Sue Thomas and Paul Midgley, of Wilmington Healthcare, explain how pharma can add value across care pathways
The ‘Next Steps on the Five Year Forward View’ explain how NHS England’s budgetary system is likely to change in order to meet the complex healthcare needs of the nation’s ageing population and the associated burden of chronic diseases.
The proposed new financial system involves integrating budgets, with one provider or a group of providers being responsible for all the healthcare needs of a defined population in order to improve outcomes and reduce costs, across a defined area – an Accountable Care System (ACS).
There will be a big emphasis on disease prevention and delivering optimal patient journeys. However, this improved system-wide efficiency must be achieved in the face of capped budgets for every disease. In line with this, ACSs will need to re-evaluate the current system and do things differently in some cases.
In order to engage with ACSs, pharma needs to define how its products can help to prevent diseases and disease progression, and how they can add value across the whole patient pathway from diagnosis to end of life care. It also needs to prove that its products are affordable in year, or will become more affordable because they will generate savings elsewhere in the system.
Engaging with clinicians will be key to getting these messages across and there are golden opportunities for pharma to harness the power of data in this regard, since many clinicians do not know much about the cost of care outside their own area.
By gathering relevant data, such as the number of previous hospital admissions, or the cost of managing comorbidity issues in a relevant cohort of patients, pharma could help clinicians to create a business case for a particular drug in order to convince the finance director of the ACS that it can improve care and cut costs.
Providing specialist services and treatments in the home, allied to new technology, and supported by specialist nurses and consultants, will increase under ACSs. There is a big role for pharma to play here from ensuring its products are easy to take at home to providing support packages that include medtech equipment to monitor patients’ well-being in the home, and a telephone helpline for patients.
Pharma also needs to consider monitoring adherence, providing patient support; and gathering feedback on the patient’s overall experience of a care pathway and on their ability to resume a normal quality of life.
Electronically controlled tablet trays, which send a signal to a central control centre when a dose is removed from its packaging, are already used in some areas for patients on multiple medications. If pharma extended this type of monitoring to high cost drugs, especially those that are delivered to patients’ homes and require refrigeration, this would cut waste and improve adherence. It could also help pharma make a strong business case for such products, since it is well documented that only between 30-50 percent of medications for long-term conditions are taken correctly.
With budgets under intense scrutiny and ACSs increasingly focussed on outcomes, pharma companies that are manufacturing highly effective, yet very expensive, drugs could find their products replaced by cheaper, less effective rivals focusing on optimising compliance. For example, a cheaper medication, that is sold in tandem with an integrated concordance programme could be proven to have better outcomes than a more expensive and more effective medication that is prescribed without any extra support for patients
This means that pharma companies producing lesser known drugs or biosimilars could have a real chance to shine under the capitated budgets system if they invest in patient support programmes that help to improve adherence; while manufacturers of big name drugs may have to start working a lot harder on concordance to ensure that their products really are offering value for money over cheaper alternatives.
Furthermore, in the past, the effectiveness of drugs has been based on clinical trials. However, the NHS can now identify real world outcomes via the use of systems such as ‘Eclipse Live’. This centrally contracted data exploration system from the Department of Health, can, for example, show how a drug is performing across a group of patients and whether the results are in line with clinical trial data. There are also apps on the market that can compare the performance of different drugs.
As a result, cost-based value propositions that guarantee outcomes and work to achieve them through enhanced compliance and concordance will become increasingly important for manufacturers of premium-priced drugs.
Integrated, capitated budgets across ACSs will completely change the way that NHS spending is managed, bringing both threats and opportunities to pharma. To succeed, the industry must be open to new, cost-effective and innovative ways of working to ensure that its drugs really can help the NHS deliver better care and improve patient outcomes in the face of challenging financial constraints.