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What role for pharma in helping to deliver integrated care?

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Steve How and Paul Midgley, of Wilmington Healthcare, explore how pharma can support local health economies in providing joined-up, holistic services.

The Long-term Plan, which states that all areas of England will be covered by an Integrated Care System (ICS), by April 2021, validated the work of health economies in England that have already become ICSs. However, for many other health economies, particularly those in financial recovery, the plan signals the start of a journey towards a very different style of working.

Understanding ICSs

Even within the first wave of 14 ICSs, there are varying levels of sophistication with a handful of high fliers leading the way. These advanced systems are exploring contracts with a greater element of risk share between providers and commissioners, allowing for more integrated working.

One such ICS is Dorset, whose Chief System Integration Officer, Dr Phil Richardson, was guest speaker at a recent Wilmington Healthcare webinar on the NHS Long Term Plan. During the webinar, Phil explained how Dorset ICS runs “a family budgeting system”, where money has already moved from one organisation to another to achieve balance across the system.

He explained that pharma needs to think about the whole person in the community and how they can help them. He added: “Pharma must move away from promotion. Co-production and development are key. We want organisations working together to solve problems like frailty and how care can be brought closer to home.”

As evidenced by Phil’s comments, there is a real opportunity for industry to get involved in shaping the strategic direction of these organisations. Top level discussions involving a pharma company’s chief executive or managing director should be held in addition to deploying sales staff to engage at clinician level on products and how they fit into care pathways. Pharma could also consider sharing best practice learnings from these ICSs with other health economies.

Poised for change

The majority of ICSs are not yet delivering fully integrated care, but they are preparing to do so. In common with all Sustainability and Transformation Partnerships (STPs), ICSs have certain areas that they must focus on under the Long Term Plan, such as diabetes, cancer and respiratory disease. Pharma needs to identify what is happening in these areas and other key workstreams and the people who are leading them.

Pharma also needs to pinpoint where transformation is occurring within individual ICSs and whether this aligns with its products and services. Information on local health systems’ priorities can be found in the plans that they must submit to NHS England (NHSE) in response to the Long Term Plan. These should be found in draft board meeting minutes published in March.

When engaging with integrated systems, it is useful to understand how the services your product is involved in are contracted. For example, where aligned incentive or risk share contracts are initiated with an integrated provider, the impact of a product could be more than clinical if, for example, it could reduce the workforce needed owing to reduced failure and readmission rates. Also, if a product is innovative, it might change aspects of the whole pathway by, for instance, reducing hospital costs by enabling self-administration of a drug.

Pharma must also engage with clinical champions and convince them of the value of a treatment. This will involve clearly linking the product to the strategic plan and showing how it can help to improve patient pathways, or even redefine them. Local data analysis for pathway evaluation would be helpful in this regard.

Starting the integrated care journey

Health economies that are embarking on integrated care strategies are required to detail how they will happen, so again it is essential to keep abreast of the local plans that have to be published in accordance with the Long Term Plan. Pharma also needs to identify the clinical leaders who are tasked with managing transformation and who will be leading workstreams.

Offering to broker cross-organisational meetings would be particularly valuable for local health systems at this stage. This could involve people from different departments or clinicians working within one department. Ultimately, however, it will need to involve wider health and social care organisations.

Pharma could also share best practice learnings from health economies that have already been through the process and show how they have implemented change and how and where this has added value.

As these STPs undergo change, pharma needs to be aware that making direct cost savings is currently a priority for them as their budgets sit in silos. However, reducing system costs across the whole pathway is the driver for future change.

Conclusion

To support local health economies in delivering integrated care, pharma needs to understand where ICSs and STPs are in their integrated care journey; identify their priorities and transformation goals and understand the challenges they face in delivering them.