This article was first published on the Pharma Field website on 10 February 2022.
The shifting mindset and preferences of the NHS customer means that Industry now needs a new way of organising and describing its commercial propositions. Wilmington Healthcare’s Oli Hudson describes what this new value proposition looks like and what it needs to cover.
Across the NHS, the basis upon which drug purchasing decisions are made is becoming more nuanced and multi-layered than ever as medicine funding changes and the pivot to system-led planning reshape the customer’s priorities and needs.
Industry needs to understand this shift in mindset and become more adept at constructing a new system-based value proposition: a strong, evidence-based argument that covers the wider span of considerations shaping NHS decision-making today.
In this article, we look at what this new proposition should include, and how Industry should approach the task.
Multi-dimensional value proposition
Let’s start by looking at what constitutes “value” in the reformed NHS environment.
On one level, the value argument made to the individual service and the trust or primary care organisation they’re part of is as important as ever: after all, they remain discrete entities with their own needs, preferences and pressure points.
A value proposition must therefore continue to describe things like the clinical efficacy, safety and patient benefits of a product, the costed benefits it can bring to a given service, and how it can help the purchaser with organisational challenges such as demand management, cost pressures and workforce capacity. All of this is familiar ground.
However, with the arrival of Integrated Care Systems (ICS), this commercial pitch now needs to speak to the needs and preferences of the wider system too, showing how a proposition can support population health goals, deliver new and more sustainable ways of providing care, and help the ICS to manage its many strategic challenges (see below).
Rob Berry, Head of Innovation and Research at Kent Surrey Sussex Academic Health Science Network has written about why articulating value at different levels of the health sector is a guiding principle for commercial success – because, in effect, the new value proposition breaks down into five fundamental areas: clinical value, value to the patient, service cost value, organisational value and system value.
Costed pathway analysis
What, then, should you be thinking about as you develop your proposition?
Firstly, every value proposition needs to clearly articulate its specific role in the pathway and the costed value it – and it alone – can bring across the whole pathway.
With ICSs actively looking at how pathways can be redesigned to manage down cost and capacity pressures, it’s no longer enough for pharma companies to point to the clinical value of the product in isolation.
Instead, they will need to show a deep and granular understanding of the patient journey through a pathway, how much each element of their care costs and the benefits it brings, and where and how their proposition can deliver best value.
Developing a Costed Integrated Patient Scenario, such as this for chronic kidney disease, can be a powerful way of evaluating the different components in a patient’s care, and showing – in an evidence-based way – what can be changed to optimise the pathway as a whole.
Demonstrating value in population health
A second consideration is around population health.
NHS England have repeatedly made it clear that ICSs – and specifically the place-based partnerships within them – will be responsible for improving health and care outcomes and experiences across their populations.
The implications of this for what the NHS customer may regard as “good value” are significant. All organisations will want to be able to demonstrate that resources are fully optimised to meet the long-term needs of the population the system is supported.
From pharma’s standpoint, this may mean emphasising:
- The preventative value of propositions that can prevent a patient’s condition from escalating to the point where they will need more costly treatment and care.
- The social value of propositions that can reduce a patient’s dependencies by relieving their symptoms and allowing them to do more things than before.
- The service value of propositions that successfully reduce demand on certain health services, and/or allow patients to be treated in a more appropriate (community) setting.
- The experiential value of propositions that improve the quality of a patient’s experience by reducing inconvenience or providing a less invasive way of treating them.
- The efficiency value of reducing the frequency with which a patient may require follow-up care and/or helping them to become fully de-medicalised over the long term.
In addition, with capacity pressures challenging all parts of the NHS, an effective value proposition might also zero in on the potential resourcing benefits of freeing up clinical time or remodelling the staffing mix required to administer a treatment – both of which may have more significance than base cost as a result of the operational priorities and pressures the NHS is currently faced with.
All of these elements need to be analysed and articulated as part of brand planning, and then blended into a commercial proposition – with costings where appropriate – as part of a clear economic case for investing in your product.
Addressing health inequalities and other strategic priorities
Consideration should also be given to how a proposition supports the strategic priorities for the NHS, as described in the latest NHS operational planning guidance and reflected in local ICS delivery plans when they are published this spring.
Managing the backlog will clearly be a first-order priority for all systems, meaning that customers will be receptive to any solutions that can build in additional capacity to reduce case lists and particularly so, where the proposition may help them manage down pressures on hard-pressed clinical teams.
But it’s also worth thinking some of the wider challenges around implementing technology-enabled solutions at scale, expanding community-based diagnostics, treatment and services, and re-asserting some of the disease-specific service improvement aspirations in the NHS Long Term Plan. These are all likely to be on the customer’s wish list too.
A final area worth noting is the increasing focus on access and health inequalities. The NHS planning guidance is explicit about the potential consequences of delays or interruptions in cancer care due to the pandemic, highlighting tens of thousands of patients not currently receiving treatment who would otherwise be expected to have presented over this timeframe.
Pharma can add considerable value by helping the NHS understand the nature of under-served and under-treated patient groups (not just in cancer but across all long-term conditions). The rich data analysis and insight that pharmaceutical companies hold can help uncover and stratify these missing patients, drawing out the cost arguments associated with late presentation and showing how it can complement NHS efforts to minimise them: it is the very definition of win-win.
In short, Industry must quickly move beyond an isolated focus on product values and attributes as the central thrust of its commercial appeal. The stakeholder landscape is changing fast, and NHS customers now need more sophisticated and rounded analysis of value.
Pharma companies will increasingly need to be able to quantify the value of its offer across multiple areas of need, skilfully straddling clinical, organisational and system requirements, and demonstrating hard evidence of the impact this can make through a whole care pathway.
Articulating all of this is not easy, but it is vital for helping the customer see how your offer can help them deliver against an increasingly challenging environment – and this, in turn, can form the basis of a strong and enduring commercial relationship for the future.