer from in future, for various reasons, do not attract any organized attention. As a result the important advice on preventive healthcare from the doctors, properly highlighting its importance, is not available to most of the patients to enable them to significantly reduce, if not eliminate, their future burden of disease.

Keeping such common practices in view and noting that ‘Preventive Healthcare’ is significantly different from ‘Curative Healthcare’, developing an appropriate protocol for ‘Preventive Healthcare’ has become a crying need of the hour.

‘Preventive Healthcare’ in India should attract high priority of the healthcare policy makers with a careful vigil on its effective implementation at the ground level:

All said and done, the ‘Preventive Healthcare’ system in India is in its very nascent stage. If appropriate measures are taken in this area, like learning to reduce the impact of mental and physical stress, avoiding sedentary life style, taking healthy diet, avoidance of tobacco and alcohol consumption, leading healthy sex life etc., it can in turn immensely help the population to remain disease free and healthy, thereby contributing to improvement of their respective work productivity in a very substantial way.

Recently re-structured Medical Council of India should also step in:

Thus the role of medical professionals in the disease prevention process is also very important. The interaction of the patients with the doctors when they meet to address any ailment provides huge opportunity to the doctors to advise those patients about various measures of underlying disease prevention, for which different patients have different types of exposures.

Keeping all these points in view, through regulatory initiatives, the newly restructured Medical Council of India (MCI) should consider making ‘Preventive Healthcare’ an integral part of each interaction of a patient with a doctor.

Include the civil society in the preventive healthcare initiatives:

The risk factors of many of the diseases like, cancer, chronic respiratory disorders, cardiovascular, diabetes, and hypertension can be identified well in advance and appropriately assessed. Therefore, such diseases can be prevented effectively, to a great extent, provided the healthcare policy of the country supports the ‘Disease Prevention’ process, program and initiatives through adequate resource allocation, improving awareness of the civil society and above all including them in this healthcare improvement process of the nation.

Need to raise general awareness towards ‘Preventive Healthcare’:

Raising the level of awareness of ‘Preventive Healthcare’ is indeed very important. It requires a change in the mindset of the community in general, together with the healthcare policy makers, medical profession, employers, patients and their families.

National Non-Communicable Disease (NCD) prevention program of the government:

As per the planning commission, the government of India has initiated the following structured measures for the prevention of NCD:

• “Health education for primary and secondary prevention of NCDs through mobilizing community action;
• Development of treatment protocols for education and training of physicians in the prevention and management of NCDs:
• Strengthening/creation of facilities for the diagnosis and treatment of CVD and stroke, and the establishment of referral linkages;
• Promotion of the production of affordable drugs to combat diabetes, hypertension, and myocardial infarction;
• Development and support of institutions for the rehabilitation of people with disabilities;
• Research support for: Multispectral population-based interventions to reduce risk factors;
• The role of nutrition and lifestyle-related factors;
• The development of cost effective interventions at each level of care”.

Conclusion:

Many diseases in India, with proper ‘Disease Prevention’ measures can be effectively averted. It is worth repeating that some common measures which can be easily practiced through community initiatives are maintenance of proper hygiene, sanitation, adequate physical activities, moderation in alcohol and tobacco consumption, healthy sexual activities, avoidance of unhealthy food etc.

All the state governments of India through Public Private Partnership (PPP) initiatives with all stakeholders, including the pharmaceutical industry and the civil society, should make the movement of ‘Preventive healthcare’ self-sustainable across the nation. Health being a state subject in India, the role and initiatives of the respective state governments towards this important initiative will be the key determinant of success or failure.

Such a movement, at the same time, needs to be strengthened by appropriate government policy measures and regulations wherever necessary. Pan India roll out of innovative disease awareness campaigns in tandem, highlighting sustainable and effective disease prevention processes will help reducing longer term healthcare cost significantly, thereby translating the well-known dictum into reality, ‘Prevention is better than cure’.

By Tapan Ray

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.